ABSTRACT
OBJECTIVES: To compare groups of urban and regional Victorian diabetic children and assess their quality of life, diabetes knowledge, access to services and metabolic control. METHODS: Forty-seven children from three regional Victorian communities (Horsham, Warrnambool and Sale; n = 16, 18 and 13, respectively) were compared with 120 age-, sex- and duration of diabetes-matched children attending the Royal Children's Hospital (RCH) diabetes clinic in Melbourne. Quality of life, diabetes knowledge, use of services, and metabolic control were assessed using the child health questionnaire (CHQ PF-50/CF-80); a diabetes-knowledge questionnaire; access to a diabetes nurse educator (DNE), dietitian and complication screening; and indices of mean HbA1C (values are taken every 3 months in the 'yearly HbA1C'), respectively. RESULTS: Comparisons of CHQ data showed that regional diabetic youth scored significantly lower on most subscales. The greatest deficits were seen in areas of mental health, self-esteem, parent impact (emotional) and family cohesion. Diabetes knowledge and median yearly HbA1C for patients were not significantly different between the regional and urban centres (8.1%, 8.9%, 8.4% and 8.6% at RCH, Horsham, Warrnambool and Sale, respectively). Patients in regional centres had reportedly less access to team-based diabetes care. CONCLUSIONS: Regional youth in Victoria, with similar levels of metabolic control and diabetes knowledge as their urban counterparts, have a markedly lower quality of life, implying a negative synergy between diabetes and the demands of regional lifestyles.
Subject(s)
Diabetes Mellitus, Type 1/therapy , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Quality of Life , Rural Health , Urban Health , Adolescent , Child , Child, Preschool , Female , Glycated Hemoglobin/metabolism , Humans , Life Style , Male , Self Care , Self Concept , VictoriaABSTRACT
OBJECTIVE: Australian screening programmes for congenital dislocation of the hip (CDH) are characterized by lower neonatal hip instability (NHI) detection rates than more successful international programmes. Through creating a quality, accountable clinical screening programme for NHI detection, the present study aimed to establish the true incidence of NHI in Australian babies and to eliminate 'late diagnosed' CDH. METHODS: Doctors responsible for routine neonatal care were made accountable for NHI detection and examined 5166 consecutive live births in the first days of life between 1989 and 2000. Techniques for clinical NHI detection were taught, and doctors practised with teaching-mannequins. Paediatricians clinically determined true positive NHI cases and managed them for a 12-month period. Peer review of NHI detection rates was introduced to encourage accountability. Surveillance for 'late diagnosed' CDH occurred regularly through a variety of methods. RESULTS: One hundred babies with NHI were detected (19.4 per 1000): 77% were female; 26% were breech presentation, 25% had a family history of hip instability; and all received some form of splinting. Follow up for 85% of these babies at 12 months revealed no significant complications. Extensive searching has revealed no baby with 'late diagnosed' CDH from the study population in 12 years. One baby commenced treatment late (at 4 months) because of a failure of process following early NHI detection. CONCLUSIONS: The true incidence of NHI in Australia is > or =19 per 1000 births. Successful clinical CDH screening programmes using primary care doctors can be created and might eliminate 'late diagnosed' CDH.
Subject(s)
Hip Dislocation, Congenital/diagnosis , Mass Screening , Australia/epidemiology , Female , Hip Dislocation, Congenital/classification , Hip Dislocation, Congenital/epidemiology , Humans , Incidence , Infant, Newborn , Male , Prospective Studies , Severity of Illness Index , Sex DistributionABSTRACT
This is the second reported case of duplication for the segment 10q22.1-q25.1, the first having been in a fetal case. The phenotype is documented in a 12 year old girl, who is mentally retarded and has a distinctive facial dysmorphology.
Subject(s)
Abnormalities, Multiple/genetics , Chromosomes, Human, Pair 10 , Gene Duplication , Mutagenesis, Insertional , Child , Face/abnormalities , Female , Humans , KaryotypingABSTRACT
OBJECTIVE: To present the first case of Munchausen syndrome by proxy involving self-induced preterm delivery. CLINICAL FEATURES: A 27-year-old Caucasian woman induced antepartum haemorrhage and rupture of membranes with a knitting needle at 26 weeks' gestation, leading to delivery of the infant. This "prenatal child abuse" led to a prolonged intensive care stay, extensive treatment and subsequent bronchopulmonary dysplasia. As the child recovered from the effects of extreme prematurity, he became a victim of fabricated illness and recurrent smothering episodes. INTERVENTION AND OUTCOME: After the diagnosis of Munchausen syndrome by proxy was made, the child was removed from the mother and he has since enjoyed good health. CONCLUSION: Self-induction of antepartum haemorrhage can lead to preterm delivery and may be recognisable by certain clinical parameters. The victim of self-induced preterm delivery, if survival ensues, may be subject to further abuse.
