bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of implementation of Integrated Management of Childhood Illness on improvement of health system in China
Authors: Zhang Yanfeng , Dai Yaohua , Zhang Shuaiming 
Published: September 2007

Aim:  To explore the impact of implementation of the Integrated Management of Childhood Illness (IMCI) strategy on the Chinese health system.Methods:  Pre‐ and post‐intervention field surveys, based on the adapted World Health Organization protocol of health facility surveys and follow‐up assessment tools, respectively. Three hundred and forty‐five health facilities were investigated pre intervention and 74 health facilities post intervention. Observation of case management of health workers, interviews with mothers and systematic checking of equipment and drug supplies were conducted in both pre‐ and post‐intervention surveys.Results:  There were significant improvements demonstrated with implementation of the IMCI strategy in terms of rational use of drugs, provision of basic equipment and drug supplies of both township and village facilities. The inappropriate use of drugs significantly decreased: injection/IV (from 43.6% to 2.7%), antibiotics (from 59.3% to 6.2%) and hormones (from 4.9% to 0). The availability of basic equipment and supplies of health facilities was improved greatly: children’s scales (from 27.8% to 90.5%), timing devices (from 89.3% to 97.3%) and utilities for mixing oral rehydration salts (ORS) (from 36.5% to 100.0%). The supply of all recommended drugs increased, with ORS, vitamin A/D, iron, tetracycline eye ointment, vitamin B complex and diazepam increased greatly.Conclusions:  The IMCI strategy has been shown to contribute to the improvement of the health system, promoting the efficient management of medical care at township and village level, as well as improving the relationship between doctors and patients.
Unintentional paediatric ingestions of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists
Authors: Balit Corrine R , Gilmore Simon P , Isbister Geoffrey K 
Published: September 2007

Aims:  There is limited information on safety of angiotensin coverting enzyme (ACE) inhibitors and angiotensin II (AII) receptor antagonists in unintentional paediatric ingestions. This study was conducted with the aim of developing referral guidelines for poison information centres.Methods:  Calls to the NSW poison information centre from January 2002 to July 2004 regarding paediatric ingestion of ACE inhibitors and AII receptor antagonists were recruited and prospectively followed up. Information collected included: demographics (age, gender, weight), type of exposure (unintentional, therapeutic error), ingested dose and clinical effects. Dose was reported in defined daily doses (DDD) to compare across and within the two drug classes with respect to the normal adult dose.Results:  Nineteen cases of paediatric ingestion of ACE inhibitors and AII receptor antagonists were included. The median age was 2 years (Interquartile range (IQR): 20–33 months) and the median dose ingested was 1 DDD (IQR: 1–2). There were nine ACE inhibitor ingestions and 10 AII receptor antagonist ingestions. One of nine children (11%) observed in hospital developed transient hypotension but required no treatment and recovered without complication. This child ingested an ACE inhibitor and ingested >3 DDD.Conclusion:  Unintentional paediatric ingestions of ACE inhibitors and AII receptor antagonists resulted in the majority of children remaining asymptomatic. ACE inhibitor ingestions under 2 DDD can be observed at home provided the child is asymptomatic and there is a responsible adult to observe the child. The dose required for observation in AII receptor antagonist ingestions is less clear.
Parasitic infestation and nutritional status among schoolchildren in Vientiane, Lao PDR
Authors: Phathammavong Outavong , Moazzam Ali , Xaysomphoo Duangphachan , Phengsavanh Alongkone , Kuroiwa Chushi 
Published: September 2007

Aims:  To investigate the prevalence of intestinal parasitic infestation among school‐aged children residing in Vientiane capital city; and to assess the impact of its infestation on nutrition status of those children.Methods:  The school‐based cross‐sectional study was conducted from December 2005 to February 2006. The systemic random samplings were employed to select schools and schoolchildren. Five hundred and thirty‐six schoolchildren (350 high‐school children and 186 parents of elementary‐school children) were completely interviewed by semistructured questionnaire and performed anthropometric measurement. The direct faecal smear was employed to analyse 299 (55.8%) stool samples. The spss version 12.01 and Epi Info version 6.0 were used for data analysisResults:  The overall prevalence of parasitic infestation was 38.1%, with 18.1% of Opisthorchis viverrini and 14.7% of Ascaris lumbricoides. The prevalences of stunting and underweight were 20.2% and 20.0%, respectively. The prevalences of stunting (OR = 3.28; P < 0.01) and underweight (OR = 2.69; P < 0.05) were higher among high‐school children who were infested by intestinal parasites.Conclusion:  Approximately one‐third of schoolchildren in Vientiane capital city were infested by intestinal parasites. The persistent parasitic infestation seemed to be associated with growth rate pattern among those children. School‐based parasite control programme and health promotion are needed to eliminate this major public health problem in Lao People Democratic Republic.
Health needs of Australian children living in out‐of‐home care
Authors: Nathanson Dania , Tzioumi Dimitra 
Published: September 2007

Background:  Children living in out‐of‐home care have high and frequently unidentified health needs. The Child Protection Unit at Sydney Children’s Hospital offers comprehensive health screening to children in care.Aims:  To report the experience of the health screening clinic and the rates of identified health problems of children in care in this sample, and to compare these rates with the general child population and children in care overseas.Methods:  Comprehensive multidisciplinary health screens were offered to children in out‐of‐home care.Results:  High rates of physical, developmental and emotional health problems were identified. The rates of poor health were greater than the average child population of New South Wales, but similar to the rates of poor health reported in children in care overseas.Conclusions:  Children in care are a vulnerable group of the child population who experience unacceptable levels of poor health. Comprehensive health screens can help identify previously undetected health problems.
Acute treatment of paediatric migraine: A meta‐analysis of efficacy
Authors: Silver Shawna , Gano Dawn , Gerretsen Philip 
Published: September 2007

Aim:  To undertake a meta‐analysis of all randomised controlled trials (RCTs) on the acute pharmacologic treatment of children and adolescents with migraine headache.Methods:  In total, 139 abstracts of clinical trials specific to the acute treatment of paediatric migraine were appraised. Inclusion criteria required clinical trials to be randomised, blinded, placebo‐controlled studies with comparable endpoints. Non‐ English language publications were excluded. 11 clinical trials qualified for inclusion in the final meta‐analysis. Two endpoints were analysed: the proportion of patients with (1) headache relief, and (2) complete pain relief, 2 h post‐treatment.Results:  The following medications were included in the analysis: acetaminophen (n = 1), ibuprofen (n = 2), sumatriptan (n = 5), zolmitriptan (n = 1), rizatriptan (n = 2) and dihydroergotamine (n = 1). Results are expressed as a relative benefit (RB) conferred over placebo and the number needed to treat (NNT). Only ibuprofen and sumatriptan provided a statistically significant relative efficacy in comparison with placebo. Two hours post‐treatment, ibuprofen was associated with an RB 1.50 (95% CI 1.15–1.95) in the generation of headache relief (NNT 2.4) and RB 1.92 (95% CI 1.28–2.86) in the production of complete pain relief (NNT 4.9). Sumatriptan rendered an RB 1.26 (95% CI 1.13–1.41) in headache relief (NNT 7.4) and an RB 1.56 (95% CI 1.26–1.93) in the production of complete pain relief (NNT 6.9).Conclusion:  Despite the pharmacological options for the management of acute migraine, few RCTs in the paediatric population exist. Composite data demonstrate that only ibuprofen and sumatriptan are significantly more effective than placebo in the generation of headache relief in children and adolescents.
The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting
Authors: McGrath Kathleen H , Caldwell Patrina HY , Jones Michael P 
Published: September 2007

Aims:  To identify the prevalence of constipation in children with nocturnal enuresis presenting to a tertiary paediatric outpatient service and to assess parental and clinician recognition of constipation.Methods:  A prospective cross‐sectional study of children with nocturnal enuresis at presentation to a continence service. Data relating to the child’s bowel habits, pattern of enuresis and other history items were obtained from parental questionnaires and paediatrician assessments. Presence and severity of constipation was assessed independently by parents and clinicians. Kappa was used to compare agreement between parental reporting and clinician assessment of constipation.Results:  Of the 277 participants aged 4.8–17.5 years (median 8.6 years), 36.1% (n = 95) were identified as constipated by the clinician‐based scoring method (‘Constipation Score’) compared with 14.1% from parental reporting (Kappa = 0.155, P = 0.003). Despite the poor overall recognition of constipation by parents, parental and clinician assessment of frequency of bowel motions (Kappa = 0.804) and soiling (Kappa = 0.384) were similar. Major factors influencing parental reporting of constipation were frequency of bowel motions and soiling with less emphasis on straining and stool consistency.Conclusions:  Prevalence of constipation was high among children with nocturnal enuresis as assessed by clinicians despite poor identification by parents. This may limit optimal diagnosis and management.
Maternal psychosocial aspects in hypernatremic dehydration with high sodium concentrations in breast milk: A case–control study
Authors: Ozbek Aylin , Kumral Abdullah , Guvenir Taner , Tas Fatma Varol , Gencer Ozlem , Duman Nuray , Ozkan Hasan 
Published: September 2007

Objective:  To investigate whether mothers, with no known biological reason to account for elevated breast milk sodium (BMS) and associated hypernatremic dehydration (HND) in their exclusively breastfed infants, have more adverse psychosocial characteristics compared with controls.Methods:  Design is prospective case–control. Mothers of 21 term infants diagnosed as HND with associated high BMS and mothers of 43 healthy, exclusively breastfed term infants, with expected milk sodium levels, were compared on rates of socio‐demographic and relationship variables, pregnancy wantedness and planning, maternal attitudes towards breastfeeding, postnatal maternal depression and anxiety. A semi‐structured interview, State and Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale were used.Results:  Reported maternal history of previous psychiatric morbidity (57.1% vs. 18.6%; P = 0.003), poor relationship with her own mother (36.8% vs. 9.6%; P = 0.026), not finding herself suitable to be a mother (28.6% vs. 4.6%; P = 0.012), unplanned pregnancy (52.4% vs. 20.9%; P = 0.020) and higher state anxiety scores (mean (SD) = 42.2 (11.1) vs. 35.5 (10.5); P = 0.038) in the post‐partum period were significantly common in mothers with elevated BMS levels compared with the controls. Univariate analyses revealed that unplanned pregnancy and maternal perception of not being suitable to be mother constitute significant risks with odds ratios 4.2 and 8.2, respectively.Conclusion:  The present study displays that mothers, with no known biological reason to account for elevated BMS, have more adverse psychosocial characteristics compared with controls; emphasising the importance of psychosocial and emotional factors during lactation and offering implications for the establishment of successful lactation through providing additional psychosocial support to vulnerable mothers.
Bronchiolitis obliterans in children: Clinical presentation, therapy and long‐term follow‐up
Authors: Chiu Chih‐Yung , Wong Kin‐Sun , Huang Yhu‐Chering , Lin Tzou‐Yien 
Published: September 2007

Aim:  To delineate the predisposing factors, clinical, radiological features and outcomes of bronchiolitis obliterans (BO) in children for minimising morbidity and mortality.Methods:  Ten children who had BO from July 1995 to July 2005 were retrospectively reviewed at a tertiary paediatric facility in northern Taiwan.Results:  Bronchiolitis obliterans complicated by infections, Stevens–Johnson syndrome was found in eight and two patients, respectively. In children with post‐infectious BO, adenoviruses were the most common etiologic agents (7/8). Among them, six patients needed intensive management and five patients needed mechanical ventilation. All patients presented persistent dyspneic respirations and wheezing since the initial lung infection. Initial focal atelectasis (n = 3) on chest radiographs progressed to atelectasis/lobar collapse (n = 8) when the diagnosis of BO was made. After adequate supportive management, atelectatic bronchiectasis was the most common complication (n = 5).Conclusion:  Severe adenovirus bronchiolitis and/or pneumonia appear to have higher risk of development of BO in children. In order to minimise associated complications of BO, meticulous respiratory care for preventing pulmonary collapse may be considered in such instances.
Lipoprotein(a) levels in girls with premature adrenarche
Authors: Andiran Nesibe , Yordam Nursen 
Published: September 2007

Aim:  Elevated lipoprotein(a) (Lp(a)) level is a risk factor for cardiovasculary disease (CVD). Women with polycystic ovary syndrome (PCOS) have higher Lp(a) and risk for CVD than controls. The girls with premature adrenarche (PA) were shown to share similar hormonal/metabolic properties with PCOS. We compared Lp(a) levels in PA, with healthy and PCOS girls.Methods:  In total, 25 PA, 20 controls and 10 girls with PCOS were evaluated. Lp(a), lipid profiles and insulin, glucose, free testosterone, dehydroepiandrosterone sulfate (DHEAS) and androstenedione levels were measured. A family history about CVD was obtained.Results:  The mean age of girls with PA, at time of the study, was 10.04 ± 1.53, control 9.83 ± 1.58 and PCOS was 16.58 ± 1.46 years. The median (range) of Lp(a) levels were 22.5 (3.50–99.90), 9.6 (3.33–32.40) and 21.2 (5.89–85.65) mg/dL in PA, control and PCOS groups, respectively (P > 0.05). The median Lp(a)’s were 14.5 (3.50–87.00) and 24.30 (6.20–99.90) mg/dL, in prepubertal (Tanner 1) and pubertal PA girls (Tanner 2–5), respectively (P > 0.05). The median Lp(a) of prepubertal peers was 8.7 (3.33–21.17), while that of pubertal ones was 15.4 (4.72–32.40) mg/dL (P > 0.05). There was no difference between Lp(a) levels of pre‐pubertal PA girls and their peers; however, significant difference was found in Lp(a) levels in pubertal stages of PA and healthy peers (P < 0.05). The positive family history of CVD was 60% in PA; 55% and 80% in the control and PCOS groups, respectively, with no statistical difference. Lp(a) level was correlated with DHEAS (r = 0.386, P = 0.008) and free testosterone (r = 0.337, P = 0.022) levels positively. There was no significant correlation between Lp(a) and body mass index, fasting insulin and fasting glucose/insulin ratio.Conclusions:  Lipoprotein(a) levels in pubertal girls with PA differ significantly from healthy peers. However, to clarify whether the girls with PA have an additional risk for CVD with respect to Lp(a), further follow‐up studies with larger number of patients are necessary.
Effect of single loading dose of intravenous caffeine infusion on superior mesenteric artery blood flow velocities in preterm infants
Authors: Soraisham Amuchou S , Elliott Davis , Amin Harish 
Published: September 2007

Aim:  To evaluate the effects of a single loading dose of caffeine base (10 mg/kg) on superior mesenteric artery (SMA) blood flow velocities (BFV).Methods:  Eighteen preterm infants of gestational age ≤32 weeks gestation were investigated prospectively. SMA BFV before infusion, 1 h, 2 h and 6 h after a single loading dose of caffeine were measured using Doppler ultrasonography.Results:  The peak systolic velocity in SMA decreased by 18% from baseline at 1 h after caffeine infusion and improved towards the baseline by 6 h after the infusion. The reduction in velocity after caffeine infusion was not statistically significant. No significant changes were observed in heart rate, blood pressure and incidence of necrotising enterocolitis.Conclusion:  A single 10 mg/kg intravenous loading dose of caffeine does not cause a significant reduction in SMA BFV and therefore does not place the preterm intestine at increased risk of ischemic injury.
Increased prevalence of constipation in pre‐school children is attributable to under‐consumption of plant foods: A community‐based study
Authors: Lee Warren TK , Ip Kin S , Chan June SH , Lui Noel WM , Young Betty WY 
Published: September 2007

Aim:  To evaluate consumption of foods rich in dietary fibre and its relation to the prevalence of constipation in pre‐school children.Methods:  In total, 368 children aged 3–5 years were randomly selected from kindergartens in Hong Kong. Constipation was confirmed by Rome‐criteria. Children with normal bowel habits served as non‐constipated controls. Consumption of vegetables, fruits, whole‐grain cereals and fluid were determined using a 3‐day food record.Results:  A total of 28.8% children were reported to have constipation. Median dietary fibre intake of constipated children was significantly lower than non‐constipated children (3.4 g/d (inter‐quartile range (IQR): 2.3–4.6 g/d) vs. 3.8 g/d (IQR: 2.7–4.9 g/d); P = 0.044) corresponding to 40% reference dietary fibre intake. Constipated children also had significantly lower intakes of vitamin C (P = 0.041), folate (P = 0.043) and magnesium (P = 0.002). Fruit intake and total plant foods intake were significantly lower in the constipated than non‐constipated children: (61 g/d (IQR: 23.8–115 g/d) vs. 78 g/d (IQR: 41.7–144.6 g/d); P = 0.047) and (142.5 g/d (IQR: 73.7–214.7 g/d) vs. 161.1 g/d (IQR: 98.3–233.3 g/d); P = 0.034), respectively. Total fluid intake did not differ between groups but milk intake among the constipated children was marginally higher than the non‐constipated children (P = 0.055)Conclusion:  Insufficient dietary fibre intake is common in Hong Kong pre‐school children. Constipated children had significantly lower intakes of dietary fibre and micronutrients including vitamin C, folate and magnesium than non‐constipated counterparts which was attributable to under‐consumption of plant foods. However, milk intake was marginally higher in the constipated children. More public education is necessary for parents to help develop healthy dietary habit and bowel habit in early life in order to prevent childhood constipation.
High volume‐low intensity exercise camp and glycemic control in diabetic children
Authors: Ruzic Lana , Sporis Goran , Matkovic Branka R 
Published: September 2007

Aim:  To evaluate the effects of the designed regime encompassing high volume‐low intensity physical activity programme on glycemic control in diabetic children, 20 subjects (age 12.81 ± 2.14) spent 2 weeks in a controlled environment of a summer camp.Methods:  An exercise physiologist and a kinesiology specialist programme and conducted the three exercise sessions a day. Total daily caloric intake was controlled and the blood glucose was monitored four times a day with special concern for hypoglycaemia episodes. Short and long‐term effects (HbA1c) of the summer camp were evaluated 10 days and 2 months following programme completion. The insulin dosage was not lowered at the beginning of the camp for everyone, but it was individually modified according to the blood glucose monitoring.Results:  Initial HbA1c was 8.28 ± 1.3% and decreased to 7.92 ± 1.42% measured 10 days after the camp (P = 0.023) while the number of children with the satisfactory HbA1c level lower than 7.5% doubled. HbA1c increased again 2 months following the camp. The average blood glucose concentrations decreased in the last days of the camp when compared with the first day in three out of four daily measurements (P < 0.05). There were only two clinically manifested hypoglycaemia episodes recorded.Conclusion:  With a low rate of hypoglycaemia crisis and better glycemic control the proposed programme was found to be satisfactory but the downside was that the duration of the effects was too short. With no participation in organised exercise programmes and with absence of controlled nutrition, the beneficial effects of the camp disappeared within 2 months after the camp.
Fulminant mitral regurgitation due to ruptured chordae tendinae in acute rheumatic fever
Authors: Anderson Yvonne , Wilson Nigel , Nicholson Ross , Finucane Kirsten 
Published: September 2007

Aims:  Description of the presentation and management of cases of fulminant mitral regurgitation in acute rheumatic fever (ARF).Methods:  Retrospective case series of 4 children, aged 6–10 years, presenting in acute pulmonary oedema because of rupture of elongation of the chordae tendinae of the mitral valve leading to flail leaflets and severe mitral regurgitation.Results:  Urgent cardiac surgery with mitral valve repair was performed. Resolution of heart failure was achieved in each case. The difficulties in diagnosis and management of this uncommon and often unrecognised presentation of ARF are discussed.Conclusions:  Cardiac surgery can be life saving for fulminant mitral regurgitation due to rupture of chordae tendinae of the mitral valve in ARF
High perinatal seroprevalence of cytomegalovirus in northern Taiwan
Authors: Chen Mei‐Huei , Chen Pau‐Chung , Jeng Suh‐Fang , Hsieh Chia‐Jung , Su Feng‐Chiao , Liao Hua‐Fang , Su Yi‐Ning , Lin Shio‐Jean , Hsieh Wu‐Shiun 
Published: September 2007

Aim:  The living style, health‐care system and socio‐economic environments have changed substantially in Taiwan over past 20 years. This study was aimed to estimate the current perinatal cytomegalovirus (CMV) seroprevalence in northern Taiwan.Methods:  In a Taiwan Birth Panel Study, 483 pairs of mothers and neonates were prospectively recruited from one tertiary medical center, one local hospital, and two obstetric clinics located in northern Taiwan from April 2004 through January 2005. Sera of their paired maternal and cord blood were tested by an enzyme‐linked immunosorbent assay method for CMV IgG and IgM antibodies. Additional data were collected for health measures and epidemiological characteristics through trained interviewers utilising structured questionnaires.Results:  Among 483 mothers studied, 93% were Taiwanese, 6.4% were immigrants from the south‐eastern Asia and Mainland China, and 0.6% was aborigines. The seropositive rate of CMV IgG and IgM among the mothers was 91.1% and 3.5%, respectively. The immigrant mothers and the mothers younger than 20 years of age had a higher IgM seroprevalence (P < 0.05). Furthermore, 90.8% of the offspring had CMV IgG seropositivity and yet none of the neonates were CMV IgM positive.Conclusion:  The seroprevalence of CMV among childbearing women is high in northern Taiwan. The immigrant mothers and the teenage mothers appear to have higher seropositivity of CMV IgM.