Terminal care of the child with cancer at home

One hundred paediatric patients with either leukaemia (36%), solid tumours (34%) or brain tumours (30%), treated at the Children's Hospital, University of Helsinki, Finland, died during 1987–92; 70 of them died while in organized terminal care. They were treated at home (60%), in hospital (29%), and partly at both (11%). One or both parents stayed at home to take care of their child. Personnel of the oncologic ward coordinated home care. The purpose of this study was to evaluate the advantages and disadvantages of a terminal care program, with special reference to terminal care at home. Evaluation included retrospective analysis of patients' records, as well as a structured interview with the two parents separately. The quality of life of the children during the terminal period was greatly influenced by their happiness at being at home. Relief of symptoms, particularly pain, was in most instances adequate. Most parents had no complaints to make afterwards. Only some of them complained of having received too little information, too little supervision and support, and insufficient preparation for the death of the child. Thus, the system of terminal care at home proved satisfactory for the child and the whole family in many different respects. For successful home care, the parents need continuous supervision, help and support by well-trained personnel.     

Associations between screen time and cognitive development in preschoolers

ObjectivesTo examine the cross-sectional associations between screen time and cognitive development in preschoolers.MethodsParticipants were 97 preschoolers (36 to 60 months) in Alberta and Ontario, Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. The time that children spent watching television, videos or DVDs (television time) or playing video or computer games (video game time) on a television, computer, or portable device was assessed using a parental questionnaire. Television time and video game time were summed to calculate total screen time. Adherence to the screen time recommendation (≤1 hour/day) of the Canadian 24-Hour Movement Guidelines was calculated. Expressive vocabulary and working memory were assessed using the Early Years Toolbox. Due to the distribution of working memory, it was categorized as a binary variable based on the median score. The associations between screen time and cognitive development were examined using mixed models (expressive vocabulary) or generalized mixed models (working memory).ResultsScreen time was not associated with expressive vocabulary. Preschoolers who had higher total screen time were less likely to have better working memory (OR=0.52; 95%CI:0.31, 0.88), despite the null associations for television time (P=0.155) and video game time (P=0.079). Preschoolers who met the screen time recommendation were more likely to have higher working memory capacity (OR=3.48; 95%CI:1.06, 11.47), compared to those who did not meet the recommendation.ConclusionLimiting total screen time to no more than one hour per day may facilitate working memory development in preschoolers. Screen time may be unrelated to expressive language development in this age group.     

Television viewing, computer use and total screen time in Canadian youth

BACKGROUND

Research has linked excessive television viewing and computer use in children and adolescents to a variety of health and social problems. Current recommendations are that screen time in children and adolescents should be limited to no more than 2 h per day.

OBJECTIVE

To determine the percentage of Canadian youth meeting the screen time guideline recommendations.

METHODS

The representative study sample consisted of 6942 Canadian youth in grades 6 to 10 who participated in the 2001/2002 World Health Organization Health Behaviour in School-Aged Children survey.

RESULTS

Only 41% of girls and 34% of boys in grades 6 to 10 watched 2 h or less of television per day. Once the time of leisure computer use was included and total daily screen time was examined, only 18% of girls and 14% of boys met the guidelines. The prevalence of those meeting the screen time guidelines was higher in girls than boys.

CONCLUSION

Fewer than 20% of Canadian youth in grades 6 to 10 met the total screen time guidelines, suggesting that increased public health interventions are needed to reduce the number of leisure time hours that Canadian youth spend watching television and using the computer.     

Effects of the home environment on unintentional domestic injuries and related health care attendance in infants

AIMS: To examine the effects of the home environment on unintentional domestic injuries and related health care attendance in infants from deprived families. METHODS: Ten mechanisms that caused unintentional domestic injury during the first year were investigated in a population-based study of 1-year-old children in southern Brazil. Odds ratios of injury-related health care attendance were estimated by number of injury mechanisms reported. Variation in number of mechanisms (in the whole sample) and odds ratios of care attendance (in children with reported injuries) were estimated for socioeconomic and psychosocial variables. RESULTS: Among all children (394) 86% had injuries; 10.9% care attendance and 0.5% hospitalisation were reported, and 14.5% presented dental trauma. Injury-related care attendance increased with the number of injury mechanisms (linear trend OR = 1.34, 95% CI = 1.09-1.66). In multivariable linear regression, injury mechanisms increased with the number of home hazards (p = 0.047) and decreased with duration of exclusive breastfeeding (p = 0.039), maternal involvement-responsiveness (p = 0.037) and mother's paid work (p = 0.018). Injury-related health care attendance among children with reported injuries was positively associated with maternal involvement-responsiveness (OR = 2.27, 95% CI = 1.11-4.67) and home organization (OR = 2.25, 95% CI = 1.09-4.65). CONCLUSION: Injury control can benefit from policy and practice that improve housing, reduce home hazards and promote breastfeeding, maternal bonds, safety practices and injury care.     

Factors associated with objectively measured total sedentary time and screen time in children aged 9–11 years

Objective

To identify factors associated with total sedentary time and screen time in children aged 9–11 years.

Differences in the development of Hungarian children, raised at home or in a child day care center

1. There are differences with regard to development of children educated at home only or at crèches additionally. 2. These differences concern as well the somatic, psychic as social development. 3. The importance of these findings are discussed.     

出生体重对儿童期和成年期高血压影响的队列研究

目的 研究出生体重对儿童期和成年期高血压的影响。方法 基于北京地区儿童血压研究队列资源,1987年基线调查时采用听诊法测量儿童期血压水平,记录Korotkoff第Ⅰ音为收缩压（SBP）、第Ⅳ音为舒张压（DBP-K4）、第Ⅴ音（消音）为舒张压（DBP-K5）,并根据2010年中国儿童血压参照标准P95诊断儿童高血压;2010年3月至2011年3月随访时采用相同方法测量成年期血压,以SBP≥140 mmHg（1 mmHg=0.133 kPa）和（或）DBP≥90 mmHg或正在服用降压药诊断为高血压。出生体重、是否早产及母乳喂养情况通过随访对象母亲的回忆进行问卷填写。采用多元线性回归分析出生体重与血压水平的关系,多因素Logistic回归模型分析出生体重与儿童期及成年期罹患高血压风险的关联。结果 出生体重有效数据936名（男492名,女444名）进入分析,其中低出生体重儿30名（3.2%）,巨大儿78名（8.3%）。出生体重与儿童期及成年期女性SBP呈负相关（P>0.05）。按低出生体重儿、巨大儿及出生体重正常进行分层分析,出生体重与儿童期血压水平的关联在不同出生体重间的规律不同,低出生体重组男性DBP-K5与出生体重呈正相关（b=32.32,P=0.030）,出生体重正常组女性SBP与出生体重呈负相关（b=-2.50,P=0.047）,巨大儿组控制性别后儿童期SBP与出生体重呈正相关（b=6.32,P=0.039）。多因素Logistic回归分析显示,低出生体重预测女性儿童期高血压（SBP与DBP-K4联合诊断）和成年期高血压的RR（95％CI）分别为5.00(1.32~18.88)和5.84(1.05~32.65);未见巨大儿对儿童期及成年期高血压的影响。 结论 不同出生体重与男女儿童血压水平的相关性不一致,低出生体重可增加儿童期及成年期女性罹患高血压的风险。     

Therapeutic and social determinants of the number of blood glucose tests performed at home by the diabetic child

The aim of this study was to assess the determinants of the use of blood glucose tests by young diabetic children participating in a summer educational program. 425 children and adolescents with insulin dependent diabetes mellitus (IDDM) were studied. The main source of the data was a questionnaire filled by the children and their parents about the use of urine and blood glucose tests during the 8 weeks before the camp and a questionnaire filled in by the Aide aux Jeunes Diabétiques (AJD) doctors about the practical knowledge of the management of the disease. The children were divided into 2 groups according to the level of their practical knowledge, "good" (n = 153) and "less good" (n = 272). In the whole group, the mean number of urine tests per day was 2.8, 75% of the children performing 3 tests per day and 4.3% not doing any urine tests. The number of blood tests is more variable; from 0 to 28 per week, with a mean of 5.6. In the group having "good" practical knowledge, the blood glucose tests were done 6 times per week, in connection with the number of hypoglycemia at home (p less than 0.01), the number of daily insulin injections (p less than 0.01) and the number of insulin supplements (p less than 0.05); there was a partial substitution between blood and urine tests. In the group having "less good" practical knowledge, the number of blood tests was 4 per week; it was not statistically different, but it was performed in the absence of detectable reasons.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diurnal cortisol secretion at home and in child care: a prospective study of 2‐year‐old toddlers

Background: Previous studies indicate that children may experience disrupted cortisol secretion in child care. The extent to which this is a transient or long‐term disruption is not known, as most studies have relied on cross‐sectional designs, and age‐heterogeneous small sample sizes. This study aims to (a) compare cortisol secretion measured at home and in child care at 2 and 3 years of age, (b) investigate cortisol changes from 2 to 3 years of age, (c) examine whether age at initiation of child care is associated with cortisol secretion, and (d) investigate whether cortisol secretion in child care is linked to behavioural problems. Methods: Saliva samples were collected in a cohort of children recruited at 2 years of age from a larger population sample composed of women seen for the first time during pregnancy. Saliva was sampled twice a day (morning and afternoon) over two consecutive days at home and in child care at 2 (n = 155) and 3 years of age (n = 116). Interviews regarding the familial socioeconomic background and child care history were conducted with the mothers. Results: At 2 years of age, children showed a flat diurnal cortisol pattern in child care and a decreasing pattern at home. At age 3 years, children showed decreasing patterns both at home and in child care. Also at 3 years, children with less child care experience (i.e., entry after 16 months) had higher cortisol levels in child care and lower levels at home. In contrast, those with more experience (i.e., entry prior to 8 months) had lower cortisol in child care and higher cortisol at home. Conclusion: The different patterns of diurnal secretion observed in child care as compared to home is transient for most children, diminishing as they get older, whereas home and child care overall levels later on may be influenced by the cumulated experience with child care.     

早期不同时间窗干预对新生儿缺氧缺血性脑病预后影响的研究

目的探讨不同时间窗治疗新生儿缺氧缺血性脑病(HIE)对神经系统预后的影响,为减少HIE神经系统后遗症的发生提供理论与临床依据。方法回顾性分析131例中度HIE患儿,根据就诊时间分为对照组(生后24～72 h就诊)和试验组(生后24 h内就诊),试验组根据就诊时间分为3个亚组,Ⅰ组(6 h之内),Ⅱ组(6～12 h),Ⅲ组(12～24 h)。每组患儿入院后给予相同的干预治疗,出院后于3、6月龄来我院采用中国标准化的贝来量表(CDCC)测智力发育指数(MDI)和运动发育指数(PDI)。结果对照组32例;试验组99例,其中Ⅰ组33例,Ⅱ组35例,Ⅲ组31例。(1)各组患儿MDI分别为66.9±12.3、79.7±11.4、71.4±10.0、68.0±11.4,Ⅰ组高于对照组、Ⅱ组、Ⅲ组,差异有统计学意义,Ⅱ组、Ⅲ组与对照组之间比较差异无统计学意义。(2)各组患儿PDI分别为70.8±11.6、83.7±10.6、75.8±11.3、72.4±12.3,Ⅰ组高于对照组、Ⅱ组、Ⅲ组,差异有统计学意义,Ⅱ组、Ⅲ组与对照组之间比较差异无统计学意义。结论不同时间窗开始治疗HIE的预后明显不同,6h内开始治疗的患儿其预后明显...     

Airway obstruction at time of symptoms prompting use of reliever therapy in children with asthma

Background: In asthma treatment, doses of inhaled corticosteroids are often adapted to symptoms and need for bronchodilators. However, in cross‐sectional studies in emergency room settings, lung function and respiratory symptoms are not always concordant. Available longitudinal data are based on written peak flow diaries, which are unreliable. Using home spirometry, we studied prospectively whether mild respiratory symptoms, prompting reliever therapy are accompanied by a clinically relevant drop in lung function in children with asthma. Methods: For 8 weeks, children with asthma scored symptoms and measured peak expiratory flow (PEF) and forced expiratory volume in 1 sec (FEV₁) on a home spirometer twice daily. Additional measurements were recorded when respiratory symptoms prompted them to use bronchodilators. Results: The mean difference between symptom free days and at times of symptoms was 6.6% of personal best for PEF (95% CI: 3.2–10.0; p = 0.0004) and 6.0% of predicted for FEV₁ (95% CI: 3.0–9.0; p = 0.0004). There was complete overlap in PEF and FEV₁ distributions between symptom free days and at times of symptoms. Conclusions: Although statistically significant, the degree of airway narrowing at times of respiratory symptoms, prompting the use of reliever therapy, is highly variable between patients, limiting the usefulness of home spirometry to monitor childhood asthma.     

Development of the pre-school child: the validation of a psychomotor screen, and the influence of the home environment on psychomotor development

ABSTRACT. The present study was designed to validate and standardize a short psychomotor screening test on Australian four-year-old-preschool children and to assess their home environment using Caldwell's HOME Inventory. The Adelaide Psychomotor Screen (APS) is a short, 10--15 minute screening test which uses 13 separate items to assess "General" development, "Gross Motor" development, "Social/Emotional Behaviour" and "Speech".
In the area of "General" development, 12 children screened as "abnormal" and 54 children screened as "normal" were further assessed by a psychologist on the McCarthy Scales of Children's Abilities. There was a high correlation between the APS "General" scores and the McCarthy (General Cognitive Index) scores (r = 0.75, p<0.001 for the younger children, and r = 0,90, p <0.001 for the older children).
Caldwell's HOME Inventory takes an hour to complete, and involves a visit by the assessor to each home. The correlation between the HOME total scores and the McCarthy (General Cognitive Index) scores was r =0.06, p < 0.001. It is suggested that the HOME Inventory may be more valuable as a predictor of a child's future development than an index of his present developmental status.
It is suggested that nurses and teachers used the APS as a screening test of the individual child, and use the HOME inventory as an assessment of the home environment.     

Basal insulin and total daily insulin dose in children with type 1 diabetes using insulin pumps

Objective:  To assess the contribution of basal insulin to the total daily dose (CBITDD) and to identify the determinant factors in children with type 1 diabetes mellitus.
Study design:  Cross-sectional study in which the basal insulin requirement was established based on a memory read-out of insulin delivery from pumps. Factors such as glycated haemoglobin A1c (HbA1c), fasting C-peptide, standard deviation score of body mass index (sdsBMI) and demographic data were determined during routine hospital visits. Study group included a total of 90 well-controlled diabetic children with the mean HbA1c 6.6 ± 0.7 (5.2–7.9), age 10.4 ± 4.4 yr (1.1–17.9 yr), diabetes duration 3.0 ± 2.6 yr (0.3–10.9 yr) and sdsBMI 0.08 (−2.27 to 1.79), excluding patients with ketoacidosis or infectious diseases.
Results:  Correlations between CBITDD and age (r = 0.39 and p < 0.005) and diabetes duration (r = 0.61 and p < 0.0001) and an inverse correlation with C-peptide (r = −0.41 and p = 0.0001) were found. C-peptide-positive patients had a significantly lower percentage of basal insulin compared with C-peptide-negative patients (20.6 ± 11 vs. 31.6 ± 11.0%, respectively; p = 0.0004); yet, no significant difference in total insulin daily dose (0.65 ± 0.3 vs. 0.78 ± 0.2 U/kg/d, respectively) was observed.
Conclusions:  The percentage of basal insulin in diabetic children is below 50% and in well-controlled diabetic children is related to the fasting C-peptide level, age of patient and diabetes duration but not to HbA1c and sdsBMI.     

Development of the pre-school child: the validation of a psychomotor screen, and the influence of the home environment on psychomotor development

The present study was designed to validate and standardize a short psychomotor screening test on Australian four-year-old-preschool children and to assess their home environment using Caldwell's HOME Inventory. The Adelaide Psychomotor Screen (APS) is a short, 10-15 minute screening test which uses 13 separate items to assess "General" development, "Gross Motor" development, "Social/Emotional Behaviour" and "Speech". In the area of "General" development, 12 children screened as "abnormal" and 54 children screened as "normal" were further assessed by a psychologist on the McCarthy Scales of Children's Abilities. There was a high correlation between the APS "General" scores and the McCarthy (General Cognitive Index) scores (r = 0.75, p less than 0.001 for the younger children, and r = 0,90, p less than 0.001 for the older children). Caldwell's HOME Inventory takes an hour to complete, and involves a visit by the assessor to each home. The correlation between the HOME total scores and the McCarthy (General Cognitive Index) scores was r = 0.06, p less than 0.001. It is suggested that the HOME Inventory may be more valuable as a predictor of a child's future development than an index of his present developmental status. It is suggested that nurses and teachers used the APS as a screening test of the individual child, and use the HOME inventory as an assessment of the home environment.