Risk factors for Helicobacter pylori infection in children: is education a main determinant?

To investigate potential risk factors associated with Helicobacter pylori (Hp) infection, we performed a case-control study in 167 consecutively selected hospitalized children in Salvador, Brazil. Hp infection was identified by the presence of IgG against Hp in serum samples. Data were gathered using a structured questionnaire, 38.3% children were found to be seropositive and classified as cases, and 61.7% were seronegative controls. After multivariate analysis, independent variables associated with Hp infection included: the educational attainment of the child's provider > or = 11 years (OR 0.1, 95% CI 0.01-0.9), poor garbage disposal service (OR 2.2, 95% CI 1.0-4.9), thumb sucking (OR 4.6, 95% CI 1.1-19.8), brushing teeth more than once a day (OR 5.6, 95% CI 1.8-17.7), having a pet dog (OR 2.5, 95% CI 1.0-6.1), and a history of chronic urticaria (OR 4.0, 95% CI 1.5-10.8). The risk factors identified are consistent with some, but not all, previous studies supporting either oral-oral or faecal-oral transmission of Hp. Our data suggested that a higher educational attainment might play an important role in preventing Hp infection.     

The Healthy People 2010 outcomes for the care of children with special health care needs: an effective national policy for meeting mental health care needs?

Objectives To assess the effectiveness of the Maternal and Child Health Bureau’s (MCHB) Six Core Outcomes for children with special health care needs (CSHCN) as indicators in measuring the degree to which mental health care needs are met. Methods This study analyzes data from the 2001 National Survey of Children with Special Health Care Needs for 9,748 CSHCN who needed mental health care. Bivariate and logistic analyses were employed to investigate the impact of the MCHB’s Six Core Outcomes on the probability of having an unmet need for mental health services. Results Of the 2.3 million CSHCN in the U.S. who needed mental health care in 2001, almost one-fifth did not receive all of the mental health services that they needed. Ultimately, eight Outcomes and sub-categories of Outcomes were considered. Sixty-one percent of CSHCN with a need for mental health care had care that fulfills six of the eight considered Outcomes. Logistic analysis indicates that individual fulfillment of each of the Core Outcomes and fulfillment of additional Outcomes have a significant association with reducing the probability of having an unmet mental health care need for CSHCN. Conclusions This study is the first attempt to apply the Six Core Outcomes to meeting the needs for mental health care among CSHCN. Estimates of unmet need for mental health care suggest that efforts can be made to improve access for CSHCN. The initial estimates generated by this study indicate that the MCHB Outcomes are important in meeting children’s mental health needs and are important indicators for informing MCHB policy.     

Unmet needs for specialty, dental, mental, and allied health care among children with special health care needs: are there racial/ethnic disparities?

We examined racial/ethnic disparities in unmet specialty, dental, mental, and allied health care needs among children with special health care needs (CSHCN) using data on 38,866 children in the National Survey of CSHCN. Compared with White CSHCN, Black CSHCN had significantly greater unmet specialty (9.6% vs. 6.7%), dental (16% vs. 8.7%), and mental (27% vs. 17%) health care needs. Hispanic CSHCN had greater unmet dental care needs (15.8% vs. 8.7%). Black females had greater unmet mental health care needs than other groups (41% vs. 13-20%). Most disparities disappeared after multivariate adjustment. Significant risk factors for unmet health care needs included uninsurance, having no personal doctor/nurse, poverty, and condition stability and severity. Eliminating unmet specialty, dental, and mental health care needs for all CSHCN, and especially minority CSHCN, may require greater efforts to reduce poverty and increase insurance coverage among CSHCN, better mental health care assessment of Black female CSHCN, and ensuring all CSHCN have a medical home.     

Parent and health care professional perspectives on family-centered care for children with special health care needs: are we on the same page?

A family-centered approach to health care for children with special health care needs (CSHCN) is widely acknowledged as the ideal model of service delivery, but less is known about the actual practice of family-centered care (FCC), especially from the viewpoints of parents and health care professionals. This cross-sectional research compared parent and health care professional perspectives on the degree to which FCC is being provided at a large, urban hospital in the United States. The Measure of Process of Care (MPOC) was administered to a representative sample of 92 parents of CSHCN; a convenience sample of 43 health care professionals completed the service provider version of the MPOC. A mixed-model analysis of variance was conducted to test for group differences on matched domain scores of the MPOC. No significant differences emerged between the two stakeholder groups, but significant differences were detected among the four domain scores. The data suggest that health professionals are generally meeting families' needs for specific communication and are respectful of parents' expertise. However, parents and professionals alike indicated the need for continued professional growth in the area of providing holistic, comprehensive services to advance FCC.     

Energy expenditure in infants with pulmonary insufficiency: is there evidence for increased energy needs?

The observed growth failure in infants with pulmonary insufficiency is postulated to be a consequence of elevated rates of energy expenditure. Assessment of energy expenditure by the classical technique of indirect calorimetry has yielded conflicting results. The adoption of the newer, doubly labeled water technique has provided evidence to support increased rates of energy expenditure in infants with chronic lung disease, congenital heart disease and in minimally ill, extremely low birth weight infants. The doubly labeled water technique holds great promise for the detailed study of energy expenditure in a variety of clinical conditions, including very ill as well as free-living subjects.     

Matching health needs of refugee children with services: how big is the gap?

Objectives: To document the health needs of refugee children accessing comprehensive refugee health services in New South Wales (NSW), to match needs with available services and establish gaps in services.
Methods: We collated clinical data on all children aged under 14 years attending the three refugee specific clinics seeing children in NSW in 2005. We compared these data to the number of refugee children settling in NSW in 2005.
Results: NSW received 1,557 refugee children (<14 years) in 2005. Around one in five (n=331) was seen in a refugee specific clinic. Most were asymptomatic. Of those tested, 25% had anaemia, 27% were serology positive for schistosomiasis, 16% had evidence of current or recent malaria, 25% were tuberculin skin test positive, 69% were hepatitis B non-immune and 20% had low vitamin D levels. Most children needed catch up immunisation. Other problems included chronic health, developmental and behavioural problems. Screening tests varied across sites. Follow up was problematic for most.
Conclusions: A small proportion of refugee children arriving in NSW have access to comprehensive screening and assessment, in spite of significant health needs. There is variation in screening practices, and follow up is poor. There is a high pick up rate for diseases of personal and public health significance.
Implications: There is a strong moral and public health imperative to provide appropriately resourced, culturally competent and comprehensive health care to optimise refugee children's wellbeing.     

Two models for defining the relationship between theory and practice in nutrition education: is the scientific method meeting our needs?

This article describes two models for linking theory and practice in nutrition education and traces how concerns about the validity of different types of research drive the choice of models. In the scientific model, theory is defined in terms of statements from which one can deduce hypotheses, which can then be tested in experimental research designs. In the scientific model, practitioners are expected to replicate the methods used by researchers to effect targeted changes in the dependent variable of interest, usually health or eating behaviors. The ethical and epistemological shortcomings of the scientific model are then examined. The report goes on to describe an alternative approach, termed the humanistic model. In the humanistic model, theory is defined in terms of statements that seek to clarify basic social values. In the humanistic model, practitioners use theory as a stimulus for dialogue about the role of eating habits in living the kind of life that community members find most valuable. Examples of humanistic research relevant to nutrition education are presented, and the limitations of establishing the certainty of claims made using humanistic criteria are discussed. The article concludes with a discussion of the implications of the humanistic model for professional preparation.     

Oseltamivir use and severe abnormal behavior in Japanese children and adolescents with influenza: Is a self-controlled case series study applicable?

ObjectiveSince the 1990s, self-controlled designs including self-controlled case series (SCCS) studies have been occasionally used in post-marketing evaluation of drug or vaccine safety. An SCCS study was tentatively applied to evaluate the relationship between oseltamivir use and abnormal behavior Type A (serious abnormal behavior potentially leading to an accident or harm to another person) in influenza patients.MethodsFrom the original prospective cohort study with approximately 10,000 Japanese children and adolescents with influenza (aged <18 years), 28 subjects (mean age: 7.3 years) who developed abnormal behavior Type A after the first visit to the collaborating hospitals/clinics were analyzed. We hypothesized four combination patterns of the effect period (i.e., the period that effect of oseltamivir on occurrence of abnormal behavior Type A is likely) and the control period. Mantel-Haenszel rate ratio (M-H RR) and its 95% confidence interval (CI) were calculated as the relative risk estimate.ResultsAmong 28 subjects in the SCCS study, 24 subjects (86%) were administered oseltamivir and 4 subjects (14%) were not. Abnormal behavior Type A was more likely to occur in the effect period than the control period in every pattern (M-H RR: 1.90–29.1). We observed the highest estimate when the effect period was set between the initial intake of oseltamivir and T_max (M-H RR: 29.1, 95% CI: 4.21–201).ConclusionAbnormal behavior Type A was more likely to develop up to approximately 30 times during the period between the initial intake of oseltamivir and T_max. However, this period overlapped with the early period of influenza where high fever was observed. Since useful approaches to control the influence of the natural disease course of influenza were not available in this study, we could not deny the possibility that abnormal behavior was induced by influenza itself. The SCCS study was not an optimal method to evaluate the relationship between oseltamivir use and abnormal behavior.     

Early childhood education and care for Native Hawaiian children in Hawai‘i: a brief history

This study provides a brief overview of the history of early childhood education and care for Native Hawaiian children in Hawai‘i. Data sources include a literature review, examination of archival documents, and interviews with a sample of Native Hawaiian parents and community members. We trace the emergence of outside-the-home early childhood education and care back to the Protestant missionaries who arrived in Hawai‘i in the early 1800s, and demonstrate how the tools of colonisation have worked over time to position centre-based care as the ‘Gold Standard’ for all children, based on a deficit view of indigenous families and communities. Documenting some of the past and current efforts to promote and support culture-based education and care options in Hawai‘i, we argue that families in diverse communities may benefit more from having options that fit with their cultural views and values.     

Erythrocyte protoporphyrin or hemoglobin: which is a better screening test for iron deficiency in children and women?

BACKGROUND: Hemoglobin and erythrocyte protoporphyrin (EP) tests are commonly used to screen for iron deficiency. However, little research has been done to systematically evaluate the sensitivity and specificity of these 2 tests. OBJECTIVE: The objective of this study was to evaluate the sensitivity and specificity of hemoglobin and EP measurements in predicting iron deficiency in preschool children and in women of childbearing age. DESIGN: We examined data from the third National Health and Nutrition Examination Survey (n = 2613 children aged 1-5 y and n = 5175 nonpregnant women aged 15-49 y). Children or women with blood lead >or= 10 microg/dL were excluded from this study. We used the receiver operating characteristic (ROC) curve to characterize the sensitivity and specificity of hemoglobin and EP measurements in screening for iron deficiency, defined as having abnormal values for >or= 2 of the following 3 indexes: mean cell volume, transferrin saturation, and serum ferritin. RESULTS: The ROC performance of EP was consistently better than that of hemoglobin for detecting iron deficiency in preschool children. However, in nonpregnant women, we found no significant difference between EP and hemoglobin in ROC performance for detecting iron deficiency. We observed the same results when we stratified the analyses by sex and race of the children and by race of the women. CONCLUSIONS: For children aged 1-5 y, EP is a better screening tool for iron deficiency than is hemoglobin. However, for nonpregnant women, EP and hemoglobin have similar sensitivity and specificity for predicting iron deficiency.     

Caring for children with disabilities in Kilifi,Kenya: what is the carer's experience?

Background Carers of children with disabilities have repeatedly highlighted their feelings of discrimination, stigma and exclusion in many domains of their lives. There is little research from Africa addressing these issues. This study investigated the challenges encountered by these carers and the mechanisms of coping with these challenges while caring for children with disabilities in a poor rural setting in Kenya. Methods Thirty‐five in‐depth interviews were conducted with 20 carers, 10 community members and 5 primary school teachers. Ten unstructured observations were also conducted in home environments to observe mechanisms used in meeting the needs of the children with disabilities. All interviews were tape‐recorded, transcribed and translated from the local dialect. Note‐taking was performed during all the observations. Data were stored in NVivo software for easy retrieval and management. Results The arrival of a disabled child severely impairs the expectations of carers. Hospital staff underestimate carers' emotional distress and need for information. Fear for the future, stress, rumour‐mongering and poverty are encountered by carers. As they grapple with lost expectations, carers develop positive adaptations in the form of learning new skills, looking for external support and in some cases searching for cure for the problem. For their emotional stability, carers apply spiritual interventions and sharing of experiences. Conclusion Despite the challenges faced by the carers, values and priorities in adaptation to the challenges caused by the child's disability were applied. It is recommended that these experiences are considered as they may influence programmes that address the needs of children with disabilities.