Roider, J; Muenchhoff, M; Goulder, PJR
Purpose of review The paediatric HIV epidemic is changing. Over the past decade, new infections have substantially reduced whilst access to antiretroviral therapy (ART) has increased. Overall this success means that numbers of children living with HIV are climbing. In addition, the problems in adults of chronic inflammation resulting from persistent immune activation even following ART-mediated suppression of viral replication are magnified in children infected from birth. Recent findings Features of immune ontogeny favor low immune activation in early life, whilst specific aspects of paediatric HIV infection tend to increase it. A subset of ART-naïve non-progressing children exists in whom normal CD4 counts are maintained in the setting of persistent high viremia and yet in the context of low immune activation. This sooty mangabey-like phenotype contrasts with non-progressing adult infection characterized by the expression of protective HLA class I molecules and low viral load. The particular factors contributing to raised or lowered immune activation in paediatric infection, and that ultimately influence disease outcome, are discussed. Summary Novel strategies to circumvent the unwanted long-term consequences of HIV infection may be possible in children in whom natural immune ontogeny in early life militates against immune activation. Defining the mechanisms underlying low immune activation in natural HIV infection would have applications beyond paediatric HIV. PMID:26679413
McAteer, Carole Ian; Truong, Nhan-Ai Thi; Aluoch, Josephine; Deathe, Andrew Roland; Nyandiko, Winstone M; Marete, Irene; Vreeman, Rachel Christine
Introduction HIV-related stigma impacts the quality of life and care management of HIV-infected and HIV-affected individuals, but how we measure stigma and its impact on children and adolescents has less often been described. Methods We conducted a systematic review of studies that measured HIV-related stigma with a quantitative tool in paediatric HIV-infected and HIV-affected populations. Results and discussion Varying measures have been used to assess stigma in paediatric populations, with most studies utilizing the full or variant form of the HIV Stigma Scale that has been validated in adult populations and utilized with paediatric populations in Africa, Asia and the United States. Other common measures included the Perceived Public Stigma Against Children Affected by HIV, primarily utilized and validated in China. Few studies implored item validation techniques with the population of interest, although scales were used in a different cultural context from the origin of the scale. Conclusions Many stigma measures have been used to assess HIV stigma in paediatric populations, globally, but few have implored methods for cultural adaptation and content validity. PMID:27717409
Amzel, Anouk; Toska, Elona; Lovich, Ronnie; Widyono, Monique; Patel, Tejal; Foti, Carrie; Dziuban, Eric J; Phelps, B Ryan; Sugandhi, Nandita; Mark, Daniella; Altschuler, Jenny
Ninety percent of the 3.4 million HIV-infected children live in sub-Saharan Africa. Their psychosocial well being is fundamental to establishing and maintaining successful treatment outcomes and overall quality of life. With the increased roll-out of antiretroviral treatment, HIV infection is shifting from a life-threatening to a chronic disease. However, even for paediatric patients enrolled in care and treatment, HIV can still be devastating due to the interaction of complex factors, particularly in the context of other household illness and overextended healthcare systems in sub-Saharan Africa.This article explores the negative effect of several interrelated HIV-specific factors on the psychosocial well being of HIV-infected children: disclosure, stigma and discrimination, and bereavement. However, drawing on clinical studies of resilience, it stresses the need to move beyond a focus on the individual as a full response to the needs of a sick child requires support for the individual child, caregiver-child dyads, extended families, communities, and institutions. This means providing early and progressive age appropriate interventions aimed at increasing the self-reliance and self-acceptance in children and their caregivers and promoting timely health-seeking behaviours. Critical barriers that cause poorer biomedical and psychosocial outcomes among children and caregiver must also be addressed as should the causes and consequences of stigma and associated gender and social norms.This article reviews interventions at different levels of the ecological model: individual-centred programs, family-centred interventions, programs that support or train healthcare providers, community interventions for HIV-infected children, and initiatives that improve the capacity of schools to provide more supportive environments for HIV-infected children. Although experience is increasing in approaches that address the psychosocial needs of vulnerable and HIV-infected children, there
There are approximately from 1,100 to 1,200 HIV-infected children in a follow-up in Spain. In 2008 an open, multicentral, retrospective and prospective Cohort of the Spanish Paediatric HIV Network (CoRISpe) was founded. The CoRISpe is divided into the node 1 and node 2 representing geographically almost the whole territory of Spain. Since 2008 seventy-five hospitals have been participating in the CoRISpe. All the retrospective data of the HIV-infected children have been kept in the CoRISpe since 1995 and prospective data since 2008. In this article we are going to present the notion of CoRISpe, its role, the structure, how the CoRISpe works and the process how a child is transferred from Paediatric to Adults Units. The main objective of the CoRISpe is to contribute to furthering scientific knowledge on paediatric HIV infection by providing demographic, sociopsychological, clinical and laboratory data from HIV-infected paediatric patients. Its aim is to enable high-quality research studies on HIV-infected children. PMID:23282073
de Jose, Ma Isabel; Jiménez de Ory, Santiago; Espiau, Maria; Fortuny, Claudia; Navarro, Ma Luisa; Soler-Palacín, Pere; Muñoz-Fernandez, Ma Angeles
There are approximately from 1,100 to 1,200 HIV-infected children in a follow-up in Spain. In 2008 an open, multicentral, retrospective and prospective Cohort of the Spanish Paediatric HIV Network (CoRISpe) was founded. The CoRISpe is divided into the node 1 and node 2 representing geographically almost the whole territory of Spain. Since 2008 seventy-five hospitals have been participating in the CoRISpe. All the retrospective data of the HIV-infected children have been kept in the CoRISpe since 1995 and prospective data since 2008. In this article we are going to present the notion of CoRISpe, its role, the structure, how the CoRISpe works and the process how a child is transferred from Paediatric to Adults Units. The main objective of the CoRISpe is to contribute to furthering scientific knowledge on paediatric HIV infection by providing demographic, sociopsychological, clinical and laboratory data from HIV-infected paediatric patients. Its aim is to enable high-quality research studies on HIV-infected children.
Giardiello, Marco; Liptrott, Neill J.; McDonald, Tom O.; Moss, Darren; Siccardi, Marco; Martin, Phil; Smith, Darren; Gurjar, Rohan; Rannard, Steve P.; Owen, Andrew
Considerable scope exists to vary the physical and chemical properties of nanoparticles, with subsequent impact on biological interactions; however, no accelerated process to access large nanoparticle material space is currently available, hampering the development of new nanomedicines. In particular, no clinically available nanotherapies exist for HIV populations and conventional paediatric HIV medicines are poorly available; one current paediatric formulation utilizes high ethanol concentrations to solubilize lopinavir, a poorly soluble antiretroviral. Here we apply accelerated nanomedicine discovery to generate a potential aqueous paediatric HIV nanotherapy, with clinical translation and regulatory approval for human evaluation. Our rapid small-scale screening approach yields large libraries of solid drug nanoparticles (160 individual components) targeting oral dose. Screening uses 1 mg of drug compound per library member and iterative pharmacological and chemical evaluation establishes potential candidates for progression through to clinical manufacture. The wide applicability of our strategy has implications for multiple therapy development programmes. PMID:27767027
Giardiello, Marco; Liptrott, Neill J.; McDonald, Tom O.; Moss, Darren; Siccardi, Marco; Martin, Phil; Smith, Darren; Gurjar, Rohan; Rannard, Steve P.; Owen, Andrew
Considerable scope exists to vary the physical and chemical properties of nanoparticles, with subsequent impact on biological interactions; however, no accelerated process to access large nanoparticle material space is currently available, hampering the development of new nanomedicines. In particular, no clinically available nanotherapies exist for HIV populations and conventional paediatric HIV medicines are poorly available; one current paediatric formulation utilizes high ethanol concentrations to solubilize lopinavir, a poorly soluble antiretroviral. Here we apply accelerated nanomedicine discovery to generate a potential aqueous paediatric HIV nanotherapy, with clinical translation and regulatory approval for human evaluation. Our rapid small-scale screening approach yields large libraries of solid drug nanoparticles (160 individual components) targeting oral dose. Screening uses 1 mg of drug compound per library member and iterative pharmacological and chemical evaluation establishes potential candidates for progression through to clinical manufacture. The wide applicability of our strategy has implications for multiple therapy development programmes.
Palladino, Claudia; Gómez, María Luisa Navarro; Soler-Palacín, Pere; González-Tomé, María Isabel; De Ory, Santiago J; Espiau, María; Hoyos, Santiago Pérez; León-Leal, Juan Antonio; Méndez, María; Moreno-Pérez, David; Guasch, Claudia Fortuny; Sierra, Antoni Mur; Guruceta, Itziar Pocheville; Guillén, Santiago Moreno; Briz, Verónica
Maraviroc (MVC) is not approved for HIV-1-infected paediatric patients. This is the first assessment of the use of MVC-based salvage therapy in vertically HIV-1-infected paediatric patients in clinical settings. The results suggest that MVC-based salvage therapy is useful in children and adolescents with extensive resistance profile leading to maintained virological suppression in up to 88% of the patients with CCR5-tropic virus. The likelihood of treatment success might increase when MVC is combined with other active drugs.
Shah, Seema K
Ethical guidelines recommend that experimental interventions should be tested in adults first before they are tested and approved in children. Some challenge this paradigm, however, and recommend initiating paediatric testing after preliminary safety testing in adults in certain cases. For instance, commentators have argued for accelerated testing of HIV vaccines in children. Additionally, HIV cure research on the use of very early therapy (VET) in infants, prompted in part by the Mississippi baby case, is one example of a strategy that is currently being tested in infants before it has been well tested in adults. Because infants’ immune systems are still developing, the timing of HIV transmission is easier to identify in infants than in adults, and infants who receive VET might never develop the viral reservoirs that make HIV so difficult to eradicate, infants may be uniquely situated to achieve HIV cure or sustained viral remission. Several commentators have now argued for earlier initiation of HIV cure interventions other than (or in addition to) VET in children. HIV cure research is therefore a good case for re-examining the important question of when to initiate paediatric research. I will argue that, despite the potential for HIV cure research to benefit children and the scientific value of involving children in this research, the HIV cure agenda should not accelerate the involvement of children for the following reasons: HIV cure research is highly speculative, risky, aimed at combination approaches and does not compare favourably with the available alternatives. I conclude by drawing general implications for the initiation of paediatric testing, including that interventions that have to be used in combination with others and cures for chronic diseases may not be valuable enough to justify early paediatric testing. PMID:27259546
Gisselquist, David; Potterat, John J; Brody, Stuart
Health care systems in sub-Saharan Africa are challenged not only to improve care for the increasing number of HIV-infected children, but also to prevent transmission of HIV to other children and health care workers through contaminated medical procedures and needlestick accidents. HIV-infected children aged to 1 year typically have high viral loads, making them dangerous reservoirs for iatrogenic transmission. Most vertically infected children experience HIV-related symptoms early, though many survive beyond 5 years. This leads to high HIV prevalence among inpatient and outpatient children. In nine African studies, HIV prevalence in inpatient children ranged from 8.2% to 63%, roughly 1-3 times the prevalence in antenatal women. Investigations of large iatrogenic outbreaks in Russia, Romania, and Libya demonstrate efficient HIV transmission through paediatric health care. Unexplained HIV infections in African children are not rare-studies published through 2003 have recorded more than 300 HIV-infected children with HIV-negative mothers. In addition, several studies have reported much higher HIV prevalence in children 5-14 years old than could be expected from mother-to-child transmission alone. Research is required to determine the extent of iatrogenic HIV infection among African children as well as to identify high-risk procedures and settings. Such research can motivate and direct prevention efforts.
Crane, Johanna T; Rossouw, Theresa M
In 2013, physician-researchers announced that a baby in Mississippi had been 'functionally cured' of HIV [Persaud, D., Gay, H., Ziemniak, C. F., Chen, Y. H., Piatak, M., Chun, T.-W., … Luzuriaga, K. (2013b, March). Functional HIV cure after very early ART of an infected infant. Paper presented at the 20th conference on retroviruses and opportunistic infections, Atlanta, GA]. Though the child later developed a detectable viral load, the case remains unprecedented, and trials to build on the findings are planned [National Institute of Allergy and Infectious Diseases. (2014). 'Mississippi baby' now has detectable HIV, researchers find. Retrieved from http://www.niaid.nih.gov/news/newsreleases/2014/pages/mississippibabyhiv.aspx ]. Whether addressing HIV 'cure' or 'remission', scrutiny of this case has focused largely on scientific questions, with only introductory attention to ethics. The social inequalities and gaps in care that made the discovery possible - and their ethical implications for paediatric HIV remission - have gone largely unexamined. This paper describes structural inequalities surrounding the 'Mississippi baby' case and a parallel case in South Africa, where proof-of-concept studies are in the early stages. We argue that an ethical programme of research into infant HIV remission ought to be 'structurally competent', and recommend that paediatric remission studies consider including a research component focused on social protection and barriers to care.
Reynolds, Nancy R.; Ofori-Atta, Angela; Lartey, Margaret; Renner, Lorna; Antwi, Sampson; Enimil, Anthony; Catlin, Ann Christine; Fernando, Sumudinie; Kyriakides, Tassos C.; Paintsil, Elijah
With the scale-up of effective antiretroviral therapy in resource-limited settings, many HIV-infected children are now able to survive into adulthood. To achieve this potential, children must navigate normative developmental processes and challenges while living with an unusually complex, stigmatizing, potentially fatal chronic illness and meeting the demands of treatment. Yet many of these children, especially preadolescents, do not know they are HIV-infected. Despite compelling evidence supporting the merits of informing children of their HIV status, there has been little emphasis on equipping the child’s caregiver with information and skills to promote disclosure, particularly, when the caregiver faces a variety of sociocultural barriers and is reluctant to do so. In this study, we present the background, process and methods for a first of its kind collaboration that is examining the efficacy of an intervention developed to facilitate the engagement of caregivers in the process of disclosure in a manner suitable to the sociocultural context and developmental age and needs of the child in Ghana. We also report preliminary data that supported the design of the intervention approach and currently available domains of the data system. Finally, we discuss challenges and implications for future research. PMID:26049537
Sohn, Annette H; Hazra, Rohan
The global paediatric HIV epidemic is shifting into a new phase as children on antiretroviral therapy (ART) move into adolescence and adulthood, and face new challenges of living with HIV. UNAIDS reports that 3.4 million children aged below 15 years and 2 million adolescents aged between 10 and 19 years have HIV. Although the vast majority of children were perinatally infected, older children are combined with behaviourally infected adolescents and youth in global reporting, making it difficult to keep track of their outcomes. Perinatally HIV-infected adolescents (PHIVA) are a highly unique patient sub-population, having been infected before development of their immune systems, been subject to suboptimal ART options and formulations, and now face transition from complete dependence on adult caregivers to becoming their own caregivers. As we are unable to track long-term complications and survival of PHIVA through national and global reporting systems, local and regional cohorts are the main sources for surveillance and research among PHIVA. This global review will utilize those data to highlight the epidemiology of PHIVA infection, treatment challenges and chronic disease risks. Unless mechanisms are created to count and separate out PHIVA outcomes, we will have few opportunities to characterize the negative consequences of life-long HIV infection in order to find ways to prevent them.
Sohn, Annette H; Hazra, Rohan
The global paediatric HIV epidemic is shifting into a new phase as children on antiretroviral therapy (ART) move into adolescence and adulthood, and face new challenges of living with HIV. UNAIDS reports that 3.4 million children aged below 15 years and 2 million adolescents aged between 10 and 19 years have HIV. Although the vast majority of children were perinatally infected, older children are combined with behaviourally infected adolescents and youth in global reporting, making it difficult to keep track of their outcomes. Perinatally HIV-infected adolescents (PHIVA) are a highly unique patient sub-population, having been infected before development of their immune systems, been subject to suboptimal ART options and formulations, and now face transition from complete dependence on adult caregivers to becoming their own caregivers. As we are unable to track long-term complications and survival of PHIVA through national and global reporting systems, local and regional cohorts are the main sources for surveillance and research among PHIVA. This global review will utilize those data to highlight the epidemiology of PHIVA infection, treatment challenges and chronic disease risks. Unless mechanisms are created to count and separate out PHIVA outcomes, we will have few opportunities to characterize the negative consequences of life-long HIV infection in order to find ways to prevent them. PMID:23782474
Jashi, Mariam; Viswanathan, Rekha; Ekpini, Rene; Chandan, Upjeet; Idele, Priscilla; Luo, Chewe; Legins, Ken; Chatterjee, Anirban
In 2005, due to slow global progress in the scale-up of prevention of mother-to-child transmission (PMTCT) and paediatric HIV programmes, the Inter-agency Task Team (IATT) on the Prevention of HIV infection among Pregnant Women, Mothers, and their Children initiated joint technical missions (JTMs) to countries of high HIV disease burden. The JTMs were intended to galvanize country actions for a more comprehensive response to PMTCT and paediatric HIV by bringing national and global stakeholders together to review national policies and programmes and develop country-specific recommendations for accelerating scale-up. Between 2005 and 2010, the IATT conducted JTMs in 18 low- and middle-income countries. In 2007, to assess the role played by the missions, a review in the first eight countries (Burkina Faso, Cameroon, Côte d'Ivoire, India, Malawi, Rwanda, Tanzania and Zambia) that hosted JTMs was undertaken. Country progress was assessed through desk review and key informant interviews. For each country, documents reviewed included JTM reports, baseline data for PMTCT and paediatric HIV care and treatment, and 2004 to 2007 trend data on key PMTCT and paediatric HIV indicators. Drawing upon the findings, this paper posits that JTMs contributed to national scale-up of PMTCT and paediatric HIV programmes through strengthening governance and co-ordination mechanisms for the programmes, promoting enabling policy environments, and supporting the development of national scale-up plans, which have been critical for leveraging additional financial resources for scale-up. Although the impact of the JTMs could be enhanced through greater follow-up and continued targeted assistance in technical areas such as infant and young child feeding, community-based programming and supply chain management, findings indicate that the JTMs are a useful mechanism for informing policy and programme decisions necessary for scaling up PMTCT and paediatric HIV responses. Moreover, by bringing
Idele, Priscilla; Hayashi, Chika; Porth, Tyler; Mamahit, Awandha; Mahy, Mary
Progress towards achievement of global targets for the prevention of mother-to-child transmission of HIV (PMTCT) and paediatric HIV care and treatment is an integral part of global and national HIV and AIDS responses. This paper documents the development of the global and national monitoring and reporting systems for PMTCT and paediatric HIV care and treatment programmes, achievements and remaining challenges. A review of the development of the monitoring and reporting process since 2002-2016 was conducted using existing published literature and taking into account changes in WHO HIV treatment guidelines, global HIV goals and targets, programmatic and methodological developments, and increased need for interagency partnerships, coordination and harmonization of global monitoring and reporting mechanisms. The number and type of indicators reported increased and evolved from monitoring of existence of national policies and guidelines, service delivery sites and trained health workers and coverage of PMTCT and paediatric HIV interventions to measuring outcomes and impact in reducing new HIV infections and AIDS related deaths, including efforts to validate elimination of mother-to-child transmission of HIV. These changes were required to mirror changes in WHO and national PMTCT and HIV treatment guidelines. The number of countries reporting PMTCT coverage increased from 53 in 2003 to over 130 in 2015. National monitoring processes have also expanded in scope and the capacity to report on disaggregated data by type of ARV regimen and for paediatric HIV care and treatment has increased. Monitoring of PMTCT and paediatric HIV programmes has contributed a rich body of evidence that helped monitor how quickly countries were adopting and implementing the latest WHO HIV treatment guidelines for pregnant and breastfeeding women and children. The reported data and experiences were instrumental in shaping global policies, national programmes, and investment choices.
Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel
Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6-65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1-58.1) of caregivers could talk privately with health workers, 56.9% (54.4-59.3) reported that queues to see health workers were too long, and 89.9% (88.4-91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.
Luyirika, Emmanuel; Towle, Megan S; Achan, Joyce; Muhangi, Justus; Senyimba, Catherine; Lule, Frank; Muhe, Lulu
Family-centred HIV care models have emerged as an approach to better target children and their caregivers for HIV testing and care, and further provide integrated health services for the family unit's range of care needs. While there is significant international interest in family-centred approaches, there is a dearth of research on operational experiences in implementation and scale-up. Our retrospective case study examined best practices and enabling factors during scale-up of family-centred care in ten health facilities and ten community clinics supported by a non-governmental organization, Mildmay, in Central Uganda. Methods included key informant interviews with programme management and families, and a desk review of hospital management information systems (HMIS) uptake data. In the 84 months following the scale-up of the family-centred approach in HIV care, Mildmay experienced a 50-fold increase of family units registered in HIV care, a 40-fold increase of children enrolled in HIV care, and nearly universal coverage of paediatric cotrimoxazole prophylaxis. The Mildmay experience emphasizes the importance of streamlining care to maximize paediatric capture. This includes integrated service provision, incentivizing care-seeking as a family, creating child-friendly service environments, and minimizing missed paediatric testing opportunities by institutionalizing early infant diagnosis and provider-initiated testing and counselling. Task-shifting towards nurse-led clinics with community outreach support enabled rapid scale-up, as did an active management structure that allowed for real-time review and corrective action. The Mildmay experience suggests that family-centred approaches are operationally feasible, produce strong coverage outcomes, and can be well-managed during rapid scale-up.
Tulloch, Olivia; Taegtmeyer, Miriam; Ananworanich, Jintanat; Chasombat, Sanchai; Kosalaraksa, Pope; Theobald, Sally
In Thailand people living with HIV (PLHIV) have played a major role in shaping policy and practice. They have acted as volunteer co-providers, although their potential in terms of paediatric service provision has seldom been explored from a health systems perspective. We describe the Thai paediatric HIV care system and use both demand- and supply-side perspectives to explore the impact, opportunities and challenges of PLHIV acting as volunteer co-providers. We employed qualitative methods to assess experiences and perceptions and triangulate stakeholder perspectives. Data were collected in Khon Kaen province, in the poorest Northeastern region of Thailand: three focus group discussions and two workshops (total participants n = 31) with co-providers and hospital staff; interviews with ART service-users (n = 35). Nationally, key informant interviews were conducted with policy actors (n = 20). Volunteer co-providers were found to be ideally placed to broker the link between clinic and communities for HIV infected children and played an important part in the vital psychosocial support component of HIV care. As co-providers they were recognized as having multiple roles linking and delivering services in clinics and communities. Clear emerging needs include strengthened coordination and training as well as strategies to support funding. Using motivated volunteers with a shared HIV status as co-providers for specific clinical services can contribute to strengthening health systems in Asia; they are critical players in delivering care (supply side) and being responsive to service-users needs (demand side). Co-providers blur the boundaries between these two spheres. Sustaining and optimising co-providers' contribution to health systems strengthening requires a health systems approach. Our findings help to guide policy makers and service providers on how to balance clinical priorities with psycho-social responsiveness and on how best to integrate the views and
Obel, Niels; Reinholdt, Hanne; Omland, Lars H; Engsig, Frederik; Sørensen, Henrik T; Hansen, Ann-Brit E
Background Hospital-based discharge registries are used increasingly for longitudinal epidemiological studies of HIV. We examined completeness of registration of HIV infections and of chronic hepatitis B (HBV) and hepatitis C (HCV) coinfections in the Danish National Hospital Registry (DNHR) covering all Danish hospitals. Methods The Danish HIV Cohort Study (DHCS) encompasses all HIV-infected patients treated in Danish HIV clinics since 1 January 1995. All 2,033 Danish patients in DHCS diagnosed with HIV-1 during the 10-year period from 1 January 1995 to 31 December 2004 were included in the current analysis. We used the DHCS as a reference to examine the completeness of HIV and of HBV and HCV coinfections recorded in DNHR. Cox regression analysis was used to estimate hazard ratios of time to diagnosis of HIV in DNHR compared to DHCS. Results Of the 2,033 HIV patients in DHCS, a total of 2,006 (99%) were registered with HIV in DNHR. Of these, 1,888 (93%) were registered in DNHR within one year of their first positive HIV test. A CD4 < 200 cells/μl, a viral load >= 100,000 copies/ml and being diagnosed after 1 January 2000, were associated with earlier registration in DNHR, both in crude and adjusted analyses. Thirty (23%) HIV patients registered with chronic HBV (n = 129) in DHCS and 126 (48%) of HIV patients with HCV (n = 264) in DHCS were registered with these diagnoses in the DNHR. Further 17 and 8 patients were registered with HBV and HCV respectively in DNHR, but not in DHCS. The positive predictive values of being registered with HBV and HCV in DHCS were thereby estimated to 0.88 and 0.97 and in DNHR to 0.32 and 0.54. Conclusion The study demonstrates that secondary data from national hospital databases may be reliable for identification of patients diagnosed with HIV infection. However, the predictive value of co-morbidity data may be low. PMID:18439245
Horwood, C.; Liebeschuetz, S.; Blaauw, D.; Cassol, S.; Qazi, S.
OBJECTIVE: To determine the validity of an algorithm used by primary care health workers to identify children with symptomatic human immunodeficiency virus (HIV) infection. This HIV algorithm is being implemented in South Africa as part of the Integrated Management of Childhood Illness (IMCI), a strategy that aims to improve childhood morbidity and mortality by improving care at the primary care level. As AIDS is a leading cause of death in children in southern Africa, diagnosis and management of symptomatic HIV infection was added to the existing IMCI algorithm. METHODS: In total, 690 children who attended the outpatients department in a district hospital in South Africa were assessed with the HIV algorithm and by a paediatrician. All children were then tested for HIV viral load. The validity of the algorithm in detecting symptomatic HIV was compared with clinical diagnosis by a paediatrician and the result of an HIV test. Detailed clinical data were used to improve the algorithm. FINDINGS: Overall, 198 (28.7%) enrolled children were infected with HIV. The paediatrician correctly identified 142 (71.7%) children infected with HIV, whereas the IMCI/HIV algorithm identified 111 (56.1%). Odds ratios were calculated to identify predictors of HIV infection and used to develop an improved HIV algorithm that is 67.2% sensitive and 81.5% specific in clinically detecting HIV infection. CONCLUSIONS: Children with symptomatic HIV infection can be identified effectively by primary level health workers through the use of an algorithm. The improved HIV algorithm developed in this study could be used by countries with high prevalences of HIV to enable IMCI practitioners to identify and care for HIV-infected children. PMID:14997238
Akpede, G O; Lawal, R S; Momoh, S O
Nigeria may be taken to represent countries with an evolving HIV/AIDS epidemic. With particular reference to paediatric HIV, the voluntary testing of young children and their parents may provide an important entry point for the institution of control measures. However, there is a paucity of knowledge about how individuals perceive voluntary testing. This knowledge is important to the development of guidelines for counselling. To reduce this gap, 258 parents of hospitalized children (> 1 month to 15 years of age) were interviewed using a structured questionnaire. In addition, to complement the data, four examples of seropositive mother's responses during post-test counselling are presented and analyzed. In the survey, 223 (86%) parents were HIV/AIDS aware but only 88 (39%) of these parents could describe one or more route(s) of transmission and none described vertical transmission. Among the respondents, 153 (62%) of 248 would consent to the screening of self, and 195 (85%) of 230 to the screening of a hospitalized child if based on his/her clinical condition. Perceptions of good health and lack of exposure, and despair owing to lack of a specific treatment, were the common reasons for refusing consent. These represent some of the issues which would need to be addressed to increase the acceptance of voluntary testing. The fear of a break up of families with seropositive mothers but seronegative fathers was a major concern expressed during post-test counselling. HIV-discordance among couples may be frequent and should be considered in the formulation of policies on counselling and voluntary testing.
Okano, Justin T.; Robbins, Danielle; Palk, Laurence; Gerstoft, Jan; Obel, Niels; Blower, Sally
Summary Background Worldwide, ~35 million individuals are infected with HIV; ~25 million in sub-Saharan Africa (SSA). The WHO proposes using “treatment as prevention” (TasP) to eliminate HIV. Treatment suppresses viral load, decreasing the probability an individual transmits HIV. The elimination threshold is one new HIV infection per 1,000 individuals. Here, we test the hypothesis that TasP can substantially reduce epidemics and eliminate HIV. We estimate the impact of TasP, between 1996–2013, on the Danish HIV epidemic in Men-who-have-Sex-with-Men (MSM), an epidemic UNAIDS has identified as a priority for elimination. Methods We use a CD4-staged Bayesian back-calculation approach to estimate incidence, and the “hidden epidemic” (the number of HIV-infected undiagnosed MSM). We use data from an ongoing nationwide population-based study: the Danish HIV Cohort Study. Findings Incidence, and the hidden epidemic, decreased substantially after treatment was introduced in 1996. By 2013, incidence was close to the elimination threshold: 1·4 (median, 95% Bayesian Credible Interval (BCI): 0·4–2·1) new HIV infections per 1,000 MSM. There were only 617 (median, 95% BCI: 264–858) undiagnosed MSM. Decreasing incidence and increasing treatment coverage are highly correlated; a threshold effect is apparent. Interpretation Our study is the first to show that TasP can substantially reduce a country’s HIV epidemic, and bring it close to elimination. However, we have shown the effectiveness of TasP under optimal conditions: very high treatment coverage, and exceptionally high (98%) viral suppression rate. Unless these extremely challenging conditions can be met in SSA, the WHO’s global elimination strategy is unlikely to succeed. Funding NIAID/NIH PMID:27174504
Idris, Nikmah S; Cheung, Michael M H; Grobbee, Diederick E; Burgner, David; Kurniati, Nia; Djer, Mulyadi M; Uiterwaal, Cuno S P M
Objective To investigate the effects of HIV infection in children on heart electrical conduction, particularly to delineate the effects of HIV infection from treatment. Methods On a 12-lead ECG, available for 37 antiretroviral therapy (ART) naïve, 42 ART-exposed vertically-acquired HIV-infected and 50 healthy children in Jakarta, Indonesia, we measured cardiac conduction parameters: PR, QRS, and QTc (corrected using Bazett's formula) intervals. The associations between HIV infection/treatment status and ECG intervals were evaluated using general linear modelling with further adjustment for potential confounders or intermediary variables. Findings are presented as (adjusted) mean differences between each of the two HIV groups and healthy children. Results Although not exceeding the clinical threshold for long QT (QTc >460 ms for girls and >440 ms for boys) compared to healthy children, mean QTc intervals were longer in ART-naïve (difference 18.2 ms, 95% CI 7.0 to 29.3) and, to greater extent, in ART-exposed HIV-infected children (difference 28.9 ms, 19.3 to 38.5). Following adjustment for RR interval, age and height, prolongation of PR interval was seen only in ART-naïve HIV-infected children (difference 12.9 ms, 2.4 to 23.3). Cardiac mass/function, high-sensitive C reactive protein, cholesterol and glycated haemoglobin levels, systolic and diastolic blood pressures, or postnatal parental smoking exposure did not affect these associations. No difference in the QRS interval was observed between groups. Conclusions Prolongation of the QTc interval occurs in ART-naïve HIV-infected children and, to a greater extent, in the ART-exposed children, whereas a longer PR interval appears to be seen only among ART-naïve HIV-infected children. PMID:27042320
Spencer, Nick; Colomer, Concha; Alperstein, Garth; Bouvier, Paul; Colomer, Julia; Duperrex, Olivier; Gokcay, Gulbin; Julien, Gilles; Kohler, Lennart; Lindström, Bengt; Macfarlane, Aidan; Mercer, Raul; Panagiotopoulos, Takis; Schulpen, Tom
Social paediatrics is an approach to child health that focuses on the child, in illness and in health, within the context of their society, environment, school, and family. The glossary clarifies the range of terms used to describe aspects of paediatric practice that overlap or are subsumed under social paediatrics and defines key social paediatric concepts. The glossary was compiled by a process of consultation and consensus building among the authors who are all members of the European Society for Social Paediatrics. Social paediatricians from outside Europe were included giving a more international perspective.
Spencer, N.; Colomer, C.; Alperstein, G.; Bouvier, P.; Colomer, J.; Duperrex, O.; Gokcay, G.; Julien, G.; Kohler, L.; Lindstrom, B.; Macfarlane, A.; Mercer, R.; Panagiotopoulos, T.; Schulpen, T.; on, b
Social paediatrics is an approach to child health that focuses on the child, in illness and in health, within the context of their society, environment, school, and family. The glossary clarifies the range of terms used to describe aspects of paediatric practice that overlap or are subsumed under social paediatrics and defines key social paediatric concepts. The glossary was compiled by a process of consultation and consensus building among the authors who are all members of the European Society for Social Paediatrics. Social paediatricians from outside Europe were included giving a more international perspective. PMID:15650140
Introduction There are limited data on paediatric HIV care and treatment programmes in low-resource settings. Methods A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). Results A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult–paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4–6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. Conclusions In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented. PMID:23336728
Eber, Ernst; Aurora, Paul; Lødrup Carlsen, Karin C; Lindblad, Anders; Dankert-Roelse, Jeannette E; Ross-Russell, Robert I; Turner, Steve W; Midulla, Fabio; Hedlin, Gunilla
The aim of this update is to describe the paediatric highlights from the 2011 European Respiratory Society (ERS) Annual Congress in Amsterdam, the Netherlands. Abstracts from all seven groups of the ERS Paediatric Assembly (Paediatric Respiratory Physiology, Paediatric Asthma and Allergy, Cystic Fibrosis, Paediatric Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Paediatric Respiratory Epidemiology, and Paediatric Bronchology) are presented in the context of current literature.
Bamford, A; Hart, M; Lyall, H; Goldblatt, D; Kelleher, P; Kampmann, B
Antiretroviral therapy (ART) only partially restores HIV-induced alterations in lymphocyte populations. We assessed B and T cell phenotypes in a cohort of children from a single centre in the United Kingdom with perinatally acquired HIV compared to healthy controls. The majority of HIV infected children (44 of 56) were on fully suppressive combination ART. Children with perinatally acquired HIV had significantly lower memory B and CD4(+) CD45RO(+) CXCR5(+) [follicular T helper cell (Tfh)-like] T cell percentages. Detectable viraemia was associated with higher CD21(-) (activated and exhausted/tissue-like memory) B cells. A greater proportion of life spent on suppressive ART was associated with higher memory B cell percentages. These results suggest that early and sustained suppressive ART may preserve B and T cell phenotypes in perinatally acquired HIV and limit deficits in humoral immunity. A lower proportion of circulating Tfh-like cells in HIV infected children appears to be independent of HIV treatment history and ongoing HIV viraemia and warrants further investigation.
Mulenga, Veronica; Musiime, Victor; Kekitiinwa, Adeodata; Cook, Adrian D; Abongomera, George; Kenny, Julia; Chabala, Chisala; Mirembe, Grace; Asiimwe, Alice; Owen-Powell, Ellen; Burger, David; McIlleron, Helen; Klein, Nigel; Chintu, Chifumbe; Thomason, Margaret J; Kityo, Cissy; Walker, A Sarah; Gibb, Diana M
Summary Background WHO 2013 guidelines recommend universal treatment for HIV-infected children younger than 5 years. No paediatric trials have compared nucleoside reverse-transcriptase inhibitors (NRTIs) in first-line antiretroviral therapy (ART) in Africa, where most HIV-infected children live. We aimed to compare stavudine, zidovudine, or abacavir as dual or triple fixed-dose-combination paediatric tablets with lamivudine and nevirapine or efavirenz. Methods In this open-label, parallel-group, randomised trial (CHAPAS-3), we enrolled children from one centre in Zambia and three in Uganda who were previously untreated (ART naive) or on stavudine for more than 2 years with viral load less than 50 copies per mL (ART experienced). Computer-generated randomisation tables were incorporated securely within the database. The primary endpoint was grade 2–4 clinical or grade 3/4 laboratory adverse events. Analysis was intention to treat. This trial is registered with the ISRCTN Registry number, 69078957. Findings Between Nov 8, 2010, and Dec 28, 2011, 480 children were randomised: 156 to stavudine, 159 to zidovudine, and 165 to abacavir. After two were excluded due to randomisation error, 156 children were analysed in the stavudine group, 158 in the zidovudine group, and 164 in the abacavir group, and followed for median 2·3 years (5% lost to follow-up). 365 (76%) were ART naive (median age 2·6 years vs 6·2 years in ART experienced). 917 grade 2–4 clinical or grade 3/4 laboratory adverse events (835 clinical [634 grade 2]; 40 laboratory) occurred in 104 (67%) children on stavudine, 103 (65%) on zidovudine, and 105 (64%), on abacavir (p=0·63; zidovudine vs stavudine: hazard ratio [HR] 0·99 [95% CI 0·75–1·29]; abacavir vs stavudine: HR 0·88 [0·67–1·15]). At 48 weeks, 98 (85%), 81 (80%) and 95 (81%) ART-naive children in the stavudine, zidovudine, and abacavir groups, respectively, had viral load less than 400 copies per mL (p=0·58); most ART
Martínez-Bonet, M; Clemente, M I; Serramía, M J; Moreno, S; Muñoz, E; Muñoz-Fernández, M A
The limitations to establishing a viral reservoir facilitated by early cART in children could play a critical role in achieving natural control of viral replication upon discontinuation of cART, which could be defined as 'functional cure'. Viral reservoirs could provide a persistent source of recrudescent viraemia after withdrawal of cART, despite temporary remission of HIV-1 infection, as observed in the 'Mississippi baby'. Intensification of cART has been proposed as a strategy to control residual replication and to diminish the reservoirs. The effects of cART intensification with maraviroc persisted after discontinuation of the drug in HIV-1-infected adults. However, in HIV-1-infected children, the emergence of CXCR4-using variants occurs very early, and the use of CCR5 antagonists in these children as intensification therapy may not be the best alternative. New treatments to eradicate HIV-1 are focused on the activation of viral production from latently infected cells to purge and clear HIV-1 reservoirs. This strategy involves the use of a wide range of small molecules called latency-reversing agents (LRAs). Histone deacetylase inhibitors (HDACi) such as givinostat, belinostat and panobinostat, and class I-selective HDACis that include oxamflatin, NCH-51 and romidepsin, are the most advanced in clinical testing for HIV-1 LRAs. Panobinostat and romidepsin show an efficient reactivation profile in J89GFP cells, a lymphocyte HIV-1 latently infected cell line considered a relevant model to study post-integration HIV-1 latency and reactivation. Clinical trials with panobinostat and romidepsin have been performed in children with other pathologies and it could be reasonable to design a clinical trial using these drugs in combination with cART in HIV-1-infected children.
Deverell, Marie; Zurynski, Yvonne A; Elliott, Elizabeth J
This report provides an update on the surveillance conducted by the Australian Paediatric Surveillance Unit (APSU) during the period January to December 2013. The APSU facilitates national active surveillance of uncommon diseases of childhood including selected communicable diseases. This report includes data on the following conditions: acute flaccid paralysis (AFP), congenital cytomegalovirus (cCMV), congenital rubella, perinatal exposure to HIV and paediatric HIV infection, neonatal herpes simplex virus (HSV), congenital varicella, neonatal varicella, severe complications of varicella and juvenile onset recurrent respiratory papillomatosis (JoRRP). Surveillance of severe complications of influenza was undertaken during the influenza season (July to September 2013).
Barnacle, Alex M.; Wilkinson, A. Graham; Roebuck, Derek J.
Paediatric interventional uroradiology lies at the intersection of the disciplines of paediatric interventional radiology and paediatric endourology. Interdisciplinary collaboration has led to the development of new techniques and refinement of procedures adopted from adult practice. This article reviews the major procedures used in paediatric interventional uroradiology, with emphasis on nephrostomy, percutaneous nephrolithotomy, balloon-burst pyeloplasty, and antegrade ureteric stenting.
Ogunlesi, Tinuade A; Adekanmbi, Folasade A; Fetuga, Bolanle M; Ogundeyi, Mojisola M
A major problem in the management of infants exposed to HIV is the issue of feeding, which stems from the need to avoid transmission of the virus via breast milk. Other important issues in the nutrition of infants exposed to the virus include severe maternal illness, which makes suckling extremely difficult, and feeding orphans. Wet nursing is one of the recommended steps in addressing the feeding problems of such infants but for reasons of sociocultural disapproval, it appears not to be popular in traditional African settings. Non-puerperal induced lactation or re-lactation of a close relation, usually a grandmother, which hitherto has been used to rehabilitate severely malnourished motherless infants, may be equally useful. The procedure of re-lactation and the limitations of the method are highlighted. Also, the need to employ information, education and communication in improving the sociocultural acceptability of this veritable infant feeding method in tropical Africa is discussed.
Chippington, Samantha J; Goodwin, Susie J
As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.
Eugen-Olsen, J; Iversen, A K; Benfield, T L; Koppelhus, U; Garred, P
We have investigated the role of the recently described mutation in CCR2b named 64I in relation to HIV resistance, CD4 T-cell counts, and disease progression in Danish individuals by polymerase chain reaction (PCR)-based methods as well as sequenced full-length CXCR4 and CCR5 genes from HIV-infected long-term nonprogressors for possible mutations. In total, 215 Danish individuals were analyzed for 64I allele frequency; disease progression was followed in 105 HIV-1-positive homosexual Danish men from their first known positive HIV-1 test result and up to 11 years. In 87 individuals, the CD4 T-cell count was monitored closely. We found no significant difference in 64I allele frequency between HIV-1-seropositive persons (0.08), high-risk HIV-1-seronegative persons (0.11), and blood donors (0.06). No significant difference was observed in annual CD4 T-cell decline, CD4 T-cell counts at the time of AIDS, in AIDS-free survival as well as survival with AIDS, between 64I allele carriers and wild-type individuals. Among 9 long-term nonprogressors, 2 carried the 64I allele, while none of 9 fast progressors carried the 64I allele. However, this was not significantly different (p=.47). Long-term nonprogression could not be explained by CXCR4 polymorphism or other polymorphisms in the CCR5 gene than the CCR5delta32 allele. Furthermore, we were not able to detect any significant independent effect of the 64I allele on development to AIDS, overall survival, and annual CD4 T-cell decline in this cohort.
Mammas, Ioannis N.; Theodoridou, Maria; Kramvis, Anna; Thiagarajan, Prakash; Gardner, Sharryn; Papaioannou, Georgia; Melidou, Angeliki; Koutsaki, Maria; Kostagianni, Georgia; Achtsidis, Vassilis; Koutsaftiki, Chryssie; Calachanis, Marcos; Zaravinos, Apostolos; Greenough, Anne; Spandidos, Demetrios A.
The ‘2nd Workshop on Paediatric Virology’, which took place on Saturday the 8th of October 2016 in Athens, Greece, provided an overview on recent views and advances on Paediatric Virology. Emphasis was given to HIV-1 management in Greece, a country under continuous financial crisis, hepatitis B vaccination in Africa, treatment options for hepatitis C virus in childhood, Zika virus in pregnancy and infancy, the burden of influenza on childhood, hand-foot-mouth disease and myocarditis associated with Coxsackie viruses. Other general topics covered included a critical evaluation of Paediatric Accident and Emergency viral infections, multimodality imaging of viral infections in children, surgical approaches of otolaryngologists to complex viral infections, new advances in the diagnosis and treatment of viral conjunctivitis and novel molecular diagnostic methods for HPV in childhood. A brief historical overview of the anti-vaccination movement was also provided, as well as presentations on the educational challenge of Paediatric Virology as a new subspecialty of Paediatrics. This review highlights selected lectures and discussions of the workshop. PMID:28352303
Midulla, Fabio; Lombardi, Enrico; Pijnenburg, Marielle; Balfour-Lynn, Ian M.; Grigg, Jonathan; Bohlin, Kajsa; Rusconi, Franca; Pohunek, Petr
The aim of this article is to describe paediatric highlights from the 2014 European Respiratory Society (ERS) International Congress in Munich, Germany. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology) are presented in the context of the current literature. PMID:27730136
The Hugh Greenwood Lecture acknowledges the extremely generous support from Mr Greenwood that has enabled the BAPS to establish funds to advance paediatric surgical training in developing countries. In this Inaugural Lecture, Dr. Sekabira, the first Hugh Greenwood Fellow, describes the influence that this has had on his career and reviews the state of paediatric surgery in Uganda.
Barbato, A; Bertuola, F; Kuehni, C; Korppi, M; Kotecha, S; Pijnenburg, M W; Ratjen, F; Seddon, P; Bush, A
The aim of this report is to describe the highlights of the European Respiratory Society annual congress in Berlin, Germany. The best abstracts in asthma and allergy, cystic fibrosis, respiratory infection, paediatric and neonatal intensive care, paediatric investigative techniques (in particular respiratory physiology and bronchoscopy) and respiratory epidemiology are presented and set in the context of the current literature.
Estrade, Marie; Tessier-Levêque, Mélanie; Wanquet-Thibault, Pascale
Restraint in general, and particularly when giving paediatric care, is a sensitive subject. This practice continues to appear often as a solution when children are disorientated or struggle during care. However, it is generally traumatic for the different care agents: the child, the parent and the care-giver. Reflection on this subject has been carried out after exchanges with professionals about the use of restraint with children aged 2-4 during paediatric emergency care.
Introduction. Costing evidence is essential for policy makers for priority setting and resource allocation. It is in this context that the clinical trials of ARVs and cotrimoxazole provided a costing component to provide evidence for budgeting and resource needs alongside the clinical efficacy studies. Methods. A micro based costing approach was adopted, using case record forms for maintaining patient records. Costs for fixed assets were allocated based on the paediatric space. Medication and other resource costs were costed using the WHO/MSH Drug Price Indicators as well as procurement data where these were available. Results. The costs for cotrimoxazole and ARVs are significantly different. The average costs for human resources were US$22 and US$71 for physician costs and $1.3 and $16 for nursing costs while in-patient costs were $257 and $15 for the cotrimoxazole and ARV cohorts, respectively. Mean or average costs were $870 for the cotrimoxazole cohort and $218 for the ARV. The causal factors for the significant cost differences are attributable to the higher human resource time, higher infections of opportunistic conditions, and longer and higher frequency of hospitalisations, among others. PMID:28042479
Regular analysis of the major journals in dermatology and paediatrics has been used to select forty articles which are representative of the past year in paediatric dermatology. This selection is not exhaustive but rather reflects the interests of the author and also the dominant topics in paediatric dermatology in 2013-2014.
Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo
Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. PMID:26235144
Barben, Jürg; Bohlin, Kajsa; Everard, Mark L.; Hall, Graham; Pijnenburg, Mariëlle; Priftis, Kostas N.; Rusconi, Franca; Midulla, Fabio
The Paediatric Assembly of the European Respiratory Society (ERS) maintained its high profile at the 2015 ERS International Congress in Amsterdam. There were symposia on preschool wheeze, respiratory sounds and cystic fibrosis; an educational skills workshop on paediatric respiratory resuscitation; a hot topic session on risk factors and early origins of respiratory diseases; a meet the expert session on paediatric lung function test reference values; and the annual paediatric grand round. In this report the Chairs of the Paediatric Assembly's Groups highlight the key messages from the abstracts presented at the Congress. PMID:27730186
Pollack, Allan; Harrison, Christopher; Charles, Janice; Britt, Helena
A 2011 BEACH-based study showed that over the past 40 years there has been increasing general practitioner (GP) involvement in the management of paediatric mental health in Australia. There has also been a changing mix of psychological conditions managed, including increased management of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD).
Moreno-Pérez, D; Andrés Martín, A; Altet Gómez, N; Baquero-Artigao, F; Escribano Montaner, A; Gómez-Pastrana Durán, D; González Montero, R; Mellado Peña, M J; Rodrigo-Gonzalo-de-Liria, C; Ruiz Serrano, M J
Tuberculosis is one of the most important health problems worldwide. There are an increasing number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration from highly endemic areas. Measures to optimise early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Paediatric Association (Spanish Society of Paediatric Infectology and Spanish Society of Paediatric Pneumology) have agreed this Consensus Document in order to homogenise diagnostic criteria in paediatric patients.
Batchelor, Hannah Katharine; Marriott, John Francis
A number of anatomical and physiological factors determine the pharmacokinetic profile of a drug. Differences in physiology in paediatric populations compared with adults can influence the concentration of drug within the plasma or tissue. Healthcare professionals need to be aware of anatomical and physiological changes that affect pharmacokinetic profiles of drugs to understand consequences of dose adjustments in infants and children. Pharmacokinetic clinical trials in children are complicated owing to the limitations on blood sample volumes and perception of pain in children resulting from blood sampling. There are alternative sampling techniques that can minimize the invasive nature of such trials. Population based models can also limit the sampling required from each individual by increasing the overall sample size to generate robust pharmacokinetic data. This review details key considerations in the design and development of paediatric pharmacokinetic clinical trials. PMID:25855821
Population pharmacokinetic (PK) approach is now often used to evaluate PK characteristics of a new compound during its clinical development. Recently, new legislation governing the development and authorization of medicines for use in children aged 0-17 years was introduced in the European Union. Among the strategies proposed in relation to clinical aspects, use of population PKs is stated. In this manuscript, comparison between standard PK and population PK methods will be briefly addressed to understand why the second is particularly adapted to perform PK studies in paediatrics. Then, specific patients' characteristics (covariates) in paediatrics will be presented. Examples of PK and PK-pharmacodynamic (PK-PD) studies will be finally given. The number of population PK studies published still exceeds largely those of PK-PD.
Batchelor, Hannah Katharine; Marriott, John Francis
A number of anatomical and physiological factors determine the pharmacokinetic profile of a drug. Differences in physiology in paediatric populations compared with adults can influence the concentration of drug within the plasma or tissue. Healthcare professionals need to be aware of anatomical and physiological changes that affect pharmacokinetic profiles of drugs to understand consequences of dose adjustments in infants and children. Pharmacokinetic clinical trials in children are complicated owing to the limitations on blood sample volumes and perception of pain in children resulting from blood sampling. There are alternative sampling techniques that can minimize the invasive nature of such trials. Population based models can also limit the sampling required from each individual by increasing the overall sample size to generate robust pharmacokinetic data. This review details key considerations in the design and development of paediatric pharmacokinetic clinical trials.
[Consensus document by the Spanish Society of Paediatric Infectious Diseases and the advisory committee on vaccines of the Spanish Paediatrics Association on vaccination in immunocompromised children].
Mellado Peña, M J; Moreno-Pérez, D; Ruíz Contreras, J; Hernández-Sampelayo Matos, T; Navarro Gómez, M L
Vaccination in immunocompromised infants, children and adolescents is a major aspect in the follow-up of this complex pathology in specific Paediatric Units. Vaccination is also an important prevention tool, as this can, to a certain extent, determine the morbidity and mortality in these patients. This consensus document was jointly prepared by Working Groups of the Spanish Society of Paediatric Infectious Diseases and the Advisory Committee on Vaccines of the Spanish Paediatric Association, who are usually involved in updating the management of vaccinations in immunocompromised children, and reflects their opinions. The consensus specifically summarises indications for vaccination in the following special paediatric populations: Solid organ and haematopoietic transplant-recipients; primary immunodeficiency; asplenic children; non-previously transplanted immunocompromised patients; chronically ill patients; HIV-infected children and also the vaccines recommended for immunodeficient children who travel.
Avez-Couturier, Justine; Wood, Chantal
There are a number of different types of analgesics in paediatrics. They must be used in accordance with the situation, the type of pain and the characteristics of the child. In all cases, strict compliance with the posology and the instructions for use is essential to avoid any risk of error. Finally, pharmacological, physical and psychological treatments are employed in a complementary manner, for the biopsychosocial management of the child's care.
Oletto, S; Giaquinto, C; Seefried, M; Ruga, E; Cozzani, S; Mazza, A; De Manzini, A; D'Elia, R; Zacchello, F
In relation to youth rights, a new view has been created in recent decades that is included in the fundamental law of the child: the recognition of the right to education and the chance to develop a mature personality capable of creativity and liberty. Because of HIV infection it is very important to pay particular attention to the rights of the seropositive child and children born to seropositive mothers, which may be hampered not only in developing countries but also in the industrial world. HIV-affected children and their families are becoming abused and at high risk of becoming abused and this encroaches upon youth rights. As a consequence, in 1991 the Italian Society of Paediatrics issued a "Charter for the rights of seropositive children", which became an important document for all health care and social workers who deal with HIV-affected children. In this paper, we also consider the impact of HIV infection on the three main rights of children: the right to live, the rights of security and the rights of socialization.
Stoyanova-Beninska, Violeta V; Wohlfarth, Tamar; Isaac, Maria; Kalverdijk, Luuk J; van den Berg, Henk; Gispen-de Wied, Christine
Child and adolescent psychiatry is a relatively young field and the recognition, classification, and treatment of disorders in children and adolescents lag behind those in adults. In recent years there is an increasing awareness of the differences between children and adults in psychopathology and pharmacology. Related to this new paediatric regulations have been introduced. This article reviews the regulatory and legislative measures that were adopted in the EU in 2007 and the subsequent impact of these measures on the field of paediatric psychopharmacology. The consequences of the paediatric regulation in the EU are reflected in several domains: regulatory, research aimed at drug development and clinical practices. In the regulatory domain, the consequences include: new paediatric indications, inclusion of special (class) warnings, specification of dose regimens, and information on safety specific to children and adolescents, and development of new medicinal formulations. The paediatric regulation leads to timely development of paediatric friendly formulations and better quality of the clinical evidence. In clinical practices, an increased awareness of the uniqueness of paediatric pharmacology is emerging among medical professionals, and subsequent improvement of medical care (i.e. correct doses, appropriate formulation, monitoring for expected adverse events). In addition, clinical guidelines will have to be revised more frequently in order to integrate the recently acquired knowledge. The new regulations stimulate transparency and discussions between academia, pharmaceutical industry, and regulators. The purpose is to optimize clinical research and obtain evidence for paediatric psychopharmacology, thereby providing adequate support for treatment.
Stott, N Susan
Paediatric musculoskeletal infection remains an important cause of morbidity. Methicillin sensitive Staphylococcus aureus is still the most common organism although the incidence of methicillin resistant S. aureus in the community is rising. Osteomyelitis and septic arthritis due to Haemophilus influenzae is decreasing in incidence secondary to immunisation and in some units has been replaced by infections with the gram negative bacillus, Kingella kingae. Recent prospective studies indicate that uncomplicated osteomyelitis can be treated by three to four weeks of antibiotics. However, there is still a small group of children who will have overwhelming disseminated infection. These children require aggressive surgical and medical intervention. Two recent reports have identified an increased incidence of septic arthritis in children who have hemophilia and are HIV positive.
Rozycki, Henry J; Zhao, Wei
Interleukins are critical immune modulators and since their first description in 1977, there has been a steady increase in the recognition of their roles in many paediatric respiratory diseases. This basic and clinical knowledge is now maturing into both approved and investigational therapies aimed at blocking or modifying the interleukin response. The purpose of this review is to bring up to date what is known about interleukin function in paediatric pulmonology, focusing on nine important lung conditions. This is followed by summaries about 18 interleukins which have been associated with these paediatric pulmonary conditions. Throughout, emphasis is placed on where interventions have been tested. Over the next several years, it is likely that many more treatments based on interleukin biology and function will become available and understanding the basis for these therapies will allow the practicing paediatric pulmonologist to take appropriate advantage of them.
Garcia-Algar, Óscar; Cuadrado González, Ainoha; Falcon, María
The prevalence of acute or chronic exposure to substances of abuse in paediatric patients, from the neonatal period to adolescence, is not well established as most cases go unnoticed. Regardless of clinical cases of acute poisoning leading to visits to emergency room, the exposure is usually detected by a questionnaire to the parents or children. In the last few years, new validated analytical methodologies have been developed in order to detect parent drugs and their metabolites in different biological matrices. These biological matrices have different time windows for detection of the exposure: acute (i.e., urine, blood, oral fluid), and chronic (i.e., hair, meconium or teeth). The aim of this paper was to review the scenarios where the use of biological matrices is indicated for the detection of acute or chronic exposure to substances of abuse.
Hall, C.M.; Lingam, S.
This book is a case study teaching manual presenting radiographs and examples of other imaging modalities from 100 paediatric patients. The material comes from the radiological teaching collection at the Hospital for Sick Children at Great Ormond Street in London and was compiled over a ten year period. With each case a short clinical history is given and a series of questions posed, similar to those encountered in postgraduate medical examinations. Sample answers with comments and more illustrations are presented on the following page. The last decade has seen a rapid expansion in the range and sophistication of diagnostic imaging modalities which are available to clinicians. Since it is impossible to achieve comprehensive coverage in a book of this size, the authors have selected examples of cases which illustrate the range of imaging modalities currently available and which may be encountered in both clinical practice and in examinations.
Bhatti, Khalid M.; Taqi, Kadhim M.; Al-Harthy, Ahmed Z. S.; Hamid, Rana S.; Al-Balushi, Zainab N.; Sankhla, Dilip K.; Al-Qadhi, Hani A.
Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7%) male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0%) received their injuries after having been hit by cars as pedestrians, while 19 (27.1%) were injured by falls, 12 (17.1%) during car accidents as passengers and four (5.7%) by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%), followed by abdominal injuries (42.9%). The most commonly involved solid organs were the liver (15.7%) and spleen (11.4%). The majority of the patients were managed conservatively (92.9%) with a good outcome (74.3%). The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach. PMID:27226913
In 1965, when the first issue of Journal of Paediatrics and Child Health appeared, medical ethics was just becoming established as a discipline. The sub-speciality of paediatric ethics did not make an appearance until the late 1980s, with the first key texts appearing in the 1990s. Professional concern to practice ethically in paediatrics obviously goes much further back than that, even if not named as such. In clinical areas of paediatrics, the story of the last 50 years is essentially a story of progress - better understanding of disease, better diagnosis, more effective treatment, better outcomes. In paediatric ethics, the story of the last 50 years is a bit more complicated. In ethics, the idea of progress, rather than just change, is not so straightforward and is sometimes hotly contested. There has certainly been change, including some quite radical shifts in attitudes and practices, but on some issues, the ethical debate now looks remarkably similar to that of 40-50 years ago. This is the story of some things that have changed in paediatric ethics, some things that have stayed the same and the key ethical ideas lying beneath the surface.
Liberal, Rodrigo; Vergani, Diego; Mieli-Vergani, Giorgina
In paediatrics, there are 2 liver disorders in which liver damage most likely stems from an autoimmune attack: 'classical' autoimmune hepatitis (AIH) and the AIH/sclerosing cholangitis overlap syndrome (also known as autoimmune sclerosing cholangitis, ASC). The presentation of childhood autoimmune liver disease (AILD) is non-specific and can mimic most other liver disorders. AIH is exquisitely responsive to immunosuppressive treatment, which should be instituted promptly to prevent rapid deterioration and promote remission and long-term survival. Difficult-to-treat or non-responsive patients should be treated with mycophenolate mofetil; if this fails then calcineurin inhibitors can be tried. Persistent failure to respond or lack of adherence to treatment result in end-stage liver disease. These patients, and those with fulminant liver failure at diagnosis, will require liver transplantation. ASC responds to the same immunosuppressive treatment used for AIH when treatment is initiated early. Abnormal liver function tests often resolve within a few months of treatment, although medium- to long-term prognosis is worse than that of AIH because bile duct disease continues to progress despite treatment in approximately 50% of patients. Ursodeoxycholic acid is usually added to conventional treatment regimen in ASC, but whether this actually helps arrest the progression of bile duct disease remains to be established. The pathogenesis of paediatric-onset AILD is not fully understood, although there is mounting evidence that genetic susceptibility, molecular mimicry and impaired immunoregulatory networks contribute to the initiation and perpetuation of the autoimmune attack. Liver damage is thought to be mediated primarily by CD4pos T-cells. While Th1 effector cells are associated with hepatocyte damage in both AIH and ASC, Th17 immune responses predominate in the latter where they correlate with biochemical indices of cholestasis, indicating that IL-17 is involved in the
Gnessin, Ehud; Chertin, Leonid; Chertin, Boris
We aimed to review a current management of paediatric nephrolithiasis. The current literature, including our own experience on the treatment of paediatric nephrolithiasis was reviewed by MEDLINE/PubMed search. We have used in our search following keywords: urolithiasis, nephrolithiasis, paediatrics, surgical treatment, conservative management, ESWL, ureteroscopy, and open renal surgery. The search was limited to the English language literature during the period of time from 1990 to 2011. All papers were reviewed independently by all co-authors and only the manuscripts directly related to the reviewed subjects were included into the current review. Due to the high incidence of predisposing factors for urolithiasis in children and high stone recurrence rates, every child with urinary stone should be given a complete metabolic evaluation. Most stones in children can be managed by ESWL and endoscopic techniques. Paediatric stone disease is an important clinical problem in paediatric urology practice. Because of its recurrent nature, every effort should be made to discover the underlying metabolic abnormality so that it can be treated appropriately. Obtaining a stone-free state with interventional management and close follow-up are of utmost importance.
Ho, W S; Ying, S Y; Wong, T W
Child abuse and neglect account for a significant number of paediatric burn injuries. It is of great importance because of the high mortality, high frequency of repeated abuse, as well as the physical, psychological and social sequelae that it causes. Burn abuse is often under-recognized and under-reported because it is difficult to define non-accidental injury. On the other hand, false accusation of burn abuse is extremely damaging to the family. Bizarre and unusual burn injuries can be caused by accident and should not automatically be assumed to be deliberate injury. Three boys of age 1-7 years with bizarre facial burns were admitted to the Burns Unit at the Prince of Wales Hospital between February 1995 and July 1999. One was burned by his baby-sitter with hot water steam and the other two were burned by their mothers with hot boiled eggs. The unusual causes of their burns raised the suspicion of child abuse and formal investigations were carried out by the Social Services Department. Detail assessment including a developmental history of the child and the psychosocial assessment of the family revealed that these three boys were burned because of poor medical advice and innocent cultural belief.
van't Hoff, William G
The aetiology of stones in children differs from that in adults. Young children, especially boys, are prone to infective stones, although this type of calculi is decreasing in frequency over time in prosperous countries. Two monogenic causes, cystinuria and hyperoxaluria, each account for 5-15% of paediatric stones. Increased factors for stone formation in children include prematurity, neurological problems, ketogenic diet and reconstructed or augmented bladders. Hypercalciuria is commonly found in paediatric stone formers, is usually idiopathic and is only rarely associated with hypercalcaemia. All children with stones should undergo a metabolic evaluation.
Moore, Dorothy L
Young children readily transmit and acquire nosocomial infections. Children are also vulnerable to endogenous infections as a result of the breakdown of their normal defences by disease, invasive procedures or therapy. The increasing acuity of illness in hospitalized children and therapeutic advances have resulted in a patient population that is increasingly at higher risk for nosocomial infections. Antibiotic resistance has emerged as a problem in some paediatric hospitals, usually in intensive care and oncology units. Infection rates are the highest in neonatal and paediatric intensive care units (where bloodstream infections are the most frequent), and are usually associated with intravascular devices. On general paediatric wards, respiratory and gastrointestinal infections predominate, reflecting the occurrence in the community. The surveillance of nosocomial infections identifies priorities for infection control activities and permits evaluation of interventions. The prevention of transmission between patients and to personnel requires that certain measures be taken with all patients, and that additional precautions be taken with some infections, based on the route of transmission. The prevention of transmission from personnel involves ensuring that personnel are appropriately immunized and counselled about working with infections. The prevention of nosocomial infection also involves control of visitors, appropriate management of invasive procedures and devices, sterilization and disinfection of equipment, provision of a clean environment and adequate staffing. Severely immunocompromised children require extra protection, including ventilation systems that reduce the risk of exposure to filamentous fungi. Infection control in paediatrics is an evolving field that must adapt to changes in the paediatric patient population and in health care technology. PMID:20084127
Song, Peige; Ren, Zhenghong; Chang, Xinlei; Liu, Xuebei; An, Lin
Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation. PMID:27420083
McBride, Joshua J; Vlieger, Arine M; Anbar, Ran D
Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis.
Vitale, M. C.
Since the early 80's, the use of laser has been introduced in the daily dental practice and the technological development has also provided over time to optimize its use. Various types of lasers with different wavelengths have been developed for use in a handy, easy and ergonomic manner. In daily paediatric dentistry, laser could be a very useful medical device which can completely replace the traditional high hand-piece and bur to realize a "micro-invasive" dentistry and a "clean" surgery, without bleeding and sutures. According to the international literature and in the light of recent researches, this work could give an overview on assisted laser therapy in paediatric dentistry, highlighting advantages and disadvantages of this new technology and pointing out the high compliance of the young patient.
Gunasekera, Hasantha; Kilham, Henry
In this article, we address how general paediatrics has evolved and adapted to change over the past 50 years and speculate on its future directions. We compare the state of general paediatrics with that of general adult medicine. We argue that general paediatrics must continue to have a strong role both in paediatric teaching hospitals and the community.
Consolaro, Alessandro; Morgan, Esi M; Giancane, Gabriella; Rosina, Silvia; Lanni, Stefano; Ravelli, Angelo
Information technology in paediatric rheumatology has seen several exciting developments in recent years. The new multidimensional questionnaires for juvenile idiopathic arthritis, juvenile dermatomyositis, and juvenile autoinflammatory diseases integrate all major parent- and child-reported outcomes (PCROs) used in these diseases into a single tool, and provide an effective guide to manage, document change in health, assess effectiveness of therapeutic interventions, and verify the parent and child satisfaction with illness outcome. The Pharmachild registry is aimed to gain information concerning the long-term effectiveness and safety of the medications currently used in juvenile idiopathic arthritis, particularly biologic agents, through collection of prospective data in a large, multinational sample of patients. Children and their parents are directly involved in the data collection by means of the regular completion of a digital version of a multidimensional questionnaire. The Patient-Reported Outcomes Measurement Information System (PROMIS) employs modern measurement science to advance assessment of PCROs, particularly HRQL, and offers multidimensional profile measures. The conceptual link of paediatric PROMIS with adult instruments facilitates harmonisation of assessments made in children and adolescents with those carried out in young adults in the process of transition of medical care. Development of electronic versions of questionnaires that permit their completion through smartphones or touch-screen devices will revolutionise information collection from parents and children, foster the regular collection of PCROs in routine care, and ultimately improve the quality of self-reported health data, and patient outcomes.
Pieles, Guido E; Horn, Richard; Williams, Craig A; Stuart, A Graham
Exercise training is an underused intervention in paediatric healthcare. This is surprising, since initial evidence demonstrates its effectiveness and safety; furthermore it confers socioeconomic benefits for healthcare systems. Pilot studies have assessed and confirmed the feasibility of exercise training in many paediatric disease settings. However, more research is needed to understand the pathophysiology, quantify treatment effects and monitor outcomes. A concerted effort from researchers, health professionals and police makers will be necessary to make exercise training an evidence-based and cost-effective intervention in paediatric care.
Sanches, M; Coelho, A; Oliveira, E; Lopes, A
A properly interpreted electrocardiogram (ECG) provides important information and is an inexpensive and easy test to perform. It continues to be the method of choice for the diagnosis of arrhythmias. Although the principles of cardiac electrophysiology are the same, there are anatomical and physiological age-dependent changes which produce specific alterations in the paediatric ECG, and which may be misinterpreted as pathological. The intention of this article is to address in a systematic way the most relevant aspects of the paediatric ECG, to propose a possible reading scheme of the ECG and to review the electrocardiograph tracings most frequently found in the paediatric age group.
Ruperto, Nicolino; Vesely, Richard; Saint-Raymond, Agnes; Martini, Alberto
Conducting clinical trials in paediatric rheumatology has been difficult mainly because of the lack of funding for academic studies and the lack of interest by pharmaceutical companies in the small and non-rewarding paediatric market. The situation changed dramatically a few years ago with the introduction of the Best Pharmaceuticals for Children Act in the USA and of specific legislation for the development of paediatric medicines (Paediatric Regulation) in the European Union (EU). The EU Paediatric Regulation had a positive impact in paediatric rheumatology-in particular, on the development of new treatments for children with juvenile idiopathic arthritis (JIA). Some problems remain, however, such as greater harmonisation of the regulatory aspects of medicines, how to handle me-too agents, how to conduct adequate pharmacokinetic studies and develop age-appropriate formulations, ethical problems in study review and implementation, and a change in the current JIA classification. The introduction of specific legislation, coupled with the existence of large international networks such as the Pediatric Rheumatology Collaborative Study Group (PRCSG at http://www.prcsg.org), covering North America, and the Paediatric Rheumatology International Trials Organisation (PRINTO at http://www.printo.it), covering more than 50 countries, has led to great advances in paediatric rheumatology. Future changes might increase the possibility of conducting trials with similar approaches in other paediatric rheumatological conditions and provide evidence-based treatments for children affected by rheumatic diseases.
Sørensen, Sarah Mejer; Bjørn, Signe Frahm; Jochumsen, Kirsten Marie; Jensen, Pernille Tine; Thranov, Ingrid Regitze; Hare-Bruun, Helle; Seibæk, Lene; Høgdall, Claus
Aim of database The Danish Gynecological Cancer Database (DGCD) is a nationwide clinical cancer database and its aim is to monitor the treatment quality of Danish gynecological cancer patients, and to generate data for scientific purposes. DGCD also records detailed data on the diagnostic measures for gynecological cancer. Study population DGCD was initiated January 1, 2005, and includes all patients treated at Danish hospitals for cancer of the ovaries, peritoneum, fallopian tubes, cervix, vulva, vagina, and uterus, including rare histological types. Main variables DGCD data are organized within separate data forms as follows: clinical data, surgery, pathology, pre- and postoperative care, complications, follow-up visits, and final quality check. DGCD is linked with additional data from the Danish “Pathology Registry”, the “National Patient Registry”, and the “Cause of Death Registry” using the unique Danish personal identification number (CPR number). Descriptive data Data from DGCD and registers are available online in the Statistical Analysis Software portal. The DGCD forms cover almost all possible clinical variables used to describe gynecological cancer courses. The only limitation is the registration of oncological treatment data, which is incomplete for a large number of patients. Conclusion The very complete collection of available data from more registries form one of the unique strengths of DGCD compared to many other clinical databases, and provides unique possibilities for validation and completeness of data. The success of the DGCD is illustrated through annual reports, high coverage, and several peer-reviewed DGCD-based publications. PMID:27822089
Cook, Kerry; Daniels, Amanda; Sheehan, Karen; Langton, Helen
Educational courses for staff working in paediatric specialties may not be financially viable because of the small numbers involved and the difficulties that potential students have in getting released from their units. The UK Paediatric Cardiac Nurses Association worked with other groups to explore the feasibility of a national multi-professional paediatric cardiac education pathway. Three options were identified, including the continuation of local in-house provision with its associated variation in standards. The relative benefits and resource implications of each option were explored and approaches made to educational institutions for support in developing the pathway. A university with an established reputation for e-learning undertook this development and a post graduate certificate in Paediatric Cardiothoracic Practice will soon be available.
Baillie, Colin T; Smith, Jennifer A
Inflammatory bowel disease (IBD) comprises two distinct but related chronic relapsing inflammatory conditions affecting different parts of the gastrointestinal tract. Crohn’s disease is characterised by a patchy transmural inflammation affecting both small and large bowel segments with several distinct phenotypic presentations. Ulcerative colitis classically presents as mucosal inflammation of the rectosigmoid (distal colitis), variably extending in a contiguous manner more proximally through the colon but not beyond the caecum (pancolitis). This article highlights aspects of the presentation, diagnosis, and management of IBD that have relevance for paediatric practice with particular emphasis on surgical considerations. Since 25% of IBD cases present in childhood or teenage years, the unique considerations and challenges of paediatric management should be widely appreciated. Conversely, we argue that the organizational separation of the paediatric and adult healthcare worlds has often resulted in late adoption of new approaches particularly in paediatric surgical practice. PMID:26034347
Brown, S; Davies, P
Chronic cough is a common presentation in paediatrics. We describe a case which highlights the need for careful history taking and summarize the key clinical features which should prompt a clinician to perform a chest X-ray.
Finlay, Fiona; Baverstock, Anna; Lenton, Simon
Over the past 30 years, there has been much research into the health benefits of humour and laughter. Although often viewed very positively, rigorous evaluation of the therapeutic effect of clowning is complex. Clowning is a multi-modal intervention, which may have an impact on medical conditions, procedures, family functioning and health care teams. Clowns help children to adapt to their hospital surroundings and can distract from, and demystify, painful or frightening procedures through 'doses of fun' to complement traditional clinical interventions. This paper provides a review of the paediatric literature and reveals studies looking at the effect of clown interventions on various practical procedures and individual medical conditions, and the effects of clowning within clinical teams.
Honour, John W
Most steroid disorders of the adrenal cortex come to clinical attention in childhood and in order to investigate these problems, there are many challenges to the laboratory which need to be appreciated to a certain extent by clinicians. The analysis of sex steroids in biological fluids from neonates, over adrenarche and puberty present challenges of specificities and concentrations often in small sample sizes. Different reference ranges are also needed for interpretations. For around 40 years, quantitative assays for the steroids and their regulatory peptide hormones have been possible using immunoassay techniques. Problems are recognised and this review aims to summarise the benefits and failings of immunoassays and introduce where tandem mass spectrometry is anticipated to meet the clinical needs for steroid analysis in paediatric endocrine investigations. It is important to keep a dialogue between clinicians and the laboratory, especially when any laboratory result does not make sense in the clinical investigation.
Most steroid disorders of the adrenal cortex come to clinical attention in childhood and in order to investigate these problems, there are many challenges to the laboratory which need to be appreciated to a certain extent by clinicians. The analysis of sex steroids in biological fluids from neonates, over adrenarche and puberty present challenges of specificities and concentrations often in small sample sizes. Different reference ranges are also needed for interpretations. For around 40 years, quantitative assays for the steroids and their regulatory peptide hormones have been possible using immunoassay techniques. Problems are recognised and this review aims to summarise the benefits and failings of immunoassays and introduce where tandem mass spectrometry is anticipated to meet the clinical needs for steroid analysis in paediatric endocrine investigations. It is important to keep a dialogue between clinicians and the laboratory, especially when any laboratory result does not make sense in the clinical investigation. Conflict of interest:None declared. PMID:21274330
Borràs, Eva; Domínguez, Àngela; Fuentes, Miriam; Batalla, Joan; Cardeñosa, Neus; Plasencia, Antoni
Background Although routine vaccination is a major tool in the primary prevention of some infectious diseases, there is some reluctance in a proportion of the population. Negative parental perceptions of vaccination are an important barrier to paediatric vaccination. The aim of this study was to investigate parental knowledge of paediatric vaccines and vaccination in Catalonia. Methods A retrospective, cross-sectional study was carried out in children aged < 3 years recruited by random sampling from municipal districts of all health regions of Catalonia. The total sample was 630 children. Parents completed a standard questionnaire for each child, which included vaccination coverage and knowledge about vaccination. The level of knowledge of vaccination was scored according to parental answers. Results An association was observed between greater vaccination coverage of the 4:4:4:3:1 schedule (defined as: 4 DTPa/w doses, 4 Hib doses, 4 OPV doses, 3 MenC doses and 1 MMR dose) and maternal age >30 years (OR: 2.30; 95% CI: 1.20–4.43) and with a knowledge of vaccination score greater than the mean (OR: 0.45; 95% CI: 0.28–0.72). The score increased with maternal educational level and in parents of vaccinated children. A total of 20.47% of parents stated that vaccines could have undesirable consequences for their children. Of these, 23.26% had no specific information and 17.83% stated that vaccines can cause adverse reactions and the same percentage stated that vaccines cause allergies and asthma. Conclusion Higher vaccination coverage is associated with older maternal age and greater knowledge of vaccination. Vaccination coverage could be raised by improving information on vaccines and vaccination. PMID:19473498
Hölmich, Lisbet Rosenkrantz; Klausen, Siri; Spaun, Eva; Schmidt, Grethe; Gad, Dorte; Svane, Inge Marie; Schmidt, Henrik; Lorentzen, Henrik Frank; Ibfelt, Else Helene
Aim of database The aim of the database is to monitor and improve the treatment and survival of melanoma patients. Study population All Danish patients with cutaneous melanoma and in situ melanomas must be registered in the Danish Melanoma Database (DMD). In 2014, 2,525 patients with invasive melanoma and 780 with in situ tumors were registered. The coverage is currently 93% compared with the Danish Pathology Register. Main variables The main variables include demographic, clinical, and pathological characteristics, including Breslow’s tumor thickness, ± ulceration, mitoses, and tumor–node–metastasis stage. Information about the date of diagnosis, treatment, type of surgery, including safety margins, results of lymphoscintigraphy in patients for whom this was indicated (tumors > T1a), results of sentinel node biopsy, pathological evaluation hereof, and follow-up information, including recurrence, nature, and treatment hereof is registered. In case of death, the cause and date are included. Currently, all data are entered manually; however, data catchment from the existing registries is planned to be included shortly. Descriptive data The DMD is an old research database, but new as a clinical quality register. The coverage is high, and the performance in the five Danish regions is quite similar due to strong adherence to guidelines provided by the Danish Melanoma Group. The list of monitored indicators is constantly expanding, and annual quality reports are issued. Several important scientific studies are based on DMD data. Conclusion DMD holds unique detailed information about tumor characteristics, the surgical treatment, and follow-up of Danish melanoma patients. Registration and monitoring is currently expanding to encompass even more clinical parameters to benefit both patient treatment and research. PMID:27822097
Ruperto, Nicolino; Martini, Alberto
Networking is key to overcoming the logistical, methodological and ethical problems related to the implementation of paediatric studies. The adoption of legislation to encourage paediatric clinical trials by the American and European regulatory agencies has opened a new era in the assessment of drug safety and efficacy in children. Two very large international trial networks--the Pediatric Rheumatology Collaborative Study Group (PRCSG) and the Paediatric Rheumatology International Trials Organisation (PRINTO)--have played a critical role in the implementation of this legislation and have facilitated several successful controlled studies on the safety and the efficacy of new and old drugs in paediatric rheumatic diseases. The PRINTO and PRCSG networks can be seen as a model for international co-operation in other paediatric subspecialties.
Whitehead, John S.
The paper is a supplement to an earlier paper in the same series which reviews Danish higher education until 1977. Expansion in higher education in the last 20 years, approaching the scale of mass higher education, culminated in a crisis in 1977. At that time, a trend toward self-government and participatory governing boards was seen as the end of…
Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager; Schaarup, Susanne Zielke; Gyllenborg, Jesper
Aim of database The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. Study population All patients with acute stroke (from 2003) or TIA (from 2013) treated at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. Main variables The registry holds prospectively collected data on key processes of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients with acute stroke and TIA. Patient outcomes are currently monitored using 30-day mortality, unplanned readmission, and for patients receiving revascularization therapy, also functional level at 3 months poststroke. Descriptive data Sociodemographic, clinical, and lifestyle factors with potential prognostic impact are registered. Conclusion The Danish Stroke Registry is a well-established clinical registry which plays a key role for monitoring and improving stroke and TIA care in Denmark. In addition, the registry is increasingly used for research. PMID:27843349
Arul, G S; Spicer, R D
We have tried to review the evidence for the organisation of paediatric surgical care. Difficulties arise because of the lack of published data from district general hospitals concerning paediatric surgical conditions. Hence much of the debate about the surgical management of children is based on anecdotal evidence. However, at a time when the provision of health care is being radically reorganised to an internal market based on a system of purchasers and providers it is more important than ever to understand the issues at stake. Two separate issues have been discussed: the role of the specialist paediatric centre and the provision of non-specialist paediatric surgery in district general hospitals. There are arguments for and against large regional specialist paediatric centres. The benefits of centralisation include concentration of expertise, more appropriate consultant on call commitment, development of support services, and junior doctor training. The disadvantages include children and their families having to travel long distances for care, and the loss of expertise at a local level. If specialist paediatric emergency transport is available the benefits of centralisation far outweigh the adverse effects of having to take children to a regional paediatric intensive care centre. Specialist paediatric centres are aware of the importance of treating children and their parents as a family unit as highlighted by the Platt committee; this is an important challenge and enormous improvements have occurred to provide proper accommodation for families while their children are treated in hospital. To keep these arguments of large distances and separation from the home in context, one paediatric intensive care unit in Victoria, Australia, providing a centralised service to a region larger in are than England and with a similar admission rate, has a lower mortality rate than the decentralised paediatric intensive care provided in the Trent region of the UK. There is clear
Carter, Melody C; Metcalfe, Dean D; Clark, Alicia S; Wayne, Alan S; Maric, Irina
The diagnostic criteria for paediatric mastocytosis are largely based on adult studies and bone marrow findings are not well described in children. We evaluated use of the World Health Organization (WHO) criteria for the diagnosis of systemic disease in paediatric mastocytosis. In addition, we identified unique clinico-histopathological features within the biopsies. One hundred and thirteen children with paediatric mastocytosis were evaluated at the National Institutes of Health between 1986 and 2013. Complete bone marrow evaluations were performed in 50 cases. Seven children had repeat procedures. Bone marrows were analysed by histopathology, flow cytometry and for KIT D816V. Bone marrow biopsies displayed mild atypical haematopoietic maturation, increased haematogones and hypocellularity in a sub-set of patients with urticaria pigmentosa, diffuse cutaneous mastocytosis and indolent systemic mastocytosis. Hypocellularity was most pronounced in those with urticaria pigmentosa. Haematogones were highest, on average, in patients with diffuse cutaneous mastocytosis or mastocytomas. There was no evidence of peripheral blood cytopenias, myelodysplastic syndrome, myeloproliferative neoplasm or leukaemia within this cohort. The WHO criteria are applicable for the diagnosis of systemic mastocytosis in paediatrics. Although unsuspected bone marrow findings typically seen in myeloproliferative disorders are frequent in paediatric mastocytosis, patients within this study remained clinically stable without progression to a more aggressive variant.
Grootenhuis, Martha A.; Bos, Albert P.
The development of paediatric intensive care has contributed to the improved survival of critically ill children. Physical and psychological sequelae and consequences for quality of life (QoL) in survivors might be significant, as has been determined in adult intensive care unit (ICU) survivors. Awareness of sequelae due to the original illness and its treatment may result in changes in treatment and support during and after the acute phase. To determine the current knowledge on physical and psychological sequelae and the quality of life in survivors of paediatric intensive care, we undertook a computerised comprehensive search of online databases for studies reporting sequelae in survivors of paediatric intensive care. Studies reporting sequelae in paediatric survivors of cardiothoracic surgery and trauma were excluded, as were studies reporting only mortality. All other studies reporting aspects of physical and psychological sequelae were analysed. Twenty-seven studies consisting of 3,444 survivors met the selection criteria. Distinct physical and psychological sequelae in patients have been determined and seemed to interfere with quality of life. Psychological sequelae in parents seem to be common. Small numbers, methodological limitations and quantitative and qualitative heterogeneity hamper the interpretation of data. We conclude that paediatric intensive care survivors and their parents have physical and psychological sequelae affecting quality of life. Further well-designed prospective studies evaluating sequelae of the original illness and its treatment are warranted. PMID:17823815
Osteoporosis, a skeletal disorder characterized by compromised bone strength and an increased risk of fractures, is an important paediatric disorder that involves almost all paediatric subspecialties. Osteogenesis imperfecta is the most common form of childhood-onset primary osteoporosis, but several other forms are also known. Secondary osteoporosis is caused by an underlying chronic illness or its treatment. The most common causes of secondary osteoporosis include chronic systemic inflammation, glucocorticoid use and neuromuscular disabilities. The skeletal sequelae can present in childhood as low-energy peripheral and vertebral fractures, or become evident in adulthood as low bone mass and an increased propensity to develop osteoporosis. Management should aim at prevention, as interventions to treat symptomatic osteoporosis in the paediatric age group are scarce. Bisphosphonates are the principal pharmacological agents that can be used in this setting, but data on their efficacy and safety in paediatric populations remain inadequate, especially in patients with secondary osteoporosis. Consequently, it is important to understand the potential skeletal effects of paediatric illnesses and their therapies in order to institute effective and timely prevention of skeletal complications.
Busoni, P; Crescioli, M; Agostino, R; Sestini, G
Postoperative vomiting is a common and unpleasant complication. The purpose of the present study was to verify if dexamethasone reduces the incidence of vomiting when injected IV in children anaesthetized with halothane for common paediatric operations. We also studied the incidence of vomiting when sevoflurane was used instead. Five hundred and 69 boys, aged 2-12 years (ASA physical status I, II), scheduled for inguinal field surgery were randomly assigned to receive halothane, halothane and dexamethasone and sevoflurane in three groups: halothane (n=180), halothane and IV dexamethasone (n=188) and sevoflurane (n=201). Anaesthesia was induced by inhalation of halothane or sevoflurane in oxygen and nitrous oxide and was maintained at minimum alveolar concentration of each agent throughout the surgery. For intra- and postoperative pain control iliac crest block was used in all the boys. Vomiting was defined as any expulsion of liquid gastric contents. The incidence of postoperative vomiting was 23% in the halothane group, which was significantly greater than that in the other groups (halothane and dexamethasone group, 9%; sevoflurane group, 13%). In conclusion, dexamethasone reduces the incidence and frequency of multiple emetic episodes when administered intravenously after halothane anaesthesia; sevoflurane reduces the overall incidence of vomiting, but not multiple emetic episodes.
Goga, Ameena Ebrahim; Singh, Yagespari; Singh, Michelle; Noveve, Nobuntu; Magasana, Vuyolwethu; Ramraj, Trisha; Abdullah, Fareed; Coovadia, Ashraf H; Bhardwaj, Sanjana; Sherman, Gayle G
Introduction Increasing access to HIV-related care and treatment for children aged 0-18 years in resource-limited settings is an urgent global priority. In 2011-2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of
The paediatric life support working party of the European Resuscitation Council was set up in 1992 with the aim of producing guidelines for basic and advanced paediatric resuscitation that would be acceptable throughout Europe. The commonest cause of cardiac arrest in children is problems with the airway. The resulting difficulties in breathing and the associated hypoxia rapidly cause a severe bradycardia or asystole. In contrast, adults have primary cardiac events resulting in ventricular fibrillation. This important difference in the pathogenesis of paediatric and adult cardiac arrest is reflected in these European Resuscitation Council guidelines, which complement those already published for adults. PMID:8019227
Patel, Preena; Koh, Michelle; Carr, Lucinda; McHugh, Kieran
Palliative care is an expanding specialty within paediatrics, which has attracted little attention in the paediatric radiological literature. Paediatric patients under a palliative care team will have numerous radiological tests which we traditionally categorise under organ systems rather than under the umbrella of palliative medicine. The prevalence of children with life-limiting illness is significant. It has been estimated to be one per thousand, and this may be an underestimate. In this review, we will focus on our experience at one institution, where radiology has proven to be an invaluable partner to palliative care. We will discuss examples of conditions commonly referred to our palliative care team and delineate the crucial role of diagnostic radiology in determining treatment options.
López-Herce, Jesús; Rodríguez, Antonio; Carrillo, Angel; de Lucas, Nieves; Calvo, Custodio; Civantos, Eva; Suárez, Eva; Pons, Sara; Manrique, Ignacio
Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support.
Wacogne, I; Scott-Jupp, R; Chambers, T
"The report of my death was an exaggeration", said Mark Twain. For a dying specialty, general paediatrics has certainly been looking very healthy recently. It is timely to examine why our specialty was thought to be at such risk, and to explore why, although in many cases shocked and confused, it is well on the way to recovery. This article explores what is needed to keep it healthy to ensure that the general paediatrician is at the centre of the delivery of paediatrics in the UK.
Valente, Enza Maria; Ferraris, Alessandro; Dallapiccola, Bruno
Paediatric neurological disorders encompass a large group of clinically heterogeneous diseases, of which some are known to have a genetic cause. Over the past few years, advances in nosological classifications and in strategies for molecular testing have substantially improved the diagnosis, genetic counselling, and clinical management of many patients, and have facilitated the possibility of prenatal diagnoses for future pregnancies. However, the increasing availability of genetic tests for paediatric neurological disorders is raising important questions with regard to the appropriateness, choice of protocols, interpretation of results, and ethical and social concerns of these services. In this Review, we discuss these topics and how these concerns affect genetic counselling.
Andronikou, Savvas; McHugh, Kieran; Abdurahman, Nuraan; Khoury, Bryan; Mngomezulu, Victor; Brant, William E; Cowan, Ian; McCulloch, Mignon; Ford, Nathan
Paediatric radiology requires dedicated equipment, specific precautions related to ionising radiation, and specialist knowledge. Developing countries face difficulties in providing adequate imaging services for children. In many African countries, children represent an increasing proportion of the population, and additional challenges follow from extreme living conditions, poverty, lack of parental care, and exposure to tuberculosis, HIV, pneumonia, diarrhoea and violent trauma. Imaging plays a critical role in the treatment of these children, but is expensive and difficult to provide. The World Health Organisation initiatives, of which the World Health Imaging System for Radiography (WHIS-RAD) unit is one result, needs to expand into other areas such as the provision of maintenance servicing. New initiatives by groups such as Rotary and the World Health Imaging Alliance to install WHIS-RAD units in developing countries and provide digital solutions, need support. Paediatric radiologists are needed to offer their services for reporting, consultation and quality assurance for free by way of teleradiology. Societies for paediatric radiology are needed to focus on providing a volunteer teleradiology reporting group, information on child safety for basic imaging, guidelines for investigations specific to the disease spectrum, and solutions for optimising imaging in children.
Danish auroral science history begins with the early auroral observations made by the Danish astronomer Tycho Brahe during the years from 1582 to 1601 preceding the Maunder minimum in solar activity. Included are also the brilliant observations made by another astronomer, Ole Rømer, from Copenhagen in 1707, as well as the early auroral observations made from Greenland by missionaries during the 18th and 19th centuries. The relations between auroras and geomagnetic variations were analysed by H. C. Ørsted, who also played a vital role in the development of Danish meteorology that came to include comprehensive auroral observations from Denmark, Iceland and Greenland as well as auroral and geomagnetic research. The very important auroral investigations made by Sophus Tromholt are outlined. His analysis from 1880 of auroral observations from Greenland prepared for the significant contributions from the Danish Meteorological Institute, DMI, (founded in 1872) to the first International Polar Year 1882/83, where an expedition headed by Adam Paulsen was sent to Greenland to conduct auroral and geomagnetic observations. Paulsen's analyses of the collected data gave many important results but also raised many new questions that gave rise to auroral expeditions to Iceland in 1899 to 1900 and to Finland in 1900 to 1901. Among the results from these expeditions were 26 unique paintings of the auroras made by the artist painter, Harald Moltke. The expedition to Finland was headed by Dan la Cour, who later as director of the DMI came to be in charge of the comprehensive international geomagnetic and auroral observations made during the Second International Polar Year in 1932/33. Finally, the article describes the important investigations made by Knud Lassen during, among others, the International Geophysical Year 1957/58 and during the International Quiet Sun Year (IQSY) in 1964/65. With his leadership the auroral and geomagnetic research at DMI reached a high international
Danish as a second language textbooks published over the last 15 years have presented the Danish cultural identity as a homogenous and purely national phenomenon. Research into teaching theory, on the other hand, has been more broad-minded, and is based on interactivity. The aim of this paper is to explain this divergence. (Contains 2 notes.)
MAMMAS, IOANNIS N.; SOURVINOS, GEORGE; SPANDIDOS, DEMETRIOS A.
Human papillomavirus (HPV) is composed of a particularly heterogeneous family of DNA viruses, which has gained much attention in recent years due to the discoveries of Professor Harald zur Hausen, who first identified a connection between HPV and cervical cancer. Professor Harald zur Hausen, the ‘Father of HPV Virology’, was the recipient of the 2008 Nobel Prize. HPV can be transmitted through physical contact via autoinoculation or fomites, sexual contact, as well as vertically from the HPV-positive mother to her newborn, causing subclinical or clinical infections. In infancy and childhood, HPV-associated clinical infections include skin warts, genital warts and juvenile recurrent respiratory papillomatosis, while cervical squamous intraepithelial lesions have also been reported among adolescent girls. To date, several research teams, worldwide, have extensively investigated HPV from the paediatric point of view. This primitive effort has been performed before the recent great expansion of paediatric HPV research due to the vaccination programmes against HPV, which were introduced into clinical practice in 2006. In this review article, we present a brief overview of paediatric HPV research after the first report in 1978 involving children in the research of HPV until the time point of this great expansion. In the future, it is expected that further unresolved issues will be addressed and clarified, as the paediatric story of HPV remains a challenging research target. PMID:25013461
The implementation of paediatric palliative care aims to fulfil objectives regarding the support provided for the child and his/her family in all aspects of care. It is guided by regulations and recommendations relating to pain relief, quality of life and support for families.
King, Gillian; Bartlett, Doreen J.; Currie, Melissa; Gilpin, Michelle; Baxter, Donna; Willoughby, Colleen; Tucker, Mary Ann; Strachan, Deborah
This article describes the development of a classification system to measure the expertise levels of practicing paediatric rehabilitation therapists. Seventy-five therapists from five disciplines (physical, occupational, speech-language, behaviour, and recreational therapy) were involved, along with 170 peers, and 188 parents of children with…
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Tolle, Michael A; Phelps, B Ryan; Desmond, Chris; Sugandhi, Nandita; Omeogu, Chinyere; Jamieson, David; Ahmed, Saeed; Reuben, Elan; Muhe, Lulu; Kellerman, Scott E
If children are to be protected from HIV, the expansion of PMTCT programs must be complemented by increased provision of paediatric treatment. This is expensive, yet there are humanitarian, equity and children's rights arguments to justify the prioritization of treating HIV-infected children. In the context of limited budgets, inefficiencies cost lives, either through lower coverage or less effective services. With the goal of informing the design and expansion of efficient paediatric treatment programs able to utilize to greatest effect the available resources allocated to the treatment of HIV-infected children, this article reviews what is known about cost drivers in paediatric HIV interventions, and makes suggestions for improving efficiency in paediatric HIV programming. High-impact interventions known to deliver disproportional returns on investment are highlighted and targeted for immediate scale-up. Progress will carry a cost - increased funding, as well as additional data on intervention costs and outcomes, will be required if universal access of HIV-infected children to treatment is to be achieved and sustained.
Mammas, Ioannis N; Greenough, Anne; Theodoridou, Maria; Kramvis, Anna; Christaki, Iliana; Koutsaftiki, Chryssie; Koutsaki, Maria; Portaliou, Dimitra M; Kostagianni, Georgia; Panagopoulou, Paraskevi; Sourvinos, George; Spandidos, Demetrios A
Paediatric Virology is a bold new scientific field, which combines Paediatrics with Virology, Epidemiology, Molecular Medicine, Evidence-based Medicine, Clinical Governance, Quality Improvement, Pharmacology and Immunology. The Workshop on Paediatric Virology, which took place on Saturday October 10, 2015 in Athens, Greece, provided an overview of recent views and advances on viral infections occurring in neonates and children. It was included in the official programme of the 20th World Congress on Advances in Oncology and the 18th International Symposium on Molecular Medicine, which attracted over 500 delegates from the five continents. During the Workshop, the topics covered included the challenges of vaccine implementation against human papillomaviruses in countries under financial crisis, strategies for eradicating poliomyelitis and its 60th vaccine anniversary, as well as the debate on the association between autism and vaccination against measles, mumps and rubella. Among the non-vaccine related topics, emphasis was given to viral infections in prematurely born infants and their long-term outcomes, new paediatric intensive care management options for bronchiolitis related to respiratory syncytial virus, the clinical implications of hepatitis B virus and cytomegalovirus genotyping, the Ebola virus threat and preparedness in Paediatric Emergency Departments, oral, oropharynx, laryngeal, nasal and ocular viral infections and Merkel cell polyomavirus as a novel emerging virus of infancy and childhood. In this review, we provide selected presentations and reports discussed at the Workshop.
MAMMAS, IOANNIS N.; GREENOUGH, ANNE; THEODORIDOU, MARIA; KRAMVIS, ANNA; CHRISTAKI, ILIANA; KOUTSAFTIKI, CHRYSSIE; KOUTSAKI, MARIA; PORTALIOU, DIMITRA M.; KOSTAGIANNI, GEORGIA; PANAGOPOULOU, PARASKEVI; SOURVINOS, GEORGE; SPANDIDOS, DEMETRIOS A.
Paediatric Virology is a bold new scientific field, which combines Paediatrics with Virology, Epidemiology, Molecular Medicine, Evidence-based Medicine, Clinical Governance, Quality Improvement, Pharmacology and Immunology. The Workshop on Paediatric Virology, which took place on Saturday October 10, 2015 in Athens, Greece, provided an overview of recent views and advances on viral infections occurring in neonates and children. It was included in the official programme of the 20th World Congress on Advances in Oncology and the 18th International Symposium on Molecular Medicine, which attracted over 500 delegates from the five continents. During the Workshop, the topics covered included the challenges of vaccine implementation against human papillomaviruses in countries under financial crisis, strategies for eradicating poliomyelitis and its 60th vaccine anniversary, as well as the debate on the association between autism and vaccination against measles, mumps and rubella. Among the non-vaccine related topics, emphasis was given to viral infections in prematurely born infants and their long-term outcomes, new paediatric intensive care management options for bronchiolitis related to respiratory syncytial virus, the clinical implications of hepatitis B virus and cytomegalovirus genotyping, the Ebola virus threat and preparedness in Paediatric Emergency Departments, oral, oropharynx, laryngeal, nasal and ocular viral infections and Merkel cell polyomavirus as a novel emerging virus of infancy and childhood. In this review, we provide selected presentations and reports discussed at the Workshop. PMID:26889211
Wright, Tracey B; Punaro, Marilynn
Investigations in paediatric SLE contributed significantly to the discovery of the association of type I IFNs with lupus and underscored the potential application of this knowledge by informing the use of glucocorticoid therapy. Recent, promising research reveals biomarkers that may yield more focused clinical monitoring and assessment of response to treatment. This article reviews unique features of paediatric SLE and details important developments in paediatric lupus research.
Hart, Dieter; Mühlbauer, Bernd
The off-label use of drugs in paediatrics is a common practice casting doubts on the adequate safety of drug therapy. Regulatory initiatives of European and national legislators aim to address this paucity of clinical drug trials in paediatrics through clarifying regulations and incentives in pharmaceutical law, thereby promoting an increase in the approval of paediatric drugs, the improvement of drug and thus treatment safety. This paper describes the present situation in paediatrics and the legal status of off-label use in pharmaceutical law, medical malpractice law and statutory health insurance law.
Sawant, Ajit S.; Kumar, Vikash; Pawar, Prakash; Tamhankar, Ashwin S.
The bladder neck distraction is a rare posterior urethral injury in paediatric age group. It mostly occurs secondary to road traffic accidents. We report three cases of paediatric bladder neck distraction injury. Three paediatric patients aged between 4 to 7 years (mean 5 year), who presented with post traumatic bladder neck distraction injury but no other major injury, they were treated with early urethro-vesical anastomosis. Postoperatively all patients were continent and with good urine flow rates. In paediatric bladder neck distraction injury, immediate urethro-vesical anastomosis gives good results. PMID:28384935
Freeman, H; Patel, J; Fernandez, D; Sharples, P; Ramanan, A V
Antiphospholipid syndrome (APS) is a systemic autoimmune condition where the presence of antiphospholipid antibodies is thought to predispose to thrombotic events. It is uncommon in the paediatric population, but current diagnostic criteria are based on adult population studies, making assessment of its true paediatric prevalence difficult. We present two cases of paediatric APS, who presented with primary neurological events, and discuss approaches to diagnosis, interpretation of screening investigations, including antinuclear antibodies (ANA), anti-extractable nuclear antigen (ENA) antibodies and lupus anticoagulant. Possible approaches to the management of paediatric APS are discussed.
Damasio, M B; Darge, K; Riccabona, M
The use of paediatric multi-slice CT (MSCT) is rapidly increasing worldwide. As technology advances its application in paediatric care is constantly expanding with an increasing need for radiation dose control and appropriate utilization. Recommendations on how and when to use CT for assessment of the paediatric urinary tract appear to be an important issue. Therefore the European Society of Paediatric Radiology (ESPR) uroradiology task force and European Society of Urogenital Radiology (ESUR) paediatric working groups created a proposal for performing renal CT in children that has recently been published. The objective of this paper is to discuss paediatric urinary tract CT (uro-CT) in more detail and depth. The specific aim is not only to offer general recommendations on clinical indications and optimization processes of paediatric CT examination, but also to address various childhood characteristics and phenomena that facilitate understanding the different approach and use of uro-CT in children compared to adults. According to ALARA principles, paediatric uro-CT should only be considered for selected indications provided high-level comprehensive US is not conclusive and alternative non-ionizing techniques such as MR are not available or appropriate. Optimization of paediatric uro-CT protocols (considering lower age-adapted kV and mAs) is mandatory, and the number of phases and acquisition series should be kept as few as possible.
Kausman, Joshua Y; Powell, Harley R
In 1965, the specialty of paediatric nephrology was in its infancy. Following the development of a landmark collaborative research study, the International Study of Kidney Disease in Childhood in the mid-1960s, the first specialist societies were formed: the European Society of Pediatric Nephrology in 1967 and the American Society of Pediatric Nephrology in 1969. The extraordinary improvements in care delivered to children with kidney disease over the past 50 years are too broad to cover in any one paper. They traverse the spectrum of diagnosis, classification, therapeutics, social well-being and transition to adult care. We have selected four case scenarios to highlight these changes in key areas of paediatric nephrology: post-streptococcal glomerulonephritis, nephrotic syndrome, haemolytic uraemic syndrome and neonatal dialysis and childhood transplantation.
Harrop, Michele; Amegavie, Laweh
Throughout the development, implementation and dissemination of the Paediatric Respiratory Newsletter, effective channels of communication between healthcare professionals have been established, highlighting the importance of collaboration. Promoting education, training, audit and research, the newsletter has nurtured both professional and practice development. The work begun during this project, and the outcomes it has achieved, have been developed into an ethos that recognises effective clinical practice and organisational development as central to the delivery of a quality service. This work informs and is informed by strategic developments, in particular, research and development, clinical audit, quality, practice development and clinical risk, all of which are observed to be the key elements of clinical governance. On a personal level, the project has provided me with an opportunity to consolidate information, forge links with the multidisciplinary team and establish a framework for the development of paediatric respiratory services. We hope it will continue to respond to, and be influenced by, changing health and social care demands.
Moore, M M; Kulaylat, A N; Brian, J M; Khaku, A; Hulse, M A; Engbrecht, B W; Methratta, S T; Boal, D K B
As the utilization of MRI in the assessment for paediatric appendicitis increases in clinical practice, it is important to recognize alternative diagnoses as the cause of abdominal pain. The purpose of this review is to share our institution's experience using MRI in the evaluation of 510 paediatric patients presenting with suspected appendicitis over a 30 month interval (July 2011 to December 2013). An alternative diagnosis was documented in 98/510 (19.2%) patients; adnexal pathology (6.3%, n = 32), enteritis-colitis (6.3%, n = 32), and mesenteric adenitis (2.2%, n = 11) comprised the majority of cases. These common entities and other less frequent illustrative cases obtained during our overall institutional experience with MRI for suspected appendicitis are reviewed.
Trachsel, D; Svendsen, J; Erb, T O; von Ungern-Sternberg, B S
Respiratory adverse events are one of the major causes of morbidity and mortality in paediatric anaesthesia. Aside from predisposing conditions associated with an increased risk of respiratory incidents in children such as concurrent infections and chronic airway irritation, there are adverse respiratory events directly attributable to the impact of anaesthesia on the respiratory system. Anaesthesia can negatively affect respiratory drive, ventilation/perfusion (V/Q) matching and tidal breathing, all resulting in potentially devastating hypoxaemia. Understanding paediatric respiratory physiology and its changes during anaesthesia will enable anaesthetists to anticipate, recognize and prevent deterioration that can lead to respiratory failure. This review aims to give a comprehensive overview of the effects of anaesthesia on respiration in children. It focuses on the impact of the different components of anaesthesia, patient positioning and procedure-related changes on respiratory physiology.
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Özcan, Cengiz; Juel, Knud; Flensted Lassen, Jens; von Kappelgaard, Lene Mia; Mortensen, Poul Erik; Gislason, Gunnar
Aim The Danish Heart Registry (DHR) seeks to monitor nationwide activity and quality of invasive diagnostic and treatment strategies in patients with ischemic heart disease as well as valvular heart disease and to provide data for research. Study population All adult (≥15 years) patients undergoing coronary angiography (CAG), percutaneous coronary intervention (PCI), coronary artery bypass grafting, and heart valve surgery performed across all Danish hospitals were included. Main variables The DHR contains a subset of the data stored in the Eastern and Western Denmark Heart Registries (EDHR and WDHR). For each type of procedure, up to 70 variables are registered in the DHR. Since 2010, the data quality protocol encompasses fulfillment of web-based validation rules of daily-submitted records and yearly approval of the data by the EDHR and WDHR. Descriptive data The data collection on procedure has been complete for PCI and surgery since 2000, and for CAG as of 2006. From 2000 to 2014, the number of CAG, PCI, and surgical procedures changed by 231%, 193%, and 99%, respectively. Until the end of 2014, a total of 357,476 CAG, 131,309 PCI, and 60,831 surgical procedures had been performed, corresponding to 249,445, 100,609, and 55,539 first-time patients, respectively. The DHR generally has a high level of completeness (1–missing) of each procedure (>90%) when compared to the National Patient Registry. Variables important for assessing the quality of care have a high level of completeness for surgery since 2000, and for CAG and PCI since 2010. Conclusion The DHR contains valuable data on cardiac invasive procedures, which makes it an important national monitoring and quality system and at the same time serves as a platform for research projects in the cardiovascular field. PMID:27822091
Jørgensen, Peter Holmberg; Lausten, Gunnar Schwarz; Pedersen, Alma B
Aim The aim of the database is to gather information about sarcomas treated in Denmark in order to continuously monitor and improve the quality of sarcoma treatment in a local, a national, and an international perspective. Study population Patients in Denmark diagnosed with a sarcoma, both skeletal and ekstraskeletal, are to be registered since 2009. Main variables The database contains information about appearance of symptoms; date of receiving referral to a sarcoma center; date of first visit; whether surgery has been performed elsewhere before referral, diagnosis, and treatment; tumor characteristics such as location, size, malignancy grade, and growth pattern; details on treatment (kind of surgery, amount of radiation therapy, type and duration of chemotherapy); complications of treatment; local recurrence and metastases; and comorbidity. In addition, several quality indicators are registered in order to measure the quality of care provided by the hospitals and make comparisons between hospitals and with international standards. Descriptive data Demographic patient-specific data such as age, sex, region of living, comorbidity, World Health Organization’s International Classification of Diseases – tenth edition codes and TNM Classification of Malignant Tumours, and date of death (after yearly coupling to the Danish Civil Registration System). Data quality and completeness are currently secured. Conclusion The Danish Sarcoma Database is population based and includes sarcomas occurring in Denmark since 2009. It is a valuable tool for monitoring sarcoma incidence and quality of treatment and its improvement, postoperative complications, and recurrence within 5 years follow-up. The database is also a valuable research tool to study the impact of technical and medical interventions on prognosis of sarcoma patients. PMID:27822116
Nixon, G; Brouillette, R
In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research. PMID:15923253
Introduction: Iliopsoas abscess is an uncommon condition in the paediatric population. The clinical presentation is variable and may be confused with other conditions such as septic arthritis, osteomyelitis and appendicular abscess. A suspicion of iliopsoas abscess requires a prompt diagnosis so that rapid management and treatment can be undertaken. Discussion: This case describes the presence of an iliopsoas abscess in a paediatric patient presenting to the emergency department within a rural community. Due to the variability in clinical presentation imaging studies are necessary to distinguish an iliopsoas abscess from other inflammatory processes. Ultrasound is often the modality of choice. Imaging guided percutaneous drainage and/or aspiration and the administration of intravenous antibiotics are minimally invasive modern techniques providing a safe treatment options in the presence of an iliopsoas abscess. Conclusion: Iliopsoas abscess is an uncommon condition in the paediatric population. Due to the variability in clinical presentation, imaging, and in particular, ultrasound play a vital role in the diagnosis of cases with a high suspicion of abscess formation. Accurate diagnosis leads to a rapid treatment plan, avoiding further insult.
Mammas, Ioannis N.; Spandidos, Demetrios A.
Hippocrates (Island of Kos, 460 B.C.-Larissa, 370 B.C.) is the founder of the most famous Medical School of the classical antiquity. In acknowledgement of his pioneering contribution to the new scientific field of Paediatric Virology, this article provides a systematic analysis of the Hippocratic Corpus, with particular focus on viral infections predominating in neonates and children. A mumps epidemic, affecting the island of Thasos in the 5th century B.C., is described in detail. ‘Herpes’, a medical term derived from the ancient Greek word ‘ἕρπειν’, meaning ‘to creep’ or ‘crawl’, is used to describe the spreading of cutaneous lesions in both childhood and adulthood. Cases of children with exanthema ‘resembling mosquito bites’ are presented in reference to varicella or smallpox infection. A variety of upper and lower respiratory tract viral infections are described with impressive accuracy, including rhinitis, pharyngitis, tonsillitis, laryngitis, bronchiolitis and bronchitis. The ‘cough of Perinthos’ epidemic, an influenza-like outbreak in the 5th century B.C., is also recorded and several cases complicated with pneumonia or fatal outcomes are discussed. Hippocrates, moreover, describes conjunctivitis, otitis, lymphadenitis, meningoencephalitis, febrile convulsions, gastroenteritis, hepatitis, poliomyelitis and skin warts, along with proposed treatment directions. Almost 2,400 years later, Hippocrates' systematic approach and methodical innovations can inspire paediatric trainees and future Paediatric Virology subspecialists. PMID:27446241
Rossin, Sara; Divisic, Antuan; De Gregorio, Alesandra; Agosto, Caterina; Catalano, Igor; Mazza, Alessandro; Sartori, Leonardo; Benini, Franca
We describe a case of a paediatric patient affected by mandibular fibrous dysplasia (FD) with severe and chronic pain who was successfully treated with zoledronic acid (ZOL): a third-generation bisphosphonate. Further research is needed to assess its safety and efficacy as a treatment option for FD in the paediatric population. PMID:27747122
Kneyber, Martin C J; van Heerde, Marc; Henneveld, Hetty Th
Paediatric shock is common. Hypovolaemic and septic shock are the main forms. Early and rapid results-oriented therapy of paediatric septic shock has a favourable effect on survival. There is an international guideline for the primary management of paediatric shock during the first hour after presentation of the patient. The goal of treatment is to prevent oxygen debt and consequently organ failure. The main symptoms of paediatric shock are tachycardia and reduced consciousness. In a child in shock, the clinical picture should be recognized within 15 minutes and an attempt should be made to reverse the situation by rapid fluid infusion. If the shock persists after 15 minutes, vasoactive medication should be given and the child should be transferred to a local paediatric intensive care unit. Intubation and mechanical ventilation are then also required.
Hansen, Ulla Darling; Gradel, Kim Oren; Larsen, Michael Due
The Danish Urogynaecological Database is established in order to ensure high quality of treatment for patients undergoing urogynecological surgery. The database contains details of all women in Denmark undergoing incontinence surgery or pelvic organ prolapse surgery amounting to ~5,200 procedures per year. The variables are collected along the course of treatment of the patient from the referral to a postoperative control. Main variables are prior obstetrical and gynecological history, symptoms, symptom-related quality of life, objective urogynecological findings, type of operation, complications if relevant, implants used if relevant, 3–6-month postoperative recording of symptoms, if any. A set of clinical quality indicators is being maintained by the steering committee for the database and is published in an annual report which also contains extensive descriptive statistics. The database has a completeness of over 90% of all urogynecological surgeries performed in Denmark. Some of the main variables have been validated using medical records as gold standard. The positive predictive value was above 90%. The data are used as a quality monitoring tool by the hospitals and in a number of scientific studies of specific urogynecological topics, broader epidemiological topics, and the use of patient reported outcome measures. PMID:27826217
Ovetchkine, Philippe; Rieder, Michael J
Azithromycin is an antibiotic that is commonly prescribed for upper and lower respiratory tract infections in children. While it has proven benefits, some concerns regarding azithromycin use have arisen in recent years. This practice point considers azithromycin therapy for acute respiratory infections in otherwise healthy children. Pharmacokinetics, spectrum of activity, the problem of resistant bacteria and clinical aspects are considered, along with recommendations for use and contraindications. Azithromycin should be avoided in patients with a significant risk of bacteremia. It is associated with pneumococcal resistance and, with stated exceptions, is generally not recommended for the treatment of acute pharyngitis, acute otitis media or pneumococcal community-acquired pneumonia in the paediatric population.
Transmission of infection in the paediatric office is of increasing concern. The present document discusses routes of transmission of infection and the principles of current infection control measures. Prevention includes appropriate office design and administrative policies, triage, routine practices for the care of all patients (eg, hand hygiene; use of gloves, masks, eye protection and gowns for specific procedures; adequate cleaning, disinfection and sterilization of surfaces and equipment including toys, and aseptic technique for invasive procedures), and additional precautions for specific infections. Personnel should be adequately immunized, and those infected should follow work-restriction policies. PMID:19412374
Vincent, Stephen J; Lee, Graham A
Acquired limbal stem cell deficiency (LSCD) describes a condition in which the corneal limbal stem cells are altered or destroyed, typically due to ocular trauma, chronic allergy or inflammation. Idiopathic LSCD is a term used to describe limbal stem cell failure in the absence of any identifiable causative factor. While several cases of adult-onset LSCD have been identified previously, this case report describes a rare presentation of bilateral asymmetric idiopathic paediatric limbal stem cell deficiency in a sixteen-year-old male with an otherwise unremarkable ocular history.
Branchard, Delphine; Tentillier, Éric; Gillet, Stéphane; Naud, Julien
In France, the organisation of aid involves the intervention of the emergency medical services (Samu), which coordinate the medical regulation platforms for site 15 and the mobile emergency and intensive care services (Smur). Since they were created, the Samu have been tirelessly adapting their response to the various characteristics of pre-hospital assignments. Pre- and inter-hospital paediatrics has seen the development of specialised teams with the aim of providing effective aid which is adapted to the youngest and most vulnerable patients.
The paediatric aspects of travel medicine can be complex, and individual advice is often required. Nonetheless, children are much more likely to acquire common infections than exotic tropical diseases whilst travelling. Important exceptions are malaria and tuberculosis, which are more frequent and severe in children. Overall, travellers' diarrhoea is the most common illness affecting travellers. This review discusses vaccines and medications that may be indicated for children who are travelling overseas. It focuses on immunizations that are given as part of the routine schedule, as well as those that are more specific to travel. Malaria and travellers' diarrhoea are also discussed. PMID:23163285
CONDÒ, R.; PERUGIA, C.; MATURO, P.; DOCIMO, R.
SUMMARY The Molar Incisor Hypomineralization (MIH) is a qualitative and quantitative defect of the enamel structure of the first permanent molars, which may vary from 1 to 4 with involvement of maxillary and jaw permanent incisors. Aim. Aim of this study is that to evaluate, among 1500 paediatric patients chosen at random aged between 0 and 14 years, afferent by the Paediatric Dentistry of the Azienda Ospedialiera Policlinico Tor Vergata of Rome from 1996 to 2011, the incidents and the prevalence of the MIH distribution, and furthermore to ascertain the possible relationship with the data described in the literature. Results and discussion. From the sample of 1500 paediatric patients, the number of those affections from MIH has turned out to be pairs to 110 (7.3%) aged between 4 and 15 years, and an average age equal to 9.7. The incidence of the hypoplastic defects is greater in the elements of the permanents series in which the functional class mainly interested is that of the first molars, with a percentage of 39.8%. Regarding the elements of the deciduous series affections from hypoplasia, they turn out to be in all in number of 20 represented in 80% of the cases from the seconds molars while in the remaining 20% of the cases the items involved are the central incisors. About the percentage of elements involved in the MIH: the molars, involved with a frequency of 56%, turn out to be more hit regarding incisors (44%). As reported in the literature, it can be asserted that the MIH can hit in equal measure both the male sex that feminine one. Conclusions. MIH represents a condition quite frequent in the paediatric population. In managing this anomaly takes an essential role in the early diagnosis and in the differential one. The study done underlined the importance of a correct application of the therapeutic protocol which, starting from a careful diagnosis and articulating themselves in the execution of preventive treatments and in severe cases restorative and
Groenvold, Mogens; Adsersen, Mathilde; Hansen, Maiken Bang
Aims The aim of the Danish Palliative Care Database (DPD) is to monitor, evaluate, and improve the clinical quality of specialized palliative care (SPC) (ie, the activity of hospital-based palliative care teams/departments and hospices) in Denmark. Study population The study population is all patients in Denmark referred to and/or in contact with SPC after January 1, 2010. Main variables The main variables in DPD are data about referral for patients admitted and not admitted to SPC, type of the first SPC contact, clinical and sociodemographic factors, multidisciplinary conference, and the patient-reported European Organisation for Research and Treatment of Cancer Quality of Life Questionaire-Core-15-Palliative Care questionnaire, assessing health-related quality of life. The data support the estimation of currently five quality of care indicators, ie, the proportions of 1) referred and eligible patients who were actually admitted to SPC, 2) patients who waited <10 days before admission to SPC, 3) patients who died from cancer and who obtained contact with SPC, 4) patients who were screened with European Organisation for Research and Treatment of Cancer Quality of Life Questionaire-Core-15-Palliative Care at admission to SPC, and 5) patients who were discussed at a multidisciplinary conference. Descriptive data In 2014, all 43 SPC units in Denmark reported their data to DPD, and all 9,434 cancer patients (100%) referred to SPC were registered in DPD. In total, 41,104 unique cancer patients were registered in DPD during the 5 years 2010–2014. Of those registered, 96% had cancer. Conclusion DPD is a national clinical quality database for SPC having clinically relevant variables and high data and patient completeness. PMID:27822111
Boerma, Ragna S; Boender, T Sonia; van Hensbroek, Michael Boele; Rinke de Wit, Tobias F; Sigaloff, Kim CE
Introduction As access to prevention of mother-to-child transmission (PMTCT) efforts has increased, the total number of children being born with HIV has significantly decreased. However, those children who do become infected after PMTCT failure are at particular risk of HIV drug resistance, selected by exposure to maternal or paediatric antiretroviral drugs used before, during or after birth. As a consequence, the response to antiretroviral therapy (ART) in these children may be compromised, particularly when non-nucleoside reverse transcriptase inhibitors (NNRTIs) are used as part of the first-line regimen. We review evidence guiding choices of first- and second-line ART. Discussion Children generally respond relatively well to ART. Clinical trials show the superiority of protease inhibitor (PI)- over NNRTI-based treatment in young children, but observational reports of NNRTI-containing regimens are usually favourable as well. This is reassuring as national guidelines often still recommend the use of NNRTI-based treatment for PMTCT-unexposed young children, due to the higher costs of PIs. After failure of NNRTI-based, first-line treatment, the rate of acquired drug resistance is high, but HIV may well be suppressed by PIs in second-line ART. By contrast, there are currently no adequate alternatives in resource-limited settings (RLS) for children failing either first- or second-line, PI-containing regimens. Conclusions Affordable salvage treatment options for children in RLS are urgently needed. PMID:26639116
Marreiros, Humberto Filipe; Loff, Clara; Calado, Eulalia
The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. Objective To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis. Methods Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury. Results Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB. PMID:22330186
Knight, Stephen P
The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies – body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior–posterior (AP)/posterior–anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes.
Knight, Stephen P
The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies – body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior–posterior (AP)/posterior–anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes. PMID:26229655
Biopharmaceutical methods are routinely used in the design of medicines to predict in vivo absorption and hence guide the development of new products. Differences in anatomy and physiology of paediatric patients require adaptation of existing biopharmaceutical methods to ensure that in vivo predictions are relevant for this population. The biopharmaceutics classification system is a tool used in drug development to guide formulation selection and manufacture from early clinical studies through to product launch. The applicability of the biopharmaceutics system to paediatric product development has yet to be explored; this note brings together some key issues in direct extrapolation from adults into paediatric populations.
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Cornwall, Jon; Roy, Melyssa
The development of verbal communication skills is an important aspect of medical education as accurate assessment in part relies on effectively obtaining information from patients. When assessing children of different cultural or ethnic backgrounds, young medics may find effective verbal communication difficult because they lack understanding about what children are really like. Animal noises are a likely tool with which to successfully engage with young children. However, these differ by culture and it is unclear whether young New Zealand medical students will be adept at effectively engaging and communicating with foreign children via this mode of communication. We therefore assessed whether medical students in our country were able to accurately reproduce animal noises from different cultures. Six current medical students from New Zealand (with English as their first language) were assessed on their ability to reproduce animal noises from three different foreign languages: Dutch, Arabic and Danish. The animals selected were duck, cow, dog, frog, pig and sheep. Students were played recordings of the foreign-language animal noises, and were then rated on a scale of 1-5 (1 = poor, 5 = outstanding) on their ability to reproduce the noise. Arabic animal noises were reproduced more convincingly than those in the other languages (mean score: 3.8), of which animal noises in Danish were worst (mean score: 3.1). Perhaps unsurprisingly, sheep noises were reproduced best (mean score: 4.7), whereas pig noises were the least convincing (mean score: 2.2). Findings indicate that New Zealand medical students are likely to be better than average at reproducing animal noises in the languages examined, and are perhaps socially and genetically predisposed to replicating sheep noises successfully. They are therefore likely to make good paediatric registrars and fabulous au pairs. The study highlights the more serious issues of multicultural understanding and tolerance of other
In this paper, I shall discuss Danish perspectives on nature, showing the interdependence of conceptions of "nature" and "nationhood" in the formations of a particular cultural community. Nature, thus construed, is never innocent of culture and cannot therefore simply be "restored" to some pristine, pre-lapsarian…
Paget, W John; Balderston, Catherine; Casas, Inmaculada; Donker, Gé; Edelman, Laurel; Fleming, Douglas; Larrauri, Amparo; Meijer, Adam; Puzelli, Simona; Rizzo, Caterina; Simonsen, Lone
The European Paediatric Influenza Analysis (EPIA) project is a multi-country project that was created to collect, analyse and present data regarding the paediatric influenza burden in European countries, with the purpose of providing the necessary information to make evidence-based decisions regarding influenza immunisation recommendations for children. The initial approach taken is based on existing weekly virological and age-specific influenza-like illness (ILI) data from surveillance networks across Europe. We use a multiple regression model guided by longitudinal weekly patterns of influenza virus to attribute the weekly ILI consultation incidence pattern to each influenza (sub)type, while controlling for the effect of respiratory syncytial virus (RSV) epidemics. Modelling the ILI consultation incidence during 2002/2003-2008 revealed that influenza infections that presented for medical attention as ILI affected between 0.3% and 9.8% of children aged 0-4 and 5-14 years in England, Italy, the Netherlands and Spain in an average season. With the exception of Spain, these rates were always higher in children aged 0-4 years. Across the six seasons analysed (five seasons were analysed from the Italian data), the model attributed 47-83% of the ILI burden in primary care to influenza virus infection in the various countries, with the A(H3N2) virus playing the most important role, followed by influenza viruses B and A(H1N1). National season averages from the four countries studied indicated that between 0.4% and 18% of children consulted a physician for ILI, with the percentage depending on the country and health care system. Influenza virus infections explained the majority of paediatric ILI consultations in all countries. The next step will be to apply the EPIA modelling approach to severe outcomes indicators (i.e. hospitalisations and mortality data) to generate a complete range of mild and severe influenza burden estimates needed for decision making concerning
Williams, Susanne K; Ellis, Lloyd A; Williams, Gigi
In 2004, traditional clinical photography services at the Educational Resource Centre were extended using new technology. This paper describes the establishment of a 3D digital imaging system in a paediatric setting at the Royal Children's Hospital, Melbourne.
Subtil, João; Rodrigues, João Carlos; Reis, Lúcia; Freitas, Luís; Filipe, Joana; Santos, Alberto; Macor, Carlos; Duarte, Aida; Jordao, Luisa
Adenoids play a key role in both respiratory and ear infection in children. It has also been shown that adenoidectomy improves these symptoms in this population. The main goal of the present study was to evaluate adenoid bacterial colonization and document a possible relation with infectious respiratory disease. A prospective observational study was designed to evaluate the proposed hypothesis in a paediatric population submitted to adenoidectomy by either infectious or non-infectious indications and compare these two cohorts. A total of 62 patients with ages ranging from 1 to 12 years old were enrolled in the study. Adenoid surface, adenoid core and middle meatus microbiota were compared. A close association between adenoid colonization and nasal infection was found, supporting that adenoids may function as bacterial reservoir for upper airway infection. The obtained results also contribute to explain the success of adenoidectomy in patients with infectious indications.
Children's attendance at emergency departments (EDs) is increasing every year, yet many children present with minor, self-limiting illnesses that could be managed at home. In light of Williams et al (2009) suggestion that healthcare professionals should improve the care available to patients at point of contact rather than try to change their health-seeking behaviours, this article describes how Tameside and Glossop Primary Care Trust has developed an advanced paediatric nurse practitioner (APNP) service in the ED to improve the care of children, and to reduce the number of admissions. The APNPs treat children in the ED then divert them to more appropriate services where support is given to the families to care for their children at home. The role contributes to meeting ED clinical quality indicators, frees up medical staff to deal with more seriously ill patients, and makes financial savings for the trust.
Baird, G; Hall, D M
There is little agreement about what constitutes good developmental paediatric practice at the level of primary care. Many of the available screening tests are intrinsically unsatisfactory or badly performed, but screening is only a small part of developmental paediatrics. Every primary care doctor should be familiar with the scientific basis of the subject even if a decision is made not to embark on a formal screening programme. PMID:2412629
Julliand, Sébastien; Lodé, Noëlla
The paediatric mobile emergency and intensive care service care teams have expertise in taking care of children in life-threatening circumstances. At the Robert-Debré Hospital in Paris, the paediatric Smur is multi-skilled, specialising particularly in transporting neonates and infants with severe cardiac or respiratory difficulties. The pathologies handled are very varied and include both neonatal pathologies and trauma pathologies in older children.
Reid, Julia E.; Reem, Rachel E.; Aylward, Shawn C.; Rogers, David L.
ABSTRACT The purpose of this study was to report the incidence and describe the characteristics of sixth cranial nerve (CN VI) palsy in paediatric patients with intracranial hypertension (IH). A retrospective chart review of central Ohio children diagnosed with IH over the 3-year period from 2010 to 2013 was conducted. IH without identifiable cause was defined as idiopathic intracranial hypertension (IIH), whereas IH with identifiable pathologic aetiology was deemed secondary intracranial hypertension (SIH). A subset of patients with CN VI palsy was identified. Data collected included patient age, gender, past medical history, aetiology of SIH, ophthalmic examination, lumbar puncture results, neuroimaging results, and response to treatment. Seventy-eight children with intracranial hypertension were included in the study. Nine (11.5%) children (four males, five females; median age 14, range: 3–18) were found to have a unilateral (n = 2) or bilateral (n = 7) CN VI palsy. Five children had IIH; the remaining four had SIH from cerebral venous sinus thrombosis (n = 2) and infection (n = 2). The mean lumbar puncture opening pressure for the nine patients with CN VI palsy was 40 cm H2O (range: 21–65 cm H2O). Papilloedema was present in 8/9 (89%) patients. One patient required a lumboperitoneal shunt, and two others required optic nerve sheath fenestrations in addition to medical management. All cases of CN VI palsy resolved with treatment. In our primary service area, the incidence of CN VI palsy is approximately 12% among paediatric IH patients. The majority of cases with CN VI palsy presented with papilloedema and all cases resolved with treatment of intracranial hypertension. PMID:27928378
Lepola, Pirkko; Needham, Allison; Mendum, Jo; Sallabank, Peter; Neubauer, David; de Wildt, Saskia
Objective Paediatric clinical trials are often conducted as multinational trials. Informed consent or assent is part of the ethics committee approval for clinical trials. The consent requirements vary between countries due to national laws and regulations, which are not harmonised in Europe. These discrepancies can present challenges for paediatric clinical trials. The aim of this study was to assemble these consent and assent requirements across the European Economic Area. The collated national requirements have not been publicly available before, despite a real need for this data. Methods National consent and assent requirements for paediatric clinical trials were analysed and collated for 25 European Union Member States and 2 European Free Trade Association countries until the end of 2014. The data were retrieved from existing databases and through communication with the competent authorities and selected ethics committees. Results from a literature search for international or national guidelines, declarations and conventions and academic societies' publications served as comparison material. Results Consent and assent requirements are heterogeneous across these countries. We compiled our findings in ‘The Informed Consent and Assent Tool Kit’, a table including 27 national consent and assent requirements listed by individual country. Conclusions Wide variation in paediatric consents and assents presents challenges for multinational paediatric trials in Europe. The toolkit is available for all those involved in paediatric clinical trials and ethics committees, providing a new platform for proactive feedback on informed consent requirements, and may finally lead to a needed harmonisation process, including uniform standards accepted across Europe. PMID:27226526
Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan
Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.
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Christensen, P B; Krarup, H B; Niesters, H G; Norder, H; Georgsen, J
In order to determine the prevalence and incidence of bloodborne viral infections among prisoners, we conducted a prospective study in a Danish medium security prison for males. The prisoners were offered an interview and blood test for hepatitis and human immunodeficiency virus HIV at inclusion as well as at release from prison or end of study. Of 403 prisoners available 325 (79%) participated in the initial survey and for 142 (44%) a follow-up test was available. 43% (140/325) of the participants were injecting drug users (IDUs) of whom 64% were positive for hepatitis B (HBV) and 87% for hepatitis C (HCV) markers. No cases of HIV or human T lymphotropic virus (HTLV) were found. 32% of all prisoners could transmit HBV and/or HCV by blood contact. 70% of IDUs had shared injecting equipment, and 60% had injected inside prison. Only 2% of IDUs were vaccinated against HBV. Duration of injecting drug use, numbers of imprisonments, and injecting in prison were independently and positively associated with the presence of HBV antibodies among IDUs by logistic regression analysis. The HBV incidence was 16/100 PY (95% CI: 2-56/100 PY) and the HCV incidence 25/100 PY (1-140) among injecting drug users (IDUs). We conclude that IDUs in prison have an incidence of hepatitis B and C 100 times higher than reported in the general Danish population. They should be vaccinated against hepatitis B and new initiatives to stop sharing of injecting equipment in and outside prison is urgently needed.
Aloi, Marina; Nuti, Federica; Stronati, Laura; Cucchiara, Salvatore
IBD includes two classic entities, Crohn's disease and ulcerative colitis, and a third undetermined form (IBD-U), characterized by a chronic relapsing course resulting in a high rate of morbidity and impaired quality of life. Children with IBD are vulnerable in terms of growth failure, malnutrition and emotional effects. The aims of therapy have now transitioned from symptomatic control to the achievement of mucosal healing and deep remission. This type of therapy has been made possible by the advent of disease-modifying drugs, such as biologic agents, which are capable of interrupting the inflammatory cascade underlying IBD. Biologic agents are generally administered in patients who are refractory to conventional therapies. However, there is growing support that such agents could be used in the initial phases of the disease, typically in paediatric patients, to interrupt and cease the inflammatory process. Until several years ago, most therapeutic programmes in paediatric patients with IBD were borrowed from adult trials, whereas paediatric studies were often retrospective and uncontrolled. However, guidelines on therapeutic management of paediatric IBD and controlled, prospective, randomized trials including children with IBD have now been published. Here, the current knowledge concerning treatment options for children with IBD are reported. We also highlight the effectiveness and safety of new therapeutic advances in these paediatric patients.
Bölling, T; Hardes, J; Dirksen, U
The management of bone tumours in paediatric oncology requires careful multidisciplinary planning due to the need for multimodal therapy approaches. The non-specific symptoms often lead to a delayed definitive diagnosis of a bone tumour. Imaging procedures are of major importance for an individualised and optimised treatment planning. They have to be carried out before any surgery, including biopsies. The introduction of multi-agent chemotherapy has led to a significant improvement in survival rates in patients suffering from Ewing's sarcomas and osteosarcomas. However, local therapy still remains indispensable in order to achieve long-term survival. For osteosarcoma, surgery remains the only adequate local therapy modality. Radiotherapy may be considered if surgery is not feasible. In these cases, high radiation doses need to be applied. The choice for local therapy modality is not as clear in patients with Ewing's sarcoma. Today, surgery is often preferred if a wide or at least marginal resection can be carried out. Additional radiotherapy is advised in patients with marginal/intralesional resection or poor histological response to induction chemotherapy. Definitive radiotherapy is recommended for inoperable lesions. In the future, new radiotherapy approaches, such as intensity-modulated radiotherapy or proton therapy, may yield better results with minor risks of late effects.
McKenna, K; Collier, J; Hewitt, M; Blake, H
This study investigated parents' information needs and involvement in decision-making processes affecting the care of children diagnosed with cancer. Interviews and questionnaires were used to assess parental satisfaction in 50 mothers and 16 fathers responsible for 58 children in an English Paediatric Oncology Unit. Parents reported that doctors contributed almost twice as much to the decision-making process as they did, but parental satisfaction was positively correlated with the amount of information provided when giving informed consent. Satisfaction about their involvement in this process relied heavily upon the level of support received from others. Parents consenting to their child's involvement in non-randomised trials perceived themselves to be under greater pressure from others during the decision-making process while those whose children were further along the treatment trajectory were more uncertain about decisions previously made. Findings indicate that the accessibility, support, information and degree of control afforded to parents by healthcare professionals impacts upon their satisfaction with both the decision-making process and their confidence in the decisions thus made. Information and support tailored to parents' specific needs may therefore enhance satisfaction with clinical decision making and reassure parents about decisions made in the long-term interest of their child's health.
Arlachov, Y; Ganatra, R H
Objectives In this article we will give a comprehensive literature review on sedation/general anaesthesia (S/GA) and discuss the international variations in practice and options available for S/GA for imaging children. Methods The key articles were obtained primarily from PubMed, MEDLINE, ERIC, NHS Evidence and The Cochrane Library. Results Recently, paediatric radiology has seen a surge of diagnostic and therapeutic procedures, some of which require children to be still and compliant for up to 1 h. It is difficult and sometimes even impossible to obtain quick and high-quality images without employing sedating techniques in certain children. As with any medical procedure, S/GA in radiological practice is not without risks and can have potentially disastrous consequences if mismanaged. In order to reduce any complications and practice safety in radiological units, it is imperative to carry out pre-sedation assessments of children, obtain parental/guardian consent, monitor them closely before, during and after the procedure and have adequate equipment, a safe environment and a well-trained personnel. Conclusion Although the S/GA techniques, sedative drugs and personnel involved vary from country to country, the ultimate goal of S/GA in radiology remains the same; namely, to provide safety and comfort for the patients. Advances in knowledge Imaging children under general anaesthesia is becoming routine and preferred by operators because it ensures patient conformity and provides a more controlled environment. PMID:22898157
Terzis, Julia K; Olivares, Fatima S
Ninety-two children, the entire series of paediatric facial reanimation by a single surgeon over thirty years, are presented. The objective is to analyse the incidence and value of secondary revisions for functional and aesthetic refinements following the two main stages of reanimation. The reconstructive strategy varied according to the denervation time, the aetiology, and whether the paralysis was uni- or bilateral, complete or partial. Irrespective of these variables, 89% of the patients required secondary surgery. Post-operative videos were available in seventy-two cases. Four independent observers graded patients' videos using a scale from poor to excellent. The effect of diverse secondary procedures was measured computing a mean-percent-gain score. Statistical differences between treatment groups means were tested by the t-test and one-way ANOVA. Two-thirds of the corrective and ancillary techniques utilized granted significantly higher mean-scores post-secondary surgery. A comparison of pre- and post-operative data found valuable improvements in all three facial zones after secondary surgery. In conclusion, inherent to dynamic procedures is the need for secondary revisions. Secondary surgery builds in the potential of reanimation surgery, effectively augmenting functional faculties and aesthesis.
Amputation of a limb is always perceived as a catastrophe. The principles underlying creation of a stump adapted to modern prosthetic fittings must be fully understood and the patient managed by a multidisciplinary team. In paediatric patients, preserving residual limb length is a crucial point that should be assessed according to the expected growth potential. Advances in prosthetic fittings have led to changes in the overall concept of socket design, which seeks to achieve three objectives: to maximise the weight-bearing surface area, to eliminate friction of the skin on the socket, and to eliminate lever-arm effects. The introduction on the market of new materials has contributed substantially to advances in prosthetic fittings. These advances require the use of new criteria for stump quality and optimisation, which exert a considerable influence on prosthesis function. Prosthetic fitting and specific management of psychological and social problems are provided during an inpatient stay in a physical medicine department, by a team of physicians, other healthcare professionals, social workers, and educators. Three-dimensional imaging and gait analysis provide valuable information.
The progress in organ transplantation has led to a rise in the demand for organs. Paediatric intensive care units are the main source for obtaining organs. Every "brain dead" patient should be regarded as a potential donor. General contraindications to organ donation are: systemic viral or bacterial infections and extra-cerebral malignancy. They are also organ-specific contraindications. The criteria for the diagnosis of "brain death" have been widely studied and defined. Care of brain dead donors consists of maintenance of cardiac, pulmonary and renal function. Monitoring requires control of central venous and arterial blood pressure, core temperature, urine flow, heart rate and biological data on both urine and blood. A 5% dextrose infusion is maintained with added potassium and sodium chloride according to the urine flow, detectable water loss, and blood and urine composition. Hypotension due to hypovolaemia requires immediate treatment with blood, colloid or albumin infusion. Persistent hypotension with cardiac pump failure is treated with inotropic agents: dopamine and/or dobutamine. Raised urine flow due to diabetes insipidus requires desmopressin (dDAVP). Progress in organ collection requires the consent of the parents and highly motivated medical teams.
Miranda, Joana O; Costa, Liane; Rodrigues, Esmeralda; Teles, Elisa L; Baptista, Maria J; Areias, José C
Dilated cardiomyopathy is the most common form of cardiomyopathy in the paediatric population and an important cause of heart transplantation in children. The clinical profile and course of dilated cardiomyopathy in children have been poorly characterised. A retrospective review of 61 patients (37 female; 24 male) diagnosed with dilated cardiomyopathy from January, 2005 to June, 2012 at a single institution was performed. The median age at diagnosis was 15 months. Heart failure was present in 83.6% of patients and 44.3% required intensive care. The most prevalent causes were idiopathic (47.5%), viral myocarditis (18.0%) and inherited metabolic diseases (11.5%). In viral myocarditis, Parvovirus B19 was the most common identified agent, in concurrence with the increasing incidence documented recently. Inherited metabolic diseases were responsible for 11.5% of dilated cardiomyopathy cases compared with the 4-6% described in the literature, which reinforces the importance of considering this aetiology in differential diagnosis of paediatric dilated cardiomyopathy. The overall mortality rate was 16.1% and five patients underwent heart transplantation. In our series, age at diagnosis and aetiology were the most important prognosis factors. We report no mortality in the five patients who underwent heart transplantation, after 2 years of follow-up.
... medicines to treat HIV (called antiretroviral therapy, or ART) the right way, every day. They can keep ... to treat HIV infection (called antiretroviral therapy, or ART) the right way, every day and his or ...
In 1987, 20,830 legal abortions were performed in Denmark. 2,845 involved women below the age of 20, and 532 involved women terminating pregnancy after the 12th week. Danish law permits all of its female citizens to have an abortion free-of-charge before the 12th week of pregnancy. After the 12th week, the abortion must be applied for through a committee of 3 members, and all counties in Denmark have a committee. It is felt in Denmark that a woman has a right to an abortion if she decides to have one. It she makes that choice, doctors and nurses are supportive. Since 1970, sex education has been mandatory in Danish schools. Teachers often collaborate closely with school doctors and nurses in this education. All counties are required to have at least 1 clinic that provides contraceptive counselling. It was recently found that the lowest number of pregnancies among teenaged girls was found in a county in Jutland where all 9th grade students visit the county clinic to learn about contraceptives, pregnancy, and abortion. Within 1 year after Copenhagen had adopted this practice, the number of abortions among teenagers declined by 20%. One fourth of all pharmacies also collaborate with schools to promote sex education, instructing students about contraceptives and pregnancy tests. The Danish Family Planning Association has produced a film on abortion, and plans to produce videos on abortion for use in schools. The organization also holds training programs for health care personnel on contraception, pregnancy, and abortion. By means of the practices described above, it is hoped that the number of abortions and unwanted pregnancies in Denmark will be reduced.
Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic; Overgaard, Søren
Aim of database The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark. Study population The DHR is a Danish nationwide arthroplasty register established in January 1995. All Danish orthopedic departments – both public and private – report to the register, and registration is compulsory. Main variables The main variables in the register include civil registration number, indication for primary and revision surgery, operation date and side, and postoperative complications. Completeness of primary and revision surgery is evaluated annually and validation of a number of variables has been carried out. Descriptive data A total of 139,525 primary THAs and 22,118 revisions have been registered in the DHR between January 1, 1995 and December 31, 2014. Since 1995, completeness of procedure registration has been high, being 97.8% and 92.0% in 2014 for primary THAs and revisions, respectively. Several risk factors, such as comorbidity, age, specific primary diagnosis and fixation types for failure of primary THAs, and postoperative complications, have been identified through the DHR. Approximately 9,000 primary THAs and 1,500 revisions are reported to the register annually. Conclusion The DHR is important for monitoring and improvement of treatment with THA and is a valuable tool for research in THA surgery due to the high quality of prospective collected data with long-term follow-up and high completeness. The register can be used for population-based epidemiology studies of THA surgery and can be linked to a range of other national databases. PMID:27822092
Andropoulos, Dean B
The significant increase in complex anaesthetic care for infants, children, adolescents, and adults with CHD has given rise to specialized fellowship training programs. Specialized paediatric cardiac anaesthesia training for residents and fellows has advanced significantly since the 1970's, when there a handful of programs. With the advent of formal paediatric anaesthesia fellowship programs in the U.S., more specialized training became available in the 1990's and early 2000's. In the past decade, increasing numbers of second year advanced fellowships in paediatric cardiac anaesthesia have been organized; today in North America there are 18 programs with 25 positions. Standardized recommendations for case numbers and curriculum have been devised and are widely available via journal publications.
Evans, Subhadra; Tsao, Jennie C I; Zeltzer, Lonnie K
Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Although research is limited for paediatric pain, CAM interventions receiving the most empirical attention include hypnotherapy, acupuncture and music therapy. Evidence also exists for the therapeutic benefits of yoga, massage, humor therapy and the use of certain biological based therapies.
Ultrasonography (US) is the mainstay of paediatric Radiology. This review aims at revisiting basic US principles, to list specific needs throughout childhood, and to discuss the application of new and modern US methods. The various sections elude to basic US physics, technical requisites and tips for handling, diagnostically valuable applications of modern techniques, and how to properly address hazards, risks and limitations. In conclusion, US holds vast potential throughout childhood in almost all body regions and many childhood specific queries - helping to reduce the need for or to optimize more invasive or irradiating imaging. Make the most of US and offerings a dedicated paediatric US service throughout the day, the week and the year thus is and will stay a major task of Paediatric Radiology.
Woo, Patricia; Colbert, Robert A.
The evidence so far suggests that the paediatric inflammatory diseases encountered in rheumatology practice may be largely genetic in origin, where common single nucleotide polymorphisms (SNPs) in multiple genes contribute to risk, with real but variable environmental components. As far as genetic susceptibility to common paediatric rheumatic diseases is concerned, only juvenile idiopathic arthritis (JIA) has been investigated in any substantial way so far. This article discusses susceptibility for different types of JIA, the different methods used and their advantages and disadvantages. The genetic code is also modifiable by epigenetic mechanisms and examples of these in immunity and rheumatoid arthritis are given to indicate another area of research in the elucidation of the genetics of paediatric rheumatic diseases. PMID:19853825
OBJECTIVE: To improve efficacy of and compliance with therapy for tuberculosis in children. OPTIONS: Short-course (6-month) multi-drug therapy, either non-supervised or directly supervised, versus long-course (more than 6-month) multi-drug therapy. OUTCOMES: Success (more than 90% of cases cured without relapse or serious side effects), development of drug resistance and compliance with treatment. EVIDENCE: Review of published reports of efficacy trials of tuberculosis therapy in children, side effects and compliance studies; consensus of expert opinion. VALUES: Values were assigned to the evidence by the Infectious Disease and Immunization Committee of the Canadian Paediatric Society through review of the data and consensus. BENEFITS, HARMS AND COSTS: Improved efficacy and compliance with short-course protocols should lower the rate of treatment failure among children in Canada and the cost of tuberculosis care. RECOMMENDATIONS: A short-course (6-month) protocol of four drugs for the first 2 months and two drugs for the subsequent 4 months is recommended to treat pulmonary tuberculosis or extrapulmonary disease causing lymphadenopathy. Tuberculous meningitis, disease involving bones and joints and tuberculosis with HIV infection require longer courses of treatment. Asymptomatic tuberculosis should be treated with daily doses of isoniazid for 9 months. Intermittent directly observed therapy is recommended if compliance cannot be ensured. Routine liver function testing is not recommended for prepubescent children taking isoniazid, but monthly assessment for clinical symptoms and periodic liver function evaluation is advised in adolescent women, especially post partum. VALIDATION: This report was reviewed by the directors of the Canadian Paediatric Society, the Hepatitis and Special Pathogens Division of the Laboratory Centre for Disease Control and the Canadian Thoracic Society. The recommendations are similar to those of the American Academy of Pediatrics. SPONSOR
Van Riet-Nales, Diana A; Kozarewicz, Piotr; Aylward, Brian; de Vries, Rutger; Egberts, Toine C G; Rademaker, Carin M A; Schobben, Alfred F A M
The availability of licensed paediatric drugs is lagging behind those for adults, and there is a lack of safe formulations in suitable doses that children are able and willing to take. As a consequence, children are commonly treated with off-label or unlicensed drugs. As off-label and unlicensed drug use are associated with a greater risk for harm than on-label drug use, a range of global initiatives have been developed to realize "better" medicines for children. This review describes the challenges and achievements of the European Union to realize this goal, with a focus on paediatric drug development and formulation design. In 2007, a European Paediatric Regulation was installed enforcing companies to consider children in the early development of drugs with a new drug substance, for a new indication or with a new route of administration. The Regulation, e.g. requires companies to develop a paediatric investigation plan discussing the proposed clinical trials in children of different ages and the formulations for future marketing. Since 2013, the pharmaceutical design of any newly marketed paediatric drug should comply with the "Guideline on the Pharmaceutical Development of Medicines for Paediatric Use." Companies should, e.g. justify the route of administration, dosage form, formulation characteristics, safety of excipients, dosing frequency, container closure system, administration device, patient acceptability and user information. In this review, the guideline's key aspects are discussed with a focus on novel formulations such as mini-tablets and orodispersible films, excipients with a potential risk for harm such as azo dyes and adequate user instructions.
van Riet – Nales, Diana A.; Römkens, Erwin G. A. W.; Saint-Raymond, Agnes; Kozarewicz, Piotr; Schobben, Alfred F. A. M.; Egberts, Toine C. G.; Rademaker, Carin M. A.
Introduction Pharmaceutical industry is no longer allowed to develop new medicines for use in adults only, as the 2007 Paediatric Regulation requires children to be considered also. The plans for such paediatric development called Paediatric Investigation Plans (PIPs) are subject to agreement by the European Medicines Agency (EMA) and its Paediatric Committee (PDCO). The aim of this study was to evaluate the key characteristics of oral paediatric medicines in the PIPs and the changes implemented as a result of the EMA/PDCO review. Methods All PIPs agreed by 31 December 2011 were identified through a proprietary EMA-database. PIPs were included if they contained an agreed proposal to develop an oral medicine for children 0 to 11 years. Information on the therapeutic area (EMA classification system); target age range (as defined by industry) and pharmaceutical characteristics (active substance, dosage form(s) as listed in the PIP, strength of each dosage form, excipients in each strength of each dosage form) was extracted from the EMA website or the EMA/PDCO assessment reports. Results A hundred and fifty PIPs were included corresponding to 16 therapeutic areas and 220 oral dosage forms in 431 strengths/compositions. Eighty-two PIPs (37%) included tablets, 44 (20%) liquids and 35 (16%) dosage forms with a specific composition/strength that were stored as a solid but swallowed as a liquid e.g. dispersible tablets. The EMA/PDCO review resulted in an increase of 13 (207 to 220) oral paediatric dosage forms and 44 (387 to 431) dosage forms with a specific composition/strength. For many PIPs, the target age range was widened and the excipient composition and usability aspects modified. Conclusion The EMA/PDCO review realized an increase in the number of requirements for the development of oral dosage forms and a larger increase in the number of dosage forms with a specific composition/strength, both targeting younger children. Changes to their pharmaceutical design were
OBJECTIVE: To assist physicians in providing guidance to parents regarding neonatal circumcision. OPTIONS: Whether to recommend the routine circumcision of newborn male infants. OUTCOMES: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases. EVIDENCE: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed. VALIDATION: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication. SPONSOR: This is an official statement of the Canadian Paediatric Society. No external
van der Zanden, Tjitske M; de Wildt, Saskia N; Liem, Yves; Offringa, Martin; de Hoog, Matthijs
As many drugs in paediatrics are used off-label, prescribers face a lack of evidence-based dosing guidelines. A Dutch framework was developed to provide dosing guidelines based on best available evidence from registration data, investigator-initiated research, professional guidelines, clinical experience and consensus. This has clarified the scientific grounds of drug use for children and encouraged uniformity in prescribing habits in the Netherlands. The developed framework and the current content of the Dutch Paediatric Formulary could be used as basis for similar initiatives worldwide, preferably in a concerted effort to ultimately provide children with effective and safe drug therapy.
The Department of Paediatrics at John Hunter Hospital, Newcastle, was invited to represent paediatric services in the New South Wales Department of Health's customer focus initiative. Six health care organisations were selected to be pathfinder centres in customer focus under this initiative. The aim of these pathfinder centres was to trial customer-oriented projects that would be applicable to other health care organisations. This article will discuss the process through which three customer-focused projects were identified and implemented, and discuss some of the outcomes of these projects.
Purchase, Susan; Cunningham, Jayne; Esser, Monika; Skinner, Donald
The burden of paediatric HIV in South Africa is extremely high. Antiretrovirals (ARVs) are now widely accessible in the country and the clinical emphasis has shifted from initiation of treatment to retention in care. This study describes the cumulative virological failure rate amongst children on ARVs in a peri-urban clinic, and suggests ways in which clinics and partners could improve treatment outcomes. The study was conducted by the non-profit organisation HOPE Cape Town Association. A retrospective file audit determined the cumulative virological failure rate, that is, the sum of all children with a viral load >1000 copies/ml, children on monotherapy, children who had stopped treatment, children lost to follow-up (LTFU) and children who had died. Interviews were conducted with a purposive sample of 12 staff members and a random sample of 21 caregivers and 4 children attending care. Cumulative virological failure rate was 42%, with most of those children having been LTFU. Both staff and caregivers consistently identified pharmacy queues, ongoing stigma and unpalatable ARVs as barriers to adherence. Staff suggestions included use of adherence aids, and better education and support groups for caregivers. Caregivers also requested support groups, as well as "same day" appointments for caregivers and children, but rejected the idea of home visits. Simple, acceptable and cost-effective strategies exist whereby clinics and their partners could significantly reduce the cumulative virological failure rate in paediatric ARV clinics. These include actively tracing defaulters, improving education, providing support groups, and campaigning for palatable ARV formulations.
Report from The International Society for Nomenclature of Paediatric and Congenital Heart Disease: cardiovascular catheterisation for congenital and paediatric cardiac disease (Part 1 - Procedural nomenclature).
Bergersen, Lisa; Everett, Allen Dale; Giroud, Jorge Manuel; Martin, Gerard R; Franklin, Rodney Cyril George; Béland, Marie Josée; Krogmann, Otto Nils; Aiello, Vera Demarchi; Colan, Steven D; Elliott, Martin J; Gaynor, J William; Kurosawa, Hiromi; Maruszewski, Bohdan; Stellin, Giovanni; Tchervenkov, Christo I; Walters, Henry Lane; Weinberg, Paul; Jacobs, Jeffrey Phillip
Interventional cardiology for paediatric and congenital cardiac disease is a relatively young and rapidly evolving field. As the profession begins to establish multi-institutional databases, a universal system of nomenclature is necessary for the field of interventional cardiology for paediatric and congenital cardiac disease. The purpose of this paper is to present the results of the efforts of The International Society for Nomenclature of Paediatric and Congenital Heart Disease to establish a system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease, focusing both on procedural nomenclature and on the nomenclature of complications associated with interventional cardiology. This system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease is a component of The International Paediatric and Congenital Cardiac Code. This manuscript is the first part of a two-part series. Part 1 will cover the procedural nomenclature associated with interventional cardiology as treatment for paediatric and congenital cardiac disease. This procedural nomenclature of The International Paediatric and Congenital Cardiac Code will be used in the IMPACT Registry™ (IMproving Pediatric and Adult Congenital Treatment) of the National Cardiovascular Data Registry® of The American College of Cardiology. Part 2 will cover the nomenclature of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease.
Oyedeji, Olusola Adetunji; Gbolahan, Olalere Omoyosola; Abe, Elizabeth Oluwatoyin; Agelebe, Efeturi
Introduction Oral diseases in the HIV infected children though commonly encountered are under researched and often overlooked by physicians in developing countries. The aim of this study is to document the types and frequency of oral lesions in HIV infected children and examine the effects of management with HAART on their rates. Methods A cross sectional study designed to identify the oral lesions in consecutive HIV infected children and their distribution at a Paediatric Anti-retroviral clinic. Information on oral disease and clinical features of the subjects were obtained by history and clinical examination and laboratory investigations by the pediatricians and dental surgeons. Results The 58 children studied consisted of 34 boys and 24 girls with their ages ranging from 3 months to 13 years. Thirty seven (63.8%) of the 58 children had oral diseases. Enamel hypoplasia, candidiasis, caries, angular chelitis, and herpes labialis were the most common oral lesions found in the patients. Oral soft tissue lesions were less frequently encountered among children on HAART. Statistical significance was recorded among those infected with candidiasis. More than 60% of the children diagnosed with oral disease had no knowledge of the state of their oral health before the study. Conclusion Oral diseases are very common amongst the children studied. Awareness of oral disease among the children and their caregivers is low. Administration of HAART may have a preventive effect on the development of oral soft tissue disease. There is a need to integrate dental care into the paediatric HIV care programs. PMID:26161210
Grimprel, E; Lorrot, M; Haas, H; Pinquier, D; Parez, N; Ferroni, A; Cohen, R
The empiric choice of initial antibiotherapy in osteoarticular infections in infants and children must take into consideration the actual epidemiology of principal pathogens, their respective antibiotic sensitivity profile, their pharmacokinetic and pharmacodynamic properties and the results of efficacy clinical studies. After a review of recent data concerning these four major points, the Paediatric Infectious Diseases Group of the French Society of Paediatrics (GPIP) has proposed guidelines for initial recommended schemes of antimicrobial therapy in acute and non complicated osteoarticular infections in infants and children.
Feteh, Vitalis F.; Tindong, Maxime; Tanyi, John T.; Bihle, Nestor Mbinkar; Angwafo, Fru F.
Background In 2010, an estimated 141 new HIV infections occurred per day in Cameroon and reports suggest an upsurge of these rates by 2020 if current trends continue. Mother—to—child transmission (MTCT) of HIV is a major public health challenge, and maternal knowledge on HIV transmission during pregnancy and its prevention is important in curtailing paediatric HIV acquisition. Objectives We aimed at establishing the prevalence of maternal HIV infection as well as assessing knowledge on HIV, MTCT and prevention of MTCT (PMTCT) of HIV among pregnant women in a rural area of Cameroon. Methods This study was conducted in two phases: a 29 month retrospective analysis of 1866 deliveries within three rural health facilities in the Babessi sub—division, Northwest Cameroon and a 1 month prospective phase wherein 150 consenting pregnant women attending antenatal care (ANC) at the study centres were consecutively recruited. Results Overall, the prevalence of maternal HIV infection was 5.0% (100/2016). All (100%) of the interviewed pregnant women were aware of HIV infection and most (76.7%) had adequate knowledge on its routes of transmission. Meanwhile, only 79.3% (119/150) of them were aware of MTCT with slightly above a third (37.0%) having adequate knowledge on the periods of transmission. The proportions of women correctly stating: during pregnancy, during labour/delivery and during breastfeeding as possible periods of MTCT of HIV were 63.0%, 60.5% and 89.1% respectively. A majority (76.3%) of these women had inadequate knowledge on PMTCT of HIV. Conclusion The overall prevalence of maternal HIV warrants strengthening of current intervention strategies including scaling—up of PMTCT measures. Among others, intensification of HIV—related ANC services to improve the pregnant women’s awareness and knowledge on MTCT and its prevention are vital steps in curbing the growing burden of paediatric HIV. PMID:28199373
Lowenthal, Elizabeth D; Bakeera-Kitaka, Sabrina; Marukutira, Tafireyi; Chapman, Jennifer; Goldrath, Kathryn; Ferrand, Rashida A
Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities. PMID:24406145
HIV Treatment HIV Treatment: The Basics (Last updated 2/24/2017; last reviewed 2/24/2017) Key Points Antiretroviral therapy (ART) ... reduces the risk of HIV transmission . How do HIV medicines work? HIV attacks and destroys the infection- ...
Ishikawa, Naoko; Dalal, Shona; Johnson, Cheryl; Hogan, Daniel R; Shimbo, Takuro; Shaffer, Nathan; Pendse, Razia N; Lo, Ying-Ru; Ghidinelli, Massimo N; Baggaley, Rachel
Introduction HIV testing is the entry point for the elimination of mother-to-child transmission of HIV. Decreasing external funding for the HIV response in some low- and middle-income countries has triggered the question of whether a focused approach to HIV testing targeting pregnant women in high-burden areas should be considered. This study aimed at determining and comparing the cost-effectiveness of universal and focused HIV testing approaches for pregnant women across high to very low HIV prevalence settings. Methods We conducted a modelling analysis on health and cost outcomes of HIV testing for pregnant women using four country-based case scenarios (Namibia, Kenya, Haiti and Viet Nam) to illustrate high, intermediate, low and very low HIV prevalence settings. We used subnational prevalence data to divide each country into high-, medium- and low-burden areas, and modelled different antenatal and testing coverage in each. Results When HIV testing services were only focused in high-burden areas within a country, mother-to-child transmission rates remained high ranging from 18 to 23%, resulting in a 25 to 69% increase in new paediatric HIV infections and increased future treatment costs for children. Universal HIV testing was found to be dominant (i.e. more QALYs gained with less cost) compared to focused approaches in the Namibia, Kenya and Haiti scenarios. The universal approach was also very cost-effective compared to focused approaches, with $ 125 per quality-adjusted life years gained in the Viet Nam-based scenario of very low HIV prevalence. Sensitivity analysis further supported the findings. Conclusions Universal approach to antenatal HIV testing achieves the best health outcomes and is cost-saving or cost-effective in the long term across the range of HIV prevalence settings. It is further a prerequisite for quality maternal and child healthcare and for the elimination of mother-to-child transmission of HIV. PMID:27978939
Ingeholm, Peter; Gögenur, Ismail; Iversen, Lene H
Aim of database The aim of the database, which has existed for registration of all patients with colorectal cancer in Denmark since 2001, is to improve the prognosis for this patient group. Study population All Danish patients with newly diagnosed colorectal cancer who are either diagnosed or treated in a surgical department of a public Danish hospital. Main variables The database comprises an array of surgical, radiological, oncological, and pathological variables. The surgeons record data such as diagnostics performed, including type and results of radiological examinations, lifestyle factors, comorbidity and performance, treatment including the surgical procedure, urgency of surgery, and intra- and postoperative complications within 30 days after surgery. The pathologists record data such as tumor type, number of lymph nodes and metastatic lymph nodes, surgical margin status, and other pathological risk factors. Descriptive data The database has had >95% completeness in including patients with colorectal adenocarcinoma with >54,000 patients registered so far with approximately one-third rectal cancers and two-third colon cancers and an overrepresentation of men among rectal cancer patients. The stage distribution has been more or less constant until 2014 with a tendency toward a lower rate of stage IV and higher rate of stage I after introduction of the national screening program in 2014. The 30-day mortality rate after elective surgery has been reduced from >7% in 2001–2003 to <2% since 2013. Conclusion The database is a national population-based clinical database with high patient and data completeness for the perioperative period. The resolution of data is high for description of the patient at the time of diagnosis, including comorbidities, and for characterizing diagnosis, surgical interventions, and short-term outcomes. The database does not have high-resolution oncological data and does not register recurrences after primary surgery. The Danish
Rose, Edward M; Kennedy, Sean E; Mackie, Fiona E
Kidney transplantation is the most effective means of treating children with end-stage kidney disease, and yet, there continues to be a limited "life span" of transplanted kidneys in paediatric recipients. Early graft monitoring, using the surveillance biopsy, has the potential to extend renal allograft survival in paediatric recipients. The surveillance biopsy provides important and timely information about acute and chronic graft pathology, particularly SCR and calcineurin inhibitor-induced nephrotoxicity, which can subsequently guide management decisions and improve long-term graft survival. The ostensible value of the surveillance biopsy is furthered by the limitations of conventional renal functional studies. However, there is still much debate surrounding the surveillance biopsy in paediatric recipients, particularly in regard to its overall utility, safety and timing. This review discusses the current literature regarding the utility, safety, and potential predictive value of surveillance biopsies for guiding post-transplant management in paediatric renal allograft recipients, as well as the viability of other potentially newer non-invasive strategies for renal allograft monitoring.
Jauhari, Prashant; Boggula, Raju; Bhave, Anupama; Bhargava, Roli; Singh, Chandrakanta; Kohli, Neera; Yadav, Rajesh; Kumar, Rashmi
Aim: To study the aetiology of intellectual disability in patients presenting to hospital and the diagnostic yield of a standardized examination. Method: Over a 1-year period, the first three children presenting to the paediatric outpatients department (OPD) on 2 selected weekdays with developmental delay, suspected intellectual disability, or…
Figueroa, Diego Grimaldi; Simas, Ana Amélia Souza
We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome. PMID:27872765
Treatment of children with cancer, in particular with acute lymphoblastic leukaemia (ALL), has been highly successful in the past two decades owing to the implementation of treatment optimization studies. Study centres appointed by scientific societies design treatment optimization study protocols (TOSPs) that address an investigator-initiated research question and detail treatment procedures according to these aims. Nearly all children with malignant diseases are treated within TOSPs, whereas children with juvenile idiopathic arthritis (JIA) and other common paediatric rheumatic diseases are mostly treated outside TOSPs and clinical trials. Despite the differences in natural course and prognosis between malignant and inflammatory diseases, aiming for the recruitment of all children with defined rheumatic diseases into TOSPs or similar protocols would enable the longitudinal collection of crucial clinical data and improve evidence-based approaches. Successful research networks already exist in paediatric rheumatology that could facilitate the implementation of this approach. Paediatric rheumatic diseases have a considerable impact on patients and their families; thus, I propose that research networks in paediatric rheumatology should recruit most--if not all--children with rheumatic diseases into study protocols with standardized treatment and outcome measures.
Persico, Antonio M; Arango, Celso; Buitelaar, Jan K; Correll, Christoph U; Glennon, Jeffrey C; Hoekstra, Pieter J; Moreno, Carmen; Vitiello, Benedetto; Vorstman, Jacob; Zuddas, Alessandro
Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking contrast, pharmacological treatment options presently available in child and adolescent psychiatry are dramatically limited. The most important currently unmet needs in paediatric psychopharmacology are: the frequent off-label prescription of medications to children and adolescents based exclusively on data from randomized controlled studies involving adult patients; the frequent lack of age-specific dose, long-term efficacy and tolerability/safety data; the lack of effective medications for many paediatric psychiatric disorders, most critically autism spectrum disorder; the scarcity and limitations of randomized placebo-controlled trials in paediatric psychopharmacology; the unexplored potential for the prevention of psychiatric disorders with adolescent- and adult-onset; the current lack of biomarkers to predict treatment response and severe adverse effects; the need for better preclinical data to foster the successful development of novel drug therapies; and the effective dissemination of evidence-based treatments to the general public, to better inform patients and families of the benefits and risks of pharmacological interventions during development. Priorities and strategies are proposed to overcome some of these limitations, including the European Child and Adolescent Clinical Psychopharmacology Network, as an overarching Pan-European infrastructure aimed at reliably carrying out much needed psychopharmacological trials in children and adolescents, in order to fill the identified gaps and improve overall outcomes.
Rashid, Mamoon; Tamimy, Muhammad Sarmad; Ehtesham-Ul-Haq; Sarwar, Saad Ur Rahman; Rizvi, Syed Taokeer Ahmed
The majority of the paediatric oral and maxillofacial tumours are benign and the mandible is involved in one-third of these cases. A review of the literature reveals only a handful of studies pertaining exclusively to benign paediatric mandibular tumours. The basis of this study was to fulfil the need to assess the suitability of major mandibular reconstructions using a vascularised fibular graft in cases of benign tumours in children. From April 1999 to April 2011 we have managed 18 cases of benign paediatric mandibular tumours. All the reconstructions were done using vascularised fibular graft. The age of these patients ranged from 8 to 16 years. The most common pathology seen in our series was Ameloblastoma, followed by Giant Cell Granuloma and vascular malformation. Other cases included fibrous dysplasia, aneurysmal bone cyst and odontogenic myxoma. Five of these were recurrent lesions. The mean length of the fibula harvested was 12 ± 2 cm. All the flaps in this series survived. Bone union occurred in all cases by 6 weeks. All the patients have maintained a satisfactory chin contour of the mandible during the follow-up period with minimal distortion occurring secondary to contralateral native mandibular growth in two cases. We conclude that, for benign paediatric mandibular tumours requiring major bone resection, the vascularised fibula is an excellent reconstructive option with the advantages of having a good bone stock, possibility for osteotomy, long pedicle length and potential for growth along with the possibility of dental rehabilitation.
Jones, I; Tweed, C; Marron, M
Survival rates in both critically and chronically ill infants and children have improved dramatically in recent years and new challenges exist in the nursing care given to these patients. Among these is the increased risk of pressure ulcer development. Children in intensive care environments are especially at risk. Prevention and management of pressure ulceration in the paediatric population requires clinical judgement and skill. The use of pressure ulcer risk assessment tools can assist in this process; however, to date, there is a lack of research evidence and further studies are needed. The pressure relief requirements of the paediatric patient are significantly different to those of the adult patient. In children under the age of 36 months, the ears and occiput are the areas most at risk of pressure injury as a result of the fact that this area is proportionately the largest and heaviest bony prominence. Despite the abundance of specialist pressure redistributing devices for adults, there is little available specifically for the paediatric patient. This article describes a review of the literature on these subject areas and follows with a short report of the evaluation of the new Paediatric Nimbus System undertaken at the Royal Hospital for Sick Children in Edinburgh.
Yersin, Corinne; Hemme, Denis; Gehri, Mario; Pittet, Anne; Rey-Bellet Gasser, Céline
In Switzerland, overcrowding in tertiary emergency departments is a frequent problem, resulting in lengthy waiting times, lower satisfaction on the part of families and a risk for patient's safety. The setting up of a nurse consultation in a university paediatric emergency centre has helped to improve the quality of care in this context.
Didelot, Nicolas; Guerrier, Catherine; Didelot, Anne; Fritsch, Sandrine; Pelte, Jean-Pierre; Socha, Marie; Javelot, Hervé
Based on an assessment of adverse events in a follow-up care and rehabilitation unit in paediatrics, audits were carried out of the medicine use pathway. The evaluation grid taken from this study today serves as a basis for the audits carried out on the medicine use pathway on a national level.
Docquier, Pierre-Louis; Paul, Laurent; Mousny, Maryline; Cornu, Olivier; Delloye, Christian
Autograft harvesting in a growing child sometimes leads to disastrous consequences. Allograft can advantageously replace autograft in the majority of the cases. This overview presents the most frequently used allografts in paediatric orthopaedic surgery and discusses their benefits. Illustrative cases are presented to highlight specific indications.
Perkins, Joanne; Aguado-Lorenzo, Virginia; Arenas-Lopez, Sara
The use of standard concentrations of intravenous infusions has been advocated by international organisations to increase intravenous medication safety in paediatric and neonatal critical care. However, there is no guidance on how to identify and implement these infusions leading to great interunit variability.
Herden, Uta; Ganschow, Rainer; Briem-Richter, Andrea; Helmke, Knut; Nashan, Bjoern; Fischer, Lutz
Nowadays, most paediatric liver transplant recipients receive a split or other technical variant graft from adult deceased or live donors, because of a lack of available age- and size matched paediatric donors. Few data are available, especially for liver grafts obtained from very young children (<6 years). We analysed all paediatric liver transplantations between 1989 and 2009. Recipients were divided into five groups (1-5) depending on donor age (<1, ≥1 to <6, ≥6 to <16, ≥16 to <45, ≥45 years). Overall, 413 paediatric liver transplantations from deceased donors were performed; 1- and 5-year graft survival rates were 75%, 80%, 78%, 81%, 74% and 75%, 64%, 70%, 67%, 46%, and 1- and 5-year patient survival rates were 88%, 91%, 90%, 89%, 78% and 88%, 84%, 84%, 83%, 63% for groups 1-5, respectively, without significant difference. Eight children received organs from donors younger than 1 year and 45 children received organs from donors between 1 and 6 years of age. Overall, vascular complications occurred in 13.2% of patients receiving organs from donors younger than 6 years. Analysis of our data revealed that the usage of liver grafts from donors younger than 6 years is a safe procedure. The outcome was comparable with grafts from older donors with excellent graft and patient survival, even for donors younger than 1 year.
Coward, R; Peters, C; Duffy, P; Corry, D; Kellett, M; Choong, S; van't, H
Background: The previous epidemiological study of paediatric nephrolithiasis in Britain was conducted more than 30 years ago. Aims: To examine the presenting features, predisposing factors, and treatment strategies used in paediatric stones presenting to a British centre over the past five years. Methods: A total of 121 children presented with a urinary tract renal stone, to one adult and one paediatric centre, over a five year period (1997–2001). All children were reviewed in a dedicated stone clinic and had a full infective and metabolic stone investigative work up. Treatment was assessed by retrospective hospital note review. Results: A metabolic abnormality was found in 44% of children, 30% were classified as infective, and 26% idiopathic. Bilateral stones on presentation occurred in 26% of the metabolic group compared to 12% in the infective/idiopathic group (odds ratio 2.7, 95% CI 1.03 to 7.02). Coexisting urinary tract infection was common (49%) in the metabolic group. Surgically, minimally invasive techniques (lithotripsy, percutaneous nephrolithotomy, and endoscopy) were used in 68% of patients. Conclusions: There has been a shift in the epidemiology of paediatric renal stone disease in the UK over the past 30 years. Underlying metabolic causes are now the most common but can be masked by coexisting urinary tract infection. Treatment has progressed, especially surgically, with sophisticated minimally invasive techniques now employed. All children with renal stones should have a metabolic screen. PMID:14612355
Background The objective of this study was to analyse the readability of paediatric oral health education leaflets available in Australia. Methods Forty paediatric oral health education materials were analysed for general readability according to the following parameters: Thoroughness; Textual framework; Terminology; and Readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog) and Simplified Measure of Gobbledygook (SMOG)). Results Leaflets produced by the industry were among the hardest to read with an average readability at the 8th grade (8.4 ± 0.1). The readability of leaflets produced by the commercial sector was at the 7th grade (7.1 ± 1.7) and the government at the 6th grade (6.3 ± 1.9). The FKGL consistently yielded readabilities 2 grades below the Fog and SMOG indexes. In the content analyses, 14 essential paediatric oral health topics were noted and Early Childhood Caries (ECC) was identified as the most commonly used jargon term. Conclusion Paediatric oral health education materials are readily available, yet their quality and readability vary widely and may be difficult to read for disadvantaged populations in Australia. A redesign of these leaflets while taking literacy into consideration is suggested. PMID:25183234
Tison-Chambellan, Camille; Daussac, Élisabeth; Barnet, Lucile; Sirven, Sabine; Bambou, Dominique
A paediatric mobile emergency and intensive care service team comprises several professionals with complementary skills. The cohesion of a team, as well as the listening and communication skills of each of its members, allow it to respond in the best possible way to emergency situations. Feedback sessions on practice and simulation exercises enhance teamwork.
Hansen, Erik; Larsson, Heidi; Nørgaard, Mette; Thind, Peter; Jensen, Jørgen Bjerggaard
Aim of database The aim of the Danish Bladder Cancer Database (DaBlaCa-data) is to monitor the treatment of all patients diagnosed with invasive bladder cancer (BC) in Denmark. Study population All patients diagnosed with BC in Denmark from 2012 onward were included in the study. Results presented in this paper are predominantly from the 2013 population. Main variables In 2013, 970 patients were diagnosed with BC in Denmark and were included in a preliminary report from the database. A total of 458 (47%) patients were diagnosed with non-muscle-invasive BC (non-MIBC) and 512 (53%) were diagnosed with muscle-invasive BC (MIBC). A total of 300 (31%) patients underwent cystectomy. Among the 135 patients diagnosed with MIBC, who were 75 years of age or younger, 67 (50%) received neoadjuvent chemotherapy prior to cystectomy. In 2013, a total of 147 patients were treated with curative-intended radiation therapy. Descriptive data One-year mortality was 28% (95% confidence interval [CI]: 15–21). One-year cancer-specific mortality was 25% (95% CI: 22–27%). One-year mortality after cystectomy was 14% (95% CI: 10–18). Ninety-day mortality after cystectomy was 3% (95% CI: 1–5) in 2013. One-year mortality following curative-intended radiation therapy was 32% (95% CI: 24–39) and 1-year cancer-specific mortality was 23% (95% CI: 16–31) in 2013. Conclusion This preliminary DaBlaCa-data report showed that the treatment of MIBC in Denmark overall meet high international academic standards. The database is able to identify Danish BC patients and monitor treatment and mortality. In the future, DaBlaCa-data will be a valuable data source and expansive observational studies on BC will be available. PMID:27822081
Nguyen-Nielsen, Mary; Høyer, Søren; Friis, Søren; Hansen, Steinbjørn; Brasso, Klaus; Jakobsen, Erik Breth; Moe, Mette; Larsson, Heidi; Søgaard, Mette; Nakano, Anne; Borre, Michael
Aim of database The Danish Prostate Cancer Database (DAPROCAdata) is a nationwide clinical cancer database that has prospectively collected data on patients with incident prostate cancer in Denmark since February 2010. The overall aim of the DAPROCAdata is to improve the quality of prostate cancer care in Denmark by systematically collecting key clinical variables for the purposes of health care monitoring, quality improvement, and research. Study population All Danish patients with histologically verified prostate cancer are included in the DAPROCAdata. Main variables The DAPROCAdata registers clinical data and selected characteristics for patients with prostate cancer at diagnosis. Data are collected from the linkage of nationwide health registries and supplemented with online registration of key clinical variables by treating physicians at urological and oncological departments. Main variables include Gleason scores, cancer staging, prostate-specific antigen values, and therapeutic measures (active surveillance, surgery, radiotherapy, endocrine therapy, and chemotherapy). Descriptive data In total, 22,332 patients with prostate cancer were registered in DAPROCAdata as of April 2015. A key feature of DAPROCAdata is the routine collection of patient-reported outcome measures (PROM), including data on quality-of-life (pain levels, physical activity, sexual function, depression, urine and fecal incontinence) and lifestyle factors (smoking, alcohol consumption, and body mass index). PROM data are derived from questionnaires distributed at diagnosis and at 1-year and 3-year follow-up. Hitherto, the PROM data have been limited by low completeness (26% among newly diagnosed patients in 2014). Conclusion DAPROCAdata is a comprehensive, yet still young clinical database. Efforts to improve data collection, data validity, and completeness are ongoing and of high priority. PMID:27843346
Vano, E.; Martinez, D.; Fernandez, J. M.; Ordiales, J. M.; Prieto, C.; Floriano, A.; Ten, J. I.
Over the last two years we have evaluated paediatric patient doses in projection radiography derived from exposure level (EL) in computed radiography (CR) in a large university hospital. Entrance surface air kerma (ESAK) for 3501 paediatric examinations was calculated from the EL, which is a dose index parameter related to the light emitted by the phosphor-stimulable plate, archived in the Digital Imaging and Communications in Medicine (DICOM) header of the images and automatically transferred to a database using custom-built dedicated software. Typical mean thicknesses for several age bands of paediatric patients was estimated to calculate ESAK from the EL values, using results of experimental measurements with phantoms for the typical x-ray beam qualities used in paediatric examinations. Mean/median ESAK values (in µGy) for the age bands of <1 year, 1-5 years, 6-10 years and 11-15 years have been obtained for chest without a bucky: 51/41, 57/34, 91/54 and 122/109; chest with a bucky (for only the last three age bands): 114/87, 129/105 and 219/170; abdomen: 119/91, 291/225, 756/600 and 1960/1508 and pelvis: 65/48, 455/314, 943/707 and 2261/1595. Sample sizes of clinical images used for the (indirect) measurements were 1724 for chest without a bucky, 799 for chest with a bucky, 337 for abdomen and 641 for pelvis. The methodology we describe could be applicable to other centres using CR as an imaging modality for paediatrics. Presently, this method is the only practical approach to automatically extract parameters contained in the DICOM header, for the calculation of patient dose values for the CR modality.
Benachi, Alexandra; Sarnacki, Sabine
With the development of prenatal ultrasound and of foetal medicine, the paediatric surgeon has extended his knowledge of the natural history of surgical malformations. He is a part of the prenatal team and parents should always be referred to him when a surgical malformation is suspected, even when termination of pregnancy is planned because of an expected poor prognosis. Direct contact between the prenatal medicine specialist and the paediatric surgeon is also highly recommended to ensure continuity in the messages delivered to the parents. Postnatal counselling does not compare with prenatal counselling, and the paediatric surgeon has learned from the obstetrician to modulate his talk by including other conditions that might affect the outcome of the foetus, especially genetically determined syndromes. When the foetal malformation is diagnosed very early, especially in the first trimester, it therefore seems important for the consultation with the paediatric surgeon to be scheduled when the complementary exams required by the anomalies diagnosed are done, in order to avoid later contradictory messages. Repeated consultations should be favoured as they allow provision of more precise information regarding changes in ultrasound and/or MRI images and so decrease parents׳ anxiety and help them to take their decision. Foetal surgery, which has reached various stages of development in different countries, requires paediatric surgeons and obstetricians to join forces to optimise procedures and evaluate their benefit/risk ratio. Since 2004, the National Rare Disease Plan in France has allowed the creation of Rare Disease Centres, which deal with congenital malformations and produce recommendations for the health care pathway of these patients by means of a multidisciplinary approach. This greatly enhances interdisciplinary communication and ensures that best care is provided to the parents-to-be and to their child.
Corró, Guillermo; Crudeli, Cintia Milena; Rocco, Carlos Alberto; Marino, Silvia Alejandra; Sen, Luisa
Introduction HIV-1-associated CD4+ T-cell depletion is a consequence of uninfected cell death. Nef is one of the viral factors that trigger apoptosis on bystander cells, though the plasma Nef levels do not correlate with Th lymphocytes counts. The aim of our study was to evaluate whether anti-Nef antibodies were involved in paediatric AIDS development and whether they can prevent the CD4+ T-cell depletion in vertically infected children. Methods Two hundred and seventy three HIV-1 vertically infected children seen at Garrahan Paediatric Hospital were randomly included in the study, adding 13 selected cases: seven LTNP (long-term non-progressors) and six RP (rapid progressors) children (n total=286). Specific anti-HIV-1-Nef antibodies were titrated by indirect ELISA and compared between groups. The plasma blocking effect on Nef-dependent cytotoxicity was evaluated in Jurkat cells using recombinant Nef as apoptotic stimulus and patient plasmas as blockers, measuring the apoptotic levels using Annexin-V stain and flow cytometry. Results Only 63.4% of the patients had specific anti-Nef antibodies, and the levels of anti-Nef antibodies found in the selected LTNPs plasmas were always significantly higher (p=1.55×10−4) than those in RPs or general HIV-1+ paediatric populations. The LTNPs’ plasma had a strong inhibitory effect on Nef-dependent cytotoxicity even at high dilutions, while RP plasmas had little or no effect on Nef-induced apoptosis. Discussion and conclusions High anti-Nef antibody levels are associated and predict slow or non-progression to AIDS in vertically HIV-1-infected children. They could be an efficient tool in preventing Nef-associated bystander effect, preserving CD4+ T-cells and the immune function in the context of paediatric HIV-1 infection. PMID:24560340
Rose, Klaus; Senn, Stephen
The European Medicines Agency (EMA) website lists all diseases that officially exist in adults only. The class waiver for juvenile melanoma was revoked in 2008 referring to US SEER statistics. This statistical justification is misleading. Melanoma in adolescents is much rarer than claimed by EMA/Paediatric Committee; < 1 ∕ 4 of adolescents with melanoma need systemic treatment; separate efficacy studies are neither medically justified nor feasible. The scarce adolescent patients should be allowed to participate in adult trials. To force companies to investigate them separately turns them into paediatric hostages, to adapt the term therapeutic orphans coined in 1968 by Shirkey. There are now five melanoma Paediatric Investigation Plans (PIPs). Probably none of the PIP-triggered clinical studies will ever be completed; we propose to call them ghost studies. An oncology research network considering a reasonable trial in melanoma, including adolescents, will compete for recruitment with the PIP-triggered trials designed by regulatory tunnel vision and sponsored by companies under EMA-imposed pressure. EMA/Paediatric Committee's territorial enthusiasm ("our patients") damages oncology research.
Argent, A C
The HIV pandemic has affected children throughout the developing world. This article describes the experience of the Paediatric Intensive Care Unit at the Red Cross War Memorial Children's Hospital in Cape Town, South Africa. Over the last 20 years we have improved our management of HIV infected children requiring intensive care admission. In the absence of anti-retroviral therapy, long term outcomes from PICU admission of HIV infected children have not improved significantly, and it is debatable whether PICU admission is justified. Once anti-retroviral therapy is available to children, there may be significant improvements in outcome and possible affected children should be admitted to the PICU if resources are available.
Gordon, Daniel E; Ghazaryan, Lusine R; Maslak, Julia; Anderson, Bridget J; Brousseau, Kathleen S; Carrascal, Alvaro F; Smith, Lou C
Decreasing mother-to-child transmission is changing the population of children and adolescents with HIV. This project used recent epidemiological data to develop short-term projections of children and adolescents living with diagnosed HIV infection in New York State. A population simulation model was created to project prevalence of diagnosed HIV cases aged 0-19 years by age, sex, race/ethnicity and risk for years 2007-2014. Using 2006 data as the baseline population and 2001-2006 diagnosis and death data, annual diagnoses and deaths were calculated for each age/sex/race/risk category and known cases were 'aged' into the next year. The model produced annual estimates until 2014. The model predicts a decline in the number of persons aged 0-19 years living with diagnosed HIV in New York from 2810 in 2006 to 1431 in 2014, a net decrease of 49%. Living cases with paediatric risk continue to decrease. Cases aged 13-19 with non-paediatric risk increase slowly, leading to a shift in the risk composition of the population. The dominant effect seen in the model is the ageing out of perinatally infected children born before measures to prevent mother-to-child transmission were broadly implemented in the mid- to late 1990s. Changing trends in the young HIV-infected population should be considered in developing public health programmes for HIV prevention and care in New York State for the coming years.
as a natural consequence of being a co-founder of the United Nations, focused on promoting peace and stability in the world, as a relatively large...Soviet invasion to a more expeditionary course of deploying forces to promote peace and stability around the globe. As a result, Danish defense policy...Danish government including the armed forces. As a consequence Defense Agreement 2010 – 2014 was replaced by Defense Agreement 2013 – 2017 including
Kinshuck, Andrew Jon; Schober, Marianne; Kokai, George; Clarke, Ray
We describe the presentation and treatment of an HIV-positive patient with an oral ranula, and review the literature. Ranulas are mucoceles or retention cysts formed by the extravasation of mucus from the sublingual gland, presumably due to continued production of saliva in the presence of ductal obstruction. Oral ranulas in children are rare and the overall prevalence of mucoceles has been reported as 0.08% in children aged 0-12 years. However, there has been a documented increased occurrence in HIV-positive patients. This has been attributed to a blockage of the salivary gland by inflammation and peri-ductal fibrosis following HIV-associated salivary gland disease. Oral lesions may indicate infection with HIV and can also predict progression of HIV to AIDS. The most common oral manifestation is oral candidiasis occurring in 67% of children with HIV. Following this salivary gland disease, periodontal and gingival disease and herpes simplex are the next most common. The exact prevalence of ranulas in an HIV population is not known but the occurrence of a paediatric patient with HIV having at least one oral lesion has been documented as high as 63% and salivary gland disease at 50%. The true extent of the relationship between HIV and ranula is as yet unknown. This represents the only reported case of oral ranula in an HIV-positive patient in the UK.
Kutny, Matthew A; Gregory, John; Feusner, James H
Acute promyelocytic leukaemia (APL) in children and adolescents shares many features with APL in adults. There are important distinctions, however, between these age groups in the presentation, complications and treatment outcomes. Paediatric patients are more likely to present with high risk features including elevated WBC count or microgranular variant (M3v). Yet the early death rate is lower in paediatric patients compared to adult patients. Overall outcomes such as CR, OS and EFS appear similar in paediatric and adult patients treated on similar regimens except that very young children may have a higher risk of relapse. While contemporary studies have clearly demonstrated improved survival in adults receiving ATO therapy, currently there is more limited data on the role of ATO in paediatric patients. Here we highlight the similarities and important distinctions between paediatric and adult APL while reviewing available data on treatment of paediatric APL.
Ganpule, Arvind P; Sripathi, Venkat
The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series.
Mougenez, Stephane; Chad, N'Djamena; Howe, John
Think of advertising and what comes to mind, soap powders, motor cars, baked beans? All of these, of course, are heavily advertised, but what about HIV? Among the most durable of the government's advertisement campaigns have been the ones concerning HIV. Tens of millions of pounds have been spent telling the public of the presence and dangers of the virus.
Christiansen, Peer; Ejlertsen, Bent; Jensen, Maj-Britt; Mouridsen, Henning
Aim of database Danish Breast Cancer Cooperative Group (DBCG), with an associated database, was introduced as a nationwide multidisciplinary group in 1977 with the ultimate aim to improve the prognosis in breast cancer. Since then, the database has registered women diagnosed with primary invasive nonmetastatic breast cancer. The data reported from the departments to the database included details of the characteristics of the primary tumor, of surgery, radiotherapy, and systemic therapies, and of follow-up reported on specific forms from the departments in question. Descriptive data From 1977 through 2014, ~110,000 patients are registered in the nationwide, clinical database. The completeness has gradually improved to more than 95%. DBCG has continuously prepared evidence-based guidelines on diagnosis and treatment of breast cancer and conducted quality control studies to ascertain the degree of adherence to the guidelines in the different departments. Conclusion Utilizing data from the DBCG database, a long array of high-quality DBCG studies of various designs and scope, nationwide or in international collaboration, have contributed to the current updating of the guidelines, and have been an instrumental resource in the improvement of management and prognosis of breast cancer in Denmark. Thus, since the establishment of DBCG, the prognosis in breast cancer has continuously improved with a decrease in 5-year mortality from ~37% to 15%. PMID:27822082
Koller, Donna; Rummens, Anneke; Le Pouesard, Morgane; Espin, Sherry; Friedman, Jeremy; Coffey, Maitreya; Kenneally, Noah
Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified. PMID:27429578
Koller, Donna; Rummens, Anneke; Le Pouesard, Morgane; Espin, Sherry; Friedman, Jeremy; Coffey, Maitreya; Kenneally, Noah
Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified.
Chappuy, H; Doz, F; Blanche, S; Gentet, J‐C; Pons, G; Tréluyer, J‐M
Aims To assess parental understanding and memorisation of the information given when seeking for consent to their child's participation to clinical research, and to identify the factors of significant influence on parents' decision making process. Methods Sixty eight parents who had been approached for enrolling their child in a clinical oncology or HIV study were asked to complete an interview. Their understanding was measured by a score which included items required to obtain a valid consent according to French legislation. Results Items that were best understood by parents were the aims of the study (75%), the risks (70%), the potential benefits to their child (83%), the potential benefits to other children (70%), the right to withdraw (73%), and voluntariness (84%). Items that were least understood were the procedures (44%), the possibility of alternative treatments (53%), and the duration of participation (39%). Less than 10% of the parents had understood all these points. Ten parents (15%) did not remember that they had signed up for a research protocol. Thirty three parents (48%) reported no difficulty in making their decision. Twenty four parents (38%) declared that they made their decision together with the investigator; 26 (41%) let the physician decide. Fifty four parents (78%) felt that the level of information given was satisfactory. Conclusion There was an apparent discrepancy between parents' evaluation of the adequacy of the information delivered and evaluation of their understanding and memorisation. The majority of parents preferred that the physician take as much responsibility as possible in the decision making process. PMID:16246853
Schulpen, Tom W J; Lombarts, Kiki M J
The development of the quality improvement programme of the Paediatric Association of the Netherlands is described within the setting of the national programme of the Dutch government. The programme is based on four pillars: site visits by peers (visitatie), continuous medical and professional education, development of clinical (evidence based) guidelines and patient safety with complication registration. The site visits by peers play a central role in assessing the quality improvement activities in hospital based paediatric care. The self assessment approach and the confidential character of the visits are well received by the surveyed specialists. Recent inclusion of quality criteria in the legally required 5 yearly medical specialist recertification process has boosted the care for quality, which could serve as example for other countries. PMID:17588977
Advanced nursing roles are one way of encouraging experienced nurses to stay in clinical practice so they can provide expert care, develop practice and be role models for junior staff. A search for literature about advanced nurse practice in paediatric intensive care units in the UK identified just four articles, including one survey, but no reports of empirical research. There is some consensus on the nature and educational requirements for advanced practice but delays in agreeing a regulatory framework and failure to recognise the potential contribution of advanced roles mean that development is hindered. Although several UK units have developed or are developing the role, more insight and better evidence is needed on how nursing can be advanced in paediatric intensive care settings.
Blumental, Sophie; Sabbe, Martine; Lepage, Philippe
Background Varicella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period. Methods Data on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash. Results Participation of 101 hospitals was obtained, covering 97.7% of the total paediatric beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of paediatric varicella hospitalisations reached 29.5/105 person-years, with the highest impact among those 0–4 years old (global incidence and odds of hospitalisation: 79/105 person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had ≥1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/552) received acyclovir. Incidence of complicated hospitalised cases was 19/105 person-years. Paediatric intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian paediatric population was 0.5/106 and fatality ratio 0.2% among our cohort. Conclusions Varicella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium. PMID:26130380
Rahman, Imdadur; Patel, Praful; Boger, Philip; Rasheed, Shahnawaz; Thomson, Mike; Afzal, Nadeem Ahmad
Since the first report of use of endoscopy in children in the 1970s, there has seen an exponential growth in published experience and innovation in the field. In this review article we focus on modern age therapeutic endoscopy practice, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the paediatric upper gastrointestinal tract. PMID:25789087
Cosentini, A; Stranieri, G; Capillo, S; Notarangelo, L; Madonna, L; Iannini, S; Ferro, V; Defilippo, V; Defilippo, R G; Rubino, R
Although relatively rare, acute pancreatitis is the most common disease complex involving the pancreas in the paediatric age group. The etiology of the disease is often unknown, and Italian epidemiological data on the paediatric population and, in particular, on the etiology of the disease are not available (except for studies of prevalence). Within the field of the most frequently encountered pancreatitis in the age range of our interest (i.e. 0-18 years), not only the commonly observed forms whose etiopathogenesis is ascribable to cholelithiasis must be mentioned but also those forms due to proteic-caloric malnutrition that are becoming increasingly common. The presenting clinical symptoms and signs may not be typical and the laboratory tests may not always be sensitive enough. In such age range chronic recurrent pancreatitis plays a very important epidemiologic role. Approximately 40% of children and teenagers admitted to the hospital with a diagnosis of pancreatitis report a previous episode of the disease. Irreversible changes in pancreatic parenchyma develop in those patients in whom the disease progresses, leading to pancreatic insufficiency. Such a morbid condition (chronic pancreatitis) is more often observed in adolescents, in whom the disease manifests itself with a vague repetitive dyspeptic symptomatology, after alternating remissions and recrudescences, not always clinically evident. In children, the clinical picture most commonly encountered is represented by recurrent abdominal pains, in view of the fact that the patients are frequently affected by thalassaemia. The pseudocystic evolution of the disease is the most common organic damage resulting from the chronic progression of the pancreatic impairment. A few differences have been found with respect to severity, etiology, and mortality of pancreatitis in the paediatric age group as compared with older age groups. Both the general practitioner with a paediatric practice and the paediatrician
Egunsola, Oluwaseun; Choonara, Imti; Sammons, Helen Mary
Objective To identify adverse events (AEs) associated with Levetiracetam (LEV) in children. Methods Databases EMBASE (1974-February 2015) and Medline (1946-February 2015) were searched for articles in which paediatric patients (≤18 years) received LEV treatment for epilepsy. All studies with reports on safety were included. Studies involving adults, mixed age population (i.e. children and adults) in which the paediatric subpopulation was not sufficiently described, were excluded. A meta-analysis of the RCTs was carried out and association between the commonly reported AEs or treatment discontinuation and the type of regimen (polytherapy or monotherapy) was determined using Chi2 analysis. Results Sixty seven articles involving 3,174 paediatric patients were identified. A total of 1,913 AEs were reported across studies. The most common AEs were behavioural problems and somnolence, which accounted for 10.9% and 8.4% of all AEs in prospective studies. 21 prospective studies involving 1120 children stated the number of children experiencing AEs. 47% of these children experienced AEs. Significantly more children experienced AEs with polytherapy (64%) than monotherapy (22%) (p<0.001). Levetiracetam was discontinued in 4.5% of all children on polytherapy and 0.9% on monotherapy (p<0.001), the majority were due to behavioural problems. Conclusion Behavioural problems and somnolence were the most prevalent adverse events to LEV and the most common causes of treatment discontinuation. Children on polytherapy have a greater risk of adverse events than those receiving monotherapy. PMID:26930201
Borlu, Murat; Çınar, Salih Levent; Kesikoğlu, Ayten; Utaş, Serap
Introduction The association between vitiligo and thyroid disease is not fully investigated especially in paediatric patients. Aim To determine the incidence of vitiligo and thyroid disorders in children. This is the first report from middle Anatolia and the second report from Turkey. Material and methods A retrospective chart review was performed to examine the presence of thyroid abnormalities in paediatric patients who had been admitted to the dermatology department with vitiligo. Results A total of 155 paediatric patients, including 80 (52%) male and 75 (48%) female patients were included. The mean age was 8.6 years. Non segmental vitiligo was the most common type of the disease in 140 (90%) reviewed patients, while segmental vitiligo appeared only in 15 (10%) patients. The mean onset of vitiligo was 5.6 ±0.9 years. A family history of vitiligo was found in 14 (9%) children. Thirty-four (22%) patients had thyroid function tests and/or thyroid autoantibody abnormality. All of these patients had non segmental vitiligo. It was statistically significant (p < 0.05) in types of vitiligo and thyroid disease parameters. Conclusions Our results show that it may be useful to screen thyroid in children with non segmental vitiligo. PMID:27512360
Callaghan, M; Doyle, Y; O'Hare, B; Healy, M; Nölke, L
Extra corporeal membrane oxygenation (ECMO) is a form of life support, which facilitates gas exchange outside the body via an oxygenator and a centrifugal pumping system. A paediatric cardiac ECMO programme was established in 2005 at Our Lady's Children's Hospital, Crumlin (OLCHC) and to date 75 patients have received ECMO, the majority being post operative cardiac patients. The outcome data compares favourably with international figures. ECMO has been most successful in the treatment of newborn infants with life threatening respiratory failure from conditions such as meconium aspiration, respiratory distress syndrome and respiratory infections. There is no formal paediatric respiratory ECMO programme at OLCHC, or anywhere else in Ireland. Currently, neonates requiring respiratory ECMO are transferred to centres in Sweden or the UK at an average cost of 133,000 Euros/infant, funded by the Health Service Executive E112 treatment abroad scheme. There is considerable morbidity associated with the transfer of critically ill infants, as well as significant psycho-social impact on families. OLCHC is not funded to provide respiratory ECMO, although the equipment and expertise required are similar to cardiac ECMO and are currently in place. The average cost of an ECMO run at OLCHC is 65,000 Euros. There is now a strong argument for a fully funded single national cardiac and respiratory paediatric ECMO centre, similar to that for adult patients.
Stroetmann, Karl A; Thiel, Rainer
Intermediate results from an ongoing health technology assessment exercise of a simulation model of paediatric cardiomyopathy are reported. Comprehensive data on paediatric cardiomyopathy/heart failure, treatment options, incidence and prevalence, prognoses for different outcomes to be expected were collected. Based on this knowledge, a detailed clinical pathway model was developed and validated against the clinical workflow in a tertiary paediatric care hospital. It combines three disease stages and various treatment options with estimates of the probabilities of a child moving from one stage to another. To reflect the complexity of initial decision taking by clinicians, a three-stage Markov model was combined with a decision tree approach - a Markov decision process. A Markov Chain simulation tool was applied to compare estimates of transition probabilities and cost data of present standard of care treatment options for a cohort of children over ten years with expected improvements from using a clinical decision support tool based on the disease model under development. Early results indicate a slight increase of overall costs resulting from the extra cost of using such a tool in spite of some savings to be expected from improved care. However, the intangible benefits in life years saved of severely ill children and the improvement in QoL to be expected for moderately ill ones should more than compensate for this.
Accurate ascertainment of the number of children living with human immunodeficiency virus (HIV) is important to plan paediatric and adolescent health services. In Europe, the first generation of perinatally HIV-infected survivors are transferring to adult care and their health needs are unknown. We undertook an online survey of HIV cohort studies participating in the EuroCoord Network of Excellence to ascertain the number of perinatally HIV-infected (pHIV) patients included, to compare it with those published by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) and to assess the ability of countries to follow up pHIV patients after transfer to adult care. At the end of 2013, 16 countries in EuroCoord reported 8,229 pHIV patients in follow-up in cohorts, compared with 5,160 cumulative diagnoses reported by the ECDC in the same area. Follow-up of pHIV patients after transfer to adult care varied. It is likely that the number of diagnoses of perinatal HIV reported to ECDC is an underestimate, although this varies by country. Further work is needed to refine estimates and encourage follow-up in adult HIV cohorts to investigate long-term outcomes and improve the care of the next generation of children with HIV.
Pufall, Erica L.; Nyamukapa, Constance; Eaton, Jeffrey W.; Mutsindiri, Reggie; Chawira, Godwin; Munyati, Shungu; Robertson, Laura; Gregson, Simon
Background There are an estimated half-million children living with HIV in sub-Saharan Africa. The predominant source of infection is presumed to be perinatal mother-to-child transmission, but general population data about paediatric HIV are sparse. We characterise the epidemiology of HIV in children in sub-Saharan Africa by describing the prevalence, possible source of infection, and effects of paediatric HIV in a southern African population. Methods From 2009 to 2011, we conducted a household-based survey of 3389 children (aged 2–14 years) in Manicaland, eastern Zimbabwe (response rate: 73.5%). Data about socio-demographic correlates of HIV, risk factors for infection, and effects on child health were analysed using multi-variable logistic regression. To assess the plausibility of mother-to-child transmission, child HIV infection was linked to maternal survival and HIV status using data from a 12-year adult HIV cohort. Results HIV prevalence was (2.2%, 95% CI: 1.6–2.8%) and did not differ significantly by sex, socio-economic status, location, religion, or child age. Infected children were more likely to be underweight (19.6% versus 10.0%, p = 0.03) or stunted (39.1% versus 30.6%, p = 0.04) but did not report poorer physical or psychological ill-health. Where maternal data were available, reported mothers of 61/62 HIV-positive children were deceased or HIV-positive. Risk factors for other sources of infection were not associated with child HIV infection, including blood transfusion, vaccinations, caring for a sick relative, and sexual abuse. The observed flat age-pattern of HIV prevalence was consistent with UNAIDS estimates which assumes perinatal mother-to-child transmission, although modelled prevalence was higher than observed prevalence. Only 19/73 HIV-positive children (26.0%) were diagnosed, but, of these, 17 were on antiretroviral therapy. Conclusions Childhood HIV infection likely arises predominantly from mother-to-child transmission and is
... National HIV/AIDS and Aging Awareness Day National Gay Men's HIV/AIDS Awareness Day National Latinx AIDS ... who have lived with HIV since they were born are living productive and healthy lives. Can HIV ...
Bradman, Kate; Maconochie, Ian
The UK paediatric early warning score (PEWS) was developed for inpatients, looking at admission to the HDU and PICU and trying to produce a system which would recognize those children at risk of admission. Since the introduction of the '4-h wait', accident and emergency (A&E) departments have been under increasing strain to assess, treat and admit patients (if required) as quickly as possible. We designed this study with the view of identifying if the PEWS score could be used as a triage tool, to detect those patients who will need admission and therefore speed up the process of admitting children to the ward. All patients who visited A&E from 1st October-16th October 2006 were audited. The PEWS scores were collated after the study period. 774 children attended A&E during the study period. 316 patients were sent home from triage following nurse-led treatment or sent to another facility. Of the 458 patients remaining, 424 (93%) were included in the study - the only exclusion criterion was the failure of complete documentation of observations. The sensitivity [the probability of a child being admitted with a score of (n)] and the specificity (the probability of a patient not being admitted with a score of 0) were calculated. For all children aged 0-16 years, a PEWS score of >or=4 had a sensitivity of 24% and a specificity of 96%. A PEWS score of >or=2 had a sensitivity of 37% and a specificity of 88%. PEWS is of limited value in predicting admission (in a triage setting) in a population of undifferentiated disease. However, a low PEWS score has a high specificity, that is, a patient scoring <2 is unlikely to need admission.
Background Intervention coverage and funding for the control of malaria in Africa has increased in recent years, however, there are few descriptions of changing disease burden and the few reports available are from isolated, single site observations or are of reports at country-level. Here we present a nationwide assessment of changes over 10 years in paediatric malaria hospitalization across Kenya. Methods Paediatric admission data on malaria and non-malaria diagnoses were assembled for the period 1999 to 2008 from in-patient registers at 17 district hospitals in Kenya and represented the diverse malaria ecology of the country. These data were then analysed using autoregressive moving average time series models with malaria and all-cause admissions as the main outcomes adjusted for rainfall, changes in service use and populations-at-risk within each hospital's catchment to establish whether there has been a statistically significant decline in paediatric malaria hospitalization during the observation period. Results Among the 17 hospital sites, adjusted paediatric malaria admissions had significantly declined at 10 hospitals over 10 years since 1999; had significantly increased at four hospitals, and remained unchanged in three hospitals. The overall estimated average reduction in malaria admission rates was 0.0063 cases per 1,000 children aged 0 to 14 years per month representing an average percentage reduction of 49% across the 10 hospitals registering a significant decline by the end of 2008. Paediatric admissions for all-causes had declined significantly with a reduction in admission rates of greater than 0.0050 cases per 1,000 children aged 0 to 14 years per month at 6 of 17 hospitals. Where malaria admissions had increased three of the four sites were located in Western Kenya close to Lake Victoria. Conversely there was an indication that areas with the largest declines in malaria admission rates were areas located along the Kenyan coast and some sites in
Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne; Foghmar, Sussie; Eichhorst, Regina; Prescott, Eva; Cerqueira, Charlotte; Soja, Anne Merete Boas; Gislason, Gunnar H; Larsen, Mogens Lytken; Andersen, Ulla Overgaard; Gustafsson, Ida; Thomsen, Kristian K; Boye Hansen, Lene; Hammer, Signe; Viggers, Lone; Christensen, Bo; Kvist, Birgitte; Lindström Egholm, Cecilie; May, Ole
Aim of database The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). Study population Hospitalized patients with CHD with stenosis on coronary angiography treated with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date onward. Main variables Patient-level data are registered by clinicians at the time of entry to CR directly into an online system with simultaneous linkage to other central patient registers. Follow-up data are entered after 6 months. The main variables collected are related to key outcome and performance indicators of CR: referral and adherence, lifestyle, patient-related outcome measures, risk factor control, and medication. Program-level online data are collected every third year. Descriptive data Based on administrative data, approximately 14,000 patients with CHD are hospitalized at 35 hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations. Conclusion The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD. Mandatory registration of data at both patient level as well as program level is done on the database. DHRD aims to systematically monitor the quality of CR over time, in order to improve the quality of CR throughout Denmark to benefit patients. PMID:27822083
Bleses, Dorthe; Vach, Werner; Slott, Malene; Wehberg, Sonja; Thomsen, Pia; Madsen, Thomas O.; Basboll, Hans
This paper presents a large-scale cross-sectional study of Danish children's early language acquisition based on the Danish adaptation of the "MacArthur-Bates Communicative Development Inventories" (CDI). Measures of validity and reliability imply that the Danish adaptation of the American CDI has been adjusted linguistically and culturally in…
Lassmann, Michael; Treves, S Ted
In 2008 the EANM published their paediatric dosage card. In 2011 the North American consensus guidelines recommended a set of administered activities for paediatric nuclear medicine. During the EANM congress in 2012 a working group of the EANM and the SNMMI met to study the possibility of harmonizing these guidelines. The purpose of this work was to identify differences between these guidelines and suggest changes in both guidelines to achieve a level of harmonization. In addition, the new version of the EANM paediatric dosage card (version 01.02.2014) is provided.
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Roden, Janet; Jarvis, Lynda
Researchers were involved in an evaluative approach to examine the health promotion activities of paediatric nurses from a paediatric tertiary hospital centre (N = 83) and five paediatric non-tertiary hospital centres (N = 48) from Sydney, Australia. The aims of this study were to understand the nature of heath promotion in paediatric nursing practice by examining nurses' attitudes, investigating paediatric nurses' involvement in the five action area of the Ottawa Charter, and identifying barriers to the implementation of health promotion in practice. The researchers developed a health promotion survey based around the Ottawa Charter for Health Promotion (World Health Organisation, 1986a), and a literature review of nurses' involvement in health promotion. Results showed that tertiary paediatric nurses undertook more varied health promotion activities such as creating supportive environments (CSE), reorienting health services (RHS) and building healthy public policy (BHPP) than did non-tertiary paediatric nurses who were involved in only one action area of the Charter, that of developing personal skills (DPS). This research revealed that within paediatric nursing practice the action areas of the Ottawa Charter of BHPP and CSE were important; and that there is support for the advocacy role of paediatric nurses. There is also evidence that paediatric nurses may have health promotion knowledge deficits associated with the Ottawa Charter, and that the environment of multidisciplinary allied health professionals in a tertiary paediatric centre may positively influence senior paediatric nurses and their capacity to be involved in varied health promotion activities associated with the Ottawa Charter.
... the right way, every day. If you have health insurance, your insurer is required to cover some medicines ... to treat HIV. If you don’t have health insurance, or you’re unable to afford your co- ...
Batchelor, Hannah K.
The objective of this paper was to review existing information regarding food effects on drug absorption within paediatric populations. Mechanisms that underpin food–drug interactions were examined to consider potential differences between adult and paediatric populations, to provide insights into how this may alter the pharmacokinetic profile in a child. Relevant literature was searched to retrieve information on food–drug interaction studies undertaken on: (i) paediatric oral drug formulations; and (ii) within paediatric populations. The applicability of existing methodology to predict food effects in adult populations was evaluated with respect to paediatric populations where clinical data was available. Several differences in physiology, anatomy and the composition of food consumed within a paediatric population are likely to lead to food–drug interactions that cannot be predicted based on adult studies. Existing methods to predict food effects cannot be directly extrapolated to allow predictions within paediatric populations. Development of systematic methods and guidelines is needed to address the general lack of information on examining food–drug interactions within paediatric populations. PMID:27417362
Batchelor, Hannah K
The objective of this paper was to review existing information regarding food effects on drug absorption within paediatric populations. Mechanisms that underpin food-drug interactions were examined to consider potential differences between adult and paediatric populations, to provide insights into how this may alter the pharmacokinetic profile in a child. Relevant literature was searched to retrieve information on food-drug interaction studies undertaken on: (i) paediatric oral drug formulations; and (ii) within paediatric populations. The applicability of existing methodology to predict food effects in adult populations was evaluated with respect to paediatric populations where clinical data was available. Several differences in physiology, anatomy and the composition of food consumed within a paediatric population are likely to lead to food-drug interactions that cannot be predicted based on adult studies. Existing methods to predict food effects cannot be directly extrapolated to allow predictions within paediatric populations. Development of systematic methods and guidelines is needed to address the general lack of information on examining food-drug interactions within paediatric populations.
Lennon, Julie; Harper, Robert; Biswas, Sus; Lloyd, Chris
This article presents a survey of the demographical, educational and visual functional characteristics of children attending a specialist paediatric low-vision assessment clinic at Manchester Royal Eye Hospital. Comprehensive data were collected retrospectively from children attending the paediatric low-vision clinic between January 2003 and…
Gupta, Pavan Kumar; T., Sivakumar; Agarwal, Vivek; Sitholey, Prabhat
Background: Considerable controversy exists regarding clinical presentation, diagnosis, and comorbidities especially with Attention Deficit Hyperactivity Disorder (ADHD), in paediatric Bipolar Disorder (BPD). Aims and objectives: To describe phenomenology and comorbidities of paediatric BPD. Method: 78 Subjects (6-16 years) attending child and…
Prieto, MC Hart; Jones, PA
INTRODUCTION This study recorded the complication rates for general paediatric surgery undertaken in our district general hospital (DGH) and compared them with the limited amount of data published in this field. There has been a gradual diminution in the numbers of general paediatric surgeons throughout the UK. The Royal College of Surgeons of England has produced guidelines to safeguard the provision of paediatric surgery in DGHs. There are minimal data on the acceptable outcomes and complication rates for elective general paediatric operations. METHODS The following operations undertaken by the paediatric urologist in our unit between November 2006 and May 2010 were scrutinised: orchidopexy, laparoscopy for undescended testes, herniotomy and circumcision. The results were compared to those in the literature and current guidelines. Complications were recorded via audit records, clinic letters or records of attendance at the accident and emergency department. RESULTS A total of 306 paediatric operations (125 orchidopexies, 28 laparoscopies, 41 herniotomies and 51 circumcisions) were undertaken over the 42-month study period. Only 4.5% of cases experienced post-operative complications. The majority of these were testicular atrophy and infection. There were no intra-operative complications. CONCLUSIONS In our DGH the complication rates for general paediatric operations compare favourably with those set out by the literature and guidelines, which support the training and delivery of general paediatric surgery within DGHs. PMID:22004639
Järvinen, H; Merimaa, K; Seuri, R; Tyrväinen, E; Perhomaa, M; Savikurki-Heikkilä, P; Svedström, E; Ziliukas, J; Lintrop, M
Despite the fact that doses to paediatric patients from computed tomography (CT) examinations are of special concern, only few data or studies for setting of paediatric diagnostic reference levels (DRLs) have been published. In this study, doses to children were estimated from chest and head CT, in order to study the feasibility of DRLs for these examinations. It is shown that for the DRLs, patient dose data from different CT scanners should be collected in age or weight groups, possibly for different indications. For practical reasons, the DRLs for paediatric chest CT should be given as a continuous DRL curve as a function of patient weight. For paediatric head CT, DRLs for a few age groups could be given. The users of the DRLs should be aware of the calibration phantom applied in the console calibration for different paediatric scanning protocols. The feasibility of DRLs should be re-evaluated every 2-3 y.
Burns, Kristin M
The National Heart, Lung, and Blood Institute, of the National Institutes of Health, is committed to supporting research in paediatric heart failure. The Institute's support of paediatric heart failure research includes both investigator-initiated grants and Institute initiatives. There were 107 funded grants in paediatric heart failure over the past 20 years in basic, translational and clinical research, technology development, and support of registries. Such research includes a broad diversity of scientific topics and approaches. The Institute also supports several initiatives for paediatric heart failure, including the Pediatric Circulatory Support Program, the Pumps for Kids, Infants, and Neonates (PumpKIN) Program, PediMACS, and the Pediatric Heart Network. This review article describes the National Heart, Lung, and Blood Institute's past, present, and future efforts to promote a better understanding of paediatric heart failure, with the ultimate goal of improving outcomes.
Recent Danish government proposals to increase the national and international mobility of scientists are reviewed, including a formalized sabbatical system in the universities, new rules for obtaining leaves of absence with or without salary, and plans for increased mobility between public and private sectors. (MSE)
Hansen, B.; Thorling, L.; Dalgaard, T.; Erlandsen, M.
This presentation assesses the long-term development in the oxic groundwater nitrate concentration and nitrogen (N) loss due to intensive farming in Denmark. Firstly, up to 20-year time-series from the national groundwater monitoring network enable a statistically systematic analysis of distribution, trends and trend reversals in the groundwater nitrate concentration. Secondly, knowledge about the N surplus in Danish agriculture since 1950 is used as an indicator of the potential loss of N. Thirdly, groundwater recharge CFC (Chlorofluorocarbon) age determination allows linking of the first two dataset. The development in the nitrate concentration of oxic groundwater clearly mirrors the development in the national agricultural N surplus, and a corresponding trend reversal is found in groundwater. Regulation and technical improvements in the intensive farming in Denmark have succeeded in decreasing the N surplus by 40% since the mid 1980s while at the same time maintaining crop yields and increasing the animal production of especially pigs. Trend analyses prove that the youngest (0-15 years old) oxic groundwater shows more pronounced significant downward nitrate trends (44%) than the oldest (25-50 years old) oxic groundwater (9%). This amounts to clear evidence of the effect of reduced nitrate leaching on groundwater nitrate concentrations in Denmark. Are the Danish groundwater monitoring strategy obtimal for detection of nitrate trends? Will the nitrate concentrations in Danish groundwater continue to decrease or are the Danish nitrate concentration levels now appropriate according to the Water Framework Directive?
Brostrom, Stig; Hansen, Ole Henrik
This article seeks to identify the relation between policy and lived life, for the small child in the Danish creche. To accomplish this, the article integrates demography, traditions, national curriculum and psychological, educational, and recent developments in research. It is an attempt to reveal knowledge and consequences, by conducting the…
Olsen, Tore Vincents
The Danish free school tradition has entailed a large degree of associational freedom for non-governmental schools, religious as well as non-religious. Until the late 1990s, the non-governmental schools were under no strict ideological or pedagogical limitations; they could recruit teachers and students according to their own value base, and were…
Hayton, Anna; Wallace, Anthony
Australian National Diagnostic Reference Levels for paediatric multi detector computed tomography were established for three protocols, Head, Chest and AbdoPelvis, across two age groups, Baby/Infant 0-4 years and Child 5-14 years by the Australian Radiation Protection and Nuclear Safety Agency in 2012. The establishment of Australian paediatric DRLs is an important step towards lowering patient CT doses on a national scale. While Adult DRLs were calculated with data collected from the web based Australian National Diagnostic Reference Level Service, no paediatric data was submitted in the first year of service operation. Data from an independent Royal Australian and New Zealand College of Radiologists Quality Use of Diagnostic Imaging paediatric optimisation survey was used. The paediatric DRLs were defined for CTDIvol (mGy) and DLP (mGy·cm) values that referenced the 16 cm PMMA phantom for the Head protocol and the 32 cm PMMA phantom for body protocols for both paediatric age groups. The Australian paediatric DRLs for multi detector computed tomography are for the Head, Chest and AbdoPelvis protocols respectively, 470, 60 and 170 mGy·cm for the Baby/Infant age group, and 600, 110 and 390 mGy·cm for the Child age group. A comparison with published international paediatric DRLs for computed tomography reveal the Australian paediatric DRLs to be lower on average. However, the comparison is complicated by misalignment of defined age ranges. It is the intention of ARPANSA to review the paediatric DRLs in conjunction with a review of the adult DRLs, which should occur within 5 years of their publication.
Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patient’s family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care
Fisker, Niels; Mygind, Lone H; Krarup, Henrik B; Licht, Dorthe; Georgsen, Jørgen; Christensen, Peer B
Denmark is a country with low prevalence and incidence of blood borne viral infections. Among health care workers (HCWs) vaccination for hepatitis B is only offered to high-risk groups. The aims of this cross sectional survey were to determine the prevalence of hepatitis B, -C, and human immunodeficiency virus (HIV) among the staff at a Danish University hospital and to correlate this with risk factors for transmission. Additionally, we wanted to examine the current frequency of blood exposure, reporting habits and hepatitis B vaccination status in the staff. Of 1439 eligible hospital staffs included, 960 (67%) were HCWs. The overall human immunodeficiency virus (HIV)-, hepatitis C Virus (HCV)- and hepatitis B Virus (HBV)-prevalence was 0% (0/1439), 0.14% (2/1439) and 1.6% (23/1439), respectively. Twenty-three percent of HCWs were vaccinated against HBV. Age, blood transfusion and stay in endemic areas were associated independently to HBV infection as opposed to job-category, duration of employment, HBV vaccination status and blood exposure. Based on a 4-week recall period, the incidence of percutaneous blood exposure was 1.5/person-year. In conclusion the HIV and hepatitis prevalence was low despite frequent blood exposure and the principal risk factors were unrelated to work. Danish HCWs do not seem to be at increased risk of hepatitis B even though universal HBV vaccination has not been implemented.
Liossi, Christina; Anderson, Anna-Karenia; Howard, Richard F
Priority setting for healthcare research is as important as conducting the research itself because rigorous and systematic processes of priority setting can make an important contribution to the quality of research. This project aimed to prioritise clinical therapeutic uncertainties in paediatric pain and palliative care in order to encourage and inform the future research agenda and raise the profile of paediatric pain and palliative care in the United Kingdom. Clinical therapeutic uncertainties were identified and transformed into patient, intervention, comparison and outcome (PICO) format and prioritised using a modified Nominal Group Technique. Members of the Clinical Studies Group in Pain and Palliative Care within National Institute for Health Research (NIHR) Clinical Research Network (CRN)-Children took part in the prioritisation exercise. There were 11 clinically active professionals spanning across a wide range of paediatric disciplines and one parent representative. The top three research priorities related to establishing the safety and efficacy of (1) gabapentin in the management of chronic pain with neuropathic characteristics, (2) intravenous non-steroidal anti-inflammatory drugs in the management of post-operative pain in pre-schoolers and (3) different opioid formulations in the management of acute pain in children while at home. Questions about the long-term effect of psychological interventions in the management of chronic pain and various pharmacological interventions to improve pain and symptom management in palliative care were among the ‘top 10’ priorities. The results of prioritisation were included in the UK Database of Uncertainties about the Effects of Treatments (DUETS) database. Increased awareness of priorities and priority-setting processes should encourage clinicians and other stakeholders to engage in such exercises in the future. PMID:28386399
Cubitt, Jonathan J; Chesney, Amy; Brown, Liz; Nguyen, Dai Q
Complications following paediatric burns are well documented and care needs to be taken to ensure the appropriate follow up of these patients. Historically this has meant follow up into adulthood however this is often not necessary. The centralisation of burns services in the UK means that patients and their parents may have to travel significant distances to receive this follow up care. To optimise our burns service we have introduced a burns outreach service to enable the patients to be treated closer to home. The aim of this study is to investigate the impact of the introduction of the burns outreach service and within this environment define the optimum length of time needed to follow up these patients. A retrospective analysis was carried out of 100 consecutive paediatric burns patients who underwent surgical management of their burn. During the follow up period there were 43 complications in 32 patients (32%). These included adverse scarring (either hypertrophic or keloid), delayed healing (taking >1 month to heal) and contractures (utilising either splinting or surgical correction). Fifty-nine percent of these complications occurred within 6 months of injury and all occurred within 18 months. Size of burn was directly correlated to the risk of developing a complication. The outreach service reduced the distance the patient needs to travel for follow up by more than 50%. There was also a significant financial benefit for the service as the follow up clinics were on average 50% cheaper with burns outreach than burns physician. Burns outreach is a feasible service that not only benefits the patients but also is cheaper for the burns service. The optimum length of follow up for paediatric burns in 18 months, after which if there have not been any complications they can be discharged.
Thust, Stefanie C.; Chong, Wui Khean Kling; Gunny, Roxana; Mazumder, Asif; Poitelea, Marius; Welsh, Anna; Ederies, Ash
Background Paediatric cerebrovascular CT angiography (CTA) can be challenging to perform due to variable cardiovascular physiology between different age groups and the risk of movement artefact. This analysis aimed to determine what proportion of CTA at our institution was of diagnostic quality and identify technical factors which could be improved. Materials and methods a retrospective analysis of 20 cases was performed at a national paediatric neurovascular centre assessing image quality with a subjective scoring system and Hounsfield Unit (HU) measurements. Demographic data, contrast dose, flow rate and triggering times were recorded for each patient. Results Using a qualitative scoring system, 75% of studies were found to be of diagnostic quality (n=9 ‘good’, n=6 ‘satisfactory’) and 25% (n=5) were ‘poor’. Those judged subjectively to be poor had arterial contrast density measured at less than 250 HU. Increased arterial opacification was achieved for cases performed with an increased flow rate (2.5-4 mL/s) and higher intravenous contrast dose (2 mL/kg). Triggering was found to be well timed in nine cases, early in four cases and late in seven cases. Of the scans triggered early, 75% were poor. Of the scans triggered late, less (29%) were poor. Conclusions High flow rates (>2.5 mL/s) were a key factor for achieving high quality paediatric cerebrovascular CTA imaging. However, appropriate triggering by starting the scan immediately on contrast opacification of the monitoring vessel plays an important role and could maintain image quality when flow rates were lower. Early triggering appeared more detrimental than late. PMID:25525579
Jensen, F P; Fenger, J
The Danish air pollution abatement is based by and large on emission control. Since the ratification of the international sulfur protocol of 1985, there has been a continuous tightening of the permissible sulfur content in fuels and of the maximum emissions from power plants. As a consequence, the total annual emission of sulfur dioxide (SO2) has been reduced from 450,000 tons in the seventies to 180,000 tons in 1990. This has had a pronounced effect on the SO2 levels in Danish urban areas. Thus, in Copenhagen, the yearly averages have fallen to about 25%. For nitrogen oxides emitted from the power plants, similar regulations are in force. With this legislation, the most important and crucial source of air pollution in Danish urban areas is road traffic. The contribution of nitrogen oxides from national traffic accounts for nearly half the total Danish emission and is increasing steadily; this is consistent with an observed increase of nitrogen oxides in ambient air. The permissible levels of lead in petrol has been reduced drastically. After an introduction of reduced tax on lead-free petrol, it now accounts for more than two-thirds of the total consumption. As a result, the concentration of lead in urban ambient air has been reduced to less than one-sixth. The introduction of 3-way catalytic converters from October 1990 will result in reductions in the emission of a series of pollutants, e.g., lead, volatile organic compounds, carbon monoxide, and nitrogen oxides. In 1980, a Danish air quality monitoring program was established as a cooperative effort between the authorities, the Government, the countries, the municipalities, and the Greater Copenhagen Council.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7821296
Gimsing, Peter; Holmström, Morten O; Klausen, Tobias Wirenfelt; Andersen, Niels Frost; Gregersen, Henrik; Pedersen, Robert Schou; Plesner, Torben; Pedersen, Per Trøllund; Frederiksen, Mikael; Frølund, Ulf; Helleberg, Carsten; Vangsted, Annette; de Nully Brown, Peter; Abildgaard, Niels
Aim The Danish National Multiple Myeloma Registry (DMMR) is a population-based clinical quality database established in January 2005. The primary aim of the database is to ensure that diagnosis and treatment of plasma cell dyscrasia are of uniform quality throughout the country. Another aim is to support research. Patients are registered with their unique Danish personal identification number, and the combined use of DMMR, other Danish National registries, and the Danish National Cancer Biobank offers a unique platform for population-based translational research. Study population All newly diagnosed patients with multiple myeloma (MM), smoldering MM, solitary plasmacytomas, and plasma cell leukemia in Denmark are registered annually; ~350 patients. Amyloid light-chain amyloidosis, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome), monoclonal gammopathy of undetermined significance and monoclonal gammopathy of undetermined significance with polyneuropathy have been registered since 2014. Main variables The main registered variables at diagnosis are patient demographics, baseline disease characteristics, myeloma-defining events, clinical complications, prognostics, first- and second-line treatments, treatment responses, progression free, and overall survival. Descriptive data Up to June 2015, 2,907 newly diagnosed patients with MM, 485 patients with smoldering MM, 64 patients with plasma cell leukemia, and 191 patients with solitary plasmacytomas were registered. Registration completeness of new patients is ~100%. A data validation study performed in 2013–2014 by the Danish Myeloma Study Group showed >95% data correctness. Conclusion The DMMR is a population-based data validated database eligible for clinical, epidemiological, and translational research. PMID:27822103
Narayan, Daniel; Rajak, Saul; Patel, Sandy; Selva, Dinesh
Primary optic nerve sheath meningiomas (PONSM) are rare in children. Cystic meningiomas are an uncommon subgroup of meningiomas. We report a case of paediatric PONSM managed using observation alone that underwent cystic change and radiological regression. A 5-year-old girl presented with visual impairment and proptosis. Magnetic resonance (MR) imaging demonstrated a PONSM. The patient was left untreated and followed up with regular MR imaging. Repeat imaging at 16 years of age showed the tumour had started to develop cystic change. Repeat imaging at 21 years of age showed the tumour had decreased in size.
Hall, Judith G
‘Epigenetics’ involves the study of gene expression and the environmental exposures that influence expression. In paediatrics, it is recognized that different physiological and developmental stages of the young individual are affected by both genetic control and environmental influence. It appears that changes in gene expression – not changes in the DNA itself – can be passed on from one generation to another. The importance for paediatricians is recognizing disorders involving epigenetics, recording events during childhood that could affect epigenetic control of gene expression, and being aware of new therapies as they become available. Paediatricians need to be able to recognize the relevant risk factors. PMID:24627653
McDonagh, Janet E
The origin of paediatric rheumatology in the UK mainly lies in adult rheumatology and this has proved invaluable in terms of transition provision, education and training, and collaborative research. The last 5 years have seen adolescent rheumatology gather momentum with the creation of an objective evidence base, a sound foundation for future work addressing the many unanswered questions and hypotheses in the area of transitional care. The aim of this paper is to review the evidence supporting the recent developments in transitional care within rheumatology. Acknowledging the non‐categorical nature of transition, the author will also refer to evidence from other chronic illnesses which has informed these developments. PMID:17715444
Rey-Bellet Gasser, C; Gehri, M; Yersin, C
Consultations in the Paediatric Emergency Department (PED) continue to climb regularly. Emergency Nurse Practitioner consultations have long been created in the English speaking countries. Since January 2013, an indepen- dent nurse consultation, under delegated medical responsibility, exists in the multidisciplinary PED of the Children's Hospital of Lausanne. The mean consultation time is the same as the medical consultation and the overall waiting time hasn't decreased yet. But a well definite working frame, a systematic approach, as well as the continual medical supervision possibility, make it a safe, efficient and appreciated consultation, by both patients and professionals.
Valenzuela, Jorge; Araneda, Patricio; Cruces, Pablo
Weaning from mechanical ventilation is one of the greatest volume and strength issues in evidence-based medicine in critically ill adults. In these patients, weaning protocols and daily interruption of sedation have been implemented, reducing the duration of mechanical ventilation and associated morbidity. In paediatrics, the information reported is less consistent, so that as yet there are no reliable criteria for weaning and extubation in this patient group. Several indices have been developed to predict the outcome of weaning. However, these have failed to replace clinical judgement, although some additional measurements could facilitate this decision.
McDonagh, Janet E
The origin of paediatric rheumatology in the UK mainly lies in adult rheumatology and this has proved invaluable in terms of transition provision, education and training, and collaborative research. The last 5 years have seen adolescent rheumatology gather momentum with the creation of an objective evidence base, a sound foundation for future work addressing the many unanswered questions and hypotheses in the area of transitional care. The aim of this paper is to review the evidence supporting the recent developments in transitional care within rheumatology. Acknowledging the non-categorical nature of transition, the author will also refer to evidence from other chronic illnesses which has informed these developments.
Rakhmanina, Natella; Lam, Kam S; Hern, Jaclyn; Young, Heather A; Walters, Alex; Castel, Amanda D
Introduction Changes in combination antiretroviral therapy (cART) throughout childhood challenge the continuity of paediatric HIV treatment. This study aimed to evaluate the prevalence of treatment interruption (TI), including lamivudine (3TC) monotherapy, and the relationship of TI to virologic and immunologic parameters in HIV-infected paediatric patients. Methods Nested within a prospective observational study of a city-wide cohort of HIV-infected persons in the District of Columbia, this sub-study collected retrospective data on antiretroviral therapy, enrolment (endpoint) and historic (lifelong) CD4 counts and HIV RNA viral load (VL) of the paediatric cohort. TI was defined as interruption of cART ≥4 consecutive weeks. Data on TI, including 3TC monotherapy TI (MTI), were collected. Descriptive statistics and univariate testing were used to compare children with TI and MTI to children on continuous treatment (CT). Results Thirty-eight (28%) out of 136 enrolled children (median age=12.9 years) experienced TI, with 14 (37%) of those placed on 3TC MTI. Significantly lower endpoint median CD4 counts (598 cells/mm3 vs. 815 cells/mm3; p=0.003) and CD4% (27.5% vs. 33%; p=0.006) were observed in the TI cohort as compared to the CT cohort. The median endpoint VL in the overall TI cohort was ~4 times higher than among the CT cohort (1427 copies/mL vs. 5581 copies/mL; p<0.0001). After a median TI duration of one year, a majority (n=31; 82%) of patients with TI restarted cART, including 100% of those with total TI and 53% of those on MTI, respectively. Conclusions In our study, we observed high frequency of the TI in HIV in paediatric HIV clinical practice. All TIs, including 3TC MTI, were associated with significantly lower endpoint median CD4 counts and higher median VLs, as compared to CT in paediatric patients. The high frequency of TI and associated poor outcomes suggest a need for a better strategy in managing the course of the paediatric and adolescent cART. PMID
Background The HOPE (Helping to Outline Paediatric Eating Disorders) Project is an ongoing registry study made up of a sequential cross-sectional sample prospectively recruited over 17 years, and is designed to answer empirical questions about paediatric eating disorders. This paper introduces the HOPE Project, describes the registry sample to-date, and discusses future directions and challenges and accomplishments. The project and clinical service were established in a tertiary academic hospital in Western Australia in 1996 with a service development grant. Research processes were inbuilt into the initial protocols and data collection was maintained in the following years. Recognisable progress with the research agenda accelerated only when dedicated research resources were obtained. The registry sample consists of consecutive children and adolescents assessed at the eating disorder program from 1996 onward. Standardised multidisciplinary data collected from family intake interview, parent and child clinical interviews, medical review, parent, child and teacher psychometric assessments, and inpatient admission records populate the HOPE Project database. Results The registry database to-date contains 941 assessments, of whom 685 met DSM-IV diagnostic criteria for an eating disorder at admission. The majority of the sample were females (91%) from metropolitan Perth (83%). The cases with eating disorders consist of eating disorders not otherwise specified (68%), anorexia nervosa (25%) and bulimia nervosa (7%). Among those with eating disorders, a history of weight loss since illness onset was almost universal (96%) with fear of weight gain (71%) common, and the median duration of illness was 8 months. Conclusions Over the next five years and more, we expect that the HOPE Project will make a strong scientific contribution to paediatric eating disorders research and will have important real-world applications to clinical practice and policy as the research unfolds
Boerma, Ragna S; Boender, T Sonia; Sigaloff, Kim C.E.; Rinke de Wit, Tobias F; van Hensbroek, Michael Boele; Ndembi, Nicaise; Adeyemo, Titilope; Temiye, Edamisan O; Osibogun, Akin; Ondoa, Pascale; Calis, Job C; Akanmu, Alani Sulaimon
Introduction Pre-treatment HIV drug resistance (PDR) is an increasing problem in sub-Saharan Africa. Children are an especially vulnerable population to develop PDR given that paediatric second-line treatment options are limited. Although monitoring of PDR is important, data on the paediatric prevalence in sub-Saharan Africa and its consequences for treatment outcomes are scarce. We designed a prospective paediatric cohort study to document the prevalence of PDR and its effect on subsequent treatment failure in Nigeria, the country with the second highest number of HIV-infected children in the world. Methods HIV-1-infected children ≤12 years, who had not been exposed to drugs for the prevention of mother-to-child transmission (PMTCT), were enrolled between 2012 and 2013, and followed up for 24 months in Lagos, Nigeria. Pre-antiretroviral treatment (ART) population-based pol genotypic testing and six-monthly viral load (VL) testing were performed. Logistic regression analysis was used to assess the effect of PDR (World Health Organization (WHO) list for transmitted drug resistance) on subsequent treatment failure (two consecutive VL measurements >1000 cps/ml or death). Results Of the total 82 PMTCT-naïve children, 13 (15.9%) had PDR. All 13 children harboured non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations, of whom seven also had nucleoside reverse transcriptase inhibitor resistance. After 24 months, 33% had experienced treatment failure. Treatment failure was associated with PDR and a higher log VL before treatment initiation (adjusted odds ratio (aOR) 7.53 (95%CI 1.61–35.15) and 2.85 (95%CI 1.04–7.78), respectively). Discussion PDR was present in one out of six Nigerian children. These high numbers corroborate with recent findings in other African countries. The presence of PDR was relevant as it was the strongest predictor of first-line treatment failure. Conclusions Our findings stress the importance of implementing fully active regimens
Knoll, J; Demol, A; Elseviers, M; Harrington, M; De Vos, J Y; Zampieron, A; Ormandy, P; Kafkia, T
The Paediatric Access Care (PAC) project, organised by the Research Board of EDTNA/ERCA, aimed to study the organisation of paediatric renal care in Europe and to investigate the practice of access care for both haemodialysis (HD) and peritoneal dialysis (PD) paediatric patients. This paper reports on the organisation of paediatric renal care. The majority of paediatric renal care units were located in specific paediatric units of university hospitals. Most of the centres had offered HD, PD and transplantation (Tx) for more than 20 years. Half of nursing staff had qualifications in paediatric and renal nursing. Most of the centres offered an extended multidisciplinary team approach with the family actively involved in the care of the patient. PD and HD were equally used. Automatic Peritoneal Dialysis (APD) was offered as the standard PD treatment in 2 out of 3 centres. The HD schedule mostly utilised was 3 x 4 hours a week. Half of the patients were on the Tx waiting list and one third of registered patients were transplanted in 2004.
HIV Overview The HIV Life Cycle (Last updated 9/13/2016; last reviewed 9/8/2016) Key Points HIV gradually destroys the immune ... life cycle. What is the connection between the HIV life cycle and HIV medicines? Antiretroviral therapy (ART) ...
Mooney, R B; McKinstry, J
Fluoroscopy guided examinations in a paediatric X ray department were initially carried out on a unit that used a conventional screen-film combination for spot-films. A new fluoroscopy unit was installed with the facilities of digital fluorography and last image hold. Comparison of equipment performance showed that the dose per image for screen-film and digital fluorography was 3 microGy and 0.4 microGy, respectively. Although the screen-film had superior image quality, the department's radiologist confirmed that digital fluorography provided a diagnostic image. Patient dose measurements showed that introduction of the new unit caused doses to fall by an average of 70%, although fluoroscopy time had not changed significantly. The new unit produced 40% less air kerma during fluoroscopy. The remaining 30% reduction in dose was due to the introduction of digital fluorography and last image hold facilities. It is concluded that the use of digital fluorography can be an effective way of reducing paediatric dose.
Acute paediatric osteo-articular infections require a fast and sensitive diagnosis allowing a treatment directed to the causative pathogen. Many micro-organisms can be incriminated, but Staphylococcus aureus and Kingella kingae markedly prevail. K. kingae became the first bacterial species responsible for septic arthritis in children < 3 years. More rarely, (2)haemolytic Streptococci and Streptococcus pneumoniae are found. The incidence of community acquired S. aureus resistant to oxacillin in osteo-articular infections is still low in France. The microbiological diagnosis of septic arthritis relies upon analysis of articular fluid, which requires systematic inoculation of a blood culture vial to increase the recovery rate of K. kingae. If the culture is negative, it is recommended to carry out a universal PCR or a PCR targeted to the main germs responsible for septic arthritis. Indeed, PCR represents an undeniable benefice for the diagnosis of paediatric septic arthritis, particularly for the DNA detection of K. kingae. The diagnosis of acute osteomyelitis relies primarily upon blood cultures, since the bone puncture is not a systematic procedure in this setting. Their efficiency is low, and there is still a need to look for other arguments of diagnosis such as search of possible portals of entry or specific serologies.
Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten
A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases.
Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten
A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases. PMID:27399744
Sergi, B; Galli, J; Battista, M; De Corso, E; Paludetti, G
We reviewed our series of surgeries for paediatric cholesteatoma to assess outcomes and functional results considering the extension of disease and surgical techniques. Between January 2003 and December 2009, 36 patients (range 6-14 years) were operated on for cholesteatoma. We considered the sites involved by the cholesteatoma (mastoid, antrum, attic, middle ear, Eustachian tube), surgical techniques used (intact canal wall, canal wall down) and how our habits changed over the years; moreover, we evaluated ossicular chain conditions and how we managed the ossiculoplasty. As outcomes, we considered the percentage of residual and recurrent cholesteatoma for each technique and hearing function (air bone gap closure, high frequencies bone conduction hearing loss) at follow-up. Intact canal wall was performed in 20 patients and canal wall down in 13 patients, in 9 as first surgery. In both groups, we observed improvement of the air bone gap; in the intact canal wall group, a residual cholesteatoma was observed in 6 patients whereas, during follow-up, 2 patients who underwent a canal wall down showed a recurrent cholesteatoma that was treated in an outpatient setting. Eradication of cholesteatoma and restoration of hearing function in paediatric patients present unique surgical challenges. Our experience shows an increased choice of intact canal wall over the years. Therefore, it is important for the surgeon to counsel parents about the probable need for multiple surgeries, especially if an intact canal wall mastoidectomy is performed.
Finley, J P; Sharratt, G P; Nanton, M A; Chen, R P; Bryan, P; Wolstenholme, J; MacDonald, C
In 1987 we established a realtime echocardiography service by telemedicine from the paediatric cardiology department of a tertiary-care hospital in Halifax. The service was initially provided to single regional hospital but was expanded to six regional hospitals in the three Canadian Maritime Provinces. The system used a dial-up broadband video-transmission service provided by the telephone companies. Records of all transmissions were kept prospectively and reviewed to January 1997. A total of 324 transmissions were made. During 1995-96 there were 135 studies: 69 (51%) were urgent examinations of newborn children and 30 (22%) were urgent examinations of older children; repeat studies and postoperative checks (usually for pericardial effusion) accounted for the other 36 studies (27%). The images were of broadcast quality except in five cases where problems with transmission or poor sedation occurred. A comparison of 26 transmitted studies with repeat, 'in person' studies showed no important discrepancies in diagnosis. During the two-year study period, the cost of the network (equipment leasing costs and telecommunications costs) was C$90,000. Use of the telemedicine network saved unnecessary patient transfer in 31 cases. The cost of the transportation avoided was C$100,000-C$118,000. This review confirms our preliminary findings that broadband echocardiography transmission provides a service comparable in availability and accuracy to that provided in our paediatric cardiology division.
Delgado-Carballar, Violeta; Elleri, Daniela; Thankamony, Ajay; Burke, G A Amos; Nicholson, James C; Dunger, David B
Summary An 11-year-old boy developed severe syndrome of inappropriate antidiuretic hormone secretion (SIADH) after diagnosis of an intracranial B-cell lymphoma. His sodium levels dropped to 118–120 mmol/L despite 70% fluid restriction. For chemotherapy, he required hyperhydration, which posed a challenge because of severe hyponatraemia. Tolvaptan is an oral, highly selective arginine vasopressin V2-receptor antagonist, which has been licensed in adults for the management of SIADH and has been used in treating paediatric heart failure. Tolvaptan gradually increased sodium levels and allowed liberalisation of fluid intake and hyperhydration. Tolvaptan had profound effects on urinary output in our patient with increases up to 8 mL/kg/h and required close monitoring of fluid balance, frequent sodium measurements and adjustments to intake. After hyperhydration, tolvaptan was stopped, and the lymphoma went into remission with reversal of SIADH. We report one of the first uses of tolvaptan in a child with SIADH, and it was an effective and safe treatment to manage severe SIADH when fluid restriction was not possible or effective. However, meticulous monitoring of fluid balance and sodium levels and adjustments of fluid intake are required to prevent rapid sodium changes. Learning points: Tolvaptan can be used in paediatric patients with SIADH to allow hyperhydration during chemotherapy. Tolvaptan has profound effects on urinary output and meticulous monitoring of fluid balance and sodium levels is therefore warranted. Tolvaptan was well tolerated without significant side effects. PMID:27857840
Principi, Nicola; Esposito, Susanna
Since its discovery in 2001, human metapneumovirus (hMPV) has been identified as one of the most frequent causes of upper and lower respiratory tract infections. Although a considerable number of hMPV infections are diagnosed in adults and the elderly, the highest incidence of infection is among children as seropositivity for hMPV approaches 100% by 5-10 years of age. Most of the diseases due to hMPV are mild or moderate, tend to resolve spontaneously, and only require outpatient treatment. However, some may be severe enough to require hospitalisation or, albeit rarely, admission to a paediatric intensive care unit because of acute respiratory failure. Mortality is exceptional, but may occur. The most severe diseases generally affect younger patients, prematurely born children, and children who acquire nosocomial hMPV infection and those with a severe chronic underlying disease. Global hMPV infection has a major impact on national health systems, which is why various attempts have recently been made to introduce effective preventive and therapeutic measures; however, although some are already in the phase of development (including vaccines and monoclonal antibodies), there is currently no substantial possibility of prevention and, despite its limitations, ribavirin is still the only possible treatment. Given the risk of severe disease in various groups of high-risk children and the frequency of infection in the otherwise healthy paediatric population, there is an urgent need for further research aimed at developing effective preventive and therapeutic measures against hMPV.
Ledenius, K; Stålhammar, F; Wiklund, L M; Fredriksson, C; Forsberg, A; Thilander-Klang, A
The aim of this study was to evaluate the possibility of reducing the radiation dose to paediatric patients undergoing computed tomography (CT) brain examination by using image-enhancing software. Artificial noise was added to the raw data collected from 20 patients aged between 1 and 10 y to simulate tube current reductions of 20, 40 and 60 mA. All images were created in duplicate; one set of images remained unprocessed whereas the other was processed with image-enhancing software. Three paediatric radiologists assessed the image quality based on their ability to visualise the high- and low-contrast structures and their overall impression of the diagnostic value of the image. For patients aged 6-10 y, it was found that dose reductions from 27 mGy (CTDI(vol)) to 23 mGy (15 %) in the upper brain and from 32 to 28 mGy (13 %) in the lower brain were possible for standard diagnostic CT examinations when using the image-enhancing filter. For patients 1-5 y, the results for standard diagnostics in the upper brain were inconclusive, for the lower brain no dose reductions were found possible.
Brick, Thomas; Agbeko, Rachel S; Davies, Patrick; Davis, Peter J; Deep, Akash; Fortune, Peter-Marc; Inwald, David P; Jones, Amy; Levin, Richard; Morris, Kevin P; Pappachan, John; Ray, Samiran; Tibby, Shane M; Tume, Lyvonne N; Peters, Mark J
The role played by fever in the outcome of critical illness in children is unclear. This survey of medical and nursing staff in 35 paediatric intensive care units and transport teams in the United Kingdom and Ireland established attitudes towards the management of children with fever. Four hundred sixty-two medical and nursing staff responded to a web-based survey request. Respondents answered eight questions regarding thresholds for temperature control in usual clinical practice, indications for paracetamol use, and readiness to participate in a clinical trial of permissive temperature control. The median reported threshold for treating fever in clinical practice was 38 °C (IQR 38-38.5 °C). Paracetamol was reported to be used as an analgesic and antipyretic but also for non-specific comfort indications. There was a widespread support for a clinical trial of a permissive versus a conservative approach to fever in paediatric intensive care units. Within a trial, 58% of the respondents considered a temperature of 39 °C acceptable without treatment.
Armstrong, Neil; Fawkner, Samantha G
Oded Bar-Or's hypothesis that children may be "metabolic non-specialists", even when engaging in specialized sports, has stimulated the study of paediatric exercise metabolism since the publication of his classic text Pediatric sports medicine for the practitioner in 1983. Evidence drawn from several methodologies indicates an interplay of anaerobic and aerobic exercise metabolism in which children have a relatively higher metabolic contribution from oxidative energy pathways than adolescents or adults, whereas there is a progressive increase in glycolytic support of exercise with age, at least into adolescence and possibly into young adulthood. The picture is generally consistent but incomplete, as research with young people has been limited by both ethical and methodological constraints. The recent rigorous introduction of non-invasive techniques such as breath-by-breath respiratory gas analysis and magnetic resonance spectroscopy into paediatric exercise physiology promises to open up new avenues of research and generate unique insights into the metabolism of the exercising muscle during growth and maturation. It therefore appears that we might have available the tools necessary to answer some of the elegant questions raised by Professor Bar-Or over 25 years ago.
Cesaro, Simone; Giacchino, Mareva; Fioredda, Francesca; Barone, Angelica; Battisti, Laura; Bezzio, Stefania; Frenos, Stefano; De Santis, Raffaella; Livadiotti, Susanna; Marinello, Serena; Zanazzo, Andrea Giulio; Caselli, Désirée
Objective. Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity. PMID:24868544
Thomas, Biju; Aurora, Paul; Spencer, Helen; Elliott, Martin; Rutman, Andrew; Hirst, Robert A; O'Callaghan, Christopher
It is unclear whether ciliary function following lung transplantation is normal or not. Our aim was to study the ciliary function and ultrastructure of epithelium above and below the airway anastomosis and the peripheral airway of children following lung transplantation. We studied the ciliary beat frequency (CBF) and beat pattern, using high speed digital video imaging and ultrastructure by transmission electron microscopy, of bronchial epithelium from above and below the airway anastomosis and the peripheral airway of 10 cystic fibrosis (CF) and 10 non-suppurative lung disease (NSLD) paediatric lung transplant recipients. Compared to epithelium below the anastomosis, the epithelium above the anastomosis in the CF group showed reduced CBF (median (interquartile range): 10.5 (9.0-11.4) Hz versus 7.4 (6.4-9.2) Hz; p<0.01) and increased dyskinesia (median (IQR): 16.5 (12.9-28.2)% versus 42.2 (32.6-56.4)%; p<0.01). In both CF and NSLD groups, compared with epithelium above the anastomosis, the epithelium below the anastomosis showed marked ultrastructural abnormalities (median duration post-transplant 7-12 months). Ciliary dysfunction is a feature of native airway epithelium in paediatric CF lung transplant recipients. The epithelium below the airway anastomosis shows profound ultrastructural abnormalities in both CF and NSLD lung transplant recipients, many months after transplantation.
Aresti, Nick; Ramachandran, Manoj
Eponyms are widely used in medicine and their use has been the subject of much debate recently. Advocates stress their historical significance, their ability to simplify complex terminology and their addition of character to science. Opponents cite the controversy among those eponyms and highlight the lack of both scientific and historical accuracy. The law of Nonoriginal Malappropriate Eponymous Nomenclature (NOMEN) suggests that no phenomenon is named after the individual(s) who originally described it. We aimed to determine whether this law is applicable to various clinical conditions and signs relevant to paediatric orthopaedics. We selected a series of 10 eponyms and performed a thorough literature review. In all cases, a description was identified preceding that from whom the disease received its eponymous name. We were also able to identify what we believe to be the earliest recorded description of each disease and sign. Our examples confirm the law of NOMEN in the field of paediatric orthopaedics. We suggest that irregularities in the descriptions and meanings of eponyms are identified and updated.
Pai Jakribettu, Ramakrishna; Boloor, Rekha; Thaliath, Andrew; Yesudasan George, Sharanya; George, Thomas; Ponadka Rai, Manoj; Rafique Sheikh, Umran; Avabratha, Kadke Shreedhara; Baliga, Manjeshwar Shrinath
Dengue is one of the arthropod-borne (arbo) viral diseases transmitted by female mosquito Aedes aegypti. Dengue fever has a wide spectrum of clinical presentation ranging from flu-like illness to severe complicated stage of dengue hemorrhagic fever leading to mortality. This was a retrospective study conducted in a tertiary care hospital in Coastal Karnataka, South India, to know the correlation between the clinical presentation and haematological parameters in the paediatric cases presented with dengue symptoms. A total of 163 paediatric cases who presented fever and dengue-like illness were included in the study. Of which, 69 were confirmed dengue patients. Critical analysis showed that there was a significant difference in the haematological parameters like total leucocyte count, percent differential leucocyte count, and platelets count, in the erythrocyte sedimentation rate (P < 0.05 to 0.0001). Additionally, when compared to nondengue patients, even the liver function and renal function parameters were significantly deranged (P < 0.05 to 0.0001). Stratification based on NS1, IgG, and IgM showed significant alterations in the haematological, hepatic, and renal parameters. With respect to the treatment a small percentage of patients, that is, 8% (4 patients), required platelet transfusion as their counts went below 20,000/μL. Two patients succumbed to their illness while three required ICU stay. PMID:26819620
Park, M A J; Freebairn, R C; Gomersall, C D
This study compares the accuracy and capabilities of various ventilators using a paediatric acute respiratory distress syndrome lung model. Various compliance settings and respiratory rate settings were used. The study was done in three parts: tidal volume and FiO2 accuracy; pressure control accuracy and positive end-expiratory pressure (PEEP) accuracy. The parameters set on the ventilator were compared with either or both of the measured parameters by the test lung and the ventilator. The results revealed that none of the ventilators could consistently deliver tidal volumes within 1 ml/kg of the set tidal volume, and the discrepancy between the delivered volume and the volume measured by the ventilator varied greatly. The target tidal volume was 8 ml/kg, but delivered tidal volumes ranged from 3.6-11.4 ml/kg and the volumes measured by the ventilator ranged from 4.1-20.6 ml/kg. All the ventilators maintained pressure within 20% of the set pressure, except one ventilator which delivered pressures of up to 27% higher than the set pressure. Two ventilators maintained PEEP within 10% of the prescribed PEEP. The majority of the readings were also within 10%. However, three ventilators delivered, at times, PEEPs over 20% higher. In conclusion, as lung compliance decreases, especially in paediatric patients, some ventilators perform better than others. This study highlights situations where ventilators may not be able to deliver, nor adequately measure, set tidal volumes, pressure, PEEP or FiO2.
Elisabeth Williams, Geraint Williams Metin Nizamoglu And
The Nursing and Midwifery Council (2008) define the standards of conduct, ethics and performance for nurses and midwives of nursing currently practicing in the UK. The Code places emphasis on the core nursing principles of kindness, respect, dignity and support for patients and relatives while under nursing care. A prospective study was conducted using a validated questionnaire to assess adherence to these core nursing principles on the basis of parental assessment in an orthopaedic paediatric inpatient unit at University Hospital Coventry and Warwickshire (UHCW). Core nursing standards were highest in respect to kindness' and 'respect' shown for patients (96% and 98% positive scores) and lowest for 'support' offered to their parents (89% positive scores). Lower 'support' scores possibly relate to information provision or emotional support. Improvement may be achieved via provision of additional time to identify parental concerns, which may be non-medical. The results demonstrate that parents perceive core nursing principles to be strongly adhered to on the orthopaedic paediatric unit at UHCW.
Fridman, Michael D; Mital, Seema
In 2015, President Obama launched the Precision Medicine Initiative (PMI), which introduced new funding to a method of research with the potential to study rare and complex diseases. Paediatric heart failure, a heterogeneous syndrome affecting approximately 1 in 100000 children, is one such condition in which precision medicine techniques may be applied with great benefit. Current heart failure therapies target downstream effects of heart failure rather than the underlying cause of heart failure. As such, they are often ineffective in paediatric heart failure, which is typically of primary (e.g. genetic) rather than secondary (e.g. acquired) aetiology. It is, therefore, important to develop therapies that can target the causes of heart failure in children with greater specificity thereby decreasing morbidity, mortality and burden of illness on both patients and their families. The benefits of co-ordinated research in genomics, proteomics, metabolomics, transcriptomics and phenomics along with dietary, lifestyle and social factors have led to novel therapeutic and prognostic applications in other fields such as oncology. Applying such co-ordinated research efforts to heart failure constitutes an important step in advancing care and improving the lives of those affected.
Havelange, Violaine; Pepermans, Xavier; Ameye, Geneviève; Théate, Ivan; Callet-Bauchu, Evelyne; Barin, Carole; Penther, Dominique; Lippert, Eric; Michaux, Lucienne; Mugneret, Francine; Dastugue, Nicole; Raphaël, Martine; Vikkula, Miikka; Poirel, Hélène A
Dysregulation of MYC is the genetic hallmark of Burkitt lymphoma (BL) but it is encountered in other aggressive mature B-cell lymphomas. MYC dysregulation needs other cooperating events for BL development. We aimed to characterize these events and assess the differences between adult and paediatric BLs that may explain the different outcomes in these two populations. We analysed patterns of genetic aberrations in a series of 24 BLs: 11 adults and 13 children. We looked for genomic imbalances (copy number variations), copy-neutral loss of heterozygosity (CN-LOH) and mutations in TP53, CDKN2A, ID3 (exon 1), TCF3 (exon17) and CCND3 (exon 6). Young patients displayed more frequent 13q31.3q32.1 amplification, 7q32q36 gain and 5q23.3 CN-LOH, while 17p13 and 18q21.3 CN-LOH were only detected in adult BLs. ID3 mutations were present in all adult samples, but only in 42% of childhood cases. CCND3 and ID3 double-hit mutations, as well as 18q21 CN-LOH, seemed to be associated with poorer outcome. For the first time, we report different genetic anomalies between adult and paediatric BLs, suggesting age-related heterogeneity in Burkitt lymphomagenesis. This may explain the poorer prognosis of adult BLs. Additional studies are needed to confirm these results in the setting of clinical trials.
Hens, Kristien; Nys, Herman; Cassiman, Jean-Jacques; Dierickx, Kris
The combination of the issue of return of individual genetic results/incidental findings and paediatric biobanks is not much discussed in ethical literature. The traditional arguments pro and con return of such findings focus on principles such as respect for persons, autonomy and solidarity. Two dimensions have been distilled from the discussion on return of individual results in a genetic research context: the respect for a participant's autonomy and the duty of the researcher. Concepts such as autonomy and solidarity do not fit easily in the discussion when paediatric biobanks are concerned. Although parents may be allowed to enrol children in minimal risk genetic research on stored tissue samples, they should not be given the option to opt out of receiving important health information. Also, children have a right to an open future: parents do not have the right to access any genetic data that a biobank holds on their children. In this respect, the guidelines on genetic testing of minors are applicable. With regard to the duty of the researcher the question of whether researchers have a more stringent duty to return important health information when their research subjects are children is more difficult to answer. A researcher's primary duty is to perform useful research, a policy to return individual results must not hamper this task. The fact that vulnerable children are concerned, is an additional factor that should be considered when a policy of returning results is laid down for a specific collection or research project.
Frawley, G; Bennett, M; Thistlethwaite, K; Banham, N
For a large number of ischaemic, infective, inflammatory or traumatic conditions, hyperbaric oxygen therapy is either the only treatment or an adjunct that significantly reduces morbidity and mortality. The primary aim of this review is to identify clinical conditions treated in a paediatric population referred to Australian hyperbaric units. Secondary aims are to describe outcomes of treatment and detail any complications occurring during treatment or during transfer between units. This was a retrospective cohort study (January 1998-December 2011) of children treated at four Australian hyperbaric medical units. A total of 112 children underwent 1099 hyperbaric treatments for 14 indications. Ages were not normally distributed with a median age of 14 years (interquartile range 11-16; range 0.25-16 years). Treatments were completed as planned in 81.5% of cases with 25 patients' treatment terminated at the request of physicians, parents or patients. Complications relating to hyperbaric oxygen therapy occurred in 58 treatments (5.3%). Central nervous system oxygen toxicity occurred in 1:366 treatments. Our findings indicate that provision of hyperbaric oxygen therapy to children is feasible in major regional hyperbaric units and is associated with low complication rates. Management of children in an adult hyperbaric facility, however, requires significant cooperation between paediatric, intensive care and hyperbaric consultants, as the need for transfer to another hospital and prolonged transports often impacts on optimal ongoing surgical and intensive care management.
Hameed, Tahir; Lawrence, Sarah
BACKGROUND: The Paediatric Chairs of Canada have been proactive in workforce planning, anticipating paediatric job opportunities in academic centres. To complement this, it is important to characterize the practice profiles of paediatricians exiting training, including those working outside of tertiary care centres. OBJECTIVE: To describe the training paths and the practice patterns of Canadian paediatric residency graduates. METHODS: A survey was completed in 2010 to 2011 by Canadian program directors regarding residents completing core paediatrics training between 2004 and 2010. Data collection included training path after completing core paediatrics training and practice type after graduation. RESULTS: Of 699 residents completing their core training in paediatrics, training path data were available for 685 (98%). Overall, 430 (63%) residents completed subspecialty training while 255 (37%) completed general paediatrics training only. There was a significant increase in subspecialty training, from 59% in earlier graduates (2004 to 2007) to 67% in later graduates (2008 to 2010) (P=0.037). Practice pattern data after completion of training were available for 245 general paediatricians and 205 subspecialists. Sixty-nine percent of general paediatricians were community based while 85% of subspecialists were hospital based in tertiary or quaternary centres. Of all residents currently in practice, only 36 (8%) were working in rural, remote or underserviced areas. CONCLUSIONS: Almost two-thirds of recent Canadian paediatric graduates pursued subspecialty training. There was a significant increase in the frequency of subspecialty training among later-year graduates. Few graduates are practicing in rural or underserviced areas. Further studies are needed to determine whether these trends continue and their impact on the future paediatric workforce in Canada. PMID:27398047
... on a person’s individual needs. Can HIV medicines cause side effects? HIV medicines help people with HIV live longer, healthier lives. Sometimes HIV medicines can also cause side effects. Most side effects from HIV medicines are manageable, ...
Nöstlinger, Christiana; Lee, Janice; Salami, Olawale; Lallemant, Marc; Ouma, Onyango; Nyamongo, Isaac; Marchal, Bruno
Background Improving access to paediatric HIV treatment requires both large-scale treatment programmes and medication that is adapted to infants and children's needs. The WHO recommends lopinavir/ritonavir as first-line antiretroviral therapy for all HIV-infected children younger than 3 years. There is currently little evidence on the acceptability of, and adherence to, a formulation of this combination treatment if given in the form of pellets. This protocol presents how we will carry a realist evaluation to assess the factors that contribute to the acceptability and adherence to the new pellets formulation in 3 hospitals in Kenya. Methods We structured the protocol along the realist evaluation cycle following 4 steps: (1) the initial programme theory, (2) the study design, (3) the data collection methods and (4) the data analysis plan. Theories of behavioural sciences were reviewed for frames that could provide insights into how using such new formulations may contribute to better acceptability and adherence. Ethics and dissemination This study was approved by the Institutional Review Board of the Institute of Tropical Medicine, the Ethical Committee of the University Hospital Antwerp and the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee. We aim to disseminate the findings through international conferences and peer-reviewed journals and to share them with Drugs for Neglected Diseases initiative's (DNDi) programme managers and with the Kenyan healthcare providers. Discussion In developing this study, we encountered some challenges. First, methods to measure the acceptability of any formulation and adherence to it are not standardised. The second challenge is common in realist evaluation and relates to how to choose from different potentially interesting theoretical frameworks. We identified relevant and empirically tested theories from behavioural science that may be helpful in our study. We will test them in 3 settings by
The aim of the European paediatric legislation is to ensure high quality paediatric clinical research, and subsequently increase availability of authorised medicines that are appropriate for children and produce better information on medicines. One of the main pillars of the regulation is the paediatric investigation plan (PIP), a new key document in the general drug development process. PIP submission and approval are now mandatory to ensure registration of a new drug in the EU. A short summary of the achievements from the introduction of the regulation in 2007 is given. In addition, PIP case studies are presented to illustrate the challenges associated when working within the framework of the new process.
Kravljanac, Ruzica; Martinović, Vanja; Dujmović, Irena; Djurić, Milena; Kuzmanović, Miloš; Weinshenker, Brian G; Drulović, Jelena
Paediatric patients with the syndrome of an inappropriate antidiuretic hormone secretion (SIADH), as a manifestation of inflammatory demyelinating disorders of the central nervous system, have been rarely described until now, in only a few cases of neuromyelitis optica spectrum disorders (NMOSDs). We present a case of relapsing SIADH associated with NMOSD, in an anti-aquaporin-4 antibody positive 14-year-old girl, who is, to our best knowledge, the first reported paediatric patient with relapsing SIADH and NMOSD. Additionally, our case further supports the notion that paediatric encephalomyelitis associated with SIADH should suggest the diagnosis of NMOSD.
O'Callaghan, C; Sexton, M; Wheeler, G
Outpatient radiotherapy treatment in the paediatric cancer patient can be a traumatic and an anxiety-provoking experience for both the patient and the family. Music therapy has been widely reported to have psychosocial, educational and physical benefits for the paediatric cancer patient. Using individual case reports, this paper shows the successful use of music therapy as a non-pharmacological anxiolytic in the paediatric radiotherapy, outpatient waiting room setting, by providing the patient and the family with a means of communication, self-expression and creativity.
This short paper mentioned the medical treatment using the 'holy' springs, the first 'eye doctor' in Denmark, the first picture of spectacles which was found in Viborg Cathedral of the high priest before he performs circumcisio praeputii on Jesus Christ, further cataract reclination in Denmark from around year zero and cataract extraction in 1667 in Denmark on a goose by Francisco Borri and on humans by the Danish Georg Heuermann in 1755. Epidemic military eye diseases in 1807, 1856 and 1865 are also described in this study. From 1856, a new ophthalmological period started in Denmark with the first eye hospital (lazaret only for eye diseases), and in 1864, patients with eye diseases were transported from the few beds in the surgical departments in the municipal hospital to the first civil eye department in Denmark, the eye hospital Sct. Annae in Copenhagen. The new scientific period started with Jacob Christian Bentz (ophthalmia granulosa, joint editor of the Danish Medical Journal) and Heinrich Lehmann.
Danish sperm donors face a particular kind of kinship trouble: they find themselves in a cultural and organizational context that offers different and contrary ways of how to make connections to donor-conceived individuals meaningful. Whereas Danish sperm banks and Danish law want sperm donors to regard these connections as contractual issues, the dominant kinship narrative in Denmark asks sperm donors to also consider them as family and kinship relations. Based on interviews with Danish sperm donors and participant observation at Danish sperm banks, I argue that Danish sperm donors make sense of connections to donor-conceived individuals as a particular kind of relatedness that cannot be reduced to either contractual or kinship relations. Making sense of these connections, sperm donors negotiate their social significance and thereby participate in opening a space which offers avenues for new kinds of sociality.
Krause, H; Heiduk, M; Wachowiak, R; Till, H
There are several reasons for the possible development of a short bowel syndrome, which, however, occurs only rarely. The main causes consist of extended intestinal resections in cases of congenital anomalies (e.g., gastroschisis, intestinal atresia or dysplasia) or ischaemic lesions due to a volvulus. In addition, an intestinal stoma at a more upper segment of the GI tract can result in the functional manifestation of a short bowel syndrome. The differentiation between temporary and persisting types is essential for initiation of an adequate treatment. Loss or exclusion of organic resorption area at the inner surface of the (small) intestine can be associated with numerous pathological consequences requiring treatment. As a principle consideration from the paediatric point of view, the potential of intestinal adaptation needs to be assessed. Basic conservative treatment options are parenteral and enteral nutrition regimens, in particular, to prevent complications (such as D-lactate acidosis). The main surgical approaches are the procedures called LILT (longitudinal intestinal lengthening and tailoring) according to Bianchi and STEP (serial transverse enteroplasty). The technique to create intestinal segments of antiperistalsis has been abandoned. Because of the encouraging results of intestinal transplantation, this novel treatment option has gained greater attention over the past few years and is now also an option for paediatric patients. The limiting factor and thus major complication is the central venous catheter for long-term treatment. Catheter-related complications are still the main reason for a considerable mortality in these children.
... AGENT HIV, a single-stranded, positive-sense, enveloped RNA virus in the genus Lentivirus. TRANSMISSION HIV can ... be diagnosed is approximately 9 days, when HIV RNA becomes detectable in blood; however, tests needed to ...
... test is performed that detects the genetic material ( RNA ) of the virus. An HIV RNA test will detect HIV in most people by ... next test to perform is an HIV-1 RNA test (nucleic acid amplification test, NAAT). If the ...
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... at risk for serious infections and certain cancers. AIDS stands for acquired immunodeficiency syndrome. It is the final stage of infection with HIV. Not everyone with HIV develops AIDS. HIV most often spreads through unprotected sex with ...
... yeast infection (thrush) Shingles (herpes zoster) Progression to AIDS If you receive no treatment for your HIV ... childbirth or breast-feeding. How does HIV become AIDS? HIV destroys CD4 cells — a specific type of ...
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Andersson, Charlotte Brix; Flems, Christina; Kesmodel, Ulrik Schiøler
Aim of the database The aim of the Danish National Quality Database for Births (DNQDB) is to measure the quality of the care provided during birth through specific indicators. Study population The database includes all hospital births in Denmark. Main variables Anesthesia/pain relief, continuous support for women in the delivery room, lacerations (third and fourth degree), cesarean section, postpartum hemorrhage, establishment of skin-to-skin contact between the mother and the newborn infant, severe fetal hypoxia (proportion of live-born children with neonatal hypoxia), delivery of a healthy child after an uncomplicated birth, and anesthesia in case of cesarean section. Descriptive data Data have been collected since 2010. As of August 2015, data on women and children representing 269,597 births and 274,153 children have been collected. All data for the DNQDB is collected from the Danish Medical Birth Registry. Registration to the Danish Medical Birth Registry is mandatory for all maternity units in Denmark. During the 5 years, performance has improved in the areas covered by the process indicators and for some of the outcome indicators. Conclusion Measuring quality of care during childbirth has inspired and enabled staff to attend to the quality of the care they provide and has led to improvements in most of the areas covered. PMID:27822105
Aim of database The Danish Neuro-Oncology Registry (DNOR) was established by the Danish Neuro-Oncology Group as a national clinical database. It was established for the purpose of supporting research and development in adult patients with primary brain tumors in Denmark. Study population DNOR has registered clinical data on diagnostics and treatment of all adult patients diagnosed with glioma since January 1, 2009, which numbers approximately 400 patients each year. Main variables The database contains information about symptoms, presurgical magnetic resonance imaging (MRI) characteristics, performance status, surgical procedures, residual tumor on postsurgical MRI, postsurgical complications, diagnostic and histology codes, radiotherapy, and chemotherapy. Descriptive data DNOR publishes annual reports on descriptive data. During the period of registration, postoperative MRI is performed in a higher proportion of the patients (Indicator II), and a higher proportion of patients have no residual tumor after surgical resection of the primary tumor (Indicator IV). Further data are available in the annual reports. The indicators reflect only minor elements of handling brain tumor patients. Another advantage of reporting indicators is the related multidisciplinary discussions giving a better understanding of what actually is going on, thereby facilitating the work on adjusting the national guidelines in the Danish Neuro-Oncology Group. Conclusion The establishment of DNOR has optimized the quality in handling primary brain tumor patients in Denmark by reporting indicators and facilitating a better multidisciplinary collaboration at a national level. DNOR provides a valuable resource for research. PMID:27822109
Vassal, Gilles; Rousseau, Raphaël; Blanc, Patricia; Moreno, Lucas; Bode, Gerlind; Schwoch, Stefan; Schrappe, Martin; Skolnik, Jeffrey; Bergman, Lothar; Bradley-Garelik, Mary Brigid; Saha, Vaskar; Pearson, Andy; Zwierzina, Heinz
Seven years after the launch of the European Paediatric Medicine Regulation, limited progress in paediatric oncology drug development remains a major concern amongst stakeholders - academics, industry, regulatory authorities, parents, patients and caregivers. Restricted increases in early phase paediatric oncology trials, legal requirements and regulatory pressure to propose early Paediatric Investigation Plans (PIPs), missed opportunities to explore new drugs potentially relevant for paediatric malignancies, lack of innovative trial designs and no new incentives to develop drugs against specific paediatric targets are some unmet needs. Better access to new anti-cancer drugs for paediatric clinical studies and improved collaboration between stakeholders are essential. The Cancer Drug Development Forum (CDDF), previously Biotherapy Development Association (BDA), with Innovative Therapy for Children with Cancer Consortium (ITCC), European Society for Paediatric Oncology (SIOPE) and European Network for Cancer Research in Children and Adolescents (ENCCA) has created a unique Paediatric Oncology Platform, involving multiple stakeholders and the European Union (EU) Commission, with an urgent remit to improve paediatric oncology drug development. The Paediatric Oncology Platform proposes to recommend immediate changes in the implementation of the Regulation and set the framework for its 2017 revision; initiatives to incentivise drug development against specific paediatric oncology targets, and repositioning of drugs not developed in adults. Underpinning these changes is a strategy for mechanism of action and biology driven selection and prioritisation of potential paediatric indications rather than the current process based on adult cancer indications. Pre-competitive research and drug prioritisation, early portfolio evaluation, cross-industry cooperation and multi-compound/sponsor trials are being explored, from which guidance for innovative trial designs will be
Wani, Khursheed Ahmed; Bhat, Javaid Ahmed; Parry, Nazir Ahmed; Shaheen, Lubna; Bhat, Sartaj Ali
Introduction Paediatric Urinary Tract Infection (UTI) is one of the commonly encountered entities by paediatricians. Studies have shown easy vulnerability of paediatric urinary tract in any acute febrile illness and a miss in diagnosis could have long term consequences like renal scaring with its adverse effects. Bearing these evidence based preludes in view we designed our study to know the prevalence of UTI in Kashmir province. Aim Aim of the present study was to know the prevalence of UTI in febrile children and to know the sensitivity of different imaging modalities like Renal and Urinary Bladder Ultrasonography (RUS), Voiding Cystourethrography (VCUG) and Dimercaptosuccinic Acid (DMSA) scan in diagnosing UTI. Materials and Methods A total of 304 patients, between 2 months to 10 years, with axillary temperature of ≥ 100.4oF (38oC), who did not have a definite source for their fever and who were not on antibiotics were included in the study. Detailed history and through clinical examination was done to rule out any potential or definite focus of infection as per the predesigned proforma. Routine urine examination with culture and sensitivity, followed by RUS and VCUG was done in all patients where routine urine examination was suggestive of UTI. DMSA was done in only culture proven cases after 6 months to document the renal scarring. Results Out of 304 children, 140 were males and 164 were females, UTI was present in 40 patients who had fever without any apparent cause giving a prevalence of 13.2%. Escherichia coli (E. coli) were the commonest isolated organism, followed by Klebsiella and Citrobacter species. Renal and Urinary Bladder Ultrasonography (RUS) detected Vesicoureteral Reflux (VUR) in 25% (10/40) while VCUG showed VUR in 55% (22/40) giving a RUS sensitivity of 45% for detecting VUR. DMSA done only after 6 months in UTI diagnosed patients showed a renal scarring in 25% (10/40) patients. Conclusion Missing a febrile paediatric UTI, can prove a future
Skellern, Catherine; Donald, Terence
In 2008 Ontario, Canada the Goudge Inquiry arose following increasing concerns about practices surrounding forensic pathology and the investigation of paediatric deaths. Some of the considerations and recommendations have relevance to child protection/forensic paediatricians, particularly in relation to their responsibilities in opinion formulation and as expert witnesses. By examining the Inquiry recommendations, this paper applies them in relation to child protection/forensic paediatrics by discussing forensic medicine and its legal context, how interpretation of published reports and data should be used in opinion formulation; issues of 'diagnosis' versus 'opinion'; issues specific to child protection paediatrics; quality control; aspects of report writing and terminological considerations. It concludes with an adaptation of key recommendations directly from those of Goudge, applied to the context of paediatric forensic medicine undertaken in child protection assessments.
Grigg, Jonathan; Balfour-Lynn, Ian M; Everard, Mark; Hall, Graham; Karadag, Bülent; Priftis, Kostas; Roehr, Charles Christoph; Rottier, Bart L; Midulla, Fabio
In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
Balfour-Lynn, Ian M.; Everard, Mark; Hall, Graham; Karadag, Bülent; Priftis, Kostas; Roehr, Charles Christoph; Rottier, Bart L.; Midulla, Fabio
In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London. PMID:28154820
Ballesteros, Tomás; Arana, Ignacio; Pérez Ezcurdia, Amaya; Alfaro, José Ramón
There are many stretcher models able to adequately achieve the spinal immobilization of adult patients during emergency transports but do not work well with children. A paediatric and neonatal immobilizer has been designed, constructed and tested. It is simple, radio-transparent, able to be adequately fastened to an ambulance, adaptable to a wide range of paediatric patient's size, providing a correct spinal immobilization without an excessive immobilization of the rest of the body, without impairing the aperture of an aerial way or the cardiopulmonary resuscitation (CPR) and without reducing the accessibility of the medical personnel to the paediatric patient. It is able to be adapted to the size and injuries of the patient instead of adapting the position of the patient to the characteristics of the immobilizer. It can also be effectively fastened to the bed of an emergency helicopter, allowing the aerial transport of the paediatric patients.
Ćurković, S; Antabak, A; Halužan, D; Luetić, T; Prlić, I; Šiško, J
Trauma is the most common cause of hospitalisation in children, and forearm fractures comprise 35% of all paediatric fractures. One-third of forearm fractures are distal forearm fractures, which are the most common fractures in the paediatric population. This type of fracture represents an everyday problem for the paediatric surgeon. The three phases of fracture healing in paediatric trauma are associated with skin temperature changes that can be measured and then compared with standard plain radiographs of visible callus formation, and eventually these methods can be used in everyday practice. Thermographic assessment of temperature distribution within the examined tissues enables a quick, non-contact, non-invasive measurement of their temperature. Medical thermography is used as a screening method in other parts of medicine, but the use of this method in traumatology has still not been researched.
Background Drug development for rare diseases is challenging, especially when these orphan drugs (OD) are intended for children. In 2007 the EU Paediatric Drug Regulation was enacted to improve the development of high quality and ethically researched medicines for children through the establishment of Paediatric Investigation Plans (PIPs). The effect of the EU Paediatric Drug Regulation on the marketing authorisation (MA) of drugs for children with rare diseases was studied. Methods Data on all designated orphan drugs, their indication, MA, PIPs and indication group (adult or child) were obtained from the European Medicines Agency (EMA). The outcome and duration of the process from orphan drug designation (ODD) to MA, was compared, per indication, by age group. The effect of the Paediatric Drug Regulation, implemented in 2007, on the application process was assessed with survival analysis. Results Eighty-one orphan drugs obtained MA since 2000 and half are authorised for (a subgroup of) children; another 34 are currently undergoing further investigations in children through agreed PIPs. The Paediatric Drug Regulation did not significantly increase the number of ODDs with potential paediatric indications (58% before vs 64% after 2007 of ODDs, p = 0.1) and did not lead to more MAs for ODs with paediatric indications (60% vs 43%, p = 0.22). ODs authorised after 2007 had a longer time to MA than those authorised before 2007 (Hazard ratio (95% CI) 2.80 (1.84-4.28), p < 0.001); potential paediatric use did not influence the time to MA (Hazard ratio (95% CI) 1.14 (0.77-1.70), p = 0.52). Conclusions The EU Paediatric Drug Regulation had a minor impact on development and availability of ODs for children, was associated with a longer time to MA, but ensured the further paediatric development of drugs still off-label to children. The impact of the Paediatric Drug Regulation on research quantity and quality in children through PIPs is not yet clear. PMID
Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga; Tewari, Anshu
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established imaging modality in adult oncological practice. Its role in childhood malignancies needs to be discussed as paediatric malignancies differ from adults in tumor subtypes and they have different tumor biology and FDG uptake patterns. This is also compounded by smaller body mass, dosimetric restrictions, and physiological factors that can affect the FDG uptake. It calls for careful planning of the PET study, preparing the child, the parents, and expertise of nuclear physicians in reporting pediatric positron emission tomography/computed tomography (PET/CT) studies. In a broad perspective, FDG-PET/CT has been used in staging, assessment of therapy response, identifying metastases and as a follow-up tool in a wide variety of pediatric malignancies. This review outlines the role of PET/CT in childhood malignancies other than hematological malignancies such as lymphoma and leukemia. PMID:27688605
Sobrino Toro, M; Riaño Galan, I; Bassat, Q; Perez-Lescure Picarzo, J; de Aranzabal Agudo, M; Krauel Vidal, X; Rivera Cuello, M
The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters.
Tapisiz, A; Polat, M; Kara, S S; Tezer, H; Simsek, H; Aktas, F
Since measles is a highly contagious respiratory infection with significant airborne transmission risk in hospitals, effective prevention measures are crucial. After a mother accompanying her child on a paediatric ward lacking a negative pressure room was diagnosed with measles, exposed persons without evidence of immunity (documentary evidence of receiving two doses of measles-mumps-rubella vaccine) were treated with vaccination or intravenous immunoglobulin (IVIG). The interruption of transmission with these treatments was evaluated. There were 44 children and 101 adults exposed to the index patient. Twenty-five children and 88 adults were considered immune, providing evidence of immunity. Nineteen children and 13 adults were either given vaccination or IVIG for post-exposure prophylaxis (PEP). There were no additional cases of measles after 3 weeks follow-up. We conclude that measles is highly preventable by adequate PEP with vaccination or IVIG in a healthcare setting that lacks the benefit of a negative pressure room.
Emergency department (ED) overcrowding has been an international phenomenon for more than 10 years. It is important to understand that ED overcrowding is a measure of health system efficiency and is not strictly related to ED volumes or capacity. ED overcrowding is defined as a situation in which the demand for emergency services exceeds the ability of physicians and nurses to provide quality care within a reasonable time. The major factor resulting in ED overcrowding is the presence of admitted patients in the ED for prolonged periods of time, not a high volume of low-acuity patients. While limited data are available for paediatric EDs, winter respiratory illnesses set the stage for ED overcrowding, which are epidemic in adult or general EDs. Prehospital-, ED- and hospital-related factors are described in the present article, and these may help prevent or manage this important patient safety problem. PMID:19030415
van Wouwe, J P; de Wolff, F A; van Gelderen, H H
Zinc concentrations in hair and urine were measured in groups of children varying in one condition - short stature, or after prolonged upper respiratory infection, or during non-infectious diarrhea, or while on chemotherapy for acute lymphatic leukaemia and in healthy controls. As compared with controls, hair zinc was significantly low after respiratory infection (p less than 0.0001) and high in short stature (p less than 0.01). Urinary zinc was increased during initial chemotherapy (p less than 0.001) and diarrhea (p less than 0.02). It is shown that zinc deficiency occurs in one of the common symptoms in paediatric medicine, namely upper respiratory tract infection. The high overlap (34-88%) proves hair and urine zinc to be of no use for reliable individual diagnostic statements.
Bittmann, Stefan; Luchter, Elisabeth; Thiel, Michael; Kameda, Genn; Hanano, Ralph; Längler, Alfred
Topical honey treatment has been shown to possess antimicrobial properties, promote autolytic debridement, stimulate growth of wound tissues to hasten healing, and to start the healing process in dormant wounds, stimulating anti-inflammatory activity that rapidly reduces pain, oedema and exudate production. This article provides an overview of the use of honey as a medicinal substance, particularly its use in wound treatment, and reviews the published data concerning honey as a form of complementary and alternative medicine in paediatric wound management. The literature reviewed was found by searching the PubMed, BIOSIS, and ISI Web of Science databases for the term honey. Exclusion criteria were articles where honey was used in a mixture with other therapeutic substances.
Hamel, B C; Schretlen, E D
Sideroblastic Anaemias are characterised by a) chronic hypochromic anemia, b) ringed sideroblasts in the bone marrow, c) an increase in total body iron, d) ineffective erythropoiesis and e) often abnormal concentrations of F.E.P. A classification of Sideroblastic Anaemia is given and the pathophysiology of Sideroblastic Anaemia is discussed. A series of seven paediatric cases with Sideroblastic Anaemia is presented and the results of studies of the iron, vitamin B6 and porphyrin metabolism are discussed. In two cases arguments for an ALA-synthetase deficiency are given. All five males were diagnosed as hereditary X-linked Sideroblastic Anaemia, one female as I.R.S.A. and the other female, who showed the features of the X-linked type, as congenital Sideroblastic Anaemia.
Morrow, Angela M; Quine, Susan; Heaton, Maria D; Craig, Jonathan C
The rising prevalence of children with chronic conditions has made quality of life an increasingly important outcome measure in paediatric practice. The discrepancy between doctors' and patients' perceptions of quality of life makes formal assessment necessary. In this paper we use a case scenario to answer commonly asked questions. What is quality of life and who can assess it? Why assess quality of life in the clinical setting? Is it feasible to measure in routine clinical practice? How is quality of life formally assessed? We provide a basic outline of the language and methods of quality of life assessment and use the case scenario to discuss the process of choosing an appropriate instrument. We conclude that quality of life assessment in clinical practice is feasible and provides benefits for both patients and doctors. The benefits include better informed doctors, improved patient doctor communication and a means to effectively monitor quality of life as a treatment outcome.
Arthurs, Owen J; Barber, Joy L; Taylor, Andrew M; Sebire, Neil J
As postmortem imaging becomes more widely used following perinatal and paediatric deaths, the correct interpretation of images becomes imperative, particularly given the increased use of postmortem magnetic resonance imaging. Many pathological processes may have similar appearances in life and following death. A thorough knowledge of normal postmortem changes is therefore required within postmortem magnetic resonance imaging to ensure that these are not mistakenly interpreted as significant pathology. Similarly, some changes that are interpreted as pathological if they occur during life may be artefacts on postmortem magnetic resonance imaging that are of limited significance. This review serves to illustrate briefly those postmortem magnetic resonance imaging changes as part of the normal changes after death in fetuses and children, and highlight imaging findings that may confuse or mislead an observer to identifying pathology where none is present.
Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews. We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation. Closed reduction was performed followed by delayed ORIF (Open Reduction and Internal Fixation) with K wires. Final follow-up at 14 weeks revealed a stable elbow and satisfactory function with full supination-pronation, range of motion from 0°-120° of flexion and normal muscle strength. This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function. The method of fixation (screws or K wires) may depend on size and number of fracture fragments. PMID:20950437
Heggie, T W
Participation in backcountry wilderness recreation has increased in recent years with children and adolescents making up an increasing number of participants visiting wilderness destinations. Engaging in wilderness activity involves the risk of injury, illness and even death. Unfortunately, there is very little research investigating the health challenges facing children and adolescents in the wilderness. With the intent of increasing awareness among the sports medicine community, this review examines reported paediatric and adolescent wilderness injuries reported in the state of Washington and in US National Parks, injuries reported during outdoor wilderness programmes and global youth expeditions, and health challenges in wilderness settings where the threat of acute mountain sickness is elevated. Future studies addressing the challenges of establishing numerator data linked to suitable denominator data and monitoring injured and non-injured children and adolescents in the wilderness are recommended.
Cass, H D; Kugler, B T
Parental and professional responses to questionnaires evaluating a paediatric disability service are reported and the viability of auditing structural, process, and outcome aspects of clinical practice are discussed. Expectations of waiting time to first appointment (met for only 52% of consumers) illustrate structural issues. Process issues are reflected in consumer reactions to outreach work (for example, 94% of parents and 84% of professionals found this supportive). Outcome measures such as consumer satisfaction with the service (76% of consumers reported being 'very satisfied' and 20% 'fairly satisfied') suggest that service aims are being met. Good concurrence of service aims with consumer needs is indicated by parental reasons for referral (for example, 75% for diagnostic help, 73% for a better understanding of the disorder, 88% for practical help), referrers' reasons (for example, 55% for a second diagnostic opinion, 45% due to lack of local expertise), and reports from most other professionals involved with the case that a similar service was not provided locally.
Meta, Mahendrakumar; Miller, David
Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews. We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation. Closed reduction was performed followed by delayed ORIF (Open Reduction and Internal Fixation) with K wires. Final follow-up at 14 weeks revealed a stable elbow and satisfactory function with full supination-pronation, range of motion from 0°-120° of flexion and normal muscle strength. This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function. The method of fixation (screws or K wires) may depend on size and number of fracture fragments.
Cheung, Jason Pui Yin; Ho, Kenneth Wai Yip; Lam, Ying Lee; Shek, Tony Wai Hung
Tuberculosis is a universal mimicker and thus could be a differential diagnosis of any osteolytic lesion. Bone biopsy is crucial in these cases for culture and histological proof of tuberculous infection. This is a case report of two paediatric patients with unusual presentations of tuberculosis. One patient presented with knee pain and had imaged findings of an osteolytic lesion at the epiphysis. Interval scan showed spread of the lesion through the physis to the metaphyseal region. The second patient presented with hip pain and an osteolytic lesion of the acetabulum. He was subsequently found to have involvement of the brain and spine as well. Both patients were diagnosed with tuberculosis by bone biopsy for culture and pathological examination. They were treated successfully with antituberculous medications without chronic sequelae. These two patients showed that early recognition and prompt treatment are critical for management of tuberculosis to avoid chronic sequelae. PMID:23087272
de Blic, J; Deschildre, A
Early disturbances in pulmonary development seem to favour the occurrence of the functional impairments observed in COPD. In utero exposure to maternal smoking is the most commonly documented antenatal factor. Early life events such as the bronchopulmonary dysplasia are responsible for hypoalveolisation. The effects of passive smoking during childhood are prolonged into adulthood. The role of viral respiratory infections in early childhood remains a subject for debate. Finally the role of genes implied in pulmonary development both pre and post natally is beginning to be recognized. The decline of the respiratory function that occurs in adulthood leads then more rapidly to the functional criteria of COPD, particularly in the event of active smoking. There thus exist epidemiological and fundamental arguments, which support the idea that the COPD has at least, in part, a paediatric origin.
Catheter-related bloodstream infections (CRBIs) are a common problem in paediatrics. Sterile insertion and proper care of the catheter is likely more important than the type of catheter in determining the rate of CRBIs. The accuracy of the diagnosis of CRBIs can be improved by comparing the time to positivity or the concentration of organisms in blood drawn through the catheter with blood drawn from other sites, or by changing the catheter over a guidewire and culturing the removed catheter. When a CRBI is suspected, the catheter should be removed if it is no longer required, the child is hemodynamically unstable, there are metastatic foci of infection, the infecting organism is Candida or a mycobacterium, or there is a tunnel infection. The necessity for catheter removal is controversial if the infecting organism is Staphylococcus aureus or a Gram-negative organism. In most other situations, the catheter only needs to be removed if bacteremia persists despite appropriate antibiotic use. PMID:19668658
Kuhn, Susan M; McCarthy, Anne E
Although malaria is principally a disease of the tropical and subtropical regions of the world, it is an important disease to be familiar with for both local and global reasons. It remains to be one of the most important infectious diseases of the world, particularly in sub-Saharan Africa, killing more than one million people – mostly children – every year. In Canada, at least 350 to 1100 imported cases are reported annually, 25% of which are in the paediatric age group, as a result of both travel and migration. Because malaria is a potentially severe and sometimes fatal disease that is unfamiliar to many paediatricians in Canada, it is important that clinicians become familiar with its clinical presentation; understand when it should be suspected; and have an approach to prompt diagnosis, appropriate treatment and effective prevention methods. PMID:19030303
Vidal G, Alberto
The assessment of asthma control takes into account the symptoms, quality of life, lung function, and inflammatory markers. In the last few years, there has been a large increase in the number of publications related to the study of biomarkers in the management of paediatric asthma. Despite the large variety of inflammatory markers described in research studies, only a small group has shown to be useful in monitoring the disease. Induced sputum eosinophils offer the most solid evidence in assessing asthma control. Exhaled breath condensate and urinary leucotrienes could be useful in the future if there is standardisation in their procedures and interpretation of the results. Nitric oxide, basic eosinophil cationic protein, and bronchial biopsy with bronchoalveolar lavage, only appeared to be useful in a reduced group of patients.
Dosman, Cara; Witmans, Manisha; Zwaigenbaum, Lonnie
Paediatric restless legs syndrome (RLS) treatment is important because RLS's associated sleep disturbance causes significant developmental-behavioural morbidity and impacts family well-being. RLS is associated with brain iron insufficiency and dopaminergic dysfunction. Diagnosis requires fulfillment of diagnostic criteria, which for children are currently in evolution, and have limitations, especially in preschoolers. The community physician needs to recognize the possibility of RLS to refer to a sleep specialist for diagnostic confirmation and management recommendations, which include oral iron therapy, even though there is currently no definitive research evidence for iron efficacy in most children with RLS. A 3 mg to 6 mg elemental iron/kg/day dose for three months could be tried if the ferritin level is <50 ug/L. Sleep hygiene and behavioural strategies are also recommended. Iron supplementation should be safe in the absence of iron metabolism disorders, provided that transferrin saturation and ferritin levels are monitored pre-and post-treatment.
Turner, Claudia; Suy, Kuong; Soeng, Sona; Day, Nicholas P. J.; Turner, Paul
Diagnosis of Burkholderia pseudomallei pneumonia in children is challenging. We investigated the utility of nasopharyngeal swabs taken from 194 paediatric patients on admission with radiologically proven pneumonia. Melioidosis was proven in 0.5% of samples tested and only in a third of those known to be bacteraemic with B. pseudomallei. It appears unlikely that culture of nasopharyngeal secretions is helpful to confirm B. pseudomallei pneumonia in paediatric patients. PMID:26874977
Allin, Benjamin; Knight, Marian
Objective Identify every paediatric surgical article published in 1998 and every paediatric surgical article published in 2013, and determine which study designs were used and whether they were appropriate for robustly assessing interventions in surgical conditions. Methods A systematic review was conducted according to a pre-specified protocol (CRD42014007629), using EMBASE and Medline. Non-English language studies were excluded. Studies were included if meeting population criteria and either condition or intervention criteria. Population: Children under the age of 18, or adults who underwent intervention for a condition managed by paediatric surgeons when they were under 18 years of age. Condition: One managed by general paediatric surgeons. Intervention: Used for treatment of a condition managed by general paediatric surgeons. Main Outcome Measure Studies were classified according to whether the IDEAL collaboration recommended their design for assessing surgical interventions or not. Change in proportions between 1998 and 2013 was calculated. Results 1581 paediatric surgical articles were published in 1998, and 3453 in 2013. The most commonly used design, accounting for 45% of studies in 1998 and 46.8% in 2013, was the retrospective case series. Only 1.8% of studies were RCTs in 1998, and 1.9% in 2013. Overall, in 1998, 9.8% of studies used a recommended design. In 2013, 11.9% used a recommended design (proportion increase 2.3%, 95% confidence interval 0.5% increase to 4% increase, p = 0.017). Conclusions and Relevance A low proportion of published paediatric surgical manuscripts utilise a design that is recommended for assessing surgical interventions. RCTs represent fewer than 1 in 50 studies. In 2013, 88.1% of studies used a less robust design, suggesting the need for a new way of approaching paediatric surgical research. PMID:26959824
Xie, Tianwu; Zaidi, Habib
PET uses specific molecules labelled with positron-emitting radionuclides to provide valuable biochemical and physiological information. However, the administration of radiotracers to patients exposes them to low-dose ionizing radiation, which is a concern in the paediatric population since children are at a higher cancer risk from radiation exposure than adults. Therefore, radiation dosimety calculations for commonly used positron-emitting radiotracers in the paediatric population are highly desired. We evaluate the absorbed dose and effective dose for 19 positron-emitting labelled radiotracers in anthropomorphic paediatric models including the newborn, 1-, 5-, 10- and 15-year-old male and female. This is achieved using pre-calculated S-values of positron-emitting radionuclides of UF-NCI paediatric phantoms and published biokinetic data for various radiotracers. The influence of the type of anthropomorphic model, tissue weight factors and direct human- versus mouse-derived biokinetic data on the effective dose for paediatric phantoms was also evaluated. In the case of 18F-FDG, dosimetry calculations of reference paediatric patients from various dose regimens were also calculated. Among the considered radiotracers, 18F-FBPA and 15O-water resulted in the highest and lowest effective dose in the paediatric phantoms, respectively. The ICRP 103 updated tissue-weighting factors decrease the effective dose in most cases. Substantial differences of radiation dose were observed between direct human- versus mouse-derived biokinetic data. Moreover, the effect of using voxel- versus MIRD-type models on the calculation of the effective dose was also studied. The generated database of absorbed organ dose and effective dose for various positron-emitting labelled radiotracers using new generation computational models and the new ICRP tissue-weighting factors can be used for the assessment of radiation risks to paediatric patients in clinical practice. This work also contributes
Widera, T; Baumgarten, E; Druckenmüller, A; Niehues, C
In Germany inpatient rehabilitation plays a major role for the treatment of children and adolescents with chronic health conditions. The German Pension Insurance carries out the rehabilitation of children and adolescents with high commitment. Paediatric rehabilitation enables children to go to kindergarten and school without interruption and participate in later professional life. The article specifies the basics of paediatric rehabilitation, describes the disease structure, defines the therapeutic care and explicates survey results.
Raouf, H E; Yassin, A S; Megahed, S A; Ashour, M S; Mansour, T M
Occult hepatitis B infection is characterized by the presence of hepatitis B virus (HBV) DNA in the serum in the absence of hepatitis B surface antigen (HBsAg). Prevalence of hepatitis C virus (HCV) infections in Egypt is among the highest in the world. In this study, we aim at analysing the rates of occult HBV infections among HCV paediatric cancer patients in Egypt. The prevalence of occult HBV was assessed in two groups of paediatric cancer patients (HCV positive and HCV negative), in addition to a third group of paediatric noncancer patients, which was used as a general control. All groups were negative for HBsAg and positive for HCV antibody. HBV DNA was detected by nested PCR and real-time PCR. HCV was detected by real-time PCR. Sequencing was carried out in order to determine HBV genotypes to all HBV patients as well as to detect any mutation that might be responsible for the occult phenotype. Occult hepatitis B infection was observed in neither the non-HCV paediatric cancer patients nor the paediatric noncancer patients but was found in 31% of the HCV-positive paediatric cancer patients. All the detected HBV patients belonged to HBV genotype D, and mutations were found in the surface genome of HBV leading to occult HBV. Occult HBV infection seems to be relatively frequent in HCV-positive paediatric cancer patients, indicating that HBsAg negativity is not sufficient to completely exclude HBV infection. These findings emphasize the importance of considering occult HBV infection in HCV-positive paediatric cancer patients especially in endemic areas as Egypt.
Jansson, Annette F; Sengler, Claudia; Kuemmerle-Deschner, Jasmin; Gruhn, Bernd; Kranz, A Birgitta; Lehmann, Hartwig; Kleinert, Daniela; Pape, Lars; Girschick, Hermann J; Foeldvari, Ivan; Haffner, Dieter; Haas, Johannes P; Moebius, Dagmar; Foell, Dirk; Peitz, Joachim; Grote, Veit
Data on B cell depletion therapy in severe autoimmune diseases in paediatric patients are very limited. We conducted a retrospective cohort study and recruited patients who were treated with rituximab (RTX) and followed up for at least 6 months through the German societies of paediatric rheumatology and nephrology. The aim was to describe the spectrum of autoimmune disorders for which RTX was used and to describe the applied therapeutic regimens, the observed efficacy, as well as potential immunological side effects. The need to develop standard treatment guidelines for future trials should be discussed. Sixty-five patients were included. Nineteen patients suffered from systemic lupus erythematosus, 13 from vasculitic disorders, 12 from hematological autoimmune diseases, 5 from mixed connective tissue disorders, 4 from juvenile idiopathic arthritis, and 9 had other autoimmune diseases. Adverse, infusion-related events were reported in 12/65 (18%) patients. Considering laboratory and clinical parameters, 13 patients (22%) were in complete remission, 31 (52%) were in partial remission, 6 (10%) were unchanged and 10 (17%) had progressed after 6 months. In 46% of the patients, the steroid dose could be more than halved. IgG, IgM and IgA decreased from normal levels prior to RTX therapy to below normal levels at 6 months in 2/22 (9%), 10/21 (48%), and 4/22 (18%) patients, respectively. Immunoglobulin deficiency or prolonged CD20 depletion was reported in eight patients after an observation period longer than 12 months. RTX therapy led to a perceivable reduction in disease activity. However, long-term immunological alterations may occur in more than 10% of the patients. Guidelines and protocols for off-label therapy are desirable to document reasonable follow-up data. Controlled prospective studies for RTX therapies in children with standardised therapeutic and diagnostic protocols are urgently needed.
Kumar, Lakshmi; Kumar, Ajay; Panikkaveetil, Ramkumar; Vasu, Bindu K; Rajan, Sunil; Nair, Suresh G
Background and Aims: Premedication is an integral component of paediatric anaesthesia which, when optimal, allows comfortable separation of the child from the parent for induction and conduct of anaesthesia. Midazolam has been accepted as a safe and effective oral premedicant. Dexmedetomidine is a selective alpha-2 agonist with sedative and analgesic effects, which is effective through the transmucosal route. We compared the efficacy and safety of standard premedication with oral midazolam versus intranasal dexmedetomidine as premedication in children undergoing elective lower abdominal surgery. Methods: This was a prospective randomised double-blinded trial comparing the effects of premedication with 0.5 mg/kg oral midazolam versus 1 μg/kg intranasal dexmedetomidine in children between 2 and 12 years undergoing abdominal surgery. Sedation scores at separation and induction were the primary outcome measures. Behaviour scores and haemodynamic changes were secondary outcomes. Student's t-test and Chi-square were used for analysis of the variables. Results: Sedation scores were superior in Group B (dexmedetomidine) than Group A (midazolam) at separation and induction (P < 0.001). The behaviour scores at separation, induction and wake up scores at extubation were similar between the two groups. The heart rate and blood pressure showed significant differences at 15, 30 and 45 min in Group B but did not require pharmacological intervention for correction. Conclusion: Intranasal dexmedetomidine at a dose of 1 μg/kg produced superior sedation scores at separation and induction but normal behavioural scores in comparison to oral midazolam in paediatric patients. PMID:28250480
Burbeck, Rachel; Low, Joe; Sampson, Elizabeth L; Scott, Rosalind; Bravery, Ruth; Candy, Bridget
Objective To assess the involvement of volunteers with direct patient/family contact in UK palliative care services for children and young people. Method Cross-sectional survey using a web-based questionnaire. Setting UK specialist paediatric palliative care services. Participants Volunteer managers/coordinators from all UK hospice providers (n=37) and one National Health Service palliative care service involving volunteers (covering 53 services in total). Main outcomes Service characteristics, number of volunteers, extent of volunteer involvement in care services, use of volunteers’ professional skills and volunteer activities by setting. Results A total of 21 providers covering 31 hospices/palliative care services responded (30 evaluable responses). Referral age limit was 16–19 years in 23 services and 23–35 years in seven services; three services were Hospice at Home or home care only. Per service, there was a median of 25 volunteers with direct patient/family contact. Services providing only home care involved fewer volunteers than hospices with beds. Volunteers entirely ran some services, notably complementary therapy and pastoral/faith-based care. Complementary therapists, school teachers and spiritual care workers most commonly volunteered their professional skills. Volunteers undertook a wide range of activities including emotional support and recreational activities with children and siblings. Conclusions This is the most detailed national survey of volunteer activity in palliative care services for children and young people to date. It highlights the range and depth of volunteers’ contribution to specialist paediatric palliative care services and will help to provide a basis for future research, which could inform expansion of volunteers’ roles. PMID:24644170
Vano, E; Ubeda, C; Leyton, F; Miranda, P
Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 microGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 microGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.
Vano, E.; Ubeda, C.; Leyton, F.; Miranda, P.
Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 µGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 µGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.
Wolff, J E A; Westphal, S; Mölenkamp, G; Gnekow, A; Warmuth-Metz, M; Rating, D; Kuehl, J
To evaluate the overall survival of paediatric patients with pontine gliomas treated with oral trophosphamide and etoposide. Patients between 3 and 17 years of age with either typical diffuse pontine glioma on MRI or histologically proven anaplastic astrocytoma/glioblastoma multiforme located in the pons, were eligible. Treatment consisted of oral trophosphamide 100 mg m−2 day−1 combined with oral etoposide at 25 mg m−2 day−1 starting simultaneously with conventional radiation. Twenty patients were enrolled (median age 6 years, male : female=9 : 11). Surgical procedures included: no surgery: five, open biopsy: three, stereotactic biopsy: six, partial resection: three, and sub-total resection: three. Histological diagnoses included pilocytic astrocytoma: one, astrocytoma with no other specification: three, anaplastic astrocytoma: three, glioblastoma multiforme: eight, no histology: five. The most frequent side effects were haematologic and gastrointestinal. There was no toxic death. The response to combined treatment in 12 evaluable patients was: complete response: 0, partial response: three, stable disease: four, and progressive disease: five. All tumours progressed locally and all patients died. The overall median survival was 8 months. The overall survival rates at 1 and 4 years were: 0.4 and 0.05 respectively. This was not different from a control group of patients documented in the same population. Oral trophosphamide in combination with etoposide did not improve survival of pontine glioma patients. The treatment was well tolerated and should be evaluated for more chemoresponsive paediatric malignancies. British Journal of Cancer (2002) 87, 945–949. doi:10.1038/sj.bjc.6600552 www.bjcancer.com © 2002 Cancer Research UK PMID:12434281
Provenza, N; Calpena, A C; Mallandrich, M; Sánchez, A; Egea, M A; Clares, B
Personalized medicine is a challenging research area in paediatric drug design since no suitable pharmaceutical forms are currently available. Furosemide is an anthranilic acid derivative used in paediatric practice to treat cardiac and pulmonary disorders in premature infants and neonates. However, it is not commercialized in suitable dosage forms for paediatrics. Elaborating new paediatric formulations when no commercial forms are available is a common practice in pharmacy laboratories; amongst these, oral liquid formulations are the most common. We developed two extemporaneous paediatric oral solutions of furosemide (pure powder). The characterization and stability study were also performed. Parameters such as organoleptic characteristics, rheology, pH, content of active substance, and microbial stability were evaluated at three temperatures for two months. Evaluation of all these parameters showed that both solutions were stable for 60 days at 4 and 25 °C. Moreover, ex vivo studies were performed to evaluate the permeation behaviour of developed solutions through porcine small intestine to evaluate the potential paediatric biological parameters influencing the bioavailability and efficacy. A validated spectrofluorometric method was also used for this purpose. Our results guarantee a correct dosification, administration and potential efficacy of furosemide when is formulated in liquid oral forms for the treatment of cardiac and pulmonary disorders in children.
Kindelan, S A; Day, P; Nichol, R; Willmott, N; Fayle, S A
This revised Clinical Guideline in Paediatric Dentistry replaces the previously published sixth guideline (Fayle SA. Int J Paediatr Dent 1999; 9: 311-314). The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated widely for consultation to all UK consultants in paediatric dentistry, council members of the British Society of Paediatric Dentistry (BSPD), and to people of related specialities recognized to have expertise in the subject. The final version of this guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. Further details regarding the process of paediatric dentistry guideline production in the UK is described in the Int J Paediatr Dent 1997; 7: 267-268.
Alatise, Olusegun I.; Anyabolu, Henry Chineme; Sowande, Oludayo; Akinola, David
Background: Paediatric endoscopy performed by adult gastroenterologists is a service delivery model that increases the access of children to endoscopy in countries where paediatric gastroenterologists with endoscopy skills are scarce. However, studies on the usefulness of this model in Nigeria and Sub-Saharan Africa are scarce. We aimed to evaluate the indications, procedures, diagnostic yield and safety of paediatric endoscopy performed by adult gastroenterologists in a Nigerian tertiary health facility. Materials and Methods: It was a retrospective study that evaluated the records of paediatric (≤18 years old) endoscopies carried out in the endoscopy suite of Obafemi Awolowo University Teaching Hospital Complex Ile-Ife, Nigeria from January 2007 to December 2014. Results: A total of 63 procedures were successfully completed in children of whom 4 were repeat procedures which were excluded. Thus, 59 endoscopies performed on children were analysed. Most (49; 83.1%) of these procedures on the children were diagnostic with oesophagogastroduodenoscopy being the commonest (43; 72.9%). Epigastric pain (22; 37.3%), haematemesis (17; 28.8%) and dysphagia (9; 15.3%) were the predominant indication for upper gastrointestinal (GI) endoscopy while haematochezia (9; 15.3%) and rectal protrusion (2; 3.4%) were the indications for colonoscopy. Injection sclerotherapy (3; 5.1%) and variceal banding (2; 3.4%) were the therapeutic upper GI endoscopic procedures conducted while polypectomies were performed during colonoscopy in 5 children (8.5%). Abnormal endoscopy findings were observed in 53 out of the 59 children making the positive diagnostic yield to be 89.8%. No complication, either from the procedure or anaesthesia was observed. Conclusion: Paediatric endoscopy performed by adult gastroenterologists is useful, feasible and safe. It is being encouraged as a viable option to fill the gap created by dearth of skilled paediatric gastroenterologists. PMID:26712292
Jensen De Lopez, Kristine; Olsen, Lone Sundahl; Chondrogianni, Vasiliki
This study examines the comprehension and production of subject and object relative clauses (SRCs, ORCs) by children with Specific Language Impairment (SLI) and their typically developing (TD) peers. The purpose is to investigate whether relative clauses are problematic for Danish children with SLI and to compare errors with those produced by TD…
Borgulya, Gábor; Jakab, Zsuzsanna; Schuler, Dezso; Garami, Miklós
Cancer registration has developed in Europe over the last 50 years, and in the last decade intensive joint activities between the European Cancer Registries, in response to the need of pan-European harmonization of registration practices, have taken place. The Hungarian Paediatric Cancer Registry has been functioning as the database of the Hungarian Paediatric Oncology Network since 1971, aiming to follow the incidence and the treatment efficacy of malignant diseases. The goals of this globally unique open source information system are the following: 1) to raise the quality of the registration system to the European level by developing an Internet-based registration and communication system, modernizing the database, establishing automatic statistical analyses and adding an Internet website, 2) to support clinical epidemiological studies that we conduct with international collaborators on detailed analyses of the characteristics of patients and their diseases, evaluation of new diagnostic and therapeutic methods, prevention programs, and long-term quality of life and side effects. The benefits of the development of the Internet-based registration and communication system are as follows: a) introduction of an Internet-based case reporting system, b) modernization of the registry database according to international recommendations, c) automatic statistical summaries, encrypted mail systems, document repository, d) application of data security and privacy standards, e) establishment of a website and compilation of educational materials. The overall objective of this scientific project is to contribute towards the improvement of cancer prevention and cancer care for the benefit of the public in general and of cancer patients in particular.
The concept of Educational Ambassadors is embedded within the so-called "Danish model" of industrial relations. The Danish industrial relations system is characterised by strong collective organisations with national coverage, which conclude the collective agreements for various industries or sectors and which are mostly grouped under…
Stokes, Stephanie F.; Bleses, Dorthe; Basboll, Hans; Lambertsen, Claus
Purpose: This research explored the impact of neighborhood density (ND), word frequency (WF), and word length (WL) on the vocabulary size of Danish-speaking children. Given the particular phonological properties of Danish, the impact was expected to differ from that reported in studies on English and French. Method: The monosyllabic words in the…
This article explores the parenting practices of wealthy Danish families and offers insight into the workings of dominant parenting norms within contemporary Danish society. Based on ethnographic fieldwork conducted among 15 families living north of Copenhagen, Denmark, this article identifies the parenting strategies of people with ample…
Li, Xue; Song, Peige; Timofeeva, Maria; Meng, Xiangrui; Rudan, Igor; Little, Julian; Satsangi, Jack; Campbell, Harry; Theodoratou, Evropi
We provide a comprehensive field synopsis of genetic and epigenetic associations for paediatric Inflammatory Bowel Disease (IBD). A systematic review was performed and included 84 genetic association studies reporting data for 183 polymorphisms in 71 genes. Meta-analyses were conducted for 20 SNPs in 10 genes of paediatric Crohn’s disease (CD) and for 8 SNPs in 5 genes of paediatric ulcerative colitis (UC). Five epigenetic studies were also included, but formal meta-analysis was not possible. Venice criteria and Bayesian false discovery probability test were applied to assess the credibility of associations. Nine SNPs in 4 genes were considered to have highly credible associations with paediatric CD, of which four variants (rs2066847, rs12521868, rs26313667, rs1800629) were not previously identified in paediatric GWAS. Differential DNA methylation in NOD2 and TNF-α, dysregulated expression in let-7 and miR-124 were associated with paediatric IBD, but not as yet replicated. Highly credible SNPs associated with paediatric IBD have also been implicated in adult IBD, with similar magnitudes of associations. Early onset and distinct phenotypic features of paediatric IBD might be due to distinct epigenetic changes, but these findings need to be replicated. Further progress identifying genetic and epigenetic susceptibility of paediatric IBD will require international collaboration, population diversity and harmonization of protocols. PMID:27670835
... drugs decrease the amount of HIV in the body. Are there any side effects of HIV drugs? Drugs used to treat HIV infection may cause ... diarrhea, headaches, and muscle aches. Less common side effects include anemia ... HIV that you have in your body. Why is it important for my viral load ...
SRD 102 HIV Structural Database (Web, free access) The HIV Protease Structural Database is an archive of experimentally determined 3-D structures of Human Immunodeficiency Virus 1 (HIV-1), Human Immunodeficiency Virus 2 (HIV-2) and Simian Immunodeficiency Virus (SIV) Proteases and their complexes with inhibitors or products of substrate cleavage.
... A Week of Healthy Breakfasts Shyness HIV and AIDS KidsHealth > For Teens > HIV and AIDS Print A A A What's in this article? ... in human history. HIV causes a condition called acquired immunodeficiency syndrome — better known as AIDS . HIV destroys a type ...
Frederiksen, Karen-Margrete; Laursen, Katja Årosin
This paper presents our reflections on developing the Computer-Assisted Language Learning (CALL) course "Danish for knowledge workers--labour market-related Danish." As defined by Laursen and Frederiksen (2015), knowledge workers are "highly educated people who typically work at universities, at other institutions of higher…
Okechukwu, Adaora Adeline; Ekop, Eno; Ndukwe, Chinwendu Daniel; Olateju, Kudirat Eyinade
Introduction Less than 10% of HIV positive children are enrolled into antiretroviral treatment program in the country. Provider-initiated testing and counseling was introduced to increasing uptake of HIV testing. The aim of this study is to determine the acceptability and factors undermining the acceptance of this laudable initiative by parents/caregivers of children attending paediatric out patient clinical services in our health institution. Methods A cross sectional study of children aged 18 months to 18 years and their parents/caregivers attending paediatric outpatient clinic of the hospital was undertaken for the above objectives. Results There were statistically more female parents/caregivers (82.5%, p=0.00), more male patients (52.9 %, p= 0.02), and 11.9% adolescents in this study. While 91.7% of parents/caregivers admitted not having knowledge of provider-initiated testing and counseling, 95.6% knew what HIV was. Acceptance of the program was high (98.7%), majority (89.7%) wanting to know the HIV status of their children/wards. Non-acceptance was small (1.2%), there main reason being prior knowledge of their HIV status. Prevalence of HIV among tested children was 1.7%. There was a strong relationship between having willingness to test for HIV and many of the study variables with religion of the parents/caregivers having the strongest relationship [OR: 13.94, (CI 1.82, 55.34)], and tribe having list association, [OR: 3.60, (CI 1.85, 17.14)]. Conclusion There was general wiliness to accept HIV test for children by their parents/caregiver in this study, and HIV prevalence in children is on a downward trend; its sustenance to be continued and adolescent clinics need to be created. PMID:27800100
Fenger, N; Broberg, M
The physician's liability in Danish law is based on negligence, which is assessed by the courts largely on the basis of expert opinions. Such opinions are provided primarily by the Medico-Legal Council rather than by experts selected by the parties. The evaluation of negligence is based on a "reasonable man" standard and the performance expected of a competent colleague; a hospital will be responsible for the negligence of its employees. The burden of proof generally lies with the plaintiff; negligence will not be presumed and the assessment of the evidence of negligence will be adapted to the individual situation, e.g. factors such as the degree of specialization involved, the time which the physician had at his disposal to make his decision and the resources available to him will be taken into consideration. The courts have shown themselves willing to allow for the fact that doctors differ, i.e. recognizing that there must be scope for reasonable discretion. Because the culpa principle is central, the standard applied to medical knowledge will be that which pertained at the time of the treatment. Where a non-specialist is confronted with a problem which may go beyond the knowledge of his limits and experience, he is under an obligation to refer the patient. The principle of informed consent to treatment is accepted in Danish law, but such consent will readily be considered to have been given tacitly.
Toft, Gunnar; Flyvbjerg, Allan; Bonde, Jens Peter
Background From animal studies it is known that currently used pesticides can disturb thyroid function. Methods In the present study we investigated the thyroid function in 122 Danish greenhouse workers, to evaluate if greenhouse workers classified as highly exposed to pesticides experiences altered thyroid levels compared to greenhouse workers with lower exposure. Serum samples from the greenhouse workers were sampled both in the spring and the fall to evaluate if differences in pesticide use between seasons resulted in altered thyroid hormone levels. Results We found a moderate reduction of free thyroxine (FT4) (10–16%) among the persons working in greenhouses with a high spraying load both in samples collected in the spring and the fall, but none of the other measured thyroid hormones differed significantly between exposure groups in the cross-sectional comparisons. However, in longitudinal analysis of the individual thyroid hormone level between the spring and the fall, more pronounced differences where found with on average 32% higher thyroid stimulating hormone (TSH) level in the spring compared to the fall and at the same time a 5–9% lower total triiodthyroxin (TT3), free triiodthyroxine (FT3) and FT4. The difference between seasons was not consistently more pronounced in the group classified as high exposure compared to the low exposure groups. Conclusion The present study indicates that pesticide exposure among Danish greenhouse workers results in only minor disturbances of thyroid hormone levels. PMID:17147831
Ehrich, Jochen; Namazova-Baranova, Leyla; Pettoello-Mantovani, Massimo
The field of pediatrics in Europe is characterized by the diversities, variations, and heterogeneities of child health care services provided in 53 European countries with more than 200 million children below 18 years of age. Managing the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within a typical environment characterized by cultural and economic complexity and large disparity in availability, affordability, and accessibility of pediatric care. Since its foundation in 1976, the European Paediatric Association-Union of National European Paediatric Societies and Associations has worked to improve both medical care of all children and cooperation of their caretakers in Europe. Such a report has been conceived in the strong belief that broadening of the intellectual basis of the European Paediatric Association-Union of National European Paediatric Societies and Associations and creating a multidisciplinary society will be necessary to reduce fragmentation of pediatrics and tackle the legal, economic, and organizational challenges of child health care in Europe.
HIV Treatment FDA-Approved HIV Medicines (Last updated 2/27/2017; last reviewed 2/27/2017) Treatment with ... 2007 Pharmacokinetic Enhancers Pharmacokinetic enhancers are used in HIV treatment to increase the effectiveness of an HIV medicine ...
... Subscribe Translate Text Size Print What Is HIV/AIDS? Human Immunodeficiency Virus (HIV) HIV stands for human ... use the HIV Testing & Care Services Locator. GO Acquired Immunodeficiency Syndrome (AIDS) AIDS stands for acquired immunodeficiency syndrome. AIDS ...
Background Malaria is a major cause of paediatric morbidity and mortality. As no clinical features clearly differentiate malaria from other febrile illnesses, and malaria diagnosis is challenged by often lacking laboratory equipment and expertise, overdiagnosis and overtreatment is common. Methods Children admitted with fever at the general paediatric wards at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania from January to June 2009 were recruited consecutively and prospectively. Demographic and clinical features were registered. Routine thick blood smear microscopy at MNH was compared to results of subsequent thin blood smear microscopy, and rapid diagnostics tests (RDTs). Genus-specific PCR of Plasmodium mitochondrial DNA was performed on DNA extracted from whole blood and species-specific PCR was done on positive samples. Results Among 304 included children, 62.6% had received anti-malarials during the last four weeks prior to admission and 65.1% during the hospital stay. Routine thick blood smears, research blood smears, PCR and RDT detected malaria in 13.2%, 6.6%, 25.0% and 13.5%, respectively. Positive routine microscopy was confirmed in only 43% (17/40), 45% (18/40) and 53% (21/40), by research microscopy, RDTs and PCR, respectively. Eighteen percent (56/304) had positive PCR but negative research microscopy. Reported low parasitaemia on routine microscopy was associated with negative research blood slide and PCR. RDT-positive cases were associated with signs of severe malaria. Palmar pallor, low haemoglobin and low platelet count were significantly associated with positive PCR, research microscopy and RDT. Conclusions The true morbidity attributable to malaria in the study population remains uncertain due to the discrepancies in results among the diagnostic methods. The current routine microscopy appears to result in overdiagnosis of malaria and, consequently, overuse of anti-malarials. Conversely, children with a false positive malaria diagnosis
Feucht, Ute D; Meyer, Anell; Thomas, Winifred N; Forsyth, Brian W C; Kruger, Mariana
HIV-infected children require early initiation of antiretroviral therapy (ART) to ensure good outcomes. The aim was to investigate missed opportunities in childhood HIV diagnosis leading to delayed ART initiation. Baseline data were reviewed of all children aged <15 years referred over a 1-year period for ART initiation to the Kalafong Hospital HIV services in Gauteng, South Africa. Of the 250 children, one-quarter (24.5%) was of school-going age, 34.5% in the preschool group, 18% between 6 and 12 months old and 23% below 6 months of age (median age = 1.5 years [interquartile range 0.5-4.8]). Most children (82%) presented with advanced/severe HIV disease, particularly those aged 6-12 months (95%). Malnutrition was prominent and referrals were mostly from hospital inpatient services (61%). A structured caregiver interview was conducted in a subgroup, with detailed review of medical records and HIV results. The majority (≥89%) of the 65 interviewed caregivers reported good access to routine healthcare, except for postnatal care (26%). Maternal HIV-testing was mostly done during the second and third pregnancy trimesters (69%). Maternal non-disclosure of HIV status was common (63%) and 83% of mothers reported a lack of psychosocial support. Routine infant HIV-testing was not done in 66%, and inadequate reporting on patient-held records (Road-to-Health Cards/Booklets) occurred frequently (74%). Children with symptomatic HIV disease were not investigated at primary healthcare in 53%, and in 68% of families the siblings were not tested. One-third of children (35%) had a previous HIV diagnosis, with 77% of caregivers aware of these prior results, while 50% acknowledged failing to attend ART services despite referral. In conclusion, a clear strategy on paediatric HIV case finding, especially at primary healthcare, is vital. Multiple barriers need to be overcome in the HIV care pathway to reach high uptake of services, of which especially maternal reasons for not
ESPR Uroradiology Task Force and ESUR Paediatric Working Group--Imaging recommendations in paediatric uroradiology, part V: childhood cystic kidney disease, childhood renal transplantation and contrast-enhanced ultrasonography in children.
Riccabona, Michael; Avni, Fred Efraim; Damasio, Maria Beatrice; Ording-Müller, Lil-Sofie; Blickman, Johan G; Darge, Kassa; Lobo, Maria Luisa; Papadopoulou, Frederica; Vivier, Pierre-Hugues; Willi, Ullrich
The ESPR Uroradiology Task Force and the ESUR Paediatric Working Group present two new recommendations on imaging in childhood cystic kidney disease and in childhood renal transplantation, and address the presently restricted availability of contrast-enhanced (ce) US in children. New insights into the genetics require an updated classification of paediatric cystic kidney disease along with a new concept of diagnostic imaging. Characteristic imaging features are key to the new classification. Available recommendations for imaging renal transplantation in children are not satisfactory. The following consensus-based algorithm proposes a more effective and more uniform imaging concept, reducing invasiveness, enhancing diagnostic accuracy, and facilitating future multicentre studies and meta-analysis. At present, ce-US in children can only be performed off-license, since the only approved US contrast agent (CA) for children has been taken off the market. Nevertheless, paediatric ce-US is practiced at multiple places using Sonovue (Bracco, Milan, Italy), a generally available agent in Europe. From a medical and scientific perspective, paediatric ce-US should be promoted, and efforts are undertaken to collect data on paediatric US-CA applications. Routine paediatric imaging depends on local expertise and availability of equipment. The imaging recommendations and supportive data are intended to ease the physicians' difficult task of dealing with the specific diagnostic demands of paediatric paediatric cystic kidney disease and transplantation.
Report from The International Society for Nomenclature of Paediatric and Congenital Heart Disease: cardiovascular catheterisation for congenital and paediatric cardiac disease (Part 2 - Nomenclature of complications associated with interventional cardiology).
Bergersen, Lisa; Giroud, Jorge Manuel; Jacobs, Jeffrey Phillip; Franklin, Rodney Cyril George; Béland, Marie Josée; Krogmann, Otto Nils; Aiello, Vera Demarchi; Colan, Steven D; Elliott, Martin J; Gaynor, J William; Kurosawa, Hiromi; Maruszewski, Bohdan; Stellin, Giovanni; Tchervenkov, Christo I; Walters, Henry Lane; Weinberg, Paul; Everett, Allen Dale
Interventional cardiology for paediatric and congenital cardiac disease is a relatively young and rapidly evolving field. As the profession begins to establish multi-institutional databases, a universal system of nomenclature is necessary for the field of interventional cardiology for paediatric and congenital cardiac disease. The purpose of this paper is to present the results of the efforts of The International Society for Nomenclature of Paediatric and Congenital Heart Disease to establish a system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease, focusing both on procedural nomenclature and the nomenclature of complications associated with interventional cardiology. This system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease is a component of The International Paediatric and Congenital Cardiac Code. This manuscript is the second part of the two-part series. Part 1 covered the procedural nomenclature associated with interventional cardiology as treatment for paediatric and congenital cardiac disease. Part 2 will cover the nomenclature of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease.
Abduljalil, Khaled; Jamei, Masoud; Rostami-Hodjegan, Amin; Johnson, Trevor N
Although both POPPK and physiologically based pharmacokinetic (PBPK) models can account for age and other covariates within a paediatric population, they generally do not account for real-time growth and maturation of the individuals through the time course of drug exposure; this may be significant in prolonged neonatal studies. The major objective of this study was to introduce age progression into a paediatric PBPK model, to allow for continuous updating of anatomical, physiological and biological processes in each individual subject over time. The Simcyp paediatric PBPK model simulator system parameters were reanalysed to assess the impact of re-defining the individual over the study period. A schedule for re-defining parameters within the Simcyp paediatric simulator, for each subject, over a prolonged study period, was devised to allow seamless prediction of pharmacokinetics (PK). The model was applied to predict concentration-time data from multiday studies on sildenafil and phenytoin performed in neonates. Among PBPK system parameters, CYP3A4 abundance was one of the fastest changing covariates and a 1-h re-sampling schedule was needed for babies below age 3.5 days in order to seamlessly predict PK (<5% change in abundance) with subject maturation. The re-sampling frequency decreased as age increased, reaching biweekly by 6 months of age. The PK of both sildenafil and phenytoin were predicted better at the end of a prolonged study period using the time varying vs fixed PBPK models. Paediatric PBPK models which account for time-varying system parameters during prolonged studies may provide more mechanistic PK predictions in neonates and infants.
Hugo-Hamman, Christopher; Jacobs, Jeffery Phillip
The first World Congress of Paediatric Cardiology was held in London, United Kingdom, in 1980, organised by Dr. Jane Somerville and Prof. Fergus Macartney. The idea was that of Jane Somerville, who worked with enormous energy and enthusiasm to bring together paediatric cardiologists and surgeons from around the world. The 2nd World Congress of Paediatric Cardiology took place in New York in 1985, organised by Bill Rashkind, Mary Ellen Engle, and Eugene Doyle. The 3rd World Congress of Paediatric Cardiology was held in Bangkok, Thailand, in 1989, organised by Chompol Vongraprateep. Although cardiac surgeons were heavily involved in these early meetings, a separate World Congress of Paediatric Cardiac Surgery was held in Bergamo, Italy, in 1988, organised by Lucio Parenzan. Thereafter, it was recognised that surgeons and cardiologists working on the same problems and driven by a desire to help children should really rather meet together. A momentous decision was taken to initiate a Joint World Congress of Paediatric Cardiology and Cardiac Surgery. A steering committee was established with membership comprising the main organisers of the four separate previous Congresses, and additional members were recruited in an effort to achieve numerical equality of cardiologists and surgeons and a broad geographical representation. The historic 1st "World Congress of Paediatric Cardiology and Cardiac Surgery" took place in Paris in June, 1993, organised by Jean Kachaner. The next was to be held in Japan, but the catastrophic Kobe earthquake in 1995 forced relocation to Hawaii in 1997. Then followed Toronto, Canada (2001, organised by Bill Williams and Lee Benson), Buenos Aires, Argentina (2005, organised by Horatio Capelli and Guillermo Kreutzer), and most recently Cairns, Australia (2009, organised by Jim Wilkinson). Having visited Europe (1993), Asia-Pacific (1997), North America (2001), South America (2005), and Australia (2009), and reflecting the "African Renaissance", the
Rabie, Helena; Frigati, Lisa; Hesseling, Anneke C; Garcia-Prats, Anthony J
Introduction In 2014 the Joint United Nations Programme on HIV/AIDS defined the ambitious 90–90–90 targets for 2020, in which 90% of people living with HIV must be diagnosed, 90% of those diagnosed should be on sustained therapy and 90% of those on therapy should have an undetectable viral load. Children are considered to be a key focus population for these targets. This review will highlight key components of the epidemiology, prevention and treatment of tuberculosis (TB) in HIV-infected children in the era of increasing access to antiretroviral therapy (ART) and their relation to the 90–90–90 targets. Discussion The majority of HIV-infected children live in countries with a high burden of TB. In settings with a high burden of both diseases such as in sub-Saharan Africa, up to 57% of children diagnosed with and treated for TB are HIV-infected. TB results in substantial morbidity and mortality in HIV-infected children, so preventing TB and optimizing its treatment in HIV-infected children will be important to ensuring good long-term outcomes. Prevention of TB can be achieved by increasing access to ART to both children and adults, and appropriate provision of isoniazid preventative therapy. Co-treatment of HIV and TB is complicated by drug-drug interactions particularly due to the use of rifampicin; these may compromise virologic outcomes if appropriate corrective actions are not taken. There remain substantial operational challenges, and improved integration of paediatric TB and HIV services, including with antenatal and routine under-five care, is an important priority. Conclusions TB may be an important barrier to achievement of the 90–90–90 targets, but specific attention to TB care in HIV-infected children may provide important opportunities to enhance the care of both TB and HIV in children. PMID:26639110
Kenny, S; Shankar, K; Rintala, R; Lamont, G; Lloyd, D
Accepted 18 September 1996 OBJECTIVES—To determine the proportion of paediatric surgical interventions that are evidence-based and to identify areas where randomised controlled trials (RCTs) or further research are required. DESIGN—Prospective review of paediatric general surgical inpatients. SETTING—A regional paediatric surgical unit. SUBJECTS—All consecutive paediatric general surgical patients admitted in November, 1995. MAIN OUTCOME MEASURES—Each patient on whom a diagnosis had been made was allocated a primary diagnosis and primary intervention (n=281). On the basis of expert knowledge, Plusnet Medline, and ISI Science Citation database searches, each intervention was categorised according to the level of supporting evidence: category 1, intervention based on RCT evidence; category 2, intervention with convincing non-experimental evidence such that an RCT would be unethical and unjustified; category 3, intervention without substantial supportive evidence. RESULTS—Of 281 patient interventions, 31 (11%) were based on controlled trials and 185 (66%) on convincing non-experimental evidence. Only 23% of interventions were category 3. CONCLUSIONS—In common with other medical specialties, the majority of paediatric surgical interventions are based on sound evidence. However, only 11% of interventions are based on RCT data, perhaps reflecting the nature of surgical practice. Further RCTs or research is indicated in a proportion of category 3interventions. PMID:9059162
Kua, Phek Hui Jade; Wu, Li; Ong, E-Lin Tessa; Lim, Zi Ying; Yiew, Jinmian Luther; Thia, Xing Hui Michelle; Sung, Sharon Cohan
INTRODUCTION A significant percentage of paediatric emergency department (ED) attendances worldwide are nonurgent, adversely affecting patient outcomes and healthcare systems. This study aimed to understand the reasons behind nonurgent ED visits, in order to develop targeted and effective preventive interventions. METHODS In-depth interviews were conducted with 49 caregivers to identify the decision-making factors related to taking children to the ED of KK Women’s and Children’s Hospital, Singapore. Interviews were carried out in the emergency room of the hospital after the children had been diagnosed with nonurgent conditions by the attending physician. Interview transcripts were analysed based on grounded theory principles. RESULTS The demographics of our study cohort were representative of the target population. The main reasons given by the caregivers for attending paediatric EDs included perceived severity of the child’s symptoms, availability of after-hours care, perceived advantage of a paediatric specialist hospital and mistrust of primary care physicians’ ability to manage paediatric conditions. Insurance or welfare was a contributing factor for only a small portion of caregivers. CONCLUSION The reasons provided by Singaporean caregivers for attending paediatric EDs were similar to those reported in studies conducted in Western countries. However, the former group had a unique understanding of the local healthcare system. The study’s findings may be used to develop interventions to change the knowledge, attitudes and behaviours of caregivers in Singapore. PMID:26805668
The present article aims to scrutinize publishing ethics in the fields of paediatrics and paediatric nursing. Full-text readings of all original research articles in paediatrics from a high-income economy, i.e. Sweden, and from all low-income economies in Sub-Saharan Africa, were reviewed as they were indexed and stored in Web of Science for the search period from 1 January 2007 to 7 October 2009. The application of quantitative and qualitative content analysis revealed a marked discrepancy in publishing frequencies between the two contrasting economies. Authors from 16 low-income economies in Sub-Saharan Africa, with at least one article stored, were obviously closely linked to co-authorships and foreign funding sources, predominantly from Europe and the USA. Statements concerning conflicts of interest were frequently missing (both regions), even when multiple financial sources, including companies, were involved. It is necessary to be aware of possible systematic bias when using electronic databases to search for certain topics and regions. Further research regarding publishing ethics in paediatrics and paediatric nursing is emphasized.
Kierkus, Jaroslaw; Oracz, Grzegorz; Korczowski, Bartosz; Szymanska, Edyta; Wiernicka, Anna; Woynarowski, Marek
Gastroesophageal reflux is one of the most common reasons for referrals to paediatricians or paediatric gastroenterologists. Gastric acid-buffering agents, mucosal surface barriers and gastric anti-secretory agents are the main groups of medications currently used for treating gastroesophageal reflux disease (GERD) in children. Recently, the use of proton pump inhibitors (PPIs) for the treatment of GERD in children has increased considerably. Their effectiveness in healing erosive oesophagitis in paediatric subjects and in improving GERD symptoms has been established in many studies. However, the effectiveness in other clinical conditions and the long-term safety of PPIs for paediatric GERD have not been fully established yet and thus are still under debate. Therefore, the aim of this article is to provide a comparative review of the efficacy, safety and tolerability of PPIs in paediatric GERD. The available data suggest that short-term use of PPIs is well tolerated. Adverse events tend to be of a mild-to-moderate nature, with headache being the most frequently reported treatment-related adverse event. However, further well-designed trials and observational studies are still needed to clarify the efficacy and safety of PPIs in the paediatric population, especially in infants under the age of 12 months.
Katyal, Vandana; Kennedy, Declan; Martin, James; Dreyer, Craig; Sampson, Wayne
The essential feature of paediatric sleep-disordered breathing (SDB) is increased upper airway resistance during sleep presenting clinically as snoring. Paediatric SDB is a continuum ranging from primary snoring (PS), which is not associated with gas exchange abnormalities or significant sleep fragmentation, to obstructive sleep apnoea (OSA) with complete upper airway obstruction, hypoxaemia, and obstructive hypoventilation. Adenotonsillar hypertrophy, obesity and craniofacial disharmonies are important predisposing factors in the development and progression of paediatric SDB. Clinical symptoms are significant and domains affected include behaviour, neurocognition, cardiovascular morbidity and quality of life. Overnight polysomnography is the current diagnostic gold standard method to assess SDB severity while adenotonsillectomy is the recommended first line of treatment. Other treatments for managing paediatric SDB include nasal continuous airway pressure, the administration of nasal steroids, dentofacial orthopaedic treatment and surgery. However, there are insufficient long-term efficacy data using dentofacial orthopaedics to treat paediatric SDB. Further studies are warranted to define the characteristics of patients who may benefit most from orthodontic treatment.
Sicotte, Claude; Lehoux, Pascale; Van Doesburg, Nicolaas; Cardinal, Godefroy; Leblanc, Yves
We analysed the cost-effectiveness of a teleconsultation service after five years of operation. The service provides diagnostic consultation at a distance for children suffering from cardiac pathologies. A retrospective study was performed with all 78 infants who had received a paediatric cardiology teleconsultation over a four-year period from January 1998. The cost-effectiveness of telecardiology was compared with that of the conventional means of providing services. Teleconsultation proved to be an effective and reliable method of enhancing access to tertiary care. The number of patient journeys (both emergency transfers and semi-urgent or elective visits to the tertiary care centre) was reduced by 42%. However, the cost analysis demonstrated that teleconsultation did not result in overall cost savings: the total cost of telecardiology was C dollars 272,327 and the total cost of conventional care would have been C dollars 157,212. There were direct savings for patients but not for the health-care system, because of the high cost of the equipment and telecommunication fees. Telemedicine therefore represented a supplementary cost of C dollars 1500 per patient. In summary, telemedicine added to cost but increased effectiveness. The incremental cost-effectiveness ratio of teleconsultation was estimated to C dollars 3488 per patient journey avoided.
Marès Bermúdez, J; van Esso Arbolave, D; Arístegui Fernández, J; Ruiz Contreras, J; González Hachero, J; Merino Moína, M; Barrio Corrales, F; Alvarez García, F J; Cilleruelo Ortega, M J; Ortigosa Del Castillo, L; Moreno Pérez, D
The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules.
Birring, Surinder S; Kavanagh, Joanne; Lai, Kefang; Chang, Anne B
Cough is one of the most common reasons that patients seek medical attention. Cough guidelines from numerous countries and societies are available to assist the clinician to investigate and manage patients with cough. We review some of the recent progress in the field of cough that may lead to revision of these guidelines. In adults with chronic cough, new causes such as obstructive sleep apnoea have been identified. A new terminology, cough hypersensitivity syndrome (CHS), has been proposed for patients with chronic cough, which emphasises cough reflex hypersensitivity as a key feature. New therapeutic options are now available, particularly for patients with refractory or idiopathic chronic cough, which include gabapentin, speech pathology management and morphine. There has been great progress in the assessment of cough with the development of validated quality of life questionnaires and cough frequency monitoring tools. In children, common aetiologies differ from adults and those managed according to guidelines have better outcomes compared to usual care. New diagnostic entities such as protracted bacterial bronchitis have been described. Paediatric-specific cough assessment tools such as the Parent/Child Quality of Life Questionnaire will help improve the assessment of patients. Further research is necessary to improve the evidence base for future clinical guideline recommendations. Guidelines in future should also aim to reach a wider audience that includes primary care physicians, non-specialists and patients.
Shalitin, S; Peter Chase, H
Type 1 diabetes (T1D) is one of the most common chronic childhood diseases and its incidence has doubled during the last decade. The goals of intensive management of diabetes were established in 1993 by the Diabetes Control and Complications Trial (DCCT) (1). Children with T1D and their caregivers continue to face the challenge to maintain blood glucose levels in the near-normal range. It is important to prevent sustained hyperglycaemia which is associated with long-term microvascular and macrovascular complications and to avoid recurrent episodes of hypoglycaemia or hyperglycaemia, especially in young children, which may have adverse effects on cognitive function and impede efforts to achieve the recommended glycaemic targets. Advances in the use of technology that may help maintain the metabolic control goals for young people with T1D were centred on continuous subcutaneous insulin infusion (CSII) (2-4), continuous glucose monitoring (CGM) (5-7), and combining both technologies into a closed-loop system (8-10). The dilemma in paediatrics of patient selection for insulin pump therapy was found to be most successful in those with more frequent self-monitoring of blood glucose (SMBG) and younger age prior to pump initiation (2). Similarly, those who used a dual-wave bolus probably paid closer attention to their management and had lower HbA1c levels (3). The advantage of using a pre-meal bolus to improve postprandial glucose levels was shown to offer another potential method to improve glycaemic control (4). SMBG is an important component of therapy in patients with diabetes, especially in the paediatric age group. Standard use of glucose meters for SMBG provides only intermittent single blood glucose levels, without giving the 'whole picture' of glucose variability during the 24 h, and especially during the night, when blood glucose levels are seldom measured. Therefore, the use of a device such as real-time continuous glucose monitoring (RT-CGM) that provides
Brown, David W; Allan, Catherine K; Newburger, Jane W
The Fellowship Program of the Department of Cardiology at Boston Children's Hospital seeks to train academically oriented leaders in clinical care and laboratory and clinical investigation of cardiovascular disease in the young. The core clinical fellowship involves 3 years in training, comprising 24 months of clinical rotations and 12 months of elective and research experience. Trainees have access to a vast array of research opportunities - clinical, basic, and translational. Clinical fellows interested in basic science may reverse the usual sequence and start their training in the laboratory, deferring clinical training for 1 or more years. An increasing number of clinical trainees apply to spend a fourth year as a senior fellow in one of the subspecialty areas of paediatric cardiology. From the founding of the Department to the present, we have maintained a fundamental and unwavering commitment to training and education in clinical care and research in basic science and clinical investigation, as well as to the training of outstanding young clinicians and investigators.
Tarantino, Samuela; Vollono, Catello; Capuano, Alessandro; Vigevano, Federico; Valeriani, Massimiliano
Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as trigeminal autonomic cephalalgia (TACs). CPH is characterised by short-lasting (2-30 min), severe and multiple (more than 5/day) pain attacks. Headache is unilateral, and fronto-orbital-temporal pain is combined with cranial autonomic symptoms. According to the International Classification of Headache Disorders, 2nd edition, the attacks are absolutely responsive to indomethacin. CPH has been only rarely and incompletely described in the developmental age. Here, we describe two cases concerning a 7-year-old boy and a 11-year-old boy with short-lasting, recurrent headache combined with cranial autonomic features. Pain was described as excruciating, and was non-responsive to most traditional analgesic drugs. The clinical features of our children's headache and the positive response to indomethacin led us to propose the diagnosis of CPH. Therefore, our children can be included amongst the very few cases of this trigeminal autonomic cephalgia described in the paediatric age.
Drusin, L M; Sohmer, M; Groshen, S L; Spiritos, M D; Senterfit, L B; Christenson, W N
Seven members of staff in a paediatric intensive care unit and two of their relatives developed hepatitis A over a period of five days. A 13 year old boy who was incontinent of faeces prior to his death, was presumed to be the source of infection. Two hundred and sixty seven other members of staff underwent serological testing and were given prophylactic pooled gamma globulin. Twenty three per cent were immune before exposure. Of people born in the United States, those at highest risk of developing the disease are physicians, dentists, nurses and those under the age of 40. Of those born outside the United States, being white and under the age of 30 are the two main risk factors. Data from a questionnaire sent to 19 nurses at risk (six cases, 13 controls) suggested that sharing food with patients or their families, drinking coffee, sharing cigarettes and eating in the nurses' office in the intensive care unit were associated with an increased incidence of hepatitis. Nurses with three or four of these habits were at particular risk. The costs of screening and prophylaxis were US $64.72 per employee, while prophylaxis alone would have cost US $8.42 per employee. Assessing risk factors on the one hand and costs of prophylaxis on the other are important elements in the control of nosocomial infections. PMID:3632014
Kapoor, Kapil; Gupta, Shalu
Acute kidney injury (AKI) is a serious complication of malaria which has a very high mortality rate. A retrospective analysis of medical record data of children treated for malarial AKI in a paediatric intensive care unit (PICU) was performed in order to evaluate the incidence, poor prognostic factors and outcome of AKI with malaria. Eighteen (48.6%) malarial patients had AKI (11 Plasmodium vivax positive, six P. falciparum positive and one mixed infection) with a male-to-female ratio of 1:2. The mean age was 75 ± 32 months (range, 1 month to 10 years). Oliguria was present in 61.1% and 55.5% required renal replacement therapy. Mortality was noted in 33.3% of patients and full recovery was achieved in 50% of patients. Oliguria, shock, central nervous system involvement, jaundice, disseminated intravascular coagulopathy and acute respiratory distress syndrome emerged as bad prognostic factors in simple univariate analysis. Malaria patients with and without AKI differ significantly in terms of shock, ventilator requirement, mortality and length of PICU stay.
López Alvarez-Buhilla, P; Astigarraga Aguirre, I; Torres Piedra, C; Azcona Zorrilla, M I; Olaizola Mendibil, A; Latorre Guisasola, M
By one-stop surgery is meant the performing of both the pre-surgery assessment and the surgical procedure on the same day. We report our experience with a pilot study on one-stop surgery in the province of Bizkaia, with a population of 124,494 children aged 1 to 14 years old. Under the new scheme, the patient average of four visits to the hospital outpatient clinics was cut down to only one. Diagnosis and pre-surgery assessments were made by the children's Primary Care Paediatricians at their NHS clinics. Seventy-five children were treated over 10 months. They had abdominal wall, genital or soft tissue surgery. Only two developed minor complications. Families were generally satisfied with the quality of the medical care received as shown by a survey: 32.7% scored it as "excellent", 36.2% "very good", 24.1% "good" and 3.4% "medium". We think that one-stop surgery is a breakthrough in ambulatory surgery. Not only does it dramatically lower the number of visits to hospital outpatient clinics, but also the waiting time for surgery, the costs, and the surgeon's workload, and helps streamline the Public Health Services and the quality of the medical care as perceived by both patients and families. Ensuring a close relationship between Paediatric Surgeons and Primary Care Paediatricians is paramount.
Kauss, Tina; Gaubert, Alexandra; Boyer, Chantal; Ba, Boubakar B; Manse, Muriel; Massip, Stephane; Léger, Jean-Michel; Fawaz, Fawaz; Lembege, Martine; Boiron, Jean-Michel; Lafarge, Xavier; Lindegardh, Niklas; White, Nicholas J; Olliaro, Piero; Millet, Pascal; Gaudin, Karen
Pharmaceutical development and manufacturing process optimization work was undertaken in order to propose a potential paediatric rectal formulation of azithromycin as an alternative to existing oral or injectable formulations. The target product profile was to be easy-to-use, cheap and stable in tropical conditions, with bioavailability comparable to oral forms, rapidly achieving and maintaining bactericidal concentrations. PEG solid solution suppositories were characterized in vitro using visual, HPLC, DSC, FTIR and XRD analyses. In vitro drug release and in vivo bioavailability were assessed; a study in rabbits compared the bioavailability of the optimized solid solution suppository to rectal solution and intra-venous product (as reference) and to the previous, non-optimized formulation (suspended azithromycin suppository). The bioavailability of azithromycin administered as solid solution suppositories relative to intra-venous was 43%, which compared well to the target of 38% (oral product in humans). The results of 3-month preliminary stability and feasibility studies were consistent with industrial production scale-up. This product has potential both as a classical antibiotic and as a product for use in severely ill children in rural areas. Industrial partners for further development are being sought.
Sonal Sekhar, M.; Sasidharan, Shalini; Joseph, Siby; Kumar, Anand
Migraine is one of the common causes of severe and recurring headache. It may be difficult to manage in primary care settings, where it is under diagnosed and medically treated. Migraine can occur in children as well as in adults and it is three times more common in women than in men. Migraine in children is different from adults in various ways. Migraine management depends on the various factors like duration and severity of pain, associated symptoms, degree of disability, and initial response to treatment. The therapy of children and adolescents with migraines includes treatment modalities for acute attacks, prophylactic medications when the attacks are frequent, and biobehavioural modes of treatment to aid long-term management of the disorder. The long lasting outcome of childhood headaches and progression into adult headaches remains largely unknown. However, it has been suggested that adult migraine may represent a progressive disorder. In children, the progressive nature is uncertain and further investigations into longitudinal outcome and phenotypic changes in childhood headaches have yet to be recognized. Even though paediatric and adult migraines seem to be slightly different from one another, but not enough to categorize either as sole. PMID:23960771
Skaburskas, K.; Estrella, F.; Shade, J.; Manset, D.; Revillard, J.; Rios, A.; Anjum, A.; Branson, A.; Bloodsworth, P.; Hauer, T.; McClatchey, R.; Rogulin, D.
The Health-e-Child (HeC) project ,  is an EC Framework Programme 6 Integrated Project that aims to develop a grid-based integrated healthcare platform for paediatrics. Using this platform biomedical informaticians will integrate heterogeneous data and perform epidemiological studies across Europe. The resulting Grid enabled biomedical information platform will be supported by robust search, optimization and matching techniques for information collected in hospitals across Europe. In particular, paediatricians will be provided with decision support, knowledge discovery and disease modelling applications that will access data in hospitals in the UK, Italy and France, integrated via the Grid. For economy of scale, reusability, extensibility, and maintainability, HeC is being developed on top of an EGEE/gLite  based infrastructure that provides all the common data and computation management services required by the applications. This paper discusses some of the major challenges in bio-medical data integration and indicates how these will be resolved in the HeC system. HeC is presented as an example of how computer science (and, in particular Grid infrastructures) originating from high energy physics can be adapted for use by biomedical informaticians to deliver tangible real-world benefits.
Kauss, Tina; Gaubert, Alexandra; Boyer, Chantal; Ba, Boubakar B.; Manse, Muriel; Massip, Stephane; Léger, Jean-Michel; Fawaz, Fawaz; Lembege, Martine; Boiron, Jean-Michel; Lafarge, Xavier; Lindegardh, Niklas; White, Nicholas J.; Olliaro, Piero; Millet, Pascal; Gaudin, Karen
Pharmaceutical development and manufacturing process optimization work was undertaken in order to propose a potential paediatric rectal formulation of azithromycin as an alternative to existing oral or injectable formulations. The target product profile was to be easy-to-use, cheap and stable in tropical conditions, with bioavailability comparable to oral forms, rapidly achieving and maintaining bactericidal concentrations. PEG solid solution suppositories were characterized in vitro using visual, HPLC, DSC, FTIR and XRD analyses. In vitro drug release and in vivo bioavailability were assessed; a study in rabbits compared the bioavailability of the optimized solid solution suppository to rectal solution and intra-venous product (as reference) and to the previous, non-optimized formulation (suspended azithromycin suppository). The bioavailability of azithromycin administered as solid solution suppositories relative to intra-venous was 43%, which compared well to the target of 38% (oral product in humans). The results of 3-month preliminary stability and feasibility studies were consistent with industrial production scale-up. This product has potential both as a classical antibiotic and as a product for use in severely ill children in rural areas. Industrial partners for further development are being sought. PMID:23220079
Churchill, Amanda; Graw, Jochen
Cataracts (opacities of the lens) are frequent in the elderly, but rare in paediatric practice. Congenital cataracts (in industrialized countries) are mainly caused by mutations affecting lens development. Much of our knowledge about the underlying mechanisms of cataractogenesis has come from the genetic analysis of affected families: there are contributions from genes coding for transcription factors (such as FoxE3, Maf, Pitx3) and structural proteins such as crystallins or connexins. In addition, there are contributions from enzymes affecting sugar pathways (particularly the galactose pathway) and from a quite unexpected area: axon guidance molecules like ephrins and their receptors. Cataractous mouse lenses can be identified easily by visual inspection, and a remarkable number of mutant lines have now been characterized. Generally, most of the mouse mutants show a similar phenotype to their human counterparts; however, there are some remarkable differences. It should be noted that many mutations affect genes that are expressed not only in the lens, but also in tissues and organs outside the eye. There is increasing evidence for pleiotropic effects of these genes, and increasing consideration that cataracts may act as early and readily detectable biomarkers for a number of systemic syndromes. PMID:21402583
Dolter, J; Wong, J; Janda, J M
Twenty-two strains of Neisseria cinerea were recovered from paediatric patients over a 7-year period and forwarded to the Microbial Diseases Laboratory for biochemical identification and/or confirmation. Eighteen of these 22 strains (82%) were recovered from the eyes of very young children (< or = 1 year), > 50% occurring during the neonatal period. The majority of eye isolates were involved in a variety of ocular infections including orbital cellulitis, conjunctivitis, and eye discharge (most common); in four of the 13 instances (31%) where laboratory data was available, Neisseria cinerea was recovered in pure culture. Neisseria cinerea isolates were often submitted to the Microbial Diseases Laboratory as possible 'N. gonorrhoeae' or 'Neisseria species' due to problems resulting from the use of commercial assays or unfamiliarity with the organism. These observations indicate that N. cinerea can produce eye infections in very young children, who presumably acquire this organism vertically from the mother during birth. Accurate identification of N. cinerea in such infants can preclude the social trauma and possible legal ramifications which can initially result from its misidentification as N. gonorrhoeae.
Couch, Elizabeth; Mead, Jean Marie; Walsh, Margaret M
Systematic oral care reduces oral complications among children in paediatric palliative care (PPC), yet little is known about the oral health perceptions of PPC nursing staff. This qualitative cross-sectional study used semi-structured interviews based on phenomenography to explore PPC nursing staff's perceptions of oral health and the relationship of oral care to comfort and quality of life. A purposive sample of nine nursing staff employed at a California PPC facility participated. Five themes emerged from the analysis of the interviews: signs of oral health, reasons for oral care, adaptation of oral care on a case-by-case basis, barriers to providing oral care, and facilitators of improving oral care. The perceived importance of oral health was the underlining similarity between the themes. A need for further research in the area of oral PPC is indicated. Collaboration with dental professionals may be needed to create oral PPC guidelines that fit the complex needs of children with life-limiting illnesses.
Ojukwu, J U; Ogbu, C N
The increasing prevalence of HIV infection in Nigeria, its similar manifestations with endemic diseases and limited facilities for screening calls for judicious HIV testing. Children aged one month to 15 years admitted into the paediatric ward of the Ebonyi State University Teaching Hospital between January 2000 and September 2001 for various endemic diseases were reviewed retrospectively. Eight clinical risk factors commonly associated with HIV infection and endemic diseases present either singly or in combination, were reviewed to determine whether they could help to predict HIV infection and at what level and finally help formulate criteria for selective screening of HIV infection. Children above 18 months of age were diagnosed as being infected with HIV if they tested positive by two different HIV enzyme-linked immunosorbent assay (ELISA) tests. In children less than 18 months of age the diagnosis of HIV infection was made if they were ELISA positive and also fulfilled the WHO criteria for symptomatic HIV infection. Of the 282 children reviewed 31 (11.0%) were HIV positive giving a sero-prevalence rate of 4.1% of total admission. The HIV seropositive rate was highest in oral candidiasis (OC) (38.2%), followed by severe malnutrition (SM) (33.8%) then generalized lymphadenopathy (GLN) (31.4%). The presence of SM, GLN, OC and chronic dermatitis were highly significant independent risk factors for predicting HIV seropositivity (p<0.05). A marked shift towards the likelihood of HIV sero-positivity in the presence of at least two of the eight risk factors was documented. Children with two risk factors present had a 9.1 times more risk of being HIV sero-positive compared with those who had only one risk factor present (chi(2)=11.6, p=0.0007, OR = 9.1, 95% Cl = 2.5-32.8). Thirteen children (41.9%) representing a vast majority of HIV-positive children showed evidence of at least two of the eight clinical risk factors. As the number of risk factors concomitantly present
Becquet, Renaud; Marston, Milly; Dabis, François; Moulton, Lawrence H.; Gray, Glenda; Coovadia, Hoosen M.; Essex, Max; Ekouevi, Didier K.; Jackson, Debra; Coutsoudis, Anna; Kilewo, Charles; Leroy, Valériane; Wiktor, Stefan Z.; Nduati, Ruth; Msellati, Philippe; Zaba, Basia; Ghys, Peter D.; Newell, Marie-Louise
Background Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant survival by timing of HIV-infection (perinatally or postnatally) are thus needed. Methodology/Principal Findings A pooled analysis was conducted of individual data of all available intervention cohorts and randomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant antiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant characteristics. The Kaplan-Meier method was used to estimate survival curves by child's HIV infection status and timing of HIV infection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000 child-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of HIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected children by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6–3.0), maternal CD4<350 cells/ml (1.4, 1.1–1.7), postnatal (3.1, 2.1–4.1) or peri-partum HIV-infection (12.4, 10.1–15.3). Conclusions/Results These results update previous work and inform future UNAIDS modelling by providing survival estimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the prevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate antiretroviral care and support for HIV-infected children. PMID:22383946
la Cour, Peter
Patterns in the psychological defenses of medical students may have implications for the way they handle and respond to the pressures and developmental issues they encounter in medical school and beyond. Using the Defense Style Questionnaire (DSQ40) to assess psychological defenses, a sample of first-year Danish medical students was compared with a sample of students at a short-term boarding school for general education. The medical students scored significantly higher on items connected with pseudo-altruism, denial, and undoing. Trends in the data furthermore suggest a greater use of sublimation, rationalization, and dissociation among medical students. When defense mechanisms were labeled into mature, neurotic, and immature categories, there were no differences between the groups or in the total defense scores.
Argüello, R J; Balbaryski, J; Barboni, G; Candi, M; Gaddi, E; Laucella, S
The association between immune dysfunction and the development of autoimmune pathology in patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is not clear. The frequency and phenotype of regulatory T cells, as well as the presence of autoantibodies, were evaluated in a paediatric cohort of HIV-infected patients without clinical evidence of autoimmune disease. Lower absolute counts but higher percentages of total CD4+ forkhead box protein 3 (FoxP3)+ T cells were recorded in children with severe immunosuppression than in those without evidence of immunosuppression. The frequencies of classical CD4+CD25+FoxP3+ regulatory T cells were not altered, whereas CD4+FoxP3+CD25- T cells were found increased significantly in patients with severe immunosuppression. Like classical regulatory T cells, CD4+FoxP3+CD25- T cells display higher cytotoxic T-lymphocyte antigen 4 (CTLA-4) but lower CD127 expression compared with CD4+FoxP3–CD25+ T cells. An improvement in CD4+ T cell counts, along with a decrease in viral load, was associated with a decrease in CD4+FoxP3+CD25- T cells. The majority of the patients with severe immunosuppression were positive for at least one out of seven autoantibodies tested and displayed hypergammaglobulinaemia. Conversely, HIV-infected children without evidence of immunosuppression had lower levels of autoantibodies and total immunoglobulins. A decline in CD4+FoxP3+ T cell numbers or a variation in their phenotype may induce a raise in antigen exposure with polyclonal B cell activation, probably contributing to the generation of autoantibodies in the absence of clinical autoimmune disease. PMID:22471284
Skerlev, M; Husar, K; Sirotković-Skerlev, M
Molluscum contagiosum (MC) is a common cutaneous infection caused by the molluscipox virus (MCV) and can affect both children and adults. Molluscum contagiosum is relatively frequent in children aged 1-5 years old and can be localized almost anywhere on the body, but in adults it is regarded as a sexually transmitted infection (STI). MCV can be transmitted directly from person to person or by autoinoculation. MC in adults characteristically involves the genital area but extragenital appearance can be more typically seen in patients with immunosuppressive conditions, especially in HIV/AIDS. The onset of MC in HIV-positive individuals can be regarded as a part of the immune reconstitution inflammatory syndrome (IRIS). MC probably affects both sexes equally in children, whereas it seems that in adults the incidence is more prevalent in males. Therapy is controversial but may be considerably beneficial in preventing transmission or autoinoculation. At present there is no aetiological treatment of MC and most treatment options are mechanical sometimes causing discomfort or are not sufficiently evidence-based. Attention should be given to the extragenital site of involvement in adults and HIV testing should be recommended. Both children and adults with MC should be educated to avoid scratching and skin contact with others to prevent transmission and autoinoculation. Adult patients with MC should be carefully screened for other STIs and appropriately counseled.
Jakobsen, Jakob Kristian; Öztürk, Buket; Søgaard, Mette
Aim of database The Danish National Penile Cancer Quality database (DaPeCa-data) aims to improve the quality of cancer care and monitor the diagnosis, staging, and treatment of all incident penile cancer cases in Denmark. The aim is to assure referral practice, guideline adherence, and treatment and development of the database in order to enhance research opportunities and increase knowledge and survival outcomes of penile cancer. Study population The DaPeCa-data registers all patients with newly diagnosed invasive squamous cell carcinoma of the penis in Denmark since June 2011. Main variables Data are systematically registered at the time of diagnosis by a combination of automated data-linkage to the central registries as well as online registration by treating clinicians. The main variables registered relate to disease prognosis and treatment morbidity and include the presence of risk factors (phimosis, lichen sclerosus, and human papillomavirus), date of diagnosis, date of treatment decision, date of beginning of treatment, type of treatment, treating hospital, type and time of complications, date of recurrence, date of death, and cause of death. Descriptive data Registration of these variables correlated to the unique Danish ten-digit civil registration number enables characterization of the cohort, individual patients, and patient groups with respect to age; 1-, 3-, and 5-year disease-specific and overall survival; recurrence patterns; and morbidity profile related to treatment modality. As of August 2015, more than 200 patients are registered with ∼65 new entries per year. Conclusion The DaPeCa-data has potential to provide meaningful, timely, and clinically relevant quality data for quality maintenance, development, and research purposes. PMID:27822104
Overgaard, Jens; Jovanovic, Aleksandar; Godballe, Christian; Grau Eriksen, Jesper
Aim of the database The Danish Head and Neck Cancer database is a nationwide clinical quality database that contains prospective data collected since the early 1960s. The overall aim of this study was to describe the outcome of the national strategy for multidisciplinary treatment of head and neck cancer in Denmark and to create a basis for clinical trials. Study population The study population consisted of all Danish patients referred for treatment of squamous cell carcinoma of the larynx, pharynx, oral cavity, or neck nodes from unknown primary or any histopathological type (except lymphoma) of cancer in the nasal sinuses, salivary glands, or thyroid gland (corresponding to the International Classification of Diseases, tenth revision, classifications C.01–C.11, C.30–C.32, C.73, and C.80). Main variables The main variables used in the study were symptoms and the duration of the symptoms; etiological factors; pretreatment and diagnostic evaluation, including tumor–node–metastasis classification, imaging, histopathology, and laboratory tests; primary treatment with semidetailed information of radiotherapy, surgery, and medical treatment; follow-up registration of tumor status and side effects; registration of relapse and treatment thereof; and registration of death and cause of death. Main results Data from >33,000 patients have been recorded during a period of >45 years. In this period, the outcome of treatment improved substantially, partly due to better treatment as a result of a series of continuous clinical trials and subsequent implementation in national guidelines. The database has furthermore been used to describe the effect of reduced waiting time, changed epidemiology, and influence of comorbidity and socioeconomic parameters. Conclusion Half a century of registration of head and neck cancer treatment and outcome has created the basis for understanding and has substantially contributed to improve the treatment of head and neck cancer at both
Lamberg, Anna Lei; Sølvsten, Henrik; Lei, Ulrikke; Vinding, Gabrielle Randskov; Stender, Ida Marie; Jemec, Gregor Borut Ernst; Vestergaard, Tine; Thormann, Henrik; Hædersdal, Merete; Dam, Tomas Norman; Olesen, Anne Braae
Aim of database The Danish Nonmelanoma Skin Cancer Dermatology Database was established in 2008. The aim of this database was to collect data on nonmelanoma skin cancer (NMSC) treatment and improve its treatment in Denmark. NMSC is the most common malignancy in the western countries and represents a significant challenge in terms of public health management and health care costs. However, high-quality epidemiological and treatment data on NMSC are sparse. Study population The NMSC database includes patients with the following skin tumors: basal cell carcinoma (BCC), squamous cell carcinoma, Bowen’s disease, and keratoacanthoma diagnosed by the participating office-based dermatologists in Denmark. Main variables Clinical and histological diagnoses, BCC subtype, localization, size, skin cancer history, skin phototype, and evidence of metastases and treatment modality are the main variables in the NMSC database. Information on recurrence, cosmetic results, and complications are registered at two follow-up visits at 3 months (between 0 and 6 months) and 12 months (between 6 and 15 months) after treatment. Descriptive data In 2014, 11,522 patients with 17,575 tumors were registered in the database. Of tumors with a histological diagnosis, 13,571 were BCCs, 840 squamous cell carcinomas, 504 Bowen’s disease, and 173 keratoakanthomas. Conclusion The NMSC database encompasses detailed information on the type of tumor, a variety of prognostic factors, treatment modalities, and outcomes after treatment. The database has revealed that overall, the quality of care of NMSC in Danish dermatological clinics is high, and the database provides the necessary data for continuous quality assurance. PMID:27822110
Tan, Alethea; Smailes, Sarah; Friebel, Thessa; Magdum, Ashish; Frew, Quentin; El-Muttardi, Naguib; Dziewulski, Peter
Burn survival has improved with advancements in fluid resuscitation, surgical wound management, wound dressings, access to antibiotics and nutritional support for burn patients. Despite these advancements, the presence of smoke inhalation injury in addition to a cutaneous burn still significantly increases morbidity and mortality. The pathophysiology of smoke inhalation has been well studied in animal models. Translation of this knowledge into effectiveness of clinical management and correlation with patient outcomes including the paediatric population, is still limited. We retrospectively reviewed our experience of 13 years of paediatric burns admitted to a regional burn's intensive care unit. We compared critical care requirements and patient outcomes between those with cutaneous burns only and those with concurrent smoke inhalation injury. Smoke inhalation increases critical care requirements and mortality in the paediatric burn population. Therefore, early critical care input in the management of these patients is advised.
Since more than 35 years, the international medical scientific community tries to solve the problem of the off-label use of paediatric drugs. The aim is simple, but ambitious: to supply children and adolescents with effective drugs, as safe as possible, with known and well-documented side effects, and with accurate and up-to-date information on dosage and administration form. However, despite the significant efforts of paediatricians, researchers and international health politics, a number of severe obstacles for the optimal supply of children and adolescents with safe drugs remain. The detailed analysis of the problem shows not only a still remaining lack of medical knowledge, but also persistent weaknesses in the ethical, legal, medical, pharmacological, and political practices that surround the phenomenon of off-label use in paediatrics. The article gives an overview about the remaining difficulties in the field of paediatric off-label medication with special consideration to ethical and regulatory questions.
Nasir, A; Khader, A; Nasir, L; Abuzayed, I; Seita, A
Most physicians who work in the United Nations Relief and Works Agency (UNRWA) infant and child health programme in Jordan are general practitioners with no postgraduate training in paediatrics. Furthermore, in resource-poor or remote settings, the ability to deliver live continuing medical education (CME) is often limited. A questionnaire exploring the resources available for accessing CME, preferences for types of CME, current sources of CME and topics of interest in the field of paediatric care was sent to all 92 physicians practising in UNRWA clinics in Jordan. Of the 89 respondents 80% had attended live medical lectures for CME and 70% CME meetings. Despite most physicians having access to the Internet only 52.8% were interested in Internet-based courses for accessing CME. There was a statistically significant relationship between year of graduation from medical school and preference for Internet-based CME. Implications for CME participation and paediatric CME topics are discussed.
Vajro, Pietro; Ferrante, Lorenza; Lenta, Selvaggia; Mandato, Claudia; Persico, Marcello
Advances in the management of children with chronic liver disease have enabled many to survive into adulthood with or without their native livers, so that the most common of these conditions are becoming increasingly common in adult hepatology practice. Because the aetiologies of chronic liver disease in children may vary significantly from those in adulthood, adults with paediatric-onset chronic liver disease may often present with clinical manifestations unfamiliar to their adulthood physician. Transition of medical care to adult practice requires that the adulthood medical staff (primary physicians and subspecialists) have a comprehensive knowledge of childhood liver disease and their implications, and of the differences in caring for these patients. Pending still unavailable Scientific Society guidelines, this article examines causes, presentation modes, evaluation, management, and complications of the main paediatric-onset chronic liver diseases, and discusses key issues to aid in planning a program of transition from paediatric to adult patients.
Frey, Bernhard; Argent, Andrew
Neonatal and paediatric intensive care has improved the prognosis for seriously sick infants and children. This has happened because of a pragmatic approach focused on stabilisation of vital functions and immense technological advances in diagnostic and therapeutic procedures. However, the belief that more medical care must inevitably lead to improved health is increasingly being questioned. This issue is especially relevant in developing countries where the introduction of highly specialised paediatric intensive care may not lead to an overall fall in child mortality. Even in developed countries, the complexity and availability of therapeutics and invasive procedures may put seriously ill children at additional risk. In both developing and industrialised countries the use of safe and simple procedures for appropriate periods, particular attention to drug prescription patterns and selection of appropriate aims and modes of therapy, including non-invasive methods, may minimise the risks of paediatric intensive care.
Delawer, F M; Isono, M; Ueki, H; Zhuben, M; Zafari, M; Seddiq, M K; Habib, H; Ayoubi, M K
Case detection, diagnosis and treatment of tuberculosis 1 B) in children are challenging issues vorldwide. This study in Afghanistan aimed to evaluate paediatric TB case management, including contact investigation, at health facilities where all diagnostic processes were available. In 7 out of 8 regions of the country 1 province was selected. Documents used for management of paediatric TB cases were reviewed in 15 distinct hospitals and 8 provincial hospitals in the selected provinces. The key issues which emerged were: a low suspect rate among total outpatients (0.4%) and a very low suspect rate among children aged < 5 years; low performance of suspect management (68.5% suspects received further examinations); low utilization of other diagnostic methods; a high early defaulter rate (14.0%); and insufficient coverage of contact management (74.0%). This survey indicated that the Afghanistan national TB programme needs to develop plans to improve the quality of diagnosis, suspect management and contact management in paediatric TB cases.
UNESCO Bulletin for Libraries, 1978
A summary of a survey conducted in 1973 of Danish library services available to immigrant workers and their families, especially those speaking Arabic, Turkish, Urdu, and the languages used in Yugoslavia. (Author/KP)
Valva, P; Gismondi, M I; Casciato, P C; Galoppo, M; Lezama, C; Galdame, O; Gadano, A; Galoppo, M C; Mullen, E; De Matteo, E N; Preciado, M V
Mechanisms leading to liver damage in chronic hepatitis C (CHC) are being discussed, but both the immune system and the virus are involved. The aim of this study was to evaluate intrahepatic viral infection, apoptosis and portal and periportal/interface infiltrate in paediatric and adult patients to elucidate the pathogenesis of chronic hepatitis C. HCV-infected, activated caspase-3(+) and TUNEL(+) hepatocytes, as well as total, CD4(+), CD8(+), Foxp3(+) and CD20(+) lymphocytes infiltrating portal and periportal/interface tracts were evaluated in 27 paediatric and 32 adult liver samples by immunohistochemistry or immunofluorescence. The number of infected hepatocytes was higher in paediatric than in adult samples (p 0.0078). In children, they correlated with apoptotic hepatocytes (activated caspase-3(+) r = 0.74, p < 0.0001; TUNEL(+) r = 0.606, p 0.0017). Also, infected (p = 0.026) and apoptotic hepatocytes (p = 0.03) were associated with the severity of fibrosis. In adults, activated caspase-3(+) cell count was increased in severe hepatitis (p = 0.009). Total, CD4(+), CD8(+) and Foxp3(+) lymphocyte count was higher in adult samples (p < 0.05). Paediatric CD8(+) cells correlated with infected (r = 0.495, p 0.04) and TUNEL(+) hepatocytes (r = 0.474, p = 0.047), while adult ones correlated with activated caspase-3(+) hepatocytes (r = 0.387, p 0.04). In adults, CD8(+) was associated with hepatitis severity (p < 0.0001) and correlated with inflammatory activity (CD8(+) r = 0.639, p 0.0003). HCV, apoptosis and immune response proved to be involved in CHC pathogenesis of both paediatric and adult patients. However, liver injury in paediatric CHC would be largely associated with a viral cytopathic effect mediated by apoptosis, while in adults it would be mainly associated with an exacerbated immune response.
Foster, Helen E; Harrison, Mark J; Pain, Clare E; Symmons, Deborah P M; Baildam, Eileen M
Adult rheumatologists in the UK have historically provided a significant contribution to clinical care for children with rheumatic disease. However, changes in postgraduate training have resulted in adult rheumatology trainees no longer being trained in paediatric rheumatology (PRh), and accordingly, they will be ill-equipped to manage children when incumbent adult rheumatology specialists retire. The objectives of this work were to ascertain the number of UK adult rheumatologists currently involved in PRh care and to inform future workforce planning. As part of the British Society for Rheumatology annual consultant workforce survey, additional questions relating to PRh were included. A questionnaire was sent to 584 adult rheumatologists, of whom 403 (69%) responded to questions about PRh; of these, 75 of 403 (19%) reported seeing children and many will retire in the next 5 and 10 years (13/75 (18%) and 35/75 (48%), respectively). The majority (58/75, 78%) reported having separate clinics for children, often alongside other health care professionals (mostly consultant paediatrician, paediatric rheumatologist, or allied health professional). Notably, 4 of 75 (5%) adult rheumatologists had clinical sessions seeing children without any paediatric input. The median (IQR) number of paediatric consultations by adult rheumatologists per month was 10 (6, 15), equating to a total 931 paediatric consultations per average month. Many UK adult rheumatologists are involved in managing paediatric rheumatic disease and many will retire over the next 10 years. This will result in a shortfall in clinical provision as their replacements in adult rheumatology will not have had appropriate PRh training. This projected shortfall needs to be addressed in future workforce planning.
Wagner, Josef; Sim, Winnie H.; Ellis, Justine A.; Ong, Eng K.; Catto-Smith, Anthony G.; Cameron, Donald J. S.; Bishop, Ruth F.; Kirkwood, Carl D.
Genetic susceptibility is an important contributor to the pathogenesis of Crohn's disease (CD). We investigated multiple CD susceptibility genes in an Australian paediatric onset CD cohort. Newly diagnosed paediatric onset CD patients (n = 72) and controls (n = 98) were genotyped for 34 single nucleotide polymorphisms (SNPs) in 18 genetic loci. Gene-gene interaction analysis, gene-disease phenotype analysis and genetic risk profiling were performed for all SNPs and all genes. Of the 34 SNPs analysed, four polymorphisms on three genes (NOD2, IL23R, and region 3p21) were significantly associated with CD status (p<0.05). All three CD specific paediatric polymorphisms on PSMG1 and TNFRSF6B showed a trend of association with p<0.1. An additive gene-gene interaction involving TLR4, PSMG1, TNFRSF6B and IRGM was identified with CD. Genes involved in microbial processing (TLR4, PSMG1, NOD2) were significantly associated either at the individual level or in gene-gene interactive roles. Colonic disease was significantly associated with disease SNP rs7517847 (IL23R) (p<0.05) and colonic and ileal/colonic disease was significantly associated with disease SNP rs125221868 (IBD5) and SLC22A4 & SLC22A4/5 variants (p<0.05). We were able to demonstrate genetic association of several genes to CD in a paediatric onset cohort. Several of the observed associations have not been reported previously in association with paediatric CD patients. Our findings demonstrate that CD genetic susceptibility in paediatric patients presents as a complex interaction between numerous genes. PMID:21079743
Salas, January T.; Chang, Theresa L.
HIV primary infection occurs at mucosa tissues, suggesting an intricate interplay between microbiome and HIV infection. Recent advanced technologies of high-throughput sequencing and bioinformatics allow researchers to explore nonculturable microbes including bacteria, virus and fungi and their association with diseases. HIV/SIV infection is associated with microbiome shifts and immune activation that may affect the outcome of disease progression. Similarly, altered microbiome and inflammation are associated with increased risks of HIV acquisition, suggesting the role of microbiome in HIV transmission. In this review, we will focus on microbiome in HIV infection at various mucosal compartments. Understanding the relationship between microbiome and HIV may offer insights into development of better strategies for HIV prevention and treatment. PMID:25439273
... Counseling and Services (CRCS) Condom Distribution as a Structural Level Intervention HIV Cost-effectiveness Program Planning Comprehensive ... 2017. Moreno CL. The relationship between culture, gender, structural factors, abuse, trauma, and HIV/AIDS for Latinas. ...
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... known as AIDS . HIV destroys a type of defense cell in the body called a CD4 helper ... are part of the body's immune system , the defense system that fights infections. When HIV destroys these ...
... Hospitalization and Palliative Care Friends & Family Dating and Marriage Family Planning Mixed-Status Couples Discrimination Legal Issues ... National HIV/AIDS and Aging Awareness Day National Gay Men's HIV/AIDS Awareness Day National Latinx AIDS ...
... HIV/AIDS Influenza Malaria Respiratory Syncytial Virus (RSV) Tuberculosis Zika Virus Find a Funding Opportunity Opportunities & Announcements ... related co-infections, such as hepatitis, malaria, and tuberculosis. Treatment of HIV Infection In the early 1980s ...
... that causes the disease AIDS. HIV Hurts the Immune System People who are HIV positive have been tested ... to everyone in the world. When the person's immune system has weakened and more of the blood's T ...
Hill, Kevin D; Henderson, Heather T; Hornik, Christoph P; Li, Jennifer S
Recent regulatory initiatives in the United States of America and Europe have transformed the paediatric clinical trials landscape by significantly increasing capital investment and paediatric trial volume. The purpose of this manuscript was to review the impact of these initiatives on the paediatric cardiovascular trials landscape when compared with other paediatric sub-specialties. We also evaluate factors that may have contributed to the success or failure of recent major paediatric cardiovascular trials so as to inform the optimal design and conduct of future trials in the field.
Bathgate, Fionna; Bennett, Emily; Cropper, Jenny; Edwards, Lindsey; Emond, Alice; Gamble, Caroline; Kentish, Rosie; Samuel, Victoria
There are relatively few clinical psychologists working in paediatric cochlear implant centres in the UK and in this respect we lag behind other countries such as the USA and The Netherlands. In an effort to promote the added value our profession can offer teams, the clinical psychologists working in paediatric CI centres have put together good practice guidelines. This article outlines the rationale for putting together the guidelines, highlights the unique contribution clinical psychologists can offer, outlines the evidence base for psychological input in this clinical population, and offers a fictional case study for illustration.
Grenier, D; Elliott, E J; Zurynski, Y; Pereira, R Rodrigues; Preece, M; Lynn, R; von Kries, R; Zimmermann, H; Dickson, N P; Virella, D
Paediatric Surveillance Units (PSUs) have been established in 14 countries and facilitate national, prospective, active surveillance for a range of conditions, with monthly reporting by child health specialists. The International Network of Paediatric Surveillance Units (INoPSU) was established in 1998 and facilitates international collaboration among member PSUs and allows for sharing of resources, simultaneous data collection and hence comparison of data from different geographical regions. The impact of data collected by PSUs, both individually and collectively as members of INoPSU, on public health outcomes, clinical care and research is described. PMID:17158859
The EU regulation (EU 1901/2006 Paediatric Regulation) that entered into force in 2007 has changed the field of medicinal drug development for children in the EU. Five years after its implementation a large number changes due to this regulation have been incorporated by Pharmaceutical Industry considering the development of new candidate drug. This report is a review of changes already implemented and the aspects of paediatric drug development, which still needs to be addressed in future working in the fields to provide better medicines for children.
Richter, Darko; Anca, Ioana; André, Francis E; Bakir, Mustafa; Chlibek, Roman; Čižman, Milan; Mangarov, Atanas; Mészner, Zsófia; Pokorn, Marko; Prymula, Roman; Salman, Nuran; Simurka, Pavol; Tamm, Eda; Tešović, Goran; Urbančíková, Ingrid; Usonis, Vytautas; Wysocki, Jacek; Zavadska, Dace; Central European Vaccination Awareness Group
Over the last decade, childhood immunization has substantially reduced morbidity and mortality from vaccine-preventable diseases. However, particular paediatric risk groups, such as those with comorbidities, may not be adequately vaccinated despite being more susceptible to complications and death from certain infectious diseases. This may be due to lack of immunization recommendations, lack of awareness, or incomplete adherence to existing guidelines. Furthermore, recommendations for immunization can be inconsistent across Europe. An expanded initiative from the Central European Vaccination Awareness Group aims to raise awareness of the different high-risk paediatric groups, differentiate them according to their specific risk, and formalise a guidance statement for the immunization of each population.
May, Diane E; Kratochvil, Christopher J
Throughout this decade, there has been significant research into pharmacotherapies for attention-deficit hyperactivity disorder (ADHD). This article considers the efficacy and safety of five of the more novel long-acting pharmacological treatments recently approved by the FDA for marketing in the US for paediatric ADHD, along with an alpha(2)-adrenoceptor agonist in preparation. Reviewed treatments include the non-stimulant atomoxetine, three novel extended-release (XR) stimulant preparations: dexmethylphenidate, lisdexamfetamine dimesylate and the methylphenidate transdermal system (TDS), and the recently approved XR alpha(2)-adrenoceptor agonist, guanfacine. Dexmethylphenidate XR is a stimulant treatment in a single isomer form, and has an efficacy and tolerability similar to two doses of immediate-release (IR) dexmethylphenidate when taken 4 hours apart, but is dosed at half of the usual d,l-methylphenidate dose. Dexmethylphenidate XR utilizes a beaded bimodal release, with 50% initially released and another 50% released 4 hours later to provide benefit lasting up to 10-12 hours. Lisdexamfetamine was the first stimulant treatment approved as a prodrug, whereby the single isomer d-amfetamine remains pharmacologically inactive until activated by cleaving the lysine. Its efficacy and tolerability are generally consistent with that of XR mixed amfetamine salts, with this activation method and more consistent absorption generally resulting in up to an 11- to 13-hour benefit. The methylphenidate TDS patch utilizes skin absorption to provide predictable and uniform delivery of methylphenidate when worn for 9 hours/day. The efficacy and tolerability of the methylphenidate TDS patch is generally consistent with that of osmotic-controlled release oral system (OROS) methylphenidate, providing benefit for about 11-12 hours. Because of their formulation, lisdexamfetamine and methylphenidate each have an onset of effect at about 2 hours after administration. An adjustable
Marès Bermúdez, J; van Esso Arbolave, D; Moreno-Pérez, D; Merino Moína, M; Alvarez García, F J; Cilleruelo Ortega, M J; Arístegui Fernández, J; Ortigosa del Castillo, L; Ruiz-Contreras, J; Barrio Corrales, F; González-Hachero, J
The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules.
Mussolin, Lara; Burnelli, Roberta; Pillon, Marta; Carraro, Elisa; Farruggia, Piero; Todesco, Alessandra; Mascarin, Maurizio; Rosolen, Angelo
Background: Extracellular circulating DNA (cfDNA) can be found in small amounts in plasma of healthy individuals. Increased levels of cfDNA have been reported in patients with cancer of breast, cervix, colon, liver and it was shown that cfDNA can originate from both tumour and non-tumour cells. Objectives: Levels of cfDNA of a large series of children with lymphoma were evaluated and analyzed in relation with clinical characteristics. Methods: plasma cfDNA levels obtained at diagnosis in 201 paediatric lymphoma patients [43 Hodgkin lymphomas (HL), 45 anaplastic large cell lymphomas (ALCL), 88 Burkitt lymphomas (BL), 17 lymphoblastic (LBL), 8 diffuse large B cell lymphoma (DLBCL)] and 15 healthy individuals were determined using a quantitative PCR assay for POLR2 gene and, in addition, for NPM-ALK fusion gene in ALCL patients. Wilcoxon rank sum test was used to compare plasma levels among different patient subgroups and controls and to analyze relationship between levels of cfDNA and clinical characteristics. Results: Levels of cfDNA in lymphoma patients were significantly higher compared with controls (p<0.0001). CfDNA was associated with median age (p=0.01) in HL, and with stage in ALCL (p=0.01). In HL patients high cfDNA levels were correlated with poor prognosis (p=0.03). In ALCL we found that most of the cfDNA (77%) was non-tumor DNA. Conclusion: level of plasma cfDNA might constitute an important non-invasive tool at diagnosis in lymphoma patients' management; in particular in patients with HL, cfDNA seems to be a promising prognostic biomarker. PMID:23678368
Tortajada-Girbés, M; Mesa Del Castillo, M; Larramona, H; Lucas, J M; Álvaro, M; Tabar, A I; Jerez, M J; Martínez-Cañavate, A
Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy (AIT). AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT.
Clifton, Dana C; Ramadhani, Habib O; Msuya, Levina J; Njau, Boniface N; Kinabo, Grace D; Buchanan, Ann M; Crump, John A
Objective As the proportion of children living low malaria transmission areas in sub-Saharan Africa increases, approaches for identifying non-malarial severe illness need to be evaluated to improve child outcomes. Design As a prospective cohort study, we identified febrile paediatric inpatients, recorded data using Integrated Management of Childhood Illness (IMCI) criteria, and collected diagnostic specimens. Setting Tertiary referral centre, northern Tanzania. Results Of 466 participants with known outcome, median age was 1.4 years (range 2 months–13.0 years), 200 (42.9%) were female, 11 (2.4%) had malaria and 34 (7.3%) died. Inpatient death was associated with: Capillary refill >3 s (OR 9.0, 95% CI 3.0 to 26.7), inability to breastfeed or drink (OR 8.9, 95% CI 4.0 to 19.6), stiff neck (OR 7.0, 95% CI 2.8 to 17.6), lethargy (OR 5.2, 95% CI 2.5 to 10.6), skin pinch >2 s (OR 4.8, 95% CI 1.9 to 12.3), respiratory difficulty (OR 4.0, 95% CI 1.9 to 8.2), generalised lymphadenopathy (OR 3.6, 95% CI 1.6 to 8.3) and oral candidiasis (OR 3.4, 95% CI 1.4 to 8.3). BCS <5 (OR 27.2, p<0.001) and severe wasting (OR 6.9, p<0.001) were independently associated with inpatient death. Conclusions In a low malaria transmission setting, IMCI criteria performed well for predicting inpatient death from non-malarial illness. Laboratory results were not as useful in predicting death, underscoring the importance of clinical examination in assessing prognosis. Healthcare workers should consider local malaria epidemiology as malaria over-diagnosis in children may delay potentially life-saving interventions in areas where malaria is uncommon. PMID:22872067
de Korte, Chris L; Nillesen, Maartje M; Saris, Anne E C M; Lopata, Richard G P; Thijssen, Johan M; Kapusta, Livia
Ultrasound imaging can be used to estimate the morphology as well as the motion and deformation of tissues. If the interrogated tissue is actively deforming, this deformation is directly related to its function and quantification of this deformation is normally referred as 'strain imaging'. Tissue can also be deformed by applying an internal or external force and the resulting, induced deformation is a function of the mechanical tissue characteristics. In combination with the load applied, these strain maps can be used to estimate or reconstruct the mechanical properties of tissue. This technique was named 'elastography' by Ophir et al. in 1991. Elastography can be used for atherosclerotic plaque characterisation, while the contractility of the heart or skeletal muscles can be assessed with strain imaging. Rather than using the conventional video format (DICOM) image information, radio frequency (RF)-based ultrasound methods enable estimation of the deformation at higher resolution and with higher precision than commercial methods using Doppler (tissue Doppler imaging) or video image data (2D speckle tracking methods). However, the improvement in accuracy is mainly achieved when measuring strain along the ultrasound beam direction, so it has to be considered a 1D technique. Recently, this method has been extended to multiple directions and precision further improved by using spatial compounding of data acquired at multiple beam steered angles. Using similar techniques, the blood velocity and flow can be determined. RF-based techniques are also beneficial for automated segmentation of the ventricular cavities. In this paper, new developments in different techniques of quantifying cardiac function by strain imaging, automated segmentation, and methods of performing blood flow imaging are reviewed and their application in paediatric cardiology is discussed.
Moreno-Pérez, D; Álvarez García, F J; Arístegui Fernández, J; Cilleruelo Ortega, M J; Corretger Rauet, J M; García Sánchez, N; Hernández Merino, A; Hernández-Sampelayo Matos, T; Merino Moína, M; Ortigosa del Castillo, L; Ruiz-Contreras, J
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimize the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy. Regarding the funded vaccines included in the official unified immunization schedule, taking into account available data, CAV-AEP recommends 2+1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine. Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27-36 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 11-12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well. Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3+1 scheme (3, 5, 7 and 13-15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants. Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk.
Moreno-Pérez, D; Álvarez García, F J; Arístegui Fernández, J; Cilleruelo Ortega, M J; Corretger Rauet, J M; García Sánchez, N; Hernández Merino, A; Hernández-Sampelayo Matos, T; Merino Moína, M; Ortigosa Del Castillo, L; Ruiz-Contreras, J
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.
Moreno-Pérez, David; Álvarez García, Francisco José; Arístegui Fernández, Javier; Cilleruelo Ortega, María José; Corretger Rauet, José María; García Sánchez, Nuria; Hernández Merino, Ángel; Hernández-Sampelayo Matos, Teresa; Merino Moína, Manuel; Ortigosa Del Castillo, Luis; Ruiz-Contreras, Jesús
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV- AEP) annually publishes the immunisation schedule which, in our opinion, is considered optimal for children resident in Spain, taking into account the evidence available on current vaccines. Pneumococcal and varicella immunisation in early childhood is already included in all funded vaccines present in the regional immunisation programmes. Furthermore, this committee establishes recommendations on vaccines not included in official calendars (non-funded immunisations), such as rotavirus, meningococcal B, and meningococcal ACWY. As regards funded immunisations, 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTaP-IPV-Hib-HB) and 13-valent pneumococcal vaccines is recommended. Administration of the 6-year booster dose with DTaP is recommended, as well as a poliomyelitis dose for children who had received the 2+1 scheme, with the Tdap vaccine for adolescents and pregnant women between 27 and 32 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 12 with a two-dose scheme (0, 6 months) should be improved. Information and recommendations for male adolescents about potential beneficial effects of the tetravalent HPV vaccine should also be provided. ACWY meningococcal vaccine is the optimal choice in adolescents. For recommended unfunded immunisations, the CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish community pharmacies, with a 3+1 scheme. CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants.
Uksal, Umit; Ozturk, Pinar; Colgecen, Emine; Taslidere, Nazan; Patiroglu, Turkan; Ozdemir, Mehmet Akif; Torun, Yasemin Altuner; Borlu, Murat
Objective: Diagnoses of skin, mucosae, hair and nail manifestations in malignant diseases are often challenging because of life-threatening drug reactions, opportunistic infections or skin involvement of primary processes. Description of morphology, configuration and distribution of lesions is important in order to differentiate the self-healing eruptions from serious side effects of chemotherapy. There are case reports from Turkey including dermatological manifestations of malignancies and case series in adult patients but there are no published large group studies assessing all manifestations in children. The aim of this study was to evaluate the morphological features of dermatological findings in children with haemato-oncological diseases. Materials and Methods: The study was performed at the Erciyes University, Faculty of Medicine Pediatric Hematology-Oncology Clinic, Turkey. Three dermatologists daily consulted all patients admitted to the clinic during a one-year period. Results: The study group comprised of 157 children (79 female/78 male) aged 1–16 years (mean 7.19±4.63). Detailed dermatological examinations were performed, including oral-genital mucosae, hair and nails. Thorough skin examination revealed that 70% of the patients exhibited at least one dermatological finding. Generalized xerosis and hyperpigmentation were the most common findings among patients undergoing chemotherapy (24.19%). Multiple nevi on at least 10 covered areas were very frequent among patients undergoing long-term chemotherapy (18.47%). Three were identified as dysplastic nevus, but malignant transformation was not observed during the one-year study period. Conclusion: Regular dermatological consultation may help resolve the diagnostic and therapeutic problems in paediatric haemato-oncology clinics. PMID:27551173
Takase, Miyuki; Carlin, John
Overcrowding is a phenomenon commonly observed at emergency departments (EDs) in many hospitals, and negatively impacts patients, healthcare professionals and organisations. Health care organisations are expected to act proactively to cope with a high patient volume by understanding and predicting the patterns of ED presentations. The aim of this study was, therefore, to identify the patterns of patient flow at a paediatric ED in order to assist the management of EDs. Data for ED presentations were collected from the Royal Children's Hospital in Melbourne, Australia, with the time-frame of July 2003 to June 2008. A linear regression analysis with trigonometric functions was used to identify the pattern of patient flow at the ED. The results showed that a logarithm of the daily average ED presentations was increasing exponentially (as explained by 0.004t + 0.00005t2 with t representing time, p<0.001). The model also indicated that there was a yearly oscillation in the frequency of ED presentations, in which lower frequencies were observed in summer and higher frequencies during winter (as explained by -0.046 sin(2(pi)t/12)-0.083 cos(2(pi)t/12), p<0.001). In addition, the variation of the oscillations was increasing over time (as explained by -0.002t*sin(2(pi)t/12)-0.001t*cos(2(pi)t/12), p<0.05). The identified regression model explained a total of 96% of the variance in the pattern of ED presentations. This model can be used to understand the trend of the current patient flow as well as to predict the future flow at the ED. Such an understanding will assist health care managers to prepare resources and environment more effectively to cope with overcrowding.
Dicko, Fatoumata; Desmonde, Sophie; Koumakpai, Sikiratou; Dior-Mbodj, Hélène; Kouéta, Fla; Baeta, Novisi; Koné, Niaboula; Akakpo, Jocelyn; Sy, Haby Signate; Ye, Diarra; Renner, Lorna; Lewden, Charlotte; Leroy, Valériane
Introduction Current knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration). Methods We performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions. Results From April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1–8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7–23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%). Conclusions Overall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings. PMID:24763078
HIV Treatment HIV Medication Adherence (Last updated 3/2/2017; last reviewed 3/2/2017) Key Points Medication adherence means sticking firmly to ... Before and After Starting HIV Medicines . What is medication adherence? Adherence means “to stick firmly.” So for ...
Keeling, Richard P.
Describes human immunodeficiency virus (HIV), newly characterized human retrovirus which causes chronic, progressive, immune deficiency disease, the most severe phase of which is Acquired Immune Deficiency Syndrome (AIDS). Reviews most important current epidemiologic, clinical, and virologic information about HIV and HIV disease and provides…
Richter, Linda; Chandan, Upjeet; Rochat, Tamsen
Paediatric wards in South African government hospitals are occupied predominantly by children with HIV and AIDS-related illnesses. Although access to anti-retroviral treatment for adults is being scaled up, it is likely to be many years before South Africa achieves anywhere near universal access for children. Currently, most children living with HIV or AIDS are identified only when they become acutely or chronically ill and/or hospitalized, if at all. In the absence of treatment, the stress of caring for ill and hospitalized HIV-positive children often results in emotional withdrawal among both health professionals and caregivers. The demoralizing cycle of repeated admissions, treatment failure and death also affect the quality of the care given to HIV-negative children in over-burdened wards. This article describes the development of simple, low-cost and context-relevant interventions to improve the care environment for young hospitalized children within the context of the HIV/AIDS epidemic and poverty.
Suresh, S; Schaldenbrand, K; Wallis, B; De Oliveira, G S
Summary The development of analgesic interventions in paediatric surgical patients is often limited by the inherent difficulties of conducting large randomized clinical trials to test interventions in those patients. Regional anaesthesia is a valid strategy to improve postoperative pain in the adult surgical population, but the effects of regional anaesthesia on postoperative pain outcomes in paediatric patients are currently not well defined. The main objective of the current review was to systematically evaluate the use of regional anaesthesia techniques to minimize postoperative pain in paediatric patients. A systematic search was performed to identify randomized controlled trials that evaluated the effects of the regional anaesthesia techniques on postoperative pain outcomes in paediatric surgical patients' procedures. Seventy-three studies on 5125 paediatric patients were evaluated. Only few surgical procedures had more than one small randomized controlled trial favouring the use of regional anaesthesia to minimize postoperative pain (ophthalmological surgery, cleft lip repair, inguinal hernia, and urological procedures). Additional evidence is required to support the use of specific regional anaesthesia techniques to improve postoperative pain for several surgical procedures (craniectomy, adenotonsillectomy, appendectomy, cardiac surgery, umbilical hernia repair, upper and lower extremity) in paediatric patients. Currently, only a very limited number of regional anaesthesia techniques have demonstrated significant improvement on postoperative pain outcomes for a restricted number of surgical procedures. More studies are needed in order to establish regional anaesthesia as a valid strategy to improve analgesia in the paediatric surgical population.
Jeong, Yong Sun; Kim, Jin Sun
Abstract Background: A blended learning can be a useful learning strategy to improve the quality of fever and fever management education for paediatric nurses. Aim: This study compared the effects of a blended and face-to-face learning program on paediatric nurses' childhood fever management, using Theory of Planned Behavior. Methods/Design: A nonequivalent control group pretest-posttest design was used. A fevermanagement education program using blended learning (combining face-to-face and online learning components) was offered to 30 paediatric nurses, and 29 paediatric nurses received face-to-face training. Results/Findings: Learning outcomes did not significantly differ between the two groups. However, learners' satisfaction was higher for the blended learning program than the face-toface learning program. Conclusion: A blended-learning paediatric fever management program was as effective as a traditional face-to-face learning program. Therefore, a blended-learning paediatric fever management-learning program could be a useful and flexible learning method for paediatric nurses.
Molinari, N; Koné Paut, I; Manna, R; Demaille, J; Daures, J P; Touitou, I
We have conducted a segregation analysis in order to characterise the transmission of Behçet Disease (BD), a multifactorial condition with a strong genetic component. Complete information about BD status and pedigree was obtained on 104 probands from our database. We used the criteria of the International Study Group for BD (ISBD) to delineate the clinical status of the sibs: possible BD (patients meeting two criteria), or ascertained BD (patients meeting at least three criteria). A proband was defined as "paediatric" when he/she completed ISBD criteria before/by the age of 16 years. Families were distinguished as paediatric (n = 67) (ascertained through a paediatric proband), and non-paediatric (n = 37) ones. An Expectation Maximization (EM) algorithm was used to estimate the Mendelian segregation ratio P in nuclear families (two parents and their offspring). The maximum likelihood estimate: Pcirc; = 0.248, calculated in the paediatric data set, was consistent with the theoretical value of P = (1/4) for autosomal recessive inheritance, whereas the Pcirc; value was 0.08 when using the non-paediatric data set. Our work provides the first evidence of genetic heterogeneity in BD, and of the existence of a Mendelian entity in the paediatric BD subgroup. Previous studies failed to show any simple mode of inheritance in BD, probably because they were performed on the whole BD population.
Mølhave, L.; Schneider, T.; Kjærgaard, S. K.; Larsen, L.; Norn, S.; Jørgensen, O.
Floor dust from Danish offices was collected and analyzed. The dust was to be used in an exposure experiment. The dust was analyzed to show the composition of the dust which can be a source of airborne dust indoors. About 11 kg of dust from vacuum cleaner bags from seven Danish office buildings with about 1047 occupants (12 751 m 2) was processed according to a standardized procedure yielding 5.5 kg of processed bulk dust. The bulk dust contained 130.000-160.000 CFU g -1 microorganisms and 71.000-90.000 CFU g -1 microfungi. The content of culturable microfungi was 65-123 CFU 30 g -1 dust. The content of endotoxins ranged from 5.06-7.24 EU g -1 (1.45 ng g -1 to 1.01 ng g -1). Allergens (ng g -1) were from 147-159 (Mite), 395-746 (dog) and 103-330 (cat). The macro molecular organic compounds (the MOD-content) varied from 7.8-9.8 mg g -1. The threshold of release of histamine from basophil leukocytes provoked by the bulk dust was between 0.3 and 1.0 mg ml -1. The water content was 2% (WGT) and the organic fraction 33%. 6.5-5.9% (dry) was water soluble. The fiber content was less than 0.2-1.5% (WGT) and the desorbable VOCs was 176-319 μg g -1. Most of the VOC were aldehydes. However, softeners for plastic (DBP and DEHP) were present. The chemical composition includes human and animal skin fragments, paper fibers, glass wool, wood and textilefibers and inorganic and metal particles. The sizes ranged from 0.001-1 mm and the average specific density was 1.0 g m -3. The bulk dust was resuspended and injected into an exposure chamber. The airborne dust was sampled and analyzed to illustrate the exposures that can result from sedimented dirt and dust. The airborne dust resulting from the bulk dust reached concentrations ranging from 0.26-0.75 mg m -3 in average contained 300-170 CFU m -3. The organic fraction was from 55-70% and the water content about 2.5% (WGT). The content of the dust was compared to the similar results reported in the literature and its toxic potency is
From pharmacovigilance to therapy amelioration in paediatric patients: the role of the clinical pharmacologists and family paediatricians. Part of a series on Paediatric Pharmacology, guest edited by Gianvincenzo Zuccotti, Emilio Clementi, and Massimo Molteni.
Napoleone, Ettore; Radice, Sonia
An active pharmacovigilance approach is advisable in paediatric pharmacotherapy as it contributes to generate knowledge promptly and to enhance the estimation of true risk in clinical practice. Reports and studies from the scientific community and regulatory agencies have shown that effective methods for early detection of adverse drug reaction and pharmacoepidemiological studies are a primary need since they increase drug safety in the paediatric population. In this perspective article we describe how pharmacologists and paediatricians may actively synergise to optimise drug therapies and their management in paediatric patients.
Newman, Christy E; Persson, Asha; Miller, Angela; Brown, Rebecca J
Young people who have grown up with perinatally acquired HIV in wealthy nations are increasingly transitioning into adult care settings which expect more independence and self-regulation than paediatric care. Drawing on the first qualitative study on growing up with HIV in Australia, this paper examines "responsibilisation" narratives in semi-structured interviews conducted with young people with HIV and their paediatric and adult care providers. Three dominant narratives were identified: responsibilisation as imperative, practice and contest. This suggests that while young people growing up with HIV in an advanced liberal setting such as Australia may value the independence of adult care, and appreciate the need to take responsibility for their health, the practices involved in becoming a responsible health citizen are shaped by individual histories and circumstances, and in some cases, can lead to serious contestation and conflict with care providers. Placing a stronger emphasis on what young people can gain from taking an active role in managing their health may more successfully foster responsibilisation, rather than focusing on what they will lose. Clinicians could benefit from greater support regarding how to engage young people with the elements of responsibilisation likely to resonate more meaningfully at different points in their lives.
Background: The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest. Aims: To examine the provision of paediatric speech and language services across London boroughs and to relate provision to the level of deprivation of the boroughs. Methods & Procedures: Information on the…
Perks, T D; Dendere, R; Irving, B; Hartley, T; Scholtz, P; Lawson, A; Trauernicht, C; Steiner, S; Douglas, T S
This paper describes modelling, application and validation of a filtration technique for a linear slot-scanning digital X-ray system to reduce radiation dose to paediatric patients while preserving diagnostic image quality. A dose prediction model was implemented, which calculates patient entrance doses using variable input parameters. Effective dose is calculated using a Monte Carlo simulation. An added filter of 1.8-mm aluminium was predicted to lower the radiation dose significantly. An objective image quality study was conducted using detective quantum efficiency (DQE). The PTW Normi 4FLU test phantom was used for quantitative assessment, showing that image contrast and spatial resolution were maintained with the proposed filter. A paediatric cadaver full-body imaging trial assessed the diagnostic quality of the images and measured the dose reduction using a 1.8-mm aluminium filter. Assessment by radiologists indicated that diagnostic quality was maintained with the added filtration, despite a reduction in DQE. A new filtration technique for full-body paediatric scanning on the Lodox Statscan has been validated, reducing entrance dose for paediatric patients by 36 % on average and effective dose by 27 % on average, while maintaining image quality.
Salunke, Smita; Liu, Fang; Batchelor, Hannah; Walsh, Jenny; Turner, Roy; Ju, Tzuchi Rob; Tuleu, Catherine
The European Paediatric Formulation Initiative (EuPFI), founded in 2007, aims to promote and facilitate the preparation of better and safe medicines for children through linking research and information dissemination. It brings together the capabilities of the industry, academics, hospitals, and regulators within a common platform in order to scope the solid understanding of the major issues, which will underpin the progress towards the future of paediatric medicines we want.The EuPFI was formed in parallel to the adoption of regulations within the EU and USA and has served as a community that drives research and dissemination through publications and the organisation of annual conferences. The membership and reach of this group have grown since its inception in 2007 and continue to develop and evolve to meet the continuing needs and ambitions of research into and development of age appropriate medicines. Five diverse workstreams (age-appropriate medicines, Biopharmaceutics, Administration Devices, Excipients and Taste Assessment & Taste Masking (TATM)) direct specific workpackages on behalf of the EuPFI. Furthermore, EuPFI interacts with multiple diverse professional groups across the globe to ensure efficient working in the area of paediatric medicines. Strong commitment and active involvement of all EuPFI stakeholders have proved to be vital to effectively address knowledge gaps related to paediatric medicines, discuss potential areas for further research and identify issues that need more attention and analysis in the future.
Francisco, Telma; Marques, Marília; Vieira, José Pedro; Brito, Maria João
Bilateral facial palsy (BFP) is a very uncommon entity, particularly in the paediatric age group. Despite its several aetiologies, neuroborreliosis should be suspected, especially in children from endemic areas presenting with acute neurological disease of unknown cause. We present two cases of BFPs as the presenting forms of neuroborreliosis. PMID:23396928
Shrimpton, Bradley J M; Willis, David J; Tongs, Cáthal D; Rolfo, Aldo G
Objectives To establish the outcomes achieved by using an innovative movie-making programme designed to reduce fear of radiotherapy among paediatric patients. Design Qualitative descriptive evaluation based on semistructured, qualitative interviews with purposeful sampling and thematic analysis. Setting Tertiary Cancer Centre. Participants 20 parents of paediatric patients who had produced a movie of their radiation therapy experience and were in a follow-up phase of cancer management. Results Participants attributed a broad range of outcomes to the movie-making program. These included that the programme had helped reduce anxiety and distress exhibited by paediatric patients and contributed to a willingness to receive treatment. Other outcomes were that the completed movies had been used in school reintegration and for maintaining social connections. Conclusions Allowing children to create a video of their experience of radiotherapy provided a range of benefits to paediatric patients that varied according to their needs. For some patients, movie-making offered a valuable medium for overcoming fear of the unknown as well as increasing understanding of treatment processes. For others, the development of a personalised video offered an important cognitive/attentional distraction through engaging with an age-appropriate activity. Together these outcomes helped children maintain self-control and a positive outlook. PMID:23328308
Morrison, Patrick J
Over 25 autosomal dominant and autosomal recessive spinocerebellar ataxias have been isolated over the last decade. The recognition of paediatric ataxia phenotypes and, in addition, other movement disorders including hereditary choreiform and parkinsonian syndromes, has improved our knowledge of these diseases. Advances in molecular genetics has allowed fuller delineation and better recognition of these diseases.
López Villar, Elena; Wu, Duojiao; Cho, William C; Madero, Luis; Wang, Xiangdong
There are important breakthroughs in the treatment of paediatric acute lymphoblastic leukaemia (ALL) since 1950, by which the prognosis of the child majority suffered from ALL has been improved. However, there are urgent needs to have disease-specific biomarkers to monitor the therapeutic efficacy and predict the patient prognosis. The present study overviewed proteomics-based research on paediatric ALL to discuss important advances to combat cancer cells and search novel and real protein biomarkers of resistance or sensitivity to drugs which target the signalling networks. We highlighted the importance and significance of a proper phospho-quantitative design and strategy for paediatric ALL between relapse and remission, when human body fluids from cerebrospinal, peripheral blood, or bone-marrow were applied. The present article also assessed the schedule for the analysis of body fluids from patients at different states, importance of proteomics-based tools to discover ALL-specific and sensitive biomarkers, to stimulate paediatric ALL research via proteomics to ‘build’ the reference map of the signalling networks from leukemic cells at relapse, and to monitor significant clinical therapies for ALL-relapse. PMID:24912534
Ricalde, P; Engroff, S L; Jansisyanont, P; Ord, R A
Necrotizing fasciitis is an uncommon but well-described entity. In the paediatric population compromising risk factors are frequently absent. We describe the successful treatment of a case of cervicofacial necrotizing fasciitis in a healthy 14-year-old male following routine extraction of an uninfected wisdom tooth for orthodontic purposes.
Zhen, Chen; Lishuang, Ma; Jinshan, Zhang; Guoliang, Qiao; Wangchen; Zhen, Zhang; Shuili, Liu; Jun, Zhang; Kaoping, Guan; Long, Li
BACKGROUNDS: Splenomegaly may contribute to hypersplenism and can result in thrombocytopenia. Many approaches are used to treat splenomegaly; however, the current management of splenomegaly has intrinsic limitations or disadvantages. Now, we initiate a new approach, that of total splenic vessel (artery and vein) ligations (TSVLs) in paediatric patients with splenomegaly. The purpose of our study is to evaluate the results obtained with TVSLs procedure for paediatric patients. PATIENTS AND METHODS: Seventeen paediatric patients with splenomegaly were screened for enrolment into this retrospective analysis. PROCEDURE: We identified and dissociated the splenic vessel. Next, we ligated the splenic artery and we used clips to ligate the vein distally and proximally. RESULT: The mean [standard deviation (SD)] splenic infarction rate of a total of 17 patients was 77.5 (5.1)% in 6 months after operation. After TSVL, the mean count of platelet (PLT) and white blood cell (WBC) increased significantly and reached a steady state in the third month. Both the PLT and WBC had a significance higher than pre-TSVL in a 1-year follow-up. CONCLUSION: Based on the evidence, we make cautious conclusions that TSVLs are a safe and effective method in the treatment of paediatric patients with splenomegaly, achieving a satisfactory long-term haematological response and benefit. PMID:27609328
Klucka, Jozef; Stourac, Petr; Stoudek, Roman; Toukalkova, Michaela; Harazim, Hana; Kosinova, Martina; Stouracova, Alena; Mrlian, Andrej; Suk, Petr; Malaska, Jan
Stroke is a rare condition in childhood with an estimated incidence of between 1.3-13/100.000 patients. Clinical manifestation and risk factors for paediatric stroke are different from those of adults. The uncommon incidence, age-associated difference and plethora of clinical symptoms make the diagnosis of such strokes extremely difficult and often delayed. The history and clinical examination should point to diseases or predisposing factors. Neuroimaging (DWI MR) is the golden standard for diagnosis of paediatric stroke and other investigations can be considered according to the clinical condition. Despite advances in paediatric stroke research and clinical care, questions remain unanswered regarding acute treatment, secondary prevention and rehabilitation. The treatment recommendations are mainly extrapolated from studies on adult populations. In the review authors summarized the clinical characteristics and diagnostic steps for stroke in children/adolescents based on the most recent international guidelines and practical directions for recognising and managing the child/adolescent with stroke in paediatric emergency. In the two case reports, we describe the clinical course in both stroke patients.
Peppermint oil (PMO) has been used to treat abdominal ailments dating to ancient Egypt, Greece and Rome. Despite its increasing paediatric use, as in irritable bowel syndrome (IBS) treatment, the pharmacokinetics (PK) of menthol in children given PMO has not been explored. Single-site, exploratory p...
Theodorou, Nana; Shipman, Tracey
A retrospective study was carried out to evaluate the paediatric visual impaired population attending the Low Vision Clinic at Sheffield Teaching Hospitals NHS Foundation Trust, over a period of 14 years. Data were collected and analysed for children less than 17 years for prevalence, demographics, registration status, aetiologies, and types of…
Grover, Kenda S.
This study employed qualitative research methodology to explore the experiences of mothers who self-directed their learning following their child's stroke diagnosis. Paediatric stroke, although rare, is among the top 10 causes of death in children in the USA, but information about the cause, treatment and long-term impact are difficult to…
Gosling, D B; Chan, T K J
PurposeTo report the clinical experience of using the Tecnis PCB00 (Abbott Medical Optics, Santa Ana, CA, USA) preloaded one-piece intraocular lens (IOL) in the setting of a tertiary referral centre for paediatric cataract.MethodsA retrospective case note review of all paediatric cataract surgeries using the Tecnis PCB00 IOL, at a single UK paediatric ophthalmology department.ResultsNine eyes in seven patients received the IOL between December 2014 and January 2016. All patients underwent lens aspiration and insertion of the IOL 'in the bag.' The indications for surgery included developmental cataract (8/9) and traumatic cataract (1/9). Mean age at the time of surgery was 7 years (range 2-14). The median improvement in logMAR best-corrected visual acuity was 0.475 (range 0.250-1.500). The mean follow-up duration was 5 months (range 1-13). No operative or post-operative complications occurred as a result of using the device.ConclusionThe Tecnis PCB00 preloaded IOL appears to be a safe and effective device in treating paediatric cataract.
Knuepffer, C.; Murdoch, B. E.; Lloyd, D.; Lewis, F. M.; Hinchliffe, F. J.
The immediate and long-term neural correlates of linguistic processing deficits reported following paediatric and adolescent traumatic brain injury (TBI) are poorly understood. Therefore, the current research investigated event-related potentials (ERPs) elicited during a semantic picture-word priming experiment in two groups of highly functioning…
López Villar, Elena; Wu, Duojiao; Cho, William C; Madero, Luis; Wang, Xiangdong
There are important breakthroughs in the treatment of paediatric acute lymphoblastic leukaemia (ALL) since 1950, by which the prognosis of the child majority suffered from ALL has been improved. However, there are urgent needs to have disease-specific biomarkers to monitor the therapeutic efficacy and predict the patient prognosis. The present study overviewed proteomics-based research on paediatric ALL to discuss important advances to combat cancer cells and search novel and real protein biomarkers of resistance or sensitivity to drugs which target the signalling networks. We highlighted the importance and significance of a proper phospho-quantitative design and strategy for paediatric ALL between relapse and remission, when human body fluids from cerebrospinal, peripheral blood, or bone-marrow were applied. The present article also assessed the schedule for the analysis of body fluids from patients at different states, importance of proteomics-based tools to discover ALL-specific and sensitive biomarkers, to stimulate paediatric ALL research via proteomics to 'build' the reference map of the signalling networks from leukemic cells at relapse, and to monitor significant clinical therapies for ALL-relapse.
McKean, M; Furness, J
British guidelines on asthma recommend nurse delivered structured discharges for all children with asthma. This study carried out a postal and telephone survey to investigate the provision of this service. Twenty out of 34 (59%) hospitals in the Northern and Yorkshire regions do not have a recognised paediatric respiratory nurse post to facilitate this aspect of care.
Goh, A; Mok, Q
AIMS—To determine the extent of futile care provided to critically ill children admitted to a paediatric intensive care setting. METHODS—Prospective evaluation of consecutive admissions to a 20 bedded multidisciplinary paediatric intensive care unit of a North London teaching hospital over a nine month period. Three previously defined criteria for futility were used: (1) imminent demise futility (those with a mortality risk greater than 90% using the Paediatric Risk of Mortality (PRISM II) score); (2) lethal condition futility (those with conditions incompatible with long term survival); and (3) qualitative futility (those with unacceptable quality of life and high morbidity). RESULTS—A total of 662 children accounting for 3409 patient bed days were studied. Thirty four patients fulfilled at least one of the criteria for futility, and used a total of 104 bed days (3%). Only 33 (0.9%) bed days were used by patients with mortality risk greater than 90%, 60 (1.8%) by patients with poor long term prognosis, and 16 (0.5%) by those with poor quality of life. Nineteen of 34 patients died; withdrawal of treatment was the mode of death in 15 (79%). CONCLUSIONS—Cost containment initiatives focusing on futility in the paediatric intensive care unit setting are unlikely to be successful as only relatively small amounts of resources were used in providing futile care. Paediatricians are recognising futility early and may have taken ethically appropriate measures to limit care that is futile. PMID:11207181
Weaver, M S; Yao, A J J; Renner, L A; Harif, M; Lam, C G
Background: Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans. Methods: We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance. Results: Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0–14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0–14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion. Conclusions: Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings. PMID:26042935
Santos, Joana; Batista, Maria do Carmo; Foley, Shane; Paulo, Graciano; McEntee, Mark F; Rainford, Louise
The purpose of the study is to perform phantom-based optimisation of paediatric computed tomography (CT) protocols and quantify the impact upon radiation dose and image noise levels. The study involved three Portuguese paediatric centres. Currently employed scanning protocols for head and chest examinations and combinations of exposure parameters were applied to a Catphan(®)600 phantom to review the CT dose impact. Contrast-noise ratio (CNR) was quantified using Radia Diagnostic(®) tool. Imaging parameters, returning similar CNRs (<1) and dose savings were applied to three paediatric anthropomorphic phantoms. OsiriX software based on standard deviation pixel values facilitated image noise analysis. Currently employed protocols and age categorisation varied between centres. Manipulation of exposure parameters facilitated mean dose reductions of 33 and 28 % for paediatric head and chest CT examinations, respectively. The majority of the optimised CT examinations resulted in image noise similar to currently employed protocols. Dose reductions of up to 33 % were achieved with image quality maintained.
Schiavone, Stefania; Neri, Margherita; Pomara, Cristoforo; Riezzo, Irene; Trabace, Luigia; Turillazzi, Emanuela
Personalized medicine (PM) is becoming increasingly important in contemporary clinical and research scenarios. In the context of PM, pharmacogenomics and pharmacogenetics are aimed at the genetic personalization of drug response. Extrinsic and intrinsic factors may explain inter-individual variability in drug response. Among such factors, age seems to specifically intervene to modulate drug response since normal developmental changes may influence the exposure-response relation. Consequently, the potential benefit of pharmacogenomics (PGx) in the paediatric population is considerable. However, many challenges still exist in incorporating PGx into clinical practice. In fact, drug prescribing in the paediatric population is often based on extrapolation from clinical trials conducted on adults as there is often a lack of paediatric data. Children are not just 'small adults', as they have their own pharmacological characteristics in terms of drug metabolism and efficacy, adverse drug reactions and toxicity. Although children might potentially benefit from such research, many ethical concerns arise at the intersection of the spheres of drug development and genetic testing. Children require particular attention because of their vulnerability both in research and the clinical applications of PGx; furthermore, children range from preterm newborns and neonates to infants and toddlers and to adolescents, thus forming a further heterogeneous target group. In this paper, we focus on some ethically relevant concerns (i.e., informed consent, stigmatization, ancillary information) that might arise as a result of the possible application of PGx tests in both paediatric practice and research.
Tsoucalas, G; Kousoulis, A A; Karamanou, M; Marineli, F; Tsoucalas, I; Androutsos, G
Hippocrates, the father of medicine, expressed some very interesting ideas on dentistry. His remarks on paediatric dentistry and orthodontics are quite impressive and influenced its practice in ancient Greece. Here we examine his writings in order to find the most important dental references.
Seruya, Francine M; Hinojosa, Jim
The professional and organizational commitment of paediatric occupational therapists working in two distinct practice settings, schools and medically based settings, was investigated. A web-based survey program was used to administer a questionnaire to occupational therapists employed in New York, New Jersey and Connecticut. The study employed social identity theory as a guiding perspective in understanding therapists' professional and organizational commitment. One hundred and fifty-seven paediatric therapists responded to the Professional Commitment Questionnaire and the Organizational Commitment Questionnaire to gauge their commitment to both the profession and their employing organizations. Results indicated that paediatric therapists, regardless of employment setting, have high professional commitment. Paediatric occupational therapists employed in medically based settings indicated statistically significant higher organizational commitment than their school-based counterparts. For therapists that work in school settings, the presence of a professional cohort did not influence professional commitment scores. As the study employed a web-based survey methodology, only individuals who were members of associations and had access to a computer and the Internet were able to participate. Further study might include widening the participant pool as well as adding additional instruments to explore both professional and organizational commitment on a more national scale.
Baastrup Nordsborg, Rikke; Meliker, Jaymie R.; Kjær Ersbøll, Annette; Jacquez, Geoffrey M.; Raaschou-Nielsen, Ole
Non-Hodgkin lymphoma (NHL) is a frequent cancer and incidence rates have increased markedly during the second half of the 20th century; however, the few established risk factors cannot explain this rise and still little is known about the aetiology of NHL. Spatial analyses have been applied in an attempt to identify environmental risk factors, but most studies do not take human mobility into account. The aim of this study was to identify clustering of NHL in space and time in Denmark, using 33 years of residential addresses. We utilised the nation-wide Danish registers and unique personal identification number that all Danish citizens have to conduct a register-based case-control study of 3210 NHL cases and two independent control groups of 3210 each. Cases were identified in the Danish Cancer Registry and controls were matched by age and sex and randomly selected from the Civil Registration System. Residential addresses of cases and controls from 1971 to 2003 were collected from the Civil Registration System and geocoded. Data on pervious hospital diagnoses and operations were obtained from the National Patient Register. We applied the methods of the newly developed Q-statistics to identify space-time clustering of NHL. All analyses were conducted with each of the two control groups, and we adjusted for previous history of autoimmune disease, HIV/AIDS or organ transplantation. Some areas with statistically significant clustering were identified; however, results were not consistent across the two control groups; thus we interpret the results as chance findings. We found no evidence for clustering of NHL in space and time using 33 years of residential histories, suggesting that if the rise in incidence of NHL is a result of risk factors that vary across space and time, the spatio-temporal variation of such factors in Denmark is too small to be detected with the applied method. PMID:23560108
Background Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors. Objective The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD. Methods Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria. Conclusions To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to
Sy, Sherwin K.B.; Malmberg, Ruben; Matsushima, Aoi; Asin-Prieto, Eduardo; Rosenkranz, Bernd; Cotton, Mark F.; Derendorf, Hartmut; Innes, Steve
Owing to significant dose-related toxicity, the adult stavudine dose was reduced in 2007. The paediatric dose, however, has not been reduced. Although the intended paediatric dose is 1 mg/kg twice daily (b.i.d.), the current weight-band dosing approach results in a mean actual dose of 1.23 ± 0.47 mg/kg. Both efficacy and mitochondrial toxicity depend on the concentration of the intracellular metabolite stavudine triphosphate (d4T-TP). We simulated the effect of reducing the paediatric dose to 0.5 mg/kg. A physiologically-based pharmacokinetic model consisting of 13 tissue compartments plus a full ADAM model was used to describe the elimination of stavudine. The volume of distribution at steady-state and apparent oral clearance were simulated and the resulting AUC profile was compared with literature data in adult and paediatric populations. A biochemical reaction model was utilised to simulate intracellular d4T-TP levels for both the standard and proposed reduced paediatric doses. Simulated and observed exposure after oral dosing showed adequate agreement. Mean steady-state d4T-TP for 1.23 mg/kg b.i.d. was 27.9 (90% CI 27.0–28.9) fmol/106 cells, 25% higher than that achieved by the 40 mg adult dose. The 0.5 mg/kg dose resulted in d4T-TP of 13.2 (12.7–13.7) fmol/106 cells, slightly higher than the adult dose of 20 mg b.i.d. [11.5 (11.2–11.9) fmol/106 cells], which has excellent antiviral efficacy and substantially less toxicity. Current paediatric dosing may result in even higher d4T-TP than the original 40 mg adult dose. Halving the paediatric dose would significantly reduce the risk of mitochondrial toxicity without compromising antiviral efficacy. PMID:25697412
This article reports the results of a survey, by mailed questionnaire, of the attitudes among a sample of the Danish population towards abortion for social and genetic reasons. Of 1080 questionnaires sent to a random sample of persons between 18 and 45 years, 731 (68%) were completed and returned. A great majority of the respondents were liberal towards early abortion both for social reasons and in case of minor disease. In contrast, there was controversy about late abortions for social reasons and in the case of Down syndrome. Further there was strong reluctance to accept late abortion in case of minor disease. An analysis of the response patterns showed that most of the respondents had gradualist views on abortion, i.e. they would allow all early abortions, but only abortions for some reasons later in pregnancy. It was also found that the number who would find an early abortion acceptable in general was much higher than the number who would accept it in their own case. These findings suggest that a great part of the resistance towards abortion does not rest on a concern for the rights and interests for the fetus. Instead it may be explained on a view according to which fetal life is ascribed intrinsic moral value.
Magyari, Melinda; Koch-Henriksen, Nils; Sørensen, Per Soelberg
Aim of the database The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the disease-modifying treatment, and it is an important data source for epidemiological research. Study population The DMSTR includes all patients with multiple sclerosis who had been treated with disease-modifying drugs since 1996. At present, more than 8,400 patients have been registered in this database. Data are continuously entered online into a central database from all sites in Denmark at start and at regular visits. Main variables Include age, sex, onset year and year of the diagnosis, basic clinical information, and information about treatment, side effects, and relapses. Descriptive data Notification is done at treatment start, and thereafter at every scheduled clinical visit 3 months after treatment start, and thereafter every 6 months. The longitudinally collected information about the disease activity and side effects made it possible to investigate the clinical efficacy and adverse events of different disease-modifying therapies. Conclusion The database contributed to a certain harmonization of treatment procedures in Denmark and will continue to be a major factor in terms of quality in clinical praxis, research and monitoring of adverse events, and plays an important role in research. PMID:27822098
Bak, Søren Alex; Björklund, Erland
Antibiotics in the environment are a potential threat to environmental ecosystems as well as human health and safety. Antibiotics are designed to have a biological effect at low doses, and the low levels detected in the environment have turned focus on the need for more research on environmental occurrence and fate, to assess the risk and requirement for future regulation. This article describes the first occurrence study of the antibiotic polyether ionophores (lasalocid, monensin, narasin, and salinomycin) in the Danish environment. Various environmental matrices (river water, sediment, and soil) have been evaluated during two different sampling campaigns carried out in July 2011 and October 2012 in an agricultural area of Zealand, Denmark. Lasalocid was not detected in any of the samples. Monensin was measured at a concentration up to 20 ng·L−1 in river water and 13 µg·kg−1 dry weight in the sediment as well as being the most frequently detected ionophore in the soil samples with concentrations up to 8 µg·kg−1 dry weight. Narasin was measured in sediment samples at 2 µg·kg−1 dry weight and in soil between 1 and 18 µg·kg−1 dry weight. Salinomycin was detected in a single soil sample at a concentration of 30 µg·kg−1 dry weight.
Ballot, Daynia E; Davies, Victor A; Cooper, Peter A; Chirwa, Tobias; Argent, Andrew; Mer, Mervyn
Objective Report on survival to discharge of children in a combined paediatric/neonatal intensive care unit (PNICU). Design and setting Retrospective cross-sectional record review. Participants All children (medical and surgical patients) admitted to PNICU between 1 January 2013 and 30 June 2015. Outcome measures Primary outcome—survival to discharge. Secondary outcomes—disease profiles and predictors of mortality in different age categories. Results There were 1454 admissions, 182 missing records, leaving 1272 admissions for review. Overall mortality rate was 25.7% (327/1272). Mortality rate was 41.4% (121/292) (95% CI 35.8% to 47.1%) for very low birthweight (VLBW) babies, 26.6% (120/451) (95% CI 22.5% to 30.5%) for bigger babies and 16.2% (86/529) (95% CI 13.1% to 19.3%) for paediatric patients. Risk factors for a reduced chance of survival to discharge in paediatric patients included postcardiac arrest (OR 0.21, 95% CI 0.09 to 0.49), inotropic support (OR 0.085, 95% CI 0.04 to 0.17), hypernatraemia (OR 0.16, 95% CI 0.04 to 0.6), bacterial sepsis (OR 0.32, 95% CI 0.16 to 0.65) and lower respiratory tract infection (OR 0.54, 95% CI 0.30 to 0.97). Major birth defects (OR 0.44, 95% CI 0.26 to 0.74), persistent pulmonary hypertension of the new born (OR 0.44, 95% CI 0.21 to 0.91), metabolic acidosis (OR 0.23, 95% CI 0.12 to 0.74), inotropic support (OR 0.23, 95% CI 0.12 to 0.45) and congenital heart defects (OR 0.29, 95% CI 0.13 to 0.62) predicted decreased survival in bigger babies. Birth weight (OR 0.997, 95% CI 0.995 to 0.999), birth outside the hospital (OR 0.21, 95% CI 0.05 to 0.84), HIV exposure (OR 0.54, 95% CI 0.30 to 0.99), resuscitation at birth (OR 0.49, 95% CI 0.25 to 0.94), metabolic acidosis (OR 0.25, 95% CI 0.10 to 0.60) and necrotising enterocolitis (OR 0.23, 95% CI 0.12 to 0.46) predicted poor survival in VLBW babies. Conclusions Ongoing mortality review is essential to improve provision of paediatric critical care. PMID:27259525
Nayyar, Charu; Thakur, Preeti; Saigal, Karnika
Introduction Stenotrophomonas maltophilia (formerly Pseudomonas maltophilia/Xanthomonas maltophilia), a Gram- negative, non-fermenting bacillus, is being increasingly recognized as a threatening nosocomial pathogen, associated with significant mortality. Aim To determine the prevalence of infection, antimicrobial susceptibility pattern and clinical outcome of S. maltophilia in a paediatric population. Materials and Methods This was a retrospective study conducted over a period of eight months, i.e., October 2015 to May 2016. All clinical samples received in the microbiology laboratory during the study period were processed using standard microbiological procedures. S. maltophilia isolates were selected. Antibiotic susceptibility was performed for levofloxacin and trimethoprim-sulphamethoxazole by Vitek 2C system (Biomerieux, France). Average length of stay and mortality caused by S. maltophilia infection was compared with age and sex matched controls without S. maltophilia infection. Results A total of 16,234 clinical specimens were received in the microbiology laboratory in the study period, with 2,734 pathogenic bacteria isolated. A total of 1,339 (1.7% of total isolates) Gram-negative bacteria were isolated, out of which 414 were non-fermenters. Among the non-fermenters, 23 (5.5%) were S. maltophilia. Out of the 23 isolates, 15 (65.2%) were isolated from blood, 4 (17.3%) were isolated from urine and tracheal aspirate each. A total of 91.3% of strains were susceptible and 8.6% were resistant to trimethoprim-sulphamethoxazole. Total 80% of strains were sensitive and 20% had intermediate susceptibility for levofloxacin. None of the strains were resistant to levofloxacin. Average length of stay of patients with S. maltophilia infection was found out to be 23.3 days as compared to 44.8 days in controls. The average mortality of patients with S. maltophilia infection was found to be same as that of controls (35.2%). Conclusion S. maltophilia is becoming an important
Moreno-Pérez, D; Alvarez García, F J; Arístegui Fernández, J; Cilleruelo Ortega, M J; Corretger Rauet, J M; García Sánchez, N; Hernández Merino, A; Hernández-Sampelayo Matos, T; Merino Moína, M; Ortigosa Del Castillo, L; Ruiz-Contreras, J
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded, as routine vaccinations, those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in special situations. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and 12 years of age. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. The recently authorised meningococcal B vaccine has opened a chapter of hope in the
Moreno-Pérez, D; Álvarez García, F J; Arístegui Fernández, J; Barrio Corrales, F; Cilleruelo Ortega, M J; Corretger Rauet, J M; González-Hachero, J; Hernández-Sampelayo Matos, T; Merino Moína, M; Ortigosa Del Castillo, L; Ruiz-Contreras, J
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 months and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age, preferably at 11-12 years. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it
Ramaswami, Uma; Cooper, Jackie; Humphries, Steve E
Background The National Institute for Health and Care Excellence 2008 guidelines on the treatment and management of familial hypercholesterolaemia (FH) recommend that children with FH should be considered for statin treatment by the age of 10 years. The Paediatric FH Register was established in 2012 to collect baseline and long-term follow-up data on all children with FH in the UK. Methods Paediatricians and adult lipidologists have been invited to enter baseline data on any child with a clinical diagnosis of FH using an electronic capture record. Results Baseline data is on 232 children (50% boys, 80% Caucasian), with an untreated mean (SD) total cholesterol of 7.61 (1.48) mmol/L and low-density lipoprotein cholesterol (LDL-C) of 5.67 (1.46) mmol/L. Overall 111/232 (47.8%) of the children were on statins. Children over the age of 10 years at the most recent follow-up were twice as likely to be on statin treatment than those under 10 years (57.6% (102/177) vs 23.1% (9/39), p=0.00009). In both age groups, those subsequently on statin treatment had significantly higher diagnostic total and LDL-C (overall 6.01 (1.46) mmol/L vs 5.31 (1.37) mmol/L, p=0.00007), and had stronger evidence of a family history of early coronary heart disease (CHD) in parent or first-degree relative (overall 28.4% vs 19.0%, p=0.09). In statin-treated children LDL-C level was reduced by 35% (2.07 (1.38) mmol/L) compared with a reduction of 5.5% (0.29 (0.87) mmol/L), p=0.0001 in those not treated. None of those on statin had measured plasma levels of creatine kinase, alanine aminotransferase and AST indicative of statin toxicity (ie, >2.5 times the upper limit of the normal range). Conclusions The data indicates that treatment decisions in children with FH are appropriately based on a stronger family history of CHD and higher LDL-C. PMID:26948823
Introduction Paediatric prescription analysis was done by vari-ous studies in tertiary care centers but not much published data, at primary care level. The Medical Council of India introduced new prescription format and also antibiotic stewardship program was launched by Government of Kerala in the year 2015. So in these contexts this study was conducted. Aim To analyse the patterns of prescriptions and drug dis-pensing in pediatric patients using WHO core drug use indicators and parameters in the prescription format prescribed by Medical Council of India. Materials and Methods Prospective study was done at a community health center, for a period of four months where parents of children attending the outpatient department were interviewed and the prescriptions and medicines that is with them was examined and analysed for any prescription errors or dispensing errors. For statistical analysis, quantitative variables were expressed in mean and standard deviation and qualitative variables in percentages. Results The mean age of the patients was 6.1 (SD±3.4) years. The average number of drugs prescribed was 2.29 (SD±35.91), 98.4% drugs were prescribed by generic name. Majority of drugs prescribed were in the form of syrups (62.73%), use of antibiotics was frequent (73.18%), but injection use was very minimal (0.006%). Weight of the patient was recorded in 58.33% of the prescriptions. Only 30 prescriptions (5.43%) were written in capital letters. A 100% of the prescriptions contain the details of the child along with provisional diagnosis and signature of the doctor. A 98.44% of the drugs prescribed were from the essential drug list. Copy of the essential drug list is available at the institution. The availability of key drugs was 100%. 98.73% knew the correct dosages and 100% of the drugs were adequately labeled. Conclusion The prescription pattern is in accordance with the standard guidelines of WHO. Interventions are needed to rectify over prescription of
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O'Gorman, Clodagh Sheila; Ziedan, Yasir; O'Neill, Michael Brendan
Aim To evaluate the quality of paediatric audits from 1966 to 1999. Methods A Medline search was performed using the MeSH terms audit, child, paediatric (and pediatric). Predefined core elements of audit were used as inclusion criteria for entry of an article into this study. These criteria were as follows: (1) an article deals with a healthcare topic; (2) a standard is predefined; (3) actual practice is evaluated; (4) actual practice is compared with the standard. The fifth criterion of audit, dissemination of information and reaudit, was not an inclusion criterion, as it was not used in the early years covered by this study. Empirical grading of standards was used. Results The search yielded 442 articles, of which 303 (100%) were related to paediatric healthcare and were reviewed. Standards were defined in 115 (38%) articles. Audit against the standard was performed in 92 (30.4%) articles, of which 42 (45.6%) were published before, and 50 (54.3%) after, 1990. 18 (5.9%) articles were re‐audited: 6 (14.3%) were published before, and 12 (24%) after, 1990. Of the 188 paediatric studies rejected, 119 (63.3%) described practice observations. Conclusion Many articles in paediatrics are published as “audits”, but they do not contain the core elements of audit. Although audit is a potentially valuable tool in clinical medicine, the publication of poor‐quality audits may lead to the decline of the audit concept. Suggestions on ways to improve the quality of published audits are made. PMID:16738000
Polizzi, Agata; Di Rosa, Gabriella; Romeo, Anna Claudia; Dipasquale, Valeria; Chirico, Valeria; Arrigo, Teresa; Ruggieri, Martino
Various neurological and psychiatric manifestations have been recorded in children with adrenal disorders. Based on literature review and on personal case-studies and case-series we focused on the pathophysiological and clinical implications of glucocorticoid-related, mineralcorticoid-related, and catecholamine-related paediatric nervous system involvement. Childhood Cushing syndrome can be associated with long-lasting cognitive deficits and abnormal behaviour, even after resolution of the hypercortisolism. Exposure to excessive replacement of exogenous glucocorticoids in the paediatric age group (e.g., during treatments for adrenal insufficiency) has been reported with neurological and magnetic resonance imaging (MRI) abnormalities (e.g., delayed myelination and brain atrophy) due to potential corticosteroid-related myelin damage in the developing brain and the possible impairment of limbic system ontogenesis. Idiopathic intracranial hypertension (IIH), a disorder of unclear pathophysiology characterised by increased cerebrospinal fluid (CSF) pressure, has been described in children with hypercortisolism, adrenal insufficiency, and hyperaldosteronism, reflecting the potential underlying involvement of the adrenal-brain axis in the regulation of CSF pressure homeostasis. Arterial hypertension caused by paediatric adenomas or tumours of the adrenal cortex or medulla has been associated with various hypertension-related neurological manifestations. The development and maturation of the central nervous system (CNS) through childhood is tightly regulated by intrinsic, paracrine, endocrine, and external modulators, and perturbations in any of these factors, including those related to adrenal hormone imbalance, could result in consequences that affect the structure and function of the paediatric brain. Animal experiments and clinical studies demonstrated that the developing (i.e., paediatric) CNS seems to be particularly vulnerable to alterations induced by adrenal
Arul, GS; Reynolds, J; DiRusso, S; Scott, A; Bree, S; Templeton, P; Midwinter, MJ
INTRODUCTION International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. METHODS All paediatric admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were analysed prospectively. Data collected included time and date of admission, patient age and weight, mechanism of injury, extent of wounding, treatment, length of hospital stay and discharge destination. RESULTS Eighty-five children (65 boys and 17 girls, median age: 8 years, median weight: 20kg) were admitted. In 63% of cases the indication for admission was battle related trauma and in 31% non-battle trauma. Of the blast injuries, 51% were due to improvised explosive devices. Non-battle emergencies were mainly due to domestic burns (46%) and road traffic accidents (29%). The most affected anatomical area was the extremities (44% of injuries). Over 30% of patients had critical injuries. Operative intervention was required in 74% of cases. The median time to theatre for all patients was 52 minutes; 3 patients with critical injuries went straight to theatre in a median of 7 minutes. A blood transfusion was required in 27 patients; 6 patients needed a massive transfusion. Computed tomography was performed on 62% of all trauma admissions and 40% of patients went to the intensive care unit. The mean length of stay was 2 days (range: 1–26 days) and there were 7 deaths. CONCLUSIONS Paediatric admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK paediatric emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK paediatric practice. PMID:22524930
Guilfoyle, Shanna M.; Denson, Lee A.; Baldassano, Robert N.; Hommel, Kevin A.
Background The psychosocial functioning of caregivers of adolescents managing inflammatory bowel disease (IBD) has been understudied; yet, poor caregiver functioning can place youth at risk for compromised disease management. The current study addressed this limitation by examining a sample of caregivers of adolescents with IBD. Study aims included: 1) document rates of paediatric parenting stress, 2) identify associated sociodemographic predictors of parenting stress, and 3) compare previously published rates of parenting stress to those within other paediatric chronic conditions, including cancer, type 1 diabetes, obesity, sickle cell disease, bladder exstrophy. Methods Caregivers of adolescents with an IBD diagnosis (Mage = 15.4±1.4, 44.4% female, 88.7% Caucasian) and receiving tertiary care within a gastroenterology clinic (N = 62) completed the Pediatric Inventory for Parents (PIP) as a measure of paediatric parenting stress with Frequency and Difficulty as PIP subscales. Paediatric gastroenterologists provided disease severity assessments. Results Adolescents with IBD were experiencing relatively mild disease activity. Bivariate correlations revealed that PIP-Difficulty was positively associated with Crohn’s disease severity (r = 0.38, p < 0.01). Caregiver age was negatively associated with the frequency of parenting stress total (r = −.25, p = .05) and communication scores (r = −.25, p <.05). The frequency and difficulty of parenting stressors within the IBD sample were similar to rates within type 1 diabetes, but were significantly lower to rates identified in other paediatric chronic conditions. Conclusions Caregivers of adolescents with IBD seem to experience low rates of parenting stress when their adolescents are receiving outpatient care and during phases of IBD relative inactivity. The sociodemographic characteristics of IBD families (i.e., primarily Caucasian, well-educated, and higher socioeconomic status) likely encourage greater access to
Salpietro, Vincenzo; Polizzi, Agata; Di Rosa, Gabriella; Romeo, Anna Claudia; Dipasquale, Valeria; Morabito, Paolo; Chirico, Valeria; Arrigo, Teresa; Ruggieri, Martino
Various neurological and psychiatric manifestations have been recorded in children with adrenal disorders. Based on literature review and on personal case-studies and case-series we focused on the pathophysiological and clinical implications of glucocorticoid-related, mineralcorticoid-related, and catecholamine-related paediatric nervous system involvement. Childhood Cushing syndrome can be associated with long-lasting cognitive deficits and abnormal behaviour, even after resolution of the hypercortisolism. Exposure to excessive replacement of exogenous glucocorticoids in the paediatric age group (e.g., during treatments for adrenal insufficiency) has been reported with neurological and magnetic resonance imaging (MRI) abnormalities (e.g., delayed myelination and brain atrophy) due to potential corticosteroid-related myelin damage in the developing brain and the possible impairment of limbic system ontogenesis. Idiopathic intracranial hypertension (IIH), a disorder of unclear pathophysiology characterised by increased cerebrospinal fluid (CSF) pressure, has been described in children with hypercortisolism, adrenal insufficiency, and hyperaldosteronism, reflecting the potential underlying involvement of the adrenal-brain axis in the regulation of CSF pressure homeostasis. Arterial hypertension caused by paediatric adenomas or tumours of the adrenal cortex or medulla has been associated with various hypertension-related neurological manifestations. The development and maturation of the central nervous system (CNS) through childhood is tightly regulated by intrinsic, paracrine, endocrine, and external modulators, and perturbations in any of these factors, including those related to adrenal hormone imbalance, could result in consequences that affect the structure and function of the paediatric brain. Animal experiments and clinical studies demonstrated that the developing (i.e., paediatric) CNS seems to be particularly vulnerable to alterations induced by adrenal
Improving glycaemic control and life skills in adolescents with type 1 diabetes: A randomised, controlled intervention study using the Guided Self-Determination-Young method in triads of adolescents, parents and health care providers integrated into routine paediatric outpatient clinics
Background Adolescents with type 1 diabetes face demanding challenges due to conflicting priorities between psychosocial needs and diabetes management. This conflict often results in poor glycaemic control and discord between adolescents and parents. Adolescent-parent conflicts are thus a barrier for health care providers (HCPs) to overcome in their attempts to involve both adolescents and parents in improvement of glycaemic control. Evidence-based interventions that involve all three parties (i.e., adolescents, parents and HCPs) and are integrated into routine outpatient clinic visits are lacking. The Guided Self-Determination method is proven effective in adult care and has been adapted to adolescents and parents (Guided Self-Determination-Young (GSD-Y)) for use in paediatric diabetes outpatient clinics. Our objective is to test whether GSD-Y used in routine paediatric outpatient clinic visits will reduce haemoglobin A1c (HbA1c) concentrations and improve adolescents' life skills compared with a control group. Methods/Design Using a mixed methods design comprising a randomised controlled trial and a nested qualitative evaluation, we will recruit 68 adolescents age 13 - 18 years with type 1 diabetes (HbA1c > 8.0%) and their parents from 2 Danish hospitals and randomise into GSD-Y or control groups. During an 8-12 month period, the GSD-Y group will complete 8 outpatient GSD-Y visits, and the control group will completes an equal number of standard visits. The primary outcome is HbA1c. Secondary outcomes include the following: number of self-monitored blood glucose values and levels of autonomous motivation, involvement and autonomy support from parents, autonomy support from HCPs, perceived competence in managing diabetes, well-being, and diabetes-related problems. Primary and secondary outcomes will be evaluated within and between groups by comparing data from baseline, after completion of the visits, and again after a 6-month follow-up. To illustrate how GSD
Nicoll, A.; McGarrigle, C.; Brady, A. R.; Ades, A. E.; Tookey, P.; Duong, T.; Mortimer, J.; Cliffe, S.; Goldberg, D.; Tappin, D.; Hudson, C.; Peckham, C.
OBJECTIVE: To describe the epidemiology of HIV-1 infection in pregnant women in the United Kingdom. DESIGN: Serial unlinked serosurveillance for HIV-1 in neonatal specimens and surveillance through registers of diagnosed maternal and paediatric infections from reporting by obstetricians, paediatricians, and microbiologists. SETTING: United Kingdom, 1988-96. SUBJECTS: Pregnant women proceeding to live births and their children. MAIN OUTCOME MEASURES: Time trends in prevalence of HIV-1 seropositivity in newborn infants (as a proxy for infection in mothers); the proportions of mothers with diagnosed HIV-1 infections, and their characteristics. RESULTS: HIV-1 prevalence among mothers in London rose sixfold between 1988 and 1996 (0.19% of women tested; 1 in 520 in 1996). Apart from in Edinburgh and Dundee, levels remained low in Scotland (0.025%; 1 in 3970) and elsewhere in the United Kingdom (0.016%; 1 in 1930). Over a third of births to infected mothers in 1996 occurred outside London. In London the reported infections were predominantly among black African women, whereas in Scotland most were associated with drug injecting. The contribution of reported infection among African women increased over time as that of drug injecting declined. In Scotland 51% of mothers' infections were diagnosed before the birth. In England, despite a national policy initiative in 1992 to increase the antenatal detection rate of HIV, no improvement in detection was observed, and in 1996 only 15% of previously unrecognised HIV infections were diagnosed during pregnancy. CONCLUSIONS: HIV-1 infection affects mothers throughout the United Kingdom but is most common in London. Levels of diagnosis in pregnant women have not improved. Surveillance data can monitor effectively the impact of initiatives to reduce preventable HIV-1 infections in children. PMID:9472504
Fallesen, Peter; Emanuel, Natalia; Wildeman, Christopher
Although recent research suggests that the cumulative risk of foster care placement is far higher for American children than originally suspected, little is known about the cumulative risk of foster care placement in other countries, which makes it difficult to gauge the degree to which factor foster care placement is salient in other contexts. In this article, we provide companion estimates to those provided in recent work on the US by using Danish registry data and synthetic cohort life tables to show how high and unequally distributed the cumulative risk of foster care placement is for Danish children. Results suggest that at the beginning of the study period (in 1998) the cumulative risk of foster care placement for Danish children was roughly in line with the risk for American children. Yet, by the end of the study period (2010), the risk had declined to half the risk for American children. Our results also show some variations by parental ethnicity and sex, but these differences are small. Indeed, they appear quite muted relative to racial/ethnic differences in these risks in the United States. Last, though cumulative risks are similar between Danish and American children (especially at the beginning of the study period), the age-specific risk profiles are markedly different, with higher risks for older Danish children than for older American children. PMID:25299657
Fallesen, Peter; Emanuel, Natalia; Wildeman, Christopher
Although recent research suggests that the cumulative risk of foster care placement is far higher for American children than originally suspected, little is known about the cumulative risk of foster care placement in other countries, which makes it difficult to gauge the degree to which factor foster care placement is salient in other contexts. In this article, we provide companion estimates to those provided in recent work on the US by using Danish registry data and synthetic cohort life tables to show how high and unequally distributed the cumulative risk of foster care placement is for Danish children. Results suggest that at the beginning of the study period (in 1998) the cumulative risk of foster care placement for Danish children was roughly in line with the risk for American children. Yet, by the end of the study period (2010), the risk had declined to half the risk for American children. Our results also show some variations by parental ethnicity and sex, but these differences are small. Indeed, they appear quite muted relative to racial/ethnic differences in these risks in the United States. Last, though cumulative risks are similar between Danish and American children (especially at the beginning of the study period), the age-specific risk profiles are markedly different, with higher risks for older Danish children than for older American children.
Kørnøv, Lone; Hill, Amanda Louise; Busck, Ole; Løkke, Søren
The push for creating a more competitive and liberalized system for traditional public services, including waste management, has been on the European agenda since the late 1980s. In 2008, changes were made in EU waste legislation allowing source-separated industrial/commercial waste that is suitable for incineration to be traded within the European market. This change has had broad implications for the Danish waste sector, which is characterized by institutionalized municipal control with all streams of waste and municipal ownership of the major treatment facilities allowing the municipal sector to integrate combustible waste in local heat and power generation. This article, applying an institutional approach, maps the institutions and actors of the Danish waste sector and analyses how the regulatory as well as normative pressure to liberalize has been met and partly neutralized in the institutional and political context. The new Danish regulation of 2010 has thus accommodated the specific requirement for liberalization, but in fact only represents a very small step towards a market-based waste management system. On the one hand, by only liberalizing industrial/commercial waste, the Danish Government chose to retain the main features of the established waste system favouring municipal control and hence the institutionalized principles of decentralized enforcement of environmental legislation as well as welfare state considerations. On the other hand, this has led to a technological and financial deadlock, particularly when it comes to reaching the recycling targets of EU, which calls for further adjustments of the Danish waste sector.
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Similar outcome of upfront-unrelated and matched sibling stem cell transplantation in idiopathic paediatric aplastic anaemia. A study on behalf of the UK Paediatric BMT Working Party, Paediatric Diseases Working Party and Severe Aplastic Anaemia Working Party of EBMT.
Dufour, Carlo; Veys, Paul; Carraro, Elisa; Bhatnagar, Neha; Pillon, Marta; Wynn, Rob; Gibson, Brenda; Vora, Ajay J; Steward, Colin G; Ewins, Anna M; Hough, Rachael E; de la Fuente, Josu; Velangi, Mark; Amrolia, Persis J; Skinner, Roderick; Bacigalupo, Andrea; Risitano, Antonio M; Socie, Gerard; Peffault de Latour, Regis; Passweg, Jakob; Rovo, Alicia; Tichelli, André; Schrezenmeier, Hubert; Hochsmann, Britta; Bader, Peter; van Biezen, Anja; Aljurf, Mahmoud D; Kulasekararaj, Austin; Marsh, Judith C; Samarasinghe, Sujith
We explored the feasibility of unrelated donor haematopoietic stem cell transplant (HSCT) upfront without prior immunosuppressive therapy (IST) in paediatric idiopathic severe aplastic anaemia (SAA). This cohort was then compared to matched historical controls who had undergone first-line therapy with a matched sibling/family donor (MSD) HSCT (n = 87) or IST with horse antithymocyte globulin and ciclosporin (n = 58) or second-line therapy with unrelated donor HSCT post-failed IST (n = 24). The 2-year overall survival in the upfront cohort was 96 ± 4% compared to 91 ± 3% in the MSD controls (P = 0·30) and 94 ± 3% in the IST controls (P = 0·68) and 74 ± 9% in the unrelated donor HSCT post-IST failure controls (P = 0·02).The 2-year event-free survival in the upfront cohort was 92 ± 5% compared to 87 ± 4% in MSD controls (P = 0·37), 40 ± 7% in IST controls (P = 0·0001) and 74 ± 9% in the unrelated donor HSCT post-IST failure controls (n = 24) (P = 0·02). Outcomes for upfront-unrelated donor HSCT in paediatric idiopathic SAA were similar to MSD HSCT and superior to IST and unrelated donor HSCT post-IST failure. Front-line therapy with matched unrelated donor HSCT is a novel treatment approach and could be considered as first-line therapy in selected paediatric patients who lack a MSD.
Bendle, Meenakshi; Bajpai, Smrati; Choudhary, Ashwini; Pazare, Amar
In India, parent to child transmission is the most important source of HIV infection in children below fifteen years of age. Transmission of HIV from mother to child can occur even at low or undetectable HIV virus levels. CD4 count or HIV RNA levels should not be the determining factor when deciding whether to use antiretroviral drugs for prevention of perinatal transmission of HIV. Use of single dose nevirapine during labour, in prevention of parent to child transmission (PPTCT) programme for pregnant females with CD4 count > 250 cells/cumm has less efficacy in reducing perinatal transmission. And there are high chances of development of nevirapine resistance to both mother and baby after single dose nevirapine exposure. Short course Protease inhibitor(PI) based triple drug combination ART from 28 weeks till delivery for perinatal prophylaxis is effective in reducing perinatal HIV transmission. PI's are safe in pregnancy and also have less chances of development of resistance when used for perinatal prophylaxis and stopped post delivery.Hence, it is opined that PI based combination ART should be offered to pregnant females in PPTCT programme, thereby preventing occurrence of paediatric HIV infection in India. This can have significant impact on the society at large.
The 62nd British Association of Paediatric Surgeons (BAPS) Annual Conference was held July 22-24, 2015, in Cardiff, Wales. This congress issue contains papers presented during the open sessions and transcripts based on invited lectures.
This article identifies a significant transformation in the role and identity of parents accompanying their child to clinic. This shift is a product of the intersection between paediatric and genetic medicine, where parents play a critical role in providing information about their child, family and ultimately, about themselves. To provide a context for this matrix, two broad areas of sociological inquiry are highlighted. The first is explanations of the role a parent plays in paediatric medicine and the second is the diagnostic process in paediatric genetics and the implications for parent and child identities. Drawing from an ethnographic study of clinical consultations, attention is paid to the changing role of parenthood and the extended role of patienthood in paediatric genetic medicine.
Andersen, Nis; Hjortdal, Jesper Østergaard; Schielke, Katja Christina; Bek, Toke; Grauslund, Jakob; Laugesen, Caroline Schmidt; Lund-Andersen, Henrik; Cerqueira, Charlotte; Andresen, Jens
Aim of database To monitor the development of diabetic eye disease in Denmark and to evaluate the accessibility and effectiveness of diabetic eye screening programs with focus on interregional variations. Target population The target population includes all patients diagnosed with diabetes. Denmark (5.5 million inhabitants) has ~320,000 diabetes patients with an annual increase of 27,000 newly diagnosed patients. The Danish Registry of Diabetic Retinopathy (DiaBase) collects data on all diabetes patients aged ≥18 years who attend screening for diabetic eye disease in hospital eye departments and in private ophthalmological practice. In 2014–2015, DiaBase included data collected from 77,968 diabetes patients. Main variables The main variables provide data for calculation of performance indicators to monitor the quality of diabetic eye screening and development of diabetic retinopathy. Data with respect to age, sex, best corrected visual acuity, screening frequency, grading of diabetic retinopathy and maculopathy at each visit, progression/regression of diabetic eye disease, and prevalence of blindness were obtained. Data analysis from DiaBase’s latest annual report (2014–2015) indicates that the prevalence of no diabetic retinopathy, nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy is 78%, 18%, and 4%, respectively. The percentage of patients without diabetic maculopathy is 97%. The proportion of patients with regression of diabetic retinopathy (20%) is greater than the proportion of patients with progression of diabetic retinopathy (10%). Conclusion The collection of data from diabetic eye screening is still expanding in Denmark. Analysis of the data collected during the period 2014–2015 reveals an overall decrease of diabetic retinopathy compared to the previous year, although the number of patients newly diagnosed with diabetes has been increasing in Denmark. DiaBase is a useful tool to observe the quality of screening
Kristensen, Erling; Jakobsen, Esben B
To implement biosecurity measures at farm-level is a motivational challenge to dairy farmers as emerging diseases and their consequences largely are unpredictable. One of the reasons for this challenge is that outcomes are more likely to benefit society than the individual farmer. From the individual farmer's point of view the impacts of zoonotic risk, international trade and welfare concerns appear less obvious than the direct costs at farm-level. Consequently, a social dilemma may arise where collective interests are at odds with private interests. To improve biosecurity at farm-level farmers must be motivated to change behavior in the 'right' direction which could provide selfish farmers with unintended possibilities to exploit the level of biosecurity provided by other dairy farmers' collective actions. Farmers' perception of risk of disease introduction into a dairy herd was explored by means of Q-methodology. Participating farmers owned very large dairy herds and were selected for this study because Danish legislation since 2008 has required that larger farms develop and implement a farm specific biosecurity plan. However, a year from introduction of this requirement, none of the participating farmers had developed a biosecurity plan. Farmers' perception of biosecurity could meaningfully be described by four families of perspectives, labeled: cooperatives; confused; defectors, and introvert. Interestingly, all families of perspectives agreed that sourcing of animals from established dealers represented the highest risk to biosecurity at farm-level. Farmers and policy-makers are faced with important questions about biosecurity at farm-level related to the sanctioning system within the contextual framework of social dilemmas. To solve these challenges we propose the development of a market-mediated system to (1) reduce the risk of free-riders, and (2) provide farmers with incentives to improve biosecurity at farm-level.
Cadierno, Teresa; Ibarretxe-Antuñano, Iraide; Hijazo-Gascón, Alberto
This study investigates semantic categorization of the meaning of placement verbs by Danish and Spanish native speakers and two groups of intermediate second language (L2) learners (Danish learners of L2 Spanish and Spanish learners of L2 Danish). Participants described 31 video clips picturing different types of placement events. Cluster analyses…
Gorlén, Tanja Fromberg; Gorlén, Thomas; Neergaard, Mette Asbjoern
Little is known about the quality of end-of-life care in Danish nursing homes (NHs). This qualitative descriptive study based on semi-structured group interviews with nursing staff members in three NHs in Copenhagen, Denmark, aimed to describe the participants' perceptions of end-of-life care in Danish NHs, with particular focus on medication administration and collaboration with GPs. Four main categories of problematic issues emerged: medication (problems with 'as needed' medication and lack of knowledge of subcutaneous administration), interpersonal relations (difficulties in cooperation and communication between relatives and GPs), decision making (problems concerning termination of life-prolonging treatment and the need for early planning of end-of-life care), and professional development (documentation and education). Considerable improvements may be achieved primarily by educating and training nursing staff and GPs. More research is warranted to optimise end-of-life care in Danish NHs.