Factors associated with mortality in children under five years old hospitalized for Severe Acute Malnutrition in Limpopo province, South Africa, 2014-2018: A cross-sectional analytic study.

BACKGROUND: In South Africa, 30.9% of children under five years with Severe Acute Malnutrition (SAM) died in 2018. We aimed to identify factors associated with mortality among children under five years hospitalized with SAM in Limpopo province, South Africa. METHODS: We conducted a cross-sectional study including children under five years admitted with SAM from 2014 to 2018 in public hospitals of Limpopo province. We extracted socio-demographic and clinical data from hospital records. We used logistic regression to identify factors associated with mortality. FINDINGS: We included 956 children, 50.2% (480/956) male and 49.8% (476/956) female. The median age was 13 months (inter quartile range: 9-19 months). The overall SAM mortality over the study period was 25.9% (248/956). The most common complications were diarrhea, 63.8% (610/956), and lower respiratory tract infections (LRTIs), 42.4% (405/956). Factors associated with mortality included herbal medication use (adjusted Odds Ratio (aOR): 2.2, 95% Confidence Interval (CI): 1.4-3.5, p = 0.001), poor appetite (aOR: 2.7, 95% CI: 1.4-5.2, p = 0.003), Mid-upper circumference (MUAC) <11.5 cm (aOR: 3.0, 95% CI: 1.9-4.7, p<0.001), lower respiratory tract infections (LRTIs) (aOR: 1.6, 95% CI: 1.2-2.0, p<0.001), anemia (aOR: 2.5, 95% CI: 1.1-5.3, p = 0.021), hypoglycemia (aOR: 12.4, 95% CI: 7.1-21.8, p<0.001) and human immunodeficiency virus (HIV) infection (aOR: 2.3, 95% CI: 1.6-3.3, p<0.001). INTERPRETATION: Herbal medication use, poor appetite, LRTIs, anemia, hypoglycemia, and HIV infection were associated with mortality among children with SAM. These factors should guide management of children with SAM.

Factors associated with child survival in children admitted to outpatient therapeutic program at public health institutions in Afar Regional State, Ethiopia: a prospective cohort study.

INTRODUCTION: About 20 million children suffer from severe acute malnutrition each year. The World Health Organization recommends the outpatient therapeutic program as a standard treatment protocol for the management of uncomplicated severe acute malnutrition and for children who are transferred from inpatient cares after recovery. This study aimed to assess the treatment outcome of severe acute malnutrition and determinants of survival in children admitted to outpatient therapeutic program at public health institutions, Afar Regional State. METHODS: Institution-based prospective cohort study was conducted on 286 children aged 6-59 months admitted to the outpatient therapeutic program, from April to September 2017, at selected public health institutions in Afar Regional State. For the comparison of time to recovery among the different groups of children on the outpatient therapeutic program, Kaplan-Meir curve was used and significance test for these differences was assessed by the log-rank test. Then, a proportional hazard in the Cox model was used to identify independent predictors of survival. p value < 0.05 was considered significant. RESULTS: Of 286 children, 238 (83.2%; 95% CI (79, 88)), 18 (6.3%), 14 (4.9%), 8 (2.8%), and 8 (2.8%) cases were cured, defaulters, non-responder, died, and transfer to inpatient care, respectively. The overall mean rate of weight gain was 10.5(± 3.45) g/kg/day, and mean length of stay was 44.15(± 8.77) days. The recovery rate of children whose mothers travel less than 2 h to the health institution was about three times (AHR, 2.91; 95% CI (2.18, 3.88)) higher than children whose mothers travel 2 h and above. Compared with children who received vitamin A supplementation, children who lack supplementation were less likely (AHR, 0.39; 95% CI (0.25, 0.59)) to be cured. Moreover, the rate of recovery from outpatient therapeutic program among children who received antibiotics was about 1.4 times (AHR, 1.38; 95% CI (1.01, 1.89)) higher compared with children who did not receive of antibiotics. CONCLUSION: This study showed that nearly eight children in every ten had recovered from severe acute malnutrition. Therefore, considering the distance of health facility from children's residence, improving vitamin A supplementation and antibiotics are vital in improving the rate of recovery. Further research is also required to identify and address barriers to the provision of antibiotics and vitamin A supplementation.

Behavior Problems in Physically Ill Children in Rwanda.

OBJECTIVES: Childhood behavior problems are underidentified in low- and middle-income countries. This study sought to systematically screen for behavior problems among children receiving medical care in Rwanda and investigate factors associated with behavior problems in this cohort. METHODS: The Pediatric Symptom Checklist (PSC) was translated into Kinyarwanda, following best practices. Children aged 5.9 to 16 years admitted to the inpatient ward of a referral hospital or seen in the outpatient department (OPD) were screened using the PSC. All PSC-positive children and every third PSC-negative child were referred for definitive assessment by a child mental health specialist. RESULTS: Among 300 eligible children, 235 were recruited; none refused. PSC scores were positive in 74 of 234 cases (32%, 95% confidence interval 26%-38%); a total of 28 of 74 (40%) PSC-positive children completed mental health assessments. Of these, 16 (57% of those assessed, and 7% of the 235 who were screened) required treatment or further assessment; none of the PSC-negative children did. Screening sensitivity was 100%, and specificity was 71%, with favorable receiver operating characteristics curve and internal consistency. In a multivariate analysis, higher PSC scores were associated with OPD care, central nervous system trauma or infection, and indices of malnutrition and with the use of traditional, complementary, and alternative medicine (TCAM). CONCLUSION: Behavior problems are common among Rwanda children seen in a referral hospital, particularly in the OPD, and are associated with use of TCAM. The Kinyarwanda PSC showed favorable screening characteristics and resulted in some 7% of children accessing needed mental health care.

Taking Refuge in Spirituality, a Main Strategy of Parents of Children with Cancer: a Qualitative Study

Background: Due to the rise in prevalence of childhood cancer the impact on family caregivers is increasing. Spirituality may be an alleviating factor for improving the quality of parent life. There is a lack of organized spiritual care in health care facilities, so that this aspect needs more emphasis. Thus this study aimed to evaluate the spiritual strategy of parents of children with cancer. Materials: This qualitative study was conducted with a conventional content analysis approach. Fifteen parents of hospitalized children with cancer at the Oncology and Hematology departments of governmental pediatric hospitals nationwide were purposefully selected. Semi-structured in-depth interviews were conducted for data collection and inductive content analysis. Results: Eleven sub-themes were extracted in the data analysis, which resulted in the generation of three themes: "spiritual strategy," "spiritual escape" and "spiritual growth". Conclusion: The spiritual approach of parents of children with cancer had a significant influence on spiritual care and consequently the acceptance of disease and coping with the associated conditions. Spiritual care clearly should be introduced into the health care system of Iran, particular for the parents of children with cancer.

Hospitalizations due to alcohol intoxication among children and adolescents - data from one clinical hospital in Poland. / Hospitalizacje z powodu zatruc alkoholem etylowym wsród dzieci i mlodziezy ­ dane pochodzace z jednego szpitala klinicznego w Polsce.

OBJECTIVES: To determine the frequency of hospitalizations due to alcohol intoxication (AI) at the Pediatric Health Center, and to attempt to identify factors contributing to the occurrence of intoxication in the population of children and adolescents. METHODS: Medical documentation of 227 patients hospitalized due to AI. 108 (48%) patients were girls and 119 (52%) patients were boys. The mean age of the study group was 14.9 years ±2.1. Data regarding patients, their families and the circumstances of intoxication underwent analysis. RESULTS: Alcohol intoxication constituted 2.8% of all hospitalizations. The number of hospitalizations between 2000 and 2011 showed an increasing tendency with some fluctuations within years. Spirits were predominant alcohol beverages. Over 10% of patients required a short-term hospital stay at the Department of Anesthesiology and Intensive Care. In 13% of children, coexisting medicine or drug intoxication was observed and 10% of patients presented with alcohol-related injury to the head or extremities. Risky sexual behaviors were noted in 25% of girls. The majority of children were raised by two parents who had received primary education. Alcoholism was present in over 20% of the families. In single-parent families, fathers were more frequently absent and a lack of a regular source of income was more often related to mothers. CONCLUSIONS: There are no uniform standards of multi-specialist medical care for children hospitalized due to AI. Identification of children consuming alcohol is recommended. It should be done by primary physicians, pediatricians, teachers and psychologists. Minor patients hospitalized due to AI should be provided with a long-term and comprehensive care.

Hospital Chaplains: Through the Eyes of Parents of Hospitalized Children.

BACKGROUND: Chaplain services are available in 68% of hospitals, but hospital chaplains are not yet incorporated into routine patient care. OBJECTIVES: To describe how families of hospitalized children view and utilize hospital chaplains. DESIGN: Telephone survey with 40 questions: Likert, yes/no, and short-answer responses. SUBJECTS: Parents visited by a hospital chaplain during their child's hospitalization in a tertiary care center. MEASUREMENTS: Descriptive statistics were used to characterize the sample. Nonparametrics were used to compare religious versus nonreligious parents. Regression was used to identify independent predictors of a chaplain visit positively influencing satisfaction with hospital care. RESULTS: Seventy-four parents were interviewed; most were 25-50 years old, and 75% felt their child was very sick. Children ranged from newborn to adolescence. Forty-two percent of parents requested a chaplain visit; of the 58% with an unsolicited visit, 11% would have preferred giving prior approval. Parents felt that chaplains provided religious and secular services, including family support and comfort, help with decision making, medical terminology, and advocacy. Chaplains helped most parents maintain hope and reduce stress. Seventy-five percent of parents viewed chaplains as a member of the healthcare team; 38% reported that chaplains helped medical personnel understand their preferences for care and communication. Most parents (66%) felt that hospital chaplaincy increased their satisfaction with hospital care. CONCLUSION: Families play a fundamental role in the recovery of hospitalized children. Parents view hospital chaplains as members of the healthcare team and report that they play an important role in the well-being of the family during childhood hospitalization. Chaplains positively influence satisfaction with hospital care.

Fear of clowns in hospitalized children: prospective experience.

Medical clowns (MC) have become an integral part of the pediatric staff of hospital wards. While several studies have demonstrated the huge benefits of MC, there are almost no data regarding fear of clowns, a known phenomenon that means an irrational fear of clowns. In the current study, we sought to examine the prevalence of fear of clowns in pediatrics wards, and to characterize the affected children. The clinical work of three certified MCs was prospectively assessed. Every child with fear of clowns was noted, data were retrieved from the medical records, and the parents/child completed a specific questionnaire with a research assistant. Fear of clowns was defined as crying, anxiety response or effort to avoid contact with the MCs in small children, while in older children, it was determined if the child either reported fear of MCs or made actions to avoid clowns' intervention. A total of 1160 children participated in the study. All were hospitalized in the department of pediatrics or the pediatric emergency medicine department at Carmel Medical Center, and were exposed to a MC intervention session. Of the 1160 children, 14 children experienced fear of clowns (1.2%). The average age of children who experienced fear of clowns was 3.5 years (range 1-15). Interestingly, most of the children demonstrating fear of clowns were girls (12 out of 14, 85.7%). We found no association between fear of clowns and specific diagnosis, fever, clinical appearance, religion, or ethnicity. CONCLUSION: The prevalence of fear of clowns in the general pediatric hospitalized population was 1.2%, with a significant predominance of girls (85.7%). Children who experienced significant fear of clowns also experienced significant fear of encountering or thinking about a MC visit. Fear of clowns can affect children at any age (range 1-15), any ethnicity, religion, or degree of illness. Further large scale studies are required to better understand this unique phenomenon of fear of clowns. What is Known: • Fear of clowns is a phenomenon known for more than several decades and related to the increased use of clowns as negative characters in horror movies and TV shows. • The increased use of medical clowns in hospital wards and corridors increases the significance of defining and characterizing this phenomenon in hospital wards. What is New: • The study is novel by giving new data related to the extent of fear of clowns in pediatrics wards and giving demographic characteristic of children experiencing fear of clowns.

Brief Report: Healing Touch Consults at a Tertiary Care Children's Hospital.

BACKGROUND AND OBJECTIVES: Components of complementary and alternative medicine are increasingly being implemented at academic medical centers. These approaches include therapeutic touch or healing touch (HT), an energy-based therapy using light touch on or near the body. Limited data exist regarding complementary and alternative medicine use at children's hospitals. The aim of this study was to evaluate patterns and clinical characteristics of HT consultations among children hospitalized at Nemours/A.I. duPont Hospital for Children. METHODS: We conducted a retrospective chart review of all patients hospitalized from January 2012 through December 2013, comparing patients who received HT consultations with those who did not. RESULTS: There were 25,396 admissions during the study period; 882 (4%) of these, representing 593 individual patients, received an HT consultation. As compared with those without an HT consultation, patients receiving HT were older (median 12 years vs 5 years, P<.001), female (58% vs 46%, P<.001), and more likely to be admitted to the hematology/oncology or blood/bone marrow transplant units (P<.001). Patients with HT consultations had longer hospitalizations (median 121 hours vs 38 hours, P<.001) and more medical problems (median 12 vs 4, P<.001). Six attending physicians were responsible for placing the majority of HT consultations. Of the 593 patients receiving an HT consultation, 21% received ≥2 consultations during the study period. CONCLUSIONS: Certain patients, such as those with longer hospitalizations and more medical problems, were more likely to receive HT consultations. Many patients received multiple consultations, suggesting that HT may be an important aspect of ongoing care for hospitalized children.

Higiene oral e pneumonia em crianças em Unidade de Terapia Intensiva: revisão sistemática / Oral hygiene and pneumonia in children in Intensive Care Units: a systematic review

Objetivo: Pacientes internados em Unidades de Terapia Intensiva (UTI) podem apresentar pneumonia associada à ventilação mecânica (PAV), grave infecção relacionada à colonização bacteriana na orofaringe. O objetivo deste estudo foi identificar evidências sobre o efeito da higiene oral na prevenção da PAV em crianças internadas em UTI neonatal ou pediátrica. Materiais e métodos: Revisão sistemática de estudos indexados nas bases Embase, Medline e Lilacs, conduzidos em crianças sob ventilação mecânica. A intervenção de interesse foi higiene oral e, o desfecho, PAV. Utilizou-se as escalas de Jadad e Newcastle-Ottawa para classificação qualitativa dos artigos. Resultados: Dentre 113 artigos localizados, selecionou-se 5. Três estudos coorte avaliaram a higiene oral como parte de um pacote de cuidados e encontraram redução significativa na incidência de PAV. Dois ensaios clínicos investigaram a escovação dentária realizada com gel de gluconato de clorexidina 0,12% comparada a placebo, e não evidenciaram redução significativa na ocorrência de PAV. Conclusão: A higiene oral integrada a um protocolo de ações de prevenção de infecção hospitalar associa-se à redução da PAV em crianças internadas em UTI; não há evidências para a eficácia da limpeza oral com clorexidina em crianças internadas em UTI.

Objective: Patients in Intensive Care Units (ICU) may present ventilator-associated pneumonia (VAP), which is a severe infection related to bacterial colonization in the oropharynx. The objective of this study was to identify scientific evidences on the effect of oral hygiene in the prevention of VAP in children admitted to neonatal or pediatric ICU. Methods: Systematic review of studies indexed in Embase, Medline and Lilacs, conducted in children on mechanical ventilation. The intervention of interest was oral hygiene and the outcome, VAP. We used the Jadad and the Newcastle-Ottawa scales for the qualitative classification of the studies. Results: Five out of 113 papers were selected. Three cohort studies evaluated oral hygiene as part of a comprehensive care bundle and found a significant reduction in the incidence of VAP. Two clinical trials investigated toothbrushing performed with 0.12% chlorhexidine gluconate gel compared to placebo, and showed no significant reduction in the occurrence of VAP. onclusion: Oral hygiene integrated into a hospital infection prevention protocol associated with the reduction of VAP in children admitted to ICU; there is no evidence for the effectiveness of oral hygiene with chlorhexidine in children admitted to ICU.

Integrative care therapies and pain in hospitalized children and adolescents: a retrospective database review.

BACKGROUND: Complementary or integrative care therapies are promising adjunctive approaches to pain management for pediatric inpatients that are currently underused and understudied. The purpose of this study was to examine the potential benefits of integrative care therapies delivered to hospitalized children and adolescents at a large Midwestern academic pediatric medical center over a 1-year period. METHODS: A retrospective chart review of an inpatient clinical database maintained by integrative care therapists over a 1-year period was used for the current study. Pre/post pain and relaxation scores associated with the delivery of inpatient integrative care therapies (primarily massage therapy and healing touch) were examined. RESULTS: Five-hundred nineteen hospitalized children and adolescents were treated by integrative care therapists for primarily pain or anxiety needs. Patients had a mean age of 10.2 years (standard deviation, 7.0), 224 were female (43%), 383 were white (74%), and most (393 [77%]) received massage therapy. Mean pain and relaxation scores decreased significantly from pre- to post-therapy across all demographic and clinical subgroups (p≤.001). CONCLUSIONS: Although integrative care therapies are increasingly requested and offered in children's hospitals, provision of these approaches is driven primarily by consumer demand rather than evidence-informed practice. Future controlled studies should examine the incremental effects of integrative care therapies as an adjunct to conventional treatment, assess how these therapies work mechanistically, and determine whether they improve outcomes, such as pain and cost, for hospitalized children and adolescents.

Care coordination for children with complex care needs significantly reduces hospital utilization.

PURPOSE: The purpose was to evaluate an ambulatory care coordination program for children with complex care needs. DESIGN AND METHODS: A pre- and postcohort evaluation design was implemented to analyze the impact on hospital utilization. RESULTS: Results included a decrease in emergency department presentations (15%, p < .001), hospital admissions (9%, p < .019), and hospital bed days (43%, p < .001). Economic analysis indicated a cost savings of $A 1.9 million per annum. PRACTICE IMPLICATIONS: Hospital utilization is significantly reduced for children with complex care needs through 24/7 care coordination.

Canto Gregoriano como redutor de ansiedade das mães de crianças hospitalizadas: estratégia para a enfermagem / Gregorian chant as complier anxiety of mothers of children in hospital: strategy for nursing

A música exerce efeitos diversos no nosso organismo como terapêutica complementar. Quando uma mãe tem um filho hospitalizado, sente-se insegura e com medo do futuro, gerando ansiedade. Este estudo objetivou verificar se o canto Gregoriano altera o estado de ansiedade de mães com filhos internados. Pesquisa do tipo descritiva, exploratória, correlacional com análise quantitativa, quase-experimental em uma unidade de internação de especialidades de hospital governamental de grande porte, pediátrico de atenção quaternária. A unidade é para atendimento a convenios empresariais, com 15 leitos ativos. Amostra inicial composta por 71 mães, sendo que 28 concluíram todas as etapas da coleta de dados. A mãe foi convidada, pessoalmente, a participar da pesquisa e após o aceite do convite, assinou o Termo de Consentimento Livre e Esclarecido e preencheu o Inventário de Diagnóstico de Ansiedade Traço. Foram agendados dois encontros no quarto individual do próprio paciente para a realização da audição musical de canto Gregoriano com utilização de equipamento digital e uso de fones de ouvido. Também foram respondidos o formulário de identificação do sujeito da pesquisa contendo dados pessoais, dados relacionados ao filho internado e informações sonoro-musicais e o Inventário de Diagnóstico de Ansiedade Estado antes e após cada audição musical. A primeira audição musical foi com, no mínimo, 48 horas de internação e a segunda audição musical foi agendada 48 horas após a primeira. A pesquisadora permaneceu no quarto nos primeiros e nos últimos 5 minutos da audição musical das mães. Os dados foram armazenados em planilha Excel for Windows Explorer® e analisados em programa SPSS - Statistical Package for the Social Sciences - Versão 18.0. Foram realizadas análises estatísticas descritivas através de: teste de normalidade (Kolmogorov-Smirnov), correlação de Pearson entre os escores da escala de ansiedade; análise de variância (ANOVA ONE WAY) para comparar os escores da escala de ansiedade; teste t de student para comparar as médias entre os escores e as variáveis sócio-demográficas. Adotado o nível de 5% de significância nas análises estatísticas. Na primeira audição musical verificou-se que 25(89,2%) mães tiveram seu estado de ansiedade diminuidos e na segunda audição musical, 25(89,2%) continuaram a ter seu estado de ansiedade diminuído. Apesar de não permitir generalizações devido o número limitado de mães participantes deste estudo, pôde-se concluir que a utilização do canto Gregoriano diminui o estado de ansiedade das mães de crianças hospitalizadas em um hospital pediátrico de atenção quaternária acomodados em quartos individuais. É necessário que se amplie o estudo dos estilos musicais para sua aplicabilidade na assistência de enfermagem com mães de crianças hospitalizadas.(AU)

The Music exerts different effects on our body, such as complement therapy. When the mother have hospitalized child feel insecurity and fear of the future, causing anxiety. This research aimed to verify if the Gregorian chant changes the state of anxiety of mothers with hospitalized children. Descriptive research, exploratory, correlational with quantitative analysis, almost-experimental, done in large-sized teaching hospital in units of quaternary care pediatric specialties, with 15 active beds, whose focus of attendance are business and individual agreements. Initial sample composed of 71 mothers, but only 28 mothers completed all stages of the data collection. Mothers were invited personally to participate in the study and after agreeing to sign the Informed Consent to fill the Diagnostic Inventory Trait Anxiety. Two meetings were scheduled in the patient bedroon individual, so they listened the Gregorian chant with the use of Digital Equipment and headphones. They were also answered the identification form the subject of the investigation that contains personal data relating to child boarding and sound-musical information and the Diagnostic Inventory State Anxiety before and after each listening session. The listening session was first with at least 48 hours of hospitalization and the second listening session was scheduled 48 hours after the fisrt. The researher stay in the room at the first and the last five minutes of music listening mothers. The datas were stored in Excel spreadsheet for Windows Explorer ® and analyzed in SPSS - Statistical Package for the Social Sciences - Version 18.0. Descriptive statistical analysis were carried out through: test of normality (Kolmogorov-Smirnov), Pearson correlation between the scores of the anxiety scale, analysis of variance (ANOVA - ONE WAY) to compare the scores of the anxiety scale; test t student to compare means between the scores and socio-demographic variables. Adopted 5% level of significance in statistical analysis. At the first listening session was verified that 25 (89.2%) mothers had decreased their anxiety state and the second listening session, 25 (89.2%) continued their state of anxiety decreased. Despite not allow generalizations due to the limited number of mothers participating in this study, so it was concluded that the use of Gregorian chant decreases anxiety of mothers with children hospitalized in quaternary care pediatric hospital accommodated in rooms individualized. It is necessary to broaden the study of musical styles to applicate in nursing care com mothers of hospitalized children.(AU)

Incompatibilidade no preparo e administração de terapia intravenosa em crianças: associação entre fármacos, soluções em ateriais dos cateteres e acessórios / Incompatibility during the prepare and administration of intyravenous drugs in children: association among drugs, solutions and materials of the catheters and disposable

Pesquisa descritiva sobre a ocorrência de incompatibilidade entre fármacos, soluções e materiais dos cateteres e acessórios de terapia intravenosa administrada a crianças hospitalizadas, em quatro unidades pediátricas de um hospital universitário do município de São Paulo, no periodo de novembro de 1999 a novembro de 2000. A população da pesquisa foi composta por 107 profissionais,sendo 32 enfermeiras, seis técnicas de enfermagem e 09 auxiliares de enfermagem. ...

Spiritual care needs of hospitalized children and their families: a national survey of pastoral care providers' perceptions.

OBJECTIVE: Although spirituality is viewed as a vital aspect of the illness experience by most Americans, little is known about this domain of pediatric health care. The objective of this study was to profile pastoral care providers' perceptions of the spiritual care needs of hospitalized children and their parents, barriers to better pastoral care, and quality of spiritual care in children's hospitals. METHODS: A cross-sectional mail survey was conducted of pastoral care providers at children's hospitals throughout the United States, with a 67% response rate from 115 institutions. RESULTS: Respondents estimated that, among patients they visited, 34% were chronically ill and 21% were clearly dying. Half or more of patients were thought to have spiritual care needs regarding feeling fearful or anxious, coping with pain or other physical symptoms, and regarding their relationship to their parents or the relationship between their parents. Among patients' parents, 60% to 80% were estimated to have felt fearful or anxious, had difficulty coping with their child's pain or other symptoms, sought more medical information about their child's illness, questioned why they and their child were going through this experience, asked about the meaning or purpose of suffering, and felt guilty. Respondents agreed on 3 barriers to providing spiritual care: inadequate staffing of the pastoral care office, inadequate training of health care providers to detect patients' spiritual needs, and being called to visit with patients and families too late to provide all the care that could have been provided. Overall, respondents judged that their hospitals were providing 60% of what they deemed as ideal spiritual care. CONCLUSIONS: Pastoral care providers believe that the spiritual care needs of hospitalized children and their parents are diverse and extensive. With system-level barriers cited as limiting the quality of spiritual care, considerable improvement may be possible.

Neurologic disorders after measles-mumps-rubella vaccination.

OBJECTIVE: The possibility of adverse neurologic events has fueled much concern about the safety of measles-mumps-rubella (MMR) vaccinations. The available evidence concerning several of the postulated complications is controversial. The aim of this study was to assess whether an association prevails between MMR vaccination and encephalitis, aseptic meningitis, and autism. METHODS: A retrospective study based on linkage of individual MMR vaccination data with a hospital discharge register was conducted among 535 544 1- to 7-year-old children who were vaccinated between November 1982 and June 1986 in Finland. For encephalitis and aseptic meningitis, the numbers of events observed within a 3-month risk interval after vaccination were compared with the expected numbers estimated on the basis of occurrence of encephalitis and aseptic meningitis during the subsequent 3-month intervals. Changes in the overall number of hospitalizations for autism after vaccination throughout the study period were searched for. In addition, hospitalizations because of inflammatory bowel diseases were checked for the children with autism. RESULTS: Of the 535 544 children who were vaccinated, 199 were hospitalized for encephalitis, 161 for aseptic meningitis, and 352 for autistic disorders. In 9 children with encephalitis and 10 with meningitis, the disease developed within 3 months of vaccination, revealing no increased occurrence within this designated risk period. We detected no clustering of hospitalizations for autism after vaccination. None of the autistic children made hospital visits for inflammatory bowel diseases. CONCLUSIONS: We did not identify any association between MMR vaccination and encephalitis, aseptic meningitis, or autism.

Conocimientos y expectativas sobre la hospitalización en escolares de Córdoba, en el ámbito rural # / Knowledges and hopes about hospitalization in a rural area of Cordoba schoolchildren´s population

Fundamento: La edad pediátrica constituye un grupo de población especialmente vulnerable al estrés de la hospitalización. Al niño hospitalizado es necesario proporcionarle junto a los cuidados sanitarios, atención psicológica y educativa.Método: Se realiza un estudio de corte transversal de conocimientos y expectativas sobre la hospitalización en escolares de la provincia de Córdoba, en medio rural, mediante cuestionario.Resultados: Participaron niños de 8 a 13 años, de 4 colegios (n =279). El análisis de los datos obtenidos muestra que el nivel de conocimientos de los escolares resultó insuficiente, con puntuación media de 4,4 sobre 10. Dan gran importancia a los cuidados y la atención (44,8 por ciento de los niños) y a la visita de familiares y amigos (44,08 por ciento). Consideraron lo mejor del Hospital el mimo y los cuidados (37,99 por ciento) y la curación más rápida (17,92 por ciento); lo peor, el dolor y la enfermedad (17,56 por ciento) y las comidas-instalaciones-ruidos (17,20 por ciento). Para la mayoría de los niños el hospital es "aburrido" (54,48 por ciento) y "no se juega" (30,11 por ciento).Conclusiones: necesidad de incrementar y estructurar la actividad ludopedagógica y reforzar el aspecto psico-social de la atención hospitalaria en la edad pediátrica, necesidad de adaptar el hospital a las necesidades del niño (AU)

Making the invisible, visible.

Special needs children experience all the difficulties experienced by any child admitted to hospital although these are hugely magnified. Parents continue to carry the burden of care, even after hospital admission, when their child has complex needs. Nurses need to remember that these children have all the needs of any child in addition to needs specific to their disability. Nurses should focus what the child can do, rather than what they cannot do.