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??Abstract??Objective??To observe the effect of amoxicillin clavulanate oral suspension for children with urinary tract infection?? so as to provide evidence for clinical treatment. Methods??A total of 68 children with urinary tract infection were divided into amoxicillin clavulanate group and amoxicillin clavulanate sequential therapy group. The effect and bacteria clearance of two groups were assessed and compared. Results??The efficiency rate of amoxicillin clavulanate group was 91.4%?? and that of amoxicillin clavulanate sequential therapy group was 93.9%??there being no difference in two groups ??P > 0.05?? ??The Bacteria clearance rate in amoxicillin clavulanate group was 81.3%??and that in amoxicillin clavulanate sequential therapy group was 85.7%??there being no significant difference in two groups ??P > 0.05??. Conclusion??Amoxicillin clavulanate oral suspension for the children with urinary tract infection is safe??effective and economicd??with is worth clinical appliation.     

Screening for visual and ocular disorders in children, evaluation of the system in Sweden

The aim of this study was to evaluate the visual screening system in Sweden. We have made a retrospective investigation of the results of screening for ocular disease and visual impairment of all children born in 1982 in three Swedish communities. The records from screening examinations from 0 to 10 y and from diagnostic follow-up at the departments of ophthalmology that the children were referred to were inspected. The data were used to evaluate the efficiency of the Swedish visual screening system. The study included 3126 children. The attendance rate at the 4-y examination was better than 99%. The sensitivity of the 4- and 5.5-y screening examinations was on the average 92% and the specificity was 97%. The average number of false negative cases at 4 y was 5.6 in 1000 (0.56%). With this screening and subsequent diagnosis and treatment, the prevalence of amblyopia at different levels of visual acuity at the age of 10 y was: 0.06% with visual acuity <0.1,0.9% with visual acuity <0.5 and 1.7% with visual acuity < 0.7. In spite of largely unchanged pressure of amblyogenic factors in the population, the prevalence of deep and moderate amblyopia has been markedly reduced by screening and early treatment.     

Screening for coeliac disease—has the time come for mass screening?

Several recent studies, in particular the Italian SIGEP study, have demonstrated that mass screening for coeliac disease using gliadin and endomysial antibody testing is now a realistic possibility. If mass screening is to receive serious consideration then it must be shown to be (i) effective, (ii) acceptable, and (iii) worthwhile (cost-effective). At present there is insufficient evidence as to the health benefits from treating screen-detected disease and as to the size of the risks associated with having undetected coeliac disease. It is also unclear whether truly asymptomatic screen-detected coeliacs will accept long-term dietary restriction. To answer these questions randomized trials of screening are needed. On current evidence, mass screening cannot be justified. Efficient case-finding may prove as effective and more acceptable.     

Ability of mothers to subjectively assess the presence of fever in their children

We assessed the ability of mothers to subjectively determine the presence or absence of fever in their children when compared with simultaneous temperature determination obtained by thermometer. Mothers who said their children were febrile were correct 52.3% of the time; those who said their children were afebrile were correct 93.9% of the time. The sensitivity was 73.9% of the specificity was 85.6%. Ninety percent of children aged 2 years or younger with temperatures of 38.9 degrees C or higher were correctly identified as febrile. Administration of antipyretics to both febrile and afebrile children was greater among those whose temperature was determined at home by thermometer than among those whose temperature was determined by subjective criteria. We conclude that maternal subjective fever assessment criteria are useful as a screening method to rule out the presence of fever at all ages and that mothers can identify high fevers in most young children without the use of a thermometer.     

Effectiveness of ultrasound screening for developmental dysplasia of the hip

OBJECTIVE: To determine the effectiveness of ultrasound screening for developmental dysplasia of the hip (DDH) after the neonatal period. DESIGN: Prospective cohort study. SETTING: Child health care centres. PARTICIPANTS: Infants attending the child health care centres. INTERVENTIONS: The intervention group (n = 5170) was screened by ultrasound at 1, 2, and 3 months of age. The control group (n = 2066) was screened by routine physical examination as part of the programme for child health surveillance at the child health care centres (CHC screening). For evaluation of the screening, the children in both the intervention and control group received an ultrasound examination after 6 months of age to detect any abnormality that might have been missed by the screening. RESULTS: The sensitivity of the ultrasound screening was 88.5%, and the referral rate 7.6%. As a result of the ultrasound screening, 4.6% of the children were treated. The sensitivity of the CHC screening was 76.4%, with a referral rate of 19.2%. The treatment rate was 2.7%. Of the treated children in the ultrasound screening group, 67% were referred before the age of 13 weeks, whereas in the CHC screening group only 29% were referred before this age. CONCLUSIONS: This study shows that ultrasound screening detects more children with DDH than CHC screening and that more of them are detected at an earlier age. To accomplish this, even fewer children have to be referred. However, even general ultrasound screening seems not to eradicate late cases of DDH. The higher treatment rate in the population screened by ultrasound may be a result of overtreatment.     

Overcoming difficulties in implementing a universal newborn hearing screening program

The aim of this paper was to present our experience with a universal newborn hearing screening program, including the specific problems and difficulties faced since its beginning, along with the measures used to overcome them and to improve its efficiency. We analyzed data from 22,195 newborns screened by transiently evoked otoacoustic emissions (TEOAE) performed during the first days after birth. 84.8% of the newborns passed on the first test and another 12.15% passed on rescreening before hospital discharge. This produced a "not pass" rate (false-positive and true positive) of 3.05%. The rate of newborns who did not undergo screening and the rate of "lost to follow-up" newborns were reduced in time, due to various applied modifications to the protocol. It may be thus concluded that our protocol proved to be successful in attaining low refer rates for follow-up screening. A major problem that remains unresolved is the absence of effective follow-up.     

Psychosocial screening in pediatric practice: a survey of interested physicians

This study followed up on 201 pediatricians and family practitioners who had requested information about the Pediatric Symptom Checklist (PSC), a parent-completed questionnaire which screens for psychosocial dysfunction in school-aged children. The physicians were sent a postcard survey asking whether they had used the PSC in their practices. Of the 157 (78%) who responded to the postcard survey, 36 (23%) reported that they had used the PSC. On a follow-up questionnaire, all of these physicians rated the PSC as useful, and nearly 80% reported that it led to increased case-finding and/or referrals. Ninety-six percent stated that they will continue to use the PSC; more than half of them routinely or frequently. The findings indicate a widespread interest in psychosocial screening, and suggest that additional educational efforts may be necessary to support the acceptance of the PSC in pediatric practice.     

Burden of recurrent Chlamydia trachomatis infections in young women: further uncovering the "hidden epidemic"

OBJECTIVE: To determine the frequency and patterns of recurrent Chlamydia trachomatis infections, the most common bacterial sexually transmitted infection in young women. DESIGN: Cohort study using different data collection methods, including face-to-face interviews, medical record reviews, urine-based screening for C trachomatis infections, and a review of state health department reports of C trachomatis diagnoses. SETTING: Ten community-based health centers that provided reproductive health care from June 1998 to September 2001. PARTICIPANTS: Eligibility criteria included being nulliparous, between the ages of 14 and 19 years, and human immunodeficiency virus-negative, all at the time of recruitment. This convenience sample (N = 411) was recruited by word of mouth, clinician referrals, and advertisements in the clinics. Prospective follow-up data were available for 93.9% (386/411) of the sample. The exposure of interest was prior chlamydia infection. Main Outcome Measure Diagnosis of recurrent C trachomatis infection. RESULTS: During the follow-up period of 23 318 person-months (mean, 4.7 years per person), 216 participants (52.6%) were diagnosed as having C trachomatis infection, and 123 participants (29.9% of the total sample and 56.9% of those with initial infections) were diagnosed as having recurrent C trachomatis infections. Of 456 C trachomatis diagnoses made during the study period, 241 (52.9%) were recurrent infections. The rate of recurrent infections was 42.1 per 1000 person-months. The median time to recurrent infection was 5.2 months. CONCLUSION: Recurrent C trachomatis infections comprise a substantial health burden among young women, possibly higher than previously recognized in this vulnerable population.     

Mild mental retardation in schoolchildren in a Swedish suburban municipality: prevalence and diagnostic aspects

The prevalence of mild mental retardation (MMR) (IQ 50–72) was investigated in a Swedish suburban municipality with special demographic characteristics. The study population consisted of the 6397 children aged 9–15 years residing in the municipality on December 31, 1994. A total of 82 children fulfilled psychometric and adaptive criteria of MMR, corresponding to a prevalence of 12.8/1000. The prevalence was higher than that reported in previous Swedish and Finnish studies using similar case-finding methods. This can probably be explained by the lower socioeconomic status in the municipality studied and by the fact that testing is now more acceptable. Nearly 90% of the MMR children had symptoms in their preschool years, mainly motor, speech/language deviations and a relative inability to perform certain tasks. These symptoms also occur in children with minimal brain dysfunction/deficits in attention, motor control and perception which should be taken into consideration when selecting screening tests.     

Preschool vision screening by family physicians

PURPOSE: To determine the rate of preschool vision screening in family practice. To evaluate attitudes and beliefs about the importance of, and barriers to, preschool vision screening. METHOD: Mail survey of a national sample of family physicians. RESULTS: The response rate was 35% (237 of 671 eligible respondents). Most (90%) considered preschool vision screening important. The majority (91%) included some component of the eye examination as part of their routine well-child care for preschool-aged children. The likelihood of formal screening increased with age (3 years, 36%; 4 years, 58%; 5 years, 73%; P < .01). Most (88%) used a wall chart to test for visual acuity. Stereoacuity was rarely (7%) tested. Barriers included the perception that children are uncooperative (39%) and that screening is too time-consuming (21%). Fifty-nine percent would only consider using a vision screening test if its false-positive rate was 10% or less. Some (26%) reported that all children should be examined by an optometrist or ophthalmologist prior to school entry, regardless of any screening. CONCLUSIONS: The rate of screening by family physicians is similar to that by pediatricians. Providing education regarding optimal vision screening strategies and expected outcomes of screening may be important for improving both the rate and the quality of preschool vision screening. Ophthalmologists may play an important role in this process through the feedback they provide to referring physicians.     

Modeling administrative outcomes in fever and neutropenia: clinical variables significantly influence length of stay and hospital charges

BACKGROUND: Administrative outcomes such as length of stay and charges are used to compare the quality of care across institutions and among individual providers. Clinical variables representing disease severity may explain some of the variability in these outcomes. OBJECTIVE: To determine the extent to which readily available clinical data can explain the variability in length of stay and charges for children with cancer admitted to the hospital for fever and neutropenia, and to assess the appropriateness of using a time-efficient electronic case-finding strategy for the development of administrative outcome models. METHODS: A retrospective cohort of 157 fever and neutropenia encounters in a single institution during 11 months in 1997 was identified using a largely automated case-finding strategy followed by independent, blinded review of the selected discharge summaries. Models of admission variables predicting log length of stay and log charges were developed using multiple linear regression. The "smearing" technique of Duan adjusted for logarithmic retransformation was used in calculating each subject's predicted length of stay and charges. R2 values were calculated. There were two secondary analyses. In one, the result of admission blood culture was entered as a potential covariate. In the second, to evaluate the appropriateness of basing models on automated case-finding without discharge summary review, the authors rederived the models using all of the encounters (n = 160) identified by the algorithm, which had included three false-positive cases. RESULTS: Mean length of stay was 6.45 days. Mean charges were $11,967. Absolute monocyte count at admission was a significant, independent negative predictor of length of stay and charges. Underlying cancer diagnosis also was significant. Charges were highest for acute myeloid leukemia, followed by central nervous system tumors, other solid tumors, and acute lymphoblastic leukemia and lymphomas. Length of stay was highest for acute myeloid leukemia, followed by central nervous system tumors, acute lymphoblastic leukemia and lymphomas, and other solid tumors. Absolute monocyte count and tumor type were the major components of the model, but admission temperature (for both administrative outcomes) and the presence of localized infection (for length of stay) also were significant predictors. R2 values were 35.3% (charges) and 38.5% (length of stay), with validation R2 values of 26.6% and 29.2%, respectively. Entering bacteremia as a covariate improved the models. Inclusion of the three false-positive cases generated models with only a modest loss of accuracy; it introduced over-and underreporting of some of the less significant predictors but did not disrupt the ability to identify the major predictors, absolute monocyte count and tumor type. CONCLUSIONS: The clinical variables that were significant in this study account, in validation R2 estimates, for more than 25% of the variability in administrative outcomes for encounters of fever and neutropenia. Adjusting length of stay and charges for these clinical variables would allow for a fairer comparison of institutions and individual providers. The electronic case-finding algorithm served as an efficient way to identify absolute monocyte count and tumor type as the major predictors and provided a conservative estimate of R2.     

Non-malignant complications of coeliac disease

Patients with coeliac disease are at increased risk of developing complications which increase morbidity and mortality. Emphasis on malignant complications has often overshadowed the non-malignant risks, which have received relatively little attention, although some of these can be very troublesome and even life-threatening. This article points out that a large population of unidentified or neglected coeliac patients is at potential risk. The challenge is to identify this group by case-finding or screening programmes in selected populations, so that they can be offered a gluten-free diet and other treatments which will not only improve general health but may also prevent or reduce the development of health problems. The non-malignant risks are outlined and bone and neuropsychiatric disturbances considered in more detail because of recent developments in these areas.     

Differences in physical characteristics,perinatal histories,and social backgrounds between children with growth hormone deficiency and constitutional short stature.

Four hundred and forty-nine children with heights below -2.5 SD were identified by screening for height a total population of 48221 in three Scottish cities. Children participating in the study could be classified into 5 groups: severe growth hormone deficiency (n = 13), partial growth hormone deficiency (n = 25), low birthweight short stature (n = 34), constitutional short stature (n = 178), and short stature associated with some underlying disease (n = 106). Children with growth hormone deficiency tended to be shorter, were more likely to be obese, were growing more slowly, more often were the products of an abnormal pregnancy, and were less socially disadvantaged than constitutionally short children. Their parents were also more likely to have sought medical advice about the short stature. These findings have important implications for improved case-finding of children suffering from growth-hormone deficiency, who in this study accounted for about 10% of all short but otherwise normal children who came from non-disadvantaged communities.     

儿童保健体检系统中嵌入孤独症谱系障碍筛查路径的诊断准确性研究

背景 孤独症谱系障碍(ASD)早期筛查已成为共识,利用我国儿童保健体检系统筛查是否可行,筛查工具和路径均有待成熟.目的 探索适合儿童保健体检系统ASD的早期筛查工具和路径.设计诊断准确性研究.方法 在2018年8月1日至2020年10月31日上海市长宁区妇幼保健院18～36月龄儿童的常规体检中嵌入ASD筛查临床路径,以...     

Color vision screening of young children.

Early detection of congenital color vision defects is desirable, but school screening studies have been stymied by lack of a suitable test. We evaluated a new color vision test, the APT-5, for use by volunteer screeners in schools and preschools. The screeners tested 1794 children, ages 3 to 13 years, and found the APT-5 easy to use with young children ages 5 years and up. Children who failed the screening were recruited for diagnostic color vision testing; for the children ages 5 to 13 years, 56% of those who failed the screening were successfully recruited. Data analysis indicated that the false-positive rate in this age group was 1% to 2%, and that for boys in this age group the positive predictive value was 71% to 81%. Retest data indicated that most false-positives were not due to the test itself, but to other factors in the school screening situation. Two thirds of all children scored as abnormal by anomaloscopy were simple deuteranomalous, indicating that the APT-5 effectively identified even mild color defects. The results of this trial indicate that the APT-5 is suitable for school color vision screening of children ages 5 years and up.     

Preschool vision screening in pediatric practices

A national sample of pediatricians was surveyed to evaluate preschool vision screening practices (response rate 55%, 377 of 690 eligible respondents). The rate of acuity screening for 3-year-old children was low (35%), but increased for 4- (73%) and 5-year-old children (66%). Few used photoscreening or autorefraction (8%). Common barriers were that screening is too time-consuming and children are uncooperative. Half reported that there should be separate reimbursement for vision screening. Financial incentives may be important for ensuring the delivery of preschool vision screening, as well as adoption of emerging screening technologies if such devices are shown to be effective.     

自动脑干诱发电位技术在高胆红素血症新生儿听力筛查中的应用

目的探讨自动脑干诱发电位技术(AABR)在高胆红素血症新生儿听力筛查中的可行性和效果。方法选择2007年1月至2011年1月本院就诊并接受新生儿听力初筛和复筛的高胆红素血症足月新生儿(血清总胆红素值>220μmol/L)为观察组,同时在我院产科正常分娩的足月新生儿为对照组。听力初筛与复筛均使用AABR的两阶段模式,初筛时间为生后2～3天,无论通过与否均于出生后42～60天来我院进行复筛;复筛未通过的患儿,于生后3个月时回院行听性脑干反应(ABR)及听性稳态反应(ASSR)检测,并同时行第3次AABR检查。结果观察组1258例(2516耳),初筛通过1540耳,初筛通过率61.2%;对照组1514例(3028耳),初筛通过2913耳,初筛通过率96.2%,两组差异有统计学意义(χ2=1053.42,P<0.001)。观察组复筛通过2003耳,复筛通过率79.6%;对照组复筛通过2970耳,复筛通过率98.1%,两组差异有统计学意义(χ2=507.64,P<0.001)。轻度、中度、重度高胆红素血症患儿复筛通过率分别为87.9%、82.9%、69.4%,差异有统计学意义(χ2=81.49,P<0.001)。经ABR及ASSR检测,对照组2例患儿(2耳)、观察组29例患儿(38耳)确诊为听力障碍。结论高胆红素血症新生儿听力障碍发生率明显高于对照组;血清胆红素水平越高,听力筛查通过率越低。高胆红素血症患儿应进行听力筛查。     

Systematic screening of deafness at a maternity ward using evoked otoacoustic emissions: practical aspects and parental attitudes]

OBJECTIVE: Evaluation of the feasibility and parental attitudes towards a hearing screening programme using evoked otoacoustic emissions, implemented in a maternity ward in France. METHODS: A hearing screening test using transiently evoked otoacoustic emissions (TEOAE) was proposed to each baby, and an anonymous questionnaire was given to parents to assess their attitudes towards the screening procedure. RESULTS: Although the refusal of the test reached 16% (mainly during the first two weeks of the program), more than 92% of parents judged the test as being useful, and 65% wished it to be systematically done. However, nearly 35% of parents admitted to have a low level anxiety about being unnecessarily worried by the test results. One hundred and twenty-four babies were screened. Fifty three per cent of the tests have been performed in less than ten minutes, with an average of 12.2 minutes. This duration does not include delays due to programme and babies management. False positive rate (uni or bilateral fail) was 10.5% at the first stage. Repeating the test before discharge decreased the false positive rate to 6.5%. CONCLUSION: Although limited in time, this study shows that a systematic hearing screening programme using TEOAE is possible and should be done in France. False positive rate was below 7%, and the test was considered as useful by more than 90% of parents, although knowledge about deafness in childhood and its consequences were clearly insufficient.     

Neonatal screening for sickle cell anemia: evaluation of a five-year experience in an area of northern Paris]

We report a five-year experience of targeted neonatal screening for sickle cell disease in the northern part of the Paris area as well as the follow-up procedure of screened patients. POPULATION: This geographic area in France is characterized by a high frequency of populations at risk for sickle cell disease. RESULTS: Among 115,480 tested newborns, 250 patients were diagnosed (frequency: 1/462). The quality of the screening was attested by the high frequency (5.34%) of newborn carriers for a hemoglobin abnormality (n = 6168). We developed an optimized strategy which avoids the majority of pitfalls (false positive and false negative responses), except for S/HPFH. More than 95% of sickle cell disease was followed, the majority by medical sickle cell disease experts from hospitals. Only two deaths were recorded during this time period. CONCLUSION: We demonstrate the efficiency of targeting the proposed methodological strategy and the follow-up of affected newborns, a major argument demonstrating the importance of newborn screening.