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目的探讨Tourette综合征(TS)发病的危险因素。方法2000-01—2004-12采用病例对照研究的方法,对温州医学院附属一院100例TS患儿及100名对照病例的相关资料进行非条件Logistic回归和主成分分析。结果非条件Logistic回归多因素分析显示,该病有统计学显著性意义的危险因素是TS家族史、注意缺陷伴多动障碍(ADHD)、过敏性哮喘、母亲孕早期受精神刺激、高热(T>39℃)和极低频磁场暴露,其标准回归系数分别为1.3987、3.6385、1.7657、1.7250、1.8973和1.0677。主成分分析提取了4个主成分,其方差累积贡献率为57.025%。结论TS的发病与遗传因素和环境因素有关。     

癫癎患儿危险因素对照分析

目的 探讨与儿童期癫(癎)发生有关的危险因素及其对癫(癎)发病率的影响.方法 2007年1-6月在华西第二医院神经门诊就诊160例癫(癎)患者为病例组.男88例,女72例;年龄1个月～16岁[(7.0±4.7)岁].癫(癎)儿童均有2次以上无诱因惊厥发作,由脑电图辅助诊断.排除脑性瘫痪、小头畸形、智力低下、先天性畸形、肿瘤性疾病者.同期华西第二医院儿童保健门诊的神经系统正常(根据病史及体格检查无癫(癎)、生长发育正常、无脑性瘫痪和其他神经系统疾病)的儿童150例为健康对照组.男72例,女78例;年龄2个月～16岁[(6.3±4.5)岁].根据其年龄和性别,作为对照进行病例对照研究.通过＜癫(癎)患者调查表＞对患儿及其父母进行病史询问获得相关数据资料,包括高热惊厥史、头部外伤史、癫(癎)家族史、异常围生史、中枢神经系统感染史及近亲结婚史等,应用SPSS 13.0软件归纳分类后进行x2检验,P＜0.05为有显著性差异.结果 病例组高热惊厥史、头部外伤史、癫(癎)家族史、异常围生史与健康对照组比较均有显著性差异(P=0.01,0.01,0,0.02),分别使癫(癎)发生危险性增加了2.72、3.75、3.61和2.47倍;而中枢神经系统感染史、近亲结婚与健康对照组比较无显著性差异(P=0.73,1.0).结论 高热惊厥史、头部外伤史、癫(癎)家族史、异常围生史是增加本地区儿童癫(癎)发病率的危险因素,其中高热惊厥史、头部外伤史和癫(癎)家族史对于癫(癎)发病率的增加较为重要,而中枢神经系统感染史、近亲结婚不增加儿童癫(癎)的发病率.     

伴高热惊厥史的儿童癫痌病例分析

分析伴高热惊厥史的癫痌患儿的临床特点,探讨高热惊厥脑损伤及其与颞叶癫痌的关系。 方法对1996～1999年本院儿科神经病房480例住院癫痌患儿进行回顾性分析,包括首发年龄、家族史、持续时 间、癫痌发作类型、神经影像学及脑电图改变等。结果115例(23.9％)患儿有前期高热惊厥史。伴高热惊厥史 的患儿癫痌发作早且易于出现癫痌持续状态。与无高热惊厥史的患儿相比,伴高热惊厥史的患儿强直-阵挛发作 较多,复杂部分性发作较少。408例患儿曾行影像学检查,4例提示有海马硬化者均无高热惊厥史。在伴高热惊厥史 的癫痌患儿中脑电图局灶起源的异常放电显著低于无高热惊厥史的癫痌患儿。有6.08％(7/115)伴高热惊厥史的癫 痌惠儿和6.84％(25/365)无高热惊厥史的癫痌患儿脑电图表现为单纯颞叶异常放电,二组相比无明显差异。结论 在癫痌患儿中,高热惊厥可能伴有脑损伤,且可能与后期的癫痌发生有关,伴高热惊厥史者不一定发展为颞叶癫痌。     

Tourette综合征患儿的预后及影响因素

目的 探讨影响Tourette综合征(TS)患儿预后的危险因素.方法 对1997-2005年在本院就诊的98例TS患儿(男85例,女13例;年龄4～16岁)进行随访.病例均符合＜美国精神疾病诊断与统计手册＞4版(DSM-Ⅳ)TS诊断标准.采用统一的调查表,由经过专门培训的调查员以直接询问或电话咨询的方式调查.将性别、发病年龄、抽动严重程度、首发症状、精神或神经病家族史、基础病、共患病、围生期异常、家庭关系等临床资料核实整理后,应用SPSS 12.0软件进行预后相关危险因素Logistic回归分析.结果 随访截止时年龄14～25岁.失访16例,其余82例(男72例,女10例)均得到随访.其中痊愈加好转50例,未愈32例.单因素非条件Logistic回归分析显示有显著意义的变量为发病年龄、抽动严重程度、精神或神经病家族史、基础病、共患病、围生期异常6个因素(Pa＜0.05);性别、首发症状、家庭关系3个因素无显著意义(Pa＞0.05).再将选出的6个有意义的危险因素引入多因素Logistic逐步回归分析,共患病、抽动严重程度、家族史3个因素进入最终回归方程(Pa＜0.05),其中共患病(OR=84.088,95%CI为10.850～651.682),抽动严重程度(OR=13.956,95%CI为2.412～80.762),家族史(OR=27.127,95%CI为1.047～702.831)影响作用依次由大到小.结论 TS患儿的预后与是否合并共患病、是否有精神或神经病家族史以及抽动严重程度等危险因素有关.     

儿童腹股沟疝发病危险因素的病例对照研究

目的：儿童腹股沟疝为出生缺陷中常见疾病类型,目前关于其发病危险因素的报道尚不多见。该研究旨在探讨儿童腹股沟疝发生的主要危险因素。方法：采用频数匹配的病例对照研究方法,对132例0～6岁腹股沟疝患儿和132例0～6岁对照儿童的情况进行问卷调查,用χ2检验和logistic回归对所收集资料进行单因素及多因素分析,计算OR值（比值比）及OR值的95%CI（可信区间）。结果：儿童腹股沟疝与儿童啼哭不安史（OR=3.701,95%CI：1.724～7.945）、母亲孕前1年和孕期头3个月腌制品摄入史（OR=2.534,95%CI：1.279～5.021）、母亲孕前1年和孕期头3个月贫血史（OR=3.761,95%CI：1.497～9.450） 及儿童腹股沟疝家族史（OR=13.505,95%CI：5.825～31.307）有关。结论： 儿童啼哭不安史、腹股沟疝家族史、母亲孕前1年和孕期头3个月贫血史及腌制品摄入史是儿童腹股沟疝发生的危险因素。     

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抽动障碍(tic disorders,TD)是儿童期常见的一种慢性心理行为疾病,临床可分为3种类型:短暂性TS、慢性运动或发声TD、Tourette综合征(TS)即发声与多种运动联合TD,其中以TS最为典型。目前,有关儿童TD的病因及发病机制仍不完全清楚,多数学者认为该病可能是由多种因素,包括遗传因素、生物因素、心理和环境因素等在儿童生长发育过程中相互作用的综合结果。1遗传因素大量研究表明,TS是一种具有明显遗传倾向的神经精神性疾病[1-2]。一般认为,TS遗传方式为常染色体不完全     

神经系统及精神疾病

921306 34例儿童复杂性高热惊厥与癫痫的高危因素探讨/刘超∥四川医学.-1991,12(6).-362～363 随访34例复杂性高热惊厥2～9年,分析其发生癫痫的危险因素与性别,惊厥发作前后表现,发作类型,伴随疾病,家族史,围产期因素,既往史均无明显关系。本组9例经临床和脑电图证实转为癫痫(癫痫组);25例     

孕早期重大负性生活事件与子代先天性心脏病病因的关联

目的 探讨孕早期重大负性生活事件与子代先天性心脏病(CHD)发生之间的关联.方法 查阅4-2-1体检筛查,并经市级以上医院确诊的CHD患儿资料,按12配对病例对照研究方法,采用面对面结构式访谈和电话访谈相结合的方式调查116例CHD患儿及232例健康对照儿童的父母人口统计学资料(包括孕前1 a的工作环境中是否接触到有毒有害物质等)、母亲既往不良妊娠史、孕期情况(包括孕早期重大负性生活事件、孕早期感冒史、孕早期发热史等环境因素暴露),运用单因素条件Logistic回归分析对研究因素初筛,然后对初选的可疑危险因素进行共线性诊断,排除变量间的共线性关系后用多因素条件Logistic逐步回归作进一步筛选.结果 母亲孕早期重大负性生活事件暴露、既往不良妊娠史、孕早期服用药物是子代发生CHD的可能危险因素,且孕早期重大负性生活事件暴露在所有危险因素中作用最强(OR=1.810).结论 加强孕早期母亲心理保健,控制或减少孕早期重大负性生活事件,可能降低子代CHD的发病危险.     

Tourette综合征发生的危险因素分析

目的：研究Tourette综合征（TS）发生的主要危险因素。方法：运用遗传流行病学病例对照研究,对门诊80例TS患儿用Li-Mantel-Gart法估算分离比,并对其一、二级亲属用Falconer回归方法估算遗传度。同时,分别对该80例TS患儿和80例以其他疾病于门诊就诊的对照患儿应用家庭环境量表和自制一般情况调查表收集资料,再用单因素和多因素方法对资料进行分析。结果：TS分离比是0.1176,一级亲属遗传度为（49.7±2.6）%,二级亲属遗传度为（21.5±3.4）%,一、二级亲属加权平均遗传度为（39.5±2.1）%。TS组的独立性、娱乐性、组织性等因子的评分明显低于对照组,而矛盾性和控制性等因子评分则明显高于对照组,两组间差异均具有统计学意义（P<0.01）。单因素分析显示TS发生的相关危险因素为TS阳性家族史、家庭教育类型、孕母吸烟、家庭矛盾性、父母文化程度低、家庭控制性、出生时缺氧。多因素logistic回归分析发现TS阳性家族史、家庭矛盾性、家庭教育类型、父母文化程度低、孕母吸烟等是TS发生的主要危险因素。结论：TS的发生是遗传和环境各种因素相互作用的结果,遗传方式为多基因遗传;具有TS家族史的儿童,积极改善其生活环境是非常必要的。     

热性惊厥复发危险因素与预后分析

目的研究热性惊厥患儿的复发危险因素及预后情况.方法结合98例热性惊厥患儿的临床及脑电图资料,研究其复发、转为癫和出现智力障碍及行为异常的情况.结果复发共52例(53.0%),复发危险因素与惊厥家族史、初次发作体温＜38.5℃、初次发作年龄＜1岁及复杂型热性惊厥有关(P＜0.01);热性惊厥转为癫共20例(20.4%),转为癫的危险因素与复杂型热性惊厥、初次发作年龄＜1岁、热性惊厥反复发作有关(P＜0.01);发生智力障碍及行为异常2例(2.0%),说明热性惊厥患儿绝大部分预后较好,智力低下及行为障碍发生率低.结论对有复发危险因素及转为癫危险因素的患儿,应密切随访,采取适当的干预措施.     

Follow-up: who needs it?

The ability of pediatric residents to appropriately assign patients to receive follow-up has not previously been studied. We independently reviewed 1693 consecutive charts of patients presenting to the pediatric emergency department. The authors agreed with 60 of the 82 resident-assigned follow-ups and identified 99 patients who should have been assigned to receive follow-up but were not (missed follow-ups). When compared with the group appropriately assigned to receive follow-up care, the missed follow-up group was similar in sex, type of insurance, and time of presentation but tended to be younger and was significantly different in terms of mean temperature and health care provider. In regard to the latter, the missed follow-up group had a lower mean temperature and more often had an identifiable routine health care provider. Young age and respiratory difficulty were the factors contributing most to the authors' assignment as a missed follow-up. Specific formal teaching directed at the appropriate use of follow-up for outpatients should be incorporated into pediatric residency training curricula.     

A randomized controlled trial: child life services in pediatric imaging

Background

Children undergoing procedures in pediatric health care facilities and their families have been shown to benefit from psychosocial services and interventions such as those provided by a Certified Child Life Specialist (CCLS). The comprehensive impact of a CCLS in a pediatric imaging department is well recognized anecdotally but has not been examined in a prospective or randomized controlled fashion.

Objective

We prospectively assessed the impact of a CCLS on parent satisfaction, staff satisfaction, child satisfaction, and parent and staff perceptions of child pain and distress in a pediatric imaging department.

Materials and methods

Eligible children between 1 and 12 years of age (n?=?137) presenting to the pediatric imaging department for an imaging procedure were randomly assigned to an intervention or control arm. Those assigned to the intervention received the comprehensive services of a CCLS. The control group received standard of care, which did not include any child life services. Quantitative measures of satisfaction and perception of child pain and distress were assessed by parents and staff using a written 5-point Likert scale questionnaire after the imaging procedure. Children 4 and older were asked to answer 3 questions on a 3-point scale.

Results

Statistically significant differences between the intervention and control groups were found in 19 out of 24 measures. Parents in the intervention group indicated higher satisfaction and a lower perception of their child’s pain and distress. Staff in the intervention group indicated greater child cooperation and a lower perception of the child’s pain and distress. Children in the intervention group indicated a better overall experience and less fear than those in the control group.

Conclusion

Child life specialists have a quantifiably positive impact on the care of children in imaging departments. Measures of parent satisfaction, staff satisfaction, child satisfaction, child pain and child distress are shown to be positively impacted by the services of a CCLS. These results have significant implications for hospitals striving to increase satisfaction, decrease costs and improve quality of care. In a health care landscape that is changing quickly and increasingly focused on the cost of care, future research should assess whether the core tenants of the child life profession support and contribute quantifiably to high-quality, cost-effective practices in health care.     

Inhibitory Deficits in Tourette Syndrome: A Function of Comorbidity and Symptom Severity

This study examined central inhibitory function in children with Tourette syndrome (TS; N = 46) and normally developing controls ( N = 22) matched on age, gender, and IQ. A negative priming task measured the ability to inhibit processing of irrelevant distractor stimuli presented on a visual display. Initial analyses indicated that participants with Tourette syndrome did not differ significantly in inhibitory function from controls. However, when the large Tourette syndrome sample was separated into subgroups, one without evidence of comorbidity ( N = 23) and the other meeting research criteria for either AD/HD, OCD, or both ( N = 23), it became evident that individuals with Tourette syndrome with comorbid conditions tended to perform less well than the control group, whereas those without comorbidity performed much like controls. Similarly, when the large Tourette syndrome sample was divided into two subgroups on the basis of severity of symptomatology ( N = 23 in each), those with more numerous and severe symptoms of Tourette syndrome, AD/HD, and OCD performed significantly less well than both controls and Tourette syndrome subjects with fewer and less severe symptoms. This suggests that neuropsychological impairment occurs as a function of comorbidity and symptom severity in Tourette syndrome. It also suggests that categorical diagnoses alone may be less useful than dimensional methods for predicting cognitive impairment in individuals with Tourette syndrome.     

Text2Breathe: Text-Message Intervention for Parent Communication and Pediatric Asthma

ObjectiveMobile health technology offers promise for reducing disparities in pediatric asthma care and outcomes by helping parents more effectively communicate with their children's primary care providers and manage their children's asthma. This study tested the impact of a text messaging program on emergency department utilization and asthma morbidity.MethodsA randomized controlled trial enrolled 221 parents of Medicaid-insured children visiting the emergency departments of 2 urban children's hospitals in the Pacific Northwest for an asthma-related concern between September 2015 and February 2019. Standardized surveys were administered to parents at baseline and 12 months later to assess the primary outcomes of emergency department utilization and morbidity as well as primary care utilization, parent communication self-efficacy, and asthma self-management knowledge. The intervention group received brief in-person education on partnering with primary care providers, followed by 3 months of educational text messages.ResultsParticipants were mostly female, English speakers, of minority race and ethnicity, and living below 200% of the federal poverty level. Negative binomial and linear regressions indicated no significant group differences in annual number of emergency department visits, morbidity, parent communication self-efficacy, or asthma self-management knowledge at 12 months’ follow-up, adjusting for baseline covariates. Average annual rate of primary care visits for asthma was 35% higher in the intervention group compared to control group at follow-up (95% confidence interval 1.03–1.76, P = .03).ConclusionsThis parent-focused text message intervention did not impact emergency department utilization or asthma morbidity; however, results suggest its potential for enhancing use of primary care for management of pediatric chronic conditions.     

Mental health problems in children and caregivers in the emergency department setting

INTRODUCTION: Although mental health problems are increasing in the primary care sector, the prevalence of mental health problems in families presenting for nonpsychiatric complaints in the emergency department (ED) setting is generally unknown. As such, we set out to assess the frequency of mental health concerns and associated risk factors in children presenting for care in a pediatric ED. METHODS: A total of 411 mother-child dyads were randomly selected during a 2-year period from the less acute area of a large pediatric ED. Mothers were interviewed for child mental health concerns using structured diagnostic instruments. Mothers were also interviewed for their own mental health symptoms. Risk factor analysis for the outcome of a pediatric mental health concern was performed using bivariate and multivariate techniques. RESULTS: Of all children, 45% met criteria for a mental health concern, with 23% of all children meeting criteria for two or more mental health concerns; 21% of mothers screened positive for a mental health problem themselves. Once adjusted, children whose mothers' screened positive for a mental illness were more likely to have a mental health concern themselves. CONCLUSION: There is a large burden of mental health concerns in children and their mothers presenting to the ED for medical care. Efficiently and accurately identifying mental illness in children presenting to a pediatric ED is the first step in the intervention process for a population that might otherwise slip through the system.     

Utilization of emergency services among patients of a pediatric group practice

Pediatric group practices in university hospitals provide primary care to children who are often from indigent families. Those practices that attempt to provide care in a continuous way often encounter difficulty in attempting to change their patients' patterns of emergency department utilization. This study attempts to define the relationship between patient characteristics such as access to a telephone and inappropriate utilization of the emergency department. A university hospital database was reviewed to identify all patients of the pediatric group practice. Emergency department records over a six-month period were reviewed to identify all visits of group practice patients to the emergency department. Patients without access to a telephone were more likely to inappropriately access care in the emergency department than were patients with phone access. However, within the cohort of emergency department utilizers, phone access was not a predictor of use. Of those who used the emergency department, babies and young children and those of indigent status were more likely to inappropriately access care than were older children and those at a higher socioeconomic level. We conclude that the demographic information of clients in a pediatric group practice can be utilized to predict inappropriate utilization of emergency department services and that this information can be used to implement programs to help foster continuity of care.     

Designing a Multi-Stakeholder Collaboration to Reduce Overuse of Neuroimaging for Minor Head Injury and Atraumatic Headache

Despite recommendations to limit the use of neuroimaging for evaluation of minor head injury and atraumatic headache in children, many children receive unnecessary imaging without clear history or physical exam indications in the emergency department (ED) or other outpatient settings. This overuse of neuroimaging has not previously been explored across clinical settings, nor for the diagnosis of atraumatic headache.We convened a multi-stakeholder design meeting to discuss reasons for overuse of neuroimaging in children and brainstorm potential interventions to reduce overuse. The meeting included didactic sessions on the risks and benefits of neuroimaging and quality improvement methodology. There were also small group discussions of challenges and potential interventions.Participants included ED physicians and nurses, radiologists, Medicaid health plan representatives, a pediatric neurologist, a pediatric primary care provider and a parent. Reasons for overuse included family anxiety and expectations for neuroimaging, pediatric phone triage protocols directing patients to the ED for evaluation, time pressures within primary care and the ED clinics, and reluctance among payers to institute prior authorization for ED-based imaging studies. Several potential interventions were identified and organized into three key driver diagrams: one each for primary care, the ED, and Medicaid health plans.Convening a multi-stakeholder meeting was feasible and resulted in the identification of common reasons for overuse of neuroimaging in children and many potential interventions across clinical settings. Similar multidisciplinary approaches may be helpful for others interested in reducing the overuse of imaging in children.Discussions from a multi-stakeholder meeting with representation from primary care, pediatric emergency departments, and Medicaid health plans resulted in the identification of common reasons for overuse of neuroimaging in children and many potential interventions across clinical settings.     

¿Deberían estar presentes los padres durante los procedimientos invasivos en urgencias?

Over the last decades, health care has been moving away from the paternalistic model, to one of family-centered care. In the pediatric emergency department, this new trend has led to parents playing a larger role in the health care of children, particularly during invasive procedures and/or resuscitation. Despite the increased attention to family presence, it remains a controversial topic, especially among emergency medical staff. Several studies have been performed that look at the advantages and disadvantages of this new way of conceiving child health care. To our knowledge, there is only one Spanish article on this topic, which is the reason why we performed a literature review on family presence in the emergency department.     

Emergency department utilization patterns and health care needs assessment among parents of Chinese American children in New York City

A limited number of publications have addressed the health care needs of Chinese American children of recently immigrated parents. We administered a Chinese-language survey to parents presenting to an urban pediatric emergency department (PED) in New York City and at community venues. The survey assessed demographics, access to health care, and utilization/expectations of the PED. Emergency Severity Index scores were recorded for emergency department patients. Three hundred fifteen families (54% in the PED) completed the survey. Of those completed in the PED, 79% sought emergency services because of pediatric referral or because their pediatrician's office was closed. Of our sickest patients with an Emergency Severity Index score of 3 or less, 28% of parents felt that the child was somewhat sick or not sick at all. Although the majority of our Chinese American families utilize the emergency department appropriately, 28% of the parents of our sickest patients did not appreciate the degree of illness of their children.     

Patient safety in the pediatric emergency care setting

Patient safety is a priority for all health care professionals, including those who work in emergency care. Unique aspects of pediatric care may increase the risk of medical error and harm to patients, especially in the emergency care setting. Although errors can happen despite the best human efforts, given the right set of circumstances, health care professionals must work proactively to improve safety in the pediatric emergency care system. Specific recommendations to improve pediatric patient safety in the emergency department are provided in this policy statement.