Current Issue : July - September Volume : 2012 Issue Number : 3 Articles : 7 Articles
Background: Since siblings of pediatric cancer patients are at risk for emotional, behavioral, and social problems,\r\nthere is considerable interest in development of early psychological interventions. This paper aimed at evaluating\r\nthe effectiveness of a two-session psychological intervention for siblings of newly diagnosed pediatric cancer\r\npatients.\r\nMethods: Thirty siblings age 6-17 years were randomly assigned to an intervention group or an active control\r\ngroup with standard psychosocial care. The manualized intervention provided to siblings in the first 2 months after\r\nthe cancer diagnosis of the ill child included medical information, promotion of coping skills, and a\r\npsychoeducational booklet for parents. At 4 to 6 weeks, 4 months, and 7 months after the diagnosis, all siblings\r\nand their parents completed measures (from standardized instruments) of social support, quality of life, medical\r\nknowledge, posttraumatic stress symptoms, and anxiety.\r\nResults: At follow-up siblings in the intervention group showed better psychological well-being, had better\r\nmedical knowledge, and reported receiving social support from more people. However, the intervention had no\r\neffects on posttraumatic stress symptoms and anxiety.\r\nConclusions: The results of this pilot trial suggest that a two-session sibling intervention can improve siblings�\r\nadjustment, particularly psychological well-being, in the early stage after a cancer diagnosis....
Background: Isolated Left Ventricular Non-compaction (LVNC) is an uncommon disorder characterized by the\r\npresence of increased trabeculations and deep intertrabecular recesses. In adults, it has been found that Ejection\r\nFraction (EF) decreases significantly as non-compaction severity increases. In children however, there are a few data\r\ndescribing the relation between anatomical characteristics of LVNC and ventricular function. We aimed to find\r\ncorrelations between morphological features and ventricular performance in children and young adolescents with\r\nLVNC using Cardiovascular Magnetic Resonance (CMR).\r\nMethods: 15 children with LVNC (10 males, mean age 9.7 y.o., range 0.6 - 17 y.o.), underwent a CMR scan.\r\nDifferent morphological measures such as the Compacted Myocardial Mass (CMM), Non-Compaction (NC) to the\r\nCompaction (C) distance ratio, Compacted Myocardial Area (CMA) and Non-Compacted Myocardial Area (NCMA),\r\ndistribution of NC, and the assessment of ventricular wall motion abnormalities were performed to investigate\r\ncorrelations with ventricular performance. EF was considered normal over 53%.\r\nResults: The distribution of non-compaction in children was similar to published adult data with a predilection for\r\napical, mid-inferior and mid-lateral segments. Five patients had systolic dysfunction with decreased EF. The number\r\nof affected segments was the strongest predictor of systolic dysfunction, all five patients had greater than 9\r\naffected segments. Basal segments were less commonly affected but they were affected only in these five severe\r\ncases.\r\nConclusion: The segmental pattern of involvement of non-compaction in children is similar to that seen in adults.\r\nSystolic dysfunction in children is closely related to the number of affected segments....
Background: Bangladesh has about 5.7 million people living in urban slums that are characterized by adverse\r\nliving conditions, poor access to healthcare services and health outcomes. In an attempt to ensure safe maternal,\r\nneonatal and child health services in the slums BRAC started a programme, MANOSHI, in 2007. This paper reports\r\nthe causes of maternal and neonatal deaths in slums and discusses the implications of those deaths for Maternal\r\nNeonatal and Child Health service delivery.\r\nMethods: Slums in three areas of Dhaka city were selected purposively. Data on causes of deaths were collected\r\nduring 2008-2009 using verbal autopsy form. Two trained physicians independently assigned the cause of deaths.\r\nResults: A total of 260 newborn and 38 maternal deaths were identified between 2008 and 2009. The majority\r\n(75%) of neonatal deaths occurred during 0-7 days. The main causes of deaths were birth asphyxia (42%), sepsis\r\n(20%) and birth trauma (7%). Post partum hemorrhage (37%) and eclampsia (16%) were the major direct causes\r\nand hepatic failure due to viral hepatitis was the most prevalent indirect cause (11%) of maternal deaths.\r\nConclusion: Delivery at a health facility with child assessment within a day of delivery and appropriate treatment\r\ncould reduce neonatal deaths. Maternal mortality is unlikely to reduce without delivering at facilities with basic\r\nEmergency Obstetric Care (EOC) and arrangements for timely referral to EOC. There is a need for a comprehensive\r\npackage of services that includes control of infectious diseases during pregnancy, EOC and adequate after delivery\r\ncare....
Background: Group A Streptococcus (GAS) causes acute tonsillopharyngitis in children, and approximately 20% of\r\nthis population are chronic carriers of GAS. Antibacterial therapy has previously been shown to be insufficient at\r\nclearing GAS carriage. Bacterial biofilms are a surface-attached bacterial community that is encased in a matrix of\r\nextracellular polymeric substances. Biofilms have been shown to provide a protective niche against the immune\r\nresponse and antibiotic treatments, and are often associated with recurrent or chronic bacterial infections. The\r\nobjective of this study was to test the hypothesis that GAS is present within tonsil tissue at the time of\r\ntonsillectomy.\r\nMethods: Blinded immunofluorescent and histological methods were employed to evaluate palatine tonsils from\r\nchildren undergoing routine tonsillectomy for adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis.\r\nResults: Immunofluorescence analysis using anti-GAS antibody was positive in 11/30 (37%) children who had\r\ntonsillectomy for adenotonsillar hypertrophy and in 10/30 (33%) children who had tonsillectomy for recurrent GAS\r\npharyngitis. Fluorescent microscopy with anti-GAS and anti-cytokeratin 8 & 18 antibodies revealed GAS was\r\nlocalized to the tonsillar reticulated crypts. Scanning electron microscopy identified 3-dimensional communities of\r\ncocci similar in size and morphology to GAS. The characteristics of these communities are similar to GAS biofilms\r\nfrom in vivo animal models.\r\nConclusion: Our study revealed the presence of GAS within the tonsillar reticulated crypts of approximately onethird\r\nof children who underwent tonsillectomy for either adenotonsillar hypertrophy or recurrent GAS\r\ntonsillopharyngitis at the Wake Forest School of Medicine....
Background: Very low birth weight (VLBW) infants (< 1,500 g) with bronchopulmonary dysplasia (BPD) develop\r\nlung damage caused by mechanical ventilation and maturational arrest. We compared functional lung\r\ndevelopment after discharge from hospital between VLBW infants with and without BPD.\r\nMethods: Comprehensive lung function assessment was performed at about 50, 70, and 100 weeks of\r\npostmenstrual age in 55 sedated VLBW infants (29 with former BPD [O2 supplementation was given at 36 weeks of\r\ngestational age] and 26 VLBW infants without BPD [controls]). Mean gestational age (26 vs. 29 weeks), birth weight\r\n(815 g vs. 1,125 g), and the proportion of infants requiring mechanical ventilation for =7 d (55% vs. 8%), differed\r\nsignificantly between BPD infants and controls.\r\nResults: Both body weight and length, determined over time, were persistently lower in former BPD infants\r\ncompared to controls, but no significant between-group differences were noted in respiratory rate, respiratory or\r\nairway resistance, functional residual capacity as determined by body plethysmography (FRCpleth), maximal\r\nexpiratory flow at the FRC (V�max FRC), or blood gas (pO2, pCO2) levels. Tidal volume, minute ventilation, respiratory\r\ncompliance, and FRC determined by SF6 multiple breath washout (representing the lung volume in actual\r\ncommunication with the airways) were significantly lower in former BPD infants compared to controls. However,\r\nthese differences became non-significant after normalization to body weight.\r\nConclusions: Although somatic growth and the development of some lung functional parameters lag in former\r\nBPD infants, the lung function of such infants appears to develop in line with that of non-BPD infants when a\r\nbody weight correction is applied. Longitudinal lung function testing of preterm infants after discharge from\r\nhospital may help to identify former BPD infants at risk of incomplete recovery of respiratory function; such infants\r\nare at risk of later respiratory problems....
Background: Program coverage is likely to be an important determinant of the effectiveness of community\r\ninterventions to reduce neonatal mortality. Rigorous examination and documentation of methods to scale-up\r\ninterventions and measure coverage are scarce, however. To address this knowledge gap, this paper describes the\r\nprocess and measurement of scaling-up coverage of a community mobilisation intervention for maternal, child and\r\nneonatal health in rural Bangladesh and critiques this real-life experience in relation to available literature on\r\nscaling-up.\r\nMethods: Scale-up activities took place in nine unions in rural Bangladesh. Recruitment and training of those who\r\ndeliver the intervention, communication and engagement with the community and other stakeholders and active\r\ndissemination of intervention activities are described. Process evaluation and population survey data are presented\r\nand used to measure coverage and the success of scale-up.\r\nResults: The intervention was scaled-up from 162 women�s groups to 810, representing a five-fold increase in\r\npopulation coverage. The proportion of women of reproductive age and pregnant women who were engaged in\r\nthe intervention increased from 9% and 3%, respectively, to 23% and 29%.\r\nConclusions: Examination and documentation of how scaling-up was successfully initiated, led, managed and\r\nmonitored in rural Bangladesh provide a deeper knowledge base and valuable lessons.\r\nStrong operational capabilities and institutional knowledge of the implementing organisation were critical to the\r\nsuccess of scale-up. It was possible to increase community engagement with the intervention without financial\r\nincentives and without an increase in managerial staff. Monitoring and feedback systems that allow for periodic\r\nprogramme corrections and continued innovation are central to successful scale-up and require programmatic and\r\noperational flexibility....
Background: This study aimed to investigate the reliability and validity of the Iranian version of the Pediatric\r\nQuality of Life Inventoryââ??¢ 4.0 (PedsQLââ??¢ 4.0) Generic Core Scales in children.\r\nMethods: A standard forward and backward translation procedure was used to translate the US English version of\r\nthe PedsQLââ??¢ 4.0 Generic Core Scales for children into the Iranian language (Persian). The Iranian version of the\r\nPedsQLââ??¢ 4.0 Generic Core Scales was completed by 503 healthy and 22 chronically ill children aged 8-12 years\r\nand their parents. The reliability was evaluated using internal consistency. Known-groups discriminant comparisons\r\nwere made, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted.\r\nResults: The internal consistency, as measured by Cronbachââ?¬â?¢s alpha coefficients, exceeded the minimum reliability\r\nstandard of 0.70. All monotrait-multimethod correlations were higher than multitrait-multimethod correlations. The\r\nintraclass correlation coefficients (ICC) between the children self-report and parent proxy-reports showed moderate\r\nto high agreement. Exploratory factor analysis extracted six factors from the PedsQLââ??¢ 4.0 for both self and proxy\r\nreports, accounting for 47.9% and 54.8% of total variance, respectively. The results of the confirmatory factor\r\nanalysis for 6-factor models for both self-report and proxy-report indicated acceptable fit for the proposed models.\r\nRegarding health status, as hypothesized from previous studies, healthy children reported significantly higher\r\nhealth-related quality of life than those with chronic illnesses.\r\nConclusions: The findings support the initial reliability and validity of the Iranian version of the PedsQLââ??¢ 4.0 as a\r\ngeneric instrument to measure health-related quality of life of children in Iran....
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