Recovery of pathogens with implementation of a weight-based algorithm for pediatric blood cultures: an observational intervention study.

BACKGROUND: Recovering pathogenic bacteria and yeast from pediatric blood cultures and reliably distinguishing between pathogens and contaminants are likely to be improved by increasing the volume of blood submitted to microbiology laboratories for culturing beyond the low volumes that have historically have been used. The primary aim of this study was to assess whether the pathogen recovery rate would increase after implementation of a weight-based algorithm for determining the intended volume of blood submitted for culturing. Secondary aims were to: 1) evaluate the effects of the algorithm implementation on the blood culture contamination rate; 2) determine whether pathogens might be found more often than contaminants in several as opposed to single bottles when more than one bottle is submitted; and 3) describe the microbiological findings for pathogens and contaminants in blood cultures by applying a clinical validation of true blood culture positivity. METHODS: A pre-post comparison of positivity and contamination rates after increasing the theoretical blood volume and number of blood culture bottles was performed, on the basis of a clinical validation of blood culture findings as pathogens vs contaminants. RESULTS: We examined 5327 blood cultures, including 186 with growth (123 true positives and 63 contaminated). The rate of true positive blood cultures significantly increased from 1.6% (42/2553) pre to 2.9% (81/2774, p = .002) post intervention. The rate of contaminated blood cultures did not change significantly during the study period (1.4% [35/2553] pre vs 1.0% [28/2774], p = .222) post intervention), but the proportion of contaminated cultures among all positive cultures decreased from 45% (35/77) pre to 26% (28/109, p = .005) post intervention. A microorganism that grew in a single bottle was considered a contaminant in 35% (8/23) of cases, whereas a microorganism that grew in at least two bottles was considered a contaminant in 2% (1/49, p < .001) of cases. According to common classification criteria relying primarily on the identity of the microorganism, 14% (17/123) of the recovered pathogens would otherwise have been classified as contaminants. CONCLUSION: Implementation of a weight-based algorithm to determine the volume and number of blood cultures in pediatric patients is associated with an increase in the pathogen recovery rate.

Orofacial signs of child or adolescent maltreatment identified by dentists and dental hygienists: A scoping review.

BACKGROUND: Child maltreatment, the abuse or neglect of children aged 0-18 years, is a severe and underreported global problem. Compared with other body parts, the orofacial region displays more signs of child maltreatment. Dentists and dental hygienists are therefore well situated to identify orofacial signs of child maltreatment. AIM: To map the current literature on orofacial signs of child maltreatment identified by dentists or dental hygienists. DESIGN: A scoping review was conducted based on systematic searches of Medline (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) for primary qualitative and quantitative studies through June 6, 2022. RESULTS: Twenty-nine studies were included in this scoping review. Though all child maltreatment types were identified in dental settings, physical abuse and dental neglect were most commonly identified. Reports of caries dominated the orofacial signs, followed by bruises (intra- and extraoral), poor oral hygiene, dental trauma, and lacerations (intra- and extraoral). Case reports were used most commonly to describe orofacial signs of child maltreatment. CONCLUSION: Dental clinicians identify orofacial signs of all child maltreatment types intraorally. Dentists identify the same extraoral signs as do other healthcare professionals, with bruising being the most common.

Use of the Strengths and Difficulties Questionnaire in child and school health services among children aged 4 and 6 years in Southern Norway: clinical considerations.

BACKGROUND: Parent reported mental health can be assessed by the Strengths and Difficulties Questionnaire (SDQ). Currently, Norwegian norms for parent-reported SDQ do not exist, whereas Swedish, Danish, and United Kingdom (UK) norms have been published. We aimed to (1) describe parent-reported SDQ among children aged 4 and 6 years in Southern Norway, (2) evaluate empirical cutoff values within the context of the Starting RightTM project in relation to the Swedish, Danish, and UK cutoffs, and (3) evaluate the representativeness of the study sample with regard to parental socioeconomic status. METHODS: This study included parent-reported observations for 665 children (63% consent rate). Means and standard deviations were calculated for the domains of SDQ, and gender differences were assessed. Based on the Swedish, Danish, and UK cutoffs and the 80th and 90th percentile cutoff values within the study, we calculated the total number of children with borderline and abnormal scores. RESULTS: Boys had higher mean total difficulties (7.3 vs 5.6) and impact scores (0.3 vs 0.1) and lower prosocial scores (8.3 vs 8.8) than girls. The differences in means were largest in the case of externalizing symptoms (5.0 vs 3.6) and hyperactivity subscore (3.2 vs 2.3). Using the UK cutoff values, 28 and 25 children had borderline and abnormal total difficulties scores, respectively. The corresponding numbers using the within study or Scandinavian cutoff values were 84-99 and 54-79, respectively. Overall, our study sample was well representative of the target population. CONCLUSIONS: Our findings consistently indicated that girls had better SDQ scores than boys among children aged 4 and 6 years. Fewer children would be identified as having mental health difficulties using the UK cutoff values than using the Scandinavian age- and gender-relevant cutoff values.

Supplementary drug treatment to reduce weight in adolescents with severe obesity. / Medikamentell tilleggsbehandling for vektreduksjon hos ungdom med alvorlig fedme.

In 2021, the Norwegian Medicines Agency approved the use of daily injection of liraglutide 3.0 mg (Saxenda) as a supplement to lifestyle treatment for weight control in children ≥ 12 years of age with obesity (isoBMI ≥ 30). We share the treatment experiences of six multidisciplinary obesity clinics in the specialist health service.

Acute poisoning among children and adolescents in southern Norway. / Akutt forgiftning blant barn og ungdom i Agder.

BACKGROUND: Self-inflicted poisoning is common in adolescents and is a risk factor for suicide. The aim of this study was to survey the circumstances surrounding hospitalisations due to acute poisoning in patients aged up to 18 years. MATERIAL AND METHOD: All hospitalisations in the Departments of Paediatric and Adolescent Medicine, Sørlandet Hospital Trust (Arendal and Kristiansand) due to acute poisoning in the period 1 August 2014-31 July 2015 were prospectively recorded with the aid of a form completed during the admission. RESULTS: There were 88 hospitalisations distributed among 68 adolescents (mean age 15.5 years, SD 1.5) and 13 children (mean age 2.8 years, SD 2.8). The poisoning was categorised as self-harm behaviour in 32 (47 %) of the adolescents, and as substance misuse-related in 35 (52 %). In total, 37 (54 %) of the adolescents had been or were under treatment at the Department of Child and Adolescent Psychiatry. Fifteen (22 %) of the adolescents were deemed to be suicidal. Thirty (94 %) of the adolescents who reported self-harm as the intention behind their poisoning were offered further follow-up at the Department of Child and Adolescent Psychiatry, along with 7 (20 %) of the group with substance misuse-related poisoning. INTERPRETATION: Adolescents who reported self-harm as their intention were usually offered further follow-up, whereas adolescents with substance misuse-related poisoning were rarely offered follow-up.