ABSTRACT
An ethical challenge arose when the parents of an adolescent girl living with severe intellectual disability requested for a permanent surgical intervention (hysterectomy) that would cause cessation of menstruation and reduce the possibility of pregnancy following nonconsensual sex. The family background was rural with poor access to extended family/community support, financial and social welfare resources. The parental distress was real with the adolescent incompetent to give informed consent. Is a non-therapeutic hysterectomy in an adolescent living with severe intellectual disability ethical? Views of a pediatrician, adolescent specialist, nurse, and an ethicist referring to literature suggesting an approach to an ethical decision are discussed herein.
Subject(s)
Intellectual Disability , Female , Pregnancy , Humans , Adolescent , Informed Consent , Menstruation , ParentsABSTRACT
JUSTIFICATION: Neurodevelopmental disorders, as per DSM-V, are described as a group of conditions with onset in the development period of childhood. There is a need to distinguish the process of habilitation and rehabilitation, especially in a developing country like India, and define the roles of all stakeholders to reduce the burden of neurodevelopmental disorders. PROCESS: Subject experts and members of Indian Academy of Pediatrics (IAP) Chapter of Neurodevelopmental Pediatrics, who reviewed the literature on the topic, developed key questions and prepared the first draft on guidelines. The guidelines were then discussed by the whole group through online meetings, and the contentious issues were discussed until a general consensus was arrived at. Following this, the final guidelines were drafted by the writing group and approved by all contributors. OBJECTIVES: These guidelines aim to provide practical clinical guidelines for pediatricians on the prevention, early diagnosis and management of neurodevelopmental disorders (NDDs) in the Indian settings. It also defines the roles of developmental pediatricians and development nurse counselor. STATEMENT: There is a need for nationwide studies with representative sampling on epidemiology of babies with early NDD in the first 1000 days in India. Specific learning disability (SLD) has been documented as the most common NDD after 6 years in India, and special efforts should be made to establish the epidemiology of infants and toddlers at risk for SLD, where ever measures are available. Preconception counseling as part of focusing on first 1000 days; Promoting efforts to organize systematic training programs in Newborn Resuscitation Program (NRP); Lactation management; Developmental follow-up and Early stimulation for SNCU/ NICU graduates; Risk stratification of NICU graduates, Newborn Screening; Counseling parents; Screening for developmental delay by trained professionals using simple validated Indian screening tools at 4, 8, 12, 18 and 24 months; Holistic assessment of 10 NDDs at child developmental clinics (CDCs) / district early intervention centre (DEICs) by multidisciplinary team members; Confirmation of diagnosis by developmental pediatrician/developmental neurologist/child psychiatrist using clinical/diagnostic tools; Providing parent guided low intensity multimodal therapies before 3 years age as a center-based or home-based or community-based rehabilitation; Developmental pediatrician to seek guidance of pediatric neurologist, geneticist, child psychiatrist, physiatrist, and other specialists, when necessary; and Need to promote ongoing academic programs in clinical child development for capacity building of community based therapies, are the chief recommendations.
Subject(s)
Neurodevelopmental Disorders , Child , Humans , Infant , Infant, Newborn , Academies and Institutes , Early Diagnosis , India , Neurodevelopmental Disorders/diagnosis , Neurodevelopmental Disorders/epidemiology , Neurodevelopmental Disorders/prevention & controlABSTRACT
BACKGROUND: Childhood asthma is a common, and often serious, chronic disease with episodic exacerbations in infants and children. There is an increasing trend in the prevalence of childhood asthma in developing countries. Objectives: To identify the determinants of childhood asthma. METHODS: A case control study with 30 cases of childhood asthma and 30 gender- and aged-matched controls selected from the paediatric outpatient department and paediatric ward of a tertiary hospital. The primary caregiver was interviewed to capture sociodemographic details, prenatal and birth history, and history of exposure to environmental risk factors. Odds ratios with 95% confidence intervals were calculated to determine the strength of association between childhood asthma and independent co-variates, followed by subgroup multiple logistic regression analysis. RESULTS: We found that children with a parental history of allergy/atopy [OR=2.88 (1.94-4.27), P<0.001], residence in houses located in industrial areas [AOR=2.72 (2.6-323.1), P<0.001], exposure to incense at home [AOR=2.03 (1.14-29.42), P<0.001], or a history of allergic rhinitis [AOR=3.09 (2.22-243.25), P<0.001] had significantly higher odds of developing childhood asthma. CONCLUSION: Our study found that having homes located in industrial areas, burning incense at home, parental history of allergy, and history of allergic rhinitis in the child are determinants of childhood asthma. The findings from our study can be used to generate awareness regarding risk factors that are linked to childhood asthma.
Subject(s)
Asthma , Rhinitis, Allergic , Infant , Female , Pregnancy , Humans , Child , Aged , Tertiary Care Centers , Case-Control Studies , Asthma/epidemiology , Asthma/etiology , Rhinitis, Allergic/epidemiology , India/epidemiologyABSTRACT
Early childhood development (ECD) refers to the physical, motor, socio-emotional, cognitive, and linguistic development of a young child. The 'Countdown to 2030' global distribution of 'children at risk of poor development' indicates the need for urgent action and investment in ECD. Nurturing care enhances ECD, even in the presence of adversities. Strategic actions should exist at multiple levels: the family, community, health care providers and government. Previously, child health related policies and programs of the Government of India functioned in isolation, but have recently started demonstrating multi-sectoral collaboration. Nonetheless, the status of ECD in India is far from optimal. There is strong evidence that parenting programs improve outcomes related to ECD. This is dependent on key programmatic areas (timing, duration, frequency, intensity, modality, content, etc.), in addition to political will, funding, partnership, and plans for scaling up. Each country must implement its unique ECD program that is need-based and customized to their stakeholder community. Barriers like inadequate sensitization of the community and low competency of health care providers need to be overcome. IAP firmly believes that responsive parenting interventions revolving around nurturing care should be incorporated in office practice. This paper outlines IAP's position on ECD, and its recommendations for pediatricians and policy makers. It also presents the roadmap in partnership with other stakeholders in maternal, neonatal, and child health; Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum (NNF), World Health Organization (WHO), and United Nation Children Fund (UNICEF).
Subject(s)
Child Development , Neonatology , Academies and Institutes , Child , Child Health , Child, Preschool , Female , Humans , Infant, Newborn , Parenting , PregnancyABSTRACT
The availability of population-based epidemiological data on the incident risk of stroke is very scarce in Argentina and other Latin American countries. In response to the priorities established by the World Health Organization and the United Nations, PREVISTA was envisaged as a population-based program to determine the risk of first-ever and recurrent stroke and transient ischemic attack incidence and mortality in Tandil, Buenos Aires, Argentina. The study will be conducted according to Standardized Tools for Stroke Surveillance (STEPS Stroke) methodology and will enroll all new (incident) and recurrent consecutive cases of stroke and transient ischemic attack in the City of Tandil between May 1st, 2013 and April 30, 2015. The study will include patients with ischemic stroke, non-traumatic primary intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack. To ensure the inclusion of every cerebrovascular event during an observation period of two years, we will instrument an 'intensive screening program', consisting of a comprehensive daily tracking of every potential event of stroke or transient ischemic attack using multiple overlapping sources. Mortality would be determined during follow-up for every enrolled patient. Also, fatal community events would be screened daily through revision of death certificates at funeral homes and local offices of vital statistics. All causes of death will be adjudicated by an ad-hoc committee. The close population of Tandil is representative of a large proportion of Latin-American countries with low- and middle-income economies. The findings and conclusions of PREVISTA may provide data that could support future health policy decision-making in the region.
Subject(s)
Stroke/epidemiology , Argentina/epidemiology , Humans , Incidence , Research DesignABSTRACT
PURPOSE: Infantile tuberculosis is common in developing countries and rarely presents as space occupying thoracic lesions mimicking congenital malformations. This case series reviews four such infants with varied presentations and their outcome. METHODS: Four cases of infantile pulmonary/mediastinal tuberculosis that presented like congenital thoracic lesions are described. Details of demography, symptomatology, contact history, immunization status, provisional diagnosis, tuberculin testing, imaging, histopathology, final diagnosis, management and outcome were retrospectively collated and analyzed. RESULTS: They were 4-6-month males, term-born and immunized. They presented with pneumonia/hyperactive airway disease since 2-12 weeks. One had a suspect and another a close tuberculous contact. The provisional diagnosis after imaging were infected congenital lung cyst, posterior mediastinal cyst and bronchopulmonary malformation. Two were tuberculin positive; none had gastric acid-fast bacilli. One underwent a pulmonary lobectomy for necrotic lung cyst; the second had a biopsy and drainage of a posterior mediastinal cyst that contained caseating material and was densely adherent to the esophagus. Surgical biopsy showed necrotizing granulomatous inflammation in both; one with acid-fast bacilli. Both succumbed to postoperative complications. The other two with tuberculous contacts who were managed with early antituberculous therapy, responded well and recovered uneventfully. CONCLUSIONS: Infantile pulmonary/mediastinal tuberculosis may mimic congenital thoracic malformations. A review of contact history, investigations and imaging help to establish the tuberculous etiology, avoids surgical misadventures and prompts early antituberculous therapy to achieve a favorable outcome.
Subject(s)
Tuberculosis, Pulmonary/diagnosis , Congenital Abnormalities/diagnosis , Diagnosis, Differential , Humans , Infant , Lung/abnormalities , Male , Retrospective Studies , Thorax/abnormalitiesABSTRACT
Objetivos: Incorporar los consultorios externos programados de Clínica del Hospital Nacional Posadas (CEP) a una red preventivo- asistencial, de complejidades crecientes dentro de la estrategia de APS. Desarrollar la gestión intersectorial para la organización de una red entre el 1º nivel de atención de los partidos de Morón e Ituzaingó y los CEP de Clínica del Hospital Posadas. Desarrollar nuevos procesos de trabajo para la circulación de personas con hipertensión arterial, diabetes, dislipemia y controles de salud entre el 1º nivel de los municipios participantes y el 2º nivel del H. Posadas. Aumentar la accesibilidad a tratamientos articulando con el Plan Remediar en el 1º nivel de atención. Desarrollar un programa de formación de residentes de clínica en el 1º nivel de atención. Facilitar la derivación entre el 1º y 2º nivel según complejidad de necesidades para otros problemas de salud. Promover prácticas que prevengan daños secundarios a estas 3 enfermedades y hábitos saludables en personas que solicitan controles de salud.
Subject(s)
Argentina , Primary Health Care , Community Networks , Fellowships and ScholarshipsABSTRACT
Objetivos: Incorporar los consultorios externos programados de Clínica del Hospital Nacional Posadas (CEP) a una red preventivo- asistencial, de complejidades crecientes dentro de la estrategia de APS. Desarrollar la gestión intersectorial para la organización de una red entre el 1º nivel de atención de los partidos de Morón e Ituzaingó y los CEP de Clínica del Hospital Posadas. Desarrollar nuevos procesos de trabajo para la circulación de personas con hipertensión arterial, diabetes, dislipemia y controles de salud entre el 1º nivel de los municipios participantes y el 2º nivel del H. Posadas. Aumentar la accesibilidad a tratamientos articulando con el Plan Remediar en el 1º nivel de atención. Desarrollar un programa de formación de residentes de clínica en el 1º nivel de atención. Facilitar la derivación entre el 1º y 2º nivel según complejidad de necesidades para otros problemas de salud. Promover prácticas que prevengan daños secundarios a estas 3 enfermedades y hábitos saludables en personas que solicitan controles de salud.
Subject(s)
Argentina , Primary Health Care , Community Networks , Fellowships and ScholarshipsABSTRACT
Objetivos: Incorporar los consultorios externos programados de Clínica del Hospital Nacional Posadas (CEP) a una red preventivo- asistencial, de complejidades crecientes dentro de la estrategia de APS. Desarrollar la gestión intersectorial para la organización de una red entre el 1º nivel de atención de los partidos de Morón e Ituzaingó y los CEP de Clínica del Hospital Posadas. Desarrollar nuevos procesos de trabajo para la circulación de personas con hipertensión arterial, diabetes, dislipemia y controles de salud entre el 1º nivel de los municipios participantes y el 2º nivel del H. Posadas. Aumentar la accesibilidad a tratamientos articulando con el Plan Remediar en el 1º nivel de atención. Desarrollar un programa de formación de residentes de clínica en el 1º nivel de atención. Facilitar la derivación entre el 1º y 2º nivel según complejidad de necesidades para otros problemas de salud. Promover prácticas que prevengan daños secundarios a estas 3 enfermedades y hábitos saludables en personas que solicitan controles de salud.
