A qualitative study of clinical reasoning in physiotherapy with preterm infants and their parents: Action and interaction

Background: Physiotherapists (PTs) in primary health care provide services to preterm infants and their parents after hospital discharge. The service should be collaborative and individualized to meet the family’s needs. In this study, we analyze pediatric PTs’ collaborative work in the clinical setting and investigate the PTs’ emerging clinical reasoning (CR) in interaction with the infant and parent(s).

Methods: The study is based on observations of 20 physical therapy sessions and 20 interviews with PTs. We performed a systematic content analysis informed by enactive theory regarding the interactions and co-creation of meaning.

Results and Discussion: CR emerged in reciprocity with the PTs’ interaction with the infant and parent(s). Based on the sensitivity to the infant’s motor abilities and signs of engagement as well as the parents’ need of support and education, the PTs individualized and reasoned about their therapeutic approach. This interactional CR was vulnerable: infant disengagement, parent expectations, and PT preoccupations could obfuscate interactions and hamper CR.

Conclusion: Through mutuality and engagement with the infant and parent(s), the PTs allow the autonomy of interaction to emerge and shape the translation of CR into successful therapeutic actions and learning together with the infant and parent(s).     

Primary Child Health Care Nurses' assessment of health risks in children of foreign origin and their parents – a theoretical model

Background:  According to recent studies, intercultural interaction in health care between clients and care-givers seems to be problematic. A recent Swedish study revealed that a majority of Primary Child Health Care Nurses (PCHNurses) experienced difficulties in their interaction with children and parents of foreign origin. As every third child in the Primary Child Heath Care (PCHC) services is of foreign origin it seem to be of utmost importance to examine in depth how these difficulties could be understood and explained.
Aim:  The present study aimed at a theoretical explanation of the core problem concerning PCHNurses' interaction with children and parents of foreign origin, as experienced by the PCHNurses.
Methods:  Fifteen PCHNurses working in the PCHC services were interviewed. Grounded Theory was used as research methodology because focus is on social interactions and the aim is to theoretically explain unarticulated social processes.
Results:  Anxiety about missing children, exposed to risks of ill-health, due to various conditions in the child's home environment, turned out to be the PCHNurses' main concern. An assessment of health risks was initiated, when PCHNurses thought that psychosocial conditions in the child's environment might cause ill health. Some of the psychosocial conditions were difficult to assess, as they were unfamiliar and not understood by the PCHNurses. In such difficult-to-assess cases, when the PCHNurses considered the possibility of undefined risk to the child's health they held on to the assessment of the cases and worked out strategies to learn and understand more about the child and the child's home environment. A theoretical model grounded in data was created accounting for the variation in the assessment process and the different strategies used. Implications are discussed and recommendations for improvements are given.     

Social modulation of facial pain display in high-catastrophizing children: an observational study in schoolchildren and their parents

The present study examined existing communal and operant accounts of children’s pain behavior by looking at the impact of parental presence and parental attention upon children’s pain expression as a function of child pain catastrophizing. Participants were 38 school children and 1 of their parents. Children completed a cold pressor pain task (CPT) twice, first when told that no one was observing (alone condition) and subsequently when told that they were being observed by their parent (parent-present condition). A 3-minute parent-child interaction occurred between the 2 CPT immersions, allowing measurement of parental attention to their child’s pain (ie, parental pain-attending talk vs non-pain-attending talk). Findings showed that child pain catastrophizing moderated the impact of parental presence upon facial displays of pain. Specifically, low-catastrophizing children expressed more pain in the presence of their parent, whereas high-catastrophizing children showed equally pronounced pain expression when alone or in the presence of a parent. Furthermore, children’s catastrophizing moderated the impact of parental attention upon facial displays and self-reports of pain; higher levels of parental nonpain talk were associated with increased facial expression and self-reports of pain among high-catastrophizing children; for low-catastrophizing children, facial and self-report of pain was independent of parental attention to pain. The findings are discussed in terms of possible mechanisms that may drive and maintain pain expression in high-catastrophizing children, as well as potential limitations of traditional theories in explaining pediatric pain expression.     

血管迷走性晕厥儿童心率变异性的年龄和性别差异

目的探讨血管迷走性晕厥(VVS)儿童心率变异性(HRV)的年龄和性别差异。方法2003—01～2007—05在中南大学湘雅二医院晕厥专科诊治的不明原因晕厥(UPS)儿童54例(晕厥组),其中<12岁儿童22例,直立倾斜试验(HUTF)全部为阳性反应。匹配48例健康儿童为对照(对照组)。晕厥组和对照组儿童均行24 h动态心电图(Holter)检查,数据经TLC3000A 12通道动态心电图分析系统自动分析结合人工干预生成HRV时域指标和频域指标。结果①晕厥儿童HRV性别比较:与男性儿童相比,女性儿童各项时域指标和频域指标均偏低,其中时域指标总体标准差(SDNN)、均值标准差(sDANN)和频域指标总功率(TP)、低频功率(LF)、极低频功率(VLF)降低显著(P<0.01或P<0.05)。②健康儿童HRV性别比较:女性儿童时域指标SDNN、差值均方根(rMSSD)、差值>50 ms的百分比(pNN50)和频域指标TP、VLF、LF低于男性儿童,其中差异有统计学意义的是频域指标VLF(P<0.01)和LF(P<0.05)。③晕厥儿童HRV年龄比较:与≥12岁儿童相比,<12岁儿童时域指标SDNN、SDANN、pNN50和频域指标TP、LF稍降低(均P>0.05)。④健康儿童HRV年龄比较:与≥12岁儿童相比,<12岁儿童时域指标rMSSD、pNN50和频域指标LF、高频功率(HF)偏高,其中差异有统计学意义的是HF(P<0.05),其余指标稍偏低(均P>0.05)。结论VVS儿童自主神经功能异常,其自主神经变化规律的年龄和性别差异与健康儿童不同。     

Lived experiences with unmet supportive care needs in pediatric cancer: Perspective of Chinese children and their parents

ObjectiveUnmet supportive care needs(SCNs) impact pediatric cancer patients and their parents. This study aimed to explore the unmet SCNs from the perspective of Chinese children with cancer and their parents through lived experiences.MethodsThe data of this study was collected using face-to-face semi-structured interviews. The participants were recruited from the oncology units of three children’s hospitals in China’s cities (Shanghai, Guangzhou, and Hefei) from October 2020 to December 2021. Data were analyzed using Colaizzi’s seven-step phenomenological analysis method.ResultsEight pediatric cancer patients and twenty-four parents were enrolled in the study. Four main themes and eight subthemes (both children’s and parent’s perspectives) were generated: 1) meeting the ongoing needs along the cancer trajectory (can you tell me what comes next; our needs are growing); 2) communicating with a family focus (they only talk to my parents; let each family member have a voice); 3) providing care beyond the treatment (I am bigger than my body [the children’s needs for emotional consolidation and information about their prognosis]; there are things beyond treatment); 4) getting support from the community (I am not a monster [the children were unhappy about being treated differently]; we want to connect with the resources near us).ConclusionThis study revealed multiple unmet SCNs from the perspective of Chinese children with cancer and their parents. The findings call for comprehensive and in-depth supportive care beyond treatment, integration of the family member voice in pediatric cancer care, and a coordinated pediatric cancer support mechanism in the Chinese healthcare system.     

Parental perceptions of barriers to physical activity in children with developmental disabilities living in Trinidad and Tobago

Abstract

Background: Parents have a strong influence on their child’s engagement in physical activities, especially for children with developmental disabilities, as these children are less likely to initiate physical activity. Knowledge is limited regarding parents’ perceptions of this phenomenon in low- and middle-income countries (LMICs); yet many rehabilitation providers work with children with developmental disabilities and their parents in these contexts. Purpose: The aim of this study was to explore the barriers perceived by parents of children with developmental disabilities to their children’s engagement in physical activity. Methods: An occupational perspective was used to explore how parents speak about barriers to their child’s engagement in physical activity. Interviews were conducted with nine parents in Port-of-Spain, Trinidad and Tobago. Findings: Parent’s perceived barriers were categorized into four themes: family priorities, not an option in our environment, need to match the activity to the child’s ability, and need for specialized supports. Conclusions: Findings provide opportunities for future rehabilitation and community programming in LMICs.

• Implications for Rehabilitation

• Children living with a developmental disability may engage more in solitary and sedentary pursuits as a result of parents choosing activities that do not present extensive social and physical demands for their child.

• Therapists can play an important role in providing knowledge to parents of appropriate physical activity and the benefits of physical activity for children with developmental disabilities in order to promote children’s participation.

• In environments where there is limited social support for families, therapists need to consider and be particularly supportive of parental priorities and schedules.

     

经外周静脉穿刺中心静脉置管与植入式静脉输液港在化疗患者中应用效果的系统评价

目的 系统评价经外周静脉穿刺中心静脉置管(peripherally inserted central catheter,PICC)与植入式静脉输液港(venous port access,VPA)两种中心静脉置管方式在化疗患者治疗中应用的差异。方法 全面检索Cochrane、JBI、PubMed、EMBASE、CINAHL、CBM、维普等数据库,收集所有讨论PICC与VPA对化疗患者应用效果的随机对照试验(randomized controlled trial,RCT)、受控的临床试验(controlled clinical trial,CCT)和队列研究,按照JBI文献评价标准对文献进行质量评价,使用RevMan 5.3进行Meta分析或描述性分析。结果 共纳入13篇文献。研究结果显示PICC导管留置时间低于VPA(RR:9.06,95%CI:5.82~14.09);PICC一次性置管成功率高于VPA,但其差别无统计学意义(RR:0.97,95%CI:0.92~1.03),P0.05;PICC并发症发生率大于VPA(RR:0.30,95%CI:0.22~0.41),P0.05;描述性分析显示VPA组生活质量优于PICC组,且留置时间大于1年时,VPA的总费用低于PICC。结论 VPA与PICC相比,并发症发生率低,留置时间长,患者生活质量高,且维护成本相对较低。但由于高质量文献较少,仍需进一步论证研究。     

Parameters of oxidative stress status in healthy subjects: their correlations and stability after sample collection

It has been proposed that sample storage may have some influence on the parameters of oxidative stress status (OSS) in biological fluids. We measured four important OSS parameters in plasma of 23 healthy subjects and repeated the measurements in the same samples kept at -70 degrees C after different time intervals. Hydroperoxides and total antioxidant capacity (TAC) were determined by ferrous ion oxidation in presence of xylenol orange (FOX) and ferric reducing antioxidant power (FRAP) assays, respectively. Sulfhydryls and carbonyls were measured spectrophotometrically. In fresh samples, OSS seemed to increase with age and relatively good correlations were found among different parameters. The mean values of hydroperoxides (6.08 microM), TAC (0.334 mM Trolox equivalent), and sulfhydryls (0.562 mM) in fresh samples did not show any significant change after 1, 7, and 30 days of storage. Mean carbonyl concentration determined after 1 day storage (2.0 nmol/mg protein) did not change after 30 days. However, extents of changes in hydroperoxide concentrations varied considerably from one individual to another, even after 1 day. A similar phenomenon was observed in TAC, but after 7 days. We suggest measuring hydroperoxides in fresh samples and TAC maximally after 1 week. Sulfhydryls and carbonyls showed more stability and can be measured at least 1 month after sample collection.     

癫痫儿童T细胞免疫功能与其发病因素的相关性分析

目的 探讨癫痫儿童的T细胞免疫功能与其发病因素的相关性.方法 对符合诊断标准的152例癫痫儿童分别于服药前、服药后检查T细胞免疫功能和血药浓度并与健康对照组进行比较.结果 服药前、服药后癫痫儿童的CD4、CD8、CD19、CD16 56 、CD4/CD8、NK细胞的比例与健康对照组比较差异有统计学意义(P＜0.05);癫痫儿童服药前、服药后T细胞免疫功能比较,无统计学意义(P＞0.05).结论 癫痫儿童存在T细胞免疫功能异常,免疫功能失衡可能参与了儿童癫痫的发病.     

颅脑外伤患儿家属的生活变化单位与家属心理状态关系的研究

[目的]探讨颅脑外伤患儿家属的生活变化单位与家属心理状态关系,为向患儿家属进行有效护理干预提供依据。[方法]应用霍尔姆斯和雷赫的社会再适应评定量表和症状自评量表(SCL-90)调查335名颅脑外伤患儿家属的生活变化单位(LCU)得分和心理状态。[结果]颅脑外伤患儿家属LCU得分高于平诊患儿家属LCU得分(对照组);患儿家属的SCL-90各因中人际关系、抑郁、焦虑3个因子分值高于国内常模;患儿LCU得分高,SCL-90总分也高。[结论]小儿颅脑外伤是一种严重的突发不可控制事件,护士应了解患儿家属家庭状况及家属心理状态,有针对性地对家属进行健康教育和心理干预,提高家庭应激支持水平。     

Cervical erector spinae and upper trapezius muscle activity in children using different information technologies

Objectives

Researchers investigating the effects of computer use and the development of musculoskeletal disorders have mainly focused on the effects of prolonged muscle loading associated with postures assumed during computer use in the adult population. The objective of this study was to investigate the effects of different forms of old and new information technology (IT) on muscle activity levels in a paediatric population.

Design

A 3 × 3 × 2 mixed model design was used for this study.

Participants

Thirty-two schoolchildren aged 4-17 years participated in this study.

Outcome measures

Surface electromyography (EMG) data were collected from the left and right cervical erector spinae and upper trapezius muscles. Participants performed a 5-minutes reading task using the three IT types (book, laptop and desktop computer).

Results

Cervical erector spinae and upper trapezius muscle activity levels were significantly higher when children used the laptop set-up (P < 0.001). The lowest muscle activity levels were found when children used the desktop set-up. Cervical erector spinae and upper trapezius muscle activities were found to be higher on the left side in the book set-up compared with higher right muscle activity levels in the computer set-ups (P = 0.047 and <0.001, respectively).

Conclusions

The three IT types had different effects on cervical erector spinae and upper trapezius muscle activity, suggesting varying risks associated with different IT types. Activity levels were often above 5% maximum EMG (MEMG). As adult studies have linked activity levels greater than 5%MEMG with the development of musculoskeletal disorders, it seems that children are potentially at risk of replicating these adverse health reactions associated with adult IT use.     

小儿扩张型心肌病同步12导联心电图P QRS T波综合振幅及ST段变化

目的探讨小儿扩张型心肌病（DCM）与同步12导联心电图P、QRS、T波综合振幅及ST段变化的关系。方法52例DCM患儿（研究组），选择匹配健康儿童52例为对照（对照组）。受检对象用广东中山SR—1000A心电自动分析仪描记同步12导联体表心电图，计算机回放，选择清晰波形自动分析合并人工干预，测量各导联P、QRS、T波振幅及ST段振幅。结果与对照组比较，研究组RavL振幅、RⅠ＋SⅢ振幅、Rv1＋Sv5振幅显著增大（P〈0．01），RavF振幅增大（P〈0．05），总P振幅（∑P振幅）、总QRS振幅（∑QRS振幅）显著增加（P〈0．01），总T振幅（∑T振幅）显著降低（P〈0．01）。Ⅰ、Ⅱ、aVF、V1、V4、Vs、V6导联ST段下移（P〈0．05或〈0．01），T波振幅除Ⅲ、V3导联增高外其他导联均降低（P〈0．01）。结论同步12导联心电图P、QRS、T波综合振幅及ST段变化能客观评价小儿DCM心脏扩大及心肌缺血，具有较好的临床诊断效果。     

直立不耐受儿童直立倾斜试验的性别和年龄差异

目的 探讨直立不耐受(OI)儿童直立倾斜试验(HUTT)的性别和年龄差异.方法 2004-01～2009-06在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的具有不明原因晕厥、头晕、胸闷、胸痛或心悸等OI症状的儿童728例,年龄3～17 岁[平均(10.67±2.85)岁],男388例,女340例.其中＜12岁416例,年龄3～11岁[平均(8.69±1.86)岁];≥12岁312例,年龄12～17岁[平均(13.30±1.50)岁].经详细询问病史、体格检查、心脏X线、超声心动图、常规12导联心电图、脑电图、头颅CT、血液生化(空腹血糖、心肌肌钙蛋白I)等排除器质性心脏病及其他疾病后行HUTT检查.结果 ①HUTT阳性率:60.71%(442/728),女性高于男性(P<0.01);≥12岁组高于＜12岁组(P<0.01).HUTT阳性率在＜12岁组男性低于女性(P<0.05),≥12岁组男性与女性比较差异无统计学意义(P＞0.05),≥12岁组男性及女性分别高于＜12岁组男性及女性(P均<0.01).②HUTT类型:以血管迷走性晕厥(VVS)多见(59.95%,265/442),其次为体位性心动过速综合征(POTS,37.56%,166/442)及体位性低血压(OH,2.49%,11/442).HUTT类型分布在男性与女性之间及＜12岁组与≥12岁组之间比较差异均无统计学意义(P均＞0.05).HUTT类型分布在男性及女性＜12岁组与≥12岁组之间比较差异无统计学意义(P均＞0.05).HUTT类型分布在＜12岁组及≥12岁组男性与女性之间比较差异无统计学意义(P均＞0.05).结论 具有不明原因晕厥、头晕、胸闷、胸痛或心悸等OI症状的儿童HUTT阳性率存在性别和年龄差异,但HUTT类型分布未见明显的性别和年龄差异.