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PubMedDate not supplied

Human immunodeficiency virus infection in Saudi Arabian children: transmission, clinical manifestations and outcome.

BACKGROUND: Vertical transmission from mother to infant is the most common mode of transmission of HIV infection in children. Data on pediatric HIV in the Middle East and Gulf region are scarce. We describe the spectrum, characteristics and outcome of HIV infection in Saudi children. METHODS: We collected descriptive data on HIV-infected or exposed children seen at the King Faisal Hospital and Research Centre (KFSH&RC) between 1986 and 2003. RESULTS: Sixty-three children had proven HIV infection. The source of infection was perinatal transmission in 63.5% of cases and contaminated blood or blood products transfusion in 34.5%. Median age at diagnosis was 6 years. In 42 patients for whom complete records were available, 90% were delivered by spontaneous vaginal delivery and 10% by cesarean delivery. Ninety-three percent of infected infants were breastfed throughout infancy. The complete medical records were available for 66% of children; for the remainder, part of the records could not be retrieved. Thirteen percent had an AIDS-defining opportunistic infection, with disseminated cytomegalovirus (CMV) infection being the most common (37.5%). All cases received antiretroviral therapy starting in 1997. Of those who received highly active antiretroviral therapy, 79% were compliant with treatment and had a sustained virologic response below the detectable level. Seventy-five percent of those diagnosed before 1995 died compared with 7.7% diagnosed later. CONCLUSION: Effective preventive measures, such as antiretroviral prophylaxis, cesarean delivery, and abstention from breastfeeding are not being applied. This could be largely due to lack of knowledge among patients and healthcare providers. Physicians must recognize the signs and symptoms of HIV infection, and have a high index of suspicion so that infected children are diagnosed early and referred to a specialized center for treatment and follow-up.

Antiretroviral Therapy, Highly Active↗

PubMed1990

An epidemic of poliomyelitis in southern Kerala.

An epidemic of poliomyelitis was recognized in May 1987 when there was a sharp increase in the number of children with acute paralytic poliomyelitis admitted to the SAT Hospital in Trivandrum in Kerala State. From May through September, 392 cases were admitted; the total admitted cases in 1987 were 458 in contrast to 119 in 1986. Evidence for type 1 poliovirus infection was found in 33 (85%) of the 39 children in whom virological investigations were done during the epidemic. In addition, evidence for poliovirus type 3 infection was found in four children. Data on the immunization status was available on 231 affected children in the epidemic; 175 (76%) had not received oral polio vaccine (OPV); 55 (24%) had received one or two doses and only one child had received three doses. Thus, lack of immunization was a major risk factor for disease. The estimated vaccine coverage with three doses of OPV in Kerala, based on the quantity of vaccine distributed during the years 1985, 1986 and 1987 were 94%, 100% and 91%, respectively. This outbreak occurred in spite of high vaccine coverage, and it illustrates the need for even higher coverage rates; the usefulness of hospitals as sentinel surveillance centres; the need for decentralized vaccine coverage data in order to prevent build-up of unimmunized susceptible children in any region; and the urgent need of a mechanism to respond to an epidemic quickly, with immunization, in order to curtail it.

Acute Disease↗

PubMed2006

Symptoms of internalizing and externalizing problems: modeling recovery curves after the death of a parent.

BACKGROUND: The death of a parent is a major family disruption that can place children at risk for later depression and other mental health problems. DESIGN: Theoretically based randomized controlled trial for parentally bereaved children. SETTING/PARTICIPANTS: Two-hundred and forty-four children and adolescents and their caregivers from 156 families were randomly assigned to the Family Bereavement Program (FBP) intervention condition (90 families; 135 children) or to a control condition (66 families; 109 children). Data collection occurred from 1996 to 1998. INTERVENTION: Children and caregivers in the intervention condition met separately for 12 two-hour weekly sessions. Skills targeted by the program for children included positive coping, stress appraisals, control beliefs, and self-esteem. The caregiver program targeted caregiver mental health, life stressors, and improved discipline in the home. Both child and caregiver programs focused on improved quality of the caregiver-child relationship. MAIN OUTCOME MEASURES: Child and caregiver reports of internalizing and externalizing symptoms. RESULTS: Longitudinal growth curve modeling was performed to model symptoms over time from the point of parental death. The rate of recovery for girls in the program condition was significantly different from that of girls in the control condition across all outcomes. Boys in both conditions showed reduced symptoms over time. CONCLUSIONS: The methodology offers a conceptually unique way of assessing recovery in terms of reduced mental health problems over time after an event and has contributed to further understanding of FBP intervention effects. The intervention program facilitated recovery among girls, who did not show reduction in behavior problems without the program, while boys demonstrated decreased symptoms even without intervention.

Adolescent↗

PubMed2004

Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis.

BACKGROUND: We analyzed individual patient data to determine the contribution of late postnatal transmission to the overall risk of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) and the timing and determinants of late postnatal transmission. METHODS: Eligible trials were conducted where breast-feeding was common; included >/=2 HIV-1 tests by 3 months, and, if follow-up continued, >/=2 tests at 3-12 months; and regularly assessed infant-feeding modality. Data on children born before January 2000 were analyzed. RESULTS: Of 4085 children from 9 trials (breast-fed singletons for whom HIV-1 testing was performed), 993 (24%) were definitively infected (placebo arms, 25.9%; treatment arms, 23.4%; P=.08). Of 539 children with known timing of infection, 225 (42%) had late postnatal transmission. Late postnatal transmission occurred throughout breast-feeding. The estimated hazard function for time to late postnatal transmission was roughly constant. The cumulative probability of late postnatal transmission at 18 months was 9.3%. The overall risk of late postnatal transmission was 8.9 transmissions/100 child-years of breast-feeding and was significantly higher with lower maternal CD4(+) cell counts and male sex. CONCLUSIONS: Late postnatal transmission contributes substantially to overall mother-to-child transmission of HIV-1. The risk of late postnatal transmission is generally constant throughout breast-feeding, and late postnatal transmission is associated with a lower maternal CD4(+) cell count and male sex. Biological and cultural mechanisms underlying the association between sex and late postnatal transmission should be further investigated. Interventions to decrease transmission of HIV-1 through breast-feeding are urgently needed.

Breast Feeding↗

PubMed2001

Mother and child perceptions of child functioning: relationship to maternal distress.

The relationship between maternal distress and mother's reports of psychosocial problems in their children has been well-documented. However, relatively little research has investigated the relationship between maternal and family distress and young children's perception of their own functioning. Using a brief questionnaire designed for use with children, data were collected from 166 mothers and their children aged 5-12 years. Children provided information about their own daily functioning, and mothers provided information about their own, their child's, and their family's psychosocial functioning. Findings indicated that while children generally agreed with the reports of their mothers, children of distressed mothers self-reported better daily functioning than their mothers did. Distressed mothers tended globally to report negatively about themselves, their child, and their family. The present findings suggest that when assessing mothers or children, the reports of children should be considered as well as the reports of mothers.

Adult↗

PubMed1999

Predictors of successful extubation in children.

Objective criteria to predict extubation outcome in mechanically ventilated children are not available. Our goal was to study factors associated with extubation success and to evaluate the usefulness of the rapid shallow breathing index (RSBI) and the compliance, resistance, oxygenation, and pressure index (CROP index) in children. Data were prospectively collected on 227 mechanically ventilated children. Patients successfully extubated had significantly better lung compliance (Cdyn: 0.59 +/- 0.91 versus 0.39 +/- 0.14 ml/kg/cm H(2)O), higher Pa(O(2))/FI(O(2)) ratio (382.4 +/- 181.2 versus 279.8 +/- 93.9), and lower Pa(CO(2)) (41.3 +/- 6.7 versus 47.3 +/- 8.5 mm Hg). Spontaneous breathing parameters showed significantly lower respiratory rates (RR) (36.6 +/- 17.9 versus 52.8 +/- 23 breaths/min), larger tidal volumes (VT) (7.3 +/- 2.6 versus 4.9 +/- 1.8 ml/kg), and greater muscle strength (negative inspiratory force [NIF]: 41.8 +/- 15.4 versus 35.1 +/- 12.5 cm H(2)O) in successfully extubated children. Extubation failures had higher RSBIs and lower CROP index values. A RSBI value of </= 8 breaths/ml/kg had a sensitivity of 74% and specificity of 74%, whereas a CROP value of >/= 0.15 ml/kg/breaths/min had a sensitivity of 83% and specificity of 53% for extubation success. Children failing extubation demonstrate abnormalities of respiratory function. The RSBI and CROP index are useful to predict pediatric extubation success.

Airway Resistance↗

PubMedDate not supplied

Social activities in the families of children with acute lymphoblastic leukemia.

The social activities of 15 children with acute lymphoblastic leukemia (ALL) and their families (index families) were compared during chemotherapy with those of control families matched for the numbers, ages, and sex of the children. Data concerning the day care arrangements for the children of all the index and control families were obtained by a questionnaire. The children under school age in the index families were more frequently cared for at home or in a family than were those in the control families (14/14 vs 13/26, P < 0.01). All visits made, visitors received, and gatherings of 12 index and 12 control families were recorded by means of diaries during two 4-week periods in May and September 1989. The adults and children in the ALL families made an average of 5.5 and 3.4 visits per person, respectively, during each 4-week period, with the corresponding figures for the control families being 5.4 and 4.4. The mean number of adult and child guests in the index and the control families and the corresponding figures for visits were similar. The mean numbers of adults and children present at places visited by an index and control family did not differ statistically significantly, and the mean number of gatherings attended per adult and child during a period of 4 weeks was also similar in both groups of families. The differences were found in day care arrangements, but social activities as recorded by visits and gatherings were similar in the families of the children with ALL and the controls.

Adolescent↗

PubMed2000

Oral care for children with leukaemia.

OBJECTIVES: To review the oral care regimens for children with acute leukaemia, and to present an easy-to-follow oral care protocol for those affected children. DATA SOURCES: Medline and non-Medline search of the literature; local data; and personal experience. STUDY SELECTION: Articles containing supportive scientific evidence were selected. DATA EXTRACTION: Data were extracted and reviewed independently by the authors. DATA SYNTHESIS: Cancer is an uncommon disease in children, yet it is second only to accidents as a cause of death for children in many countries. Acute leukaemia is the most common type of malignancy encountered in children. The disease and its treatment can directly or indirectly affect the child's oral health and dental development. Any existing lesions that might have normally been dormant can also flare up and become life-threatening once the child is immunosuppressed. Proper oral care before, during, and after cancer therapy has been found to be effective in preventing and controlling such oral complications. CONCLUSION: Proper oral care for children with leukaemia is critical. Long-term follow-up of these children is also necessary to monitor their dental and orofacial growth.

Child↗

PubMedDate not supplied

Dental erosion among children in an Istanbul public school.

The aim of this study was to evaluate the prevalence, clinical manifestations, and etiology of dental erosion among children. A total of 153 healthy, 11-year-old children were sampled from a downtown public school in Istanbul, Turkey comprised of middle-class children. Data were obtained via: (1) dinical examination; (2) questionnaire; and (3) standardized data records. A new dental erosion index for children designed by O'Sullivan (2000) was used. Twenty-eight percent (N=43) of the children exhibited dental erosion. Of children who consumed orange juice, 32% showed erosion, while 40% who consumed carbonated beverages showed erosion. Of children who consumed fruit yogurt, 36% showed erosion. Of children who swam professionally in swimming pools, 60% showed erosion. Multiple regression analysis revealed no relationship between dental erosion and related erosive sources (P > .05).

Carbonated Beverages↗

PubMed1990

Discriminant function analysis: a case study of some socioeconomic constraints on child nutrition.

Discriminant function analysis was used to understand the combination of socioeconomic variables in various forms of malnutrition in preschool children. Data available (1976) from two sets viz., 4000 children of rural and urban areas of Hyderabad (in south India) and 215 children of urban and rural areas of Jaipur (in north India) were used for the study. The prevalence rates of various forms of malnutrition in children were different by variations in socioeconomic status and sex (P less than 0.05). Discriminant function analysis of all socioeconomic indicators showed that educational levels and occupational status of parents and percaput income were most important for differentiation of children who were normals and undernourished. Occupational status of the father and the child's calorie intake or duration of lactation improved the differentiation of normals from those who were under-nourished. Higher prevalence of malnutrition in female children than in the male children was found due to variations in per capita income and levels of maternal education. Closely associated best set of factors could be traced using the discriminant function analysis.

Child Nutrition Disorders↗

PubMed1994

[Exposure to lead in selected population groups. IV. Lead exposure among nursery children in Chorzow].

Main goal of this studies was to determine the level of exposure to lead of selected representatives of children's population attended nursery school, aged 2 to 4 years, residing in three different districts of Chorzów as far as the traffic intensity is concerned. It is the most densely populated town in Poland with the high concentration of industry and considerable intensity of traffic. Number of tested samples of children were 41, 43, 40. The tests were made in summer. Lead (Pb-B), zinc protoporphyrin level (ZPP), hemoglobin (Hb), erythrocyte count in blood (E) and delta-aminolevulinic acid (ALA) and creatinine concentration in urine were determined. The highest Pb-B level observed was 300 micrograms/l, the geometric mean of the blood lead concentrations were: 131, 132, and 199 micrograms/l and were not statistically valid in their differences. Median ranges were 118, 133 and 144 micrograms/l. Averages above the level 200 micrograms/l were found in the case of 19.5%, 11.8% and 15% children. Data were estimated in comparison with WHO recommended admissible blood lead level in overall population. The obtained data suggest higher lead absorption in the examined children's population.

Aminolevulinic Acid↗

PubMed2004

Single high-dose rectal acetaminophen in children.

OBJECTIVE: To determine whether there is sufficient evidence to support the use of one-time high-dose (>30 mg/kg) rectally administered acetaminophen to control postoperative pain in children. DATA SOURCES: Literature was accessed through MEDLINE (1966-May 2004) and bibliographic searches. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated and all studies regarding the use of greater than 30 mg/kg of acetaminophen in children were included for this review. DATA SYNTHESIS: A single high dose of rectally administered acetaminophen has been used in children to control postoperative pain. Ten randomized controlled trials and pharmacokinetic studies evaluating the use of greater than 30 mg/kg of rectally administered acetaminophen in children were identified and reviewed. Each study had a unique objective. The studies also differed substantially in regard to design, study population, dosing, rectal formulation used, and monitoring. CONCLUSIONS: Due to limited study data, wide study variability, and lack of standardization in terms of design, objectives, study population, dosing, rectal formulation, and monitoring, compounded by the fact that children often require additional doses of acetaminophen to control postoperative pain, the practice of using one-time, high-dose, rectally administered acetaminophen in children cannot be recommended at this time.

Acetaminophen↗

PubMed1988

Longitudinal study of dental health behaviors and other caries predictors in early childhood.

This longitudinal study of 231 preschoolchildren from a medium sized Norwegian town had three aims: firstly, to examine the children's early dental behavior, secondly to study the variation of dental health behavior according to mother's education, mother's dental health, and her dental attendance pattern, and thirdly to identify any behavioral or social predictors of dental caries in 36-month-old children. Data were collected at health centers, using precoded questionnaires and examinations, when the children were 6, 18, and 36 months old. Data about the mothers were collected at the maternity ward. At 36 months of age, 80% of the children were caries free. Favorable dental behaviors were related to toothbrushing and use of fluorides. These behaviors were so well established and consistent at all ages that they can be regarded as norms for this community. The most unfavorable and inconsistent behavior was related to sugar consumption. Dental health education could be most usefully applied to this area, where the greatest potential for improvement in behavior exists. A relationship was found between the children's caries experience and the number of missing teeth of the mother, her dental attendance pattern and her level of education. None of the social or behavioral variables tested had a strong enough association with caries experience to justify their use as caries predictors in this age group.

Child Behavior↗

PubMed1998

Misuse of drugs in acute diarrhoea in under-five children.

This was a community based, thirty cluster survey, carried out in Chittagong metropolitan area of Bangladesh, aimed to determine the extent of misuse of drugs in acute diarrhoea among under-five children. Data were collected from 360 mothers whose under-five children had suffered from acute diarrhoea during the preceding two weeks of interview. Data were pertained to type and duration of diarrhoea and treatment received. There were 339(94.2%) cases of acute watery diarrhoea and 21 (5.8%) cases of dysentery i.e. blood in stool. The mean duration of the diarrhoeal episode was 3.17 +/- 1.69 days (95% CI, 2.99-3.34). Three hundred twenty eight (91.1%) cases received treatment. There was a total of 401 consultations, out of which 328(81.8%) had first, 69(17.2%) had second and 4(1.0%) had third consultations. The first and second treatment were provided predominantly by care-providers (43.3%) and physicians (5.5%) respectively. Only 82(26.7%) cases of acute watery diarrhoea received WHO recommended treatment and only 5(23.8%) cases of dysentery received appropriate antibiotics. The rest 241(73.5%) cases received inappropriate treatment either antibiotic or drugs other than WHO recommendation. The average number of drugs prescribed per patient was 1.5 during the episode. The commonly prescribed drugs were metronidazole (38.6%) and antibiotics (17.3%). Those who consulted health professionals were at 5.7 times higher risk of receiving drugs. The mean duration of the episode of acute watery diarrhoea was increased significantly when drug is used in the treatment. It is concluded that there was high prevalence of misuse of drugs in the treatment of acute diarrhoea among under-five children which calls for intervention to improve the prescribing pattern as per WHO recommendation.

Acute Disease↗

PubMed1992

The pharmacokinetics of new oral cephalosporins in children.

Differences in the pharmacokinetic parameters of cephalosporins between children and adults may be predictable on the basis of the level of maturation of the physiologic processes involved in drug disposition. It appears that the most important of these factors (gastrointestinal, renal and hepatic function) are reasonably mature by the age of 1 year. As a result, the primary difference between adults and children relates to size and body composition. Comparable bioavailability is expected in children and adults. However, absolute values for systemic clearance (ClS) and volume of distribution (VSS) will be lower in children. It has been suggested that ClS in children is reduced in proportion to body surface area. This may also be true for the VSS of the cephalosporins since they distribute primarily into the extracellular fluid space which has been shown to be similar in children and adults when adjusted for surface area. If both ClS and VSS are proportional to surface area, half-life will be similar in adults and children. Data with cefetamet generally support these principles. Clearance normalized for body surface area averaged 69.3 ml/min/m2 in children aged 3-7 years, 64.9 ml/min/m2 in children of 8-12 years and 68.9 ml/min/m2 in adults. The VSS remained somewhat smaller in children than adults even after correction for surface area. Bioavailability and elimination half-life in children were similar to values in adults. Data with other new cephalosporins are limited, but differences between children and adults in bioavailability and half-life appear to be insignificant.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

PubMed2001

Using the Rasch measurement model to investigate the construct of motor ability in young children.

This paper reports the use of a Rasch measurement model, the Extended Logistic Model of Rasch (Andrich, 1988), to explore the construct of a general motor ability in young children. Data were collected from 332 five and six year old children performing 24 motor skills, including run, hop, balance and ball skills. The data were categorised based on threshold estimates provided by the measurement model. Gender differences in performances on items were hypothesised to contribute to initial item and person misfit for the total sample. The data for boys and for girls were separated and independently analysed resulting in improved item and person fit. Two different, unidimensional scales for boys and for girls were created.

Aptitude↗

PubMed1994

Procedure for assessing verbal working memory in normal school-age children: some preliminary data.

A procedure for assessing children's recall of lexical items in the presence of a competing language task is described. The Competing Language Processing Task was designed to reflect the dynamic processes carried out in working memory during language comprehension and production by requiring that the subject hold words in temporary storage while analyzing and responding as true or false to statements. The development of the procedure is described and results of testing of 68 normal children ages 6, 8, 10, and 12 years are presented.

Child↗

PubMed1995

Helicobacter pylori, gastroduodenal disease, and recurrent abdominal pain in children.

OBJECTIVE: To assess the evidence for a cause-and-effect relationship between Helicobacter pylori infection and antral gastritis, peptic ulcer disease, and recurrent abdominal pain in children. DATA SOURCES: A MEDLINE search from January 1983 through July 1994 was used to identify pertinent English-language publications. Current Contents and selected specialty journals were searched manually. Editorials, reviews, case reports, abstracts, and letters to the editor were excluded. STUDY SELECTION: All studies in children (ie, 0 to 18 years) were included. DATA EXTRACTION: Hill's criteria for causal inference were used to determine the strength of the evidence for a causal relationship. DATA SYNTHESIS: In total, 45 studies (case series, cross-sectional surveys, and treatment trials) were retrieved. The rate ratio of antral gastritis in children with H pylori infection (compared with uninfected children) ranged from 1.9 to 71.0 (median, 4.6). The prevalence of H pylori infection in children with duodenal ulcer was high (range, 33% to 100%; median, 92%) compared with children with gastric ulcer (range, 11% to 75%; median, 25%). Prevalence rates of infection in children with recurrent abdominal pain were inconsistent (range, 0% to 81%; median, 22%), with lower rates in children meeting Apley's criteria (range, 0% to 9%; median, 6%). CONCLUSIONS: There is strong evidence for an association between H pylori infection and antral gastritis and duodenal ulcer disease in children; however, data from randomized, double-blind, placebo-controlled treatment trials are required. There is weak evidence for an association with gastric ulcer and weak or no evidence for an association with recurrent abdominal pain.

Abdominal Pain↗