bluuebunny/crossref_metadata_2025_split huggingface dataset:
The management of acute abdominal pain in children
Authors: SIMPSON ET , SMITH A 
Published: March 2008

Abstract Objective: Acute abdominal pain is a common problem in childhood, and appendicitis is frequently diagnosed by general practitioners and doctors working in emergency departments. The objective of the present report was to determine the frequency of appendicitis in a group of children with acute abdominal pain presenting to the emergency department of a general hospital, as well as attempting to analyse the manner in which these patients were managed. Methodology: The initial assessment in hospital (by resident hospital staff) of the study group of patients was analysed and their subsequent clinical progress documented. Results: The present report shows that the vast majority of children with acute abdominal pain do not have appendicitis and that appendicitis is significantly over‐diagnosed by junior hospital doctors. Conclusions: Appendicitis is a clinical diagnosis, best made by an experienced member of the paediatric surgical team. Frequent review, with a minimum of investigations, provides the best means of making a rational decision regarding surgery.
Gender differences in adolescent weight and shape‐related beliefs and behaviours
Authors: NOWAK M , SPEARE R , CRAWFORD D 
Published: March 2008

Abstract Objective: To describe the beliefs, attitudes and behaviours of North Queensland adolescents about weight, weight loss and body shape, and to examine the influence of gender. Methodology: A questionnaire was used to survey 791 year 8 adolescents from private schools in north Queensland. Results: Only 41% of the girls and 54% of the boys were satisfied with their weight; 52% of the girls and 27% of the boys wanted to lose weight, 52% of the girls thought their thighs were too fat and 26% of the boys thought their stomachs were too fat. When surveyed, 35% of the girls and 22% of the boys were trying to lose weight. Conclusions: The weight loss drive, so prevalent in our culture, is already apparent among 12‐14 year old schoolchildren. The challenge is to prevent obesity without encouraging an accompanying obsession with weight loss; however, good information, appropriately delivered, may be insufficient without a change in cultural expectations and assistance from the fashion and advertising industries.
Late‐onset infections of infants in neonatal units
Authors: ISAACS D , BARFIELD C , CLOTHIER T , DARLOW B , DIPLOCK R , EHRLICH J , GRIMWOOD K , HUMPHREY I , JEFFERY H , KOHAN R , McNEIL R , McPHEE A , MINUTILLO C , MOREY F , TUDEHOPE D , WONG M 
Published: March 2008

Abstract Objective: To examine regional variations in the incidence of late‐onset neonatal infections in Australian and New Zealand neonatal units. Methodology: A longitudinal, prospective surveillance study of systemic sepsis (septicaemia or meningitis) in 11 neonatal units: 10 in the Australian States of the Northern Territory, New South Wales, Queensland, Victoria and Western Australia, and 1 in Christchurch, New Zealand. The results are reported of late‐onset neonatal infection (defined as sepsis after 48 h) for the second year of prospective surveillance, data being collected from 1 October 1992 to 30 September 1993. Results: Data were available on 24 535 live births in Australia, representing approximately 10% of all live births in the country. There were 320 episodes of sepsis in Australian units affecting 294 babies. One hundred of these episodes (31%) were earty‐onset; 3.0% of babies admitted to six tertiary care neonatal units attached to maternity hospitals developed late sepsis, and this rate did not differ between units. The proportion of babies infected was inversely related to birthweight: 22.6% of babies under 1000 g, but 0.6% over 2000 g. Coagulase negative staphylococci were the commonest cause of late‐onset sepsis. There were 26 episodes of S. aureus septicaemia, of which only one was due to MRSA. Meningitis occurred in 13 babies (5.9%) with late‐onset sepsis. The mortality from late‐onset sepsis was 7.7%. Conclusions: Coagulase‐negative staphylococci are the commonest cause of late‐onset sepsis of babies in neonatal units. There were no major regional differences in the incidence of, or the organisms causing, late sepsis.
Childhood asthma complicated by anxiety: An application of cognitive behavioural therapy
Authors: PARK SJ , SAWYER SM , GLAUN DE 
Published: March 2008

Abstract Objective: To identify characteristics within the patient and the environment that might be instrumental in triggering and maintaining an episode of asthma in children whose objective lung function tests suggested a less severe exacerbation than the subjective report and behaviour indicated, and also to investigate the efficacy of a cognitive behavioural intervention, using the paradigm of a panic anxiety disorder. Methodology: A retrospective investigation of 23 case records and psychosocial histories, focusing on the characteristics of the sample and the number of presentations and admissions before and after the intervention, which is described. Results: Children aged 10‐12 years predominated. A precipitating event triggered a fear that their condition had deteriorated in the context of a growing understanding that asthma in a child could be fatal. A reduction in presentations and admissions post‐intervention is shown. Conclusions: The paradigm of panic disorder is useful to understand the sudden onset of apparent deterioration in the severity of asthma when objective lung function tests do not support the subjective experience.
Congenital dyserythropoietic anaemia: Report of three cases
Authors: ARIFFIN WA , KARNANEEDI S , CHOO KE , NORMAH J 
Published: March 2008

ABSTRACTBetween January 1985 and June 1992, the Paediatric Department of Hospital Universiti Sains Malaysia has diagnosed congenital dyserythropoietic anaemia in three children, two of whom were siblings. The age of onset ranged from 1 to 3 years. All of them became transfusion‐dependent before the age of 4 months. One of them was successfully treated with bone marrow transplantation.
Computer administration of a school‐based adolescent health survey
Authors: HIBBERT ME , HAMILL C , ROSIER M , CAUST J , PATTON G , BOWES G 
Published: March 2008

Objective: To examine the utility of notebook computers in the collection of data in large scale surveys. Methodology: A notebook computer administered survey of health in adolescents was conducted in 1992 using a multi‐instrument questionnaire. Students in school years 7,9 and 11 in private and government schools in Melbourne and rural Victoria participated. Results: Parental consent was obtained with an 83% response rate. Each student answered questions directly onto the computer taking an average of 68 min to complete the highly branched confidential but not anonymous questionnaire. Students were presented with on average 33% of the 897 possible questions. Over 90% of students reported enjoying using the computer. Those who reported answering the questions honestly all the time ranged from 68 to 85%, increasing with grade level. Conclusions: The use of computers in survey research provides many advantages in data collection including exposure only to relevant questions and the opportunity of asking sensitive questions.
Antibodies to diphtheria, tetanus and pertussis in infants before and after immunization with DTP (Triple Antigen) vaccine
Authors: STEWART TA , NOLAN TM , HOGG G , McEWEN J 
Published: March 2008

Objective: To determine antibody levels to the Australian manufactured combined diphtheria, tetanus and pertussis (DTP) vaccine (Triple Antigen, CSL Ltd) in infante before and after their primary immunization course. Methodology: Serosurvey (antibody prevalence study) in two groups: infants aged 5‐9 weeks who had not received any immunizations (n= 25), and infants aged 7‐10 months who had received two (n= 25) or three immunizations (n= 57) with DTP, sampled from infants attending the Royal Children's Hospital, Melbourne, either as inpatients or outpatients between February and April 1993. The immunization history for each infant was determined from hospital records, the parent‐held child health record, or the local council or family doctor who immunized the infant. Results: Enzyme immunoassay (EIA) of antibodies to diphtheria and tetanus showed all infants to have adequate protective levels after two or three vaccinations (£0.01 IU/mL). All subjects who had received all three DTP vaccinations had detectable antibody to at least one pertussis antigen. Antibodies to the pertussis antigens filamentous haemagglutinin and pertussigen (pertussis toxin) were comparable to levels determined for whole cell pertussis vaccines used elsewhere in the world. EIA‐determined antibodies to pertussis agglutinogen type 2 and agglutinogen type 3 showed substantially higher geometric mean titres when results for pre‐immunization and post‐immunization subjects were compared. Conclusions: These data show that the Australian manufactured DTP vaccine has immunogenic properties similar to those of vaccines used elsewhere, and that antibody concentrations following immunization are at levels consistent with efficacy.
The high morbidity associated with a measles outbreak in a West Australian town
Authors: JEREMIJENKO AM , KELLY H , PATEL M 
Published: March 2008

Objective: To determine the effectiveness of the measles vaccine and to record the morbidity during a measles outbreak. Methodology: A retrospective cohort study was carried out. It was a community‐based study in Bunbury. Western Australia, between February and May 1994, of 53 cases of measles and their household contacts. Results: Of the 53 cases of measles, 24 were from one high school. Only two cases occurred in the high school class that had received the National Health and Medical Research Council of Australia recommended measles, mumps and rubella (MMR) booster 12 months earlier. Neither had been vaccinated. Vaccine effectiveness was 91% (95% confidence interval 67‐97%). Ten cases had complications of measles and a further five were admitted to hospital. Doctors prescribed antibiotics to 29 cases and metoclopramide to five cases. One month elapsed between the day the index case became ill and the first notification to the community health centre. Conclusions: The low herd immunity that led to this high school outbreak can be attributed to low vaccine coverage. There was a significant morbidity associated with this outbreak that may have been averted if earlier notification had occurred. The MMR booster dose should be offered to all 10‐16 year olds to prevent high school outbreaks.
Use of an occupational therapy motor performance checklist by a school health service: A pilot study
Authors: GWYNNE K , BLICK B , HUGHES L 
Published: March 2008

Objective: The aim of this pilot study was to assess whether the School Health Service could play a role in identifying the children in most need of community occupational therapy services. Methodology: A two‐tiered referral system, which incorporated a Motor Performance Checklist (MPC) devised by the authors, was used. This checklist consisted of 12 gross and fine motor items and was administered to 123 children in their first year of school. Comparison was made between parent/teacher referrals alone and the two‐tiered referral system as measured against a ‘gold standard’ test (the Bruininks‐Oseretsky Test of Motor Proficiency) in a smaller subgroup. Results: Results indicated that the two‐tiered referral system incorporating the MPC had a sensitivity of 75% and specificity of 95% while the teacher/parent referrals had a sensitivity of 88% but a low specificity of only 41%. There was no significant difference in sensitivity (z= 0, P < 0.05) but a highly significant difference in specificity (z= 3.56, P > 0.005) between these two systems. Conclusions: This two‐tiered referral system has the potential to impact significantly on paediatric occupational therapy utilization, service delivery and waiting times in the community health setting.
Patterns of disease among children: A simple and versatile measure of child health in communities
Authors: DUGDALE AE 
Published: March 2008

Objective: To derive an indicator of community child health that is simple, stable, cost‐effective and suitable for small communities. Methodology: Discharge diagnoses of children have been tabulated for hospitals in Australia and other countries and from an Aboriginal community, for up to 40 years. The differences in ratios between main diagnostic groups relate to the child health status in the community. Results: As we pass from ‘developing’ to ‘developed’ conditions, the proportion of different diagnoses changes with a relative decrease in gastroenteritis and a relative increase in respiratory and other diseases. These changes parallel changes in infant mortality rates and child growth that are independent indicators of community child health. Conclusions: The ratios of diagnoses of hospital discharges, the ‘disease pyramid’ is a reliable, valid and cost‐effective way of measuring child health in a community while avoiding many of the uncertainties of conventional disease‐specific and age‐specific discharge rate statistics.
Low‐dose inhaled nitric oxide for neonates with pulmonary hypertension
Authors: TANG SF , MILLER OI 
Published: March 2008

Objective: Inhaled nitric oxide (iNO) has been shown to cause selective pulmonary vasodilatation and improve ventilation‐perfusion matching and may be an important therapeutic option for the treatment of persistent pulmonary hypertension of the newborn (PPHN). We report our experience on the use of iNO in neonates with severe PPHN. Methodology: Inhaled NO was administered to 10 infants with PPHN and persistent hypoxaemia (meconium aspiration syndrome, n= 9; pneumonia, n= 1) after failure of conventional therapy to improve oxygenation. With the exception of one infant, iNO was commenced at 10 ppm. Results: After 30 min exposure to iNO, the arterial oxygen tension (PaO2) rose from a median of 49 mmHg (6.5 kPa) [range 12‐82 mmHg (1.6‐10.9 kPa)] to 75 mmHg (10 kPa) [range 17‐450 mmHg (2.3‐60 kPa)] (P= 0.005), while the median oxygenation index fell (pre‐iNO of 37 vs post‐iNO 20) (P= 0.005) and median systemic arterial pressure rose (pre‐iNO 46.5 mmHg (6.2 kPa) [range 32‐63 mmHg (4.3 to 8.4 kPa vs post‐iNO 54.5 mmHg (7.3 kPa) [range 36‐74 kPa]) P= 0.005). All infants subsequently continued to receive iNO with the duration of exposure to iNO ranging from 12 to 168 h (median duration 100 h). Three infants died despite showing an initial beneficial response to iNO. The mean duration of intubation for survivors was 11.9 ± 2.6 days. Methaemoglobinaemia and toxic levels of nitrogen dioxide were not seen during iNO administration. Of the seven survivors, 12 month follow up in two infants and 4 month follow up in four infants showed age‐appropriate neurodevelopmental skills, with one infant having very mild hearing loss. Conclusions: Inhaled NO reduces the oxygenation index by improving the PaO2 and decreasing ventilation pressures, and appears to be clinically useful in severely hypoxaemic infants with PPHN refractory to conventional treatment.
Stress responses in preterm neonates after normal and at‐risk pregnancies
Authors: VAN REEMPTS PJ , WOUTERS A , DE COCK W , VAN ACKER KJ 
Published: March 2008

Objective: To evaluate the autonomic response in preterm neonates born after an at‐risk pregnancy. Methodology: Twenty‐one preterm neonates (gestational age; GA) 29‐37 weeks; bodyweight (BW): 720‐2113 g; postnatal age: 2‐126 days), born after at‐risk pregnancies (stressed (STR) group), were compared to 30 preterm neonates (GA: 26‐36 weeks; BW: 813‐2380 g; postnatal age: 2‐86 days) without any intrauterine risk factor (C group). A 10s pain stimulus was given on the forefoot and heart rate, respiratory rate and blood pressure were measured at 15 and 30 s, at 1, 2, 3, 4 and 5 min. After 10 s ocular compression six cardiac variables were recorded. Results: After the pain stimulus the STR‐group had a significant increase of heart rate at 15 s and an increase of diastolic blood pressure at 30 s. In the C group a significant increase of heart rate at 15 s was recorded. For the respiratory rate both groups showed an initial depression (significant at 15 s in the C group) followed by an increase. The time to react to the ocular compression was significantly shorter in the STR‐group than in the C‐group and thus more parasympathetic. Conclusions: We hypothesize that the different sympathetic and parasympathetic reaction patterns of the vital parameters to triggers in the STR‐group are due to chronic stress, pointing to an altered maturation of the two components of the autonomic nervous system after chronic intrauterine stress (CIUSTR).
Chest radiograph abnormalities in very low birthweight survivors of chronic neonatal lung disease
Authors: FITZGERALD DA , ASPEREN PP VAN , LAM AH , SILVA M DE , HENDERSON‐SMART DJ 
Published: March 2008

Objective: To determine whether the neonatal chest radiograph (CXR) at 28 days in very low birthweight (VLBW) infants who develop chronic neonatal lung disease (CNLD) predicts oxygen therapy duration or CXR abnormalities in early childhood. Also, to assess the inter‐observer reliability of the radiologists scoring the CXR. Methodology: Clinically well survivors of CNLD (n= 46) had neonatal CXR scored (mean age 28.5 days) and compared with current CXR (mean age 40 months). The CXR were scored independently and ‘blindly’ by two paediatric radiologists using a standardized scoring system (range 0‐10). Results: There was no correlation between neonatal CXR scores and current CXR scores for either radiologist. There was no association between CXR severity scores and duration of oxygen therapy for either neonatal or current CXR. Radiologist A scored the current CXR significantly more abnormal than radiologist B [medians (range): 3 (1‐6) vs 1 (0‐5), P <0.001] with reasonable correlation (r= 0.593, P <0.005) but worse than chance agreement (kappa = ‐ 0.034). The median scores for the neonatal CXR were similar [1.5 (0‐8) vs 2 (0‐8), P= 0.789] and again there was good correlation (r= 0.760, P <0.0005) although poor individual agreement (kappa = 0.243) between radiologists. Conclusions: Follow‐up CXR abnormalities in VLBW infants with CNLD are usually minor and are not predictive of the duration of oxygen therapy that will be required nor of the CXR appearance in early childhood. Considerable inter‐observer variation exists in the interpretation of the CXR in CNLD.
Measuring health outcome in paediatrics: Development of the RAHC measure of function
Authors: DOSSETOR DR , LIDDLE JLM , MELLIS CM 
Published: March 2008

Objective: To develop a generic measure of health outcome (the RAHC Measure of Function) for paediatric health services. Methodology: The RAHC Measure of Function (MOF) was modified from the Child Global Assessment Scale. The utility and reliability of the MOF was then tested by inter‐clinician agreement on case scenarios, by inter‐clinician agreement in outpatients, by parent‐clinician agreement in outpatients and by responsiveness to change in acute admissions. Results: The inter‐clinician agreement on MOF ratings for case scenarios was moderately good, with an overall kappa of 0.42; P <0.0001. Clinicians at respiratory and child psychiatry clinics nominated the same or adjacent MOF category to describe 100% (95% Cl: 71.5‐100) and 90% (95% Cl: 68.3‐98.8%) of 11 and 20 cases assessed, respectively. Parents nominated the same or adjacent MOF category as the attending clinician for 89.7% (95% Cl: 72.7‐97.8) and 82.9% (95% Cl: 67.9‐92.9) of 29 and 41 children in the same two clinics. Twenty‐eight inpatient children had an MOF assessed on admission and discharge, and the median MOF score improved from 50.5 to 79 points (z= 4.53; P <0.0001). Conclusions: The MOF is easy to use and provides a valuable description of health outcome that parents are able to understand. The MOF is moderately reliable, is likely to be sufficiently reliable to compare groups of paediatric patients and is responsive to change.
Pre‐admission management of acute gastroenteritis
Authors: ELLIOTT EJ , BACKHOUSE JA , LEACH JW 
Published: March 2008

Objective: Acute gastroenteritis contributes to significant morbidity and need for hospital admission. The current literature suggests outpatient management is often inappropriate. This study examines the pre‐admission management of children admitted with acute gastroenteritis to a major children's hospital.Methodology: Information was obtained from parental questionnaires and the medical notes for 164 children.Results: Parents were poorly informed regarding appropriate home management Over 70% sought professional advice prior to admission, usually from their general practitioner. Although 58% received advice on fluid therapy, an oral rehydration solution was recommended for only 32%. and only 9% actually used one before admission. Advice regarding fluid requirements was usually inadequate. Inappropriate medications were prescribed for 22% of children, including antibiotics (15.4%). antidiarrhoeals (1.2%) and anti‐emetics (5.5%). Hospitalized children were generally well nourished with minimal dehydration and electrolyte disturbance.Conclusions: Oral rehydration therapy is utilized rarely and medications are over‐utilized in home management of gastroenteritis. Education of parents, general practitioners and hospital doctors is essential to optimize outpatient management The impact of optimal outpatient management on hospital admission rates and morbidity requires formal assessment.
Predictive value of the Griffiths assessment in extremely low birthweight infants
Authors: BOWEN JR , GIBSON FL , LESLIE Gl , ARNOLD JD , MA PJ , STARTE DR 
Published: March 2008

Objective: To assess the relationship between the Griffiths Mental Development Scales at 1 and 3 years and the Stanford‐Binet Intelligence Scale (S‐B) and Beery Test of Visual‐Motor Integration (VMI) at 5 years in extremely low birthweight (ELBW) children. Methodology: Prospective study of 45 ELBW infants, without severe neurosensory impairment, cared for in a single Level III neonatal intensive care unit. Results: At 5 years, 36 (80%) children were of average intelligence, 8 (18%) had borderline intelligence and one was mentally retarded. The Griffiths general quotient (GQ) at 1 year had a weak correlation with the S year IQ (corr. coeff. = 0.47), with only 17% of children with a GQ< — 1 s.d. at 1 year receiving an IQ< — 1s.d. at 5 years. In contrast, the Griffiths GQ at 3 years correlated strongly with 5 year IQ (corr. coeff. = 0.78). Among those children with a 3 year GQ< — 1s.d., 67% had a 5 year IQ< — 1 s.d. and all had a 5 year IQ<89. The 3 year hearing and speech subscale correlated strongly with the 5 year S‐B verbal comprehension factor (corr. coeff = 0.753) and the 3 year combined eye/hand co‐ordination/performance quotient had a moderate correlation with the S‐B non‐verbal reasoning factor (corr coeff = 0.597) and with the Beery VMI (corr coeff = 0.49). Conclusions: The 3 year Griffiths GQ is a good predictor of 5 year S‐B IQ in ELBW children and can be used to identify children who may benefit from intervention prior to school entry.