The mutual prospective influence of child and parental post-traumatic stress symptoms in pediatric patients.

BACKGROUND: Previous studies found notable rates of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) in pediatric patients and their parents and suggest a significant association between child and parent PTSS. However, little is known about mutual influences between child and parental PTSS over time. This study prospectively examined the presence of PTSS and PTSD and the mutual influence of child and parental PTSS in a large sample of pediatric patients with different medical conditions. METHODS: A total of 287 children (aged 6.5-16 years) and their mothers (n = 239) and fathers (n = 221) were assessed at 5-6 weeks and 1 year after an accident or a new diagnosis of cancer or diabetes mellitus type 1 in the child. RESULTS: At the first assessment 11.1% and at the second assessment 10.2% of the children had moderate to severe PTSS. At 5-6 weeks 29.3% of mothers and 18.6% of fathers met criteria for PTSD. At 1 year the rates were 14.6% for mothers and 7.9% for fathers. There were considerable differences of PTSS among different medical diagnostic groups in children and parents. Mothers were more vulnerable than fathers. Structural equation analysis revealed that initially high PTSS in mothers and fathers were longitudinally related to poorer recovery from PTSS in the child. Cross-lagged effects from the child to the parents and from one parent to the other were not significant. CONCLUSIONS: This study highlights the long-term influence of parental PTSS on the child's recovery after trauma and calls for a family systems approach and for early interventions in the treatment of traumatized pediatric patients.

Post-traumatic stress impacts on quality of life in children after road traffic accidents: prospective study.

OBJECTIVE: There is little knowledge on health-related quality of life (HRQOL) of injured children and adolescents after road traffic accidents (RTA). Although findings in injured adults suggest that post-traumatic stress symptoms (PTSS) may be important predictors of HRQOL, this issue has never been prospectively examined in children. The aim of the present study was therefore to prospectively assess HRQOL in children after RTA and specifically examine the impact of PTSS on HRQOL. METHOD: Sixty-eight children (aged 6.5-14.5 years) were interviewed 1 month and 1 year after an RTA using the Child PTSD Reaction Index and the Toegepast Natuurwetenschappelijk Onderzoek-Academisch Ziekenhuis Leiden (TNO-AZL) Questionnaire for Children's Health-Related Quality of Life. Parents and physicians were assessed with questionnaires. RESULTS: Eleven children (16.2%) showed moderate to severe post-traumatic stress reactions at 1 month, and 12 children (17.6%) at 1 year. At 1 month, patients reported reduced motor functioning and autonomy and impairments in some parts of emotional functioning compared to a community sample. At 1 year all dimensions of HRQOL were within or above normal ranges. Multivariate analysis indicated that PTSS at 1 month significantly predicted HRQOL at 1 year. CONCLUSIONS: This prospective study provides evidence for a long-term negative influence of early PTSS on HRQOL in injured children. The return of injured children to pre-injury HRQOL may therefore not only depend on optimal medical care but also on awareness and timely interventions regarding PTSS.

A multicenter, cross-sectional study on the prevalence and risk factors for nasal colonization with Staphylococcus aureus in patients admitted to children's hospitals in Switzerland.

The rate of nasal carriage of Staphylococcus aureus and associated risk factors were determined in a cross-sectional study involving Swiss children's hospitals. S. aureus was isolated in 562 of 1363 cases. In a stepwise multivariate analysis, the variables age, duration of antibiotic use, and hospitalization of a household member were independently associated with carriage of S. aureus.

Tick-borne encephalitis in Swiss children 2000-2004: five-year nationwide surveillance of epidemiologic characteristics and clinical course.

Tick-borne encephalitis occurred in 55 children, ranging from 6 weeks to 15 years old. Average annual incidence was 1.0 per 100,000 in all children, and 0.4 per 100,000 in children less than 6 years old. Moderate to severe residua were present in 5 patients (9%) at hospital discharge and in one 9-year-old patient (1.8%) at follow-up. Permanent residua occur in children approximately 10 times less often than in adults.

A fatal tick bite occurring during the course of tick-borne encephalitis vaccination.

In Western Europe tick-borne encephalitis virus infections with fatal outcome are rare, especially in children. We report the case of an adolescent who died of meningoencephalitis after a tick bite that occurred between the first 2 tick-borne encephalitis vaccinations. The case demonstrates the difficulty of differentiating possible adverse events associated with the immunization from symptoms of simultaneous infection with tick-borne encephalitis virus.

Prevalence of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) in children a multicenter cross-sectional study.

In this cross-sectional multicenter study, we determined the rate of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) in children admitted to 9 training hospitals in Switzerland during 1 month. From 1337 patients, 1363 nasal swabs were obtained (mean age 6.1 years, median 4.7 years, interquartile range 1.3-10.4 years) and 562 (41.3%) grew S. aureus. Only one isolate was MRSA (0.18%) which encoded mecA and femA genes as well as SCCmec type IV, whereas Panton-Valentine leukocidin (PVL) was absent.

Health-related quality of life in children with newly diagnosed cancer: a one year follow-up study.

BACKGROUND: Most studies on health-related quality of life (HRQOL) in children with cancer focussed on survivors. Only few studies have evaluated patients during ongoing oncological treatment. The aim of this study was a prospective assessment of HRQOL in children during the first year after diagnosis of cancer and an examination of demographic, medical, and parental predictors of HRQOL. METHODS: Fifty-two patients (mean age: 10.9 years) were assessed 6 weeks and 1 year after diagnosis with the TNO-AZL Questionnaire for Children's Health-Related Quality of Life. Parents completed the Brief Symptom Inventory. RESULTS: Compared to a community sample, patients reported more physical complaints, reduced motor functioning and autonomy, and impaired positive emotional functioning 6 weeks after diagnosis. HRQOL significantly improved over the year. However, at 1 year, patients still showed reduced motor and emotional functioning. At 6 weeks, children with leukemia were most affected. At 1 year, patients with brain tumors complained about more physical symptoms than the other groups. Intensity of treatment and presence of medical complications mainly influenced HRQOL at 6 weeks but less at 1 year. Parental psychopathology was associated with better cognitive functioning in the child. CONCLUSION: This prospective study found several domains of HRQOL to be compromised 6 weeks and 1 year after the diagnosis of cancer. Although HRQOL significantly increased over the year, there were important differences between diagnostic groups. The findings highlight the importance of repeated evaluation of HRQOL in children undergoing cancer treatment and consideration of specific differences between diagnostic groups.

Predicting posttraumatic stress symptoms in children after road traffic accidents.

OBJECTIVE: To prospectively assess the prevalence, course, and predictors of posttraumatic stress symptoms (PTSSs) in children after road traffic accidents (RTAs). METHOD: Sixty-eight children (6.5-14.5 years old) were interviewed 4-6 weeks and 12 months after an RTA with the Child PTSD Reaction Index (response rate 58.6%). Their mothers (n = 60) and fathers (n = 53) were assessed with the Posttraumatic Diagnostic Scale. RESULTS: The prevalence of moderate to severe PTSSs in children was 16.2% at 4-6 weeks, and 17.6% at 12 months. Mean PTSS scores did not decrease between the two assessments. Five children showed a delayed onset of PTSSs. Twelve mothers (20%) and six fathers (11.3%) met criteria for posttraumatic stress disorder (PTSD) at 4 to 6 weeks. At 12 months, three mothers (5.7%) and no fathers met diagnostic criteria. Child PTSSs at 12 months was significantly predicted by PTSS at 4-6 weeks and by severity of father's PTSD. Age, sex, injury severity, threat appraisal, and maternal PTSD did not significantly contribute to child PTSSs at follow-up. CONCLUSIONS: There is a need for careful psychological assessment of children and their parents after an RTA. The possibility of delayed onset of PTSSs implies a monitoring beyond the first weeks after the accident. The impact of fathers' PTSD on child PTSSs suggests that fathers ought to be actively involved in family-based prevention and treatment interventions of child PTSSs after RTAs.

Prospective study of posttraumatic stress disorder in parents of children with newly diagnosed type 1 diabetes.

OBJECTIVE: To determine the prevalence, course, and predictors of posttraumatic stress disorder (PTSD) in mothers and fathers of children with newly diagnosed type 1 diabetes. METHOD: Forty-nine mothers and 48 fathers of 52 children (response rate 65%) with newly diagnosed diabetes (age 6.5-15 years) were assessed at 6 weeks, 6 months, and 12 months after the diagnosis with the Posttraumatic Diagnostic Scale. RESULTS: The prevalence of current PTSD in mothers was 22.4% at 6 weeks, 16.3% at 6 months, and 20.4% at 12 months. In fathers, PTSD was found in 14.6%, 10.4%, and 8.3%, respectively. Mothers endorsed more symptoms of PTSD at all assessments. Multivariate analyses controlling for demographics, metabolic control, and threat appraisals revealed that in mothers, the number of preceding life events and PTSD symptoms at 6 months predicted PTSD at 12 months. In fathers, PTSD severity at 6 months was the only significant predictor for PTSD at 12 months. CONCLUSIONS: The results suggest that the diagnosis and treatment of diabetes in their child constitute traumatic events for parents. The findings confirm the applicability of a posttraumatic stress model for investigating the psychological impact of diabetes on parents.

Congenital tuberculosis in a premature infant.

Congenital tuberculosis was first suspected in a premature infant with patent ductus arteriosus (PDA), progressive respiratory distress and septic shock, when an enlarged mediastinal lymph node was noted intraoperatively at the time of PDA ligature. Culture revealed Mycobacterium tuberculosis. The asymptomatic mother was subsequently diagnosed with urogenital tuberculosis.

Evaluation of the compliance with recommended procedures in newborns exposed to HBsAg-positive mothers: a multicenter collaborative study.

BACKGROUND: Maternal-infant transmission of hepatitis B virus (HBV) during birth carries a high risk for chronic HBV infection in infants with frequent subsequent development of chronic disease. This can be efficiently prevented by early immunization of exposed newborns. The purpose of this study was to determine the compliance with official recommendations for prevention of perinatal HBV transmission in hepatitis B surface antigen (HBsAg) exposed infants. METHODS: Records of pregnant women at 4 sites in Switzerland, admitted for delivery in 2005 and 2006, were screened for maternal HBsAg testing. In HBsAg-exposed infants, recommended procedures (postnatal active and passive immunization, completion of immunization series, and serological success control) were checked. RESULTS: Of 27,131 women tested for HBsAg, 194 (0.73%) were positive with 196 exposed neonates. Of these neonates, 143 (73%) were enrolled and 141 (99%) received simultaneous active and passive HBV immunization within 24 hours of birth. After discharge, the HBV immunization series was completed in 83%. Only 38% of children were tested for anti-HBs afterwards and protective antibody values (>100 U/L) were documented in 27% of the study cohort. No chronically infected child was identified. Analysis of hospital discharge letters revealed significant quality problems. CONCLUSIONS: Intensified efforts are needed to improve the currently suboptimal medical care in HBsAg-exposed infants. We propose standardized discharge letters, as well as reminders to primary care physicians with precise instructions on the need to complete the immunization series in HBsAg-exposed infants and to evaluate success by determination of anti-HBs antibodies after the last dose.

Coping with an HIV infection. A multicenter qualitative survey on HIV positive adolescents' perceptions of their disease, therapeutic adherence and treatment.

HIV-positive adolescents face a number of challenges in dealing with their disease and its treatment. In this qualitative study, twenty-nine HIV-positive adolescents aged 13 to 20 years (22 girls), who live in Switzerland, were asked, in a semi-structured interview (duration of 40-110 minutes), to describe their perceptions and experiences with the disease itself and with therapeutic adherence. While younger adolescents most often thought of their disease as fate, older adolescents usually knew that they had received it through vertical transmission, although the topic appeared to be particularly difficult to discuss for those living with their HIV-positive mothers. Based on their attending physician's assessment, 18 subjects were judged highly adherent, 4 fairly and 7 poorly adherent. High adherence appeared linked with adequate psychological adjustment and effective coping mechanisms, as well as with the discussion and adoption of explicit medication-taking strategies. The setting and organisation of health care teams should allow for ongoing discussions with HIV-positive adolescents that focus on their perceptions of their disease, how they cope with it and with the treatment, and how they could improve their adherence.

Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology.

UNLABELLED: The aim of this study was to obtain comprehensive data on clinical presentation, microbiology, computed tomography, surgical findings and histology in acute, sub-acute and chronic mastoiditis. We performed a prospective, observational study in children under 16 years of age presenting to our institution during the 2-year period beginning in April 2000. The children were examined and their condition treated in accordance with a standardized protocol elaborated by the paediatric, otolaryngology (ORL) and radiology departments. Thirty-eight patients were hospitalized (22 with acute mastoiditis, seven with sub-acute mastoiditis, nine with chronic mastoiditis). There were 30 complications present in 21 patients (55%). Streptococcus pyogenes was the most common pathogen (7/24 cases), followed by Streptococcus pneumoniae (4/24 cases). Mastoid surgery was performed in 29 patients. Histology of mastoid tissue revealed predominantly acute inflammation in two cases, mixed acute/chronic inflammation in 19 cases and predominantly chronic inflammation in seven cases. Radiologic data were evaluated retrospectively. Spiral, volume-based high-resolution (HR) computed tomography (CT) of the temporal bone had a sensitivity of 100%, specificity of 38%, positive predictive value (PPV) of 50% and negative predictive value (NPV) of 100% in detecting coalescence of mastoid trabeculae. Cranial CT with contrast had a sensitivity of 80%, specificity of 94%, PPV of 80% and NPV of 94% in identifying intra-cranial extension. CONCLUSION: histological evidence suggests that sub-acute/chronic infection underlies not only sub-acute and chronic mastoiditis, but most cases of acute mastoiditis as well. HR-CT of the temporal bone is effective in ruling out coalescence. Cranial CT is valuable in identifying intra-cranial extension. Cranial and HR-CT are recommended in the examination of children with mastoiditis.

Prediction of posttraumatic stress in fathers of children with chronic diseases or unintentional injuries: a six-months follow-up study.

BACKGROUND: While fathers were neglected for a long time in research investigating families of pediatric patients, there are now a few studies available on fathers' posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD). However, little is known about the course of PTSS and PTSD in fathers of pediatric patients. The present study aimed to compare the prevalence and course of PTSS and PTSD in fathers of children with different chronic and acute conditions and to identify factors that contribute to fathers' PTSS. METHODS: Sixty-nine fathers of children newly diagnosed with either cancer, type I diabetes mellitus, or epilepsy and 70 fathers of children suffering from an unintentional injury completed questionnaires at 4-6 weeks (Time 1) and six months (Time 2) after diagnosis or injury. RESULTS: Noticeable PTSD rates were found in fathers of children with a chronic disease (26% at Time 1 and 21% at Time 2, respectively). These rates were significantly higher than rates found in fathers of children with unintentional injuries (12% at Time 1 and 6% at Time 2, respectively). Within six months after the child's diagnosis or accident a decrease in severity of PTSS was observed in both groups. Significant predictors of PTSS at Time 2 were the father's initial level of PTSS, the child's medical condition (injuries vs. chronic diseases) and functional status, the father's use of dysfunctional coping strategies, and father's level of neuroticism. CONCLUSION: Our findings suggest that fathers with initially high PTSS levels are at greater risk to experience PTSS at follow-up, particularly fathers of children with a chronic disease. Sensitizing health care professionals to the identification of PTSS symptoms but also to indicators of neuroticism and the use of specific coping strategies early in the treatment course is essential for the planning and implementation of adequate intervention strategies.

Early appearance of bactericidal antibodies after polysaccharide challenge of toddlers primed with a group C meningococcal conjugate vaccine: what is its role in the maintenance of protection?

The contribution of memory responses after meningococcal vaccination to protection may depend on the rapidity of the response. Toddlers were challenged with a licensed polysaccharide (PS) vaccine 1 year after vaccination with a single dose of meningococcal group C-CRM(197) conjugate (MCC) vaccine at the age of 12 to 15 months. Bactericidal antibodies and immunoglobulin G (IgG) antibodies detected by an enzyme-linked immunosorbent assay (ELISA) were measured before challenge and 4, 7, 14, or 21 Days later ("Days" refer to treatment groups, "days" to sampling days). Among 281 subjects in the intent-to-treat population, 173 per-protocol (PP) subjects were challenged with 10 microg PS antigen and 103 others with a 50-microg PS vaccinating dose. Capsular PS-specific ELISA IgG titers were negligible in baseline samples and increased only twofold within 4 days of PS administration. In contrast, the proportion of PP subjects with serum bactericidal antibody (SBA) titers of >or=1:8 or >or=1:128 increased, respectively, from 41% and 16% before challenge to 84% and 74% at Day 4 and to 100% and 97% at Day 7. Recipients of 50 microg PS responded with similar kinetics but showed a trend toward higher antibody levels. Unexpectedly, 69% of subjects bled on days 2 to 3 already had achieved SBA titers of >or=1:8. The majority of toddlers previously immunized with MCC and challenged 1 year later with PS antigen mounted protective levels of bactericidal antibody within 2 to 4 days.

Incidence and associations of parental and child posttraumatic stress symptoms in pediatric patients.

BACKGROUND: Previous studies consistently found remarkable prevalence rates of posttraumatic stress symptoms (PTSS) and posttraumatic stress disorders (PTSD) in pediatric patients and their parents. Findings suggest a significant association between child and parent PTSS. The present study examined, in a sample of pediatric patients with different conditions, incidence rates and determinants of PTSS and PTSD in the patients, and their mothers and fathers. Also, associations of maternal, paternal and child PTSS and PTSD were analyzed. METHOD: Two hundred and nine children (aged 6.5-14.5 years) were interviewed 5-6 weeks after an accident or a new diagnosis of cancer or diabetes mellitus type 1 by means of the Child PTSD Reaction Index. Their mothers (n = 180) and fathers (n = 175) were assessed with the Posttraumatic Diagnostic Scale. RESULTS: Children reported PTSS levels in the mild range. Sixteen percent of the fathers and 23.9% of the mothers met full DSM-IV diagnostic criteria for current PTSD. Type of trauma impacted differently on parents and children. In children, accident-related injury was associated with higher PTSS scores. Conversely, in parents, diagnosis of cancer in their child was associated with more symptoms. Functional status of the child was also found to be an important predictor of PTSS in children and parents. PTSS scores of mothers and fathers were significantly correlated with each other. However, child PTSS were not significantly related to PTSS of mothers and fathers. This was true for total scores as well as for DSM-IV symptom clusters. CONCLUSIONS: There is a need for careful evaluation of PTSS and PTSD in pediatric patients with accidental injuries or sudden onset of severe chronic diseases and in their respective parents. Importantly, children, their mothers, and their fathers should be assessed separately, because a significant association between child and parental PTSS may not exist.

A pair of monozygotic twins with anomalous pancreaticobiliary junction and pancreatitis.

The authors describe a pair of white 7-year-old monozygotic twin girls with the same anomaly of the pancreaticobiliary junction (APBJ), in whom the clinical presentation and disease evolution are slightly divergent. The pathogenesis and genetic control of the disease are discussed.

Posttraumatic stress disorder in parents of children with newly diagnosed type 1 diabetes.

OBJECTIVE: To determine rates of posttraumatic stress disorder (PTSD) and symptoms in mothers and fathers of children with newly diagnosed type 1 diabetes. METHODS: Parents of 38 children with newly diagnosed type 1 diabetes were assessed with the Posttraumatic Diagnostic Scale 6 weeks after diagnosis. RESULTS: Twenty-four percent of the mothers and 22% of the fathers met full diagnostic criteria for current PTSD. In addition, 51% of the mothers and 41% of the fathers met criteria for partial or subclinical PTSD. Co-occurence of PTSD in couples was very low. Posttraumatic stress symptomatology did not correlate with age and gender of the child, socioeconomic status, family structure, or length of hospital stay. CONCLUSIONS: The findings support applicability of a posttraumatic stress model for investigating the psychological impact of type 1 diabetes on parents.