Health care and its costs for children with perinatally acquired HIV infection

Objective : To describe survival patterns, use of health services and related costs for Australian children with perinatally acquired human immunodeficiency virus (HIV) infection.
Methodology : A retrospective cross-sectional survey was made of 20 children with HIV infection (91% of those diagnosed) and 13 children with maternal antibodies who subsequently seroreverted, treated at 10 medical centres. Details of disease progression and use of health services were obtained from hospital medical records. Monthly costs for three phases of infection were estimated by linking service usage rates with estimates of the unit cost of each service. The average lifetime cost was estimated by combining monthly costs and phase duration estimates from the literature.
Results : Patterns of disease progression were similar to those reported internationally, with a median survival of 8 years. Use, of health services increased with severity of illness. Mean monthly costs were $120 per month (1992 Australian dollars) for children with maternal antibodies who subsequently seroreverted, $320 per month for children with HIV infection but no acquired immunodeficiency syndrome (AIDS)-defining illness, and $1830 per month for children with AIDS. The present value of total lifetime cost for a child with HIV infection was $48174,46% of which was for treatment of AIDS.
Discussion : The mean lifetime cost for a perinatally infected child was just over half that for a man with HIV in Australia. Health service usage and costs were lower for Australian than American children with HIV.     

PREDICTORS OF BEREAVED PARENTS' SATISFACTION WITH GROUP SUPPORT: AN ISRAELI PERSPECTIVE

This study evaluates various aspects of groupwork with bereaved parents who lost a child during military service. More specifically, it assesses the unique and cumulative contributions of various features of groupwork to the participants' satisfaction with the group support. One hundred and thirty-eight bereaved parents, who participated in 16 support groups, answered a battery of questionnaires tapping 3 aspects of the groupwork: their motives for joining the group, the interpersonal relations among the group members, and the group leadership style. In addition, the participants were asked to evaluate the contribution of the intervention to their adjustment. The findings indicate that the supportive elements of the intervention were associated with the groups' perceived contribution. The clinical implications of these results are discussed.     

The effect of dental education and dental treatment on the dental status of a handicapped population: a longitudinal study

Thirty-nine patients, aged 3 to 22, who have handicapping conditions were examined twice in a range of 1 1/2 years to determine oral hygiene level, periodontal treatment needs, and level of caries. During this period, each patient was given periodontal treatment, including scaling, caries treatment, and oral health education, which also was given to hospital staff members. Findings showed a slight increase in the DMF rate, a minor improvement in oral hygiene, and a significant reduction in periodontal treatment needs. The results showed that without cooperation of the staff members, a dental education program would not succeed in this setting.     

Distress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics

This study analysed the frequency of distress at induction (DAI) in 2122 paediatric patients. The data were analysed to assess predictors of DAI and to examine associations between predictors of DAI and recovery characteristics. Patient age, preoperative behaviour, premedication (oral midazolam, n =480) and venue for anaesthesia induction were associated with changes in the incidence of DAI. Distressed preoperative behaviour was a good predictor of DAI in all age groups. Premedication reduced the incidence of DAI in children aged 0.5–2 years old, and in older children who were distressed preoperatively. Induction in the Day Surgery Unit was associated with a reduction of the incidence of DAI in younger children. Children with DAI were more likely to suffer from distress at arousal ( P =0.001). Average early recovery time was prolonged 4.4 minutes and average discharge time in daypatients was delayed 36 minutes by the use of oral midazolam premedication. Premedication was not significantly associated with arousal distress. We conclude that a policy of optimizing nonpharmacological approaches for minimizing induction distress, combined with selective premedication with oral midazolam, can produce a low incidence of induction distress and adverse effects.     

Naming norms for brief environmental sounds: Effects of age and dementia

Brief nontonal sounds are used in electrophysiology in the novelty oddball paradigm. These sounds vary in the brain activity they elicit and in the degree to which they can be identified, named, and remembered. Because ease of sound identification may influence sound processing, naming and conceptual norms were determined for 100 sounds for 77 young adults (Experiment 1). Naming ability decreases in normal and pathological aging. Therefore, norms were also derived for older adults (Experiment 2) and for probable Alzheimer's disease patients (Experiment 3). With respect to the young adults, perseverative naming behavior increased in these groups, and sound and picture naming performance were correlated. In Experiment 4, the sound-naming performance of children aged 5–6, 9–11, and 14–16 yers was compared. Name and conceptual agreements improved with age, whereas perseverative behavior decreased. These normative data should be useful in guiding sound selection in future studies and help clarify the relationships between sound naming and other variables, including direct and indirect memory performance.     

Stability of caregiver‐reported manual ability and gross motor function classifications of cerebral palsy

Aim To examine the stability of caregiver‐reported classifications of function of children with cerebral palsy (CP) measured 12 months apart. Method Participants were 86 children (50 males, 36 females) with CP of all motor types and severities who were recruited into a population‐based longitudinal study. Children were aged 11 years 8 months (SD 6mo) on the first assessment and 12 years 8 months (SD 6mo) on the second assessment. Data were gathered through a postal survey. Caregivers reported on the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and other demographic characteristics. The percentage absolute agreement and the intraclass coefficient correlation (ICC) equivalent of the weighted kappa were calculated to assess consistency between assessments for the MACS and GMFCS. We also examined associations between changes in classification and background variables. Results Fifty‐eight caregivers (67%) classified their child at the same MACS level on both assessments (ICC 0.92; 95% confidence interval [CI] 0.87–0.95), whereas 79% did so with the GMFCS (ICC 0.95; 95% CI 0.92–0.96). The evidence suggests that caregivers who were not born in Australia or who spoke a language other than English in the home were more likely to classify their child differently on the MACS at the second assessment, although this was not evident for the GMFCS. Interpretation Caregiver‐reported MACS and GMFCS levels were generally stable over 12 months.