Parental attitudes regarding analgesic use for children: differences in ethnicity and language

Purpose

The aim of this study was to identify the impact of ethnicity and language on parental attitudes regarding analgesic use to treat children's pain.

Methods

A total of 206 parents of children undergoing outpatient surgery were recruited to complete the Medication Attitudes Questionnaire, a measure of parental beliefs about using analgesic medications to treat children's pain. Parents were grouped into one of 3 categories according to ethnicity and primary language spoken: English-speaking white, English-speaking Hispanic, and Spanish-speaking Hispanic. Group differences in pain medication attitudes were examined.

Results

After controlling for socioeconomic status, English-speaking Hispanic parents endorsed higher levels of misconceptions about pain medication use, including a tendency to avoid analgesic use for children, compared with English-speaking white and Spanish-speaking Hispanic parents.

Conclusions

This study highlights parental characteristics, including ethnicity and language, which may place children at higher risk for undertreatment of acute pain based on misconceptions about analgesic use for children. Specifically, English-speaking Hispanic parents may be most likely to undertreat children's pain at home. Future studies are needed to identify the most appropriate means of providing education to counter parental misconceptions and support optimal pain management of children's pain in the home setting.     

Improving the health of African American men: experiences from the Targeting Cancer in Blacks (TCiB) Project

Background

African-American men lack knowledge of cancer facts and risk factors, and their personal attitudes and beliefs along with health care system interactions are barriers to cancer prevention. This paper highlights cancer prevention information from men in the Southeastern United States.

Methods

This community-based participatory research project surveyed 12,444 Black adult residents in Nashville and Chattanooga, Tennessee and in Atlanta and Decatur, Georgia regarding their cancer prevention knowledge, attitudes and practices. A sample (928) of 1407 men's responses was analyzed for education and income differences.

Results

Analyses found no significant differences in cancer prevention practices between men with high income and high education versus those with lower income and lower education level, but did show significant differences between education and income groups in cancer prevention knowledge and attitudes.

Conclusions

Income and education are not equal predictors of cancer prevention. Direct outreach efforts to black men of low education and income levels may be effective if interventions are tailored to separate socio-economic groups. Clear and thorough information about diseases, including their risks, prevention/detection procedures, treatment and cure are needed within the health care system itself, as well as for patients in the office, clinic, and community in innovative interactions to assist underserved men to increase and improve their knowledge, attitudes and practices regarding health promotion.     

Comparison of short- and long-term functional outcome of nonoperatively managed renal injuries in children

Purpose

The purpose of this study was to better determine the long-term functional outcome of nonoperatively managed renal injuries in children.

Methods

After Institutional Review Board approval, all children with blunt renal injuries were retrospectively reviewed. Renal function, after complete healing had been documented radiographically (3 months postinjury), was evaluated through measurements of blood urea nitrogen, serum creatinine, blood pressure, and split percentage of renal function using technetium-99m-dimercaptosuccinic acid nuclear scanning. Repeated data at 1 year postinjury were compared with the early follow-up results.

Results

Sixteen consecutive children (mean age, 10 years; range, 3-16 years) had complete follow-up over the study period. All children were managed without laparotomy. Injury grades were as follows: grades I to III, 4; grade IV, 9; and grade V, 3. No child had an abnormal blood urea nitrogen, serum creatinine, or blood pressure measurement at follow-up. Consistent with previous results, percentage of renal function by technetium-99m-dimercaptosuccinic acid scanning was influenced by injury grade at the early 3-month follow-up (46.5% ± 4.5%, 42% ± 7.1%, and 32.7% ± 5.9% [mean ± SD] for grades I-III, grade IV, and grade V, respectively). One-year functional results for the high-grade injuries also correlated to initial injury grade and were not significantly different from the results at early follow-up (43.8% ± 4.8%, 41.9% ± 6.6%, and 31.35 ± 5.7% [mean ± SD] for grades I-III, grade IV, and grade V, respectively; P = not significant). No child required delayed surgery.

Conclusions

Long-term (1 year) functional outcome in nonoperatively managed renal injuries in children appears preserved and is influenced by injury grade.     

Sexual attitudes and behavior of young adults who were burned as children

Objective

Little is known about sexual attitudes and behaviors of adults burned as children. We hypothesized that survivors with large burn scars would have differences in sexual attitudes and behaviors from their unburned counterparts.

Methods

Ninety-two young adults (50 males and 42 females), ages 21.0 ± 2.7 years old, who were burned 30% total body surface area or more as children 14.2 ± 5.4 years earlier, completed the questionnaire “What Young People Believe and Do” by RC Sorenson, 1972. The questionnaire explores sources of sexual information, attitudes toward different sexual behaviors, and experience with different sexual behaviors.

Results

Sixty-five percent of the females and 52% of the males currently had a significant other. Although only 54% women and 60% of men felt they were sexually attractive, 83 and 87%, respectively, endorsed feeling confident about sex. Experience with sexual intercourse was common: 90% of females and 76% of males. Burn severity was not significantly correlated with sexual attitudes and behaviors.

Conclusion

The majority of 92 young adults burned as children described sexual attitudes and behaviors comparable to the general population and the vast majority had significant sexual experience. Females reported more sexual behavior post-burn than males.     

Incidence and risk factors of non-fatal injuries in Chinese children aged 0-6 years: A case-control study

Aim

To identify the incidence and related risk factors of injuries in pre-school children aged 0-6 years in China.

Methods

Children with non-fatal injuries (n = 122) were matched to healthy controls by sex, age, community of residency and history of injury. Conditional multiple logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

Results

The overall incidence of injuries was 3.3%. After adjustment for all selected variables, the risk factors for childhood injuries included father's occupation as a self-employed person (OR: 5.7, 95% CI: 1.8-18.5), child's active temperament type (OR: 2.8, 95% CI: 1.5-5.3), inappropriate storage of medicines (OR: 3.1, 95% CI: 1.3-6.9) and inappropriate placement of heating equipments (OR: 2.1, 95% CI: 1.0-4.4). The protective factors included children's acquirements of safety education from their teachers at school (OR: 0.03, 95% CI: 0.01-0.2), and from their parents (OR: 0.08, 95% CI: 0.02-0.3).

Conclusions

Interventions targeting the risk factors specifically may help prevent and reduce the occurrence of injuries in young children.     

Using the parents' video camera for the follow-up of children who have undergone hypospadias surgery decreases hospital anxiety of children

Purpose

We investigated the benefits of using the parents' video camera records for the follow-up of children who had undergone hypospadias surgery in terms of reducing fear and hospital anxiety of the children and the time spent in the waiting room.

Methods

This prospective study was performed on children with proximal hypospadias. The patients were called for the follow-up appointment on the 7th postoperative day and were divided into 3 groups. The first group was the control group where parents were not given any follow-up visit direction. The parents of the second group were told to have their child drink enough fluids and come with a full bladder, while the third group of parents recorded their child's micturition using a video camera. The fear and anxiety of children at the postoperative visit were evaluated and recorded using a scoring system between 0 and 4 using the Children's Fear Scale (CFS) brochure. The time elapsed from the arrival of the parents in the outpatient clinic to their departure was also recorded for comparison of the total time spent during the follow-up visit among the groups.

Results

Thirty boys who underwent hypospadias repair were enrolled in this study. The median CFS scores at the postoperative follow-up visit were 2.99 ± 0.99 (range: 1–4) in the first group, 2.90 ± 0.87 (range: 1–4) in the second group, and 0.00 (range 0–0) in the third group. The median total time spent during the follow-up visit in the 3 groups was 61.50 ± 17.08 (range 35–88), 18.1 ± 13.01 (range 4–45), and 4.0 ± 0.81 (3–5) minutes, respectively. Both CFS and total time spent were significantly lower in the third group (p < 0.01).

Conclusion

Imaging of micturition at home by using a video camera for outpatient visits following hypospadias surgery will decrease the fear and anxiety of children and the time that the family spends at the hospital.     

Communication between HIV-infected children and their caregivers about HIV medicines: a cross-sectional study in Jinja district,Uganda

Introduction

Knowledge of antiretroviral therapy (ART) among children with HIV depends on open communication with them about their health and medicines. Guidelines assign responsibility for communication to children''s home caregivers. Other research suggests that communication is poor and knowledge about ART is low among children on treatment in low-income countries. This study sought to describe communication about medicine for HIV in quantitative terms from the perspectives of both children and caregivers. Thereafter, it established the factors associated with this communication and with children''s knowledge about their HIV medicines.

Methods

We undertook a cross-sectional survey of a random sample of 394 children with HIV on treatment and their caregivers at nine health facilities in Jinja District, Uganda. We assessed reported frequency and content of communication regarding their medicines as well as knowledge of what the medicines were for. Logistic regression analysis was used to determine the factors associated with communication patterns and children''s knowledge of HIV medicines.

Results

Although 79.6% of the caregivers reported that they explained to the children about the medicines, only half (50.8%) of the children said they knew that they were taking medicines for HIV. Older children aged 15–17 years were less likely to communicate with a caregiver about the HIV medicines in the preceding month (OR 0.5, 95% CI 0.3–0.7, p=0.002). Children aged 11–14 years (OR 6.1, 95% CI 2.8–13.7, p<0.001) and 15–17 years (OR 12.6, 95% CI 4.6–34.3, p<0.001) were more likely to know they were taking medicines for HIV compared to the younger ones. The least common reported topic of discussion between children and caregivers was “what the medicines are for” while “the time to take medicines” was by far the most mentioned by children.

Conclusions

Communication about, and knowledge of, HIV medicines among children with HIV is low. Young age (less than 15 years) was associated with more frequent communication. Caregivers should be supported to communicate diagnosis and treatment to children with HIV. Age-sensitive guidelines about the nature and content of communication should be developed.     

Psychosocial impact of childhood face burns: a multicenter, prospective, longitudinal study of 390 children and adolescents

Introduction

This two-year longitudinal study of the health-related quality of life (HRQoL) of children with face burns was conducted in three regional pediatric burn care centers. Subjects were 390 children less than 18 years old at injury, admitted for burn treatment from September 2001 to December 2004.

Methods

HRQoL was assessed using the age-specific Burn Outcomes Questionnaire (BOQ) administered at scheduled time points following discharge up to 24 months thereafter. A psychosocial score was determined from domains of the BOQ, and these scores from children with both face burns and grafts were compared to those of children with non-face burns or with face burns but no face grafts.

Results

The parents of both the 0-4 year olds and the 5-18 year olds, who had facial burns and grafts, reported decreased BOQ psychosocial scores. When the teenagers (11-18 year olds) with facial burns and grafts filled out the BOQ themselves, they also reported low psychosocial scores compared to those with no facial burns with grafts.

Conclusions

Severe face burn influences HRQoL in children. Additional psychosocial support is suggested to enhance recovery for patients with severe face burns and their families during the years following injury.     

Outcomes and delivery of care in pediatric injury

Purpose

To design effective pediatric trauma care delivery systems, it is important to correlate site of care with corresponding outcomes. Using a multistate administrative database, we describe recent patient allocation and outcomes in pediatric injury.

Methods

The 2000 Kids' Inpatient Database, containing 2,516,833 inpatient discharge records from 27 states, was filtered by E-code to yield pediatric injury cases. Injury Severity Scores (ISSs) were derived for each discharge using ICDMAP-90 (Tri-Analytics, Inc, Forest Hill, MD). After weighting to estimate national trends, cases were grouped by age (0-10, >10-20 years), ISS (≤15, >15), and National Association of Children's Hospitals and Related Institutions-designated site of care. Measured outcomes included mortality, length of stay, and total charges. Analysis was completed using Student's t test and χ².

Results

Among 79,673 injury cases, mean age was 12.2 ± 6.2 years and ISS was 7.4 ± 7.6. Eighty-nine percent of injured children received care outside of children's hospitals. In the subgroup of patients aged 0 to 10 years with ISS of greater than 15, the mean ISS for adult hospitals and children's hospitals was not significantly different (18.9 ± 9.1 vs. 19.4 ± 9.3, P = .08). However, in-hospital mortality, length of stay, and charges were all significantly higher in adult hospitals (P < .0001).

Conclusions

Younger and more seriously injured children have improved outcomes in children's hospitals. Appropriate triage may improve outcomes in pediatric trauma.     

Effects of a hospital based Wellness and Exercise program on quality of life of children with severe burns

Objective

To examine the effect of a 12-week Wellness and Exercise (W&E) program on the quality of life of pediatric burn survivors with burns of ≥40% total body surface area. We hypothesized this comprehensive regimen would improve physical and psychosocial outcomes.

Methods

Children were recruited for participation upon their discharge from the ICU. They were not taking anabolic/cardiovascular agents. Seventeen children participated in the W&E group and 14 children in the Standard of Care (SOC) group. Quality of life was assessed with the Child Health Questionnaire (CHQ) at discharge and 3 months. Children completed the CHQ-CF 87 and caregivers completed the CHQ-PF 28.

Results

The mean age of children in the W&E group was 14.07 ± 3.5 years and mean TBSA was 58 ± 11.8%. The mean age of children in the SOC group was 13.9 ± 3.1 years and mean TBSA was 49 ± 7.8%. ANOVA did not reveal statistically significant differences between the groups. Matched paired t-tests revealed that parents with children in the W&E group reported significant improvements with their children's physical functioning, role/social physical functioning, mental health, overall physical and psychosocial functioning after exercise.

Conclusions

These results are clinically relevant in that a comprehensive W&E program may be beneficial in promoting physical and psychosocial outcomes.     

Daily transabdominal electrical stimulation at home increased defecation in children with slow-transit constipation: a pilot study

Purpose

Transcutaneous electrical stimulation (TES) (3 sessions/wk) over the abdomen stimulated bowel functions in a randomized controlled trial. This pilot study assessed whether daily TES at home with a safe, portable machine would be possible and more efficacious than trial results.

Methods

Eleven patients (6 male/5 female; mean age, 14 years; range, 12-18 years) with slow-transit constipation who relapsed or responded poorly in the trial were recruited (11 ± 5 months later). An EPM-IF-4160 (Fuji Dynamics, Hong Kong) portable machine (sine waveform, 4 kHz carrier frequency, 80-160 Hz beat frequency, intensity <33 mA) delivering interferential current (2 electrodes over epigastrium + 2 over kidneys) was applied 1 hour daily at home. Continence diaries were kept for 1 month before and 2 months during treatment.

Results

All children completed more than 1 month of treatment after baseline recording. Defecation increased in 9 of 11 children, and soiling decreased in 4 of 11 children. There was a significant increase in total episodes of defecation per week (mean ± SD, 2.5 ± 2.1 vs 6.7 ± 4.4; P = .008) and a nonsignificant decrease in soiling (3.8 ± 1.6 vs 1.1 ± 0.5 episodes/wk, P = .1). Daily stimulation does not affect abdominal pain. No adverse events occurred.

Conclusions

Daily TES at home is safe and significantly improved bowel function in children who did not respond to 3 times per week of TES. Home TES may be a novel treatment of intractable slow transit constipation, avoiding hospital visits.     

High and intermediate imperforate anus: psychosocial consequences among school-aged children

Background/Purpose

Imperforate anus is an unusual malformation, which, even after surgical intervention, usually entails constipation and fecal incontinence. This study aimed to evaluate ongoing psychosocial effects of this birth defect in school-aged children.

Methods

Twenty-five children born with high and intermediate imperforate anus participated in the study, along with their parents and classroom teachers. One group of healthy children and 1 group of children with juvenile chronic arthritis, along with their parents, served as controls. Children and parents individually answered a questionnaire devised for this study. Parents filled out the Child Behavior Checklist and the children's teacher filled out the Teacher's Report Form.

Results

According to test results, children with imperforate anus were happy and optimistic. They liked school better and reported better relationships with schoolmates than the other children. The index group reported statistically significantly more frequent constipation. According to parental responses, the imperforate-anus children suffered from fecal incontinence and odor, as well as constipation (P < .001). Index-group parents reported on the Child Behavior Checklist that their children had more emotional and behavioral problems. On the Teacher's Report Form, teachers reported few problems for the same children.

Conclusions

Patients with imperforate anus did not experience psychosocial impairment despite significant functional problems.     

Das Polytrauma von Kindern und Jugendlichen

Background

The number of (seriously) injured children increased again for the first time in 2011. The aim of this study was to analyse differences compared to multiple injured adults and to show the reality of daily treatment.

Methods

All cases of the DGU Trauma Registry® from the years 1997 to 2010 were examined. The documented cases were divided into different the age groups. The study investigated, e.g. the mechanism of accident, injury pattern, the number of hospital and ICU days, and lethality.

Results

At 38.8?% the largest percentage of severely injured children and adolescents belongs to the group of 16–17 year olds. The group of 0–5 year olds (15.9?%) has the lowest percentage. The most common accident cause was traffic accidents (58.5?%). The mechanism of accident and the injury patterns changes with age. Younger patients are often treated in supraregional trauma centers (0–5 year olds: 78.2?% vs. 16–17 year olds: 73.1?% vs. >?65 years: 63.2?%). The average lethality rate was 14.8?% (16.3?% RISC).

Conclusions

The percentage of severely injured children in the overall population is only 7.4?%. Because the majority of patients are primarily treated in supraregional trauma centers, trauma centers with specialisation in paediatric traumatology are mandatory.

     

How does reflux affect laryngeal tissue quality? An experimental and histopathologic animal study

Objective

To investigate the histopathologic changes in intact laryngeal epithelium and mucosa exposed to endogenous gastric acid and pepsin in an experimental model of reflux.

Study Design

Randomized trial.

Setting

The study was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital.

Subjects and Methods

Eighteen healthy 200- to 220-g, 20-week-old Sprague-Dawley rats were used. The animals were divided into three groups according to exposure time (1-, 4-, and 12-week exposures), and four rats were examined as controls who underwent sham operation. An experimental model of gastroesophageal reflux was induced. After exposure, the animals were euthanized, and their larynges were removed. The histopathologic changes in the larynx were observed under a light microscope.

Results

The mean scores for inflammation in the control, one-, four-, and 12-week groups were 0.75 ± 0.50, 1.75 ± 0.50, 2.20 ± 0.45, and 1.94 ± 0.87, respectively. However, mean scores for vascular engorgement in the control, one-, and four-week groups were 0, and in the 12-week group was 2.0 ± 0.70. The mean scores for subepithelial edema in the control, one-, four-, and 12-week groups were 1.00 ± 0, 1.75 ± 0.95, 1.80 ± 0.45, and 2.20 ± 0.84, respectively. However, mean scores for keratinization for the control, one-, and four-week groups were 0, and for the 12-week group was 1.60 ± 0.55. When we compared inflammation, vascular engorgement, subepithelial edema, and keratinization mean scores between the control and study groups, there were statistically significant increases (P = 0.005, P = 0.001, P = 0.043, P = 0.002, respectively).

Conclusion

Our findings suggest that reflux induces significant histopathologic changes in larynx mucosa.     

CD4 count is predictive of outcome in HIV-positive patients undergoing abdominal operations

Background

The impact of immune status and surgical outcome in patients with HIV and acquired immunodeficiency syndrome (AIDS) remains unknown.

Methods

Clinical variables of HIV/AIDS patients undergoing abdominal surgery were examined for their impact on outcome.

Results

Major abdominal procedures were performed in 77 patients with a diagnosis of HIV/AIDS (55 males, mean age 41.1 years, mean CD4 count 210 mg/dL). A majority of operations (53%) were performed on an urgent basis. Patients undergoing urgent procedures had lower CD4 counts (129 ± 121 vs 303 ± 324, P = .002). The mean CD4 count was lower for patients with complications (146 ± 156 vs 288 ± 319, P = .013) and for those who died (112 ± 113 vs 251 ± 283, P = .026). On multivariate analysis, CD4 count was independently associated with an increased risk for complication, and urgent operation was associated with an increased risk for mortality.

Conclusion

Patients with HIV/AIDS who had lower CD4 counts were more likely to require an urgent operation and experience a complication with increased mortality.     

Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Purpose

To develop an evidence-based guideline for the management of grades I–III neck pain and associated disorders (NAD).

Methods

This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I–III NAD <6 months duration.

Recommendation 1

Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III.

Recommendation 2

Clinicians should assess prognostic factors for delayed recovery from NAD.

Recommendation 3

Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I–III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care.

Recommendation 4

For NAD grades I–II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat.

Recommendation 5

For NAD grades I–II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections.

Recommendation 6

For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction.

Recommendation 7

For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management.

Recommendation 8

Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

     

Sexual issues: let's hear it from the Malaysian boys

Background

This paper explored adolescents’ sexuality with specific reference to their attitudes towards sex, safe sex, their risk-handling skills, sources of sexual information and how this information influenced their knowledge and attitudes.

Methods

This qualitative study utilized focus group methodology. Four focus groups were conducted, involving a total of 31 Malaysian adolescent boys aged between 13 and 17 years.

Results

Findings from the focus groups revealed that the concept of sex was seen within the context of marriage and sex was also viewed as synonymous with love. All the participants denied having sex. The reasons for having sex were: ‘to have fun’, ‘part of natural urge’, curiosity, tension and pressure from family, schoolwork and being away from family. Procreation and the expression of love were also noted as reasons why people have sex. Masturbation was fairly well known among the boys but was felt to have negative consequences on one's health. There was a general lack of awareness on the issue of wet dreams. There were mixed feelings with regards to sexual abstinence before marriage. Knowledge on safe sex was still vague. The boys also perceived themselves to be at risk of HIV infection, but lacked the skills for handling this issue. Sources of sexual information were mainly from male friends or through the mass media. None of their parents talked to them about sexual matters.

Conclusions

Level of awareness and knowledge on sexual issues is still lacking. Misconceptions still prevail. Sex education and research in this area is warranted.