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Kaye, Alison, Columbine Che, William L. Chew, Elizabeth A. Stueve, and Shao Jiang. "Cleft Care of Internationally Adopted Children From China." Cleft Palate-Craniofacial Journal 56, no. 1 (2018): 46–55. http://dx.doi.org/10.1177/1055665618771423.
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Objective: To quantify a population of international adoptees from China with cleft lip and/or palate to assess presentations and team management practices. Design: Single institution retrospective. Patients: One hundred one patients with cleft lip and/or palate and history of international adoption from China. Results: Forty-nine males and 52 females were adopted from 2001 to 2014. Median age at arrival was 26 months. A total of 88.1% had a combined cleft lip and palate: 59 unilateral, 30 bilateral. Only 4 patients had isolated cleft palate. A total of 85.6% had cleft lip repair before adoption; 41.6% had both cleft lip and palate repairs in China. A total of 14.9% of adoptees had no prior surgery. In China, median age at lip repair was 10 months, and palate repair was 19 months. Once in the United States, lip repair was at 24 months and palate repair at 24 months. Eighty-three revision surgeries were performed. A total of 79.2% of children demonstrated moderate to severe articulation disorders. A total of 36.6% had velopharyngeal insufficiency with hypernasal speech. Forty percent required palatal revision surgery to achieve normal resonance. Fifty seven percent of patients presented with concomitant medical issues but less than 10% with global delays or autism. Conclusions: Chinese adoptees have more complex presentations and delayed surgical care compared to their domestic counterparts. Engaging prospective families starting before adoption helps to manage expectations. Long-range planning, timely surgery, aggressive therapy, and close careful follow-up can mitigate some of these differences. Speech and language problems including articulation disorders, expressive delays, and hypernasality are frequent and can persist despite interventions.
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Sperling, Randi, Danielle Steinberg, and Zachary Belnavis. "The medical evaluation of the internationally adopted child." Adoption & Fostering 45, no. 2 (2021): 228–34. http://dx.doi.org/10.1177/03085759211019724.
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Children who have been internationally adopted often have complex health issues and unique challenges. 1 The paediatric office provides a medical home by offering continuity of care, links to community support, and appropriate evaluation and treatment. During the pre-adoption evaluation, biographical and medical information provided by the child’s country of origin is reviewed. Additionally, soon after the child’s adoption, a complete medical history and physical examination should be completed. Although laboratory work may have been performed previously, studies should be repeated to ensure reliability. Developmental assessment and review of vaccinations should be completed as well. Anticipatory guidance should be provided regarding medical concerns, effects of institutionalisation and the possibility of attachment issues. Follow-up care ensures optimal medical, developmental and behavioural surveillance in this patient population.
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Knipper, Emily, Julian Davies, Caitlin Smith, and Timothy Earley. "Perioperative care for internationally adopted children: Medical, surgical, and psychosocial considerations for a population of concern." Pediatric Anesthesia 30, no. 6 (2020): 647–52. http://dx.doi.org/10.1111/pan.13866.
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Kawaguchi, Atsushi, L. Duncan Saunders, Yutaka Yasui, and Allan DeCaen. "Effects of Medical Transport on Outcomes in Children Requiring Intensive Care." Journal of Intensive Care Medicine 35, no. 9 (2018): 889–95. http://dx.doi.org/10.1177/0885066618796460.
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Background and Objectives: The need to centralize patients for specialty care in the setting of regionalization may delay access to specialist services and compromise outcomes, particularly in a large geographic area. The aim of this study was to explore the effects of interhospital transferring of children requiring intensive care in a Canadian regionalization model. Methods: A retrospective cohort design with a matched pair analysis was adopted to compare the outcomes in children younger than 17 years admitted to a pediatric intensive care unit (PICU) of a Canadian children’s hospital by a specialized transport team (pediatric critical care transported [PCCT] group) and those children admitted directly to PICU from its pediatric emergency department (PED group). The outcomes of interest included mortality 72 hours from initial contact with the critical care team (ie, either PICU transport team or intrahospital PICU team). Results: In total, 680 (27%) transports met our inclusion criteria, whereas 866 (7%) cases of 11 570 total PICU admissions were admitted directly from the emergency department. A total of 493 pairs were formed for the matched analyses. Odds of mortality within 72 hours in the PCCT group were significantly higher than in the PED group (odds ratio [OR]: 2.18, 95% confidence interval [CI]: 1.07-4.45; P = .032). When excluding cases who had at least one episode of cardiac arrest before involvement of the pediatric critical care (PCC) transport team, the OR dropped to 1.66 (95% CI: 0.77-3.46). Conclusions: Children transported from nonpediatric hospitals had a higher 72-hour mortality when compared to those children admitted directly to a children’s hospital PICU from its own PED in a Canadian regionalized health-care model.
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Restivo, Lea, Gurpreet Khaira, Amonpreet Sandhu, and Susan Kuhn. "64 Is it enough: An Assessment of Parental Satisfaction with an International Adoption Clinic at a Pediatric Tertiary Care Center." Paediatrics & Child Health 25, Supplement_2 (2020): e26-e27. http://dx.doi.org/10.1093/pch/pxaa068.063.
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Abstract Background The circumstance in which internationally adopted children are born and live prior to adoption put them at high risk for health issues. Nearly all adoptees have complex medical conditions, the most common being cleft lip/palate, orthopaedic problems, infectious diseases, congenital heart diseases, and/or nutritional deficiencies, as well as cognitive impairments, and/or developmental delays. Specifically, nearly all institutionalized children will have expressive language delays and most will have motor delays. Although improvement can be seen with time, most do not attain their full potential. Additionally, by nature of adoption, all children experience trauma. In some situations, this will be further compounded by neglect and/or abuse faced prior to adoption, or during institutionalization. Consequently, almost all adoptees develop attachment difficulties. Trained medical professionals are required to screen, monitor, and provide management suggestions for this complex and unique population. Objectives To our knowledge, parental experience of an international adoption clinic has not yet been published. This parent-based evaluation of the parental experience at a pediatric tertiary care center’s international adoption clinic, provides insights that may help guide provision of care for this high-risk population in our centre, throughout the country, and internationally. Design/Methods A qualitative, exploratory design was employed using telephone interviews of eighteen parents of adoptees assessed by a pediatric tertiary care center’s international adoption clinic since 2010. This approach was chosen to allow for more extensive exploration of parental experience, and to identify barriers and facilitators of care. Interviews were 30 to 90 minutes, semi-structured, and transcribed verbatim. Field notes were made during the interviews to note intonation and major concerns, and were used to supplement transcripts during data analysis. Questions covered experiences with pre-adoption counselling, arranging the first clinic visit, health and developmental assessments, life after clinic discharge, and general comments/suggestions. Thematic analysis was performed on the transcripts using Maguire’s step-by-step guide. Results Analysis resulted in four main themes and seven subthemes. The first theme was “difficulty of international adoption”. The second theme “utility and impact of services offered” was subdivided into “pre-adoption counselling”, “clinic visits and medical assessments”, and “post adoption seminars”. The third theme “the administrative procedures of the clinic” was subdivided into “timing and ease of organizing a first visit”, and “hours of operation”. The final theme “gaps in care” was divided into “ongoing difficulty with attachment”, and “allied healthcare services”. These results demonstrate that parents of internationally adopted children often feel overwhelmed by the medical needs of their children and feel unsupported. They recommend comprehensive and in-person pre-adoption counselling with standard referral processes to ensure timely access to care. Post-arrival medical and developmental assessments should be flexible and complete. Most importantly, clinics should incorporate support from allied healthcare professionals, including social work, psychology, occupational therapy, and physiotherapy. In particular, parents were interested in further management of attachment. Conclusion This first parent-based evaluation of the parental experience at a pediatric tertiary care center’s international adoption clinic provides insights that may help guide provision of care to this high-risk population in centres across Canada and internationally.
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Aggrawal, Pratima, and Papa Dasari. "Clinical profile of women seeking medical termination of pregnancy at a tertiary care institute, South India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 4 (2021): 1580. http://dx.doi.org/10.18203/2320-1770.ijrcog20211140.
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Background: Medical termination of pregnancy (MTP) has largely become a medical procedure rather than surgical and in the recent times and few women approach public health care facility and hence the profile of women has changed and is different in various hospitals. Hence this study was undertaken with the objectives to know the proportion of indications as per MTP act and gestational age in women who opted MTP. The study also aimed to find out the clinic-demographic profile and the method of MTP and contraception adopted along with MTP.Methods: A retrospective cohort over 3 year period (2016-2019). Data was extracted from the medical records of women who were hospitalised for MTP and analysed for the outcome parameters Viz: Women were categorised as per the indication for MTP. In each category of indication, age, socioeconomic status, trimester of MTP, number of living children, methods of MTP and methods of contraception adopted was noted. The results were expressed as proportions and frequencies and the trend over 3 years was expressed as percentage per total number of deliveries per year.Results: There were 640 MTPs over 3 year period and this constituted 1.22% of total deliveries (52,555). Fifty one percent were first trimester MTPs. Thirty eight percent were done for congenital malformations, 32% for socio-economic reasons of family limitation, 17% for saving physical or mental health , 4% for rape victims and 8% for failure of contraception. The mean age was 28 years and the age in humanitarian group was ≤ 20 years. More than 88% belonged to lower socioeconomic class and 37% were third gravidae with 2 living children. Medical methods were used in 90% of terminations and 46% adopted contraception.Conclusions: The most common reason for opting MTP is congenital malformation of fetus. Women who achieved the desired family size and non-practice of contraception was the next common indication for termination of pregnancy and majority of terminations in this group were first trimester. Practice of contraception to avoid unwanted pregnancy and measures to prevent congenital malformations are essential to reduce medical termination of pregnancies.
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Abebe, Ephrem, Sarah Wiehe, and Richard J. Holden. "11384 Medication Use Safety During Care Transitions for Children with Medical Complexity." Journal of Clinical and Translational Science 5, s1 (2021): 133. http://dx.doi.org/10.1017/cts.2021.740.
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ABSTRACT IMPACT: This study will generate preliminary data to address a critical, care transition-related patient safety gap involving medication use among children with medical complexity. OBJECTIVES/GOALS: The objectives of this study are: (1) to understand care transition-related medication safety risks for children with medical complexity (CMC), and (2) through a participatory, human centered design (PD) approach, to develop an early prototype intervention to address identified safety risks. METHODS/STUDY POPULATION: The study population includes children with medical complexity (CMC), a medically fragile pediatric population with intensive healthcare needs. CMC rely on multiple and complex medication regimens and/or medical devices for optimal functioning. Parents of CMC report multiple unmet healthcare needs. For Aim 1, we will conduct observations and interviews with ˜15 clinicians as well as semi-structured interviews with ˜30 family caregivers during three care transition experiences: from Cardiac ICU to home, Neonatal ICU to home, and those between primary care/specialty clinic to home. For Aim 2, we will conduct participatory design sessions with up to 5 participants (separately for clinicians and family caregivers) from each of the three care transition settings to co-design a prototype intervention. RESULTS/ANTICIPATED RESULTS: The study is currently recruiting family caregivers of CMC for aim 1 research activities, with interviews planned to be completed in February/March 2021. Transcribed interviews will be used to inform development of patient journey maps. A patient journey map helps to visually depict healthcare services through the patient and family lens, and highlights important ‘touch points’ along the patient journey (e.g., decisions, encounters, constraints, emotional states, etc.) that shape the patient and family experience. The journey map will distill findings from qualitative data and generate a concise visual story focused on the medication use experience of CMC as they transition between the hospital and their home. Individual journey maps will also be combined to generate a consolidated journey map. DISCUSSION/SIGNIFICANCE OF FINDINGS: An-in-depth understanding of medication safety risks unique to the context of CMC care would be essential to develop interventions that are useful, scalable, and sustainable. This is even more important because current interventions are primarily adopted from adult care settings with mixed outcomes.
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Mattsson, Janet, Maria Forsner, Maaret Castrén, and Maria Arman. "Caring for children in pediatric intensive care units." Nursing Ethics 20, no. 5 (2013): 528–38. http://dx.doi.org/10.1177/0969733012466000.
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Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses’ concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing—here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children’s needs unmet; parent-oriented nursing care—here, the nursing care emphasizes the parents’ needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation—here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit.
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Rojjananukulpong, Rattanakarun, Mokbul Morshed Ahmad, and Shahab E. Saqib. "Disparities in Physical Accessibility among Rural Thais Under Universal Health Coverage." American Journal of Tropical Medicine and Hygiene 105, no. 3 (2021): 837–45. http://dx.doi.org/10.4269/ajtmh.20-1627.
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ABSTRACT. This study aims to explore various barriers in accessing outpatient care among the participants from different age groups and to identify determinants associated with physician visits. The study had adopted Andersen’s Behavioral Model (ABM) of Health Services Use. A cross-sectional study design was adopted to collect data from 417 participants through a questionnaire survey. Poisson regression models were used to explore determinants for explaining the differences in outpatient care use. The regression results revealed that divergent relationships existed among age groups. Children and elderly participants tended to decrease the probability of seeking care. Elderly participants confronted more difficulties in access and were dependent on family members. Despite free care provisions, participants visited and spent their out-of-pocket expenditure mostly at non-universal health coverage (non-UHC) facilities. Convenience and the availability of specialist physicians led the higher-income parents to seek care of their children at non-UHC facilities. Highly educated people of working age preferred more self-care or institutionalized care to save time. Children up to the primary level of education were more likely to visit a doctor. We concluded that investments in education or well-informed health services provision would improve health care utilization. Findings of Andersen’s Behavioral Model variables suggested that improvements in the quality of services, medical professional skills, and efficient resource allocation may induce seeking care at UHC facilities. Consequently, it will reduce the number of referred cases, caseloads at tertiary care units, and visits to non-UHC facilities at longer distances.
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Ó Néill, Clayton. "Re H (A Child) (Parental Responsibility: Vaccination): The Merits of Adopting A Softer Approach To Vaccination of A Child in Care?" Medical Law Review 28, no. 4 (2020): 817–26. http://dx.doi.org/10.1093/medlaw/fwaa025.
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Abstract In Re H (A Child) (Parental Responsibility: Vaccination), the Court of Appeal decided that vaccination did not represent ‘grave’ or ‘serious’ medical treatment and determined that, in the case of a child under the care of a Local Authority, court authorization for consent to and arrangement of vaccination is no longer required. This is due to the strong medical evidence in support of vaccination. Thus, with due reference to 33(3)(b) Children Act 1989 and while considering proportionality and, particularly, the proportionate response to interference with the parents’ right to respect for private and family life under Article 8 of the European Convention on Human Rights, the court held that vaccination is in line with the best interests of the child. This commentary supports this judgment but identifies a slight prospective anomaly in the approach adopted to children in care and those who are not in care. The resolution of this dichotomy lies in broadening the scope of King LJ’s approach in this case.
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Said, Khadiga M., Safaa F. Deraz, and Amal G. Sebaq. "Effect of Designed Practice Guidelines on Nurses’ Performance and Outcome of Children with Head Injuries." Evidence-Based Nursing Research 1, no. 2 (2020): 12. http://dx.doi.org/10.47104/ebnrojs3.v1i2.89.
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Contexts Acute head injury resulting from a trauma to the head, leading to brain injury or bleeding within the brain, it can cause edema and hypoxia. Head injury is the leading cause of death in the first four decades of life. Effective nursing management strategies for children with severe traumatic brain injury are still a remarkable issue and a difficult task for neurologists, neurosurgeons, and nurses.
 Aim: To evaluate the effect of designed practice guidelines on nurses' performance regarding the care of children with head injuries.
 Methods: A quasi-experimental research design utilized to conduct the current study on pediatric neurosurgery departments of Benha University Hospital and Benha Teaching Hospital. A purposive sample of 72 children with head injuries and a convenient sample of all available nurses. They were 62 nurses who are working on the previously mentioned study settings. Four tools used to collect data in this study. A structured interviewing questionnaire sheet developed to assess the studied nursing personal characteristic of the studied nurses and nurses' knowledge regarding head injuries. Child medical data record developed to assess children's personal and head injuries characteristics for children. Glasgow coma scale adopted to assess the child conscious level. Observational checklists to assess the actual nurses' practices regarding the care of children with head injuries.
 Results: There was a statistically significant improvement in nurses' knowledge and practice regarding the care of children with head injuries before and after the implementation of designed practice guidelines (p˂0.001). There was a statistically significant improvement regarding the occurrence of convulsion after the implementation of the program.
 Conclusion: The study concluded that the implementation of designed practice guidelines for nurses improves their knowledge and practice as well as reduced occurrence of frequency, duration, and timing of convulsion, which support the current research hypotheses. The study emphasizing the importance of implementing of designed practice guidelines for nurses caring of children with a head injury to reduce the occurrence of head injury complications, which is an effective and safe non-invasive intervention in neurosurgery and emergency departments as a standard of care for all head-injured children.
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Venturini, Elisabetta, Lara Fusani, Antonia Mantella, et al. "Strongyloidiasis in Children Outside the Tropics: Do We Need to Increase Awareness?" Microorganisms 9, no. 9 (2021): 1905. http://dx.doi.org/10.3390/microorganisms9091905.
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Strongyloidiasis belongs to the group of neglected tropical diseases, due to diagnostic difficulties and the lack of systematic screening. Studies on strongyloidiasis prevalence are often heterogenous and mainly performed in adults in endemic countries. We retrospectively enrolled 2633 children referred to a tertiary care hospital in Italy between 2009 and 2020 and tested for S. stercoralis infection. Sixty-one (2.3%) had a positive serology and for 55 of them, clinical and epidemiological information were available. Thirteen cases (24%) were diagnosed in Italian children without history residency or travel to foreign countries, while the remaining were internationally adopted or migrant children. Seropositive patients were mostly asymptomatic, and often eosinophilia was the only sign of strongyloidiasis. Sero-reactivity to Toxocara canis was found in 1/3 of patients. Ivermectin was used in 37 (75.5%) treated patients. A significant reduction of eosinophil levels and IgG titer was seen after treatment. Our study confirms that strongyloidiasis is usually asymptomatic in children. However, due to the ability of the parasite to cause a life-long infection together with the risk of a severe form in case of immunosuppression, it is important to identify and treat infected children. Special consideration should be reserved to high-risk groups, such as immigrants and international adoptees, where screening for S. stercoralis is indicated. However, the study highlights that sporadic cases of autochthonous strongyloidiasis in Italy may occur. Therefore, pediatricians should be aware of this condition, which is often under-recognized.
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Huysentruyt, Koen, Kim Brunet-Wood, Robert Bandsma, et al. "Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals." Nutrients 13, no. 8 (2021): 2635. http://dx.doi.org/10.3390/nu13082635.
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Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.
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Paramasivamsasanger, Kamalavarshini, Bhakiyanathan Arumugam, Parimalakrishnan Sundararajan, and Praveen Kumar Ravi Kumar. "Drugs used in wheeze associated respiratory infection among children in tertiary care teaching hospital." International Journal of Basic & Clinical Pharmacology 9, no. 9 (2020): 1392. http://dx.doi.org/10.18203/2319-2003.ijbcp20203625.
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Background: This study was done to study the drugs used in wheeze associated lower respiratory infected paediatric patients in tertiary care teaching hospital.Methods: Sample size was calculated as 78 and patients were selected based on the inclusion and exclusion criteria. The study was a prospective observational study and conducted in Department of Pediatrics, Rajah Muthiah Medical College and Hospital (RMMCH), Annamalai University.Results: Our study shows that male children (63%) are affected with more than female children (37%). The most frequently prescribed drugs are antibiotics (96%), antipyretics (63%), expectorants and antitussives (54%) followed by beta adrenergic agonist (46%), beta adrenergic agonist with anticholinergic combination (14%) corticosteroids (18%). Our study also shows wheeze associated lower respiratory infection (WALRI) in children were significantly associated with bacterial infections (72%).Conclusions: Our study concluded that antibiotics and antipyretics are the most commonly prescribed drugs for WALRI followed by expectorants and antitussives, beta adrenergic agonist, corticosteroids, beta adrenergic agonist with anticholinergic combination. Most of the treatment strategies are adopted from Standard Treatment Guidelines (STG) and World Health Organisation (WHO). The average number of prescribed drugs per encounter was more than that of WHO standards. The percentage of encounters in which an antibiotics and injections was higher than the ideal WHO standards it leads to anti-microbial resistance and costly forms of drug therapy.
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Becker, Bruce M., Michael T. Handrigan, Liudvikas Jagminas, and Tanya J. Becker. "Emergency Medical Services in the Reconstruction Phase following a Major Earthquake: A Case Study of the 1988 Armenia Earthquake." Prehospital and Disaster Medicine 13, no. 1 (1998): 28–33. http://dx.doi.org/10.1017/s1049023x00033008.
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AbstractStudy Objective:To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical need of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel.Methods:The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS).Results:Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem.Conclusion:In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.
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Pickering, Larry K., Carol J. Baker, Gary L. Freed, et al. "Immunization Programs for Infants, Children, Adolescents, and Adults: Clinical Practice Guidelines by the Infectious Diseases Society of America." Clinical Infectious Diseases 49, no. 6 (2009): 817–40. http://dx.doi.org/10.1086/605430.
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Abstract Evidence-based guidelines for immunization of infants, children, adolescents, and adults have been prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). These updated guidelines replace the previous immunization guidelines published in 2002. These guidelines are prepared for health care professionals who care for either immunocompetent or immunocompromised people of all ages. Since 2002, the capacity to prevent more infectious diseases has increased markedly for several reasons: new vaccines have been licensed (human papillomavirus vaccine; live, attenuated influenza vaccine; meningococcal conjugate vaccine; rotavirus vaccine; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap] vaccine; and zoster vaccine), new combination vaccines have become available (measles, mumps, rubella and varicella vaccine; tetanus, diphtheria, and pertussis and inactivated polio vaccine; and tetanus, diphtheria, and pertussis and inactivated polio/Haemophilus influenzae type b vaccine), hepatitis A vaccines are now recommended universally for young children, influenza vaccines are recommended annually for all children aged 6 months through 18 years and for adults aged ⩾50 years, and a second dose of varicella vaccine has been added to the routine childhood and adolescent immunization schedule. Many of these changes have resulted in expansion of the adolescent and adult immunization schedules. In addition, increased emphasis has been placed on removing barriers to immunization, eliminating racial/ethnic disparities, addressing vaccine safety issues, financing recommended vaccines, and immunizing specific groups, including health care providers, immunocompromised people, pregnant women, international travelers, and internationally adopted children. This document includes 46 standards that, if followed, should lead to optimal disease prevention through vaccination in multiple population groups while maintaining high levels of safety.
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Korobeev, A. I., and A. A. Shirshov. "Live Birth Criteria when Defning Life as an Object of Protection under Criminal Law." Lex Russica, no. 5 (May 20, 2020): 64–72. http://dx.doi.org/10.17803/1729-5920.2020.162.5.064-072.
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The achievements of modern medical science have led to the situation when children born deeply premature have a chance to survive. In the paper, the authors examine the problems of determining the initial moment of human life associated with the life birth criteria, analyze approaches to the definition of live birth criteria adopted by the World Health Organization and consolidated by Russian experts in the Order of the Ministry of Health and Social Development of Russia of 27 December 2011 No. 1687n “On Medical Criteria of Birth, Form of the Birth Document and the Procedure for its Issuance” (as amended on 13 September 2019).The authors intended to identify and analyze some issues related to the lack of regulation of the legal status of deeply premature babies born 22 weeks premature or if the body weight of such children is not more than 500 g from the moment of their birth until they are seven days old. The authors are critical of the actual lack of legal regulation of the status of such children, assess the legal provisions regulating the mandatory resuscitation measures in relation to such children with due regard to the risks of further development of pathologies.The paper provides for the conclusions about the need to clarify the conceptual and categorical apparatus in relation to the criteria of live birth, more complete consideration by domestic specialists of the criteria of live birth proposed by the World Health Organization, the need to take into account parents’ opinion concerning the extent of medical care for deeply premature children, including intensive care, within the framework of the institution of informed voluntary consent.The authors call for special caution to examine any proposals to extend the limits of responsibility of medical workers, especially those related to the existence of gaps and ambiguities of the legal regulation.
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Ankush, Ankush, Amit Dias, M. P. Silveira, Yash Talwadker, and Joachim Piedade Souza. "Quality of life in children with thalassemia major following up at a tertiary care center in India (GOTQoL)." International Journal of Contemporary Pediatrics 6, no. 1 (2018): 168. http://dx.doi.org/10.18203/2349-3291.ijcp20185203.
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Background: This study aims to measure the quality of life (QoL) scores in children with thalassemia major following up at a tertiary care center for routine blood transfusion in comparison to healthy children.Methods: A case control study design was adopted, wherein on the QoL of 36 children with thalassemia in the age group 5 to 18 following up for blood transfusion at Goa Medical College, was measured using PedsQL™ 4.0. This was compared to the QoL in age and gender matched healthy children from a government school. A higher score on a subscale indicates better quality of life on this instrument.Results: The children with thalassemia had lower mean scores on physical (67.85 vs 84.24; P <0.001), social (78.34 vs 87.95; P=0.002) and school (62.64 vs 79.48; P <0.001) functioning subscales compared to the healthy children. They also had lower mean psychosocial summary score (73.32 vs 82.01; P=0.003) and total health summary score (71.95 vs 82.57; P <0.001). The physical functioning subscale had significantly higher score among the children who were on chelation and also among the ones whose parents reported as being informed about the condition.Conclusions: The children with thalassemia have poor QoL in physical, social and school functioning domains. Improvement in QoL requires consolidated efforts on part of doctors, parents, school authorities and policy makers. These patients should be provided with low cost-effective chelation therapy. The parents need to be counselled about this disease by the treating team.
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Morkem, Rachael, Scott Patten, John Queenan, and David Barber. "Recent Trends in the Prescribing of ADHD Medications in Canadian Primary Care." Journal of Attention Disorders 24, no. 2 (2017): 301–8. http://dx.doi.org/10.1177/1087054717720719.
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Objective: The aim of this study was to describe the prevalence and incidence of ADHD medication prescribing, by age and gender, from 2005 to 2015 in Canadian primary care. Method: A population-based retrospective cohort study was conducted to evaluate the prescribing of ADHD medications between 2005 and 2015 using electronic medical record data. Yearly prevalence and incidence of ADHD medication prescribing were calculated for preschoolers (up to 5 years old), school-aged children (6-17 years old), and adults (18-65 years old) along with a description of the types of ADHD medications prescribed between 2005 and 2015. Results: Between 2005 and 2015, there was a 2.6-fold increase in the prevalence of ADHD medication prescribing to preschoolers, a 2.5-fold increase in school-aged children, and a fourfold increase in adults. There was a corresponding rise in incidence of prescribing although this rise was moderate and estimates were much lower compared with prevalence. The most commonly prescribed medication was Methylphenidate (65.0% of all ADHD medications prescribed). Conclusion: Although the prevalence of ADHD has remained stable over time, this study found an increase in the prescribing of ADHD medications in all age groups between 2005 and 2015. Incidence of new prescriptions was small relative to prevalence, suggesting that longer term treatments are being adopted.
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Vasyliev, V. S. "eHealth as a united information space for doctors and patients." Infusion & Chemotherapy, no. 3.2 (December 15, 2020): 26–27. http://dx.doi.org/10.32902/2663-0338-2020-3.2-26-27.
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Background. The national primary healthcare system (PHS) includes 1939 institutions, 27.7 million patients, 24,607 doctors, 1122 pharmacies and 9395 pharmacists. The eHealth informational space was created to coordinate the work of the PHS.
 Objective. To describe the features and functioning of the eHealth informational space.
 Materials and methods. Analysis of the current situation regarding the work of eHealth.
 Results and discussion. An important function of eHealth is the transition to electronic prescriptions and electronic referrals to specialists under the medical guarantee program. Adopted in 2020 budget of this program amounted to 72 billion UAH, which was allocated to primary care, secondary, tertiary, emergency and palliative care, medical care for children, medical care for pregnancy and childbirth, medical rehabilitation. In total, UAH 1758 billion was spent on the diagnosis and treatment of oncological diseases, of which 80.7 % – on diagnosis and chemotherapy, and 29.3 % – on the diagnosis and radiation treatment. The eHealth system provides the cooperation between the Ministry of Health of Ukraine, the National Health Service of Ukraine and medical institutions with medical information systems. Benefits of the united informational system include the elimination of paperwork, creating a united medical card of each patient, online registration for a doctor’s consultation, eliminating the possibility of drug receipt falsification, increasing the availability of telemedicine consultations, improving communication between healthcare professionals, planning and monitoring of strategic procurement. If the patient uses a smartphone, this informational space allows him to transmit his data (for example, the results of blood pressure measurements) through a mobile application to the telemedicine platform with their subsequent analysis and correction of prescriptions. Additional opportunities of the informational space include monitoring of drugs’ side effects, educational programs for doctors, and the possibility of creating professional communities.
 Conclusions. 1. The eHealth system enables Ukrainian doctors and patients to use electronic prescriptions and electronic referrals to the specialists. 2. Benefits of this informational system include the elimination of paperwork, the creation of a united medical card of each patient, online registration for a doctor’s consultation, improved communication between health professionals, improved planning of strategic procurement, etc. 3. The eHealth system includes a number of useful services for both doctor and patient.
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Fabre, Laëtitia, Aurélia Delauné, Emmanuelle Espié та ін. "Chromosomal Integration of the Extended-Spectrum β-Lactamase Gene blaCTX-M-15 in Salmonella enterica Serotype Concord Isolates from Internationally Adopted Children". Antimicrobial Agents and Chemotherapy 53, № 5 (2009): 1808–16. http://dx.doi.org/10.1128/aac.00451-08.
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ABSTRACT We report the emergence of Salmonella enterica isolates of serotype Concord (and its monophasic variant 6,7:l,v:-) producing the extended-spectrum β-lactamases (ESBLs) SHV-12 and CTX-M-15 in France and Norway between 2001 and 2006 (43 in France and 26 in Norway). The majority of these isolates were from adopted children from Ethiopia, most of whom were healthy carriers. Several symptomatic secondary cases were found in the adoptive families and health care facilities in France. Serotype Concord isolates collected before 2003 produced SHV-12 encoded on a 340-kb conjugative plasmid of replicon IncI1. Isolates collected after 2003 produced CTX-M-15. We detected two conjugative plasmids carrying bla CTX-M-15. One plasmid, approximately 300 kb in size, was positive for the IncHI2 replicon and the plasmid-mediated quinolone resistance gene qnrA1. The other plasmid, from one of the earliest CTX-M-15-producing isolates collected, was a fusion plasmid with IncY and IncA/C2 replicons and was 200 kb in size. However, we showed, using Southern hybridization of I-CeuI-digested chromosomal DNA and S1 nuclease analysis of plasmid DNA, that most isolates had a bla CTX-M-15 gene located on chromosomal DNA. Analysis of the flanking regions of the chromosomally located bla CTX-M-15 gene by cloning revealed an ISEcp1 truncated by an intact IS26 upstream from the bla CTX-M-15 gene and a truncated orf477 gene downstream from bla CTX-M-15. We found regions beyond the IS26 and the orf477 genes that were derived from IncA/C2 plasmids, suggesting the chromosomal integration of part of the bla CTX-M-15-carrying IncY and IncA/C2 fusion plasmid from early CTX-M-15-producing isolates.
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Cooper, A., D. Gonzalez, M. Frogel, et al. "(A47) Pediatric Mass-Casualty Triage: The New York City Approach." Prehospital and Disaster Medicine 26, S1 (2011): s16. http://dx.doi.org/10.1017/s1049023x11000641.
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IntroductionA Mass-Casualty Event (MCE) involving pediatric victims could overwhelm existing pediatric resources. Therefore, early recognition of critically ill infants and children is essential for proper distribution among pediatric capable hospitals. However, emergency medical services (EMS) personnel have limited experience with pediatric assessments, and less with pediatric mass-casualty triage (MCT). To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) in collaboration with the Fire Department (FDNY) and Office of Emergency Management, made simple alterations to the START-based NYC-MCT Algorithm that can be rapidly and accurately applied by EMS personnel in the field with minimal additional education and preparation, obviating the requirement for extensive and expensive retraining.MethodsThe PDC includes experts in pediatric emergency preparedness, emergency medicine, critical care, and trauma surgery in NYC, as well as DOHMH, FDNY-OMA, and OEM. Its Triage Subcommittee determined the minimum essential pediatric alterations to the Algorithm, which then was tested by FDNY-EMS.ResultsAfter focused literature review and multiple draft revisions aimed to maximize pediatric benefit yet minimize unnecessary complexity, the Algorithm was modified to ensure that: (1) five rescue breaths will be provided to infants or children prior to being categorized as Dead or Expectant; (2) infants under 12 months old will be categorized as Critical and receive priority transport, and (3) children initially categorized as Delayed or Minor will be uptriaged to a new Urgent (Orange) category to receive such care in a rapid manner. To date, > 3,000 FDNY personnel have been trained in its use, and tested its accuracy using tabletop scenarios. Mean accuracy is 80–90%.ConclusionsThe model is an effective, multidisciplinary approach to planning. Minimum alterations to the Algorithm were adopted by the regional EMS system. The Modified Algorithm improves identification of critically ill infants and children. This approach could be adopted by other large urban centers.
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Czerwińska-Osipiak, Agnieszka, Beata Pięta, Justyna Kamińska, and Halina Nowakowska. "Women’s postnatal care based on the Polish and international recommendations." Pielegniarstwo XXI wieku / Nursing in the 21st Century 17, no. 3 (2018): 65–68. http://dx.doi.org/10.2478/pielxxiw-2018-0020.
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Abstract Introduction. The issue of high-risk pregnancy has been widely discussed in the recent years. As a result, many countries have introduced programs to improve perinatal care in order to meet the needs of pregnant women as well as those going into labour. Much less attention was dedicated to health and social circumstances of women in the postpartum period. The World Health Organisation developed a document (WHO Recommendations on Postnatal Care of the Mother and Newborn, 2013) in which it clearly defines recommendations formulated for the professionals who are care providers to the child and the mother after birth. The authors of the report indicate that the postnatal period is crucial for both the mothers and their children, and the lack of proper care given to them may lead to deterioration of their health and even death. According to the code of professional practice, the Polish midwife identifies and determines individuals’ requirements as well as health needs, recognizes nursing difficulties, and, effectively plans and oversees their care. The Polish guideline for the highest standard of medical care during pregnancy, the delivery, the postpartum period and the neonatal care is the Regulation of the Health Minister from 20th September 2012. Aim. This paper collected current and adopted recommendations regarding postpartum care with an emphasis on the significant role of the midwife.
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Brazier, Ellen, Olga Tymejczyk, Elizabeth Zaniewski, et al. "Effects of National Adoption of Treat-All Guidelines on Pre-Antiretroviral Therapy (ART) CD4 Testing and Viral Load Monitoring After ART initiation: A Regression Discontinuity Analysis." Clinical Infectious Diseases 73, no. 6 (2021): e1273-e1281. http://dx.doi.org/10.1093/cid/ciab222.
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Abstract Background The World Health Organization’s Treat-All guidance recommends CD4 testing before initiating antiretroviral therapy (ART), and routine viral load (VL) monitoring (over CD4 monitoring) for patients on ART. Methods We used regression discontinuity analyses to estimate changes in CD4 testing and VL monitoring among 547 837 ART-naive patients enrolling in human immunodeficiency virus (HIV) care during 2006–2018 at 225 clinics in 26 countries where Treat-All policies were adopted. We examined CD4 testing within 12 months before and VL monitoring 6 months after ART initiation among adults (≥20 years), adolescents (10–19 years), and children (0–9 years) in low/lower-middle-income countries (L/LMICs) and high/upper-middle-income countries (H/UMICs). Results Treat-All adoption led to an immediate decrease in pre-ART CD4 testing among adults in L/LMICs, from 57.0% to 48.1% (−8.9 percentage points [pp]; 95% CI: −11.0, −6.8), and a small increase in H/UMICs, from 90.1% to 91.7% (+1.6pp; 95% CI: 0.2, 3.0), with no changes among adolescents or children; decreases in pre-ART CD4 testing accelerated after Treat-All adoption in L/LMICs. In L/LMICs, VL monitoring after ART initiation was low among all patients in L/LMICs before Treat-All; while there was no immediate change at Treat-All adoption, VL monitoring trends significantly increased afterwards. VL monitoring increased among adults immediately after Treat-All adoption, from 58.2% to 61.1% (+2.9pp; 95% CI: 0.5, 5.4), with no significant changes among adolescents/children. Conclusions While on-ART VL monitoring has improved in L/LMICs, Treat-All adoption has accelerated and disparately worsened suboptimal pre-ART CD4 monitoring, which may compromise care outcomes for individuals with advanced HIV.
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Redwood-Campbell, Lynda J., Sharonya N. Sekhar, and Christine R. Persaud. "Health Care Workers in Danger Zones: A Special Report on Safety and Security in a Changing Environment." Prehospital and Disaster Medicine 29, no. 5 (2014): 503–7. http://dx.doi.org/10.1017/s1049023x14000934.
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AbstractIntroductionViolence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often at a time when it is most needed.ProblemAttacks may be intentional or unintentional and can take a range of forms from road blockades and check points which delay or block transport, to the direct targeting of hospitals, attacks against medical personnel, suppliers, patients, and armed entry into health facilities. Lack of access to vital health care services weakens the entire health system and exacerbates existing vulnerabilities, particularly among communities of women, children, the elderly, and the disabled, or anyone else in need of urgent or chronic care. Health care workers, especially local workers, are often the target.MethodsThis report reviews the work being spearheaded by the Red Cross and Red Crescent Movement on the Health Care in Danger initiative, which aims to strengthen the protections for health care workers and facilities in armed conflicts and ensure safe access for patients. This includes a review of internal reports generated from the expert workshops on a number of topics as well as a number of public sources documenting innovative coping mechanisms adopted by National Red Cross and Red Crescent Societies. The work of other organizations is also briefly examined. This is followed by a review of security mechanisms within the humanitarian sector to ensure the safety and security of health care personnel operating in armed conflicts.ResultsFrom the existing literature, a number of gaps have been identified with current security frameworks that need to be addressed to improve the safety of health care workers and ensure the protection and access of vulnerable populations requiring assistance. A way forward for policy, research, and practice is proposed for consideration.ConclusionWhile there is work being done to improve conditions for health care personnel and patients, there need to be concerted actions to stigmatize attacks against workers, facilities, and patients to protect the neutrality of the medical mission.Redwood-CampbellLJ, SekharSN, PersaudCR. Health care workers in danger zones: a special report on safety and security in a changing environment. Prehosp Disaster Med. 2014;29(5):1-5.
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Hansen, Patricia, and Frank Ainsworth. "Parent blaming in child protection and health settings: A matter for concern." Children Australia 32, no. 2 (2007): 29–35. http://dx.doi.org/10.1017/s103507720001155x.
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This article is about parent blaming. It draws on the authors’ experience in health care agencies and the children’s court. Parent blaming involves practitioners attributing to parents an ‘excess’ level of responsibility expressed as ‘blame’ in regard to child care and protection or child treatment issues in the context of health. In the course of this process, structural factors such as low income, poor housing, unemployment, social isolation and prejudice that affect a parent’s capacity to protect and care for a child are frequently ignored.Parent blaming is not a new phenomenon although currently it seems to be in vogue among practitioners in these fields. When blame is conveyed to parents, it creates anger and resentment and guarantees a non-cooperative response from them. This response is then all too readily used as evidence to support the view that parents are indeed to blame for their child’s lack of safety or medical condition. In practice, a blaming approach is futile. Suggestions are made about how this phenomenon can be avoided and how more positive approaches can be adopted to providing services to children and their families.
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Dawson, Cromwell Prince, Genevieve Cecilia Aryeetey, Samuel Agyei Agyemang, Kofi Mensah, Rebecca Addo, and Justice Nonvignon. "Costs, burden and quality of life associated with informal caregiving for children with Lymphoma attending a tertiary hospital in Ghana." International Journal of Care Coordination 23, no. 4 (2020): 165–72. http://dx.doi.org/10.1177/2053434520981357.
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Introduction Primary family caregivers provide substantial support in the management of lymphoma, potentially affecting their quality of life and increasing household health care costs. Our aim was thus to determine the economic costs and quality of life of primary caregivers of children with lymphoma. Methods This cross-sectional study involved primary informal caregivers of children with lymphoma attending the pediatric cancer unit at Komfo Anokye Teaching Hospital. The study adopted a cost-of-illness approach to estimate the direct costs (medical and non- medical) incurred and indirect cost (productive losses) to caregivers over the one-month period preceding the data collection. Zarit Burden Interview was used to determine caregiver burden and EUROHIS-QoL tool was used to determine the quality of life of primary caregivers. Results The average cost of managing lymphoma in children was estimated to be US$440.32, 97% of which were direct costs. On average, caregiver burden was 26.3 on the scale of 0 to 48. About 94% of caregivers reported high burden, with more males reporting high burden. Overall, average quality of life among caregivers was 2.20 on the 1 to 5 range. Approximately 85% of respondents reported low quality of life, with females reporting lower quality of life than males. Discussion This study shows that lymphoma is associated with substantial cost and increased burden, and affects quality of life of family caregivers. Future studies can explore the impact of social protection interventions (in the form of health insurance) to reduce the household economic burden of managing lymphoma in children.
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Kayhan, Nilay, and Latife Ozaydin. "The Quality of Mainstreaming in Preschool: The Views of Parents of Children with Down Syndrome." Journal of Education and Learning 7, no. 2 (2017): 157. http://dx.doi.org/10.5539/jel.v7n2p157.
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Down syndrome (DS), one of the developmental (cognitive) deficits, is the most common syndrome that arises from genetic disorders. The mothers of children with DS who encounter the most intense emotional situations since the tendency to take responsibility the children’s care and development usually belongs them. Among these intensive feelings, mothers are also responsible for providing needs, such as special education support, searching for a suitable preschool institution to accept their children, and access to specialists who can understand their medical needs. This case study aims to investigate the opinions of the mothers whose children with DS aged between 36-72 months were attending preschool. The data were collected using semi-structured interview techniques in three different preschool institutions where the mainstreaming was carried out in the district center of Gaziantep, Şahinbey. Interviews were conducted with five mothers whose DS children went to the preschool institution in the spring semester during 2015-2106 academic year. Descriptive and content qualitative analyses were used to analyze the data. The findings regarding the opinions of the mothers of DS children on the quality of the mainstreaming practices revealed the following salient themes: Early experiences before mainstreaming, quality of mainstreaming at preschool and inclusion. The findings showed that inclusion practices have not been adopted in mainstreaming practices in our country; therefore, the most reliable sources mothers preferred to follow was the experienced families who had children with DS in the preschool.
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Hoffmann, Izabel Cristina, Wendel Mombaque dos Santos, Stela Maris de Mello Padoin, and Sonia Maria Oliveira de Barros. "A five-year review of vertical HIV transmission in a specialized service: cross-sectional study." Sao Paulo Medical Journal 134, no. 6 (2016): 508–12. http://dx.doi.org/10.1590/1516-3180.2016.0139140616.
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ABSTRACT CONTEXT AND OBJECTIVE: Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it. DESIGN AND SETTING: Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil. METHODS: A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children. RESULTS: The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported. CONCLUSIONS: The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.
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Barbosa Filho, Valter Cordeiro, Rafael Martins da Costa, Margarethe Thaisi Garro Knebel, Bruno Nunes de Oliveira, Camila Brasileiro de Araújo Silva, and Kelly Samara da Silva. "The prevalence of global physical activity among young people: a systematic review for the Report Card Brazil 2018." Brazilian Journal of Kinanthropometry and Human Performance 20, no. 4 (2018): 367–87. http://dx.doi.org/10.5007/1980-0037.2018v20n4p367.
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The aim of this study was to summarize data on the prevalence of global physical activity (PA) among children and adolescents in Brazil. This systematic review included an electronic search in 8 databases (PubMed, Scopus, Web of Science, LILACS, SPORTDiscus, BIREME, Scielo, and Google Scholar) and a manual search in the references of retrieved studies. Observational studies that assessed global PA among Brazilian children and adolescents were included. A narrative approach toward results was adopted. An initial database search reached 3276 potentially relevant titles (2534 titles after duplicate analysis); 92 (62 different studies) met all inclusion criteria. Studies were carried out between 2001 and 2015; most studies were conducted in Southern and Northeastern Brazil. Three were nationwide surveys (4.8%), but no studies included children aged 0-5 years. Eighteen different instruments for PA measurement were used; only two studies used objectively-measured PA. The most used definition was ≥ 300 minutes/week of moderate-to-vigorous PA. The overall proportion of young people who were physically active ranged from 6.5% to 92.3%. Fourteen studies (22.6%) found a prevalence of ≥ 50%. Three nationwide surveys reported the prevalence of physically active students ranging from 29.0% to 66.0%. A wide variability of PA estimates were found. Important research gaps (e.g., studies with objectively-measured PA, children aged up to 6 years-old and in Northern Brazil) should be considered to develop new research studies in Brazil.
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Lama, S., and AKI Krishna. "Barriers in Utilization of Maternal Health Care Services: Perceptions of Rural Women in Eastern Nepal." Kathmandu University Medical Journal 12, no. 4 (2015): 253–58. http://dx.doi.org/10.3126/kumj.v12i4.13730.
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Background Nepal is promoting safe motherhood through maternity incentives schemes. Still about two-thirds of births take place at home. Inadequate access to health care and under utilization of services is the major reasons for poor health of women and children.Objectives The study aim to explore the barriers in utilization of maternal health care services in eastern Nepal specifically to explore the reasons for not availing the services and to assess the indigenous practices regarding maternal health.Methods An exploratory study design was adopted to elicit the information from the selected respondents from different villages. Focus group discussions and in-depth interviews were conducted. Data was transcribed and analyzed manually to identify themes.Results The barriers to maternal health care service utilization were identified as social factors like family pressure, superstition, shyness, misconception, negligence, illiteracy, alcoholism. Likewise, large family size, jobless, unnecessary expenditure on health services was identified as economic barrier. Some cultural practices were also found as barrier for not availing the health services.Conclusion The study explored factors that are contributing in not availing the maternal health care services. The elimination of these barriers will facilitate quality of care and health outcomes. Therefore, the interventions should be developed and implemented to improve the health status of women and children. The result of this study can be utilized to draw the attention of local government, in strategic planning related to maternal health interventions.Kathmandu University Medical Journal Vol.12(4) 2014; 253-258
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Praborini, Asti, Dyah Febriyanti, and Ria Subekti. "Induced Lactation for Adoptive Breastfeeding Dyads." Clinical Lactation 10, no. 3 (2019): 127–35. http://dx.doi.org/10.1891/2158-0782.10.3.127.
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IntroductionBreastfeeding has many benefits for both mother and baby, but not all mothers can have their own babies. Here we used an induced lactation protocol to breastfeed adopted babies.Materials and MethodWe implement and describe an induced lactation protocol for adoptive breastfeeding dyads at Kemang Medical Care (KMC) Women and Children Hospital and Permata Depok Hospital, Greater Jakarta, Indonesia. Participants included 32 of 48 breastfeeding dyads or subjects undergoing induced lactation protocols and fulfilling the inclusion criteria. The induced lactation protocol included the Praborini Method (hospitalization for nipple confusion) to promote latching, pharmacologically induced lactation, and at-breast supplementation.ResultsNineteen babies (59.4%) were aged <1 month and nine (28.1%) were aged 1–3 months at protocol initiation. Almost all (31 babies, 96.8%) were adopted after birth. At first examination, 20 babies (62.5%) could not latch, but all dyads could breastfeed after hospitalization for <1–2 days. Breast milk was induced after one cycle of Yasmin in 24 cases (75%). All mothers took domperidone and no side-effects were reported. Average breastfeeding duration was 8.5 months, with weaning at 2–25 months of age, with working mothers weaning at ≤4 months. At-breast supplementation was used until weaning.ConclusionsAdopted babies can achieve long-term breastfeeding through this multimodal protocol. Further prospective studies are warranted.
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Ferranti, Greta, Isabella Marchesi, Marcella Favale, Paola Borella, and Annalisa Bargellini. "Aetiology, source and prevention of waterborne healthcare-associated infections: a review." Journal of Medical Microbiology 63, no. 10 (2014): 1247–59. http://dx.doi.org/10.1099/jmm.0.075713-0.
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The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAIs) published from 1990 to 2012. The review focuses on aquatic bacteria and describes both outbreaks and single cases in relation to patient characteristics, the settings and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of the prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot-water distribution systems were the primary source of legionnaires’ disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. The intensive care unit was the most frequently involved setting, but patient characteristics were the main risk factor, independent of the ward. As it is difficult to avoid water contamination by microbes and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients in terms of tap-water exposure and also their personal hygiene, and should regularly use sterile water for rinsing/cleaning devices.
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Oladele, Olaseni Abayomi, and Okhakhume Aide Sylvester. "Socio-Demographic Predictors of Perceived Burden of Care among Care Givers of Non-Mentally and Mentally Retarded Students in Ibadan, Nigeria." American Economic & Social Review 5, no. 2 (2019): 38–44. http://dx.doi.org/10.46281/aesr.v5i2.362.
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The care of mentally retarded children is often stressful experiences for family members, as the child grows up and disability becomes quite noticeable by others, parents face a very distressing predicament of social embarrassment and stigma, they require more attention and time while at the same time the need for special equipment, and medical care increases; implicating financial income and capability of the care providers. The aftermath effect on the care provider(s) most often is restrictive and disruptive to economic, social or emotional deficiency. The study examines the influence of socio-demographic variables on care burden of care providers of non-mentally and mentally retarded students in Ibadan metropolis. The study adopted cross sectional research design across types of job, social support, religion, ethnicity and age. A total number of 100 care providers participated in the study (50 care providers of non-mentally retarded students & 50 care providers of the mentally retarded students). The instruments that were used was Care Givers Burden Scale developed by Zarit et al (1980). The result of the study revealed that demographic variables (age, sex, marital status, education level, job type, religion and ethnicity) do not jointly predict burden of care among care providers of mentally retarded students in Ibadan metropolis. [F(7,43)=1.722;p>.05], but revealed that demographic variables jointly predict burden of care among care providers of non-mentally retarded students in Ibadan metropolis. [F(7,43)=2.39;p<.05], and finally revealed that social support had significant influence on burden of care among care providers of mentally retarded students in Ibadan metropolis [t(98)= 11.13; P<.05]. The study therefore concludes that demographic variables jointly predict burden of care among care providers of non-mentally retarded students not mentally retarded students. While social support was found to significantly influence burden of care among care providers of mentally retarded students in Ibadan metropolis.
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chakraborty, Palash, and Dr Debasish Dhar. "Attitude of Parents (Father & Mother) Towards Visually Impaired Students of Secondary Level in “Education”." International Journal of Innovative Science and Research Technology 5, no. 7 (2020): 1038–50. http://dx.doi.org/10.38124/ijisrt20jul781.
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Children with visually impaired may face difficulties that result in their experiencing emotional disturbance. There are very reasons for mood disorder among children with visual loss, such as feeling loneliness, avoidance to appear to learn in formal schools and greater dependency on help. According to RCI Act,1992 responsibility for visual disabilities including low vision and blindness PWD Act,1995 proposed the provision of improve educational services, medical care, vocational learning ,employment and social security for all persons with disabilities including blind and low vision. There are two educational systems for children with visually impaired 1. education in special schools 2. education in inclusive schools. The attitude of parents towards visually impaired students are very important in case of of their visually impaired children . The purpose of the study was to find out the attitude of parents(father & mother) to visually impaired students of class 9 standard. 20 visually impaired students of class 9 were taken for the study. Survey method was adopted to study the attitude of parents (father & mother) towards visually impaired students of secondary level and attitude scale were taken as tools & techniques.For the study the samples are taken from two blind schools of Kolkata. It was found that attitudes(father& mother) are favourable towards the visually impaired students of secondary level. They are very much sympathetic for the education of the their visually impaired sons or daughter.
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Lu, Shan, Yan Zhang, Yadong Niu, and Liang Zhang. "Exploring Medical Expenditure Clustering and the Determinants of High-Cost Populations from the Family Perspective: A Population-Based Retrospective Study from Rural China." International Journal of Environmental Research and Public Health 15, no. 12 (2018): 2673. http://dx.doi.org/10.3390/ijerph15122673.
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The costliest 5% of the population (identified as the “high-cost” population) accounts for 50% of healthcare spending. Understanding the high-cost population in rural China from the family perspective is essential for health insurers, governments, and families. Using the health insurance database, we tallied 202,482 families that generated medical expenditure in 2014. The Lorentz curve and the Gini coefficient were adopted to describe the medical expenditure clustering, and a logistic regression model was used to identify the determinants of high-cost families. Household medical expenditure showed an extremely uneven distribution, with a Gini coefficient of 0.76. High-cost families spent 54.0% of the total expenditure. The values for family size, average age, and distance from and arrival time to the county hospital of high-cost families were 4.05, 43.18 years, 29.67 km, and 45.09 min, respectively, which differed from the values of the remaining families (3.68, 42.46 years, 30.47 km, and 46.29 min, respectively). More high-cost families live in towns with low-capacity township hospitals and better traffic conditions than the remaining families (28.98% vs. 12.99%, and 71.19% vs. 69.6%, respectively). The logistic regression model indicated that family size, average age, children, time to county hospital, capacity of township hospital, traffic conditions, economic status, healthcare utilizations, and the utilization level were associated with high household medical expenditure. Primary care and health insurance policy should be improved to guide the behaviors of rural residents, reduce their economic burden, and minimize healthcare spending.
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Murray, Thomas S., M. Elizabeth Groth, Carol Weitzman, and Michael Cappello. "Epidemiology and Management of Infectious Diseases in International Adoptees." Clinical Microbiology Reviews 18, no. 3 (2005): 510–20. http://dx.doi.org/10.1128/cmr.18.3.510-520.2005.
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SUMMARY International adoptees represent a group of children with unique health care needs. Data from published studies, along with the recent experience of the Yale International Adoption Clinic, suggest that the risk of serious infections in adoptees is low, although infections associated with institutionalization still occur commonly. Interpretation of these data must be undertaken with caution, however, since many, if not most, international adoptees are not evaluated in specialty clinics. Thus, prospective studies designed to minimize selection and referral bias are needed in order to accurately define the risk of infectious and noninfectious diseases in all international adoptees.
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Noval Canga, C., R. Hernández Antón, S. Cepedello Pérez, et al. "A bizarre love." European Psychiatry 33, S1 (2016): S355. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1271.
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IntroductionAdoption constitutes a discontinuity in child care trajectory, that falls into a separation and a lost of reference figures, and therefore, the need to set up new attachment figures into a suitable familiar atmosphere.ObjectivesThis case is a review of how a child adoption process, that can be something positive at first, can also produce many problems in the future, added to dificulties in order to regulate stressing situations and also solving problems.MethodsThe clinical case consists in a 25-year-old woman, who suffers from anxiety and self-injure behaviour. She has a diagnosis of non-specified personality disorder with limit characteristics. The patient was adopted a few months after her birth. At the moment she's living with her adoptive father, her adoptive mother passed away when she was 4. At the age of 21, the patient meets her biological mother and since that moment she spends most of the weekends with her. After a few medical appointments, she admits that she has allowed sexual relationships with her biological mother since six months ago.ResultsIt's important to appreciate the value of familiar atmosphere, and in addition, the attachment between child and his parental figures. The quality of the attachment is going to have influence in emotional regulation.ConclusionsChildren who have suffered neglect from their biological parents and have been adopted develop attachment behaviours characterized by negative experiences. In spite of being in a good familiar environment, they feel vulnerable and insecure. Early and appropriate attachment experiences can improve relationships between children and their new family.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hanafy, Nesreen Fathy, Reham Khedr, Eglal Ahmed Abd-Elwahab, and Sherif Abouelnaga. "Enhancing a Specialized Nursing Care Guidelines Improves Acute Lymphoblastic Leukemia Patients' Outcome during Induction Phase; A Developing Country Experience." Blood 132, Supplement 1 (2018): 5850. http://dx.doi.org/10.1182/blood-2018-99-119160.
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Abstract Introduction: Pediatric Cancer patients are treated with therapeutic research protocols that detail medical treatment in low- and middle-income countries (LMICs). Unfortunately, there is no precise definition of a structured nursing care plan that is mandatory to enhance the quality of care needed for these patients. Our study aimed to examine the impact of implementing a designed nursing care guidelines (NCG) on acute lymphoblastic leukemia (ALL) patient outcomes during the induction phase concerning; incidence, duration, and intensity of the patient's gastrointestinal tract GIT adverse events. Methods: A Quasi-experimental research design was utilized in this study with posttest only control group conducted at the Hematology Units of Children Cancer Hospital Egypt 57357. Seventy-four oncology nurses received adequate education for the designed nursing care plan. A total of (132) ALL children in induction phase were enrolled in the study and were divided into two groups: group 1 (intervention group) was implemented the nursing care guidelines and group II (control group) who was left to the routine hospital care. Tools: data collection instruments included; "patient outcomes audit chart" to assess the GIT adverse - events data: the incidence, duration, and intensity. The intensity grading of the adverse events Adopted from the NCI (National Cancer Institute) Common Terminology Criteria for Adverse Events v4.0 (CTCAE) Published on May 28, 2009. Results: A significant positive correlation between implementing the NCG and GIT adverse events incidence, duration and severity were observed (Figure 1). Incidence was reported higher in the control group than the study group with a mean score of ±SD (2.48± .949) versus (0.67± 0.751) respectively, and a p-value (P<0.0001). The duration of incidence was (15.32± 5.920) versus (3.70± 5.108) in the intervention group (t =12.074) df (130) and a p-value (P<0.0001). The intensity grading of the adverse events was less in the study group than the control. (figure 2) Mean scores for nurses' post-NCG knowledge in the study group were significantly higher than the nurse's knowledge scores in the control group. The intensity of incidence revealed that a significantly higher on the intervention group. Conclusion: Designing and implementing NCG for all treatment protocols is essential for the enhancement of patients' outcomes. Developing a pediatric oncology nurse residency program for education and teaching of the required practical skills in LMIC is mandatory. Figure 1 Figure 2 Disclosures No relevant conflicts of interest to declare.
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Sung, Lillian, Todd A. Alonzo, Robert B. Gerbing, et al. "High Mortality In Extreme Hyperleukocytosis In Pediatric Acute Myeloid Leukemia: A Report From the Children's Oncology Group." Blood 116, no. 21 (2010): 1072. http://dx.doi.org/10.1182/blood.v116.21.1072.1072.
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Abstract Abstract 1072 Background: Children with acute myeloid leukemia (AML) may present with high white blood cell counts (WBC). While it is well known that hyperleukocytosis is associated with leukostasis and tumor lysis syndrome, precise estimates of incidence of associated complications and death rates during induction are lacking from homogenously treated children with contemporary supportive care. The Children's Oncology Group (COG) adopted a modified AML Medical Research Council backbone and reviewed adverse event reports in real time to optimize accurate toxicity data. From August 14, 2006 to March 31, 2010, COG AAML0531 randomized 968 children and young adults with de novo AML to gemtuzumab ozogamicin (GMTZ) versus no GMTZ. The objectives in this report were to describe the prevalence of hyperleukocytosis as defined as an initial WBC ≥ 100×109/L and its association with incidence of metabolic, pulmonary and central nervous system (CNS) toxicities and the rate of Induction I deaths. Methods: AAML0531 included those ≥ 1 month to ≤ 30 years with de novo AML and used a 5 cycle chemotherapy regimen. Induction I consisted of cytarabine, daunorubicin, and etoposide (ADE 10+3+5). All Common Terminology Criteria for Adverse Events v3.0 ≥ grade 3 toxicities were collected prospectively. Results: Among the 968 children, initial WBC was available for 923 patients. Of these, 744 (80.6%) had an initial WBC < 100×109/L and 179 (19.4%) had an initial WBC ≥ 100×109/L. The Table illustrates the prevalence of metabolic, pulmonary and CNS ≥ grade 3 toxicities during Induction I. Hyperkalemia, high creatinine and hyperuricemia were generally rare. Higher initial WBC was significantly associated with hyperuricemia (P=0.005) and severe high creatinine (P=0.009). No significant differences in hyperphosphatemia or hyperkalemia were seen according to the initial WBC. The prevalence of hypoxia was 30.8% among the 13 children with an initial WBC ≥ 400×109/L and higher initial WBC was significantly associated with more hypoxia (P<0.001) and pulmonary hemorrhage (P<0.001). While CNS ischemia or hemorrhage occurred in 5.3% of children with an initial WBC ≥ 300 to < 400×109/L and 7.7% with an initial WBC ≥ 400×109/L, seizures were not reported for these patients with extremely elevated initial WBC. CNS ischemia/hemorrhage was significantly associated with increasing initial WBC (P<0.001) while there was no association between seizures and WBC. Deaths during Induction I occurred in 10.5% of those with initial WBC ≥ 300 to < 400×109/L and 15.4% of those with an initial WBC ≥ 400×109/L. The Induction I death rate was significantly higher with higher initial WBC (P=0.005). Conclusions: Almost 20% of newly diagnosed children with AML have hyperleukocytosis. With contemporary supportive care and homogenous AML therapy, tumor lysis syndrome is uncommon and hyperkalemia is no longer affected by high initial WBC although hyperuricemia and acute renal failure still occur in spite of contemporary supportive care. In addition, pulmonary toxicities in terms of hypoxia and pulmonary hemorrhage as well as CNS ischemia/hemorrhage remain problematic with increasing risk by initial WBC. At least 10 to 15% of patients with an initial WBC ≥ 300 × 109/L died during their first chemotherapy cycle and thus, strategies to improve outcomes related to pulmonary toxicity and CNS injury in hyperleukocytosis are important future goals. Disclosures: Smith: Pfizer, Inc: Member, Medical Advisory Committee (for bosutinib, not GO).
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Kudeikina, Inga, and Karina Palkova. "The right to health in context of ensuring the best interests of the child." SHS Web of Conferences 51 (2018): 01015. http://dx.doi.org/10.1051/shsconf/20185101015.
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The right to health is one of the human fundamental rights. In present socio-legal area in health security issues, the human as an unconditional obedient patient, transforms into medical practitioner's associate, actively participating in all discussions of issues, which affect his health and executable medical manipulations. The human from medical object has turned into the medical subject. As exceptions can be mentioned persons who, for objective reasons, are not able to exercise their rights in full. One of such person group is children. Children have no capability to exercise their rights themselves. Therefore it is important to understand whether the volume of child's right is equal to the volume of adult's rights. Conditionally, we can say that in the stage of exercising the right, children depend on their representatives. The article will provide information on the issues, which affect child's right to health in context of ensuring the best interests of the child in Latvia according to the local and the European Union legal documents. In addition, the article will show the mechanism for dispute resolving, which may occur between a medical institution (doctor) and a person, who represents the child in Latvia. Both international and national legal acts stipulate that a child requires a special care, which includes ensuring the best interests of the child. It is essential that the concept “best interests of the child” is not defined in legislation and in all cases it is subject to interpretation of the adopter of the law (the user). On the fact, how fully the child's natural or legal guardians will defend the interests of the child, depends observation of the child's fundamental right – right to health. To find the answers to the current research questions descriptive, analytical, deduction-induction methods, etc. are used.
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Et. al., Suleiman Mohammed Saeed. "Socio-Economic Effects of HIV/AIDS on Households with People Living With HIV/AIDS in Northern Nigeria." Turkish Journal of Computer and Mathematics Education (TURCOMAT) 12, no. 3 (2021): 5406–15. http://dx.doi.org/10.17762/turcomat.v12i3.2188.
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The purpose of this paper is to review the socio-economic effects of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) on households with People Living with HIV/AIDS (PLWHA) in Northern Nigeria. The pandemic is devastating and constitutes a serious threat to the socio-economic development of infected, affected, and society at large. This study was qualitative in nature, thus it utilized in-depth interviews to pull together information from the 39 key informants as its method. It is observed that HIV/AIDS occurrence rate has led to poor health, loss of jobs, and a high rate of labour reduction in all sectors, and this has contributed to the tremendous decline of the economy. This study discovered that increased expenses of households with PLWHA on financing funerals, healthcare, and other medical expenditures with decreased investment. Children emerging as head of the households and tasks of caring for orphans are increasingly inconsistent with many other studies. The pandemic has been a serious threat to the social and economic interests and survival of the households with PLWHA and their members. Many lives are lost due to the pandemic. The worst affected group is young people in their productive ages and by implication affects the socio-economic development of PLWHA, their households, and society at large. Thus, households with PLWHA experience numerous forms of stigma and prejudice together with human rights abuse that is detrimental to the total well-being of PLWHA. The dimensions of the stigma can be classified as internalized, community, and social-based. The patterns of managing the challenges of HIV/AIDS-related stigma adopted from the experience of households with PLWHA adopted include isolation, non-disclosure, and loss of follow-up as well as migration. The paper suggested that the government should come up with policies that can take care and support the socio-economic activities of households with PLWHA and also need to introduce policies and procedures for the reduction of stigma and discrimination against households with PLWHA and its members living with the epidemic. Households with PLWHA need to be assisted with medication subsidies to reduce medical expenses and stress on the households’ capitals among other recommendations.
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Mantovani, Lorenzo Giovanni, Luciana Scalone, Simona Ravera, Marieke Krol, Carin Uyl-de Groot, and Maria Domenica Cappellini. "Direct and Indirect Cost of Beta Thalassemia Major: Resuts from the ITHACA Study." Blood 108, no. 11 (2006): 3343. http://dx.doi.org/10.1182/blood.v108.11.3343.3343.
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Abstract Background: Patients with beta Thalassemia Major (TM) require life-long blood transfusions and, to avoid iron overload, Iron Chelation Treatment (ICT), based on 8–12 hour infusions of Deferoxamine (DFO) for 5–7 days/week, and/or Deferiprone (L1) orally administered. ICT regimen often causes low satisfaction and low compliance, with potentially negative consequences on patients’ health, wellbeing and costs. Aims: to investigate direct and indirect costs for TM patients on ICT. Methods: The Italian-THAlassemia-Cost-&-Outcomes-Assessment (ITHACA) was a naturalistic multicentre study conducted to evaluate costs, quality of life, compliance and treatment satisfaction in TM patients undergoing ICT. Patients of any age, on ICT for at least 3 years, were sequentially enrolled at 8 Italian Thalassemia Care Centers. Direct and indirect costs were estimated from retrospective data: those on direct costs were drawn from medical records, referred to a median of 11.6 months before enrolment. As regards as indirect costs, patients completed modified versions of the Health and Labour Questionnaire (HLQ). Questions on indirect costs were referred to a 2 weeks (adults) or a 12 weeks (children) time horizon. Costs were estimated from a societal perspective, using tariffs, prices, average net earning applied in 2006, as appropriate. Results: 137 patients were enrolled and aged a median of 28.3 years (2.7–48.5), 49.6% were male. Overall, mean direct cost was 1,245.33euro/patient/month, with ICT representing 55.4% of costs, followed by transfusions (33.1%), hospitalizations and surgery (3.3%), laboratory and instrumental tests and medical visits (3.1%), concomitant medications (1.6%), non-medical costs (transportation, 3.4%). Patients treated with DFO were 51.5%, 31.6% were treated with L1, 16.9% with DFO+L1. Treatment in patients taking DFO cost on average 552.88euro/patient/month plus 211.20 euro for pump and consumables; patients taking L1 cost 383.25 euro/patient/month, patients taking DFO+L1 cost 918.41 euro. Concerning indirect costs, 116 adults (> 16 years old) completed the HLQ. Sixty-one patients (52.7%) were in paid employment. Twenty-one patients (34.4%) had experienced absenteeism from work in the previous 2 weeks due to ill health. The average absenteeism among patients in paid employment was 0.7 days/week. Indirect costs related to absenteeism were 27.6 euro/patient/week. Fifteen patients (26.6% of patients in paid employment) were hindered by health problems at work. Indirect costs per patient based on hours needed to catch up on tasks neglected due to health problems were 9.4 euro/week. Patients received 1.24 hours of household help/week. Twenty-one children (<15 years old) or their caregivers completed the HLQ children-part. Eighteen children (85.7%) missed schooldays in previous twelve weeks (mean=0.66 days/week) and 6 missed regular activities. Discussion: Transfusions and ICT account for 90% of total costs in TM patients, corresponding to approximately 1,000 euro/patient/month. The disease and the current treatment adopted have a high socio-economic impact on both TM patients and the healthcare system.
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Huang, Yii-Ting, Ying-Hsien Huang, Ching-Hua Hsieh, Chao-Jui Li, and I.-Min Chiu. "Comparison of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score in Predicting the Mortality and Prolonged ICU Stay of Traumatic Young Children: A Cross-Sectional Retrospective Study." Emergency Medicine International 2019 (December 1, 2019): 1–7. http://dx.doi.org/10.1155/2019/5453624.
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Introduction. The purpose of this study was to examine the capacity of commonly used trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries. Methods. This retrospective study was conducted for the period from 2009 to 2016 in Kaohsiung Chang Gung Memorial Medical Hospital, a level I trauma center. We included all children under the age of 6 years admitted to the hospital via the emergency department with any traumatic injury and compared the trauma scores of GCS, ISS, and RTS on patients’ outcome. The primary outcomes were mortality and prolonged Intensive Care Unit (ICU) stay, with the latter defined as an ICU stay longer than 14 days. The secondary outcome was the hospital length of stay (HLOS). Receiver operating characteristic (ROC) analysis was also adopted with the value of the area under the ROC curve (AUC) for comparing trauma score prediction with patient mortality. Cutoff values from each trauma score for mortality prediction were also measured by determining the point along the ROC curve where Youden’s index was maximum. Results. We included a total of 938 patients in this study, with a mean age of 3.1 ± 1.82 years. The mortality rate was 0.9%, and 93 (9.9%) patients had a prolonged ICU stay. An elevated ISS (34 ± 19.9 vs. 5 ± 5.1, p=0.004), lower GCS (8 ± 5.0 vs. 15 ± 1.3, p=0.006), and lower RTS (5.58 ± 1.498 vs. 7.64 ± 0.640, p=0.006) were all associated with mortality. All three scores were considered to be independent risk factors of mortality and prolonged ICU stay and had a linear correlation with increased HLOS. With regard to predicting mortality, ISS has the highest AUC value (ISS: 0.975; GCS: 0.864; and RTS: 0.899). The prediction cutoff values of ISS, GCS, and RTS on mortality were 15, 11, and 7, respectively. Conclusion. Regarding traumatic injuries in young children, worse ISS, GCS, and RTS were all associated with increased mortality, prolonged ICU stay, and longer hospital LOS. Of these scoring systems, ISS was the best at predicting mortality.
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Hristozova, Mariya. "CHILDREN'S RIGHT TO HEALTH IN THE ACTS OF THE UNITED NATIONS ORGANIZATION." Knowledge International Journal 28, no. 6 (2018): 2051–55. http://dx.doi.org/10.35120/kij28062051m.
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One of the most vulnerable people in every society is children who, due to their physical, emotional, psychological and social immaturity, can not protect their fundamental rights and freedoms themselves and need increased support from the international community and national authorities. In view of these objective circumstances, in the system of the United Nations has adopted a number of legal acts which lay down minimum international standards for the protection of children's righThe most important and comprehensive international treaty for the protection of children 's rights is the 1989 United Nations Convention on the Rights of the Child. This Act proclaims a number of civil, economic, social and cultural rights for children who should be protected in all legal systems, such as: the right to education, the right to social security, the right to a standard of living appropriate to the physical, mental, social development of the child and other rights.Article 24 of the UN Convention also sets out the right of every child to enjoy "the highest attainable standard of health and health services to treat illness and restore his health." The right of children to health includes in its content, separate, autonomous rights and freedoms, such as the right to access quality medical care and remedies for illness and health rehabilitation, the right to control one's own health and body and others.In fulfillment of their obligations under the UN Convention on the Rights of the Child, States have an obligation to take comprehensive measures to ensure the fundamental human rights enshrined in the international treaty, including children's health, such as legislative, administrative, economic and other measures.However, the adoption of an appropriate legal framework is not sufficient to ensure effective protection of children's health. That right falls under the category of social rights, the full exercise of which requires active cooperation from the States. Today in a number of reports by international organizations is stated that many countries do not have sufficient financial resources to ensure the practical implementation of their obligations under international treaties, which creates a real risk to the children's right to health and for all their fundamental rights. In view of these disturbing data, further steps need to be taken to strengthen and guarantee all children's fundamental rights, especially their right to health, both at international and national level.
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Kozlov, A. V., I. V. Kazantsev, T. V. Yukhta, et al. "The use of checkpoint inhibitors in children with non-Hodgkin lymphomas." Pediatric Hematology/Oncology and Immunopathology 19, no. 2 (2020): 112–20. http://dx.doi.org/10.24287/1726-1708-2020-19-2-112-120.
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The majority of children with NHL can be cured with first-line therapy but 10–25% of affected patients develop relapsed or refractory disease (R-R). The prognosis in these cases is unfavorable, no matter what form of modern treatment is adopted. New approaches to the treatment of this small, yet important, group of patients need to be introduced, including, first and foremost, targeted therapy and immunotherapy. As is known, PD-L1 is frequently expressed in non-Hodgkin lymphomas (NHL), which means that the use of checkpoint inhibitors (CPI) is theoretically justified. Objectives: to analyze the results of treatment with checkpoint inhibitors Nivolumab and Pembrolizumab in children with R-R NHL. The study was approved by the Independent Ethics Committee of the I.P. Pavlov First Saint-Petersburg State Medical University. We used CPIs in 8 children with R-R NHL undergoing treatment at the R.M. Gorbacheva Research Institute for Pediatric Oncology, Hematology and Transplantation. The median age was 12 (2–17) years. The distribution of the patients by diagnosis was as follows: primary mediastinal large B-cell lymphoma (PMBCL, n = 3), peripheral T-cell lymphoma (PTCL, n = 2), diffuse large B-cell lymphoma (n = 1), lymphoblastic lymphoma (n = 2). The median number of prior lines of therapy was 3 (1–5), and all patients had received at least 1 line of standard treatment. Refractory NHL was observed in 5 cases, and 3 patients had had multiple relapses (≥ 3). All patients had progression of their primary disease at the time of prescription of the CPI therapy. Nivolumab was administered at a dose of either 1 mg/kg (n = 4) or 3 mg/kg (n = 3) every 2 weeks, Pembrolizumab - at a dose of 2 mg/kg once every 3 weeks (n = 1). The median number of CPI doses received by the patients was 5.5 (2–12). In 5 patients, CPIs were administered as monotherapy, in 3 – in combination with cytostatic agents: FLAG, Gemcitabine and intrathecal triples (n = 1), Brentuximab vedotin (n = 1) and Bendamustine (n = 1). The efficacy of the treatment was evaluated in accordance with the LYRIC criteria. Once remission was achieved, we used hematopoietic stem cell transplantation and/or radiotherapy for consolidation. Response to the CPI therapy was observed in 4 out of 8 patients (complete response – in 2 patients). Interestingly, only patients with PMBCL and PTCL responded to the treatment. At the median follow-up of 368 (36–879) days, 5 patients were alive, with three of them remaining in long-term remission. During the follow-up period, there was only 1 clinically significant complication (cytopenia) that resolved after treatment with glucocorticosteroids. Finally, we would like to point out that this paper is one of the first reports on the successful use of CPIs in children with R-R NHL. PMBCL and PTCL turned out to be responsive to the treatment. This therapy can be used to achieve remission or possibly even cure in children whose only option would be palliative care if they were treated with standard approaches.
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Werner, Ellen M., Lorraine Brown, Kathryn L. Hassell, and Donna DiMichele. "Healthy People 2020 Blood Disorders and Blood Safety: A Vision of Improved Health for Patients with Sickle Cell Disease, Thalassemias and Hemophilia." Blood 118, no. 21 (2011): 4771. http://dx.doi.org/10.1182/blood.v118.21.4771.4771.
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Abstract Abstract 4771 In December 2010, the US Department of Health and Human Services released Healthy People 2020 (HP2020) Objectives for the nation. For the first time in its thirty-year history, US health objectives include rare blood disorders and blood safety (BDBS). HP2020 is a public health program that incorporates current clinical evidence and best practices in medicine and public health to identify public health priorities. The objectives are not clinical practice guidelines. Rather, they are scientifically-based, quantified goals to improve the health of specific populations, such as children and older adults. Their development and implementation necessitate partnerships among governmental agencies, organizations, private companies, and medical and health associations at the local, state and national levels. Partners collaborate on implementing activities to reach targeted health objectives for specific populations using educational campaigns, media and other communication venues. NHLBI led the effort with HRSA, CDC, FDA, and the Office of the Secretary to develop, vet and plan implementation of the BDBS objectives. The development process was based on qualitative research methods such as key informant interviews, semi-structured interviews and categorization of data into patterns. For example, categorization of interview results (“data”) identified specific objective topics, such as screening for complications and penicillin prophylaxis in sickle cell patients aged 4 months to 5 years. Other BDBS Objective topics are: vaccinations; patient and family referrals; care in a medical home; disease-modifying therapies; avoidable hospitalizations; high school completion; community health education; awareness of carrier status; joint health; and alloimmunization in chronic transfusion. http://healthypeople.gov/2020/topicsobjectives2020/default.aspx By sponsoring the BDBS objectives, lead governmental agencies commit to collecting, analyzing and reporting data on progress. We adopted the default target of a 10% improvement for each objective by 2020. If targets for each objective are met, the question will be: What is the impact of reaching these targets on morbidity, mortality and quality of life for patients with sickle cell disease, thalassemias and hemophilia? Disclosures: Hassell: NIH: Research Funding.
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Svodziwa, Mathew, and Faith Kurete. "Cohabitation among Tertiary Education Students: An Exploratory Study in Bulawayo." Human and Social Studies 6, no. 1 (2017): 138–48. http://dx.doi.org/10.1515/hssr-2016-0009.
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Abstract Cohabiting has been associated with a number of problems including sexually transmitted diseases and HIV and AIDS, abortions, sexual abuse and violence, low academic performance, increased cost of medical care and unwanted pregnancies. However, there is little documented information on the extent and the factors influencing cohabitation among the youth and especially among tertiary education students. This study therefore sought to fill this gap by investigating factors that lead to the prevalence and practice of cohabitation by tertiary education students. The research adopted the interpretivist philosophy. The qualitative research methodology was employed in order to understand in greater detail the behaviors, attitudes, opinions, and beliefs of the respondents on cohabitation among tertiary education students. The study used the survey research design. Primary research was conducted using questionnaire surveys that were administered to tertiary education students who participated at the Tertiary Education Sports Association of Zimbabwe in July 2016. There were 100 questionnaires distributed and 78 questionnaires were returned making 78% response rate. The respondents were randomly sampled to participate in the study. The study reflects that cohabitation among the Tertiary education students is quite common. The study noted that it is mostly caused by lack of accommodation, problems with roommates, lack of privacy and the need to be close and intimate with one's lover. In results cohabitation exposes students to premarital sex and other consequences such as unwanted pregnancies, abortion, complications and sexually transmitted infections. The study recommends that tertiary education students should be enlightened during orientations about the dangers of cohabitation. Parents should be encouraged to visit their children and find where and whom they live with while in school.
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Fagerlund, Asbjørn Johansen, Inger Marie Holm, and Paolo Zanaboni. "General practitioners’ perceptions towards the use of digital health services for citizens in primary care: a qualitative interview study." BMJ Open 9, no. 5 (2019): e028251. http://dx.doi.org/10.1136/bmjopen-2018-028251.
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ObjectivesTo explore general practitioners’ (GPs) perceptions towards use of four digital health services for citizens: an electronic booking service to make reservations with the GP; an electronic prescription service to request renewal of maintenance drugs; a service for text-based non-clinical enquiries to the GP office and a service for text-based electronic consultation (e-consultation) with the GP.DesignA qualitative study based on semi-structured interviews.SettingPrimary care.ParticipantsNine GPs who were early adopters of the four services were interviewed.MethodOne moderator presented topics using open-ended questions, facilitated the discussion and followed up with further questions. Phone interviews were conducted, audio recorded and transcribed verbatim. Qualitative data were analysed using the framework method.ResultsThe use of digital services in primary care in Norway is growing, although the use of text-based e-consultations is still limited. Most GPs were positive about all four services, but there was still some scepticism regarding their effects. Advantages for GP offices included reduced phone load, increased efficiency, released time for medical assessments, less crowded waiting rooms and more precise communication. Benefits for patients were increased flexibility, autonomy and time and money savings. Children, the elderly and people with low computer literacy might still need traditional alternatives.ConclusionsMore defined and standardised routines, as well as more evidence of the effects, are necessary for large-scale adoption.
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Alias, Hamidah, Sie Chong Doris Lau, C.-Khai Loh, Christine J. Harrison, and Jeyanthy Eswaran. "Improved Treatment of Childhood ALL in Malaysia." Blood 134, Supplement_1 (2019): 5828. http://dx.doi.org/10.1182/blood-2019-129402.
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The survival rate of childhood acute lymphoblastic leukemia (ALL) has reached >80-90% in developed countries, which is a triumph of modern medicine. This success is due to implementation of contemporary treatment protocols, optimal application of risk stratification, risk-directed multi-agent chemotherapy regimens, and improved supportive care. Unfortunately, such improvements have not translated to Low Middle Income Countries (LMICs), where 90% of the world's children live. The estimated 5 year survival rates in Asia range widely between 44.3% and 80%. The Intercontinental-BFM2002 study, conducted in 15 upper-middle and high-income countries reported a 5 year event-free survival (EFS) and overall survival (OS) rates of 74% and 82%, respectively. Factors that may contribute to the lower survival in LMICs are highly complex, including delays in presentation, diagnostic inaccuracy, restricted budget for risk-stratification and appropriate treatment, treatment abandonment and socio economic status. In Malaysia, different protocols are used by different leukemia treatment centers for treating children with ALL. In UKM Medical Centre (UKMMC), the UKALL protocols (modified UK X, XI, XII, 97(99) and 2003) have been used in the Pediatric Hemato-Oncology Unit since the 1990s. Herein, we report the adopted protocol, the stratification profile and outcome of children with ALL, treated with modified UKALL 97(99) and UKALL 2003 in our institution from 2006 to 2014. Clinical data from children with ALL, who received these modified therapies, were retrospectively reviewed. Prednisolone was used in modified UKALL97(99) and Dexamethasone in modified UKALL 2003, while 6-mercaptopurine was used in both modified protocols. Otherwise, chemotherapy and duration of treatment were identical to the original protocols of Regimens A, B and C. ALL was diagnosed based on standard morphology and immunophenotyping criteria. At diagnosis, patients were stratified according to the National Cancer Institute (NCI) risk criteria and using FISH for detection of cytogenetic abnormalities. EFS and OS were determined using the Kaplan-Meier methods. Newly diagnosed ALL in 156 children were included in the study; 103 (66.0%) were standard risk, 49 (31.4%) were high risk and 4 (2.5%) were infants. There were 2 children with Down syndrome. The success rate of FISH was 76.4% (94/123). Patients were stratified as standard risk, based on ETV6-RUNX1, and high risk based on unfavorable cytogenetics, BCR-ABL and MLL rearrangements. Half of the patients with unfavorable cytogenetics were classified in the NCI high risk group, with WCC >100x109/L. A total of 151 patients were treated as per risk stratification, 2 patients transferred care, while 3 patients refused treatment. Mortality from sepsis during treatment was approximately 10%, including 2 deaths during induction remission and induction at relapse. The majority of disease progression was relapse-related, however, treatment abandonment also contributed to relapse. Approximately 5% of patients abandoned their treatment (3 patients abandoned and 3 patients refused treatment). The 5-year OS for the standard risk group was 86.6%, with 3-year and 5-year EFS of 88.1% and 83.4%, respectively. The 5-year OS for the high risk group was 65.7%, while 3-year and 5-year EFS were 64.7% and 58.2%, respectively (Figure 1). The MRC UKALL97 stratification by NCI risk reported a 5-year EFS of 83.1% for the standard risk group and 66.9% for the high risk group, while the UKALL2003 interim analysis reported a 5-year EFS of 87.7%. The MRC UKALL97/99 reported a 5-year OS of 88%. The cure rate of children with standard risk ALL at UKMMC, using modified UKALL 97(99) and UKALL 2003 protocols, was comparable to MRC UKALL97. However, the cure rate for high risk ALL was comparatively lower. This single center study from UKMMC has highlighted some critical factors that improved the outcome of children with ALL and suggests further improvements that are necessary to reduce the relapse rate, especially in the high risk ALL patients. Disclosures No relevant conflicts of interest to declare.