Management of seizures in the elderly: a survey of UK geriatricians.

The incidence and prevalence of epilepsy increase substantially with old age. Despite this, the investigation and management of this patient population remains a grey area. Four hundred and eleven (53%) consultant geriatricians responded to a questionnaire exploring their approach to seizures in the elderly in order to establish an overview of current clinical practice. Between one and five patients presenting with seizures, predominantly aged between 75-85 years, were reviewed monthly. Seventy per cent of geriatricians undertook to investigate the patients themselves with biochemical and haematological profiles performed by most. Electroencephalography and computerized tomographic scanning were routinely requested by a quarter of responders. Only 58% would themselves initiate therapy with antiepileptic drugs, with 16% of consultants starting treatment following the first seizure, 59% after a second and 5% after a third. Phenytoin was first choice for generalized tonic-clonic seizures with carbamazepine preferred for partial seizures. If good control was not obtained, 67% would substitute another first line drug, while 27% would add in a second. Less than 3% would use the new anticonvulsants lamotrigine or vigabatrin. Sixty per cent monitored anticonvulsant concentrations in patients with poor control or suspected toxicity. A wide variability was seen in the current approach to seizures in the elderly, which reflects a lack of established practice. Epilepsy clinics for the elderly would encourage structured research into the many unanswered questions affecting the care of older people with seizures.     

西宁市某托幼机构集体儿童膳食调查结果分析

目的 了解西宁市有代表性的某托幼机构集体儿童膳食结构情况,为制定营养配餐提供科学依据.方法 选取西宁市某幼儿园,对2009年11月至2014年11月5年间儿童膳食采取称重法进行调查记录,并通过膳食调查软件测算其营养量,用SPSS统计软件进行分析.结果 学龄前儿童的膳食营养量呈逐年升高趋势,每人每日能量、蛋白质、维生素A、钙、铁、锌的实际摄入量占推荐摄入量的比例分别为84.21%~96.05%、98.2%~114%、41.15%~84.35%、45.17%~92.57%、285.38%~150.83%和41.25%~50.63%.蛋白质、脂肪、碳水化合物分别占热能的15.05%~16.32%,25.74%~35.57%,和48.11%~59.72%.结论 西宁市集体儿童膳食状况逐年得到改善,钙、维生素A的摄入量比例也逐渐合理,铁摄入比例虽大,但以植物类食物为主,锌摄入量仍不足.为确保学龄前儿童健康成长,应根据儿童生理特点调整微量元素和矿物质.     

Suspected testicular torsion: a survey of clinical practice in North West England

Several aspects of the management of suspected testicular torsion are controversial. A questionnaire was mailed to all 33 consultant urologists in the North West region of England to elicit their policies for routine clinical management. 29 of 33 questionnaires were returned (2 incomplete). As regards radiological investigation, 4 consultants always request ultrasound examination; the others do not favour routine imaging. When the diagnosis of testicular torsion is confirmed at operation, all consultants would perform bilateral testicular fixation, although with considerable variations in technique; most use Vicryl sutures (66%) and three-point fixation (57%). One-third would do an ipsilateral orchidopexy if there was no clear evidence of testicular torsion at operation. The variation revealed by this survey prompted an attempt to formulate a protocol for management. A review of the published work indicates that, in cases of proven testicular torsion, treatment should include bilateral fixation with delayed-absorption or non-absorbable sutures; fixation should be at three points. When torsion is not found at operation, there is no evidence of benefit from orchidopexy.     

A survey of dietetic practice in obesity management

Introduction: Little is known about how dietitians organize the management of overweight and obese clients. The aim of this survey was to identify current dietetic practice in the management of such clients. Methods: In preparation for the joint Association for the Study of Obesity/British Dietetic Association (BDA) symposium in November 1997, a questionnaire was sent to BDA members registered on two BDA databases in order to identify current practice in the dietetic management of obesity. A total of 347 BDA members were contacted; 252 dietetic heads of service (or equivalent) and 95 members on the BDA freelance register. Information relating to referral criteria, organizational details and key features of typical management programmes was collected. Results: A poor response rate of 40% was achieved, with a similar response rate from dietetic heads of service and freelance dietitians. Of those who did respond, 91% accepted referrals for overweight or obese clients. The majority of respondents allocated up to 30 min for a new client appointment, and offered at least one follow-up appointment, usually at 4-week intervals and lasting up to 20 min. Freelance respondents allocated longer times for new client and follow-up appointments, and also reviewed patients more frequently (but did not allocate more follow-up appointments), than dietetic heads of service. Most consultations were on an individual basis and were not guided by standardized protocols. Conclusion: There is clearly an opportunity for dietitians to move towards evidence-based treatment of obesity, without substantial resource implications, by offering longer-term treatment using group therapy. The use of clinical guidelines, and auditing future dietetic practice against these guidelines, should be considered.     

Review of current practice in 'clean' diets in the UK

A survey of current practice in the provision of 'clean' diets at UK bone-marrow transplant (BMT) centres was carried out as a basis for updating the information given to patients at Sheffield Children's Hospital (SCH). 'Clean' diets are used to minimize the risk of infection from food in immuno-suppressed patients.
Information received varied greatly from sterile diets to modified ward diets. It was found difficult to collate the results for this reason. In addition, there has been little documented evidence on the use and effectiveness of these diets.
In general, there appears to be a move away from a stringent sterile diet towards a more relaxed diet, giving patients a greater choice of foods. Following this survey, the information given to BMT patients at SCH was modified to allow greater freedom of choice, whilst maintaining sensible food hygiene guidelines.     

Care co-ordination and key worker schemes for disabled children: results of a UK-wide survey

AIM: To investigate the prevalence and nature of care co-ordination and key worker services for disabled children and their families. METHODS: Postal survey of 225 Children with Disabilities Teams across the UK. RESULTS: Out of 159 questionnaires returned (70%), 35 (22%) reported having a care co-ordination scheme, with 30 (19%) of these providing key workers for families. The majority had multiagency and parent involvement in setting up and overseeing the schemes. However, multiagency funding was less common and funding for many schemes was short term. Different models of key working were apparent. Five schemes employed full-time key workers. In 21 schemes, professionals key worked with a few families as part of a larger case load, and in three schemes, both types of key workers were employed. Most schemes provided initial or ongoing training for key workers, but a few provided neither of these. DISCUSSION: The proportion of areas having care co-ordination or key worker services is consistent with findings on research with parents of disabled children, which reports that less than one-third of families have a key worker. The extent of multiagency involvement in planning and overseeing the operation of the service was positive but joint funding was more problematic. There was considerable variation in service models and as yet, little is known about whether or how such variations relate to outcomes for children and families. Further research will investigate these issues.     

上海1 320名儿童肥胖流行状况调查

【目的】 了解上海部分地区儿童肥胖流行现状, 研究人口学特征与儿童肥胖的关系,为制定预防儿童肥胖措施提供依据。 【方法】 利用整群抽样的方法,随机抽取上海市虹口区、普陀区、浦东新区3个区的10所幼儿园共计儿童1 320名。自行设计问卷调查儿童的身高、体重、生活习惯和父母的情况等。 被调查儿童的身高和体重数据来源于当年的“六一”体检资料, 使用χ²检验及多因素Logistic回归分析人口学特征与肥胖的关系。 【结果】 研究结果显示, 调查到的1 320名儿童中,肥胖及超重儿童分别占被调查人数的10.5%和14.0%;在不控制其他变量时,户籍、父母亲的体质指数(body mass index, BMI)、独生子女、家庭结构与儿童肥胖有关,在考虑其它变量的影响后,父亲BMI、母亲BMI、家庭结构3个因素与儿童肥胖有关。 【结论】 儿童肥胖和超重的检出率已接近发达国家,父母BMI高的和核心家庭是上海儿童肥胖的主要影响因素。     

Changing morbidity patterns in children in Dutch general practice: 1987–2001

Objectives: To examine the presentation and pattern of childhood morbidity in general practice compared with 14 years ago.

Methods: We used data of all children aged 0–17 years from two cross-sectional surveys performed in 1987 and 2001 in general practice in the Netherlands. The total number of children in the practices participating in these surveys were 86,577 children in 1987 and 82,053 children in 2001. First of all, we compared consultation rates of children in general practice. Secondly, childhood morbidity was assessed by episodes of disease, coded according to the International Classification of Primary Care (ICPC). We compared childhood morbidity in 1987 and 2001 by assessing the distribution of episodes among ICPC chapters stratified by ethnicity, and by comparing incidence rates of most frequently presented diseases.

Results: Childhood consultation rates have decreased from 2.7 visits a year per child in 1987 to 2.1 in 2001. The distribution of episodes among ICPC chapters has also changed. Respiratory problems are still the most frequently presented health problem in children but the proportion has decreased from 25.5% in 1987 to 23.3% in 2001. Skin problems were presented more often (23.0% in 2001 versus 17.8% in 1987), and Western children more often presented with skin problems than with respiratory problems in 2001. Incidence rates of most respiratory diseases have decreased and specific skin diseases (dermatomycosis, impetigo and eczema) were diagnosed more often.

Conclusion: In the Netherlands, childhood morbidity has changed. Skin diseases have become more important in general practice and respiratory problems are declining.     

Loneliness of left‐behind children: a cross‐sectional survey in a sample of rural China

Background It is reported that about 28.3% of rural children estimated at 58 million were left behind in China when their parents migrated to cities to find work. These children may encounter critical situations of psychological well‐being. We conducted a cross‐sectional study to explore whether left‐behind children are lonelier than the non‐left‐behind and to highlight subpopulations that are particular at risk. Methods We conducted a community‐based cross‐sectional study on a representative sample in rural China. Semi‐structured questionnaires were applied to 324 left‐behind and 282 non‐left‐behind children. Logistic regression analysis was used to find out risk factors associated with loneliness. Results We found that whether children were left behind or not influenced their likelihood of being lonely. Compared with non‐left‐behind children, the left‐behind were 2.5 times (95% CI 1.7, 3.5) more likely to suffer from loneliness and 6.4 times (95% CI 4.2, 9.7) more likely to be very lonely. Left‐behind children who were brought up by grandparents, or having poor economic status, bad relationship and low frequency of communication with parents were prone to encounter more as well as more severe loneliness. In particular, children who had a bad relationship with parents were at highest risk for severe loneliness (OR 14.5; 95% CI 2.1, 99.5). Conclusions Left‐behind children are at significant risk for loneliness. More specific investigations targeted towards the psychological well‐being of these children are needed to identify the underlying preventable risk factors.     

A survey of clinical teaching fellowships in UK medical schools

CONTEXT: Undergraduate medical education in the UK has changed considerably over the last decade. One development has involved the creation of teaching-specific posts for junior doctors by medical schools. These posts are generally termed 'clinical teaching fellowships', but it is not known how many of them exist, or whether they are similar in terms of educational activities, professional development, and research and clinical experience opportunities. METHODS: Teaching deans in all UK medical schools were sent a questionnaire relating to clinical teaching fellowships, and were asked to distribute a second set of different questionnaires to their clinical teaching fellows, which were to be returned to the authors separately. RESULTS: A total of 28 deans and 46 fellows responded. Fifteen medical schools had clinical teaching fellows and there appeared to be a total of 77 such posts in the UK. There was little uniformity in the activities undertaken within the posts. Deans who employed clinical teaching fellows were unanimously positive regarding the posts. Fellows were generally positive but expressed reservations relating to approval for postgraduate training, career development, deterioration in clinical skills, financial disincentives, credibility within one's own specialty, and provision of training and support. CONCLUSIONS: Clinical teaching fellow posts are generally enjoyed by fellows and valued by deans. Fellows carry out differing duties and their training in medical education is variable. The posts can be unstructured and may lack credibility to doctors outside medical education. Providing specific structured training in medical education, recognised at a national level, would help deal with these concerns.     

学龄前儿童家长意外伤害知识-态度-行为及其相关因素分析

目的:了解学龄前儿童家长意外伤害知识、态度、行为的现状,分析其影响因素。方法:采用问卷调查方法对228名学龄前儿童家长进行调查。结果:家长意外伤害的平均知识得分为(72.65±0.6)分;态度得分(68.54±1.08)分;行为得分(72.77±0.86)分。家长的文化、职业、家庭人口数、父母关系、管教方式对意外伤害知识得分的影响显著,家庭收入、儿童年龄对家长态度得分影响显著。家长从社区宣传中获得知识只占14.9%。结论:家长对儿童意外伤害的KAP是相互关联的。家长意外伤害知识欠缺,随着儿童年龄增长,家长侥幸心理增加,社区卫生工作者应加强儿童意外伤害的健康教育。     

德阳市851例学龄前儿童龋患调查分析

目的了解本地区学龄前儿童龋齿发病的年龄分布特点,口腔保健与儿童患龋率的发生关系。方法采用随机整群抽样的调查方法对德阳市851例学龄前儿童的龋患情况和口腔卫生习惯进行调查,对各年龄段患龋率、龋均、口腔卫生习惯进行统计分析。结果本地区学龄前儿童患龋率为41．83％,龋均0．46,随年龄增加龋患情况逐渐加重。仅有39．8％的学龄前儿童坚持每天清洁牙齿,但开始刷牙年龄较晚。结论口腔卫生保健是防止儿童龋齿的主要方法,应加强对口腔卫生知识的指导,培养儿童良好的口腔卫生习惯,餐后漱口,保持刷牙习惯和正确的刷牙方法,避免睡前吃零食等不良习惯,能够有效地防止龋齿的发生。     

Safe storage of methadone takeaway doses - a survey of patient practice

OBJECTIVE: To determine current methadone takeaway storage practice among patients receiving supervised methadone treatment and takeaway doses at community pharmacies. METHODS: A cross-sectional survey was conducted in 2006 in Sydney, New South Wales. It addressed: safe storage of methadone takeaways; knowledge of risk of methadone ingestion by small children; and information provision from health care providers about the safe storage of methadone. RESULTS: Eighty-seven patients participated in the survey. The majority stored their methadone takeaways in a cupboard (48%) or secure cabinet (34%). All but one participant were aware of the risks of methadone ingestion by small children. Eighty-seven per cent had discussed safe storage of takeaways with a health professional. CONCLUSIONS: Most patients receiving methadone takeaways store them safely and are aware of the risk that methadone ingestion poses to children. IMPLICATIONS: Clinicians should ensure patients are adequately informed about safe takeaway storage and the risk of methadone ingestion by children.     

河北省易县学龄儿童碘营养状况调查

目的评价2011年河北省易县8～10岁学龄儿童碘营养状况,为下一步碘缺乏病防治工作提供科学依据。方法全县按东、西、南、北、中划分为5个抽样片区,在东、西、南、北片区各随机抽取2个乡镇,在中部片区随机抽取1个乡镇,共抽取9个乡镇做为监测点。于监测点随机抽取部分儿童开展甲状腺肿调查、尿碘检测和对儿童家中食用盐进行碘盐监测。结果共调查儿童甲状腺肿1 781人,甲状腺肿大率3.87%;监测尿样100人份,尿碘中位数为204.12μg/L;监测学生家中食用盐1 770份,合格碘盐食用率98.14%。结论目前易县学龄儿童碘营养状况良好,各项指标均达到国家碘缺乏病消除标准,与1993年前比较碘营养状况有显著改善。     

Current practice in the management of children with cerebral palsy: a national survey of paediatric dietitians

Background Dietitians play a key role in the clinical management of children with cerebral palsy. This survey was conducted with the aim of establishing an overview of current dietetic practice in the management of these children. Method A questionnaire which asked for information on aspects of dietetic practice relating to children with cerebral palsy was circulated to members of the British Dietetic Association during May to October 2000. Results Many respondents had a small caseload size. However, a larger caseload was linked to membership of a multi‐disciplinary team, a greater proportion of severely disabled children and use of a wider range of anthropometric measurements. Dietitians who were members of a multi‐disciplinary team were more likely to visit children at home. Conclusions This survey provides an overview of current dietetic practice in the UK regarding the management of children with cerebral palsy. There is a potential shortfall in specialist dietitians and this survey highlights some of the gaps in service provision. Children with cerebral palsy benefit from dietetic input and there is an increasing need for specialist dietitians to be involved in their management. It will be necessary to continue to identify any gaps and find ways to overcome them.