bluuebunny/crossref_metadata_2025 huggingface dataset:
Transition from paediatric to adult care for persons with cystic fibrosis: Patient and parent perspectives
Authors: Westwood ATR , Henley LD , Willcox P
Published: March 2003

Objectives: To gauge the perspectives of adolescents and adults with cystic fibrosis (CF) and their parents regarding the transition from paediatric to adult‐oriented health care.

Methods: Cross‐sectional survey using an anonymous, semi‐structured questionnaire. The study population consisted of adolescents and adults attending a paediatric and an adult CF clinic in Cape Town, South Africa and their parents.

Results: Forty‐seven of the 61 subjects completed the questionnaire (response rate 77%). Autonomy in health care was ‘extremely important’ to most persons with CF. Transfer at the age of 16–18 years of age was the preferred option for most respondents. Whereas over 80% of parents felt their children needed more CF‐related information, only 38% of adolescents expressed this need (P < 0.05). Adolescents also reported little need for general health information. More than 80% of respondents were ‘unsure’ about transfer. Over 90% felt that a transition clinic would be useful. As viewed by the respondents, its main purpose would be to provide information about the adult clinic and an opportunity to meet the CF doctor in the adult clinic.

Conclusions: There are significant concerns about the transition process in this population. Given the expressed need for autonomy and a transition clinic, the basis for a smoother transition in the future has been laid.
A painful limp
Authors: Narchi H , Thomas M
Published: March 2003

Abstract: We describe a healthy 18‐month‐old child who developed a painful limp, without a history of trauma or fever. The initial laboratory investigations showed normal results but the radiological findings were suggestive of scurvy. Diagnosis was confirmed by blood tests and by a rapid recovery following replacement therapy.
The prevalence of recurrent abdominal pain in 11‐ to 16‐year‐old Malaysian schoolchildren
Authors: Boey CCM , Yap SB , Goh K‐L
Published: March 2003

Objective: To determine the prevalence of recurrent abdominal pain (RAP) among Malaysian school children aged from 11 to 16 years.

Methodology: A preliminary cross‐sectional survey in which three urban schools and three rural schools were selected randomly. Two classes were selected randomly from each year. A questionnaire was given to each child asking him or her about whether they had experienced abdominal pain occurring at least three times over a period of at least 3 months, interfering with normal daily activity.
1 Interfering with normal daily activity was defined as missing school and/or having to stop doing a routine daily activity on account of the pain. Girls whose pains were related to periods were excluded. After the forms had been completed, each child was again interviewed to ensure that Apley’s criteria
1 was fulfilled in cases of RAP.

Results: The overall prevalence of RAP among 1549 schoolchildren (764 boys; 785 girls) was 10.2% (95% confidence interval (CI), 8.8–11.8). There appeared to be a higher prevalence in rural schoolchildren (P = 0.008; odds ratio (OR) 1.58), in those with a lower family income (P < 0.001; OR 2.02) and in children whose fathers have a lower educational attainment (P = 0.002; OR 1.92). There were no significant differences in the prevalence of RAP among children of different sex, age, ethnic group and family size.

Conclusion: In spite of differences in time and culture, the overall prevalence of 10.2% found in this study is similar to that determined by Apley.
1 There are significant differences in the prevalence of RAP between children from rural and urban schools, among children with different family incomes and among children whose parents have different educational backgrounds.
Bromocriptine for the management of autonomic dysfunction after severe traumatic brain injury
Authors: Russo R N , O’Flaherty S
Published: March 2003

Abstract: This case report describes a child with severe traumatic brain injury with clinical features of autonomic dysfunction in the immediate post‐traumatic period. A history of severe asthma in this child contraindicated the use of beta‐blockers, the first line approach, and she was managed with bromocriptine (0.05 mg/kg t.d.s) with good effect.
Asthma management in indigenous children of a remote community using an indigenous health model
Authors: Chang A B , Shannon C , O’Neil M C , Tiemann A M , Valery P C , Craig D , Fa'afoi E , Masters I B
Published: March 2003

Objective: To describe the management of asthma in children in a remote indigenous community and the delivery of subspecialist service through the indigenous health‐care model.

Methodology: Children referred by indigenous health‐care workers were evaluated prospectively by paediatric respiratory physicians, based on a standardized protocol, at a primary health care setting at Thursday Island, Queensland.

Results: Forty of the 54 children referred with a provisional diagnosis of asthma did have asthma, with 30% having persistent asthma. Only 59% of parents knew the dose of the medication prescribed and 80% had minimal knowledge of the medications. In 88% of children, the management of asthma was improved by introduction of an appropriate spacer device and changing the dose and type of medications.

Conclusions: The management of children with asthma in the Torres region can be improved substantially by the use of age appropriate delivery devices and medications, and improving knowledge of asthma. Specialist delivery service to remote indigenous communities can be effectively delivered in partnership with the indigenous health service. The high proportion of persistent asthma in the Torres Straits community in comparison to urbanised Australia raises issues of inequity of appropriate medical service delivery to remote indigenous communities.
Rib fractures in infants: Red alert!
Authors: Cadzow Sp , Armstrong Kl
Published: March 2003

Objective: To examine clinical features, investigation methods and outcomes of infants with rib fractures.

Methodology: All infants aged 2 years or younger who presented over a 5‐year period with documented rib fractures were identified from the medical records database of a tertiary referral paediatric hospital and data collected by retrospective chart review. Additional data regarding notifications and placements were obtained from the Department of Families Youth and Community Care, Queensland.

Results: Rib fractures were attributed to child abuse in 15 of 18 infants identified. The initial presentation in the abused infants was most often as a result of intracranial pathology and limb fractures. In four cases the rib fractures were incidental findings when abuse had not been suspected. Bone scintigraphy revealed eight previously undetected rib injuries in four cases. In three cases of abuse, the rib fractures were an isolated finding. Three of the infants with inflicted rib injuries were discharged home. In one such infant a significant re‐injury occurred. Three returned home with implicated adults no longer in residence, and nine spent a mean period of 12 months in foster care.

Conclusions: Rib fractures in infancy are usually caused by severe physical abuse. Accidental rib fractures are rare in infants and result from massive trauma. Rib fractures, multiple or single, may occur in isolation in abused infants. The implications of such injuries must be recognized to ensure appropriate, safe and consistent child protection outcomes. Bone scintigraphy is more sensitive than radiographs in the detection of acute rib fractures and should be performed in all cases of suspected infant abuse.
Adoption, permanent care and foster care: Home‐based care in and beyond the 1990s
Authors: O’Neill C
Published: March 2003

Abstract: Home‐based care in Australia has changed considerably in the past two decades. The majority of children in adoptive, permanent care and foster families are likely to have experienced abuse, neglect and multiple placements. The disruptive behaviours displayed by these children undermine the potential for attachment offered by their new families. While the needs of the child will be obvious, the challenge for paediatricians is to recognize the relative instability of these newly established families and the high levels of stress they experience.
Tension pneumo‐orbitus and pneumocephalus induced by a nasal oxygen cannula: Report on two paediatric cases
Authors: O’Brien Bj , Rosenfeld Jv , Elder Je
Published: March 2003

Abstract: The present paper highlights the potential dangers of misplaced nasopharyngeal oxygen cannulae causing secondary pneumo‐orbitus and pneumocephalus in two paediatric patients. While this complication is uncommon, early recognition allows prompt and appropriate intervention, with cessation of nasal oxygen, cannula removal, early investigation with computed tomography (CT) head/orbit scan and orbital or cranial decompression, if required. Early CT imaging identifies medial orbital or paranasal sinus fractures, the presence of sinusitis, associated intracranial air and assessment of the degree of orbital or intracranial tension. Antibiotics are not usually required for this type of clean injury unless pre‐existing sinusitis is identified. In both cases, direct orbital decompression was performed with excellent results after identification of marked unilateral tense exophthalmos, delayed pupillary reactions to light and ophthalmopegia.
The impact of pacifier use on breastfeeding: A prospective cohort study
Authors: Vogel AM , Hutchison BL , Mitchell EA
Published: March 2003

Objectives: To determine the predictors of pacifier use during the first year of life and to assess the influence of pacifier use on the duration of breastfeeding.

Methodology: A prospective cohort study was conducted. Three hundred and fifty mother–infant pairs were followed to 1 year of age to determine the impact of the use of a pacifier on the duration of breastfeeding.

Results: A cohort of 441 mothers were enrolled and 79% participated. Ninety four per cent were followed up to 1 year. Daily pacifier use was associated with early cessation of breastfeeding (risk ratio (RR) 1.71; 95% confidence interval (95%CI) 1.29, 2.28) and a reduced duration of full breastfeeding (adjusted (adj.) RR 1.35; 95%CI 1.05, 1.74). Finger sucking was not associated with a reduced duration of breastfeeding (RR 1.05; 95%CI 0.81, 1.37). Pacifier use less than daily was not associated with a change in duration of breastfeeding (RR 1.02; 95%CI 0.75, 1.39). Most mothers commenced the use of a pacifier within the first month. Multiple logistic regression analysis found that the use of a pacifier was associated with male gender (adj. RR 1.97; 95%CI 1.23, 3.13), maternal smoking in pregnancy (adj. RR 2.23; 95%CI 1.01, 4.95), and low maternal confidence with breastfeeding (adj. RR 2.70; 95%CI 1.48, 4.93).

Conclusions: Daily pacifier use is associated with a reduced duration of breastfeeding. Less frequent pacifier use does not reduce the duration of breastfeeding.
Factors associated with breastfeeding at discharge and duration of breastfeeding
Authors: Scott JA , Landers MCG , Hughes RM , Binns CW
Published: March 2003

Objective: To identify determinants of the initiation and duration of breastfeeding amongst Australian women.

Methods: A prospective cohort study of 556 women in Perth, Western Australia and 503 women from the Darling Downs area, Queensland, Australia.

Results: Breastfeeding at discharge was most strongly associated with perceived paternal support of breastfeeding with an adjusted odds ratio of 9.13 (95% CI 4.83–17.26), using multivariate logistic regression analysis. Duration of breastfeeding was most strongly associated with the length of time a mother intended to breastfeed with an adjusted relative risk of 4.18 (95% CI 2.81–6.22) for ≥ 4 months relative to < 4 months.

Conclusions: Interventions which aim to increase the length of time a woman intends to breastfeed, and which highlight the role of the father in successful breastfeeding, are recommended to help achieve recommended targets for breastfeeding initiation and duration.
Growth and nutrition of Chinese vegetarian children in Hong Kong
Authors: Leung SSF , Lee RHY , Sung RYT , Luo HY , Kam CW , Yuen MP , Hjelm M , Lee SH
Published: March 2003

Objective: The study investigated the nutritional status of Chinese lacto‐ovo‐vegetarian children aged 4–14 years.

Methodology: Dietary intake over 7 days was assessed using a computer program, previously used for a local population‐based dietary survey. Anthropometric measurements were made and fasting venous blood was examined for serum lipids, haematological data, iron, vitamin B12 and folate status. Bone mineral density (BMD) of the spine (L2 – L4) was measured as a reflection of calcium status.

Results: Fifty‐one lacto‐ovo‐vegetarians aged 4–14 years were investigated. The mean ± standard deviation (SD) daily energy intake was 1600 ± 425 kcal. The mean (± SD) daily protein intake was 1.6 ± 0.6 g/kg bodyweight which met the United States recommended dietary allowance. Compared to that of the local omnivore diet, the vegetarian diet was closer to the recommended healthy diet with lower fat (20–23%), more fibre (5.8–8.7 g/day) and better polyunsaturated to saturated fatty acid ratio (1.0–1.1). Growth and BMD of the vegetarian children were comparable to the general omnivore population. Two children had iron deficiency and two children had anaemia. The calcium status, as reflected by the BMD, was not impaired. Serum folate and vitamin B12 were within the normal range. Six (25%) boys and four (15%) girls were obese. Three boys had hyperlipidaemia.

Conclusions: A Hong Kong Chinese vegetarian diet appears healthy, providing adequate iron and vitamin B12 nutrition, but the prevalence of obesity was high.
Coordinated outpatient care of the narcotic‐dependent infant
Authors: Oei J , Feller JM , Lui K
Published: March 2003

Objective: Concern regarding parental capacity to manage their infant's drug withdrawal traditionally leads to prolonged hospitalization for both mother and infant. This study examines the impact of a multidisciplinary follow‐up clinic for infants discharged home on morphine.

Methodology: Records of full‐term infants born to mothers with narcotic dependency were reviewed retrospectively. Two periods were compared: 1995–1997 (period A) and 1998 to September 1999 with clinic established (period B).

Results: Twenty‐five and 26 mothers were identified in periods A and B, respectively. Almost half had fewer than four antenatal clinic visits and most were on methadone with other substance usage. Despite higher maternal methadone doses (mean 48.5 vs 89.5 mg/day, P = 0.009) and withdrawal rates, the mean length of stay was significantly shorter for period B mothers (7.8 ± 4.8 vs 5.4 ± 3.3 days, P = 0.01) and babies (14.8 ± 9.7 vs 8.7 ± 7.2, P = 0.01). Median duration of morphine treatment was significantly shorter in period A (17 vs 60 days, P = 0.0001) when only four babies were discharged on morphine. In contrast, 18 treated period B babies were discharged on morphine. No families were lost to follow up. Compliance with clinic attendance was 92%.

Conclusions: Hospital stay was reduced with establishment of the clinic. The shorter treatment duration before establishment of the clinic could have been related to a lesser abstinence severity or a perceived need of a more rapid weaning prior to discharge. Further studies are needed to assess the impact of this model of care on the health outcome of the narcotic‐dependent mother and infant unit.
Determinants of linear growth in Malaysian children with cerebral palsy
Authors: Zainah SH , Ong LC , Sofiah A , Poh BK , Hussain IHMI
Published: March 2003

Objective: To compare the linear growth and nutritional parameters of a group of Malaysian children with cerebral palsy (CP) against a group of controls, and to determine the nutritional, medical and sociodemographic factors associated with poor growth in children with CP.

Methodology: The linear growth of 101 children with CP and of their healthy controls matched for age, sex and ethnicity was measured using upper‐arm length (UAL). Nutritional parameters of weight, triceps skin‐fold thickness and mid‐arm circumference were also measured. Total caloric intake was assessed using a 24‐h recall of a 3‐day food intake and calculated as a percentage of the Recommended Daily Allowance. Multiple regression analysis was used to determine nutritional, medical and sociodemographic factors associated with poor growth (using z‐scores of UAL) in children with CP.

Results: Compared with the controls, children with CP had significantly lower mean UAL measurements (difference between means –;1.1, 95% confidence interval –;1.65 to –; 0.59), weight (difference between means –;6.0, 95% CI –;7.66 to –;4.34), mid‐arm circumference (difference between means –;1.3, 95% CI –;2.06 to –;0.56) and triceps skin‐fold thickness (difference between means –;2.5, 95% CI –;3.5 to –;1.43). Factors associated with low z‐scores of UAL were a lower percentage of median weight (P < 0.001), tube feeding (P < 0.001) and increasing age (P < 0.001).

Conclusion: A large proportion of Malaysian children with CP have poor nutritional status and linear growth. Nutritional assessment and management at an early age might help this group of children achieve adequate growth.
Seroprevalence of hepatitis B, hepatitis C and human immunodeficiency virus antibodies among multitransfused thalassaemic children in Shiraz, Iran
Authors: Karimi M , Ghavanini AA
Published: March 2003

Objective: To evaluate the rate of seropositivity to hepatitis B and C and human immunodeficiency virus (HIV) infections among children with β‐thalassaemia major receiving multiple transfusions in Shiraz, Iran, compared with healthy controls.

Methodology: The study was performed during 1999–2000 on multitransfused children with β‐thalassaemia major registered by the Shiraz Thalassaemia Society. Hepatitis B surface antigen (HBsAg), anti‐hepatitis C virus (HCV) antibodies (Ab) and HIV Ab were checked using a second‐generation enzyme‐linked immunosorbent assay (ELISA). Positive tests were confirmed by western blots. Healthy blood donors were used for the control group.

Results: Hepatitis B surface antigen, anti‐HCV Ab and HIV Ab were positive in four of 755 (0.53%, 95% confidence interval (CI) = 0.17–1.3), 73 of 466 (15.7%; 95% CI = 12.6–19.2) and none of 466 patients tested, respectively. Positive sera for HBsAg, anti‐HCV Ab and HIV Ab were found in 85 (1.07%), 47 (0.59%) and 27 (0.34%) of 7879 control children, respectively. The rate of anti‐HCV Ab was significantly higher in patients than in the control group (P < 0.0001). In patients, the rate of positive anti‐HCV Ab was significantly higher than the rate for positive HBsAg (P < 0.0001).

Conclusion: It is concluded that HCV is the current major problem in multitransfused children with thalassaemia major and more careful pretransfusion screening of blood for anti‐HCV must be introduced in our blood banks.
Perspectives on infective ear disease in indigenous Australian children
Authors: Leach AJ , Morris PS
Published: March 2003

Abstract: Australian Aboriginal children experience the highest rates of bacterial respiratory diseases reported in the literature. Neonatal acquisition of multiple bacterial pathogenic species and strains predicts persistent and severe disease throughout childhood, particularly infective ear disease. The dynamics of bacterial nasopharyngeal colonization and transmission are poorly understood. The importance of host factors, bacterial competition and co‐operation in the transition from asymptomatic carriage to disease are also uncertain. Treatment outcomes are poor, possibly due to the high density of bacterial infection following early age exposure, poor compliance and increasing levels of antibiotic resistance. The relationship between antibiotic use, clinical outcomes and bacterial resistance needs to be better understood in high‐risk populations if the benefits associated with treatment are to be maximized. While there is an urgent need for vaccines, the early age of infection and the high rates of transmission and bacterial antigenic diversity mean these may also be less effective than predicted from studies in low‐risk populations.
Scientific rationale and benefits of nucleotide supplementation of infant formula*
Authors: Yu VYH
Published: March 2003

Abstract:  The present review examines the role of dietary nucleotides in infants, and the scientific rationale and benefits of nucleotide supplementation of infant formula. The immunoprotective benefits of human milk, the biology of human milk nucleotides, and the immunological and gastrointestinal effects of dietary nucleotides in animal studies and in vitro experiments are examined. Clinical studies are reviewed, especially those examining the efficacy of nucleotide‐supplemented infant formula in enhancing immunity and reducing the risk of sepsis. The presence of human milk cells, and a variety of immunoactive and trophic components of human milk, can explain the reduced incidence of sepsis in breastfed term and preterm infants. Nucleotides, believed to play an immunomodulatory role, are found in lower concentrations in infant formula. Animal studies have shown that dietary nucleotides enhance a number of immune responses and the growth, differentiation and repair of the gut. Several clinical studies have reported beneficial effects of nucleotide supplementation on gut microflora, diarrhoea and immune function, and one study has reported better catch‐up growth in term infants with severe intrauterine growth retardation. More basic research studying the metabolism of nucleotides in neonates is encouraged. Additional randomized controlled trials are necessary to demonstrate the clinical benefits of nucleotide supplementation of infant formula, as it cannot be presumed that nucleotides produce the same benefits for the infant as human milk. Studies are especially necessary in high‐risk neonatal situations, such as extreme prematurity, significant suboptimal nutrient intake before and after birth, and recovery from gut injury.
Cardiac involvement in infantile Sandhoff disease
Authors: Venugopalan P , Joshi SN
Published: March 2003

Abstract: An 18‐month‐old boy with enzyme assay‐confirmed infantile Sandhoff disease (MIM 268800) is reported. Besides the classical neurological features, this patient exhibited severe mitral regurgitation secondary to mitral valve prolapse and mild aortic regurgitation from aortic valve prolapse. He also had asymmetric hypertrophy of the interventricular septum without left ventricular outflow tract obstruction.
Acute flaccid paralysis in Australian children
Authors: Morris AMS , Elliott EJ , D’Souza RM , Antony J , Kennett M , Longbottom H
Published: March 2003

Objectives:  To describe the epidemiology and causes of acute flaccid paralysis (AFP) in Australian children, and the clinical features of the two most common causes of AFP, Guillain−Barré syndrome and transverse myelitis.

Methods:  Monthly active surveillance for AFP was carried out through the Australian Paediatric Surveillance Unit, with AFP defined as ‘acute onset of flaccid paralysis in one or more limbs or of bulbar paralysis in any child less than 15 years of age’.

Results:  Between March 1995 and December 1999, 143 cases of AFP were reported (approximately 0.8 per 100 000 children < 15 years of age per annum). The age range was 2 months−14 years and 59% were boys. Out of these children, 137 (96%) were hospitalized and 47 required intensive care. No case of wild or vaccine‐associated poliomyelitis was identified. The most common causes of AFP were Guillain−Barré syndrome in 67 (47%) and transverse myelitis in 27 (19%). Other diagnoses included acute disseminated encephalomyelitis, trauma, tick‐bite paralysis and infantile botulism.

Conclusion:  The participation of paediatricians in AFP surveillance contributed to the accreditation of Australia (along with the other 36 countries of the western Pacific region) as ‘polio free’ by the World Health Organization in October 2000. The surveillance also provided data on the frequency of AFP and identified Guillain−Barré syndrome and transverse myelitis as the most common diagnoses. In this large national series, many other conditions that may present as non‐polio AFP were identified.
Suspected infection in children with cancer
Authors: JONES PD , HENRY RL HENRY , STUART J STUART , FRANCIS L FRANCIS
Published: March 2003

The microbiology and severity of suspected infections in children with cancer admitted to the John Hunter Children’s Hospital was determined in order to assess whether any alteration to the infection treatment protocol was required. All children with cancer aged 1–17 years who had an episode of suspected or proven infection that required parenteral treatment at John Hunter Children’s Hospital (JHCH) during 1994/95 were reviewed. Thirty‐seven children were treated for cancer at JHCH; 62 admissions for suspected infection which involved 26 children were reviewed. Sixteen of these children had a permanent central line. Children with a central line had an increase in the number of days of inpatient treatment required for the treatment of suspected infection, and they had more episodes of infection. A pathogen was isolated more frequently with blood cultures being positive more often and Gram‐ positive species were methicillin resistant more often. These differences were not statistically significant. A pathogen was isolated in 52% of admissions. Sixteen pathogens were Gram positive; 12 were Gram negative, two were fungal and two were viral. Blood cultures were positive in 21 of 62 admissions, skin swabs in four admissions, urine cultures in three admissions, stool in two admissions and one species was isolated from an epidural catheter tip and from the sputum. In 16% of admissions, the identified organism was resistant to the initial empirical therapy of tobramycin and piperacillin. In a further 13%, flucloxacillin was added to the empirical regimen when a sensitive Staphylococcus was identified. No significant differences between the culture‐negative and culture‐positive groups were observed in admission pulse, fever or admission neutrophil count. However, those patients with a central line had a higher incidence of having a pathogen isolated if their temperature was > 39.5°C. The median length of stay was longer for patients with a pathogen isolated on blood culture. Admission blood cultures were positive in 53% of admissions with an initial neutrophil count > 1000 × 109/mL. Each of these children had a central line. Only one child died of infection during the 2‐year study period. This review supports the observations that Gram‐positive infection is now more common than Gram‐negative infection in children with cancer. Despite the management advantages a permanent central line affords it is clear those children with a central line have an increased rate of infection and there needs to be caution in their use. The most important is the observation that any fever > 39.5°C in a child with a central line is likely to be associated with a documented infection irrespective of the neutrophil count. The clinical outcomes observed in the present study indicate that tobramycin and piperacillin are effective empirical treatments for suspected infection in children with cancer.
Standardising surveillance of nosocomial infections: The HISS Program
Authors: McLaws Mary‐Louise , Murphy Cathryn , Whitby Michael
Published: March 2003

Abstract Standardised surveillance of nosocomial infections in Australia had not been addressed until June 1998 when the New South Wales Health Department funded the development and implementation of the first standardised surveillance system for hospital infection: the Hospital Infection Standardised Surveillance program (HISS). The introduction of a standardised surveillance system needs to balance the requirements of a Health Department and the needs of hospitals. The Health Department requires data to develop aggregated rates for the setting of thresholds for all nosocomial infections while hospitals require rates to reflect the quality of clinical care and provide data for evidence‐based infection control practices. The Hospital Infection Epidemiology and Surveillance (HIES) Unit has attempted to balance these requirements using a ‘sentinel surveillance’ approach with standardised definitions and methodology. The HISS program utilizes eICAT® software modified for its standardised requirements of data collection. To date, 10 hospitals surveyed sentinel multiple resistant organisms (MRO), eight also elected sentinel surgical procedures (SSP) and intravascular device‐related bacteraemia (IVDRB) modules, and two the seasonal respiratory syncytial (RSV) and rota‐virus modules in paediatric patients. The surgical site infection rates in three commonly monitored SSP were 1.8% (95% confidence interval (CI) 0.7–3.9%) for coronary artery bypass (CABG), 3.3% (95% CI 1.4–6.8%) lower segment Caesarean section (LSCS) and 7.7% (95% CI 3.4–14.6%) colorectal surgery. The rate of IVDRB was 4.7 per 1000 central venous catheter days (95% CI 2.2–8.6) and 1.1 per 1000 peripheral line‐days (95% CI 0.1–3.9). Methicillin resistant Staphylococcus aureus (MRSA) accounted for 99% of all new infections diagnosed with an endemic MRO.
Pressure ulcer prevention and care: A survey of current practice
Authors: Sharp Catherine , Burr Gayle , Broadbent Margaret , Cummins Marianne , Casey Hellen , Merriman Amelia
Published: March 2003

Abstract The incidence and management of pressure ulcers in hospitalised patients is an ongoing concern for nurses. Efforts to prevent pressure ulcer development are plagued with inconsistencies and a general lack of best practice guidelines. Establishing current practice approaches to the assessment, prevention and management of pressure ulcers is a necessary first step in the implementation of evidence‐based/best practice guidelines. Anecdotal evidence suggested a range of different approaches were being used in a Sydney metropolitan area health service (AHS) to assess patients to identify those at risk, to prevent pressure ulcers and to treat existing ulcers. A collaborative research project was undertaken to examine current practice and to explore the apparent clinical variance. It involved the distribution of a questionnaire to registered nurses working within the AHS (n = 2113) and a review of nursing policy documents in the various hospitals in the health service area. While the overall response rate was satisfactory (40%) many of the returned questionnaires were incomplete. Only 21% (n = 444) of the questionnaires were deemed suitable for analysis. The findings highlight a range of inconsistencies within and across nursing practice domains. Nurses generally do not use a tool to assess pressure ulcer risk potential, but rely on a range of practice procedures and risk indicators to determine risk potential of developing pressure ulcers. Repositioning patients is the most common approach used in an attempt to prevent the development of pressure ulcers, but additional measures are diverse. Most nurses seem to be familiar with modern wound dressings such as hydrocolloids, foams and alginates in the treatment of second and third stage ulceration. However, the care provided by some nurses reflects an adherence to outdated practices, including the use of water filled gloves, povidone iodine and gauze packing.
Hospital stay and discharge outcomes after knee arthroplasty
Authors: Oldmeadow Leonie B , McBurney Helen , Robertson Valma J
Published: March 2003

Abstract The impact of shorter hospital lengths of stay on patient outcomes at discharge from acute care after knee arthroplasty was investigated in a prospective observational outcome study at three Melbourne public hospitals during a 5‐month period from October 1999 to March 2000. The participants were 105 consecutive patients (35 at each hospital), with a mean age of 71 years. Outcome measures were length of stay, destination (home or rehabilitation) and functional mobility at discharge from the acute care facility. During the study period mean hospital length of stay across the three hospitals was 6.5 days, more than 30% less than the Victorian average for the preceding year. This was associated with high rates of discharge to rehabilitation facilities (mean 64%), with rates varying between the three hospitals (97%, 57% and 40%). However, in each hospital, one‐third of this group had already achieved a level of independent functional mobility adequate for discharge home, highlighting an apparent influence of non‐clinical factors on discharge decisions, including pressure to decrease length of stay, hospital policy and availability of a rehabilitation bed. Ways of achieving discharge directly home for a greater number of patients following knee arthroplasty and of determining optimal length of stay are discussed.
Structure and dynamics of food webs in Andean lakes
Authors: Modenutti Beatriz E. , Balseiro Esteban G. , Queimaliños Claudia P. , Añón Suárez Diego A. , Diéguez María C. , Albariño Ricardo J.
Published: March 2003

Food webs from oligotrophic Andean lakes of Bariloche region (41°S) are described. Their peculiarities in comparison with Northern Hemisphere studies are noted. The endemic species composition, the extended euphotic zone, and the oxygenated bottom allow a particular structure of the pelagic and benthic food webs. Experimental work with pelagic communities indicates that models based only on zooplankton body size are questionable and that nutrient enrichment does not necessarily lead to a positive effect on herbivorous populations. Invertebrate predation effects depend on the lake and type of predator, while vertebrate predation does control crustacean populations. The characteristic low species richness of top predators is likely to change following the introduction of exotic salmonids. The benthic food web is quite distinctive with a slow rate of decaying organic matter and easily altered by the introduction of exotic tree species.
Distribution of macrobenthic fauna in Phawong and U‐Taphao canals flowing into a lagoonal lake, Songkhla, Thailand
Authors: Angsupanich S. , Kuwabara R.
Published: March 2003

The macrobenthic fauna of two discharge ecosystems, Phawong Canal and U‐Taphao Canal flowing into Songkhla Lake in Thailand, were studied from August 1994 to August 1995. The salinity of Phawong Canal and U‐Taphao Canal ranged from 0.1 to 27.8 and 0.1 to 17.0 practical salinity units (PSU), respectively. The biochemical oxygen demand (BOD) of Phawong Canal ranged from 2.5 to 33.0 mg L−1, while that of U‐Taphao Canal ranged from 1.1 to 12.6 mg L−1. Temporal changes in the number of species and individuals were determined throughout a year. During the season of heavy rains (November– December), the density and number of most species decreased markedly. Only chironomid larvae increased and these were distributed in the uppermost reaches of the canals during this period. Sixty‐two and 52 species of macrobenthic fauna were found in Phawong Canal and U‐Taphao Canal, respectively; however, the abundance and number of species collected at each sampling was very low in the upper reaches of the canals. The most numerous benthic fauna in the Phawong Canal were polychaetes, followed by amphipods. Pelecypods and gastropods were the dominant groups in U‐Taphao Canal. A distribution pattern of macrobenthic fauna associated with pollution gradients (BOD) was observed only at Phawong Canal. In addition, species diversity according to the Shannon‐Wiener index only was not applicable to the assessment of benthic environmental health when the few individuals found were evenly distributed among the few species present at U‐Taphao Canal. It is recommended that a coastal care project be established by the appropriate government agencies in the study areas.
Fish yields in Cuban reservoirs and relationships with some morphometric and edaphic parameters
Authors: Laíz Averhoff Orlando R.
Published: March 2003

Cuba is located between 19°49′ and 23°18′ north latitude and 74°08′ and 84°57′ west longitude. It is the largest island in the Caribbean Sea and the paucity of natural lakes and the prolonged dry season makes it necessary to construct reservoirs. During the past 36 years, Cuba has built 220 large reservoirs (> 100 ha) and 800 smaller ones (< 100 ha). Reservoirs are the most important standing waters in Cuba and their fish, although of low diversity, support productive fisheries, with tilapias contributing 92% of the total production by weight. The fisheries in reservoirs located in the eastern and central parts of the island were analysed during the period 1983–92. The mean depth (z) of reservoirs here is 5.9 m, ranging from 1.8 to 16.0 m. The best correlation coefficients and fit regression in 54 Cuban reservoirs were between FY (fish yield) and DE (diversity of exploitation); when data were analysed with a multiplicative statistical model, r = 0.70, FY = 4.795 DE0.9292; and between TC (total catch) and A (area), but in this case data were analysed with a linear statistical model, r = 0.91, TC = 17209A–6635.56. Regression between FY versus z was relatively low and inverse, r = −0.20, FY = 249.145–11.04z, although all regressions were statistically significant (P < 0.01).
Basis for the protection and management of tropical lakes
Authors: Lewis William M.
Published: March 2003

Management of lakes for the protection of water quality, aquatic life and other uses must be approached somewhat differently in the tropics from how it is approached at temperate latitudes. More than half of all tropical lakes are accounted for by natural river lakes or reservoirs. Therefore, degradation of water quality in rivers will have direct negative effects on the majority of lakes in the tropics. Also, regulation of rivers, which is one result of river impoundment, is a potential cause of damage to river lakes. Tropical lakes are more sensitive than temperate lakes to increases in nutrient supply and show higher proportionate changes in water quality and biotic communities in response to eutrophication. Tropical lakes are especially prone to loss of deep‐water oxygen, and in order to maintain ecological stasis therefore require more stringent regulation of organic and nutrient loading than temperate lakes. Nutrient containment must be more strongly oriented toward nitrogen, the most probable limiting nutrient in tropical lakes, than has been the case at temperate latitudes. However, phosphorus control is also important. Nitrogen management may be more feasible in the tropics because of high temperature, which is one of the critical conditions for efficient denitrification. Planktonic and benthic communities of the tropics bear a close resemblance, both in composition and diversity, to those of temperate latitudes; there is no parallel to the latitudinal gradient in biodiversity that is characteristic of terrestrial ecosystems. Foci of biodiversity, which require special attention, include the endemic species of ancient lakes and the diverse fish communities of very large rivers. The latter are an especially valuable untapped economic resource, but face severe impairment due to hydrological regulation and pollution of rivers. Effective management programs for tropical lakes will focus on interception of nutrients, protection of aquatic habitats from invasive species, and minimization of hydrological changes in rivers to which lakes are connected. In the absence of protective management, tropical lakes will decline greatly in their utility for water supply, production of commercially useful species, and recreation.
Influence of sewage from different water treatment plants in the Cracow Region (Poland) on early developmental stages of water snails
Authors: Wagner Aleksandra
Published: March 2003

The cocoons of the great pond snail, Lymnaea stagnalis (L.), and the great ramshorn, Planorbarius corneus (L.) were exposed to mechanically and biologically treated sewage from different water treatment plants in the region of Cracow (southern Poland). The control group consisted of snails from the same cocoon as the experimental snails. Mineral water and pond water from Zabierzów Bochenski (near Cracow) were used for the control groups. We found that mechanically treated sewage from the Plaszów sewage treatment plant was highly toxic (100% embryo lethality). The toxicity was reduced after mixing sewage with the control water (25% solution). However, in this group, the development of embryos was slower than in the control. No toxicity was observed in the biologically treated sewage from the same plant. The sewage from the Myslenice plant (mechanical treatment) was also very toxic (100% lethality), but this toxicity disappeared after keeping the sample at room temperature for 1 year. Water from the Vistula River was not toxic.
Zinc, lead and cadmium speciation in Dnieper water‐bodies
Authors: Linnik Peter M.
Published: March 2003

Data on the concentrations and movements of Zn, Pb and Cd in Dnieper reservoirs and the Dnieper‐Bug estuary are considered. There is a clear trend of increasing concentrations, often two‐ to fourfold, of these materials from the 1960s to the end of the 1980s. Large increases may be explained as the result of increased human impact on the water‐bodies and also because of reduced water discharge in the Dnieper River (discharge has been reduced by nearly 10 km3 in recent years). At present, the average concentrations of Zn, Pb and Cd in Dnieper water‐bodies are 35.0–50.0, 15.0–18.0 and 0.5–1.8 μg L–1, respectively. Anodic stripping voltammetry, membrane filtration, ion‐exchange and gel permeation chromatography on neutral sephadexes were methods used for analysis. The influence of adsorption and complexation processes on the mobility of Zn, Pb and Cd, and the ratio of their forms were compared. Ratios of free metal ions to ions bound in complexes with natural organic ligands were studied. The binding of metals in complexes with dissolved organic matter (DOM), or their adsorption onto suspended particles, were major processes reducing the concentration of free ions in their most toxic form. The percentage of Zn, Pb, and Cd free ions in the total balance of dissolved forms was no more than 3.6–4.8, 0.2–0.6 and 7.2–9.5%, respectively. The molecular‐weight distribution of organic metal complexes and their chemical nature, as well as the potential for complexing of DOM were investigated. Most Zn, Pb and Cd was found as complex compounds with DOM of different chemical natures and molecular weights. Humic substances, particularly fulvic acids, played a major role in the migration of the metals. These ligands bind from 40 to 80% of metals in the composition of organic complexes. Metal complex compounds of relatively low molecular weight (< 5000 Da) predominated in organic complexes of Zn (38–50%), Pb (38–52%) and Cd (22–47%). The role of inorganic ligands in complexation in surface waters was less important.
Chemical and biological features of a high altitude lake in the southern Alps (Laghetto Inferiore, Switzerland)
Authors: Barbieri Alberto , Mosello Rosario , Simona Marco
Published: March 2003

Since 1980, surveys have been performed nearly every three years on approximately 50 small high altitude alpine lakes located in the Swiss part of the Lake Maggiore watershed. On the basis of this information, since 1996 Laghetto Inferiore has been included in the Mountain Lakes Research (MOLAR) project, an extensive European cooperative research project with 23 partners. Laghetto Inferiore is located at 2074 m a.s.l.; its watershed is mainly composed of crystalline silicic rocks; it has a maximum depth of 33 m, and a theoretical renewal time of 41 days. The pH of the water is approximately 5.6; the alkalinity of the surface water is approximately 30 μmol and that of the bottom water approximately 60 μmol. Chemical studies were performed on the inputs from atmospheric deposition and the main tributary streams, the lake concentration (on a monthly basis), and the outflow. The results show that the characteristics of summer deposition (rain) differ significantly from those of winter deposition (snow). By means of a budget model it was possible to distinguish between the contribution from atmospheric deposition and the contribution from weathering. Biological studies revealed a considerable variety of phytoplankton species and a scarcity of zooplankton species. The vertical distribution of the main algal species shows a marked vertical stratification, with biomass concentrations higher in the profundal. Along this profile, the species of the same taxonomic class tend to gather in a particular depth band, while the single classes tend to be distributed at different depths, according to their specific light requirements.
Management issues in the Lake Victoria watershed
Authors: Ntiba M. J. , Kudoja W. M. , Mukasa C. T.
Published: March 2003

Lake Victoria is the largest lake in Africa (68 800 km2) and is the eighth largest lake in the world by volume. The three East African countries of Tanzania, Uganda and Kenya share Lake Victoria and its resources. The total annual catch of fish from the lake ranges between 400 × 106 kg and 500 × 106 kg, bringing these riparian countries a combined annual income of approximately US$250 000–500 000 from exports alone. Approximately 30 million people live in the riparian region and the catchment, with about 2 million of these depending directly or indirectly on fishing activities. Tragically, Lake Victoria’s extremely diverse fauna was decimated in only 30 years following the introduction of non‐native Nile perch in the early 1960s. An estimated 200 endemic cichlid species became extinct. Dramatic increases in overfishing, pollution from various sources, effects of noxious water weeds and other associated problems threaten the sustainability of the lake’s resources and the economies of the riparian governments and peoples. Regulations governing Lake Victoria’s resources are different in each country. The laws concerning treatment of effluents from point sources in the three countries are not harmonized, neither are implementation or enforcement provisions. The governments of Kenya, Uganda and Tanzania have begun to put in place regional mechanisms to address the lake’s many problems including the creation of a permanent regional international institution through the establishment of the Lake Victoria Fisheries Organization (LVFO). A strategic vision document and action plans have been developed. Efforts are being made at local, national and regional levels to control the water hyacinth, including manual pulling, mechanical harvesting and introduction of weevils that weaken hyacinth root systems. To address the problem of overfishing, fishermen committees at landing beaches have been put in place. Each country has committed to take all necessary measures including legislation to implement the decisions of the LVFO governing bodies. All three countries have agreed to adopt and enforce legislation and regulations prohibiting the introduction of non‐indigenous species to the lake and to enforce existing regulations regarding fisheries. A Global Environment Facility project which provides funding to the Lake Victoria Fisheries Organization addresses land use management, catchment forestation, fisheries research and management, water hyacinth control, industrial effluent treatment and municipal waste treatment.