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1.
Medicine (Baltimore) ; 100(5): e23786, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592835

RESUMO

ABSTRACT: Community acquired-pneumonia (CAP) has varying causative pathogens and clinical characteristics. This study investigated the prevalence of Mycoplasma pneumoniae (M pneumoniae) and evaluated the clinical characteristics in infected hospitalized children by disease severity.From throat swabs of hospitalized children (5 months to 14 years) with CAP collected between November 2017 and May 2018, M pneumoniae and other CAP pathogens were identified using polymerase chain reaction (PCR). Differences in clinical and laboratory test data were compared between severe and mild case groups.Of 333 hospitalized children enrolled, 221/333 (66.4%) tested positive for M pneumoniae and 24/221 (10.9%) patients were (n = 9, aged <5 years vs n = 15, ≥5 years) single infection by PCR, however, only 170/333 (51.1%) patients were presented with M pneumoniae IgM-positive. M pneumoniae detection rate by PCR was higher than by immunoglobulin (IgM) serology. In 123/221 (55.7%) M pneumoniae infected patients, coinfection with bacterial pathogens (n = 61, <5 years vs n = 62, ≥5 years) occurred. Children (aged 3-8 years) had most M pneumoniae infection. Severe M pneumoniae pneumonia (MPP) in children occurred mostly in older age (7 [interquartile ranges {IQR}, 6-8] years; P < .0001), with longer cough days (14 [IQR, 10-19.5] days; P = .002) and hospitalization duration (9.5 [IQR, 7-12.3] days; P < .0001), lower lymphocyte ratio (24.1, [IQR, 20.0-31.1] %; P = .001), higher neutrophils ratio (66.0, [IQR, 60.2-70.3]%; P < .0001), and serum C-reactive protein (CRP) level (3.8, [IQR, 1.3-10.9] mg/L; P = .027).M pneumoniae is the most commonly detected pathogen in CAP. High coinfection prevalence increases diagnosis difficulty by clinically nonspecific characteristics. M pneumoniae detection by PCR with IgM may improve precise and reliable diagnosis of community-acquired MPP.


Assuntos
Criança Hospitalizada/estatística & dados numéricos , Infecções Comunitárias Adquiridas/epidemiologia , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/epidemiologia , Adolescente , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Criança , Pré-Escolar , China/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Lactente , Masculino , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/microbiologia , Reação em Cadeia da Polimerase , Prevalência
2.
J Surg Res ; 257: 232-238, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862050

RESUMO

BACKGROUND: The purpose of this study was to identify the pattern of injuries that relates to abuse and neglect in children with burn injuries. METHODS: The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged less than 18 y admitted with burn injuries. The primary outcome was child maltreatment identified at the index admission. The secondary outcome was readmission for maltreatment. A subgroup analysis was performed on patients without a diagnosis of maltreatment during the index admission. Multivariable logistic regression was performed for each outcome. RESULTS: There were 57,939 admissions identified and 1960 (3.4%) involved maltreatment at the index admission. Maltreatment was associated with total body surface area burned >20% (odds ratio (OR) 2.79, P < 0.001) and burn of the lower limbs (OR 1.37, P < 0.001). Readmission for maltreatment was found in 120 (0.2%), and the strongest risk factor was maltreatment identified at the index admission (OR 5.11, P < 0.001). After excluding the patients with maltreatment identified at the index admission, 96 (0.17%) children were found to have a readmission for maltreatment that may have been present on the index admission and subsequently missed. The strongest risk factor was burn of the eye or ocular adnexa (OR 3.79, P = 0.001). CONCLUSIONS: This study demonstrates that a portion of admissions for burn injuries in children could involve maltreatment that was undiagnosed. Identifying these at-risk individuals is critical to prevention efforts.


Assuntos
Queimaduras/etiologia , Maus-Tratos Infantis/diagnóstico , Criança Hospitalizada/estatística & dados numéricos , Diagnóstico Ausente/estatística & dados numéricos , Adolescente , Queimaduras/terapia , Criança , Maus-Tratos Infantis/prevenção & controle , Maus-Tratos Infantis/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Estados Unidos
3.
Allergol. immunopatol ; 48(6): 686-693, nov.-dic. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-199259

RESUMO

BACKGROUND: Activated Phospho-Inositide 3 (PI3) Kinases Delta syndrome (APDS) can underlie primary immune deficiency. The prevalence and phenotypic characterization of these patients are not well described in Egypt. OBJECTIVES: To describe patients with APDS in hospitalized children with recurrent respiratory tract infections with suspected primary immune deficiency. METHODS: 79 patients were included in the study. E1021K and E525K mutations of PI3K δ chain gene were screened by Sanger sequencing technique. RESULTS: one patient was heterozygous to E1021K mutation; a female child was diagnosed clinically as Combined Immune Deficiency with CD4 and B lymphopenia and markedly deficient IgG and increased IgM. The E525K mutation was not detected in our cohort. CONCLUSIONS: Screening for APDS in patients with recurrent respiratory tract infections with undefined antibody deficiency or combined immune deficiency with or without bronchiectasis is required. These patients need great attention to benefit from the available treatment. Further studies on the Egyptian population are recommended to increase the knowledge about the prevalence and phenotypic characterization of this disease in Egypt


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Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Síndromes de Imunodeficiência/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Transversais , Classe I de Fosfatidilinositol 3-Quinases , Infecções Respiratórias/genética , Síndromes de Imunodeficiência/genética , Estatísticas não Paramétricas , Citometria de Fluxo , Distribuição por Sexo , Egito/epidemiologia , Prevalência , Criança Hospitalizada/estatística & dados numéricos
5.
Mikrobiyol Bul ; 54(2): 318-325, 2020 Apr.
Artigo em Turco | MEDLINE | ID: mdl-32723286

RESUMO

Influenza is an important cause of respiratory illness in children and is still an important cause of morbidity and mortality in children. The influenza virus subtypes determine the prevalence of the epidemic and pandemic influenza, the hospitalization and mortality rates in children each year. Surveillance of the circulation of different influenza virus strains is important in ensuring a good strain con-cordance for the composition of the annual influenza vaccine. The Global Influenza Hospital Surveillance Network® (GIHSN) is an international institution in which tertiary hospitals from many countries participate and where epidemiological surveillance of influenza disease is conducted. Six centers from Turkey participated in the study organized by GIHSN during the influenza season 2016 2017. The aim of this study was to demonstrate the frequency of influenza, virus types, clinical characteristics and vaccination rates in children admitted to our hospital with influenza-like symptoms in the influenza season 2016-2017. Informed consents were obtained from patients. 217 pediatric patients were screened with in the 24th and 48th hours of the hospitalization. Then a nasal/nasopharyngeal swab were collected from 184 patients who met the inclusion criteria. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) was used to obtain laboratory results. Influenza virus, influenza virus subtypes were studied by rRT-PCR. The 83.3% of the patients with positive influenza was under 5 years of age. The rate of influenza positivity was 16.3% (n= 30 patients). Influenza A (H3N2) was the predominant strain in children. The 70% of isolates were influenza A (H3N2) and the 30% were influenza B (Yamagata). There were no case of influenza A (H1N1) or influenza B (Victoria). In 30% of cases with influenza positivity, there was an underlying disease. The most prevalent of them were neuromuscular disease followed by cardiovascular disease and asthma. Tobacco exposure was 86.6% in influenza positive cases. The empirical oseltamivir prescription rate was 28.2%. The vaccination rate of the influenza vaccine was very low (1.6%). The out of 3 patients with influenza positivity were admitted to pediatric intensive care unit, and 2 of them required mechanical ventilation. None of these patients required extracorpereal membrane oxygenation and did not die. Our results highlight the importance of surveillance for influenza and in particular, influenza vaccination rates of groups with risk for morbidity and mortality, such as children, need to be increased.


Assuntos
Vírus da Influenza A Subtipo H3N2 , Vírus da Influenza B , Vacinas contra Influenza , Influenza Humana , Vacinação , Criança , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Humanos , Vírus da Influenza A Subtipo H3N2/genética , Vírus da Influenza B/genética , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Turquia/epidemiologia , Vacinação/estatística & dados numéricos
6.
PLoS One ; 15(5): e0232838, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384106

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/mortalidade , Criança Hospitalizada/estatística & dados numéricos , Mortalidade Hospitalar , Transtornos da Nutrição do Lactente/mortalidade , Desnutrição Aguda Grave/mortalidade , Adulto , Anemia/epidemiologia , Cuidadores/estatística & dados numéricos , Criança , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Comorbidade , Estudos Transversais , Diarreia Infantil/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Hipoglicemia/epidemiologia , Lactente , Transtornos da Nutrição do Lactente/terapia , Modelos Logísticos , Malária/epidemiologia , Masculino , Preparações de Plantas , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , África do Sul/epidemiologia
7.
Lancet Child Adolesc Health ; 4(4): 312-321, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32087768

RESUMO

Delirium is a syndrome characterised by an acute and fluctuating alteration in cognition and awareness. It occurs frequently in children with serious medical illness, and is associated with adverse outcomes such as increased length of hospital stay, duration of mechanical ventilation, hospital costs, and mortality. Delirium-especially the hypoactive subtype-is often overlooked by paediatric practitioners, but can be reduced by mitigating risks and effectively managed if detected early. Non-modifiable risk factors of delirium include young age (age <2 years), cognitive or neurological disabilities, need for invasive mechanical ventilation, severe underlying illness and pre-existing chronic conditions, and poor nutritional status. Routine bedside screening using validated tools can enable early detection of delirium. To reduce delirium in hospitalised children, health-care providers should optimise the hospital environment (eg, by reducing sleep disruption and keeping the child stimulated during the day), improve pain management, and decrease sedation (particularly use of benzodiazepines).


Assuntos
Criança Hospitalizada/psicologia , Delírio/prevenção & controle , Delírio/psicologia , Respiração Artificial/efeitos adversos , Estudos de Casos e Controles , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Disfunção Cognitiva/epidemiologia , Delírio/classificação , Delírio/mortalidade , Diagnóstico Precoce , Humanos , Lactente , Tempo de Internação/tendências , Programas de Rastreamento/métodos , Doenças do Sistema Nervoso/epidemiologia , Estado Nutricional , Testes Imediatos/normas , Respiração Artificial/estatística & dados numéricos , Fatores de Risco
8.
Medicine (Baltimore) ; 99(4): e18584, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977849

RESUMO

To evaluate epidemiology and risk factors of severe adenovirus respiratory infection in hospitalized children in Guangzhou, China.A retrospective review study was conducted, and 542 children hospitalized for adenovirus respiratory infection, were included from January 2011 to December 2014. Patients were younger than 14 years. Disease severity was classified into severe and mild. Laboratory tests and clinical characteristics were analyzed for risk factors of adenovirus respiratory infection by multivariable logistic regression.Among these 542 children, 92.1% were aged < 6 years. Clinical diagnoses were upper respiratory infections in 11.6%, bronchiolitis in 16%, and mild pneumonia in 62.0% of children. Severe pneumonia rate was 10.3% (56/542) with a mortality rate of 0.9% (5/542). The cohort comprised 542 patients; 486 patients with mild adenovirus respiratory infection and 56 patients with severe adenovirus respiratory infection. Multivariable logistic regression was used to confirm associations between variables and adenovirus respiratory infection, after age and gender adjustment. Hospital stay, still significantly associated with adenovirus respiratory infection. Patients with longer hospital stay (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.13-1.28, P < .001), lower LYMPH (OR = 0.73 95% CI: 0.55-0.99, P = .039), and increased LDH (OR = 1.002, 95% CI: 1.001-1.003, P =  .001) had a higher risk of severe adenovirus respiratory infection.Adenovirus is a major pathogen in hospitalized children with respiratory infection. High serum LDH level and low lymphocyte count could be used as predictors of adenovirus respiratory infection severity in children.


Assuntos
Infecções por Adenovirus Humanos/epidemiologia , Criança Hospitalizada/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções por Adenovirus Humanos/mortalidade , Adolescente , Fatores Etários , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Tempo de Internação , Modelos Logísticos , Masculino , Pneumonia/epidemiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
9.
Pediatr Blood Cancer ; 67(1): e28013, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31612605

RESUMO

BACKGROUND: There is growing evidence that palliative care (PC) is associated with increased quality of life in children with cancer. Despite increasing recommendations in support of PC to improve pediatric oncology care, little is known about its patterns of use. METHODS: We analyzed the 2005-2011 National Inpatient Sample, a representative, cross-sectional sample of US hospital admissions. Our study cohort comprised 10 960 hospitalizations of children with cancer and high in-hospital mortality risk. Survey-weighted regression models were constructed to determine associations of person- and hospital-level characteristics with PC involvement and healthcare costs. RESULTS: Overall, 4.4% of hospitalizations included PC involvement. In regression models invoking stepwise variable selection, a shorter length of stay (PC vs no PC; mean: 23.9 vs 32.6 days), solid cancer (solid vs hematologic vs brain cancer; PC use: 7.4% vs 2.8% vs 5.5%), and older age (PC vs no PC; mean: 10.2 vs 8.9 years) were associated with PC use. PC utilization was also associated with lower overall and daily hospital costs. CONCLUSIONS: One in 20 pediatric inpatients with cancer and high mortality risk receives PC, with differential utilization by socio-economic groups. These results have significant implications for public health resource allocation and the delivery of pediatric PC as high-value care. Future research should focus on the development of new tools to help physicians assess when PC is appropriate for their patients.


Assuntos
Criança Hospitalizada/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Mortalidade Hospitalar/tendências , Neoplasias/terapia , Cuidados Paliativos/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Humanos , Lactente , Tempo de Internação , Masculino , Neoplasias/patologia , Neoplasias/psicologia , Cuidados Paliativos/métodos , Prognóstico
10.
Nutr Clin Pract ; 35(1): 157-163, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31144381

RESUMO

BACKGROUND: Hospitalized children present higher rates of undernutrition. Malnutrition can lead to a more complex hospitalization process with an increased length of stay and higher costs. Our aim was to analyze nutrition risk in hospitalized children and its relationship with clinical outcomes in a tertiary level hospital. METHODS: This is a single institution prospective observational study. The research involved 282 consecutive children admitted along 3 months. Anthropometric measurements and nutrition risk by means of the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) tool were performed at admission. The incidence of infectious complications, length of hospital stay, weight loss, hospital expenses, and need of nutrition support were recorded. RESULTS: The percentage of children with high, moderate, and low nutrition risk was 12.8%, 45%, and 42%, respectively. The prevalence of acute and chronic malnutrition was 13.7% and 7.4%. STRONGkids score correlated with clinical outcomes: longer stay, higher hospital expenses, and need of nutrition support were observed in children with high nutrition risk scores compared with the other groups (P < 0.001). The overall incidence of infectious complications was low (3.5%); a higher STRONGkids score did not predict a higher rate. CONCLUSION: Hospitalized children exposed to high nutrition risk have poorer clinical outcomes: longer stay, higher hospital expenses, and need of nutrition support. More studies are required to assess if applying STRONGkids and starting a nutrition intervention would result in lower costs and a shorter length of stay.


Assuntos
Criança Hospitalizada/estatística & dados numéricos , Desnutrição/economia , Desnutrição/epidemiologia , Estado Nutricional , Adolescente , Criança , Pré-Escolar , Feminino , Custos Hospitalares , Hospitalização/estatística & dados numéricos , Humanos , Infecções/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Desnutrição/diagnóstico , Avaliação Nutricional , Apoio Nutricional/métodos , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Centros de Atenção Terciária , Perda de Peso
11.
Rev Bras Enferm ; 72(suppl 3): 251-258, 2019 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851261

RESUMO

OBJECTIVE: to understand the meaning of the care of hospitalized children for the nursing professionals of a pediatric unit. METHOD: phenomenological study, based on the existential phenomenology of Martin Heidegger. Ten nursing professionals were interviewed with the guiding question: "What is the care of hospitalized children for you? Tell me, in detail, your experience with taking care of hospitalized children." RESULTS: the meaning of the care of hospitalized children materializes between the profession and the various ways of preoccupation. By engaging in/worrying about the ways of being of everyday life, the professionals tend to improperness when trying to mediate and level all possibilities of being. However, when they extrapolate reassurance and do not get caught up in themselves, they achieve empathy, respect, and indulgence. FINAL CONSIDERATIONS: it is necessary to reassess the teaching and practice of care, so that authentic care is offered to children and their families in the context of hospitalization.


Assuntos
Criança Hospitalizada/psicologia , Enfermeiras e Enfermeiros/psicologia , Enfermagem Pediátrica/métodos , Adulto , Criança , Criança Hospitalizada/estatística & dados numéricos , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Enfermagem Pediátrica/tendências , Pesquisa Qualitativa
12.
JAMA Netw Open ; 2(12): e1918306, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31880799

RESUMO

Importance: As the proportion of children with Medicaid coverage increases, many pediatric health systems are searching for effective strategies to improve management of this high-risk population and reduce the need for inpatient resources. Objective: To estimate the association of a targeted population health management intervention for children eligible for Medicaid with changes in monthly hospital admissions and bed-days. Design, Setting, and Participants: This quality improvement study, using difference-in-differences analysis, deployed integrated team interventions in an academic pediatric health system with 31 in-network primary care practices among children enrolled in Medicaid who received care at the health system's hospital and primary care practices. Data were collected from January 2014 to June 2017. Data analysis took place from January 2018 to June 2019. Exposures: Targeted deployment of integrated team interventions, each including electronic medical record registry development and reporting alongside a common longitudinal quality improvement framework to distribute workflow among interdisciplinary clinicians and community health workers. Main Outcomes and Measures: Trends in monthly inpatient admissions and bed-days (per 1000 beneficiaries) during the preimplementation period (ie, January 1, 2014, to June 30, 2015) compared with the postimplementation period (ie, July 1, 2015, to June 30, 2017). Results: Of 25 460 children admitted to the hospital's health system during the study period, 8418 (33.1%) (3869 [46.0%] girls; 3308 [39.3%] aged ≤1 year; 5694 [67.6%] black) were from in-network practices, and 17 042 (67.9%) (7779 [45.7%] girls; 6031 [35.4%] aged ≤1 year; 7167 [41.2%] black) were from out-of-network practices. Compared with out-of-network patients, in-network patients experienced a decrease of 0.39 (95% CI, 0.10-0.68) monthly admissions per 1000 beneficiaries (P = .009) and 2.20 (95% CI, 0.90-3.49) monthly bed-days per 1000 beneficiaries (P = .001). Accounting for disproportionate growth in the number of children with medical complexity who were in-network to the health system, this group experienced a monthly decrease in admissions of 0.54 (95% CI, 0.13-0.95) per 1000 beneficiaries (P = .01) and in bed-days of 3.25 (95% CI, 1.46-5.04) per 1000 beneficiaries (P = .001) compared with out-of-network patients. Annualized, these differences could translate to a reduction of 3600 bed-days for a population of 93 000 children eligible for Medicaid. Conclusions and Relevance: In this quality improvement study, a population health management approach providing targeted integrated care team interventions for children with medical and social complexity being cared for in a primary care network was associated with a reduction in service utilization compared with an out-of-network comparison group. Standardizing the work of care teams with quality improvement methods and integrated information technology tools may provide a scalable strategy for health systems to mitigate risk from a growing population of children who are eligible for Medicaid.


Assuntos
Criança Hospitalizada/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Gestão da Saúde da População , Criança , Pré-Escolar , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Medicaid/economia , Melhoria de Qualidade/estatística & dados numéricos , Estados Unidos
13.
Can J Urol ; 26(6): 10022-10025, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860418

RESUMO

INTRODUCTION: The American Academy of Pediatrics views Certified Child Life Specialists (CCLS) as "an important component of pediatric hospital based care to address the psychosocial concerns that accompany hospitalization." CCLSs help patients and parents navigate the complex medical system in order to minimize psychosocial and emotional stress by implementing age appropriate coping skills. This survey explores the perceptions towards CCLS and their utilization with pediatric urology. MATERIALS AND METHODS: A Survey Monkey questionnaire was developed and distributed to Society for Pediatric Urology members (SPU) (n = 314). Providers were queried about CCLS implementation and their perception regarding CCLS's role in improving health related quality of life (HRQOL). RESULTS: There was a 34.1% response rate (n = 107). Ninety-four providers (87.9%) reported CCLS interaction with their patients and greater than 95% of providers felt CCLS imparted some degree of benefit to their patients' HRQOL. Only 4.7% felt CCLS offered no benefit to the patients. CCLS were consistently used in a minority of inpatient and outpatient settings and never in the radiological setting. They were used at least 50% of the time by the most responders in inpatient and radiological setting and nearly the same in the ambulatory surgery setting. CONCLUSIONS: This survey illuminates that the majority of providers interact with CCLS in clinical settings and believe their involvement is beneficial. However, CCLSs are under-utilized during invasive urological procedures where patient anxiety is high. By understanding perceptions of providers and their practice patterns we can overcome barriers to CCLS use and improve their quality of life.


Assuntos
Atitude do Pessoal de Saúde , Criança Hospitalizada , Diagnóstico por Imagem , Pessoal de Saúde , Urologia/estatística & dados numéricos , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/psicologia , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Criança , Criança Hospitalizada/psicologia , Criança Hospitalizada/estatística & dados numéricos , Diagnóstico por Imagem/psicologia , Diagnóstico por Imagem/estatística & dados numéricos , Família , Pesquisas sobre Serviços de Saúde , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Qualidade de Vida
14.
Artigo em Inglês | MEDLINE | ID: mdl-31766400

RESUMO

BACKGROUND: Environmental tobacco smoke (ETS) exposure is associated with altered cytokine levels in children. We sought to examine ETS exposure prevalence and the relationship between ETS exposure and cytokine levels in a sample of hospitalized children. (2) Methods: Inflammatory markers (IL-8, IL-1ß, IL-10, and TNF-α) and cotinine were measured in saliva of hospitalized, nonsmoking children (N = 112). To assess the association between ETS exposure and immune system response, we built a multivariate regression model including the four inflammatory markers as the response variables and cotinine, age, sex, and discharge diagnosis as explanatory variables while assessing possible interaction effects. (3) Results: Mean age (SD) was 5.8(5.0) years; Geometric Mean (GeoM) cotinine = 1.8 [95% CI = 1.4-2.2]. Children with non-inflammatory other diagnoses had lower IL-10 (p = 0.003) and TNF-α (p = 0.009) levels than children with inflammatory other diagnoses. Children with asthma (p = 0.01) and bacterial illnesses and/or pneumonia (p = 0.002) had higher IL-8 levels. Independent of diagnosis, there was a significant curvilinear association between cotinine and IL-1ß (p = 0.002) reflecting no association for cotinine levels <5 ng/mL and a positive association for >5 ng/mL. (4) Conclusions: Children with higher ETS exposure levels have higher IL-1ß levels regardless of age, sex, and diagnosis. ETS exposure may increase pro-inflammatory immune responses in children and may interfere with native immune responses and the ability to heal and fight infection.


Assuntos
Asma/induzido quimicamente , Cotinina/análise , Exposição Ambiental/efeitos adversos , Inflamação/induzido quimicamente , Interleucina-1beta/análise , Saliva/química , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Biomarcadores/análise , Criança , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
15.
J Health Popul Nutr ; 38(1): 35, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775913

RESUMO

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.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Transtornos da Nutrição Infantil/mortalidade , Criança Hospitalizada/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Desnutrição Aguda Grave/mortalidade , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Suplementos Nutricionais , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Estudos Prospectivos , Desnutrição Aguda Grave/terapia , Fatores de Tempo , Resultado do Tratamento , Vitamina A/administração & dosagem , Ganho de Peso
16.
An. pediatr. (2003. Ed. impr.) ; 91(5): 328-335, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186770

RESUMO

Introducción: La desnutrición en el paciente pediátrico hospitalizado es una comorbilidad prevalente que puede influir en la evolución clínica y se estima en un 31,4% en nuestro medio. Objetivo: Nuestro objetivo fue describir el riesgo de desnutrición de los pacientes que ingresan en nuestro centro, mediante la herramienta Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), así como analizar su asociación con la evolución del ingreso hospitalario. Métodos: Se realizó un estudio prospectivo, unicéntrico y analítico desde octubre hasta diciembre de 2017 en pacientes hospitalizados, de edades entre 1 mes y 15 años. Se recogieron variables clínicas y datos antropométricos (peso, talla, peso según Waterlow al ingreso (T0), a las 48 h (T1) y al alta (T2). Se construyeron modelos multivariantes para identificar variables predictoras de gravedad. Resultados: Analizamos a 200 pacientes (55% varones) con una mediana de edad de 15,8 meses (RIQ 2,5-42,8) y una estancia media de 3 días (RIQ 1-18 días). El 48,3% presentaba alto riesgo de desnutrición en T0 (STAMP ≥ 4) y un 48,2% riesgo moderado (STAMP = 2-3). En el análisis bivariante, una mayor puntuación de STAMP se asoció a mayor estancia media (p < 0,01) y a mayor gravedad (p < 0,01). En el análisis multivariante, el STAMP en T0 fue predictor de gravedad (OR 1,48; IC 95%: 1,18-1,86; p < 0,01). Conclusiones: Casi el 50% de los pacientes ingresados tenían un elevado riesgo de desnutrición durante el ingreso. El riesgo de desnutrición al ingreso medido según el cribado nutricional STAMP se asoció con una mayor estancia media y mayor gravedad. Es importante evaluar el riesgo de desnutrición al ingreso dada su influencia en la evolución de la enfermedad


Introduction: Paediatric malnutrition during hospital admission is a prevalent comorbidity, which it is estimated around 31.4% in our environment, and could influence the clinical outcomes of paediatric patients. Objective: The aim of this study was to describe the malnutrition risk in hospitalised children using STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics), and to study its relationship with clinical outcomes. Methods: A single-centre, analytical and prospective study was conducted on children aged 1 month to 15 years hospitalised in a tertiary hospital between October and December 2017. An analysis was made of the clinical data and anthropometric measurements (weight, height, Waterlow weight classification). Patients were classified according to STAMP, which is a validated screening tool used to classify the risk of paediatric malnutrition during hospital admission. Multivariate statistical analysis was used to identify predictive variables of illness severity. Results: An analysis was made on a total of 200 patients (55% male), with a median age of 15.8 months (IQR 2.5-42.8), and a median length of stay of 3 days (IQR 1-18 days). Almost half (48.3%) of them had high risk of malnutrition at admission (STAMP ≥ 4), and 48.2% showed medium risk (STAMP 2-3). A higher STAMP score was associated with longer length of hospital stay (P < .01) and greater severity (P < .01). Multivariable analysis showed that STAMP could be a predictor of illness severity (OR 1.48, 95% CI: 1.18-1.86, P < .01). Conclusions: Nearly 50% of hospitalised children have a high risk of malnutrition at admission according to the STAMP screening tool. Risk of malnutrition at admission measured according to STAMP nutritional screening was associated with a longer length of stay and greater severity of illness. It is important to evaluate the risk of malnutrition as this could be related to illness severity


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Estado Nutricional , Criança Hospitalizada/estatística & dados numéricos , Transtornos da Nutrição Infantil/epidemiologia , Estudos Prospectivos , Antropometria , Fatores de Risco , Estudos Longitudinais
17.
J Pediatr Nurs ; 49: 67-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31654892

RESUMO

All nurses have a responsibility for monitoring their patients for signs of substance misuse or substance use disorder. Adolescents and young adults are at risk for substance use. Prescription medications may be used by adolescents for non-medical reasons such as to feel high, to assist with sleep, to avoid negative feelings or thoughts or to avoid withdrawal symptoms after chronic use. Some adolescents with legally prescribed medications have been asked to divert those medications by giving them to someone else. Drug diversion by employees is often reported in healthcare settings, but diversion of medications done by patients is far less commonly reported. This paper is a report of two patients with complex medical issues and chronic pain who diverted opioid medications while hospitalized. Hiring clinical staff, such as nurses, working in Drug Diversion Prevention positions will provide knowledge and expertise to facilitate investigations and to help reduce risks for diversion in healthcare settings. In addition, nurses with concerns about patient diversion should discuss these concerns with the care team. Organizational leaders need to support their teams by providing education and resources so staff feel comfortable addressing these challenging situations.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Comportamento de Procura de Droga , Papel do Profissional de Enfermagem , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Adolescente , Analgésicos Opioides/administração & dosagem , Criança Hospitalizada/estatística & dados numéricos , Dor Crônica/diagnóstico , Relação Dose-Resposta a Droga , Feminino , Humanos , Tempo de Internação , Masculino , Monitorização Fisiológica/métodos , Transtornos Relacionados ao Uso de Opioides/enfermagem , Enfermagem Pediátrica , Estudos Retrospectivos , Medição de Risco , Amostragem , Estados Unidos
18.
Dev Med Child Neurol ; 61(12): 1432-1438, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31378936

RESUMO

AIM: This cross-sectional study characterized the prevalence, trends, sociodemographic factors, and clinical factors that are associated with a coded diagnosis of malnutrition (CDM) among hospitalized children with cerebral palsy (CP) in the USA. METHOD: We used data from the 2002 to 2015 National Inpatient Sample database and restricted the analysis to hospitalized children with CP between 2 and 17 years of age. International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis codes for CP, malnutrition, and comorbidities associated with CP were used to characterize hospitalizations for this population. Logistic regression models were conducted to identify the sociodemographic factors and comorbidities associated with a diagnosis of malnutrition. RESULTS: The average documented rate of CDM among hospitalized children with CP was 7.9% and nearly doubled during the study period. The model suggests that younger age, non-white ethnicity, lower income, and non-private insurance/payer status were associated with increased odds of documented malnutrition. Concomitant inpatient diagnoses of epilepsy, dysphagia, scoliosis, reflux, and constipation were associated with higher rates of CDM. INTERPRETATION: The rate of CDM in hospitalized patients with CP is well under the estimated clinical prevalence of 30% to 40%. Multiple sociodemographic, hospital, and clinical factors are associated with higher rates of CDM. WHAT THIS PAPER ADDS: The documented rate of malnutrition in hospitalized children with cerebral palsy (CP) averaged 7.9% yearly. For hospitalized children with CP, documentation of malnutrition nearly doubled between 2002 and 2015. Economically disadvantaged and minority ethnic groups had a greater likelihood of malnutrition documentation. Inpatient malnutrition documentation was more likely with some comorbidities indicative of greater impairments. Gastrointestinal disorders increased the likelihood of an inpatient-documented diagnosis of malnutrition.


Assuntos
Paralisia Cerebral/epidemiologia , Criança Hospitalizada/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Desnutrição/epidemiologia , Adolescente , Paralisia Cerebral/terapia , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Grupos Minoritários/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Fatores Socioeconômicos , Populações Vulneráveis/estatística & dados numéricos
19.
PLoS One ; 14(8): e0219463, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31461462

RESUMO

BACKGROUND: Radiologic evaluation of children with Mycoplasma pneumoniae is important for diagnosis and management. OBJECTIVE: To investigate the correlation between chest radiographic findings and the clinical features in children with Mycoplasma pneumoniae pneumonia. MATERIALS AND METHODS: This study included 393 hospitalized children diagnosed with M. pneumoniae pneumonia between January 2000 and August 2016. Their clinical features and chest radiographs were reviewed. Radiographic findings were categorized and grouped as consolidation group (lobar or segmental consolidation) and non-consolidation group (patchy infiltration, localized reticulonodular infiltration, or parahilar peribronchial infiltration). RESULTS: Lobar or segmental consolidation (37%) was the most common finding, followed by parahilar or peribronchial infiltration (27%), localized reticulonodular infiltration (21%) and patchy infiltration (15%). The consolidation group was more frequently accompanied by pleural effusions (63%), compared to the non-consolidation group (16%). Compared with patients in the non-consolidation group, those in the consolidation group were associated with a significantly higher rate of hypoxia, tachypnea, tachycardia, extrapulmonary manifestations, prolonged fever, and longer periods of anti-mycoplasma therapy and hospitalization. Lobar or segmental consolidation was significantly more frequent in children ≥5 years old (44%) compared with children 2-5 years old (34%) and <2 years old (13%). Parahilar peribronchial infiltration was significantly more frequent in children <2 years old (56%) compared with children 2-5 years old (32%) and ≥5 years old (18%). CONCLUSION: The chest radiographic findings of children with M. pneumoniae pneumonia correlate well with the clinical features. Consolidative lesions were frequently observed in older children and were associated with more severe clinical features.


Assuntos
Criança Hospitalizada/estatística & dados numéricos , Mycoplasma pneumoniae/fisiologia , Pneumonia por Mycoplasma/diagnóstico por imagem , Tórax/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pneumonia por Mycoplasma/terapia , Radiografia
20.
J Dev Behav Pediatr ; 40(8): 642-650, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369465

RESUMO

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.


Assuntos
Sintomas Comportamentais/diagnóstico , Transtornos do Comportamento Infantil/diagnóstico , Criança Hospitalizada , Terapias Complementares , Ambulatório Hospitalar , Escalas de Graduação Psiquiátrica/normas , Adolescente , Sintomas Comportamentais/epidemiologia , Lista de Checagem/normas , Criança , Transtornos do Comportamento Infantil/epidemiologia , Criança Hospitalizada/estatística & dados numéricos , Estudos de Coortes , Terapias Complementares/estatística & dados numéricos , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Ambulatório Hospitalar/estatística & dados numéricos , Comportamento Problema , Ruanda/epidemiologia , Sensibilidade e Especificidade
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