Contraception and adolescents

Although adolescent pregnancy rates in the United States have decreased significantly over the past decade, births to adolescents remain both an individual and public health issue. As advocates for the health and well-being of all young people, the American Academy of Pediatrics strongly supports the recommendation that adolescents postpone consensual sexual activity until they are fully ready for the emotional, physical, and financial consequences of sex. The academy recognizes, however, that some young people will choose not to postpone sexual activity, and as health care providers, the responsibility of pediatricians includes helping teens reduce risks and negative health consequences associated with adolescent sexual behaviors, including unintended pregnancies and sexually transmitted infections. This policy statement provides the pediatrician with updated information on contraception methods and guidelines for counseling adolescents.     

Psychosocial aspects of infertility and decisions about reproduction in young cancer survivors: a review.

BACKGROUND: Several types of cancer treatment interfere with male and female fertility or can complicate pregnancy. Rates of birth defects and cancer have also been studied in the offspring of cancer survivors. Little is known, however, about the impact of a history of cancer on survivors' attitudes, anxieties, and choices about having children of their own. PROCEDURE: We review the relevant literature on cancer survivor's concerns about infertility and childbearing and propose areas for future research. RESULTS: We generate several hypotheses, including that cancer survivors will be more distressed than infertility patients without a major medical disorder, that survivors diagnosed in adolescence will have the most anxieties about parenthood, that women will be more distressed over infertility and more concerned about their children's health than men, that survivors who rate their overall quality of life more negatively will be less concerned about infertility and more apt to decide to forego parenthood, that survivors of inheritable cancer syndromes will have more distress about childbearing issues than other survivors, and that survivors who do have children after treatment will perceive them more positively than do parents who have not confronted cancer. CONCLUSIONS: Research on the emotional aspects of infertility after cancer and on the factors that influence survivors' decisions about having children assumes increasing importance with the growth in number of survivors of reproductive age.     

Children’s exposure to intimate partner violence: Impacts and interventions

Exposure to intimate partner violence is increasingly being recognized as a form of child maltreatment; it is prevalent, and is associated with significant mental health impairment and other important consequences. The present article provides an evidence-based overview regarding children’s exposure to intimate partner violence, including epidemiology, risks, consequences, assessment and interventions to identify and prevent both initial exposure and impairment after exposure. It concludes with specific guidance for the clinician.     

A sentinel fatal paediatric case of community-associated methicillin-resistant Staphylococcus aureus in Canada

Community-associated methicillin-resistant Staphylococcus aureus is an established pathogen in many centres in the United States, but has yet to establish a firm foothold in Canada. In the present article, the authors report, to their knowledge, Canada’s first fatal paediatric case of invasive disease due to community-associated methicillin-resistant S aureus and review its pathogenesis, epidemiology and treatment.     

Case-control study of symptoms and neonatal outcome of human milk-transmitted cytomegalovirus infection in premature infants

OBJECTIVE: Preterm infants are at risk of acquiring human cytomegalovirus (CMV) infection through breast milk transmission, possibly leading to serious symptoms, as suggested by previous studies. Over a period of 8.5 years, we compared infants infected postnatally with CMV with noninfected controls to determine whether CMV infection transmitted through breast milk poses serious acute risks. STUDY DESIGN: CMV monitoring included maternal serologic testing and biweekly viral culture and polymerase chain reaction in breast milk and infant urine. Clinical and laboratory test findings were assessed retrospectively in infected infants and controls matched for gestational age during the initial hospital stay. RESULTS: Forty CMV-infected infants met the study criteria. They had lower minimal platelet and neutrophil counts and a higher frequency of C-reactive protein (CRP) elevations to 10 to 20 mg/L than their matched controls (P < or = .001). But no association of CMV infection with bronchopulmonary dysplasia, necrotizing enterocolitis, growth, or CRP elevations to > 20 mg/L was found. Cholestasis appeared in 3 infants in the CMV-infected group, but disappeared within 10 weeks. CONCLUSIONS: Neonatal symptoms related to postnatal CMV infection were transient and had no affect on neonatal outcome in these infants, in contrast with uncontrolled reports. Whether withholding or pasteurizing breast milk is warranted, however, depends on long-term outcome.     

Breastfeeding and Helicobacter Pylori Infection in Children with Digestive Symptoms

Objective

This study aims to evaluate the role of breastfeeding in the acquisition of Helicobacter pylori (H. pylori) infection in Iran and to compare the histopathologic changes occurring in children feeding on breast milk with those in infants feeding on formula.

Methods

In a case-control study parents of children with and without H. pylori infection who had undergone endoscopic survey and gastric biopsy in the Children''s Medical Center, Tehran, were asked about their feeding practices during the first 6 months after birth, the duration of breastfeeding period, the symptoms, and the duration of symptoms and concomitant diseases.

Findings

A total of 154 children were included in this study. From this sample, 77 children formed the case group and 77 children formed the control group. A significant difference was found between H. pylori infection and feeding with formula (P=0.045). In case group, a significant difference was found between breastfeeding and age of the infected child (P=0.034), shorter duration of symptoms (P=0.016), and finally degree of H. pylori colonization (P=0.021).

Conclusion

It appears that breastfeeding in the first 6 months after birth can decrease the degree of H. pylori colonization, postpone infection until older age, shorten the duration of symptoms, and be concomitant with milder gastritis.     

Travellers�� diarrhea in children

Diarrhea is the most common medical problem affecting all travellers to developing countries. Younger children are at especially high risk of acquiring travellers’ diarrhea and of suffering more severe consequences. Up to 50% of travellers from developed to developing countries can expect to have at least one episode of acute diarrhea during a two-week stay. Episodes of travellers’ diarrhea usually begin abruptly, either during travel or soon after returning home, and are generally self-limited.     

Preparation for parenting multiple birth children

The experience of expecting and parenting multiples is decidedly different from that of a singleton pregnancy and parenthood. Multiple births are associated with substantial medical, health care, socio-emotional, developmental, educational and economic consequences for both families and society. This paper aims to advise health professionals on how best to help families prepare for and successfully respond to the demands of multiple pregnancy and the first 5 years of parenthood after the births of twins, triplets or more. Four inter-related principles of good practice are vital to the care of multiple birth families: the involvement of a range of disciplines, of the family and of the multiple birth community; the provision of specialised care; coordinated services; and the building of family competency including the capacity to make informed decisions. Preparation should include education on the special aspects of multiple pregnancy and parenting using multiples-focused resources, health promotion and risk modification strategies, infant care and feeding, child development and advice on securing help and support while ensuring family participation in all care decisions.     

Radiation biology risk of imaging procedures

The environmental radiation burden of man in Germany is about 1 mGy (Milligray) per year. This is, of course, also valid for children. Due to diagnostical procedures this burden is increased to about 1.3 mGy. The question arises wether this can be neglected, or important consequences have to be drawn. To give a clear answer, the action of ionizing radiation in living cells and in organisms is explained in detail. Many of the radiation actions at the DNA can soon be repaired by the cell, if the radiation dose was small. Some damage, however will remain irreparable for the cell and consequently leads to cell death, to mutations or to cell transformation. The number of these lesion increases or decreases linearily with radiation dose. Therefore, it must be expected that the risk of tumour induction is increased to above the normal background even by the smallest doses. This small but not negligible risk has to be compared with other risks of civilization or with other medical risks. But also the benefit and the efficacy of diagnostic procedures have to be considered. A suitable cooperation of all medical doctors--not only of the radiologists--is recommended.     

Parentalité chez les personnes souffrant d’un trouble du développement intellectuel : état de la situation en France

The question of parenthood for people suffering with intellectual development disorders is new. The increasing number of people suffering from this condition and the need to fit them into our society make it a topical subject. Nevertheless, studies on this question are limited and there are no parenting assistance programs existing to date. Parents with mental disorders face problems in their exercise of parenthood while their children are more vulnerable. It is important to consider the few models in our possession to develop an efficient support network for establishing peaceful parenthood situations.     

Marriage as a public issue

Over the past fifty years, powerful cultural and social forces have made marriage less central to Americans' family lives. In reaction, the United States is now engaged in a wide-ranging debate about the place of marriage in contemporary society. In this article, Steven Nock examines the national marriage debate. He begins by reviewing the social and demographic trends that have changed the role of marriage and the family: the weakening link between marriage and parenthood caused by the contraceptive revolution, the declining significance of marriage as an organizing principle of adult life, and the increasingly accepted view that marriage and parenthood are private matters, relevant only to the individuals directly involved. He then considers the abundant scientific evidence on the positive consequences of marriage for both the economic well-being and the health of American adults. He notes that based partly on the evidence that marriage is good for adults and children, numerous public and private groups, including religious activists, therapeutic professionals, family practitioners, educators, and federal and state government officials, have initiated programs to strengthen marriage, lower divorce rates, reduce out-of-wedlock births, and encourage responsible fatherhood. He then reviews some of those programs. Nock observes that although large cultural and social forces are driving the decline in marriage, most of the new programs attempting to restore or strengthen marriage in the United States focus on changing individuals, not their culture or society. He argues that the problem cannot be addressed solely at the individual level and cautions that given how little researchers and professionals know about how to help couples get or stay married, expectations of policies in these areas should be modest. But despite the shortage of effective strategies to promote marriage, he notes, a political, cultural, and scientific consensus appears to be emerging that the best arrangement for children is to live in a family with two loving parents. He believes that the contemporary marriage debate is an acknowledgment of the cultural nature of the problem, and views it as a crucial national conversation among Americans struggling to interpret and make sense of the place of marriage and family in today's society.     

Th1/Th2 Cytokine Profile and Its Diagnostic Value in Mycoplasma pneumoniae Pneumonia

Background:

The levels of Th₁/Th₂ cytokine can alter in pathogenic infection in children with pneumonia.

Objectives:

To evaluate Th₁/Th₂ cytokine profile and its diagnostic value in M. pneumoniae pneumonia in children.

Patients and Methods:

Children with M. pneumoniae mono-infection and 30 healthy children were tested with cytokines assay. We used real time PCR to detect M. pneumoniae in children with pneumonia.

Results:

M. pneumoniae test was positive in 2188 (16.62%) out of 13161 pneumonia children. Children aged 5 - 9 years had the highest rate and summer was a season with high rate of M. pneumoniae incidence in Zhejiang province. During the course of study, in 526 pneumonia children with M. pneumoniae mono-infection and 30 healthy children cytokines assay was performed. IL-2 level of M. pneumoniae pneumonia children was lower than that of healthy children (median levels, pg/mL: IL-2: 3.2 vs. 5.7, P = 0.00), while IL-4, IL-10 and IFN-γ were higher than in healthy children (median levels, pg/mL: IL-4: 3.2 vs. 1.5, P = 0.00; IL-10: 5.6 vs. 2.5, P = 0.001; IFN-γ: 20.4 vs. 4.8, P = 0.001).

Conclusions:

IL-2 decreases and IL-4, IL-10 and IFN-γ increase in children with M. pneumoniae pneumonia, which has a promising prospect in diagnosis of this disease in clinical practice.     

Eradication of Helicobacter pylori in Children by Triple Therapy Regimens of Amoxicillin,Omeprazole, and Clarithromycin or Azithromycin

Background and Objectives:

The present study aimed to evaluate the effect of classical and azithromycin-containing triple therapy eradication regimen against H. Pylori in children, and to determine the level of patients’ tolerance.

Patients and Methods:

This single clinical trial was performed in 2014 on 2 to 15 years old children. All children, in whom H. Pylori infection was confirmed through multiple biopsies of the stomach and required treatment, were enrolled in the study. H. Pylori-positive patients were treated alternately with two different drug regimens; Group OCA received clarithromycin 7.5 mg/kg/day every 12 hours for 10 days, amoxicillin 50 mg/kg/day every 12 hours for 10 days, and omeprazole 1 mg/kg/day every 12 hours for two weeks, and Group OAA received azithromycin 10 mg/kg/day once a day (before meal) for 6 days along with amoxicillin and omeprazole. Four to six weeks after completion of treatment, patients’ stool was tested for H. Pylori through the monoclonal method using the Helicobacter antigen quick kit.

Results:

There were no significant differences between the two groups regarding gender and age of patients. Based on ITT analysis, the therapeutic response in the OAA and OCA groups were 56.2% and 62.5%, respectively (P = 0.40). Drug adverse effects were 15.6% in the OCA and 3.1% in the OAA group (P = 0.19).

Conclusions:

The therapeutic response was seen in more than half of the patients treated with triple therapy of H. Pylori eradication regimen including azithromycin or clarithromycin, and there was no significant difference between the two treatment groups.     

Biotechnologies et procréation : vers un nouveau genre de la famille et de la parentalité ?

ObjectiveThe objective is to better understand the parental and family projects of unconventional future parents in France (same-sex couples, single women, “old” mothers and couples who use a third party) from their own discourses and experiences and to question, from a socio-demographic perspective, their impact on parenthood and the family in France.MethodThree main studies conducted by the author (2008–2012) and published are mobilized. The total corpus is made up of 176 interviews with men, women and couples who mainly use biotechnologies (most often abroad) to conceive a child.ResultsThe interviews thus conducted show that individuals and couples who use biotechnologies to build a family, derogate from the dominant social norm of family and parenthood that socially defines the appropriate moment and situation to be parents (to be between 25 and 40 years old, to be a heterosexual couple into a stable and privileged relationship, and to conceive a child within this union); but doing so, they also reproduce other normative components (a two-parent child in same sex couples, the ideal of the father in single women, being a mother earlier in women over 40).ConclusionBiotechnologies contribute to the diversification of parenthood and the pluralization of families. In doing so, they participate in the deconstruction of dominant norms. However, they are embodied in projects that remain statistically marginal.     

Paediatric primary care quality and accessibility: Parents�� perspective

OBJECTIVE

To measure parents’ satisfaction with paediatric primary care quality and accessibility.

BACKGROUND

High-quality paediatric primary care is a cornerstone of efforts to improve health outcomes and access to care, as well as to control health care spending. A strong primary care infrastructure is related to improved health outcomes, including an improved mortality rate.

METHODS

A cross-sectional survey using the Parents’ Perception of Primary Care questionnaire and evidence-based items from the Rourke Baby Record were used to measure parents’ satisfaction.

RESULTS

Of 200 questionnaires sent, 130 were returned. The mean number of children per family was 1.7±0.8 (mean ± SD). Sixty-six per cent of children received their primary care from general practitioners, 19% received their primary care from paediatricians, and 15% had no regular physician and identified other professionals (community nurses, midwives or chiropractors) as their primary care providers. Parents were questioned about their child’s hearing in 66% of cases. Only 41% of parents received guidance about breastfeeding, 37% about adequate sleeping position, 17% about the dangers of second-hand smoke and 16% about car safety seats. The level of satisfaction with communication, contextual knowledge and coordination of care was higher for families followed by general practitioners and paediatricians than for families followed by nonphysicians. According to the Parents’ Perception of Primary Care scores, the overall satisfaction with primary care was higher for care given by general practitioners and paediatricians than for care given by midwives or chiropractors, and intermediate when given by nurses.

CONCLUSION

In this survey, the majority of children received their primary care from physicians, most commonly general practitioners. Parents’ overall satisfaction regarding their infant’s primary health care was higher when it was delivered by physicians than by alternative health care providers. Evidence-based guidance recommendations were rarely followed.     

For love and money? The impact of family structure on family income

What do the half-century decline in U.S. marriage and the attendant rise in single parenthood mean for the economic well-being of children, especially children living in single-parent families? Adam Thomas and Isabel Sawhill show how differing living arrangements can be expected to affect families' economic well-being. Married-parent and cohabiting households, for example, can benefit from economies of scale and from having two adult earners. The availability of child support for single-parent families and the marriage penalties in the tax and transfer system reduce but rarely completely offset the economic benefits of marriage. Consistent with these expectations, national data on family income show that across all races and for a variety of income measures, children in lone-parent families (single-parent households with no cohabiter) have less family income and are more likely to be poor than children in married-parent families. Cohabiting families are generally better off economically than lone-parent families, but considerably worse off than married-parent families. Thomas and Sawhill acknowledge the possibility that the link between famlily structure and family resources may not be causal. But new research that simulates niarriages between existing single mothers and unattached men with similar characteristics suggests that family structure does affect family resources and that child poverty rates would drop substantially if these mothers were to marry. It does not necessarily follow, however, that policymakers ought to, or even can, do anything about family structure. Marriage is not an economic cure-all for the complex problem of child poverty. It would be a mistake for policymakers to focus on promoting marriage to the exclusion of encouraging and rewarding work or addressing problems such as early out-of-wedlock childbearing. Still, Thomas and Sawhill conclude that a continuation of recent declines in single parenthood, linked most recently to declines in teen and out-of-wedlock births, offers great promise for improving the economic welfare of U.S. children.     

Attitudes regarding fertility preservation in female adolescent cancer patients

Infertility is a devastating side effect of cancer treatment. Advances in fertility research have brought new preservation techniques to the forefront for women. The implication of this research in the field of pediatric oncology has not been reported. The objective of this study was to determine whether female adolescents with a diagnosis of cancer and their parents were interested in trying to preserve fertility. We conducted a cross-sectional survey of female patients, aged 10 to 21 years, and their parents. There were 39 parent/adolescent pair responses, 3 parent-only responses, and 8 adolescent-only responses. We found that adolescents and parents had thought about the future and were interested in research treatments to help preserve fertility, but not willing to postpone cancer therapy. Achieving a state of good health was most important to the adolescent group (P<0.001). There was no statistical difference between attitudes of parents and adolescents. In summary, parents and female adolescents are interested in options to help preserve fertility during cancer treatments, but they are not willing to postpone treatment for this purpose.     

Patient attitudes toward fertility preservation

The increased survival rates for pediatric cancer patients and for some malignancies that are common in young adults, such as testicular cancer and Hodgkin disease have led to an increased focus on preserving fertility. Research on the psychosocial aspects of cancer‐related infertility is a recent development, but we know that both young men and women value parenthood after cancer. At least 75% of survivors who were childless at diagnosis would like future offspring. For those who do not become parents, long‐term distress is common. Younger teens may have difficulty assessing whether parenthood will be important to them in the future, and informed consent protocols need to respect their desires rather than deferring too much to parents. We do not know whether parenting a non‐biological child (adopted, conceived through third‐party reproduction, or a stepchild) reduces distress as much as being able to have one's own genetic offspring. Survivors often have exaggerated concerns about their children's health risks, but still prefer to have biological children if possible. More research is needed on whether participating in fertility preservation reduces long‐term distress about cancer‐related fertility. Better evidence‐based programs to educate families and reduce decisional conflict are needed. Pediatr Blood Cancer 2009;53:281–284. © 2009 Wiley‐Liss, Inc.