Community-acquired methicillin-resistant Staphylococcus aureus colonization in healthy children attending an outpatient pediatric clinic.

BACKGROUND: We previously showed that children attending an inner city pediatric emergency department were sometimes asymptomatically colonized with clindamycin-susceptible community-acquired methicillin-resistant Staphylococcus aureus (MRSA) and borderline methicillin-resistant S. aureus (BRSA) as well. We wished to ascertain whether healthy children attending an outpatient clinic were colonized with these organisms. Therefore to estimate the prevalence of community-acquired MRSA and BRSA nasal colonization in a well child population, we cultured children attending an inner city pediatric outpatient clinic. STUDY DESIGN: This was a prospective cross-sectional study conducted from January to August, 1999, at a primary care outpatient facility at the University of Chicago. The target population was 500 healthy children < or = 16 years of age who attended this facility to receive well child care. RESULTS: One hundred twenty-two (24.4%) children were colonized with S. aureus. Three of the 122 (2.5%) S. aureus isolates were MRSA; they came from children who lacked predisposing risk factors and were susceptible to clindamycin, gentamicin, trimethoprim-sulfamethoxazole, rifampin and ciprofloxacin. Two (1.6%) additional S. aureus isolates were BRSA; both children had predisposing risk factors for MRSA colonization. The mecA gene was present in the 3 MRSA isolates and absent in both BRSA isolates. CONCLUSIONS: These data document that a reservoir of asymptomatic MRSA colonization exists among healthy children who lack traditional risk factors for MRSA infections.     

Parent satisfaction in a nurse led clinic compared with a paediatric gastroenterology clinic for the management of intractable, functional constipation.

AIMS: To assess parent satisfaction with a nurse led clinic for children with intractable, functional constipation compared with a paediatric gastroenterology outpatient clinic. METHODS: A validated questionnaire covering six separate domains in 48 statements (provision of information, empathy with the patient, technical quality and competence, attitude towards the patient, access to and continuity with the caregiver, and overall satisfaction) was employed. For all outcomes, the data were analysed on an intention-to-treat basis. RESULTS: 90/107 (84%) questionnaires were returned: 40/51 (78%) from the paediatric gastroenterology clinic and 50/56 (89%) from the nurse led clinic. Results indicated a high "total" satisfaction with the clinical care, but these were statistically significantly higher in the nurse led clinic compared with the paediatric gastroenterology clinic (median score 8.7 and 7.3 respectively, out of a maximum score of 10). This difference was consistent across all domains when the scores from those attending the nurse led clinic were compared with those attending the paediatric gastroenterology clinic (information median score 8.7 v 7.5; empathy 9.0 v 7.3; competence 9.1 v 8.0; attitude 8.7 v 7.3; access 8.2 v 6.7). All comparisons were highly statistically significant. CONCLUSION: These results provide firm evidence that parents of children with intractable constipation are satisfied with the care they receive in both the paediatric and nursing clinic setting. Parent satisfaction, however, was significantly higher in those attending the nurse led clinic. This study adds further support to the development of a nurse led service to manage intractable, functional constipation in children.     

Use of complementary and alternative therapies and probiotic agents by children attending gastroenterology outpatient clinics

OBJECTIVES: Complementary and alternative medicines (CAM) and probiotic therapies appear to be increasingly accepted and used. This questionnaire-based study aimed to ascertain the frequency of use and the acceptance of these therapies by children attending outpatient gastroenterology clinics. METHODS: Parents accompanying children to their appointments were asked to complete a questionnaire in order to determine usage of probiotic and alternative therapies. Questions also ascertained relevant background information and parental acceptance of alternative therapies. RESULTS: Ninety-two questionnaires were completed. The ages of the children varied from 6 months to 16 years (mean +/- SD; 6.5 +/- 4.3 years) and they had been prescribed an average of 1.7 +/- 1.3 (range 0-6) conventional medications. Thirty-three children (35.9%) were taking CAM and 98.6% of parents answered that they would be prepared to administer CAM to their child. Symptomatic improvements were attributed to CAM by the parents of 24 out of 33 children given these therapies. In addition, probiotic therapies were utilized by 23.8% of children, and 93.0% of parents would administer probiotic agents if recommended for their child's condition. CONCLUSION: Complementary and alternative medicines and probiotic therapies are used frequently by children attending gastroenterology clinics and are accepted widely by their parents.     

Overweight in children and its perception by parents: cross-sectional observation in a general pediatric outpatient clinic

Background

Childhood overweight is a growing problem in industrialized countries. Parents play a major role in the development and the treatment of overweight in their children. A key factor here is the perception of their child’s weight status. As we know of other studies, parental perception of children’s weight status is very poor. This study aimed to determine factors associated with childhood overweight and parental misperception of weight status. The height and weight of children, as reported by parents were compared with measured data.

Methods

The study was conducted at a general pediatric outpatient clinic in Vienna, Austria. A total of 600 children (aged 0–14 years) participated in the study. Collection of data was performed by means of a questionnaire comprising items relating to parental weight and social demographics. The parents were also asked to indicate their children’s weight and height, as well as the estimated weight status. Children were weighed and measured and BMI was calculated, allowing a comparison of estimated values and weight categories with the measured data.

Results

Parental BMI, parental weight and a higher birth weight were identified as factors associated with childhood overweight. No association with the parents’ educational status or citizenship could be proven. We compared parents’ estimations of weight and height of their children with measured data. Here we found, that parental estimated values often differ from measured data. Using only parental estimated data to define weight status leads to misclassifications. It could be seen that parents of overweight children tend to underestimate the weight status of their children, compared to parents of children with normal weight.

Conclusions

Pediatricians should bear in mind that parental assessment often differs from the measured weight of their children. Hence children should be weighed and measured regularly to prevent them from becoming overweight. This is of particular importance in children with higher birth weight and children of overweight parents.

Trial registration

Study was not registered. The study was approved by the Ethic committee of the city of Vienna. (EK 13–146-VK).

     

Evaluation of voiding dysfunctions in children with chronic functional constipation

There are controversial results about the role of dysfunctional bowel emptying in disorders of the urinary tract like urinary tract infection (UTI), vesicoureteral reflux (VUR) and enuresis. Constipation may cause UTI, enuresis and VUR due to the uninhibited bladder contraction. The aim of this study was to investigate the frequency of nocturnal enuresis, UTI and instability symptoms in chronic functional constipation (CFC). This study included 38 children with CFC and 31 children as the control group. Detailed past and present history of UTIs or symptoms pointing to this diagnosis, enuresis, encopresis, urgency and urge incontinence was obtained from both groups as well as the family history of UTI. Urinalysis, urine culture and stool parasite analysis as well as abdominal ultrasonography were performed on both groups. Age range of the children with CFC was 6-192 months (mean +/- standard deviation (SD) 63.5 +/- 51 months); that of the control group was 4-180 months (mean +/- SD 82 +/- 46.2 months). Frequency of UTI and urgency was significantly higher in the CFC group. However, frequencies of urge incontinence, nocturnal enuresis, and genitourinary abnormalities were not different between the two groups. In conclusion, risk of UTI and urgency is increased in CFC, but that of other voiding dysfunctions like urge incontinence do not change significantly. Therefore, we suggest that UTI and urgency should be questioned in children with CFC and vice versa.     

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便秘(constipation)是指以大便干燥、排便困难,排便时间间隔久或虽有便意而排不出大便等一系列症状为临床表现的疾病,是儿童时期的常见病与多发病,影响儿童生活质量,给儿童及家长带来痛苦。了解便秘的临床特点及诊治流程,对于合理及有效地治疗便秘有重要的意义。1便秘的流行病学及临床特点1.1便秘的流行病学儿童便秘的发病率高,其中90%～95%为功能性便秘(FC)。由于仅有一小部分患儿会因便秘问题就诊,且诊断标准又多有不同,导致很多对便秘发     

Painful defecation and chronic functional constipation in children: Diagnosis and treatment

AIM: The aim of this study was to report our results on the treatment of chronic constipation associated with pain during defecation. METHODS: From January 1999 to January 2004, 60 patients (25 females, 35 males; age range, 6 months to 12 years) who met the ROMA II diagnostic criteria for chronic functional constipation associated with pain on defecation were enrolled in the study. All subjects underwent anorectal manometry to determine rectosphincter inhibitory reflex function. A retraining program for daily defecation, a diet high in fiber and lactulose, and local administration of prilocaine/lidocaine were instituted. At rectal anal endosonography, 7 drug-treatment-resistant patients presented with increased thickness of the internal anal sphincter and received botulin toxin A injection at the sphincter. Because symptoms persisted in 2 of these patients, they received a sphincterectomy. RESULTS: At the end of treatment, 40 (71.4%) of the 56 patients who completed the study had a daily bowel movement without pain; 9 experienced a relapse; in the 2 surgical patients the alveus returned to normal function at 2 and 6 weeks, respectively. CONCLUSIONS: Our treatment strategy breaks the vicious circle of spasm-pain-spasm with use of prolonged analgesic treatment and feces softener over the course of the day. In treatment-resistant patients with functioning rectosphincter reflexes and thickened internal anal sphincter, administration of botulin toxin A may be a valuable aid in place of standard sphincterectomy.     

Characteristics of chronic non-specific musculoskeletal pain in children and adolescents attending a rheumatology outpatients clinic: a cross-sectional study

Background  

Chronic non-specific musculoskeletal pain (CNSMSP) may develop in childhood and adolescence, leading to disability and reduced quality of life that continues into adulthood. The purpose of the study was to build a biopsychosocial profile of children and adolescents with CNSMSP.     

小麦纤维素治疗儿童功能性便秘的疗效观察

目的：研究小麦纤维素治疗儿童功能性便秘的有效性和安全性。方法：采用前瞻性自身对照研究方法,对34例功能性便秘的患儿给予小麦纤维素治疗2周,观察治疗前后便秘症状及粪便性状改善情况,并进行量化评分比较。结果：治疗后3 d、7 d和14 d,粪便性状、排便间隔、排便困难积分均明显下降;便秘症状总积分也明显下降,与治疗前比较差异有统计学意义（P<0.05）。治疗后3、7、14 d总有效率分别为37%、87%和90%。医生非常满意和比较满意率为57%,患儿家长非常满意和比较满意率为63%。服用小麦纤维素期间无不良反应发生。结论：小麦纤维素治疗儿童功能性便秘疗效确切,安全性好。     

生物反馈治疗小儿功能性便秘的疗效研究

目的 评价生物反馈治疗盆底肌协调障碍引起的小儿功能性便秘的疗效.方法 对47例肛门直肠动力检查提示盆底肌协调障碍的功能性便秘患儿进行生物反馈治疗,每周2次,对完成3次及以上生物反馈治疗者进行了疗效分析.结果 共有27例患儿完成至少3次生物反馈治疗,其中男20例,女7例,年龄4～12岁[(6.7±2.2)岁],病程6个月～8年[(3.0±2.3)年].共完成5次生物反馈治疗者有16例,完成7次生物反馈治疗者8例.随着生物反馈治疗次数增加,直肠最大排便压力(mm Hg,1 mm Hg=0.133 kPa)增高,治疗前和治疗3、5、7次后依次为36.2±10.4,45.1±9.5,47.6±9.1,47.8±8.8(P<0.01),而肛门外括约肌肌电值逐渐下降,但差异无统计学意义.治疗后通过电话随访3个月至1年,根据排便症状改善情况进行疗效评定.27例患儿中治愈13例,显效8例,有效3例,无效2例,失访1例,总有效率88.9%(24/27).结论 生物反馈疗法可提高最大排便压力,能有效地治疗盆底肌协调障碍引起的儿童功能性便秘.