Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.169
Filtrar
2.
Medicine (Baltimore) ; 100(16): e25626, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879736

RESUMO

ABSTRACT: Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children's Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area.


Assuntos
Corpos Estranhos/cirurgia , Cavidade Nasal/lesões , Nariz/lesões , Otolaringologia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , China , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Estudos Retrospectivos
4.
PLoS One ; 16(4): e0249550, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793673

RESUMO

Data on the prevalence of the SARS-CoV-2 antibody in healthcare workers (HCWs) is scarce, especially in pediatric settings. The purpose of this study was to evaluate SARS-CoV-2 IgG-positivity among HCWs of a tertiary pediatric hospital. In addition, follow-up of the serological response in the subgroup of seropositive HCWs was analysed, to gain some insight on the persistence of IgG antibodies to SARS-CoV-2. We performed a retrospective analysis of voluntary SARS-CoV-2 IgG testing, which was made available free of charge to HCWs of the Children's Memorial Health Institute in Warsaw (Poland). Plasma samples were collected between July 1 and August 9, 2020, and tested using the Abbott SARS-CoV-2 IgG assay. Of 2,282 eligible participants, 1,879 (82.3%) HCWs volunteered to undergo testing. Sixteen HCWs tested positive for SARS-CoV-2 IgG, corresponding to a seroprevalence of 0.85%. Among seropositive HCWs, three HCWs had confirmed COVID-19. Nine (56.3%) of the seropositive HCWs reported neither symptoms nor unprotected contact with confirmed SARS-CoV-2 cases in the previous months. A decline in the IgG index was observed at a median time of 86.5 days (range:84‒128 days) after symptom onset or RT-PCR testing. Further studies are necessary to elucidate the duration of persistence of anti-SARS-CoV-2 antibodies, as well as the correlation between seropositivity and protective immunity against reinfection. Regardless of the persistence of antibodies and their protective properties, such low prevalence indicates that this population is vulnerable to a second wave of the COVID-19 pandemic.


Assuntos
Anticorpos Antivirais/sangue , Pessoal de Saúde/estatística & dados numéricos , Imunoglobulina G/sangue , /imunologia , Adulto , /imunologia , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Polônia , Prevalência , Estudos Retrospectivos , Estudos Soroepidemiológicos , Centros de Atenção Terciária/estatística & dados numéricos
5.
CJEM ; 23(1): 80-84, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33683615

RESUMO

OBJECTIVES: To understand the feasibility, utilization rate, and satisfaction of the first Virtual Pediatric ED (V-PED) in Canada. METHODS: We conducted a prospective cohort study examining the feasibility and impact of virtual care as an adjunct to in-person emergency care at a tertiary pediatric hospital from May to July 2020. Children (< 18 years) from Ontario and Quebec seeking V-PED care were included. A secure, encrypted, video platform within the hospital's electronic medical record was used. Caregivers self-determined appropriateness of V-PED using a standardized online triage questionnaire to request their appointment. The V-PED is directly launched from the patient's chart and the family joins the portal via hyperlink. Outcome measures included the number of V-PED visits, hospital admission rates, and caregiver satisfaction using a 10-item voluntary post-visit online survey. RESULTS: A total of 1036 V-PED visits were seen of which 176 (17.0%) were referred for further in-person ED assessment, and 8 (0.8%) required hospital admission. Of the 107 completing patient experience surveys (10% response), most respondents (69%) endorsed they "very likely" or "definitely" would have presented in-person to the ED if V-PED were unavailable. Overall satisfaction was rated as excellent (9 or 10 out of 10) in 87% of respondents. CONCLUSION: Our novel V-PED is feasible, has high caregiver satisfaction, and can reduce the burden of in-person ED visits. Future work must ensure the safety of emergency virtual care and examine how to increase capacity and integrate V-PED within traditional emergency medicine.


Assuntos
Emergências/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Encaminhamento e Consulta , Telemedicina/métodos , Triagem/métodos , Realidade Virtual , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Ontário/epidemiologia , Estudos Prospectivos , Quebeque/epidemiologia
6.
Medicine (Baltimore) ; 100(13): e25334, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787631

RESUMO

ABSTRACT: Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children.


Assuntos
Braquetes/efeitos adversos , Atlas Cervical/lesões , Tratamento Conservador/métodos , Processo Odontoide/lesões , Fraturas da Coluna Vertebral/terapia , Atlas Cervical/diagnóstico por imagem , Pré-Escolar , Tratamento Conservador/efeitos adversos , Tratamento Conservador/instrumentação , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Processo Odontoide/diagnóstico por imagem , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Tomografia Computadorizada por Raios X , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento
7.
Am J Emerg Med ; 43: 109-114, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33550101

RESUMO

BACKGROUND: The Bronx has the highest prevalence of asthma in the United States (US), and was also an early COVID-19 epicenter, making it a unique study location. Worldwide reports describe significant declines in pediatric emergency department (PED) visits during COVID-19. The ongoing impact of COVID-19 on all PED presentations, including asthma, at an early epicenter has not been studied beyond the pandemic peak and into the early phases of state re-opening. OBJECTIVES: To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019. METHODS: Retrospective chart review of children <21 years utilizing the PED at a high-volume quaternary children's hospital in The Bronx, NY from March 15th 2020 - July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to pre-determined diagnostic categories. Demographic and clinical data were compared. RESULTS: 19,981 visits were included. Visits declined by 66% during 2020. Proportions of asthma visits (2% vs. 7%, p < 0.0001) and minor medical problems (61% vs. 67%, p < 0.0001) had significant declines in the pandemic cohort, while major medical problems (13% vs. 8%, p < 0.0001), appendicitis (1% vs. 0.4%, p < 0.0001) and other surgical complaints (1% vs. 0.5%, p < 0.0001) had proportional increases in the pandemic cohort. No significant proportional changes were noted among psychosocial and trauma groups between the two cohorts. CONCLUSION: The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase-II re-opening. Despite being located in an asthma hub, the incidence of asthma-related PED visits declined appreciably in the pandemic cohort. Future studies examining the effects of indoor allergens in isolation on pediatric asthma are warranted.


Assuntos
Asma/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Hospitais Pediátricos/estatística & dados numéricos , Pandemias , Adolescente , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Incidência , Masculino , Cidade de Nova Iorque/epidemiologia , Prevalência , Estudos Retrospectivos
8.
Am J Emerg Med ; 43: 115-117, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33556796

RESUMO

INTRODUCTION: The aim of this study was to describe the rate and types of community-acquired respiratory infections observed in a pediatric ED during the SARS-CoV-2 related lockdown in Italy and to compare data with the same period of previous year. METHODS: A retrospective analysis of medical charts of patients arrived at the ED of Gaslini Children's Hospital from 10th March 2020 to 30th April 2019 and the same frame of 2020 were performed. We compared two groups by demographics, duration of fever before ED admission, triage code, number of patients hospitalized after ED evaluation. We calculated proportion and incidence rate for airborne infections, fever, and urinary tract infections (UTI), appendicitis, and gastroenteritis for control. RESULTS: 1362 children arrived at the ED during the lockdown compared to 5628 in the same period of 2019 (-75,8%). No difference was noticed (27.7% vs 28.4%) in the total amount of infectious episodes. A significant reduction in rate of incidence and proportion were observed for upper respiratory tract infections (21,4% vs 28%), otitis (2,6% vs 16,2%), streptococcal infections (0,5% vs 5,2%) and bronchiolitis (2,1% vs 5,7%). Conversely, FUO (27,8 vs 11,1%), infectious mononucleosis (2,6% vs 0,4%), UTI (7,4% vs 2,9%) and appendicitis (6,8% vs 1,1%) significantly increased. Median time from the onset of fever and arrival in ED was significantly lower in 2020 group. CONCLUSION: Our results demonstrated a reduction in community-acquired respiratory infections during the lockdown for COVID-19. The increase in rate of FUO and febrile conditions, together with the short time from fever onset and ED visit could be related to the fear for a SARS-CoV-2 infection.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Quarentena , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Itália/epidemiologia , Masculino , Estudos Retrospectivos
10.
Hosp Pediatr ; 11(2): 208-212, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33436416

RESUMO

BACKGROUND AND OBJECTIVES: The coronavirus disease (COVID-19) pandemic has broad implications for children and families. Particular attention has been paid to delays in accessing timely pediatric care leading to unintended morbidity. In this study, we aim to describe the broader spectrum of unintended negative consequences for pediatric patients and families due to recent health care and societal changes. METHODS: All full-time doctors, dentists, and nurse practitioners working at a tertiary care children's hospital in Canada were surveyed every 2 weeks throughout the initial phase of the COVID-19 pandemic to identify clinical cases in which they perceived a negative outcome associated with hospital or societal changes as a result of the COVID-19 pandemic. Analysis followed a qualitative case series methodology using a narrative synthesis approach to determine similarities and associated themes. RESULTS: One hundred and forty-one clinicians, representing 26 hospital divisions, reported 57 unique cases in the first 6 weeks of the study. Thematic analysis of the first 50 reported cases was used to identify 6 primary themes focusing on health care quality domains as described by the Agency for Healthcare Research and Quality (safe, effective, patient-centered, timely, efficient, and equitable care). CONCLUSIONS: In this preliminary case analysis, we describe the broad social and clinical impact of COVID-19 on hospitalized pediatric patients and their families. These themes highlight the unintended consequence on families, siblings, disease diagnosis, and hospital-based care provision. Recognition and understanding of the broad implications of the COVID-19 pandemic are necessary as we strive to deliver safe, high-quality, family-centered pediatric care in this new era.


Assuntos
/epidemiologia , Hospitais Pediátricos/estatística & dados numéricos , Pandemias , Canadá/epidemiologia , Criança , Feminino , Humanos , Masculino
11.
Ital J Pediatr ; 47(1): 21, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514391

RESUMO

BACKGROUND: Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children's hospital, composed by two different pediatric centers, one located in Rome's city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED's) and urgent hospitalizations compared to prepandemic period. METHODS: The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. RESULTS: The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. CONCLUSIONS: In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn't demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.


Assuntos
/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Criança , Feminino , Humanos , Itália/epidemiologia , Masculino , Pandemias
12.
Pediatr Emerg Care ; 37(1): 48-53, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394945

RESUMO

OBJECTIVE: We aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States. METHODS: We conducted a prospective multicenter survey of PED medical director(s) from selected children's hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children's hospitals were identified for recruitment through an established national research network. RESULTS: We report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non-COVID-19 patients, 60% had COVID-19-dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%). CONCLUSIONS: This national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.


Assuntos
/epidemiologia , Planejamento em Desastres , Serviço Hospitalar de Emergência/organização & administração , Pesquisas sobre Serviços de Saúde , Pandemias , Recursos Humanos em Hospital/educação , Criança , Estudos Transversais , Planejamento em Desastres/estatística & dados numéricos , Educação a Distância , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Equipamento de Proteção Individual , Estudos Prospectivos , Treinamento por Simulação , Telecomunicações , Triagem , Estados Unidos
13.
J Healthc Risk Manag ; 40(4): 38-44, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33496074

RESUMO

The provision of health care in the perioperative setting has undergone significant changes due to severe respiratory distress syndrome coronavirus-2 (SARS-CoV-2). Hospital facilities have been tasked with developing and implementing personal protective equipment (PPE) protocols to protect both medical providers and patients. Texas Children's Hospital has created a set of protocols for donning and doffing PPE while managing surgical pediatric patients. These requirements have undergone numerous modifications as a result of our internal infrastructural recommendations and the Centers for Disease Control and Prevention guidance, which has led to more lenient regulations. While these perioperative PPE protocols were less stringent compared to the original guidelines, we were able to create a safe surgical environment without further exposing patients and health care providers to SARS-CoV-2. In this article, we detail the design, distribution, implementation, and modification of our institutional surgical PPE protocols.


Assuntos
/prevenção & controle , Pessoal de Saúde/normas , Hospitais Pediátricos/normas , Controle de Infecções/normas , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , Centros de Atenção Terciária/normas , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Pessoal de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Controle de Infecções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária/estatística & dados numéricos , Texas
14.
J Hosp Infect ; 110: 60-66, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33422589

RESUMO

BACKGROUND: Healthcare workers (HCWs) have been disproportionately affected by coronavirus disease 2019 (COVID-19), which may be driven, in part, by nosocomial exposure. If HCW exposure is predominantly nosocomial, HCWs in paediatric facilities, where few patients are admitted with COVID-19, may lack antibodies to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and be at increased risk during the current resurgence. AIM: To compare the seroprevalence of SARS-CoV-2 amongst HCWs in paediatric facilities in seven European countries and South Africa (N=8). METHODS: All categories of paediatric HCWs were invited to participate in the study, irrespective of previous symptoms. A single blood sample was taken and data about previous symptoms were documented. Serum was shipped to a central laboratory in London where SARS-CoV-2 immunoglobulin G was measured. FINDINGS: In total, 4114 HCWs were recruited between 1st May and mid-July 2020. The range of seroprevalence was 0-16.93%. The highest seroprevalence was found in London (16.93%), followed by Cape Town, South Africa (10.36%). There were no positive HCWs in the Austrian, Estonian and Latvian cohorts; 2/300 [0.66%, 95% confidence interval (CI) 0.18-2.4] HCWs tested positive in Lithuania; 1/124 (0.81%, 95% CI 0.14-4.3) HCWs tested positive in Romania; and 1/76 (1.3%, 95% CI 0.23-7.0) HCWs tested positive in Greece. CONCLUSION: Overall seroprevalence amongst paediatric HCWs is similar to their national populations and linked to the national COVID-19 burden. Staff working in paediatric facilities in low-burden countries have very low seroprevalence rates and thus are likely to be susceptible to COVID-19. Their susceptibility to infection may affect their ability to provide care in the face of increasing cases of COVID-19, and this highlights the need for appropriate preventative strategies in paediatric healthcare settings.


Assuntos
Anticorpos Antivirais/sangue , Pessoal de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Medição de Risco/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos , África do Sul/epidemiologia , Adulto Jovem
15.
Indian Pediatr ; 58(2): 126-128, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33340072

RESUMO

OBJECTIVE: To describe the broader clinical spectrum of COVID-19 in children. METHODS: In this descriptive, prospective study, we included confirmed pediatric patients with COVID-19 who presented to the emergency department of a pediatric tertiary care center from April to July, 2020. All patients were confirmed by the SARS-CoV-2 RT-PCR test, and we analyzed 24 symptoms and 25 signs. RESULTS: Among the 50 patients with COVID-19, the most common symptoms were fever, excessive cry and dry cough; digestive symptoms were frequently found (24%). The most common signs were pharyngeal erythema and irritability. CONCLUSIONS: Clinicians should recognize that the clinical spectrum of COVID-19 in children is wider than previously described, often with nonspecific signs and symptoms, and digestive symptoms should raise suspicion.


Assuntos
Doenças do Sistema Digestório , Avaliação de Sintomas , /epidemiologia , /psicologia , /estatística & dados numéricos , Criança , Pré-Escolar , Tosse/diagnóstico , Tosse/etiologia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/virologia , Feminino , Febre/diagnóstico , Febre/etiologia , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Humor Irritável/fisiologia , Masculino , México/epidemiologia , Estudos Prospectivos , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
16.
Hosp Pediatr ; 11(3): e48-e53, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33361400

RESUMO

OBJECTIVES: Asymptomatic transmission of coronavirus disease 2019 (COVID-19) in health care settings is not well understood. In this study, we aimed to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies in health care and hospital workers (HCHWs) and assess how antibody levels change over time. METHODS: Cross-sectional study of employed HCHWs at a freestanding, urban pediatric tertiary care hospital. Employed HCHWs ≥18 years old who were asymptomatic and worked in clinical hospital locations were eligible to participate. Participants completed blood draws and surveys at baseline (between May 4, 2020, and June 2, 2020) and 2 months later (between July 6, 2020, and August 7, 2020). Surveys collected demographic information, SARS-CoV-2 exposures, and previous COVID-19 diagnosis. RESULTS: In total, 530 participants enrolled in and completed baseline study activities. The median age was 37 years (range 19-67 years); 86% identified as female, and 80% identified as white. Two months later, 481 (91%) HCHWs completed another survey and blood draw. Four of 5 (0.9%) seropositive subjects at baseline remained seropositive at 2 months, although 3 had decreasing IgG indices. Five (1.0%) seropositive individuals, including 4 who were previously seropositive and 1 newly seropositive, were detected 2 months later. History of positive SARS-CoV-2 polymerase chain reaction testing results (P < .001) and history of COVID-19 exposure (P < .001) were associated with presence of SARS-CoV-2 antibodies. CONCLUSIONS: SARS-CoV-2 antibodies were detected in 1% of HCHWs in an urban pediatric hospital in a city with moderate SARS-CoV-2 prevalence. Participants with a known previous COVID-19 diagnosis showed a decline or loss of IgG antibodies over 2 months. These results have implications for identifying those with previous exposure and for ongoing public health recommendations for ensuring workplace safety.


Assuntos
Anticorpos Antivirais/imunologia , Pessoal de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Imunoglobulina G/imunologia , /imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
17.
Pediatrics ; 147(3)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33328339

RESUMO

OBJECTIVES: Elevated rates of mental health concerns have been identified during the coronavirus disease 2019 (COVID-19) pandemic. In this study, we sought to evaluate whether youth reported a greater frequency of suicide-related behaviors during the 2020 COVID-19 pandemic as compared with 2019. We hypothesized that rates of suicide-related behaviors would be elevated between the months of March and July 2020 as compared with 2019, corresponding to the onset of the COVID-19 pandemic. METHODS: Routine suicide-risk screening was completed with youth aged 11 to 21 in a pediatric emergency department. Electronic health records data for suicide-risk screens completed between January and July 2019 and January and July 2020 were evaluated. A total of 9092 completed screens were examined (mean age 14.72 years, 47.7% Hispanic and/or Latinx, 26.7% non-Hispanic white, 18.7% non-Hispanic Black). RESULTS: Rates of positive suicide-risk screen results from January to July 2020 were compared with corresponding rates from January to July 2019. Results indicated a significantly higher rate of suicide ideation in March and July 2020 and higher rates of suicide attempts in February, March, April, and July 2020 as compared with the same months in 2019. CONCLUSIONS: Rates of suicide ideation and attempts were higher during some months of 2020 as compared with 2019 but were not universally higher across this period. Months with significantly higher rates of suicide-related behaviors appear to correspond to times when COVID-19-related stressors and community responses were heightened, indicating that youth experienced elevated distress during these periods.


Assuntos
/psicologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Criança , Feminino , Humanos , Masculino , Pandemias , Prevalência , Estresse Psicológico , Estados Unidos/epidemiologia , Adulto Jovem
18.
Hosp Top ; 99(1): 44-47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33357127

RESUMO

Pediatric Hospital Medicine (PHM) is a growing subspecialty with a broad scope. The Covid-19 pandemic demands flexible staffing models. Advanced practice providers (APPs) can be a valuable addition to hospital medicine teams, although there is no established training program for APPs within PHM. The authors' purpose is to describe how one institution rapidly established a PHM APP team by collaborating with experienced APPs working in other areas of the hospital. This APP team cared for 16% of the average daily census during the pilot period with no significant difference in length of stay compared to traditional teams.


Assuntos
Prática Avançada de Enfermagem/estatística & dados numéricos , Hospitais Pediátricos/tendências , Prática Avançada de Enfermagem/tendências , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Equipe de Assistência ao Paciente , Projetos Piloto , Capacidade de Resposta ante Emergências/normas , Capacidade de Resposta ante Emergências/estatística & dados numéricos
19.
PLoS One ; 15(12): e0243795, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33320881

RESUMO

Survival rates for pediatric acute leukemia vary dramatically worldwide. Infections are a leading cause of morbidity and mortality, and the impact is amplified in low and middle-income countries. Defining the epidemiology of infection in a specific health care setting is paramount to developing effective interventions. This study aimed to define the epidemiology of and outcomes from infection in children with acute leukemia treated in a large public pediatric hospital in the Dominican Republic. A retrospective cohort was assembled of children newly diagnosed with acute leukemia between July 1, 2015 to June 30, 2017 at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo. Patients were identified from the Pediatric Oncology Network Database (PONDTM) and hospital admissions from the Oncology admissions logbook. Medical records and microbiology results were reviewed to identify all inpatient invasive infections. Distance from a child's home to the hospital was determined using ArcGIS by Esri. Infection rates were described in discrete time periods after diagnosis and risk factors for invasive infection were explored using negative binomial regression. Overall, invasive infections were common and a prominent source of death in this cohort. Rates were highest in the first 60 days after diagnosis. Gastroenteritis/colitis, cellulitis, and pneumonia were most frequent, with bacteremia common early on. Multidrug resistant bacteria were prevalent among a small number of positive cultures. In a multivariate negative binomial regression model, age ≥ 10 years and distance from the hospital > 100 km were each protective against invasive infection in the first 180 days after diagnosis, findings that were unexpected and warrant further investigation. Over one-third of patient deaths were related to infection. Interventions aimed at reducing infection should target the first 60 days after diagnosis, improved supportive care inside and outside the hospital, and increased antimicrobial stewardship and infection prevention and control measures.


Assuntos
Hospitais Pediátricos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Infecções/complicações , Pacientes Internados/estatística & dados numéricos , Leucemia Mieloide Aguda/complicações , Adolescente , Criança , Pré-Escolar , República Dominicana , Feminino , Humanos , Lactente , Infecções/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Prognóstico , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...