bluuebunny/crossref_metadata_2025 huggingface dataset:
8 The Observed Teaching Encounter: Providing Residents Feedback on Their Teaching Skills
Authors: Doshi Ankur
Published: May 2008

Introduction:  Emergency medicine residents spend a significant portion of their time teaching junior residents and medical students in the clinical setting. Feedback is an integral component of any teaching curriculum, and therefore, feedback on residents’ skill in teaching abilities is an essential part of their learning to teach. We have developed a structured method of providing feedback to senior residents on their teaching competence.

Methods:  Upcoming senior residents receive an 8‐hour course on clinical teaching during their useful conference time. In our ED, attending faculty and senior “teaching” residents are matched with medical student learners. The Observed Teaching Encounter (OTE) is used during usual clinical ED shifts to reinforce concepts in teaching. During the OTE, the teaching resident is directly observed by a faculty physician while teaching a student learner. A checklist is completed by both the faculty member and the student learner in order to provide feedback to the teaching resident. Assessed skills correlate with teaching theory provided to residents in their didactic curriculum. Written formative comments are provided to the resident from faculty, as well.

Results:  Attending faculty, senior residents, and student learners have all provided positive feedback on the OTE. Assessment of residents’ retention of knowledge on methodology of teaching is presently in progress as a tool to evaluate the efficacy of the OTE.
9 A Communication Tool for Emergency Medicine Residents to Improve Patient Care and Professional Development
Authors: Mahal Jacqueline
Published: May 2008

For every patient in the ED, a web of communication is created. A resident is at the center of this web – connecting team members in and outside the ED. Careful communication, a required ACGME competency, helps the team provide safe, high‐quality care and master their respective specialties. We designed a three module curriculum that supports ACGME core competencies by providing training in professional communication and a framework with which to organize patient data. In the first module, residents are introduced to the concept that there is more to communication than content alone. Other elements include context, audience and forum. Together, these components comprise relevant communication. The second module introduces the Disposition, Situation, Background, Assessment, Recommendation, Safety (D‐SBARS) Framework, an ED modification of The Joint Commission's communication tool. This framework will enable the resident to focus on communicating the relevant data for a particular audience in an appropriate manner. In the last module, residents participate in a case‐based role‐play. After presentation of a complicated patient, residents are each assigned a communication task. They communicate with attendings, ED staff and consultants. Each role is played by senior residents. Finally, participants deliver presentations to the on‐coming team on “rounds” under time constraints, declining from two minutes to 30 seconds. Residents experience how the D‐SBARS tool helps them communicate critical clinical and safety.
Nordic consensus on treatment of undescended testes
Authors: Martin Ritzén E. , Bergh A , Bjerknes R , Christiansen P , Cortes D , Haugen SE , Jörgensen N , Kollin C , Lindahl S , Läckgren G , Main KM , Nordenskjöld A , Rajpert‐De Meyts E , Söder O , Taskinen S , Thorsson A , Thorup J , Toppari J , Virtanen H
Published: May 2008

Aim: To reach consensus among specialists from the Nordic countries on the present state‐of‐the‐art in treatment of undescended testicles.

Methods: A group of specialists in testicular physiology, paediatric surgery/urology, endocrinology, andrology, pathology and anaesthesiology from all the Nordic countries met for two days. Before the meeting, reviews of the literature had been prepared by the participants.

Recommendations: The group came to the following unanimous conclusions: (1) In general, hormonal treatment is not recommended, considering the poor immediate results and the possible long term adverse effects on spermatogenesis. Thus, surgery is to be preferred. (2) Orchiopexy should be done between 6 and 12 months of age, or upon diagnosis, if that occurs later. (3) Orchiopexy before age one year should only be done at centres with both paediatric surgeons/urologists and paediatric anaesthesiologists. (4) If a testis is found to be undescended at any age after 6 months, the patient should be referred for surgery—to paediatric rather than general surgeons/urologists if the boy is less than one year old or if he has bilateral or non‐palpable testes, or if he has got relapse of cryptorchidism.
Understanding diagnostic tests 3: receiver operating characteristic curves
Authors: Akobeng Anthony K
Published: May 2008

The results of many clinical tests are quantitative and are provided on a continuous scale. To help decide the presence or absence of disease, a cut‐off point for ‘normal’ or ‘abnormal’ is chosen. The sensitivity and specificity of a test vary according to the level that is chosen as the cut‐off point. The receiver operating characteristic (ROC) curve, a graphical technique for describing and comparing the accuracy of diagnostic tests, is obtained by plotting the sensitivity of a test on the y axis against 1‐specificity on the x axis. Two methods commonly used to establish the optimal cut‐off point include the point on the ROC curve closest to (0, 1) and the Youden index. The area under the ROC curve provides a measure of the overall performance of a diagnostic test. In this paper, the author explains how the ROC curve can be used to select optimal cut‐off points for a test result, to assess the diagnostic accuracy of a test, and to compare the usefulness of tests.

Conclusion: The ROC curve is obtained by calculating the sensitivity and specificity of a test at every possible cut‐off point, and plotting sensitivity against 1‐specificity. The curve may be used to select optimal cut‐off values for a test result, to assess the diagnostic accuracy of a test, and to compare the usefulness of different tests.
Fetal exposure to cocaine and infections during the first 18 months of life in infants from a mediterranean city
Authors: García‐Algar Óscar , Felipe Aida , Puig Carme , Monleón Toni , Pacifici Roberta , Pichini Simona
Published: May 2008

Aim: The incidence of infections during the first 18 months of life was investigated in 36 infants prenatally exposed to cocaine and in 72 non‐exposed controls from Barcelona, Spain.

Methods: Fetal exposure to cocaine was ascertained by meconium analysis, infections by structured questionnaire.

Results: A higher incidence of infections, if excluding those acquired in utero, was not found in exposed infants versus non‐exposed infants of similar demographical and socioeconomic characteristics.

Conclusions: A possible role for life style factor in those cases where increased infections are associated with fetal exposure to cocaine is hypothesized.
The opinions of clinical staff regarding neonatal procedural pain in two Norwegian neonatal intensive care units
Authors: Andersen Randi Dovland , Greve‐Isdahl Margrethe , Jylli Leena
Published: May 2008

Aim: Neonates are subjected to numerous painful procedures without sufficient pain management. The aim of this study was to describe the opinions of Norwegian physicians, nurses and nurse assistants who care for neonates, regarding procedural pain in neonates.

Methods: A replication of a previous questionnaire study was conducted in two Norwegian neonatal intensive care units (NICU's). The questionnaire aimed at evaluating procedure painfulness, the current use of pharmacological agents and comfort measures and the optimal use of both.

Results: Ninety members of the clinical staff participated, which is a response rate of 87%. Opinions on how procedural pain is currently and optimally managed differed significantly. Although most respondents rated a majority of the listed procedures as being more than moderately painful, pharmacological agents were rarely used, except for the insertion of a chest tube and endotracheal intubation. Comfort measures were also believed to be underutilized, but not to the same degree as pharmacological agents.

Conclusion: Procedural pain in neonates is not sufficiently managed and both pharmacological agents and comfort measures are underutilized, according to clinicians at two Norwegian NICU's.
Characteristics of severely malnourished under‐five children hospitalized with diarrhoea, and their policy implications
Authors: Chisti Mohammod J , Hossain Mohammad I , Malek Mohammad A , Faruque Abu SG , Ahmed Tahmeed , Salam Mohammed A
Published: May 2008

Aim: Identify clinical and nutritional features, and complications among severely malnourished, under‐five children in an urban diarrhoeal disease facility in Bangladesh.

Methods: For this case‐control design, children of both sexes, aged 0–59 months were studied. Severely (<−3 z‐score) underweight, stunted or wasted constituted cases and those with better nutritional status (z‐score ≥−3) constituted controls.

Results: During 2000–2005, of the total 6881 children, 1103 (16%) were severely underweight, 705 (11%) severely stunted and 217 (3%) severely wasted. In logistic regression analysis, severely underweight children were more likely to be older than 11 months (OR 3.7, 95% CI 3.1–4.3, p < 0.001), non‐breastfed (OR 1.5, 95% CI 1.3–1.8, p < 0.001), have illiterate mothers (OR 2.6, 95% CI 2.2–3.0, p < 0.001), non‐sanitary toilet (OR 1.4, 95% CI 1.2–1.6, p < 0.001), a history of measles in preceding 6 months (OR 1.7, 95% CI 1.3–2.4, p = 0.001), dehydrating diarrhoea (OR 1.9, 95% CI 1.6–2.2, p < 0.001), abnormal findings in lung auscultation (OR 1.7, 95% CI 1.3–2.3, p < 0.001) and require hospitalization ≥48 h (OR 2.2, 95% CI 1.8–2.5, p < 0.001).

Conclusion: There thus is a need to incorporate appropriate, cost‐effective and sustainable preventive strategies and improved management policies in the health systems as well as in social support systems in Bangladesh.
Neonatal end‐of‐life practice in a German perinatal centre
Authors: Schulz‐Baldes A , Huseman D , Loui A , Dudenhausen JW , Obladen M
Published: May 2008

Aim: To investigate the end‐of‐life practice in a large perinatal centre in Germany.

Methods: Retrospective chart review was performed in all neonates deceased in the delivery room (n = 31) and the neonatal intensive care unit (n = 47) between 2002 and 2004.

Results: Neonatal death was preceded by an end‐of‐life decision (EOLD) in 81% of cases in the delivery room and 83% in the neonatal intensive care unit. The majority of deceased neonates were born prematurely or with congenital malformation. Life‐sustaining treatment was not initiated in 74% of the infants deceased in the delivery room. In the unit, 52% died after withdrawal of therapy. Mechanical ventilation was withdrawn most frequently (79% of cases). Futility and immediate death were common considerations in EOLD, but the infant's suffering and future quality of life also played a role. Parents were involved in EOLD‐making in all but emergency cases. No active termination of life was performed.

Conclusion: In our perinatal centre, the majority of neonatal deaths occurred after limitation of therapy. Treatment was actively withdrawn in half of the infants in the neonatal intensive care unit. Actual end‐of‐life practice in a large perinatal centre differs from the restrictive attitude towards EOLD reported for German neonatologists in previous surveys.
Long‐term psychosocial consequences of hormone treatment for short stature
Authors: Visser‐van Balen Hanneke , Geenen Rinie , Kamp Gerdine A , Huisman Jaap , Wit Jan M , Sinnema Gerben
Published: May 2008

Aim: To examine psychosocial functioning of young adults with idiopathic short stature or short stature born small for gestational age after growth hormone (GH) and gonadotropin‐releasing hormone agonist (GnRHa) treatment in early adolescence or no intervention.

Methods: Thirty young adults (18 treated, 12 untreated; age 17–23 years; on average 5.5 years after the end of treatment) completed questionnaires regarding perceived competence and psychological distress. They and their parents were interviewed on social circumstances, height‐related psychosocial stressors and parental worries about prospects in society.

Results: Height gain was on average 2.3 cm more for the treated than for the untreated group. On none of the psychosocial variables differences were found between treated and untreated participants. Compared to Dutch population norms, psychological and social functioning was normal.

Conclusion: GH/GnRHa treatment, with arrest of pubertal development and lower than expected effects on final height, is not observed to lead to long‐term negative or positive effects. Both treated and untreated participants go well through the psychosocial transition period of young adulthood. This suggests that, in the long term and independent of hormone treatment, adequate psychosocial adjustment is expected in case of short stature.
Bone mass, biochemical markers and growth in children with chronic kidney disease: a 1‐year prospective study
Authors: Swolin‐Eide Diana , Magnusson Per , Hansson Sverker
Published: May 2008

Aim: This study was designed to investigate bone mineral density (BMD), growth parameters and biochemical markers in children with chronic kidney disease (CKD).

Methods: Sixteen patients, 4–18 years, with CKD were prospectively followed for 1 year. Auxological data, body composition, BMD by dual‐energy X‐ray absorptiometry, bone age, bone turnover markers, vitamin D, parathyroid hormone (PTH), leptin, osteoprotegerin, insulin‐like growth factor‐I (IGF‐I) and IGF binding protein‐3 were measured. A questionnaire regarding bone health and diet was also performed.

Results: Delayed bone age was observed (n = 11) and the BMD Z‐scores for total body were below zero in seven patients. However, total body BMD (TBBMD) increased in 12 patients. Most patients had increased osteocalcin and carboxy‐terminal telopeptide of type I collagen, but normal alkaline phosphatase, type I procollagen intact amino‐terminal propeptide and tartrate‐resistant acid phosphatase 5b. Ten patients had increased PTH. Most children had normal levels of leptin, osteoprotegerin, IGF‐I and IGFBP‐3. Leptin, at baseline, correlated with differences in TBBMD over 1 year.

Conclusions: Only seven (44%) had negative Z‐scores and TBBMD increased over 1 year. Bone markers at baseline did not predict the longitudinal changes in BMD.
Efficacy and safety of hormonal treatment of cryptorchidism: current state of the art
Authors: Thorsson Arni V , Christiansen Peter , Ritzén Martin
Published: May 2008

Meta‐analyses of randomised trials using hCG or GnRH for treatment on testicular descent show in most studies overall efficacy of about 20%, less if retractile testes were excluded. In recent years a number of potentially serious side effects have been reported.

Conclusion: Considering the efficacy and the possible side effects of the hormonal treatment, the general use of hCG and GnRH in the treatment of cryptorchidism cannot be further recommended.
Surgical treatment of undescended testes
Authors: Thorup J , Haugen S , Kollin C , Lindahl S , Läckgren G , Nordenskjold A , Taskinen S
Published: May 2008

The mainstay of therapy for undescended testes is operative treatment within the first years of life in order to avoid ongoing testicular degenerative changes. The surgical therapy for the palpable undescended testis is orchiopexy and when the testis is non‐palpable, a supplementary laparoscopic approach. Success of orchiopexy for inguinal testes has been >95% and for abdominal testes >85–90% in most series.

Conclusion: Operation within the first year of life is a safe therapy for undescended testes.
The familial form of atrial septal defect
Authors: Gelernter‐Yaniv Liat , Lorber Avraham
Published: May 2008

Background: The secundum atrial septal defect accounts for 10% of congenital heart disease. Familial occurrence is rare and may present as an isolated lesion or with conduction and skeletal abnormalities. Predisposing genes were described.

Objectives: To evaluate familial defect's prevalence and associated anomalies and assess the yield of screening.

Methods: Family history, physical, electrocardiographic and echocardiographic evaluation of 286 ASD patients and families regarding heart disease, conduction and skeletal anomalies were performed.

Results: Eleven new families with familial defects were identified yielding 28 patients. The rate of transmission was 40–100%, suggestive of autosomal dominant inheritance. Parents were healthy in four families with multiple offspring with ASDs. Two families had ASDs with atrioventricular conduction abnormalities in five of six subjects, not requiring pacing. One subject had skeletal malformation. Ten patients had surgery, 12 had transcatheter ASD closure and six await treatment.

Conclusions: In view of the high prevalence of familial occurrence of secundum ASD (10% of all ASD patients), we recommend screening all first degree relatives of ASD patients for cardiac, conduction and skeletal anomalies. Although a routine genetic investigation is not yet available, genetic patterns of inheritance may be compatible with autosomal dominant inheritance. Healthy parents of affected offspring may suggest a variable gene penetrance or past spontaneous ASD closure. Conduction anomalies may be present or may develop throughout life, and thus should be periodically screened for.
Health‐related‐quality‐of‐life in obese adolescents is decreased and inversely related to BMI.
Authors: De Beer M , Hofsteenge G H , Koot HM , Hirasing RA , Delemarre‐van de Waal HA , Gemke RJBJ
Published: May 2008

Aim: To compare health related quality of life (HRQoL) of obese adolescents with normal weight controls and to explore the relation between Body Mass Index (BMI) and HRQoL.

Methods: Cross‐sectional study in 31 adolescents (12–18 years), referred for obesity, in comparison with 62 age and sex matched normal weight controls. HRQoL was assessed using the PedsQL 4.0 and Child Health Questionnaire (CHQ). The main outcome measure was difference in HRQoL between obese and control subjects.

Results: Mean BMI (SD) in patients versus controls was 34.9 (8.8) versus 19.5 (2.2) kg/m2. In obese adolescents, lower HRQoL in three PedsQL and seven CHQ scales was found (p < 0.05). Variance in HRQoL scales explained by obesity ranged from 8% (CHQ Physical Functioning) to 28% (CHQ Global Health). BMI z‐score was inversely correlated with five PedsQL and 10 CHQ scales while the percentage of scale variance explained by BMI z‐score ranged from 7% (CHQ Physical summary scale) to 33% (CHQ Global Health).

Conclusion: HRQoL in obese adolescents is less than in normal weight controls, and is partially explained by obesity‐related comorbidity. Overall HRQoL was inversely associated with BMI. Hence, HRQoL is an important indicator of impact of obesity and effect of interventions, complementary to clinical variables.
Early breastfeeding cessation: validation of a prognostic breastfeeding score
Authors: Kronborg Hanne , Væth Michael , Olsen Jørn , Iversen Lars , Harder Ingegerd
Published: May 2008

Aim: To validate a simple breastfeeding score to identify mothers who stop breastfeeding within 4 months after birth.

Methods: Two independent cohorts of Danish mothers in 1999 and 2004 with 4 months of follow‐up on breastfeeding duration were used. The breastfeeding score was developed from 471 mothers' responses to a questionnaire in 1999 and based on duration of schooling, previous breastfeeding experience, self‐efficacy, and mother's confidence in ability to produce milk. The 2004 cohort consisting of 723 mothers was used to validate the score.

Results: A breastfeeding score of 7 or higher classified 45% of the mothers in the 2004 cohort as being at risk of breastfeeding cessation. With this cut‐point the sensitivity was 70% and the specificity 71%. Among primipara the cut‐point gave a sensitivity of 76% and a specificity of 54% and classified 60% to be in the risk group. Among multipara the corresponding figures were 66%, 81% and 34%, respectively. The area under the ROC curve was 0.78.

Conclusion: The breastfeeding score based on a simple scoring system derived from four risk factors was capable of predicting the breastfeeding duration in an independent sample. It may help health professionals to identify mothers at risk of breastfeeding cessation before 4 months.
A validation study of the Norwegian version of the Ages and Stages Questionnaires
Authors: Richter Jörg , Janson Harald
Published: May 2008

Aim: To explore the construct validity of the ASQ in relation to premature birth; maternal age, completeness of the family and level of education; and the child's gender.

Methods: Norwegian mothers' evaluations of 1172 children who completed age appropriate ASQs twice were statistically analysed by means of univariate and multivariate methods.

Results: The developmental level of girls is on average higher than that of boys at both assessments and there is a substantial increase between follow‐up assessments in all ASQ scores except for gross motor skills. The mother's level of education; whether the child was born prematurely or at full‐term; and the interaction between the child's gender and his/her mother's level of education are important factors relating to the child's developmental status in both assessments.

Conclusion: The results that were derived by means of the Ages and Stages Questionnaires concerning the impact of maternal socio‐demographical factors, the child's gender, and premature birth upon early childhood development largely confirm the findings in the literature supporting the construct validity of the ASQ. The ASQ was found to be an effective diagnostic tool of developmental delay and/or disturbances. The development of gender dependent norms is recommended.
Neonatology has always been a bargain – even when we weren't very good at it!
Authors: Buchh Basharat , Graham Neil , Harris Barbara , Sims Sherrol , Corpuz Maria , Lantos John , Meadow William
Published: May 2008

Objective: We wondered whether Neonatal Intensive Care Unit resources for Extremely Low Birth Weight infants have always been disproportionately devoted to survivors, even when ELBW infants were very likely to die.

Methods: We documented survival and length of stay (LOS) for 2354 ELBW infants (BW 450–1000 g) admitted to the NICU at the University of Chicago between 1978 and 2003. NICU bed‐days were a proxy for medical expenses.

Results: Over the past 25 years, ELBW admissions have risen four‐fold from 25 to 100/year, and ELBW bed‐days have risen ten‐fold, from 700 to 7000/year. In 1978, when ELBW mortality was 80%, only 30% of ELBW bed‐days were expended on non‐survivors. Currently, the percentage of ELBW non‐survivor bed days (NSBD) is below 10%. Even more striking, as soon as there were any survivors with BW 450—750 g, the NSBD index fell below 30%, and settled quickly around 10%.

Conclusions: It is almost self‐evident that there are no credible distributive justice arguments to deflect NICU care for ELBW infants now, when survival is so good. But, surprisingly, even when NICU survival was much worse, there have never been credible distributive justice arguments against NICU care for infants with BW <1000 g, whether dollars spent on survivors or ‘intact survivors’ is the outcome measure.
Liver disease as risk factor for cystic fibrosis‐related diabetes development
Authors: Minicucci L , Lorini R , Giannattasio A , Colombo C , Iapichino L , Reali MF , Padoan R , Calevo MG , Casciaro R , De Alessandri A , Haupt R
Published: May 2008

Aim: To evaluate clinical and genetic factors, besides pancreatic insufficiency, associated with increased risk of cystic fibrosis‐related diabetes.

Methods: Case‐control (1:1) study on 138 cystic fibrosis patients. Data were collected on gender, age at diagnosis, reason for cystic fibrosis diagnosis, family history of type 1 or 2 diabetes mellitus, pre‐existing severe liver disease, and class of cystic fibrosis transmembrane regulation mutation. Moreover, information was obtained on lung involvement and degree of exocrine pancreatic insufficiency evaluated 1 year before the diagnosis of cystic fibrosis‐related diabetes in patients and age‐matched controls.

Results: Compared to controls, patients with cystic fibrosis‐related diabetes had a higher probability of having already been diagnosed with liver disease (16.7% versus 1.7%, OR = 11.6, 95% CI 1.43–93.0). Moreover, in the year before diabetes onset, cases had slightly worse pulmonary function compared to controls (FEV1= 58.4 ± 27% predicted versus 67.4 ± 21% predicted; p = 0.05). No significant effects related to the other factors considered were found.

Conclusion: Severe liver disease was found to significantly increase the risk of developing cystic fibrosis‐related diabetes. Patients with liver disease should be scheduled for earlier diabetes screening in order to identify and possibly treat glucose intolerance.
Fatal and near‐fatal encephalopathy with hyponatraemia in two siblings with fluticasone‐induced adrenal suppression
Authors: Donaldson MDC , Morrison C , Lees C , McNeill E , Howatson AG , Paton JY , McWilliam R
Published: May 2008

Aim: To document previously unreported acute effects of adrenal insufficiency.

Methods: We describe two siblings who presented acutely with hyponatraemia and cerebral oedema following prolonged treatment with high dose inhaled fluticasone.

Results: A girl aged 5.5 years presented with vomiting, headache, visual impairment and seizures. She was hyponatraemic but not hypoglycaemic. Her conscious level continued to deteriorate and she died, post mortem examination showing small adrenal glands and cerebral oedema. Four weeks later her 7‐year‐old brother presented with similar symptoms. Assessment showed hyponatraemia with cerebral oedema. His illness responded to intensive care. A diagnosis of adrenal insufficiency was made retrospectively in both cases. The siblings had been receiving Fluticasone propionate (FP) in doses of up to 2000 μg/day for several years.

Conclusion: We believe that the hyponatraemia and cerebral oedema was related to cortisol deficiency, leading to impaired excretion of water. We emphasize the need for careful cerebral monitoring in acute adrenal insufficiency presenting with impaired consciousness.
Fasting plasma glucose levels in healthy preschool children: effects of weight and lifestyle
Authors: Ludvigsson Johnny , Huus Karina , Eklöv Kristina , Klintström Rebecka , Lahdenperä Anne
Published: May 2008

Aim: To investigate whether a modern lifestyle, with a high‐energy intake and a low level of physical activity, influences fasting plasma glucose concentration in healthy children.

Methods: As a part of the prospective study ‘All Babies in Southeast Sweden’, 127 children from six preschool units chose to participate. The children, 56% girls and 44% boys, were 5–7 years old. Parents answered a questionnaire about their children's heredity, and physical exercise and eating habits. In the morning, before the children ate breakfast, fasting plasma glucose levels and weight, height and waist circumference were measured.

Results: Fasting plasma glucose levels varied between 3.7 and 6.1 mmol/L, with both mean and median values of 4.7 mmol/L. There was no association between fasting plasma glucose level and body mass index (BMI), eating habits or degree of physical exercise. BMI and waist circumference were significantly correlated (p < 0.01). Children who play outdoors most frequently had a significantly lower BMI (p < 0.05) and waist circumference (p < 0.01), whereas children who more often watch TV had a significantly higher BMI (p < 0.01).

Conclusion: A modern lifestyle, with low levels of exercise and high‐energy consumption, may explain the increasing weight and even obesity of otherwise healthy, preschool children, but does not influence their fasting plasma glucose levels.
Child behaviour after anaesthesia: associated risk factors
Authors: Karling M , Stenlund H , Hägglöf B
Published: May 2008

Aim: To identify hospital care factors which are associated with problematic behaviours in children after hospitalization.

Method: A cohort of 340 children ages 2–13 was studied in connection with elective procedures which included anaesthesia. Data collected: sociodemograhic, type of procedure, anaesthesia induction technique and premedication. Staff and parents assessed child anxiety at induction of anaesthesia, pain, anxiety and nausea in recovery room and hospital ward. Parents assessed their child's pain and nausea and the behaviour measured with the Post Hospital Behavioural Questionnaire two weeks after hospitalization.

Results: One‐third (34.4 %) of the children developed at least one problematic behaviour, measured by the PHBQ subscales. Multiple logistic regression identified the following risk factors: age <5, pain at home but not at hospital, nausea, child anxiety at anaesthesia induction, postoperative nausea, postoperative distress, previous hospitalizations, living in a one adult family and having some previous problematic behaviours. Moderate‐to‐severe pain at home, but not at hospital, was associated with the greatest risk (OR 6.39 CI: 3.53–11.6). Previous anaesthesia, midazolam use in premedication and living in rural areas seemed to be protective factors.

Conclusion: Pain at home but not in hospital is a strong risk factor for the onset or worsening of problematic behaviour after childhood hospitalization, which included anaesthesia. Proactive interventions are suggested to prevent this by improving pain treatment at home.
Increased fetal blood pressure response to maternal norepinephrine after pharmacological inhibition f norepinephrine uptake in pregnant sheep
Authors: Hansson SR , Bottalico B , Amer‐Wahlin I , Marsál K , Ley D
Published: May 2008

Objective: Norepinephrine (NE) is elevated in pregnancies complicated by preeclampsia (PE). Specific uptake of NE by the NE transporter (NET) plays a central role as regulator of NE levels. Expression of NET is reduced in placentas from PE pregnancies. To study adverse fetal effects of reduced NET expression on the placental buffering capacity, the NET was pharmacologically blocked by a specific uptake inhibitor reboxetine.

Study Design: We evaluated the effect of NE uptake inhibition on maternal and fetal arterial blood pressure responses to increasing maternal doses of NE in 10 chronically prepared fetal sheep. Arterial blood pressure was monitored continuously during increasing doses of iv NE.

Results: NET inhibition increased both fetal and maternal mean arterial blood pressure (p < 0.001, respectively).

Conclusion: Reuptake by NET appears to be a mechanism protecting the fetus from NE. A reduced uptake capacity in preeclamptic pregnancies due to reduced NE uptake may lead to increased fetal arterial blood pressure.
Bronchiolitis due to respiratory syncytial virus in hospitalized children: a study of seasonal rhythm
Authors: Alonso A , Andres JM , Garmendia JR , Diez I , Gil JM , Ardura J
Published: May 2008

Aim: The objective of this study was to describe the rhythm of respiratory syncytial virus (RSV) bronchiolitis seasonal outbreaks in hospitalized children.

Methods: Data was collected from 1324 patients, who were admitted to our hospital with bronchiolitis, over an 11‐year period, from 1994 to 2004. The epidemic onset was established according to the epidemic index. Virological diagnosis was made with immunofluorescent assay from nasopharyngeal washings. Rhythm study was carried‐out by spectral analysis with the fast‐Fourier transformed and cosinor method.

Results: Epidemics begin in September (45%) and October (55%); the highest peak was observed in January, the minimum in August and the end in February (73%), March (18%) and April (9%). When the epidemic outbreak begins sooner, the end is sooner as well. Epidemic onset varies but not its length and the onset was less variable than its conclusion. Spectral analysis showed a 12‐months cyclic period along the study years and cosinor analysis demonstrated significant circannual rhythm. When data was segregated by long and short hospital stay, no significant differences were found between the rhythms. Comorbid association among bronchiolitis, otitis and gastroenteritis was very common.

Conclusion: Bronchiolitis epidemics onset and conclusion varies along time years in hospitalized infants and showed circannual rhythmicity with a 12‐months period.
Maternal methadone may cause arrhythmias in neonates
Authors: Hussain Tarique , Ewer Andrew K
Published: May 2008

Methadone treatment is a well recognised cause of QT interval lengthening in adults. In this case report, we present for the first time, clinically significant QT interval lengthening in a neonate secondary to maternal methadone treatment. Neonatal paediatricians should be aware of this important and potentially serious clinical phenomenon.

Conclusion: Bradycardia, tachycardia or an irregular heart rate in an infant born to a mother on methadone treatment should not be ignored and a 12‐lead electrocardiogram should be performed. Furthermore, there is also a need for a prospective study of QTc intervals in infants born to mothers receiving methadone.
Indices of iron deficiency and anaemia in Bedouin and Jewish toddlers in southern Israel
Authors: Urkin J , Adam D , Weitzman D , Gazala E , Chamni S , Kapelushnik J
Published: May 2008

Aims: To estimate the prevalence of iron deficiency and iron deficiency anaemia using haematological indices.

Methods: Prospective interventional study. Healthy toddlers from Bedouin and Jewish towns in southern Israel. Capillary blood was sampled to assess iron status and nutritional history recorded. Parents were given specific nutritional instructions. Anaemia was defined as haemoglobin level ≤11 gr/dL. Iron deficiency without anaemia was defined as mean corpuscular volume (MCV) <70 fL and/or red blood cell width (RDW) ≥ 16, with haemoglobin level > 11 gr/dL. Toddlers with iron deficiency were treated with 5 mg/kg/day of elemental iron. Follow‐up iron and nutritional status was performed 1 and 2 months after enrolment.

Results: At the time of enrolment 42% of the 107 Jewish and 93% of the 43 Bedouin toddlers were iron deficient (p < 0.001). Significantly higher proportions of Bedouin toddlers were breastfed, drank tea, did not eat meat, did not take supplementary iron in their first year of life and were previously diagnosed with anaemia. Rate of follow‐up was 55% among Bedouins and 33% among Jews. The mean haemoglobin rise over two months was 0.91 gr/dL (95% CI: 0.63–1.18 gr/dL; p < 0.001) in Bedouins and 0.58 gr/dL (95% CI: 0.14–1.02 gr/dL; p = 0.014) in Jews.

Conclusions: Higher rates of anaemia and iron deficiency, as well as most of the risk factors, found among the Bedouin toddlers, call for the design and implementation of innovative, culturally appropriate interventions in the Bedouin population.
Impedance index or standard anthropometric measurements, which is the better variable for predicting fat‐free mass in sick children?
Authors: Dung Nguyen Quang , Fusch Gerhard , Armbrust Sven , Jochum Frank , Fusch Christoph
Published: May 2008

Aim: To compare the predictive value of impedance index (ZI, height2/impedance) with anthropometric measurements for estimating fat‐free mass (FFM).

Methods: FFM of 120 white paediatric children (46 males, 74 females), aged 2.5–18 years was measured by using dual energy X‐ray absorptiometry. Weight, height, mid‐upper arm circumference (MUAC), skinfold thickness (biceps, triceps, subscapular and suprailiac) and bioelectrical impedance were also obtained. Stepwise multiple regression analysis and residual plots were performed to determine the most significant variables to predict FFM.

Results: The single best predictor of FFM was ZI, which explained 96.2% of the variance in FFM (r = 0.981, SEE = 2.15 kg). Addition of weight to the model containing ZI increased the explained variance of FFM to 96.6% (r = 0.983, SEE = 2.03 kg). BMI and MUAC were the poorest predictors of FFM: r = 0.422, SEE = 10.2 kg and r = 0.621, SEE = 8.93 kg, respectively.

Conclusion: Impedance index is a more significant single predictor of FFM than other anthropometric measurements. The predictive accuracy of bioelectrical impedance analysis‐based prediction equations for FFM was improved by addition of weight.
Attention behaviour and hyperactivity at age 4 and duration of breast‐feeding
Authors: Julvez Jordi , Ribas‐Fitó Núria , Forns Maria , Garcia‐Esteban Raquel , Torrent Maties , Sunyer Jordi
Published: May 2008

Aim: The relation of longer duration of breast‐feeding to cognitive development was been demonstrated in several previous studies, however its potential impact on behaviour is unknown. We assess which behavioural areas (executive function, social competence, attention behaviour and hyperactivity) are related to long‐term breast‐feeding in young children.

Methods: Two prospective population‐based birth cohorts, one from the island of Menorca (N = 421) and the second from Ribera d'Ebre county (N = 79) in Spain were followed up at the age of 4 years during a two year period (2001–2003). Children were assessed by three psychologists and their respective teachers for neuropsychological functions (McCarthy test), attention‐hyperactivity behaviours (Attention‐Deficit Hyperactivity Disorder Criteria of DSM‐IV) and social behaviour (California Preschool Social Competence Scale).

Results: Long‐term breast‐feeding was associated with executive function scores (an increase of 4.9 points after breast‐feeding >20 weeks), and the improvement of social competence scores (relative risk for being in the poorest 20%, RR = 0.57; 0.52–0.66, after >12 weeks) and attention‐deficit hyperactivity symptom scores (RR = 0.56; 0.37–0.85, after >12 weeks). All three outcomes remained significant when included as covariates in the regression models.

Conclusion: Long‐term breast‐feeding was found to be associated with fewer attention and hyperactivity symptoms and an improvement in related behavioural areas (neuropsychological and socio‐behavioural outcomes).
Noncardiac comorbidities of congenital heart disease in children
Authors: Massin Martial M , Astadicko Iyawa , Dessy Hugues
Published: May 2008

Background: Noncardiac conditions may complicate heart disease care, contribute to the progression of the disease and alter the response to treatment. The aim of this prospective study was to evaluate the proportion of cardiac children with such significant conditions.

Methods: Of the 1058 children with congenital heart disease primarily diagnosed during a 10‐year‐period in one hospital, we identified those patients who had significant congenital and acquired comorbidities.

Results: Associated problems were diagnosed in 224 children (21.2%). Among them, 118 children (11.2%) had genetic or syndromic conditions, of which 38 had Trisomy 21. Six subspecialty areas accounted for the vast majority of the cases: neurology (n = 140), pulmonology (n = 36), orthopaedics (n = 26), nephro‐urology (n = 19), gastroenterology (n = 14) and endocrinology (n = 13). The most frequent associated conditions were mental retardation, asthma, epilepsy and scoliosis. During the study period, death occurred in 46 of the children (4.3%) and was not related to the cardiac disease in 20 cases (1.9%).

Conclusion: A substantial proportion of children with congenital heart disease have significant noncardiac comorbidities. Close collaboration between paediatric cardiologists and paediatricians of other subspecialties is imperative to optimize care for these children.
Inflammation at birth and the insulin‐like growth factor system in very preterm infants
Authors: Hansen‐Pupp I , Hellström‐Westas L , Cilio CM , Andersson S , Fellman V , Ley D
Published: May 2008

Background: Foetal inflammation is associated with an increased risk of brain damage in preterm infants whereas IGF‐I is essential for cerebral development and exhibits anti‐apoptotic properties.

Aim: To assess levels of IGF‐I and IGF binding proteins at very preterm birth and to evaluate their relationship with foetal pro‐inflammation and cerebral damage.

Methods: Levels of IGF‐I, IGF binding protein 3 (IGFBP‐3), high‐ (hp) and low‐phosphorylated (lp) IGFBP‐1 in cord blood and neonatal blood at 72 h after delivery were analysed in relation to levels of cytokines and cerebral damage as detected by ultrasound in 74 inborn infants [mean gestational age (GA) 27.1 weeks]. Evaluation was performed separately according to birth weight for GA.

Results: In cord blood of infants appropriate for gestational age (AGA) higher levels of IL‐6 and IL‐8 were associated with lower IGF‐I (r =−0.38, p = 0.008 and r =−0.36, p = 0.014). Higher levels of IL‐6, IL‐8 and TNF‐α were associated with both higher levels of lpIGFBP‐1 (r = 0.54, p < 0.001, r = 0.50, p < 0.001 and r = 0.13, p = 0.012, respectively) and hpIGFBP‐1 (r = 0.55, p < 0.001, r = 0.45, p = 0.002 and r = 0.32, p = 0.026, respectively). Infants with intraventricular haemorrhage grade III (n = 5) had higher levels of lp/hpIGFBP‐1 in cord blood (p = 0.001 and 0.002, respectively).

Conclusion: Pro‐inflammation at birth is associated with changes in the IGF‐system. This may be of importance for development of brain damage in preterm infants.
Mental health in adolescents with chronic physical illness versus controls in Northern Russia
Authors: Zashikhina A , Hagglof B
Published: May 2008

Aim: To study the behaviour/emotional problems and depression in adolescents with and without physical illnesses; to compare the same psychological parameters in adolescents with different disorders.

Methods: The sample consisted of 148 adolescents aged 13–16 years with one of the following physical chronic conditions: diabetes (n = 55), asthma (n = 59), or epilepsy (n = 59). Comparative data were obtained from a group of 301 schoolchildren. Test batteries (Child Behaviour Check‐List, Youth Self Report, Beck Depression Inventory, socio‐economic status questions) were individually completed by adolescents and their mothers.

Results: Overall adolescents with physical illness had more behaviour/emotional problems and were more depressed compared to controls although results varied according to the informants and the disease severity. Two risk groups were revealed: girls with asthma and boys with epilepsy.

Conclusion: Our results suggest that mental health in adolescents with chronic physical illnesses is poorer than in controls and their mental health state is very much associated with the disease severity. The findings of the study can help to develop disease targeted and comprehensive interventions in outpatient clinics of Northern Russia in order to reduce behaviour and mood disorders in adolescents with chronic physical illnesses and therefore to smooth the transition through their teenage years.
Trends in the duration of school‐day sleep among 10‐ to 15‐year‐old South Australians between 1985 and 2004
Authors: Dollman J , Ridley K , Olds T , Lowe E
Published: May 2008

Aim: To compare self‐reported school‐day sleep duration in 10‐ to 15‐year‐old South Australians between 1985 and 2004.

Methods: Data were collected from 10‐ to 15‐year‐old participants in the 1985 Australian Schools Health and Fitness Survey (n = 390) and the 2004 South Australian Physical Activity Survey (n = 510). Identical self‐report questionnaires were administered in both surveys, providing data on school‐day bed‐time, wake‐time and sleep duration; as well as age, gender and socioeconomic status (SES). Analysis of co‐variance (ANCOVA), controlling for age and SES, was used to compare all sleep variables between surveys.

Results: Declines in sleep duration were found for both girls (28 min) and boys (33 min) between surveys. The reduction was more pronounced in ‘lower SES’ boys (44 min) than ‘higher SES’ boys (23 min). Boys reported later bed‐time than girls in the 2004 survey, while no gender differences were apparent in the 1985 survey.

Conclusion: Our findings suggest reductions in school‐day sleep duration have occurred in Australian children and adolescents over the last 20 years, due largely to later bed‐times. The physiological significance of these declines and mediating influences, such as SES, are yet to be explicated.
Effect of formula thickened with reduced concentration of locust bean gum on gastroesophageal reflux
Authors: Miyazawa R , Tomomasa T , Kaneko H , Arakawa H , Morikawa A
Published: May 2008

Aim: Previous studies showed that HL‐350, a formula thickened with a reduced concentration of locust bean gum, decreased frequent regurgitation in 4‐month old infants with reflux. In this study, we investigated the effect of HL‐350 in younger infants.

Methods: We studied 20 infants less than 2 months old who had three or more episodes of regurgitation or vomiting per day. Ten infants (group A) were fed with HL‐350 for the first week, and with control milk, HL‐00, for the following week. The other 10 infants (group B) were fed in reverse order. Mothers recorded number of regurgitation episodes, feeding volume and time and number of bowel movements. To evaluate gastric emptying we measured antral cross sectional areas ultrasonographically at various time points after feeding.

Results: The median number of regurgitation episodes decreased significantly with feeding of HL‐350 (2.3/day) compared to feeding with control milk (5.2/day) (p = 0.00048). No significant difference was evident in feeding volume and time, body weight gain, or gastric emptying rate between HL‐350 and control milk.

Conclusion: HL‐350 decreased the number of regurgitation episodes without affecting gastric emptying delay in very young infants with recurrent vomiting.
Satisfactory long‐term results after Nissen fundoplication
Authors: Kristensen C , Åvitsland T , Emblem R , Refsum S , Bjørnland K
Published: May 2008

Background: Complications and unsatisfactory long‐term results after antireflux surgery in children have received increased attention. The aim of this study was to report parental assessment of outcome after Nissen fundoplication.

Methods: Ninety‐three patients operated with primary Nissen fundoplication between 1990 and 2001 were included. Medical records were reviewed, and parents were interviewed for evaluation of postoperative results.

Results: Of the 93 children, 51 were neurologically impaired and 14 children had repaired esophageal atresia. Median follow‐up time was 6.0 years. Total mortality for the patient population was 13%. Five children died as a complication of the surgery, whereas eight deaths were unrelated to the Nissen fundoplication. Ninety‐two percent of the parents reported better well‐being of the child after the Nissen fundoplication, and 83% were completely satisfied with the postoperative results. Pulmonary symptoms were reduced in 59%, and quality of sleep improved in 68% of the children. Nine children (10%) had been operated with a redo NF.

Conclusion: The majority of parents were satisfied with the long term results of the Nissen fundoplication.