Current Issue : April - June Volume : 2015 Issue Number : 2 Articles : 8 Articles
Background: To assess the mental health and behavioral problems of children in institutional placements in Jordan\nto inform understanding of current needs, and to explore the effects of placement change on functioning and staff\nperceptions of goodness-of-fit.\nMethods: An assessment was completed of 134 children between 1.5 12 years-of-age residing in Jordanian\norphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and\ninternalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with\neach child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time\nsince last move, and an anticipation clock measuring time to next move.\nResults: 28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing\ndomain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive\ndevelopmental disorder, and conduct problems. Internalizing problems were found to decrease with time in\nplacement as children adjust to a prior move, whereas externalizing problems increased as the time to their next\nage-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the\nchange clocks were predictive of staff perceptions of goodness-of-fit with the children under their care.\nConclusions: These findings add to the evidence demonstrating the negative effects of orphanage rearing, and\nhighlight the importance of the association between behavioral problems and child-caregiver relationship pathways\nincluding the timing of placement disruptions and staff perceptions of goodness-of-fit....
Background: Childhood intelligence is an important determinant of health outcomes in adulthood. The first years\nof life are critical to child development. This study aimed to identify early life (perinatal and during the first year of\nlife) predictors of low cognitive performance at age 6.\nMethods: A birth cohort study started in the city of Pelotas, southern Brazil, in 2004 and children were followed from\nbirth to age six. Information on a broad set of biological and social predictors was collected. Cognitive abilityââ?¬â?the\nstudy outcomeââ?¬â?was assessed using the Wechsler Intelligence Scale for Children (WISC). IQ scores were standardized\ninto z-scores and low IQ defined as z < ?1. We applied bootstrapping methods for internal validation with a multivariate\nlogistic regression model and carried out external validation using a second study from the 1993 Pelotas Birth Cohort.\nResults: The proportion of children with IQ z-score < ?1 was 16.9% (95% CI 15.6ââ?¬â??18.1). The final model included the\nfollowing early life variables: childââ?¬â?¢s gender; parentsââ?¬â?¢ skin color; number of siblings; fatherââ?¬â?¢s and motherââ?¬â?¢s employment\nstatus; household income; maternal education; number of persons per room; duration of breastfeeding; height-for-age\ndeficit; head circumference-for-age deficit; parental smoking during pregnancy; and maternal perception of the childââ?¬â?¢s\nhealth status. The area under the ROC curve for our final model was 0.8, with sensitivity of 72% and specificity of 74%.\nSimilar results were found when testing external validation by using data from the 1993 Pelotas Birth Cohort.\nConclusions: The study results suggest that a childââ?¬â?¢s and her/his familyââ?¬â?¢s social conditions are strong predictors of\ncognitive ability in childhood. Interventions for promoting a healthy early childhood development are needed\ntargeting children at risk of low IQ so that they can reach their full cognitive potential....
Background: New standardised parenteral nutrition (SPN) formulations were implemented in July 2011 in many\nneonatal intensive care units in New South Wales following consensus group recommendations. The aim was to\nevaluate the efficacy and safety profile of new consensus formulations in preterm infants born less than 32 weeks.\nMethods: A before-after intervention study conducted at a tertiary neonatal intensive care unit. Data from the\npost-consensus cohort (2011 to 2012) were prospectively collected and compared retrospectively with a\npre-consensus cohort of neonates (2010).\nResults: Post-consensus group commenced parenteral nutrition (PN) significantly earlier (6 v 11 hours of age,\np 0.005). In comparison to the pre-consensus cohort, there was a higher protein intake from day 1 (1.34 v 0.49 g/kg,\np 0.000) to day 7 (3.55 v 2.35 g/kg, p 0.000), higher caloric intake from day 1 (30 v 26 kcal/kg, p 0.004) to day 3 (64 v\n62 kcal/kg, p 0.026), and less daily fluid intake from day 3 (105.8 v 113.8 mL/kg, p 0.011) to day 7 (148.8 v 156.2 mL/kg,\np 0.025), and reduced duration of lipid therapy (253 v 475 hr, p 0.011). This group also had a significantly greater weight\ngain in the first 4 weeks (285 v 220 g, p 0.003).\nConclusions: New consensus SPN solutions provided better protein intake in the first 7 days and were associated\nwith greater weight gain in the first 4 weeks. However, protein intake on day 1 was below the consensus goal of\n2 g/kg/day....
Background: There is little published data regarding the rate of bilirubin clearance in newborns following total\nparenteral nutrition (TPN) cessation, particularly in the neonatal intensive care unit (NICU) population without\nintestinal failure.\nMethods: The primary aim of this retrospective chart review was to determine the duration and severity of bilirubin\nelevation in neonates without intestinal failure. Secondary aims were to determine factors that would influence the\nduration and severity of this biochemical elevation. The authors conducted a retrospective chart review of all\ninfants receiving TPN for ? 21 days and with elevated conjugated bilirubin (CB) ?3 mg/dL upon TPN cessation in a\ntertiary care NICU from January 1, 2008 to December 1, 2010. Patients with known causes of liver disease or without\nlaboratory values at least four weeks after PN cessation were excluded. Time to maximum conjugated bilirubin\n(maxCB) post TPN cessation and normalization were the primary outcomes. Secondary factors including number/\ntiming of sepsis events, ethnicity, and ursodiol use were also evaluated.\nResults: Forty three infants met inclusion criteria. The majority of patients had increased CB post TPN cessation\n( up group; 27/43, 63%) with maxCB reached 13 days (SD ?10.3) after TPN cessation. The majority of the cohort\nachieved normalization of the bilirubin prior to discharge (28/43, 65%). There was no difference in rate of\nnormalization (p = 0.342) between the up group (59%) and the group of patients whose bilirubin trended\ndownward following PN cessation ( down group, 75%). There were no differences between the two groups with\nrespect to gestational age at birth, birth weight, number of sepsis events, gram negative sepsis events, or intestinal\nresection. Only 30% of Hispanic patients had increased CB post TPN cessation compared to the majority (71%) of\nnon-Hispanic patients. The maxCB of those that had complete normalization was significantly lower value than the\nmaxCB of those that did not normalize (p = 0.016).\nConclusions: Nearly two-thirds of infants experience a rise in serum bilirubin following PN cessation that can last\nfor weeks, but cholestasis generally improves with time in the majority of infants...
Background: HIV-related stigma diminishes the quality of life of affected patients. Little is known about perceived\nand enacted stigma of HIV-infected children in resources-limited settings. We documented the prevalence of\nperceived stigma and associated factors associated among children on antiretroviral therapy (ART) at a referral\nhospital in Cambodia.\nMethods: After informed consent, a standardized pre-tested 47-item questionnaire was confidentially administered\nto consecutive children (7 to 15 years) or their guardians if the child was 18 months to 6 years, during their routine\nART visits. The questionnaire explored the sociodemographics of the child and the parents, HIV history, adherence\nto ART, tolerance of ART and perceived stigma. Associations between perceived stigma and the children s characteristics\nwere measured by bivariate and multivariate analyses.\nResults: Of 183 children, 101 (55.2%) had lost at least one and 45 (24.6%) both parents; 166 (90.7%) went to school. Of\n183 children (female: 84, 45.9%, median age 7.0 years, interquartile range: 2.0-9.6), 79 (43.2%) experienced perceived\nstigma, including rejection by others (26.8%), no invitations to social activities (18.6%) and exclusion from games (14.2%).\nA total of 43 (23.5%) children were fearful of their disease and 61 (53.9%) of 113 older than 6 years reported knowledge\nof their HIV status. Of 136 children over five years and eligible for education, 7 (3.8%) could not go to school due to\nperceived stigma. Incomplete adherence to ART was reported for 17 (9.2%) children. In multivariate analysis, school\nattendance (odds ratio [OR]: 3.9; 95% confidence interval [CI]: 2.0-7.9) and income of less than one dollar per person\nper day (OR: 2.2, 95% CI: 1.1-4.5) were associated with perceived stigma. Conversely, receipt of social support (OR: 0.4,\n95% CI 0.2-0.9) was associated with lower risk of perceived stigma.\nConclusion: Perceived stigma in pediatric ART patients remains a significant issue in Cambodia. Psychological support\nand interventions should be developed in hospitals, schools, and underprivileged communities to prevent HIV-related\nstigma for affected children....
Background: Preterm-born or asphyxiated term-born children show more emotional and behavioral problems at\npreschool age than term-born children without a medical condition. It is uncertain whether parenting intervention\nprograms aimed at the general population, are effective in this specific group. In earlier findings from the present\ntrial, Primary Care Triple P was not effective in reducing parent-reported child behavioral problems. However, parenting\nprograms claim to positively change child behavior through enhancement of the parentââ?¬â??child interaction. Therefore,\nwe investigated whether Primary Care Triple P is effective in improving the quality of parentââ?¬â??child interaction and\nincreasing the application of trained parenting skills in parents of preterm-born or asphyxiated term-born preschoolers\nwith behavioral problems.\nMethods: For this pragmatic, open randomized clinical trial, participants were recruited from a cohort of infants\nadmitted to the neonatal intensive care units of two Dutch hospitals. Children aged 2ââ?¬â??5 years, with a gestational age\n<32 weeks and/or birth weight <1500 g and children with a gestational age 37ââ?¬â??42 weeks and perinatal asphyxia were\nincluded. After screening for a t-score ?60 on the Child Behavior Checklist, children were randomly assigned to Primary\nCare Triple P (n = 34) or a wait-list control group (n = 33). Trial outcomes were the quality of parentââ?¬â??child interaction\nand the application of trained parenting skills, both scored from structured observation tasks.\nResults: There was no effect of the intervention on either of the observational outcome measures at the 6-month trial\nendpoint.\nConclusions: Primary Care Triple P, is not effective in improving the quality of parentââ?¬â??child interaction nor does it\nincrease the application of trained parenting skills in parents of preterm-born or asphyxiated term-born children with\nbehavioral problems. Further research should focus on personalized care for these parents, with an emphasis on\npsychological support to reduce stress and promote self-regulation....
Abstract\nBackground: Serious thromboembolic events connected with rFVIIa therapy in hemophilia patients are rare. Only\nthree cases are reported in children, all of them with hemophilia A.\nCase presentation: We present unique case of patient with hemophilia B and high titer inhibitors to coagulation\nFIX, who developed severe renal damage due to thromboembolic event during rFVIIa therapy, associated with\nunsuspected renovascular anomalies.\nConclusion: Caution is necessary if hematuria B requires administration of rFVIIa. US color doppler renal imaging\nbefore and after drug administration should be sufficient as an early warning....
Background: Poor sleep contributes to the developmental problems seen in preterm infants. We evaluated sleep\nproblems in preterm infants 6 months of post-gestational age using the subjective Brief Infant Sleep Questionnaire\n(BISQ) and objective sleep tests. We also compared the sleep of premature infants with that of full-term infants.\nMethods: The study included 68 6-month-old full-term healthy infants and 191 premature infants born at <37 weeks\ngestation. All parents completed the BISQ-Chinese version and sleep diaries. At the same time, all premature infants\nwere submitted to one night of polysomnography (PSG) in the sleep laboratory and also were set up with an actigraph\nkept for 7 days. Statistical analyses were performed using correlation coefficients and the t-test with SPSS version 18 to\ncompare questionnaire responses with other subjective and objective measures of sleep.\nResults: The sleep problems indicated in the subjective questionnaire for the premature infants, particularly:\nââ?¬Å?the nocturnal sleep duration, number of night awakenings, daytime sleep duration, duration of time with\nmouth breathing, and loud-noisy breathingââ?¬Â had significant correlations with sleep diaries, actigraphy and PSG\nresults. The BISQ showed that duration of infantââ?¬â?¢s sleeping on one side, nocturnal sleep duration, being held\nto fall asleep, number of nighttime awakenings, daytime sleep duration, subjective consideration of sleep\nproblems, loud-noisy breathing, and duration spent crying during the night were significantly different between the\npremature infants and the term infants. PSG confirmed the presence of a very high percentage (80.6%) of premature\ninfants with AHI > 1 event/hour as indicated by the questionnaire.\nConclusion: Premature infants have more sleep problems than full-term infants, including the known risk of abnormal\nbreathing during sleep, which has been well demonstrated already with the BISQ-Chinese (CBISQ)....
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