Developmental and psychological factors in children's pain

It is clear that previously we were ill-informed and misinformed about children's pain. Recent investigations have led not only to a burgeoning of understanding of pediatric pain, but also an increase in our ability to appropriately measure and treat children's pain. Both pharmaceutical and nonpharmaceutical treatments have made major strides in the past few years. Even more crucial is the change that has happened in the willingness of health professionals to recognize that children do suffer pain and that aggressive treatment is often indicated. However, careful consideration must be given to physiologic, cognitive, affective, and psychosocial development, both in order to maximize the effectiveness of interventions and to recognize the limits that development may place on any specific approach.     

儿童支气管哮喘相关死亡的现状与危险因素

支气管哮喘(简称哮喘)是最常见的儿童呼吸系统慢性疾病。随着吸入性糖皮质激素使用的增加,全球哮喘死亡下降了近2/3。在世界范围内,儿童哮喘死亡率非常低,为0～0.7/10万,但大多数的死亡仍存在可能避免的危险因素。哮喘死亡的危险因素包括哮喘控制不良、治疗依从性差、医师处方的药量不足、肺功能监测不足、精神心理问题以及存在有...     

血管迷走性晕厥与心理因素的关系

血管迷走性晕厥(VS)是由多种因素触发引起周围血管扩张、低血压、心动过缓及一过性脑缺血所致的自限性晕厥发作.晕厥患者的心理特质、相关的家族因素、晕厥发作过程及干预、目击血液、损伤恐惧和晕针等心因性原因在晕厥的发生及其预后中扮演重要角色.该文综述近年国外文献.强调心理因素对VS的发生、发展和预后等方面的影响不容忽视.     

心理因素所致小儿腹痛

1　非特异性腹痛　　非特异性腹痛 :是一种常见的儿童期心身疾病 ,患病率在 5 %～ 10 %。主要临床特征 :非特异性腹痛性质为弥漫性疼痛 ,常常为发作性过程 ,持续数十分钟或数小时而自行缓解 ;疼痛程度并不剧烈 ,多数为隐隐作痛 ,可以伴有恶心、呕吐等症状 ;疼痛部位不定 ,以上腹部或者脐周为多见 ,也可以讲不清具体疼痛部位 ;临床检查或实验室检查往往没有阳性发现 ;一般不具备慢性器质性疼痛的特点 :如疼痛部位比较局限 ,常有夜间发作等 ,多数有特殊的体征。原因不明 ,常见原因有以下几种 :①情绪因素 :非特异性腹痛与情绪改变有关 ,所有能…     

Confronting obesity in children: behavioral and psychological factors

The problem of obesity in children must be taken seriously and treated aggressively. The long-term psychological, social, and medical consequences of childhood obesity can be quite serious. Behavior modification has shown new promise compared to the discouraging results of traditional approaches such as inpatient starvation, the use of appetite suppressants, and dietary counseling. The behavioral program involves a systematic approach to nutrition, exercise, eating patterns, attitudes, and family support.     

Assessment and treatment of psychological factors in pediatric chest pain

Chest pain is regularly encountered in pediatric medical settings and may be associated with many organic diagnoses that vary widely in morbidity and mortality. Patients with chest pain with and without organic disease may also suffer from comorbid, exacerbating, or causal psychopathology. This article provides practical general guidelines for psychological diagnosis and alleviation of emotional and behavioral difficulties. Specific medical conditions that may benefit from psychological consultation are highlighted. Pediatric chest pain, including an analysis of medically unexplained chest pain, is examined from a psychological perspective that includes a critical review of relevant literature and suggestions for the clinical management of this condition.     

Implications of psychological and family factors in the treatment of diabetes

The authors delineate and discuss in detail those psychological and familial factors that have implications in treatment and in fostering the optimal emotional and physical health of children and adolescents with diabetes mellitus.     

Self-reported level of and factors influencing the compliance to desferrioxamine therapy in multitransfused thalassaemias

Aim: To analyse the self‐reported degree of and factors influencing the compliance to desferrioxamine (DFO) therapy in children with transfusion‐dependent thalassaemia major in Malaysia. Methods: A cross‐sectional study was conducted on all children with thalassaemia major on DFO attending Likas Hospital, Sabah, in September 2008. Patients or carer‐providers were interviewed to report on the degree of compliance as either highly (administering >90% of DFO), moderately (51–90%), poorly (1%–50%) or non‐compliant (0%) to DFO in the preceding month. The latest serum ferritin levels were noted. Results: The median (range) age at first blood transfusion of these 139 (73 males, median (range) age at interview: 9.0 years (2–16 years)) patients were 1.0 year (2 months to 10 years). The median (range) duration of regular DFO therapy was 2 years (2 months to 10 years). Forty‐three (31%) of the patients reported themselves to be highly compliant, 70 (50%) moderately and 26 (19%) poorly or non‐compliant. Multivariate analysis showed that a lower family income negatively affected the degree of compliance, while family support positively affected the degree of compliance to DFO. No correlation existed between self‐reported degree of compliance and latest serum ferritin level (6444 ± µmol/L; P = 0.186). Conclusion: The self‐reported compliance to DFO therapy was moderate in this cohort of patients with thalassaemia major in Malaysia. The serum ferritin level was high, possibly because of the relatively short duration of DFO therapy and compliance. Oral iron chelator should be considered to improve the compliance to iron chelation.     

癫癎儿童心理状态及影响因素的调查研究

目的评估癫癎儿童的心理状态,分析影响癫癎儿童心理状态的可能因素。方法采用儿少心理健康量表(MHS-CA)对113例癫癎儿童和114例正常儿童进行心理状态评定及比较。癫癎组儿童填写患儿一般情况和癫癎病情及治疗情况调查表。正常对照组儿童填写儿童一般情况调查表。分析影响癫癎儿童心理状态的可能因素。结果癫癎儿童在认知、思维、情绪、意志行为、个性特征上的心理健康状态均低于对照组儿童,差异有统计学意义(P0.05)。多因素logistic回归分析显示家庭教育方式、家庭关系、癫癎发作频率、癫癎发作持续时间、近6个月EEG癎样放电、抗癫癎药物使用种数为影响癫癎儿童心理状态的危险因素。结论癫癎儿童较正常儿童存在更广泛的心理健康问题。家庭生活环境差、癫癎控制不佳及多种抗癫癎药物应用是影响癫癎儿童心理状态的危险因素;改善家庭生活环境,尽量控制癫癎发作及使用单药治疗有助于改善癫癎患儿心理状态。