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PubMed2004

A paediatric and perinatal HIV/AIDS leadership initiative in Kingston, Jamaica.

BACKGROUND AND PURPOSE: In Jamaica 1-2% of pregnant women are HIV-positive; 876 HIV-positive pregnant women will deliver and at least 283 newly infected HIV-infected infants will be born in 2003; HIV/AIDS is the leading cause of death in children aged one to four years. We describe a collaborative "Town and Gown" programme to address the paediatric and perinatal HIV epidemic in Kingston. METHOD: A team of academic and government healthcare personnel, comprising paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data management and information technology personnel collaborated to address this public health emergency. RESULT: A five-point plan was implemented This comprised leadership and training of a core group of paediatric/perinatal HIVprofessionals to serve Greater Kingston and St Catherine and be a model for the rest of Jamaica. Mother-to-child transmission of HIV/AIDS is prevented by counselling and HIV-testing women in the antenatal clinics, giving azidothymidine (AZT) to HIV pregnant women beginning at 28 weeks gestation, throughout labour and to the HIV-exposed infants for the first six weeks of life. A unified parallel programme for identifying the HIV-infected infant and delivering paediatric HIV care at the major paediatric centres was implemented In three years, over 30,000 pregnant women are being tested for HIV; 600 HIV-exposed babies are being identified and about 140 paediatric HIV infections will be prevented The team is building research capacity which emphasizes a strong outcomes-based research agenda and implementation of clinical trials. We are collaborating, locally, regionally and internationally. CONCLUSION: Collaboratively, the mission of reducing mother-to-child transmission of HIV/AIDS and improving the quality of life for those already living and affected by HIV/AIDS can be achieved.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Nursing interventions in the Kingston Paediatric and Perinatal HIV/AIDS Programme in Jamaica.

BACKGROUND: Nursing care has been the "grass roots" of healthcare management even before nursing became a profession. Literature on the nursing experience with HIV is minimal and so it is challenging to comment on, or to compare experiences. PURPOSE: This paper highlights the nursing interventions as a key feature in the ongoing development and success of a prevention of mother-to-child HIV transmission (pMTCT) programme in a resource-limited setting. METHOD: In the Kingston Paediatric and Perinatal HIV/AIDS Programme, the nurses and midwives were carefully selected and then trained in the management of preventing mother-to-child transmission (pMTCT) of HIV/AIDS, voluntary counselling and testing and the identification and nursing management of paediatric and perinatal HIV/AIDS. The sites of the programme included three large maternity centres and four paediatric centres, with several feeder clinics for pregnant women. A nurse coordinator supervised the interventions at each site. A multidisciplinary team followed protocol-driven management for the care of pregnant HIV-positive women and children. There was strong collaboration with the Jamaican government and other agencies. RESULTS: The nursing interventions served to: sensitize and encourage other healthcare workers in the care of persons living with HIV/AIDS; sensitize persons in the community about the disease; improve the comfort level of women and families with accessing healthcare; enable prospective data collection for programme assessment and research purposes and to enhance multidisciplinary collaboration to widen the scope of patient care and prevent duplication of healthcare services. CONCLUSION: Nursing intervention is a vital part of a pMTCT HIV programme; however, ongoing education and training of the entire healthcare team needs to be continued in order to strengthen the programme. It is hoped that much of what is done in the Kingston Paediatric and Perinatal HIV/AIDS Programme will become integrated in the nursing management of maternal and child health nationally.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Acute pancreatitis in the paediatric age group: a personal experience.

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 encounter a large number of difficulties in this field of pathology. Therefore, an adequate and correct "management" of children with acute or chronic pancreatitis seems to be mandatory.

Adolescent↗

PubMed2005

[Paediatric cardiac surgery and autoevaluation: risk score, complexity score and graphic analysis].

The creation of a paediatric surgical unit requires autoevaluation in order to: assess the quality of the results with respect to recognised international standards, answer the family's questions about the results obtained and adhere to criteria of accreditation Between January 2003 and December 2004, 201 consecutive patients, children (N= 164) or operated for adult congenital heart disease (N= 37) were treated. No patient was excluded. The RACHS-1 risk score, the ARISTOTLE scores of complexity and performance and the CUSUM and VLAD graphic analyses were applied to the study of hospital mortality. An original "variable performance-adjusted display" (VPAD) graphic analysis was performed to show up any possible variations of performance. Paediatric hospital survival was 97.56% (95% CI: 93.9 - 99.1). The paediatric complexity and performance scores were 6.79 +/- 0.22 and 6.62 respectively. In the absence of statistical significance in this field of autoevaluation, graphic analyses indicated the performance of our unit with no "learning" curves. Graphic scores and analyses allow assessment of the function of a paediatric cardiac surgical unit and the variations of complexity with respect to time, before the appearance of statistical significance. The ARISTOTLE complexity and performance scores and their adaptation in VPAD seem to be more reliable and discriminating than the RACHS-1 score.

Adolescent↗

PubMed2005

Free sugar concentration and pH of paediatric medicines in Brazil.

OBJECTIVE: This study aimed to determine free sugar concentration and pH of paediatric syrup medicines. Setting Ten paediatric syrup medicines most frequently prescribed in urban centres in Brazil were randomly chosen to be tested. OUTCOME MEASURES: Three different bottles from each type of syrup medicine were analysed (n = 30). Analysis of free sugars was performed using normal phase High-Performance Liquid Cromatography (HPLC). Quantification of free sugars was achieved by peak height comparison with standards of sucrose, fructose, glucose and sorbitol (Merck). The results were average of replicates from three bottles of each medicine. The pH of the three different bottles of each medicine was determined using a digital pHmeter (Analion - PM 600). RESULTS: Sucrose and glucose were detected in seven of the ten types of paediatric syrup medicines, with concentrations varying from 3.7 to 49.4% (w/w) (Median 32.7%) and 2.1 to 23.2% (w/w) (Median = 6.1%), respectively. Only two medicines contained fructose, and three, sorbitol, with respective medians of 12.8% (3.1-22.4%) and 24.6% (22.8-27.4%). The median of pH values was 4.9 (2.6-6.1). CONCLUSIONS: Most paediatric syrup medicines showed high concentration of free sugars and pH below the critical value (5.5), which can increase their cariogenic and erosive potentials.

Brazil↗

PubMed2004

Effectiveness of an uninterrupted procedure to transfer adolescents with Type 1 diabetes from the Paediatric to the Adult Clinic held in the same hospital: eight-year experience with the Parma protocol.

This paper reports an 8-yr retrospective study on the effects of an uninterrupted procedure of transition of 73 adolescents with Type 1 diabetes from the Paediatric to the Adult Clinic held in the same hospital. Interviewed patients had a mean age of 21.0+/-0.95 yr at transition. Patients were satisfied with the information received before transition (100%), and appreciated being introduced to the adult physician prior to being transferred (92%), and having found their paediatrician during the first visit at the Adult Clinic (100%). Consensus for transition was attained after 2-4 consultations in 66.6% of patients. Seventy-nine percent of patients considered 20 yr of age as an appropriate age to be transferred. Patients confirmed to have found at the Adult Clinic: privacy (85%), confidentiality (95%), short waiting times (78%), informal atmosphere (100%), and the same consultant (100%). Only 3% of patients tried to go back to the Paediatric Clinic but they were discouraged. Clinic attendance rate ranged between 92 and 100%. We consider that the key factors for a successful process of transition from a Paediatric to an Adult Clinic are: age at transfer around 20 yr, smooth movement within the same hospital, consensus of patients and their parents, prior personal contact with the adult physician, paediatrician attendance at the first visit at the adult service and his unambiguous role against all attempts to go back to the paediatric service and, finally, the availability of the same physician at out-patient clinic visits.

Adolescent↗

PubMed2005

Paediatric exercise immunology: health and clinical applications.

Considerable advances have been made in exercise immunology over the last two decades, and it is becoming evident that many of the health benefits of regular physical activity may be directly related to activation of the immune system. The number of investigations devoted to the paediatric population, however, remains low, and our understanding of the interaction between acute and chronic exercise and the immune system in youth is, therefore, relatively deficient. The purpose of this review is to disseminate the existing knowledge in the area of paediatric exercise immunology and to discuss growth-related issues with respect to exercise and the immune system in health and disease. In general, healthy children experience smaller overall perturbations to the immune system in response to an acute bout of exercise, and demonstrate a faster recovery of the immune system following exercise. The immune effects of chronic exercise and/or exercise training in healthy children and adolescents have not been well-documented, and there is only limited evidence to suggest that moderate to high levels of habitual physical activity are associated with a reduction in the incidence of infection and illness in youth. A number of paediatric clinical conditions expressing a strong immune component are also discussed in the context of acute exercise effects and the potential benefits of enhanced physical activity. Given the linkage between childhood health and adult disease, paediatric exercise immunology represents a fruitful area for future study.

Adolescent↗

PubMed2006

Normal variants in the paediatric orthopaedic population.

Normal variations of lower limb development are a common source of parental concern and are commonly referred to paediatric orthopaedic clinics. To determine the proportion of children referred to a paediatric orthopaedic outpatients with potentially normal developmental variations, referral letters and case notes of children attending the paediatric orthopaedic clinic at our institution over three months were analysed and categorized according to the main reason for referral. The number with true orthopaedic pathology was documented. Variations of normal anatomy and physiology accounted for 53.1% of all new referrals seen at the clinic with intoeing and flexible flat feet being the commonest referrals in this category. The rate of true primary pathology was only 16.3%. Normal developmental variations form a significant proportion of all new referrals to paediatric orthopaedic clinics. These take time and resources to process. Strategies to minimise these referrals are needed.

Child↗

PubMed2006

Operative workload of a paediatric otolaryngology department over a five-year period.

INTRODUCTION: The KK Women's and Children's Hospital (KKWCH) is Singapore's only tertiary institution dedicated wholly to the provision of healthcare for women and children. Since its opening in 1997, the clinical caseloads and the complexity of medical conditions managed by the various departments has increased considerably. This review aims to analyse the operative caseloads in the Department of Otolaryngology over five years from 2000 to 2004. METHODS: This is a retrospective review of the KKWCH Department of Otolaryngology operative records from year 2000 to 2004. The data on the type of operation and their frequency were collated, and the data are presented in a descriptive format. RESULTS: There was an increase in the number of operations performed from 656 in year 2000 to 1,148 in 2004, an increase of 75 percent. The increase in the staffing and operating clinical hours (in 2003 and 2004) plus the significant demand for paediatric otolaryngology service probably contributed to this increase. Tonsillectomy, with or without adenoidectomy, continues to be the most common procedure being performed in children, with myringotomy and tympanostomy tube insertion being the second commonest. Together, the ten most common operative procedures constitute 78.2 percent of all paediatric otolaryngological operative workload in the department over a five-year period. CONCLUSION: The data provided a review of the current pattern of otolaryngological surgical disease in the Singapore paediatric population, which may require operative intervention. Understanding and monitoring of this trend is important, as it allows the proper allocation of appropriate resources for the prevention and treatment of common paediatric surgical otolaryngological conditions.

Humans↗

PubMed2005

Organization of paediatric diabetes units in Italy.

Aim of this work is to give a realistic picture of the medical care situation in Italy and to verify its congruence with ISPAD and SIEDP guidelines and the law. In Italy diabetes is recognized as a disease of great social interest by a state act. Sixteen years after its approval, all of the Italian Regions have received the law n. 115/87 with the different acts. Nearly all regional acts provide for both the institution of specialized centres of paediatric diabetology and their individuation at local level. In Italy diabetological paediatric care is well distributed all over the national territory. Activities are operating in almost every region. Actually a lot of paediatric diabetology activities have no formal recognition and no operating autonomy and sometimes the person in charge of the activity is not a diabetologist paediatrician. In spite of what stated by ISPAD and SIEDP guidelines, this is the real situation. Perhaps in the future a larger presence of scientific societies involved in problems concerning sanitary politics about diabetes, will bring to an appreciable improvement of the quality of care system of paediatric diabetology.

Adolescent↗

PubMed2006

A comparison of paediatrics occupational therapy university program curricula in New Zealand, Australia, and Canada.

Comparisons were made of the paediatric content of professional entry-level occupational therapy university program curricula in Australia, New Zealand, and Canada using an ex post facto survey methodology. The findings indicated that in Australia/New Zealand, paediatrics made up 20% of the total curriculum, but only 13% in Canada. Canadian reference materials were utilized less often in Canadian universities than in Australia/New Zealand. Theories taught most often in Australia/New Zealand were: Sensory Integration, Neurodevelopmental Therapy, Client-Centered Practice, Playfulness, and the Model of Human Occupation. In Canada, the most frequent theories were: Piaget's Stages of Cognitive/Intellectual Development, Neurodevelopmental Therapy, Erikson's Eight Stages of Psychosocial Development and Sensory Integration. The most frequently taught paediatric assessment tools in both regions were the Bruininks-Oseretsky Test of Motor Proficiency and Miller Assessment for Preschoolers. Paediatric intervention methods taught to students in all three countries focused on activities of daily living/self-care, motor skills, perceptual and visual motor integration, and infant and child development.

Australia↗

PubMed2006

Use of complementary and alternative medicine in paediatric oncology patients in Singapore.

INTRODUCTION: Complementary and alternative medicine (CAM) is garnering increasing interest and acceptance among the general population. Although usage is thought to be widespread among paediatric cancer patients, local studies have not been done. We aimed to investigate the prevalence and predictors of CAM usage in paediatric cancer patients in a single institution. MATERIALS AND METHODS: Parents of 73 paediatric cancer patients treated at KK Women's & Children's Hospital completed an interviewer-administered questionnaire. Data about the types of CAM therapies used, motivations for use, adverse effects, costs and discussion of usage with the patient's physician were obtained. General perceptions towards CAM and conventional medicine were explored. A subsequent telephone survey enquired about spirituality, benefits of CAM use and overall satisfaction with the therapies. RESULTS: Two-thirds of patients used at least 1 CAM treatment, mainly as supportive adjuncts to conventional cancer treatment. Dietary changes, health supplements, herbal tea and bird's nest were the most common therapies used. Few patients (8.1%) consulted a CAM practitioner. Positive predictors of CAM usage included being of Chinese race, the practice of Buddhism or Taoism, the use of CAM prior to diagnosis, perception of CAM effectiveness and dissatisfaction with conventional treatment. Significantly, 55.1% of the parents had not discussed their CAM usage with their child's physician. CONCLUSIONS: A substantial proportion of paediatric cancer patients utilises CAM therapies, often without their physician's knowledge. Healthcare providers need to remain cognisant of the potential implications of CAM usage in order to proactively counsel patients. This would ensure that conventional therapy remains uncompromised.

Adolescent↗

PubMed1991

Paediatric cardiology. A proposed training programme.

In January 1989, The Royal Liverpool Children's Hospital, Myrtle Street, moved to the Alder Hey branch site. This involved all paediatric in-patient services, including the Supra-Regional Paediatric Cardiac Unit. As a result of this amalgamation, the cardiac theatre nursing staff became part of the general theatre complex and an integration of theatre staff occurred. This identified a need by the general theatre nursing staff for paediatric cardiology experience. This programme of paediatric cardiac experience is designed to ensure the integration of theory and practice. The participants of the programme are seen as autonomous learners who will be supported throughout the programme by a facilitator who will be an experienced nurse within the cardiac unit or cardiac theatre. It is therefore envisaged that the programme will be flexible and acknowledge the participants previous theoretical and practical nursing skills.

Cardiac Surgical Procedures↗

PubMed1991

[The 'Phadiatop Paediatric': a useful in-vitro test on an atopic immune response in infants and young children].

The aim of this study was to evaluate a new test for IgE antibody screening in children--the Phadiatop Paediatric. The mixture of allergens in this test contains the food and inhalant allergens for infants and children most relevant. 180 sera were selected from samples submitted for routine diagnostic IgE antibody assay. 91% of these sera were from children less than 5 year old. Half the sera were positive in RASTs that were initially requested by the physicians and the highest RAST scores for each serum were equally distributed over the range RAST class 1-4. 20 control sera were from children 1-4 years old. Results of the Phadiatop Paediatric were compared with results of the combination 'Phadiatop + mixed-food-RAST'. 22% of the sera that were negative in all RASTs that were initially requested by the physicians were positive in both tests. This suggests that an IgE antibody response to food components or inhalants was underdiagnosed in these cases. Whereas 135 sera were found positive in the Phadiatop Paediatric, only 116 sera had a positive Phadiatop result and/or a result of the mixed-food-RAST that was RAST class 1 (greater than or equal to 0.35 PRU/ml) or higher. In 11 of 16 sera with RAST class 0/1 (0.18-0.35 PRU/ml) in the mixed-food-RAST specific IgE against individual food allergens with RAST class 1 or higher could be demonstrated. Results of Phadiatop and Phadiatop Paediatric were not only expressed as 'positive' or 'negative', but also as a serum:reference ratio. Clinical documentation was collected retrospectively from the written case reports of 171 children.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗

PubMedDate not supplied

A paediatric observation ward.

The paediatric ward and paediatric outpatients at Port Moresby General Hospital have become increasingly crowded during the past few years. 15% of paediatric admissions stayed less than 24 hours, which meant that much work was done unnecessarily on these patients who would be better regarded as outpatients. A paediatric observation ward was opened in September 1982 to help overcome these problems. An analysis of the 2132 admissions to the observation ward during 1983 showed that 89% of the children were later sent home without requiring hospital admission.

Child↗

PubMed1994

Pain and symptom control in paediatric palliative care.

Important differences become evident in a comparison of cancer pain between children and adults. Management of pain in children is commonly multidisciplinary, is less dependent on invasive measures and relies more on systemic therapy. Children are not little adults: their immaturity, developing cognition and dependence all influence their experience and interpretation of pain. Much progress has been made in altering practices such as under-prescribing and underdosing that have adversely affected adequate control of pain in children. The challenge for paediatric health care providers in the mid 1990s is not only to be informed of current practices in pain and symptom control in paediatric palliative care, but also to remember to establish those practices in day to day management. Even though pain and its effects in children are now better understood, it is often still not managed optimally. Good management of pain in children depends on accurate assessment. In the past 10 years, assessment of pain in children has advanced considerably. However, assessment of pain in the preverbal child is still inadequate and in need of attention. Sedation, tolerance and involuntary movements may occur as side effects of opioids in children and may cause significant problems in management of the dying child. Psychostimulants can diminish sedation to some extent, but there is little information as yet on the value of these drugs in children. Tolerance to opioids may develop quickly, leading to poor control of pain and distress for the child. Strategies to improve management of tolerance include use of regional anaesthetic techniques such as the epidural/intrathecal route for opioid administration. Involuntary movements induced by opioids are uncommon but have the potential to cause significant distress. The mechanisms underlying these side effects of opioids need to be established. Strategies are needed for the effective treatment and prevention of these side effects. Neuropathic pain can be severe, distressing and difficult to treat. Experience of its treatment in terminally ill children is limited. Effective use of tricyclic antidepressants and systemically administered local anaesthetics is still to be determined. Regional anaesthetic techniques may be of great benefit when neuropathic pain cannot be controlled with systemic therapy. Procedural pain is more common than pain related to disease in the management of paediatric cancer. Further research is needed to identify the best approach to its management. We have found nitrous oxide to be of great benefit in management of procedural pain in children. Non-pharmacological methods of treatment of pain in children, such as transcutaneous electrical nerve stimulation or acupuncture, may also be useful and should receive continuing evaluation. There are significant and current issues in paediatric palliative care besides management of pain. There are difficulties in the provision of home nursing care for children with cancer in the terminal phase of their illness, including lack of community nursing services at night and on weekends and lack of adequate home help for parents. Attitudes of staff involved in the care of the child and family and their commitment to working as a multidisciplinary team strongly influence the quality and success of care given. Pain control and palliative medicine are evaluable by measures of quality assurance or outcome, and adoption of such evaluations should improve standards of care. Euthanasia in children is even more difficult as an ethical dilemma than in adults. Optimum symptom control with current techniques should almost always obviate its consideration. We are opposed to euthanasia. Psychosocial and cultural issues all influence the family's experience of palliative care. Further research is necessary in all of these areas.(ABSTRACT TRUNCATED)

Adolescent↗

PubMed1996

Paediatric surgical manpower in the 1990s.

An accurate audit of consultant manpower in paediatric surgery in the UK was performed based on two surveys carried out in 1992 and 1994. There were 70 paediatric surgeons in 1992 and 84.5 in 1994 (a 21 per cent increase). The ratio of paediatric surgeon per population was approximately 1 in 800,000 for the UK although marked regional differences were noted. The expressed aim of the British Association of Paediatric Surgeons is to achieve a ratio of 1 per 500,000 population which implies a further increase to about 110 consultant posts in the UK. It will be necessary to plan for a commensurate increase in the number of training posts in this specialty.

Child↗

PubMed1996

Development of atopic disease during childhood and its prediction by Phadiatop Paediatric.

BACKGROUND: Evaluating in vivo and/or in vitro tests for 'early' prediction of childhood allergy is of interest in paediatric allergology. OBJECTIVE: To determine whether the measurement of Phadiatop Paediatric (PP) during early childhood could be used to predict the development of atopic disease during the first 5 years of life among infants with a family history of atopic disease. METHODS: Phadiatop Paediatric was evaluated in 134 infants. The analysis was performed at 6 months, at 18 months and at 5 years of age and the numbers of available serum samples were 61, 85 and 134, respectively. The potential capacity of the test to predict the development of atopic disease was studied by relating the result of the test, a positive or a negative score, to the accumulated incidence of atopic diseases from birth to 18 months of age and from birth to 5 years of age. RESULTS: Three of four children with a positive PP at 6 months of age developed clinical signs/symptoms of atopic disease before 18 months and all four before 5 years of age. The predictive value of a positive test at 18 months for symptoms before 5 years of age was 80% (12/15). If the diagnostic criterion, instead of clinical signs/symptoms of atopic disease, was at least one positive skin-prick test to major food or inhalant allergens, the predictive value of a positive PP-test at 18 months decreased to 53% (8/15). CONCLUSION: Although the presence of circulating IgE antibodies, as detected by Phadiatop Paediatric, can predict the development of atopic diseases during childhood, the usefulness of the test is limited by its low sensitivity (22-47%).

Allergens↗