RESUMO
The number of children admitted to paediatric emergencies is increasing steadily, and is responsible for an altered quality in the patients' reception and some major perturbations in the care organization. In this context, the primary care physicians play a major role in explaining their patients "how to use" the paediatric emergency department (priority in case of vital emergency, periods with lot of admissions and increased waiting time ...). Everything must be done to find an altemative to the pediatric emergency department passage by facilitating communication between caregivers and for example by offering semi urgent consultations possibility.
Assuntos
Cuidados Críticos/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Pediatria/organização & administração , Criança , Serviços de Saúde da Criança/métodos , Serviços de Saúde da Criança/organização & administração , Procedimentos Clínicos/organização & administração , Emergências , França , HumanosAssuntos
Distinções e Prêmios , Lesões Encefálicas/enfermagem , Serviços de Saúde da Criança/história , Coma/diagnóstico , Coma/enfermagem , Técnicas de Diagnóstico Neurológico/história , Adolescente , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/prevenção & controle , Criança , Serviços de Saúde da Criança/métodos , Pré-Escolar , História do Século XXI , Humanos , Lactente , Recém-Nascido , Reino UnidoRESUMO
Sleep related breathing disorders (SRBD) have historically been under-recognised and under-treated. Obstructive sleep apnoea (OSA) affects approximately 3% of children. In line with the increased recognition of SRBD there has been an increase in demand for diagnostic services. We determined the awareness of SRBD amongst Irish paediatricians, examined the provision of sleep services to children throughout the country between 2007 and 2011 and audited diagnostic sleep services in a tertiary centre in 2011. Amongst respondents there was an awareness of SRBD but a poor understanding of diagnostic evaluation with 31/46 (67) referring to inappropriate services. There has been a sharp increase in both diagnostic sleep tests (433-1793 [414]) and in the use of non-invasive ventilation (NIV) (31-186 [627]) for treatment of SRBD between 2007 and 2011. Paediatric sleep services are organized in an ad-hoc manner nationally with significant service variation. The use of domiciliary overnight oximetry reduced the requirement for more formal polysomnography by 70%.
Assuntos
Serviços de Diagnóstico/estatística & dados numéricos , Gerenciamento Clínico , Síndromes da Apneia do Sono , Criança , Serviços de Saúde da Criança/métodos , Serviços de Saúde da Criança/estatística & dados numéricos , Técnicas de Diagnóstico do Sistema Respiratório , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Irlanda/epidemiologia , Polissonografia/estatística & dados numéricos , Prevalência , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/etiologia , Síndromes da Apneia do Sono/terapiaRESUMO
BACKGROUND: Youth substance use (SU) is prevalent and costly, affecting mental and physical health. American Academy of Pediatrics and Affordable Care Act call for SU screening and prevention. The Youth Risk Index(©) (YRI) was tested as a screening tool for having initiated and propensity to initiate SU before high school (which forecasts SU disorder). YRI was hypothesized to have good to excellent psychometrics, feasibility and stakeholder acceptability for use during well-child check-ups. DESIGN: A high-risk longitudinal design with two cross-sectional replication samples, ages 9-13 was used. Analyses included receiver operating characteristics and regression analyses. PARTICIPANTS: A one-year longitudinal sample (N=640) was used for YRI derivation. Replication samples were a cross-sectional sample (N=345) and well-child check-up patients (N=105) for testing feasibility, validity and acceptability as a screening tool. RESULTS: YRI has excellent test-retest reliability and good sensitivity and specificity for concurrent and one-year-later SU (odds ratios=7.44, CI=4.3-13.0) and conduct problems (odds ratios=7.33, CI=3.9-13.7). Results were replicated in both cross-sectional samples. Well-child patients, parents and pediatric staff rated YRI screening as important, acceptable, and a needed service. CONCLUSIONS: Identifying at-risk youth prior to age 13 could reap years of opportunity to intervene before onset of SU disorder. Most results pertained to YRI's association with concurrent or recent past risky behaviors; further replication ought to specify its predictive validity, especially adolescent-onset risky behaviors. YRI well identifies youth at risk for SU and conduct problems prior to high school, is feasible and valid for screening during well-child check-ups, and is acceptable to stakeholders.
Assuntos
Comportamento do Adolescente/psicologia , Serviços de Saúde da Criança/métodos , Assunção de Riscos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Atitude do Pessoal de Saúde , Criança , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Satisfação do Paciente , Psicometria , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Estados UnidosRESUMO
In 2010 the guideline on mild traumatic head/ brain injury for both adults and children was revised under the supervision of the Dutch Neurology Society. The revised guideline endorsed rules for decisions on whether to carry out diagnostic imaging investigations (brain CT scanning) and formulates indications for admission. Unfortunately, 5 years after its introduction, it is clear that the guideline rules result in excessive brain CT scanning, in which no more serious head injury is diagnosed. Brain injury may be present in (small) children even if symptoms are absent at first presentation. Also, clinical signs do not predict intracranial complications. This was nicely demonstrated in a study by Tilma, Bekhof and Brand of 410 children with mTBI: no clinical symptom or sign reliably predicted the risk of intracranial bleeding. They advise hospitalisation for observation instead of brain CT scanning. It may be necessary to review part of the Dutch guideline on mTBI.
Assuntos
Lesões Encefálicas/diagnóstico por imagem , Serviços de Saúde da Criança/normas , Guias de Prática Clínica como Assunto/normas , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Lesões Encefálicas/diagnóstico , Criança , Serviços de Saúde da Criança/métodos , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/diagnóstico por imagem , Países BaixosRESUMO
The Millennium Development Goals (MDGs) provide a framework for measuring the progress of nations. Several of these goals relate to child malnutrition, which remains an important contributor to child morbidity and mortality, accounting for approximately 45% of child deaths globally. A high proportion of undernourished children still live in Africa and parts of Asia, and the uneven rate of reduction in the prevalence of various types of child malnutrition among different income groups worldwide is worrying. Attempts to reduce child malnutrition should therefore begin from the grassroots by improving primary healthcare services in developing countries with particular focus on basic requirements. Adequate nutrition should be provided from birth, through infancy, preschool and early childhood to adolescence. The overall strategy should be one of careful and meticulous planning involving all development sectors with an emphasis on a bottom-up approach within a stable and disciplined polity; the MDGs will be only be useful if they are seen not as narrow objectives with unidirectional interventions but as multifaceted and co-ordinated. The setting of deadlines, whether 2015 or 2035, should not be emphasised so as to avoid hasty decision making. The top priority should be the implementation of the essential social services of basic education, primary healthcare, nutrition, reproductive health care, water and sanitation in partnership with the developed economies.
Assuntos
Serviços de Saúde da Criança/métodos , Transtornos da Nutrição Infantil/prevenção & controle , Proteção da Criança , Promoção da Saúde , Criança , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Países em Desenvolvimento , Saúde Global , Objetivos , Humanos , Estado Nutricional , Fatores Socioeconômicos , Nações UnidasRESUMO
It is not inconceivable that by 2035 the substantial gaps in child health across the Pacific can close significantly. Currently, Australia and New Zealand have child mortality rates of 5 and 6 per 1000 live births, respectively, while Pacific island developing nations have under 5 mortality rates ranging from 13 to 16 (Vanuatu, Fiji and Tonga) to 47 and 58 per 1000 live births (Kiribati and Papua New Guinea, respectively). However, these Pacific child mortality rates are falling, by an average of 1.4% per year since 1990, and more rapidly (1.9% per year) since 2000. Based on progress elsewhere, there is a need to (i) define the specific things needed to close the gaps in child health; (ii) be far more ambitious and hopeful than ever before; and (iii) form a new regional compact based on solidarity and interdependence.
Assuntos
Serviços de Saúde da Criança/tendências , Mortalidade da Criança/tendências , Proteção da Criança/tendências , Países em Desenvolvimento/estatística & dados numéricos , Objetivos , Necessidades e Demandas de Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Austrália/epidemiologia , Criança , Serviços de Saúde da Criança/métodos , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/provisão & distribuição , Países Desenvolvidos/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/tendências , Disparidades nos Níveis de Saúde , Humanos , Ilhas do Pacífico/epidemiologia , Serviços de Saúde Rural/provisão & distribuição , Serviços de Saúde Rural/tendênciasRESUMO
Today, in 2014, the Manchester Triage System is an evidence-based triage system for the emergency room. It has been nationally and internationally validated and is safe for children. Why use the non-validated Netherlands Triage Standard that has no specific triage that has been suitably adapted and tested for children?
Assuntos
Serviços de Saúde da Criança/normas , Serviço Hospitalar de Emergência , Triagem/normas , Adolescente , Criança , Serviços de Saúde da Criança/métodos , Pré-Escolar , Humanos , Países BaixosRESUMO
Selective prevention programs hold the promise of alleviating child anxiety symptoms, decreasing the risk for emotional problems across the lifespan. Such programs have particular public health import for young children of poor, underserved communities. Identifying factors related to parent engagement, and methods to improve engagement, are paramount in the effort to develop anxiety-focused, community prevention programs. This feasibility study investigated the effect of an enhanced recruitment strategy to maximize parent engagement, as well as factors related to attendance in a single session focused on anxiety prevention. Participants were poor, ethnic minority parents of children aged 11-71 months (n = 256) who completed a survey that assessed anxiety risk according to trauma exposure, child anxiety, or parent anxiety, as well as preferences for preventive services (phase 1). Those meeting risk criteria (n = 101) were invited to a preventive group session (phase 2). Half of parents received enhanced recruitment (ER), which included personalized outreach, matching parent preferences, and community endorsement. Other parents were invited by mail. Chi square analyses indicated that ER was associated with planning to attend (49 vs. 6% of control). Parents receiving ER were 3.5 times more likely to attend. Higher sociodemographic risk was correlated with higher child anxiety symptoms but not attendance. Results highlight the need for improved strategies for engaging parents in preventive, community-based interventions.
Assuntos
Transtornos de Ansiedade/prevenção & controle , Ansiedade/prevenção & controle , Serviços de Saúde da Criança/métodos , Pais , Preferência do Paciente , Seleção de Pacientes , Serviços Preventivos de Saúde/métodos , Adulto , Pré-Escolar , Etnicidade , Estudos de Viabilidade , Feminino , Humanos , Lactente , Acontecimentos que Mudam a Vida , Masculino , Grupos Minoritários , Pobreza , Medição de Risco , Populações Vulneráveis , Adulto JovemRESUMO
Nearly 27% of all annual emergency department (ED) visits are pediatric related, a relatively small percentage in comparison to the number of visits from the adult population. The majority of the 31 million children and adolescents access care in nonpediatric facilities and have different clinical presentations and needs than adults. Administered by the Health Resources and Services Administration within the Department of Health and Human Services, the Emergency Medical Services for Children (EMSC) program is a federal entity that aims to ensure that pediatric care is well integrated into the entire emergency medical services system so that no matter where a child lives or travels, he or she can receive appropriate and timely care. The objective of this article is to describe the role of the EMSC program in the development of the pediatric emergency care system. The program is striving to improve pediatric emergency care in a number of ways: EMSC State Partnership grant performance measures address the ability of the out-of-hospital and hospital settings to care for children; the National Pediatric Readiness project works with EDs to ensure that essential resources are present to care for children; regionalization grants focus on the challenges of geographic isolation, access to specialty care, and limited resources; and the targeted issue grants focus on the care of the child in the out-of-hospital setting in which there is a paucity of evidence-based knowledge.
Assuntos
Serviços Médicos de Emergência , Necessidades e Demandas de Serviços de Saúde , Adolescente , Criança , Serviços de Saúde da Criança/métodos , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde , Humanos , Estados Unidos , United States Health Resources and Services Administration/organização & administraçãoRESUMO
This study investigated whether and which evidence-based treatment (EBT) components might generalize to youths served by the wraparound process. To examine these questions, the study used relevance mapping, an empirical methodology that compares youths in a given clinical population with participants in published randomized trials to determine who may be "coverable" by EBTs and which treatments may collectively be most applicable. In a large diverse clinical sample, youths receiving wraparound services (n = 828) were compared with youths receiving other services (n = 3,104) regarding (a) demographic and clinical profiles, (b) "coverability" by any EBTs, and (c) specific practices from those EBTs that most efficiently applied to each group. Participants in studies of EBTs matched the demographic and clinical characteristics of nearly as many youths receiving wraparound (58-59%) as those receiving non-wraparound services (61-64%). Moreover, the best-fitting solutions of relevant sets of practices were highly similar across groups. These results provide the first large-scale empirical characterization of fit between EBTs and youths receiving wraparound and suggest that these youths are well suited to benefit from clinical strategies commonly used in EBTs.
Assuntos
Serviços de Saúde do Adolescente , Serviços de Saúde da Criança/métodos , Medicina Baseada em Evidências , Adolescente , Criança , Pré-Escolar , Pesquisa Empírica , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To examine associations between use of on-site multidisciplinary services at a pediatric primary care clinic, perceptions of the clinic, and health care utilization. STUDY DESIGN: Eighty caregivers were interviewed during clinic visits assessing on-site service use, satisfaction, and perception of the clinic as a medical home. Acute care, emergency department, and well-child visit data were abstracted from children's medical records. Student's t test and multivariate regression were used to examine associations between service use, satisfaction, and health care utilization. RESULTS: Use of ≥3 clinic services was associated with improved satisfaction (Client Satisfaction Questionnaire-8 mean: 31.8 vs 31.0, P < .05), stronger perception of the clinic as a medical home (Parents' Perception of Primary Care mean: 97.6 vs 93.4, P < .01), and increased missed well-child care visits (mean: 0.49 vs 0.20, P < .05). CONCLUSIONS: On-site service use was associated with improved caregiver satisfaction but decreased well-child visit adherence. Caregivers using support services may face barriers to accessing preventive care.