Recommendations for the diagnosis of pediatric tuberculosis.

Tuberculosis (TB) is still the world's second most frequent cause of death due to infectious diseases after HIV infection, and this has aroused greater interest in identifying and managing exposed subjects, whether they are simply infected or have developed one of the clinical variants of the disease. Unfortunately, not even the latest laboratory techniques are always successful in identifying affected children because they are more likely to have negative cultures and tuberculin skin test results, equivocal chest X-ray findings, and atypical clinical manifestations than adults. Furthermore, they are at greater risk of progressing from infection to active disease, particularly if they are very young. Consequently, pediatricians have to use different diagnostic strategies that specifically address the needs of children. This document describes the recommendations of a group of scientific societies concerning the signs and symptoms suggesting pediatric TB, and the diagnostic approach towards children with suspected disease.

Commuting patterns among Italian nurses: a cross-sectional study.

UNLABELLED: Commuting is an additional burden that affects working stress, reduces leisure time and raises the risk of accidents. Little data are available about nurses' commuting patterns or the impact of commuting on their lives. OBJECTIVES: The study aims to describe commuting patterns among Italian nurses and to explore possible associations with nurses' intention to change job. METHODS: This is a cross-sectional study carried out in central Italy. Nurses were invited to participate through a variety of public measures. Those participating completed an online questionnaire available on a website established for this specific purpose. RESULTS: Five hundred sixty-five nurses participated. The mean distance covered every day to go to work and back home is 30.8 km. A total of 43.3% of nurses cover 25 km or more every day to work; 5.7% cover 100 km or more. The mean time spent in commuting is 52.9 min daily. Furthermore, 14.5% of nurses spend every month commuting a time equal to or longer than the working time of 1 week. The mean monthly expenditure is 87.30 Euro (6% of mean salary). Nurses younger than 30 cover longer distances (P=0.0006), spend more time (P=0.001) and have higher expenditure (P=0.003) than their older colleagues. Willingness to change job seems associated with the use of public means of transportation (P=0.04). Nurses from the population under study cover longer distances, spend longer time in daily commuting and have higher monthly costs than the rest of the Italian workers' population. CONCLUSIONS: Travelling to work represents a non-negligible burden for nurses, particularly for younger nurses. Nurses seem to have lesser opportunities to rest and to recover energies than other workers. The Italian nurses' recruiting system may have a role in explaining our data. Further studies are needed to investigate the impact of nurses' commuting on the healthcare system.

Impact of hospitalization on the sleep patterns of newborns, infants and toddlers admitted to a pediatric ward: a cross-sectional study.

AIM: Sleep is essential for children's physical and mental recovery and it is indispensable for their growth, for endocrine and for immune function, and for the development of cognitive behavioral skills. The purpose of this study is to describe the impact of hospitalization on the sleep patterns of newborns, infants and toddlers, as well as mothers' perceptions of any changes in their children's sleep patterns. METHODS: This was a single-centre cross-sectional study. The study included children aged up to 2 years who had been hospitalized for more than two days, selected by accidental sampling. Data were collected using an anonymous questionnaire with open and closed questions administered to mothers. RESULTS: Two hundred and one children aged on average 11.2 months (SD 10.3) were enrolled in the study. The percentage of children who at home used to sleep less than 5 hours a night increased by 4.7% in hospital, while the percentage of children sleeping 9 to 11 hours at home decreased by 5.9% in hospital. In hospital mothers put their children to bed later than at home. Indeed, the number of individuals going to bed between 9 and 10 p.m. decreased by 9.8% in hospital, while the number of children going to bed between 10 and 11 p.m. increased by 10.1%. The number of children who had 2 to 4 awakenings per night increased by 13.9% and the number of those who had 4 to 6 nocturnal awakenings increased by 4.8%; 50.5% of mothers reported that their children's sleep was interrupted by nurses to provide care. Mothers generally perceived their children's sleep as adequate, even if they noticed that their children were more restless and irritable. Mothers with only one child reported that they had more difficulty helping their children fall asleep (P=0.02). CONCLUSION: The study highlights the need to review the routine in paediatric wards on the basis of the sleep needs of children. Further studies are needed to estimate the effectiveness of the specific measures suggested by mothers.