Attitudes and knowledge on breastfeeding among paediatricians, family physicians, and gynaecologists in Israel

OBJECTIVES: Many women in Western countries fail to breastfeed long enough. The aim of this study was to examine the attitudes and knowledge of Israeli family physicians (FPs), gynaecologists and paediatricians towards breastfeeding. DESIGN AND PARTICIPANTS: A questionnaire examined Physicians' attitudes towards breastfeeding and their role in encouraging it, their sources of information and adequacy of knowledge. RESULTS: Four hundred and seventy-eight physicians responded to the survey: 123 FPs, 134 gynaecologists and 221 paediatricians. Ninety to -hundred per cent of physicians agreed that breastfeeding is the best feeding method for infants and agree that physicians should encourage it. Less than 20% of physicians discuss breastfeeding with pregnant women, and less than 30% discuss it with women 3 months or more postnatally. On average, physicians correctly answered 3.5 +/- 1.7 out of seven questions examining knowledge. Physicians state their main sources of information as their own experience and reading. One hundred and ninety physicians specified how they encourage breastfeeding--of those, 75.3% speak only of the advantages of breastfeeding. CONCLUSION: Physicians have a positive disposition towards breastfeeding but their knowledge is somewhat low. It seems awareness is lacking to the importance of continuous support and practical guidance beginning before birth and continuing until 3 months or more postnatal.     

Improving bicycle safety: The role of paediatricians and family physicians

Cycling is a complex activity requiring motor, sensory and cognitive skills that develop at different rates from childhood to adolescence. While children can successfully ride a two-wheeled bicycle at age five or six, judgment of road hazards are poor at that age and matures slowly until adult-like judgment is reached in early adolescence. Safe cycling depends on the care, skills and judgment of cyclists and motorists; roadway design that promotes safe coexistence of bicycles and motor vehicles; and the use of safety devices, including bicycle helmets, lights and reflective tape. Whereas, research into optimal roadway design and educational programs for drivers to improve road safety has yielded contradictory results, the benefits of bicycle helmet use and programs to enhance their use have been clearly shown. This paper has the following objectives for paediatricians and family physicians:

1. To understand the relationship between bicycle safety and children’s motor and cognitive skills.
2. To understand the effectiveness and limitations of strategies to improve bicycle safety.
3. To describe activities to promote bicycle safety that physicians can undertake in clinical settings and in the community.

     

Attitudes and practices of family paediatricians in Italy regarding infant feeding

Aim: The aim of this study was to examine attitudes and practices of family paediatricians in Italy towards infant feeding. Methods: A questionnaire was sent to 850 paediatricians across Italy, asking about attitudes and practices towards infant feeding with focus on the World Health Organization’s criteria. Results: The response rate was 91.2%. Breastfeeding is recommended for 6–11 months (70.6%) or longer (29.4%). A 95% of paediatricians recommend introducing complementary foods throughout 4–5.9 months. Among paediatricians who give indications about the minimum acceptable diet (61.7%), recommendations agree with WHO in 71.3% and 83.3% of cases for infants aged 6–8 or 9–11 months, respectively. A 95.6% of paediatricians recommend consumption of meat for infants aged 6 months or more, and 98.4% use of formula milk for infants having breastfeeding stopped in the first year of life. Paediatricians reported own experience (73.4%) and reading (54.2%) as main sources of information. A 70% of paediatricians know the WHO/Infant and Young Child Feeding Practices criteria regarding breastfeeding but <5% the complementary feeding indicators. Conclusion: Family paediatricians in Italy have positive disposition towards infant feeding but their knowledge and practices are suboptimal with respect to the WHO criteria, especially regarding complementary feeding.     

肥胖和母乳喂养对儿童哮喘及哮喘样症状影响的交互效应

目的：探讨肥胖和母乳喂养对儿童哮喘及哮喘样症状影响的交互效应。方法采用整群随机抽样法,在沈阳市5个行政区各抽取2所幼儿园和1所小学,5个行政区共10所幼儿园和5所小学。采用国际统一标准问卷ATS调查表,对所选学校儿童出生时的喂养方式、生活环境和呼吸系统疾病与症状等状况进行调查,同时对儿童进行体质测量。结果本次研究共发放9335份问卷,回收问卷共8371份,应答率为89．7%,经逻辑审查符合上机进行统计分析的共8212份问卷,合格率为98．1%。儿童超重和肥胖率分别为12．7%和15．5%,母乳喂养率为78．9%。肥胖儿童哮喘患病率(8．5%)显著高于正常体重儿童患病水平(5．8%)(χ2=13．48, P=0．0012);而母乳喂养儿童哮喘患病率(6．05%)显著低于非母乳喂养儿童患病水平(7．38%)(χ2=4．05, P=0．04)。多因素分析结果显示,在母乳喂养的儿童中,与正常体重的儿童相比,肥胖儿童患有哮喘的风险性增加了38%( OR=1．38,95%CI=1．05~1．82);而在非母乳喂养的儿童中,肥胖对哮喘的风险性增加了56%( OR =1．56,95%CI =0．99~2．44),进一步分析结果显示肥胖与母乳喂养对儿童咳痰及喘息的交互效应具有统计学意义(P<0．05)。结论母乳喂养可显著降低超重肥胖对儿童患有哮喘及哮喘样症状的影响,两者存在显著的交互效应。     

Respiratory Symptoms and Asthma in Primary School Children in Kuala Lumpur

In a Cross-sectional Study of 7 to 12-year-old primary school children in Kuala Lumpur, the prevalence of chronic cough and/or phlegm, persistent wheeze, and doctor-diagnosed asthma were 8.0%, 8.0% and 8.7%, respectively. The prevalence of asthma (defined as persistent wheeze and/or doctor-diagnosed asthma) was 13.8%, 4.3% experienced at least one episode of chest illness that resulted in inactivity for at least 3 days in the previous year. The mean age of commencement of symptoms in the doctor-diagnosed asthma group was 2.75 years. The prevalence of chronic cough and/or phlegm and persistent wheeze were highest among Indian children (p<0.05). More Malays had been diagnosed as having asthma than the other ethnic groups but the differences were not statistically significant. The patients' fathers' low levels of education were associated with chronic cough and/or phelgm (p<0.05) but not with other complaints. Asthma was significantly more common among boys than girls. No age differences were noted. Further analysis showed that persistent wheeze and doctor-diagnosed asthma were associated with increased likelihood of other respiratory illnesses or doctor-diagnosed allergy before the age of 2 years.     

Asthma in rural Bangladeshi children

Objective Although bronchial asthma causes a great deal of morbidity among children in Bangladesh, few epidemiological studies addressed this problem. The study aims to determine the prevalence of wheezing and its association with environmental and host factors. Methods A total of 1587 children aged 60–71 mth living in 50 villages in rural Bangladesh at Matlab was studied. Trained field workers interviewed caretakers of these children to diagnose wheezing using an adopted questionnaire of the International Studies of Asthma and Allergies in Childhood (ISAAC). History of pneumonia among wheezing and non-wheezing children during their childhood was obtained from the surveillance records. Results The prevalence of wheezing in the last 12 mth prior to survey was 16.1% (95% Cl: 14.3%, 18.0%), significantly higher among children who had attacks of pneumonia during their infancy compared to children who did not (23.0% vs 14.6%, p<0.0001). Risk factors associated with wheezing were pneumonia at ages 0–12m (OR= 1.50, 95% Cl 1.08, 2.10) and 13–24m (OR= 2.12, 1.46, 3.08), maternal asthma (OR=3.01, 95% Cl 2.02, 4.47), paternal asthma (OR= 3.12, 95% Cl 1.85, 5.26), maternal eczema (OR=1.81, 95% Cl 1.14, 2.87) and family income ≤ 100 US$ (OR for US$ 51–99= 1.63, 95% Cl 1.05, 2.53; OR for US$ ≤ 50= 2.12, 95% Cl 1.31, 3.44). Conclusion Our results suggest that wheezing is a significant cause of morbidity among children in rural Bangladesh. Greater efforts are needed to prevent pneumonia among children during their infancy to reduce the chances of subsequent development of wheezing.     

Prescribing practices and knowledge of tricyclic antidepressants among physicians caring for children

We did not find any significant difference between pediatricians and family practitioners with regard to their knowledge of the potentially serious toxicities of the tricyclic antidepressants. One of this group, imipramine, is in widespread use for the treatment of enuresis. A large proportion of the pediatricians (40%) and family practitioners (50%) surveyed use this drug as the first or only approach to enuresis. It is disquieting to discover that, of those physicians choosing to use the drug, one third appear to be unaware of its toxic potential. Other effective treatment modes are available, and it is to be hoped that more physicians will explore them before turning to the more hazardous pharmacologic alternatives. Pediatricians, although not more knowledgeable than family practitioners, exhibited more careful prescribing practices.     

Trends in hospitalization among asthmatic children in Finland from 1972 to 1986

Trends in hospitalization among asthmatic children were examined over a period of 15 years on the basis of a hospital discharge register covering all hospitals in Finland. The annual mean population under 15 years of age, 992 994, had a total of 37 965 hospitalization periods on account of asthma during the interval studied. Examination in 5 year are groups showed treatment periods for boys under 5 years to have increased by 1.8% annually relative to the total population (95% confidence interval +0.6–+3.1) and those for girls by 2.2% (95% CI+0.7–+3.7), whereas the changes in the older age groups were insignificant. First admissions decreased annually in all age groups in the case of both boys and girls. The numbers of hospitalization periods due to asthma were significantly higher for boys than for girls. The use of hospital services by asthmatic children was appropriate during the period concerned, which may partly be explained by the fact that child health care is well organized in Finland and the treatment of childhood asthma entirely in the hands of paediatricians.     

P物质与哮喘的关系(英文)

目的：动态研究哮喘患儿血浆及哮喘豚鼠血液、支气管肺泡灌洗液 (BALF)和肺组织中P物质(SP)含量及SPmRNA表达变化 ,探讨SP与小儿哮喘发病机制的关系。方法：用放射免疫方法 ,动态测定 35例不同严重程度哮喘患儿急性发作期及其临床症状缓解期的血浆SP含量变化 ;并在豚鼠哮喘模型上同期进行了不同严重程度哮喘豚鼠血液、BALF和肺组织中SP含量的对比研究 ,利用RT -PCR方法研究肺组织SPmRNA表达变化。结果：①哮喘患儿急性发作期血浆SP含量较其自身症状缓解期及正常对照组均明显增高 ,差异有显著性(P <0 .0 1) ;症状航馄谘 P含量较正常对照组差异无显著性 (P >0 .0 5 ) ;②重症哮喘急性发作期血浆SP含量 ,较轻、中度哮喘急性发作期的含量显著增高 ,差异有显著性 (P <0 .0 5 ) ;③哮喘豚鼠血液、BALF和肺组织中SP含量较正常豚鼠均显著增高 (P <0 .0 1) ,反复诱喘豚鼠各组织中SP含量均显著高于诱喘一次豚鼠 (P <0 .0 5 ) ;④哮喘豚鼠肺组织内SPmRNA表达较正常组显著增高 ,反复诱喘豚鼠SPmRNA表达显著高于诱喘一次的豚鼠 (P <0 .0 1)。结论：哮喘患儿及哮喘豚鼠SP含量增加 ,哮喘豚鼠肺组织中SPmRNA的表达明显上调 ,均与病情呈显著正相关。SP与小儿哮喘关系密切 ,可能参与了小儿哮喘的发病机制     

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目的了解临床医生对儿童哮喘防治的情况。方法首都儿科研究所哮喘中心于2002～2003年,对参加全国儿童哮喘学术会议和山西、广东、福建等地哮喘学术报告会的临床儿科医生,于哮喘会议前或者学术报告会前统一发放哮喘防治推广情况问卷调查表,当时填写完即刻收卷,共收回有效问卷290份(人)。结果253人(87.2%)听说过全球哮喘防治创议(GINA),178人(61.4%)已经执行该方案;272人(93.8%)能够正确认识到哮喘的主要病理基础;峰流速仪的使用率为63.1%(183/290);208人(71.7%)认为中度以上持续哮喘最重要的治疗是联合吸入激素,医生选择联合吸入激素治疗的比例为93.4%(271/290);174人(60%)选择应用局部激素治疗变应性鼻炎。结论各级临床医师对哮喘基础知识、临床用药、GINA方案的应用、峰流速仪及气雾剂的掌握情况均较6年前有明显改善。今后哮喘防治工作应该继续推广GINA,将该方案从大、中城市扩大到小城市、乡村卫生机构等医疗单位。     

鼻病毒感染与儿童哮喘

病毒感染可引起各年龄段的喘息与哮喘发作。在儿童时期,喘息性疾病常由病毒感染所致,而反复喘息与儿童哮喘有着密切关联。近些年有证据表明鼻病毒与儿童哮喘关系密切。该文简要介绍鼻病毒感染在喘息儿童中的年龄分布、流行季节及易患因素,同时对鼻病毒与喘息的关系、临床实验室检查及相关治疗现状作一综述。     

Antidepressant use in children and adolescents: Practice touch points to guide paediatricians

Depression in children and youth is common, and requires an understanding of its developmental character and associated comorbid conditions. Initial treatment of mild depression involves active supportive measures with a focus on symptom reduction and improved daily function. Where pharmacotherapy is warranted, evidence supports the use of selective serotonin reuptake inhibitor (SSRI) antidepressants, particularly fluoxetine, to manage moderate/severe depression. SSRI treatment should include a comprehensive management plan in the context of interdisciplinary care, an understanding of its pharmacology and clearly articulated goals for symptom reduction, functional status tracking (school, home and peers) and monitoring for the emergence of suicidal ideation/behaviour. For children with more severe symptoms or complicating factors (comorbid conditions), referral to mental health clinicians should be considered. Use of an SSRI should be associated with family/patient education about medication effects, specific social and health goals that promote self-esteem, improved function and close monitoring for adverse effects.     

儿童支气管哮喘相关死亡的现状与危险因素

支气管哮喘(简称哮喘)是最常见的儿童呼吸系统慢性疾病。随着吸入性糖皮质激素使用的增加,全球哮喘死亡下降了近2/3。在世界范围内,儿童哮喘死亡率非常低,为0～0.7/10万,但大多数的死亡仍存在可能避免的危险因素。哮喘死亡的危险因素包括哮喘控制不良、治疗依从性差、医师处方的药量不足、肺功能监测不足、精神心理问题以及存在有...     

Quality of life in children with undiagnosed and diagnosed asthma

This study describes the impact of undiagnosed and diagnosed asthma on quality of life in schoolchildren aged 7–10 years and their caregivers in a cross-sectional community-based study. Diagnosed asthma was defined as the parents’ confirmation of a physician’s diagnosis of asthma. Undiagnosed asthma was defined by asthma symptoms combined with airway reversibility or bronchial hyperresponsiveness. Quality of life was evaluated in all children with asthma and a sample of healthy controls by the Pediatric Asthma Quality of Life Questionnaire, and by the Paediatric Asthma Caregiver’s Quality of Life Questionnaire. We studied the impact of breathing problems on school absence. Compared with healthy controls, quality of life scores among children and their caregivers were lower if the child had asthma (P < 0.05), with lowest scores in diagnosed asthma (P < 0.05 compared with undiagnosed asthma). Children with asthma reported more school absence (P < 0.05), with highest absence rate in those with diagnosed asthma. In conclusion, both undiagnosed and diagnosed asthma have a significant impact on the quality of life of both children and their caregivers.     

Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians

WHO estimated that of 9.4 million cases of tuberculosis (TB) worldwide in 2008, 440,000 (3.6%) had multidrug-resistant (MDR)-TB. Childhood TB is estimated at 10-15% of the total burden, but little is known about the burden of MDR-TB in children. Children in close contact with MDR-TB cases are likely to become infected with the same resistant strains and are vulnerable to develop disease. Although MDR-TB is a microbiological diagnosis, children should be treated empirically according to the drug susceptibility result of the likely source case, as often cultures cannot be obtained from the child. MDR-TB treatment in children is guided by the same principles, using the same second-line drugs as in adults, with careful monitoring for adverse effects. Co-infection with HIV poses particular challenges and requires early initiation of antiretroviral therapy. Preventive therapy for high-risk MDR-TB contacts is necessary, but no consensus guidance exists on how best to manage these cases. Pragmatic and effective Infection control measures are essential to limit the spread of MDR-TB.     

支气管哮喘患儿尿白三烯E4 的测定及其临床意义

目的　探讨支气管哮喘患儿尿白三烯E4(LTE4)测定的临床意义。方法　采用竞争性酶联免疫吸附试验技术检测 2 8例哮喘患儿急性发作期和非急性发作期的尿LTE4水平 ,并与健康组儿童相比较 ;同时对哮喘患儿的尿LTE4与第 1秒用力呼气容积 (FEV1)及外周血嗜酸性粒细胞计数 (EC)进行相关性分析。结果　哮喘患儿非急性发作期尿LTE4比急性发作期明显下降 (P <0 0 1) ,但两期均明显高于健康组儿童 (均P <0 0 1)。急性发作期尿LTE4和FEV1呈负相关 (r =- 0 6 15 ,P <0 0 1) ,和EC无相关性 (r =0 16 3,P >0 0 5 )。结论　动态检测支气管哮喘患儿尿中LTE4水平 ,可能为将来的临床诊断和治疗提供有意义的参考指标。     

Chronic night cough and asthma severity in children with stable asthma

The relationship between night cough and other indices of asthma severity was studied in 21 children with clinically stable asthma and persistent night cough. Overnight cough was quantified and related to symptom scores, oxygen saturation (S_aO₂) during sleep, evening and morning peak flow recordings and daytime tests of lung function. In the index group the median number of coughing episodes was 23 (range 1–158). Only 4 children had counts of <10 overnight, similar to the comparison group of 12 children all of whom had counts of <10. There was a trend towards the association of overnight cough with reduced evening peak flow (r=–0.407,P=0.07) and reduced S_aO₂ (r=–0.36,P=0.10). Abnormalities in daytime tests of lung function were observed in 13 children. There was no relationship between night cough and daytime indices of lung function abnormality although children with more severe daytime abnormalities also had significant night cough. Conversely, five children with chronic night cough had normal daytime function.Conclusion Night-time cough in children with asthma is not simply a reflection of daytime lung function status, whereas, overnight S_aO₂ correlates well. Other factors need to be explored to explain the variability of night-time cough in these children.