Search Results (54)

Background/Objectives: The variety of magnetic resonance imaging (MRI) scales available to measure soft tissue and osteochondral changes in joints of persons with hemophilia poses challenges in evaluating published clinical/research studies. To evaluate the value of four MRI scales [(i) the 17-point International Prophylaxis Study Group [IPSG] additive scale; (ii) and (iii) the compatible IPSG progressive (P) and additive (A) scales; and (iv) the Denver progressive scale] to assess joint change in boys with hemophilia participating in a prospective two-year prophylaxis study. Methods: Boys with severe hemophilia A (ages, 7–16 years) followed at the Hospital for Sick Children, Toronto, Canada had MRI evaluations of six index joints (ankles, knees, elbows) at study entry and exit. Musculoskeletal (MSK) outcomes included in the study were the Colorado Child Physical Examination (PE) scale; the Pettersson (X-ray) scale; and the aforementioned 4 MRI scales. Results: Very strong (r ≥ 0.80) correlations were observed between the IPSG 17-point, the IPSG progressive (P) and the Denver MRI scales, and moderate (r = 0.40–0.59) to strong (r = 0.60–0.79) correlations for the IPSG 17 point and the IPSG additive (A) MRI scales. Very weak (r = 0.20–0.39) or no correlations were observed between soft tissue MRI scores and the swelling item of the Child PE scale. Conclusions: All four MRI scales demonstrated relative comparability of their construct validities for assessing mild/moderate hemophilic arthropathy. The 17-point IPSG additive scale is recommended as a reference standard in future long-term studies of young boys with hemophilia receiving factor and non-factor-based preventive therapies. Full article

Objective: The development of a normal sleep–wake rhythm in the first weeks of life depends on the physiological sensory needs of the newborn as well as the environment surrounding them. This includes, for example, avoiding pain, exposure to bright light at night and high noise levels. In high-risk newborns, this process can be influenced by immaturity of the central and peripheral nervous systems, therapeutic strategies and the work organization of an intensive care unit. Methods: This study used a narrative review to examine the literature on the interrelationship of sensory modalities on sleep–wake behavior in the context of neonatal intensive care. The current Cochrane reviews on cycled lighting’s effect on premature infants’ circadian rhythm development and noise or sound management in the neonatal intensive care unit, as well as the World Health Organization (WHO) global position paper on kangaroo mother care, were included. Results: An extensive body of literature relates to fetal and neonatal development of the five sensory modalities: touch, taste, smell, hearing and sight. In contrast, there is a lack of evidence regarding the choice of optimal lighting and suitable measures for noise reduction. Since 2023, the WHO has recommended that, from the moment of birth, every “small and sick” newborn should remain in skin-to-skin contact (SSC) with their mother. Developmental support pursues a multimodal approach with the goal of fostering early parent–child bonding, including the child’s needs and environmental conditions. Discussion: The implementation of early SSC and attention to the sleep–wake cycle require systemic changes in both the obstetric and neonatal settings to ensure seamless perinatal management and subsequent neonatal intensive care. Since there is a lack of evidence on the optimal sensory environment, well-designed, well-conducted and fully reported randomized controlled trials are needed that analyze short-term effects and long-term neurodevelopmental outcomes. Full article

Background/Objectives: The high sensitivity of paediatric nurses directly influences the quality of nursing care provided to patients. The purpose of this study is to present the most frequent issues faced by paediatric nurses in their everyday work and their responses to difficult situations at work, define the actions applied when a difficult situation occurs, and assess the level of stress and other factors influencing the level of stress experienced by paediatric nurses. Methods: This study was conducted using an original survey form and a standardised psychological questionnaire based on the Perceived Stress Scale (PSS-10) for paediatric nurses. Results: The study involved 416 paediatric nurses and indicated a medium level of stress among the nurses. The median stress level, calculated as the sum of answers to questions based on the PSS-10, was 18 (16.0 ÷ 20.0), and the mean was 17.9 (min–max = 1–30). The median Sten score was 6 (5.0 ÷ 7.0), and the mean Sten score was 5.94 (min–max = 2–9). Nurses aged 21–30 years, who live in a city, have a Bachelor of Science in Nursing or a Master of Science in Nursing, and work ≥ 61 h a week and 161–250 h a month experience a higher level of stress. Factors such as choosing which child to help first, spending a great deal of time filling out medical documentation, obtaining a sick child’s consent to perform nursing procedures which the child does not understand, involving the minor in decision-making, impolite or offensive behaviour from a sick child or their parents, ineffective nursing and treatment methods, providing care against the opinion/views of a sick child or their parents, difficulties in or a lack of understanding of the situation of a sick child and their family, performing nursing procedures that can cause the child pain, and the inability to fulfil a sick child’s request increase the level of stress experienced by paediatric nurses. When a difficult situation occurs at work occurs, the nurses usually meet and talk about the situation with someone close (72.4%) or engage in other activities to avoid thinking about the situation (66.6%). They consult a psychologist/psychotherapist very rarely (9.6%) and a psychiatrist extremely rarely (4.6%). Conclusions: Polish paediatric nurses were found to experience a medium level of stress. Since paediatric nurses are exposed to stress, providing them with psychological care is important. The level of perceived stress is dependent on the nurse’s age, place of residence, and education, as well as weekly and monthly working durations. Paediatric nurses experience many difficult situations in their everyday work that influence their stress levels. Management should pay special attention to difficult workplace situations faced by paediatric nurses and implement regular actions to reduce the levels of stress experienced. Full article

In neonates, estimation of the glomerular filtration rate is problematic, and assessment of renal impairment is challenging. Serum creatinine is a widely used marker, and urine output is an important vital parameter monitored in intensive care settings, particularly in unwell neonates. However, the rapid changes after birth with adaptation to the extrauterine environment is a unique situation in which absolute serum creatinine is not a reliable indicator of renal function. A rise in serum creatinine from the previous value during the neonatal period can be a result of worsening renal function in neonates but is dependent on many other factors. In addition, urine output can be difficult to measure in sick neonates during their intensive care stay. Despite a high prevalence of acute kidney injury (AKI) in preterm and/or unwell infants, the current definitions are not straightforward and do not take postnatal adaptation processes into account. The management of AKI is challenging in very young and small patients because the assessment of fluid status as well as balancing nutritional needs with fluid restriction can be problematic. The Australian Neonatal Medicines Formulary provides advice on drug dosing in the face of reduced renal function in neonates. Predictors (or long-term outcome, or recovery) after AKI diagnosis are still poorly described. Therefore, the diagnosis of neonatal AKI needs to be documented and transferred to the paediatrician responsible for the follow-up of the child. This educational review aims to give a perspective on neonatal kidney function and AKI, the relation of fluid balance and creatinine, the management of neonatal AKI and the consequences for drug dosing and long-term outcomes. Full article

Background/Objectives: Parents who accompany their children with a complex chronic illness until their death experience a unique situation, with vulnerabilities, specific needs and enormous suffering. The aim of the study was to describe the lived experience of parents who accompanied their children with a complex chronic illness until their death, in a paediatric palliative care setting. Methods: We opted for a qualitative methodology, with a descriptive phenomenological orientation. Phenomenological interviews were carried out with nine intentionally selected mothers, with the support of a paediatric palliative care hospital team. The procedural phases of van Kaam’s method, modified by Moustakas, were used to analyse the data. Results: An understanding of the essential structure of the phenomenon is revealed in a description made up of three essential themes: ‘facing the harbinger of illness’; ‘living (together) with a sick child’; and ‘starting again without ever forgetting: living with an absent child’, the latter being the subject of this article. Conclusions: The participants attribute a self-transforming meaning to their lived experience of accompanying their children. Nurses will be able to access the lived experience of these mothers and improve their intervention in the process of their children’s illness, as well as in their bereavement process. There are also contributions to research and teaching in palliative care in the area of child and paediatric health. Full article

Background: The presence of chronic illnesses in both a mother and a child poses a significant challenge for mothers in managing these conditions, yet how maternal attitudes adapt to dual illness remains poorly understood. This study aims to explore parenting styles in families dealing with mother–child chronic illnesses. Methods: Mothers of children aged 2–6 were recruited from three pediatric clinics and categorized based on the health status of both the mother and the child. Data collection included case files and the Parental Attitude Scale (PAS), which assessed democratic, authoritarian, overprotective, and permissive attitudes. The interaction between mother–child health status and higher levels of parental subscales was analyzed using the chi-square test. Multiple logistic regression analysis was then performed to evaluate this interaction, controlling for confounding baseline characteristics. Results: In total, 878 mother–child pairs were included. Mothers exhibited varying attitudes based on education, employment, and the child’s age. Chronic illness in both mother and child and only the child having an illness were significantly associated with higher overprotective scores (p < 0.001). The percentage of mothers with high permissive scores was higher when only the mother had an illness and when both were healthy, compared to the case of both mother and child having an illness (p = 0.018). After adjusting for confounding factors, having a sick child showed a 1.6-fold increase in the likelihood of a high overprotective score, and both the mother and child having an illness showed a 2.94-fold increase. Similarly, after adjusting for the same confounding factors, the likelihood of a high permissive score was 2.56 times lower when both were ill compared to when both were healthy. Conclusions: This study reveals that when a child is affected by a chronic illness—whether or not the mother is also ill—mothers tend to exhibit higher levels of overprotection and lower levels of permissiveness, while their levels of authoritarianism and democratic attitudes in parenting remain relatively stable. Full article

Background: The PediCenter and Niles Children’s Clinic provide pediatric primary and urgent care services in central California. We remained open throughout the COVID-19 pandemic, providing scheduled well child-care and sick visits. Methods: Beginning in September 2020, we implemented a COVID-19 screening program. Screening was performed on all patients presenting for care and was made available to patients requiring testing for any purpose. Herein, we provide results from that program, including a description of clinical characteristics of COVID-19 in our patients. Results: Key findings: A total of 11,649 COVID-19 antigen screening tests were performed (age range 0.1 to 17.0, mean 8.7, SD 4.5). In total, 1560 pts. (13.4%) tested positive. Among these, 665 (43%) were asymptomatic, 560 (36%) had mild disease, 318 (20%) had moderate disease, and 17 (1%) had severe disease. No critical cases or transfers to the emergency room were reported. Younger patient age was associated with an increased severity of illness, as was time from the onset of the pandemic. A total of 4446 patients reported no symptoms at the time of screening, 15% of whom tested positive. In total, 7203 patients reported symptoms at the time of testing. Among these, 87.6% tested negative and 12.4% tested positive. Disease severity was similar between these two groups. COVID-19 is generally a mild respiratory tract infection in healthy children. Conclusions: Screening is effective in identifying cases, including asymptomatic cases. Statistical models further revealed associations between patient age, time from the onset of the pandemic, and disease severity. Full article

This qualitative study explores the experiences of child welfare workers during the COVID-19 pandemic through virtual interviews, focusing on the challenges and adaptations in their work and support systems. Participants reported significant difficulties in maintaining a healthy work–life balance, heightened stress, anxiety, and increased workloads due to sick leaves and burnout. This study highlights the dual role of technology as both a stressor and a crucial tool, with rapid integration posing challenges while also enabling continued support for children and families. Despite these challenges, workers demonstrated resilience and creativity, developing innovative solutions to navigate the new landscape. The findings underscore the importance of robust support systems, clear communication, and equitable access to technology. This study suggests integrating lessons learned during the pandemic into future child welfare practices to enhance resilience and adaptability in the face of future crises. Full article

The caregivers of children suffering from rare diseases face numerous emotional, social, economic, organizational, and other difficulties, which can significantly impair their quality of life and mental health. Therefore, among other things, it is important to understand the factors which can influence psychosocial well-being. This research aimed to explore the association between healthcare satisfaction and social support and stress, depression, and life satisfaction in caregivers, with a moderating role of the ill child’s dependence on their caregiver. Methods: A cross-sectional study was conducted among 185 female caregivers of children with rare diseases. The data were analysed by using hierarchical regression analysis to examine the moderating effect of the child’s dependence. Results: Lower dependence of the child moderated the association between a higher level of healthcare satisfaction and reduced stress and a higher level of life satisfaction. Furthermore, lower child dependence moderated the association between a higher level of social support and a reduction in depression. In contrast, this association was absent in female caregivers with highly dependent children. On the other hand, the research confirmed that a higher level of social support led to stress reduction and increased life satisfaction in all respondents, regardless of the child’s dependence. Furthermore, the research confirmed that higher levels of healthcare satisfaction are associated with a reduction in depression in caregivers, regardless of the child’s dependence level. Conclusion: This research highlights the importance of providing adequate social support and high-quality healthcare in order to improve the psychosocial well-being of caregivers of children with rare diseases. Interventions to increase this support can reduce stress and depression and increase caregivers’ life satisfaction. Thus, future research should focus on the development and evaluation of specific interventions that support these factors. Full article

The COVID-19 pandemic affected economic, social, health, and political aspects of most global, national, and local populations, including urban and rural communities. Government measures like lockdowns resulted in the closure of schools and businesses, while social distancing preventing group gatherings impacted public and private spaces. Based on key informants’ interviews with 36 participants drawn equally from three senatorial districts of Edo and Delta states of Nigeria, we analyzed the impact of the COVID-19 pandemic on the type of work men and women do and division of household activities, such as cooking, child, and family care. The findings show that traditional gender role ideology (GRI) defines and shapes rural men’s and women’s work, with women more engaged in farming, rearing livestock, and trading while men are engaged in farming, rearing livestock, and carrying out skilled jobs like carpentry, plumbing, and blacksmithing. The lockdown of schools and workplaces resulted in women disproportionately bearing the burden of cooking and caring for children, the elderly, and the sick. A few rural men shared childcare, while women spent more time on housework and childcare activities than in the pre-pandemic period when children were in school for 6–7 h daily. During the pandemic, rural men and women spent more time with the children, such that rural women stayed at home or took children to the farms and marketplaces where possible. Older siblings and the elderly also provided support for women. In conclusion, work and family activities during COVID were, to an extent, difficult to manage as parents had to cope with increasing food insecurity, economic and transportation costs, and social deprivation fostered by social norms, values, and practices that perpetuate gender inequality and marginalization of women. Full article

Background: HIV case finding is an essential component for ending AIDS, but there is limited evidence on the effectiveness of such a strategy in the pediatric population. We sought to determine HIV positivity rates among children according to entry points in Cameroon. Methods: A facility-based survey was conducted from January 2015 to December 2019 among mother–child couples at various entry points of health facilities in six regions of Cameroon. A questionnaire was administered to parents/guardians. Children were tested by polymerase chain reaction (PCR). Positivity rates were compared between entry points. Associations were quantified using the unadjusted positivity ratio (PR) for univariate analyses and the adjusted positivity ratio (aPR) for multiple Poisson regression analyses with 95% confidence intervals (CIs). p-values < 0.05 were considered significant. Results: Overall, 24,097 children were enrolled. Among them, 75.91% were tested through the HIV prevention of mother-to-child transmission (PMTCT) program, followed by outpatient (13.27%) and immunization (6.27%) services. In total, PMTCT, immunization, and outpatient services accounted for 95.39% of children. The overall positivity was 5.71%, with significant differences (p < 0.001) between entry points. Univariate analysis showed that inpatient service (PR = 1.45; 95% CI: [1.08, 1.94]; p = 0.014), infant welfare (PR = 0.43; 95% CI: [0.28, 0.66]; p < 0.001), immunization (PR = 0.56; 95% CI: [0.45, 0.70]; p < 0.001), and PMTCT (PR = 0.41; 95% CI: [0.37, 0.46]; p < 0.001) were associated with HIV transmission. After adjusting for other covariates, only PMTCT was associated with transmission (aPR = 0.66; 95% CI: [0.51, 0.86]; p = 0.002). Conclusions: While PMTCT accounts for most tested children, high HIV positivity rates were found among children presenting at inpatient, nutrition, and outpatient services and HIV care units. Thus, systematic HIV testing should be proposed for all sick children presenting at the hospital who have escaped the PMTCT cascade. Full article

Preschool education institutions, where children have close contact and social interactions, can serve as potential environments for the transmission of infectious diseases. This issue poses a significant health concern, impacting both individual and public well-being. Thus, the present research set out to determine the prevalence of infectious diseases in preschool children and the views of parents and teachers on the prevention of infectious diseases. The study employed a mixed-method approach and involved 397 parents and 46 preschool teachers. The study was survey-based via in-person interviews. The results revealed that after they started school (almost in 5 months), children with a mean age of 4.7 ± 0.5 years experienced illness approximately 3.5 ± 2.0 times, of whom 91.5% used antibiotics. The prevalence of infectious diseases was found to be associated with the child’s being born at term, maternal education level, and the public/private status of preschool institutions. The presence of a sick child in the classroom elicits negative emotions from both teachers and parents. They recommend that studies on education, safety, hygiene, school health, health screenings, regulation of the learning environment, legal regulations, and school exclusion policies be carried out to prevent infectious diseases. When children with infectious diseases come to school, nearly half of the teachers admit them to the classroom due to various reasons and pressures. Parents request teachers to monitor medication, control sweating, and use a nebulizer for their sick children. Some of the teachers meet these requests, but they claim that the educational process is negatively affected. At preschool education institutions, the risk factors of infectious diseases have a complex structure and can be influenced by variables related to teachers, children, parents and the institution itself. Infectious diseases not only pose a threat to health but also impact teachers’ and parents’ emotions, teacher–child relationships, and the overall atmosphere within schools and classrooms. Full article

Universal health coverage (UHC) defines individuals’ timely access to healthcare services without suffering any health-related financial constraints. The Senegalese government has shown commitments towards achievement of UHC as a way of improving access by the population to quality healthcare services. This is very pertinent for promoting some indicators of under-five health in Senegal. Therefore, this study analyzed the factors influencing sick children’s utilization of the nearest healthcare facilities and their wait times in Senegal. The data were from the Service Provision Assessment (SPA) survey, which was conducted in 2018. The instrumental Tobit regression model was used for data analysis. The results showed that 63.50% and 86.01% of the children utilized health posts and publicly owned facilities, respectively. Also, 98.46% of the children utilized urban facilities. The nearest facilities were utilized by 74.55%, and 78.19% spent less than an hour in the facilities. The likelihood of using the nearest healthcare facilities significantly reduced (p < 0.05) with caregivers’ primary education, higher education, residence in some regions (Fatick, Kaokack, Saint Louis, Sediou, and Tambacounda), and use of private/NGO not-for-profit facilities, but increased with not having visited any other providers, residence in the Kaffrie region, vomiting symptoms, use of health centers, and use of health posts. Moreover, treatment wait times significantly increased (p < 0.05) with the use of nearest facilities, residence in some regions (Diourbel, Kaokack, Matam and Saint Louis), use of private for-profit facilities, use of private not-for-profit facilities, and urban residence, but decreased with secondary education, use of health centers, use of health posts, vomiting symptoms, and showing other symptoms. It was concluded that reduction in wait times and utilization of the nearest healthcare facilities are fundamental to achieving UHC in Senegal. Therefore, more efforts should be integrated at promoting regional and sectoral equities through facilitated public and private healthcare investment. Full article

Uneven division of domestic factors may contribute to sex differences in sickness absence with psychiatric disorders. The aim of this scoping review was to compile current Nordic research on domestic factors and sickness absence with psychiatric disorders. A systematic search was performed to identify studies from the Nordic countries published between 1 January 2010 and 31 December 2019. Twelve studies were included. Marital status, family situation, work-home interference (in both directions), social affiliation, and loss of child/young adult (suicide, accident, or natural death) were identified as measures of domestic factors. In 8 of the 12 studies, domestic factors were used as co-variates, while four used them as the main exposure. Social affiliation, home-to-work conflict, and total workload were not associated with the outcome. One study found that parents with children older than two years, widows/widowers, and those divorced or unmarried had an increased risk of sickness absence with psychiatric disorders. One study found that work-to-home conflict was associated with sickness absence with stress-related diagnoses in men, and with other mental disorders in women. Finally, one study found that losing a son or daughter aged 16–24 years increased the risk of future sickness absence with a psychiatric disorder regardless of the cause of death. Future studies need to develop concepts, study designs, and measurements to move this research area further. In particular, the concept of “unpaid domestic work” needs theoretical and empirical development. Full article

Chronic diseases, such as childhood diabetes mellitus (DM), are a complex and continuous struggle as well as a great challenge both for the children who face the disease and for their parents. DM is characterized by the complex management of therapeutic treatments, thus causing physical and psychological complications infamily members. There are many families who, upon hearing the diagnosis of their child with DM, stand still in front of these new facts as their lives change. All these unprecedented conditions cause parents intense stress and discomfort, leading them to a mental burden, as the only thing that concerns them upon diagnosis is how the family will survive in the face of the current conditions they are experiencing as well as the future of the sick child. The purpose of this brief literature review is to present the research findings related to the psychological burden of families withchildren with DM, focusing on the quality of life and stress. Full article