bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malnutrition, gastroenteritis and trypsinogen concentration in hospitalised Aboriginal children
Authors: BRIARS GL , THORNTON SJ , FORREST Y , EHRLICH J , SHEPHERD RW , CLEGHORN GJ 
Published: November 2003

Objective:To explore relationships between malnutrition and pancreatic damage in hospitalised aboriginal children.Methods:Immunoreactive trypsinogen (IRT) concentrations were measured in two populations of hospitalised aboriginal children in Australia: 472 children aged 0–3 years, in Alice Springs (Northern Territory); and 187 children aged 0–16 years in Mount Isa (Queensland). Correlation of whole blood IRT with height and weight z‐scores, four‐site skinfold thickness and upper arm circumference was sought.Results:In Mount Isa, the geometric mean IRT concentration rose with decreasing weight z‐score. The IRT concentration was otherwise unrelated to nutritional indices. Sixty percent of the 39 Mount Isa patients with gastroenteritis and 24.5% of the 358 Alice Springs patients with gastroenteritis had an IRT concentration in the upper quartile for their population, compared with 16% for patients with other diagnoses in both populations.Conclusions:A high IRT concentration in patients with low weight z‐scores is a confounding effect of gastroenteritis, and may result from subclinical pancreatic disease in gastroenteritis.
Overdose of ergometrine in the newborn infant: Acute symptomatology and long‐term outcome
Authors: DARGAVILLE PA , CAMPBELL NT 
Published: November 2003

Objective:To document the short‐ and long‐term effects of accidental administration of ergometrine in adult dosage to the newborn infant.Methods:The case records of all infants admitted to the Royal Children’s Hospital (RCH) since 1970 with a diagnosis of acute ergometrine overdose were reviewed, and details of the acute symptomatology, management, and the neurodevelopmental outcome at follow‐up were noted. Similar information was obtained, where available, from previous case reports, and from two major drug information services. Additionally, data relating to administration of uterotonic agents and vitamin K were collected from tertiary perinatal centres around Australia.Results:Seven cases of neonatal ergometrine overdose were identified at RCH. The major features of the acute toxicity syndrome were: encephalopathy (100% RCH cases, 79% combined cases); seizures (100%, 70%); peripheral vascular disturbances (100%, 83%); and oliguria (43%, 34%). Other important symptoms were hypoxaemia, hypertension and feed intolerance. 86% of RCH cases (72% overall) required ventilatory support. Virtually all symptoms resolved within 4 days, and 86% of RCH infants (86% all cases) were neurologically intact at the time of discharge. Long‐term neurodevelopmental outcome was normal in 100% of RCH infants (n=6). All the perinatal centres surveyed give vitamin K in the labour ward soon after delivery, and 7 of 18 (39%) reported using Syntometrine (ergometrine 0.5 mg, Syntocinon 5 IU) routinely during the third stage of labour. Thus the circumstances in which ergometrine overdose can occur still exist in many labour wards around the country.Conclusions:Despite the catastrophic initial presentation, the long‐term prognosis after neonatal ergometrine overdose appears to be favourable. To prevent further cases of this life‐threatening drug error, we recommend that administration of vitamin K be deferred until just prior to, or shortly after, transfer of the newborn infant to the postnatal ward.
The use of an interactive computer program for the education of parents of asthmatic children
Authors: FALL AJ , HENRY RL , HAZELL T 
Published: November 2003

Objective: To assess whether an interactive computer program improves the asthma knowledge of parents of asthmatic children attending a respiratory clinic, and to assess the acceptability of this educational method to parents.Methodology:Parents’ knowledge was assessed before and one month after using the computer program. Knowledge scores were compared using paired Student’s t‐tests. Parents’ comments about the program were invited.Results:Whilst knowledge scores improved after exposure to the computer program, the improvement was not statistically significant (P=0.06). However, parents felt subjectively that the program was both enjoyable and useful to them.Conclusion:Used as the sole instrument for asthma education, the program did not produce a large increase in asthma knowledge in the study population. It was, however, universally popular and may prove useful in other settings and in combination with other forms of asthma education.
Psychosocial aspects of adolescent cancer survival
Authors: BAULD C , ANDERSON V , ARNOLD J 
Published: November 2003

Objective:The purpose of this research was to examine the psychosocial status of adolescent cancer survivors and compare them with healthy peers. It has been suggested in previous research that the majority of survivors display equivalent levels of psychosocial functioning post‐treatment as compared with healthy controls. However, despite successful treatment, survivors may have to adjust to living with a chronic illness and its associated late effects interspersed across the lifespan (e.g. infertility, cognitive deficits, heart complications). Whilst young people appear to have similar levels of psychosocial functioning, avoidance strategies such as denial may result in previous research findings being confounded and in underestimating the true psychosocial status of survivors. It is important to understand the psychosocial status of survivors in order to optimise their quality of life.Methodology:Coping mechanisms, anxiety levels and self‐concepts of 32 adolescent cancer survivors, predominantly Acute Lymphoblastic Leukaemia (ALL) were compared with 34 healthy adolescents (age range 12–17 years), via a mailout.Results:Survivors’ self‐reports suggest no overt psychological dysfunctioning. Whilst the two groups shared similar coping strategies, survivors were found to be less anxious than peers, with a tendency to employ avoidance strategies to deal with problems faced in adolescence. Age, gender and specific illness variables, such as age at diagnosis and time since treatment, were strong predictors of psychological outcome.Conclusions:Results can be interpreted as suggesting that whilst cancer survivors have a similar psychosocial profile to healthy peers, they are more likely to utilise avoidance strategies to manage problems.
Efficacy and safety of oral desmopressin in the treatment of primary nocturnal enuresis in Asian children
Authors: YAP HK , CHAO SM , TAN AYS , MURUGASU B , ONG EK , LOW EH 
Published: November 2003

Objective:To determine the efficacy and safety of oral desmopressin (DDAVP) treatment in Asian children with nocturnal enuresis.Methodology:This was a multicentre randomized placebo‐controlled double‐blind cross‐over study. Patients were randomized to either active treatment with oral 400 mg DDAVP or placebo, with a 2‐week medication‐free period between the cross‐over. Children with primary monosymptomatic nocturnal enuresis, aged between 7 and 18 years, with a minimum frequency of wetting of 6 nights or more during a 2‐week observation period were recruited. Efficacy was measured by reduction in the average number of wet nights per week.Results:Of the 37 children initially recruited, the outcomes for 34 children were included in the final cross‐over analysis, as they had complete data for both the treatment periods. Statistical analysis by anova showed that there was no significant difference between the medication‐free period and the pretreatment period. However, the average number of wet nights per week for the DDAVP treatment period (2.5±2.7) was significantly lower than that of the placebo treatment period (4.5±2.1) (P<0.0001). In terms of the safety profile, there was no significant change in bodyweight, blood pressure, serum sodium, serum osmolality, and urine osmolality following DDAVP treatment.Conclusion:Oral DDAVP is a safe and efficacious drug for the short‐term treatment of children with primary nocturnal enuresis.
Shortcomings in psychosocial history taking in a paediatric emergency department
Authors: GREEN J , SULLIVAN AL , JUREIDINI And J 
Published: November 2003

Objective:To assess the quality of documentation of the psychosocial history taken from parents who repeatedly bring their infants and young children to an emergency department.Methodology:We prepared a list of 26 psychosocial items, indicated by the literature to be important elements of a history taken in this setting. We then reviewed subjects’ casenotes, and compared each history to this ideal list.Participants/Setting:Case note review of 104 children under 2 years who had presented to a paediatric emergency department at least five times in 1 year.Results:Documentation of psychosocial history for these subjects was very poor, with a mean of only 5 of the 26 possible psychosocial items mentioned per set of casenotes. The majority of records lacked important information, including basic demographic data.Conclusions:We canvass possible reasons for poor psychosocial history taking, and argue for changes in medical education, the development of techniques to efficiently identify at risk children and families, and improved resources for referral.
Iron status and dietary iron intake of 6–24‐month‐old children in Adelaide
Authors: OTI‐BOATENG P , SESHADRI R , PETRICK S , GIBSON RA , SIMMER K 
Published: November 2003

Objective:Chronic iron deficiency in children is associated with anaemia and impaired mental and psychomotor development. The aim of this study was to assess the iron status and dietary intake of 6–24‐month‐old Caucasian and Asian children living in metropolitan Adelaide.Method:A total of 234 healthy children (82% Caucasian and 18% Asian) aged 6–24 months were studied. Dietary iron intake of children was estimated from semiquantitative diet recall questionnaire administered to their parents. Blood samples for full blood count, serum ferritin (SF), serum iron (SI) and transferrin (TF) level estimations were obtained by venesection. Based on the laboratory test results, infants were classified as iron sufficient (IS) if the haemoglobin (Hb) concentration was >110 g L−1, SF ≥15 μg L−1, TF2 3.0 g L−1, SI ≥8 μmol L−1 and iron saturation (ISAT) ≥12%; or nonanaemic iron deficiency (NAID) if the Hb concentration was >110 g L−1 and SF <15 μg L−1 or SI <8 μmol L−1, TF >3.0 g L−1, and ISAT <12%; or as iron deficiency anaemia (IDA) if the Hb concentration was <110 g L−1 in association with SF <15 μg L−1 or with SI <8 μmol L−1, TF >3.0 g L−1 and ISAT <12%.Results:Sixty‐nine per cent of Caucasian children were classified IS, 25% as NAID and 6% were IDA; while 72% of Asian children were classified IS, 14% as NAID and 14% were IDA. Multivariate analysis demonstrated that factors associated with iron deficiency (SF </5 μg L−1) included age, duration of breast‐feeding and cows’ milk intake.Conclusion:Iron deficiency is common in our young population. Additional strategies to prevent IDA need be developed and evaluated in Australian infants.
Sleep deprivation or postnatal depression in later infancy: Separating the chicken from the egg
Authors: ARMSTRONG KL , HAERINGEN AR VAN , DADDS MR , CASH R 
Published: November 2003

Objectives:To explore the association between maternal distress and depression in the first years of a newborn’s life and the child’s sleeping behaviour and problems associated with this behaviour. To asses the effectiveness of an outpatient‐based individualised behaviour modification programme to modify children’s sleep behaviour and to decrease levels of maternal distress and depression.Method:Families were referred to an outpatient childhood sleep problems clinic. Intervention consisted of an individualised management programme including recognised modes of child sleep behaviour management (‘controlled crying’, ‘cold turkey,’ rewards) together with occasional use of short‐term (less than 2 weeks) tapering dose sedating medication for the child. Two months after the initial contact with the clinic, families completed a second questionnaire collating similar data to that collected at time of enrolment.Results:A total of 114 consecutive families referred to the clinic provided initial data. Follow‐up questionnaires were returned by 70 (61%). Significant change was recorded in children’s sleep parameters including reduction in mean number of night time awakenings (4.1–1.3, P<0.001), proportion of children requiring longer than 30 min to settle at night (49% to 21%, P<0.01) and in the proportion of children settling after 8 pm (51% to 33%, P<0.01). Sleep problem rating on a 0–10 scale decreased from a mean of 8.1–3.1 (P<0.001). On initial assessment, 40% of mothers had Edinburgh Postnatal Depression Scale (EPNDS) scores greater than 12 (screening cut‐off point). At repeat assessment, 4.3% had scores greater than 12. The mean score on the EPNDS fell from 11.2 to 5.8 (P<0.001).Conclusions:An outpatient‐based individualised approach to modifying children’s problematic sleep behaviour using recognised behaviour management techniques is effective. Modification of problematic childhood sleep behaviour is associated with significant improvement in maternal mood. Given the high incidence of childhood sleep problem and diagnosed postnatal depression, it is likely significant numbers of mothers being diagnosed as having postnatal depression are suffering the effects of chronic sleep deprivation. Management of postnatal mood disorder and childhood sleep behaviour must occur with due recognition to their close association.
Review Article Reducing the risk of sudden infant death syndrome: A review of the scientific literature
Authors: HENDERSON‐SMART DJ , PONSONBY A‐L , MURPHY E 
Published: November 2003

In March 1997 a multidisciplinary forum was convened by the National SIDS Council of Australia to review recent evidence concerning risk factors of sudden infant death syndrome (SIDS) and to revise and refine the current guidelines for reducing the risk of SIDS. The forum provided an assessment of the evidence for recommendations to reduce the risk of SIDS using an evidence‐based process. Strong evidence has now accumulated that the intervention campaigns to reduce prone sleeping during infancy have been followed by SIDS rate declines. Recent data indicate that the supine position is not associated with an increase in significant morbidity outcomes and provides greater protection for SIDS than the side position, which may be unstable. Covering of the baby’s head by bedding is strongly related to SIDS. The infant’s sleeping environment should be carefully set up to ensure that the baby’s head, including the face, cannot be obstructed during sleep. Parental smoking is strongly associated with SIDS. Structural supportive interventions for parental smoking cessation are required. Bedsharing increases the risk of SIDS amongst smokers and the data are currently not sufficient to provide complete reassurance to nonsmoking parents that bedsharing is safe. Infants should be maintained in a comfortable temperature zone. The evidence for a protective effect of breast‐feeding is conflicting, so breast‐feeding cannot be promoted strongly as reducing the risk of SIDS. Immunisation has not been associated with SIDS. Parents and carers should be aware of the current guidelines. Health professionals should also be aware of the evidence on which the current recommendations are based. Effective health education programmes should lead to a further decline in SIDS mortality in Australia.
Postural drainage in cystic fibrosis: Is there a link with gastro‐oesophageal reflux?
Authors: BUTTON BM , HEINE RG , CATTO‐SMITH AG , PHELAN PD 
Published: November 2003

Objectives:To determine the clinical effects of a change from postural drainage (PD) to positive expiratory pressure chest physiotherapy (PEP) in children with cystic fibrosis (CF) and symptoms of gastro‐oesophageal reflux (GOR). To measure the effects of PD on GOR in children with CF.Methods: Study 1: Six adolescents with CF and symptoms of GOR during PD were changed to upright PEP physiotherapy. The effects on lung function, reflux symptom scores and annual hospital days were measured. Study 2: Twenty‐four children with CF (mean age 11 years) and symptoms suggestive of GOR underwent 24‐h pH monitoring, including periods of chest physiotherapy.Results: Study 1: All six patients reported a reduction in reflux symptoms during PEP therapy (P<0.001). Lung function parameters improved during the first 6 months of PEP (P<0.001). This improvement was sustained for a further 18 months. Annual hospital days decreased significantly (P<0.0005). Study 2: Nine of 24 patients (37.5%) had pathological GOR. Reflux episodes were significantly increased during PD (P<0.0001), as was fractional reflux time (P<0.01).Conclusions:Upright PEP physiotherapy may be more appropriate than PD in selected patients with CF and symptomatic GOR. The role of GOR as a cofactor in the progression of pulmonary disease in CF needs further evaluation.
Hospitalisation for pneumonia in children in Auckland, New Zealand
Authors: GRANT CC , SCRAGG R , TAN D , PATI A , AICKIN R , YEE RL 
Published: November 2003

Objective:To describe the epidemiology of hospitalisations for pneumonia in children in Auckland, New Zealand.Methods:A consecutive sample of children hospitalised with pneumonia at the Starship Childrens Hospital from 1 July 1993 to 30 June 1996. Subjects were Pacific Island, Maori, and European/other children aged 0–14 years resident in north, west and central Auckland who were hospitalised with pneumonia. Comparisons were made of the number of hospitalisations by year, ethnicity, age and season; and of the hospitalisation rates by year, ethnicity and age.Results:There were 681 children who were hospitalised with pneumonia during 1993–94, 731 during 1994–95 and 630 during 1995–96. The average annual hospitalisation rate was 5.0 per 1000 children aged 0–14 years (95% CI 4.8–5.2). The average annual hospitalisation rate for Pacific Island children was 14.0 per 1000 (95% CI 13.0–14.9), for Maori children 6.7 per 1000 (95% CI 6.0–7.4) and for European/other children was 2.7 per 1000 (95% CI 2.6–2.9). Fifty‐three per cent of the hospitalised children were less than 2 years of age. A larger percentage of Pacific Island (61%) and Maori (60%) children were aged less than 2 years compared to European/other (42%) children (P<0.001). There was marked seasonal variability in the number of hospitalisations, with peaks in hospitalisations corresponding to peaks in positive respiratory viral isolates.Conclusions:Pneumonia was a consistent cause of hospitalisation for a large number of Auckland children during this 3‐year period. Hospitalisation rates and age distribution varied with ethnicity. Hospitalisation rates were highest for Pacific Island, intermediate for Maori and lowest for European/other children. Based on these hospitalisation data, pneumonia is a significant cause of morbidity for children in Auckland, New Zealand.
Transcatheter occlusion of atrial septal defects: An initial experience with the Amplatzer septal occluder
Authors: CHAN KY , YIP WCL , GODMAN MJ 
Published: November 2003

Objective:To discuss the initial experience with the use of a new double disc occluding device, the Amplatzer septal occluder in transcatheter occlusion of secundum atrial septal defects (ASD).Methods:Transvenous sizing of secundum ASD was performed in five children under general anaesthesia using transoesophageal echocardiographic and fluoroscopic guidance. An Amplatzer septal occluder equal to or minimally larger than the stretched diameter of the ASD was used for transcatheter occlusion of the defect in three suitable patients. Pulmonary balloon valvuloplasty with a 18 mm×3 cm Mansfield balloon catheter was carried out in one patient with associated pulmonary valvar stenosis in the same procedure setting.Results:Stretched diameters of the defects in the three patients ranged from 14 to 17 mm. Devices of sizes 14, 17 and 17 were deployed through 7F and 8F sheaths, respectively. The upper and lower rims of interatrial septum were more than 8 mm in all patients. All patients had successful occlusion with complete obliteration of the atrial left to right shunting. Simultaneous pulmonary balloon valvuloplasty for the valvar stenosis reduced pressure gradient from 53 mmHg to 22 mmHg across the valve prior to septal occlusion in one patient. No intraprocedural or short‐term complication was encountered.Conclusions:The design of the Amplatzer septal occluder permits ease in loading, delivery, deployment and stable seating of the device. This initial experience shows that Amplatzer device occlusion is feasible, relatively safe and effective and appears to be a viable alternative to surgical closure of secundum atrial septal defects in properly selected patients.
Immunisation has no effect on arousal from sleep in the newborn infant
Authors: LOY CS , HORNE RSC , READ PA , CRANAGE SM , CHAU B , ADAMSON TM 
Published: November 2003

Objective:To investigate arousal from sleep in infants before and after triple antigen immunisation (DTP).Methodology:Arousal thresholds were determined in both active sleep (AS) and quiet sleep (QS) the day before and the day following the first DTP immunisation in 14 infants. Arousal was induced using a pulsatile puff of air delivered alternately to the nostrils of the infant.Results:Arousal threshold was significantly higher in QS compared to AS in both studies (P<0.001). Mean arousal threshold in the pre immunisation study was not different from that in the post immunisation study in either sleep state. Core temperature and heart rate measured at the time of stimulus delivery were both significantly elevated in the post immunisation study (P<0.001). Sleep duration and number of awakenings from sleep were unaffected by immunisation.Conclusion:The first triple antigen immunisation has no effect on arousal from sleep in either AS or QS in this group of infants.
Treatment and outcome of 104 hospitalized patients with legionnaires’ disease
Authors: Howden B. P. , Stuart R. L. , Tallis G. , Bailey M. , Johnson P. D. R. 
Published: November 2003

Abstract Background:  Large outbreaks of Legionella pneumonia are rare, but when they occur provide an opportunity to assess predictors of mortality and efficacy of drug therapy. Although erythromycin has been the treatment of choice for many years, newer antimicrobials with increased activity against Legionella are available. A large outbreak of legionnaires’ disease associated with the Melbourne Aquarium occurred in April 2000.Aim:  To describe the patterns and impact of Legionella therapy, and predictors of outcome in a large group of hospitalized patients with legionnaires’ disease.Methods:  A 6‐month retrospective audit of hospitalized patients with proven legionnaires’ disease around the time of the Melbourne Aquarium outbreak was conducted. Statistical analysis was performed using SAS version 8.0 (SAS Institute Inc., NC, USA).Results:  Data were obtained on 104 patients (71 aquarium related, 33 not related). There were six deaths (mortality rate 5.8%), three of which were attributable directly to progressive legionnaires’ disease. The major predictors of death were pre‐existing cardiac failure (P = 0.0035) and renal disease (P = 0.026). Erythro­mycin is still the most commonly used antibiotic (80% received i.v. erythromycin) with clinicians prescribing more than one active Legionella drug in the majority of cases (76%). Choice of initial antibiotic therapy did not statistically affect outcome as measured by death, length of hospital stay or time to defervescence, although there was a trend towards improved survival with i.v. erythromycin (P = 0.063). Intravenous erythromycin was associated with a 19% rate of phlebitis, whereas side‐effects from other antibiotics were uncommon.Conclusion:  The most commonly used Legionella therapy in Australia remains erythromycin. This continues to be an effective agent, however, side‐effects are common. (Intern Med J 2003; 33: 484−488)