Current trends in paediatric and neonatal ventilatory care – a nationwide survey

Aim: To assess daily practices in paediatric and neonatal ventilatory care in Finland. Methods: All neonatal and paediatric intensive care units in Finland were sent a questionnaire on ventilatory strategies and were offered a 3‐month prospective survey. Results: A total of 96% of units returned the questionnaire, and clinicians agreed on most of the principles of lung‐protective ventilation. Seventeen hospitals (94%) joined the prospective survey. On average, 2.3 new ventilation episodes were started daily, and totally 211 episodes were monitored. Pulmonary problems (64%) were the main cause of treatment in neonates and postoperative care (68%) in older children. Synchronized intermittent mandatory ventilation with pressure support was the primary mode in 42% of episodes. Hypocapnia was observed repeatedly in all units. In adult intensive care units, children often received high oxygen fraction, leading to hyperoxia, and they were frequently sedated with propofol, which is not licensed for that purpose. A large proportion of children had only light sedation or no sedation at all. Despite the different strategies and practices, most episodes resulted in a favourable outcome. Conclusion: Most of the principles of lung‐protective ventilation have been well accepted by clinicians. More attention should be paid to achieving normocapnia and normoxia and to the correct use of sedatives, especially in units that only occasionally provide paediatric ventilation.     

Rhinovirus species and clinical characteristics in the first wheezing episode in children

The clinical data on the first wheezing episodes induced by different rhinovirus (RV) species are still limited. We aimed to investigate the prevalence of RV genotypes, sensitization status, and clinical characteristics of patients having a respiratory infection caused by either different RV species or other respiratory viruses. The study enrolled 111 patients (aged 3–23 months, 79% hospitalized, 76% with RV infection) with the first wheezing episode. RV‐specific sequences were identified by partial sequencing of VP4/VP2 and 5′ non‐coding regions with 80% success rate. The investigated clinical and laboratory variables included atopic characteristics and illness severity, parental atopic illnesses, and parental smoking. Of the study children, 56% percent had > 1 atopic characteristic (atopy, eczema and/or blood eosinophil count > 0.4 × 10⁹/L) and 23% were sensitised to allergens. RV‐C was detected in 58% of RV positive samples, followed by RV‐A (20%) and RV‐B (1.2%). Children with RV‐A and RV‐C induced wheezing were older (P = 0.014) and had more atopic characteristics (P = 0.001) than those with non‐RV. RV‐A and RV‐C illnesses had shorter duration of preadmission symptoms and required more bronchodilator use at the ward than non‐RV illnesses (both P < 0.05, respectively). RV‐C is the most common cause of severe early wheezing. Atopic and illness severity features are associated with children having RV‐A or RV‐C induced first wheezing episode rather than with children having a non‐RV induced wheezing. J. Med. Virol. 88:2059–2068, 2016. © 2016 Wiley Periodicals, Inc.

     

Classroom climate and the mental health of primary school children

This study was carried out to examine associations between classroom climate and pupils' mental health in primary school, and whether pupils who had emotional and behavioural problems in the second grade are more vulnerable to the effects of a poor classroom climate 4 years later. The study was carried out by means of questionnaires to teachers. The students (n = 861) were surveyed in the second (aged 8 years, Time 1) and sixth grade (aged 12 years, Time 2). The Rutter Teacher Questionnaire (RB2) at Time 1 and the Teacher Report Form (TRF) at Time 2 were used to measure internalizing, externalizing and total problem scores. Classroom climate was measured using a composite variable at Time 2. The results show associations between poor sixth-grade classroom climate and an increase in emotional and behavioural problems in both boys and girls. In addition, the girls who were overall poorly adjusted, particularly those who had externalizing problems in the second grade, were especially vulnerable to a poor classroom climate in the sixth grade.     

Process indicators from ten centres in the Finnish breast cancer screening programme from 1991 to 2000

The aim of this study was to evaluate the quality of the Finnish mammography programme by assessing process indicators from 10 screening centres using data from the first and subsequent screens. We compared these screen-specific indicators with European standards and results from countries with similar screening protocols. Ten Finnish centres invited approximately 1,000,000 women from 1991-2000. Women were mainly 50-64 years old. Mean compliance amongst this age group was 90% at the first and 93% at subsequent screens. The corresponding recall rates were 4.6% and 2.3%, respectively. The average breast cancer detection rates were 0.44% and 0.36%, respectively. The positive predictive values (PPVs) of mammography at the first and subsequent screens were 10% (range 7-20%) and 16% (range 12-31%), and the corresponding benign to malignant (B:M) biopsy ratios were 1:1 (range 0.5-1.8:1) and 0.4:1 (range 0.3-0.8:1). The PPV of mammography increased significantly during the study period, and the average process indicators fulfilled the criteria of the European community for the most part. However, the variation in PPVs was wide, as has been seen for other European mammography programmes, indicating meaningful differences in diagnostic criteria and potential adverse effects.     

Parental mental health and children's adjustment: the quality of marital interaction and parenting as mediating factors

BACKGROUND: Research has put emphasis on the process of transmission of mental-health problems from parents to children. This study examines the specificity of the interpersonal relationships mediating these symptoms. METHOD: Information about parent and child mental health, marital interaction, and parenting was received from 527 mothers and fathers. Information about child mental health was also received from their 12-year-old children (260 girls and 267 boys). RESULTS: The results confirm that parental mental-health problems can compromise a mother's and father's parenting abilities and represent a threat to their children's adjustment. The results suggest that the different types of parental mental-health problems initiate specific paths between parental and child mental-health problems. The results also reveal examples of how the mediation may depend on both the parents' and the children's gender. CONCLUSIONS: The results further suggest that opposite-sex parenting is important to children's adjustment during the years of early adolescence. Keywords: Child development, epidemiology, gender, marital relationships, mental health, parenting.     

Four-year follow-up study of sleep and psychiatric symptoms in preadolescents: relationship of persistent and temporary sleep problems to psychiatric symptoms

The course of sleep disturbances in preadolescents was assessed during a 4-year follow-up, and psychiatric problems associated with persistent and temporary sleep problems were investigated in an epidemiological setting. A representative random sample of 1,290 children, their parents, and school teachers filled out various questionnaires when the children were aged 8 and 12 years. Response rates to the relevant items varied between 66.8% and 81.2%. Parental reports of sleep problems decreased from 23.4% to 9.1% during the 4-year period, whereas children's reports remained steady at 18%. Persistent sleep disturbances were found in 12% of children, and 33.3% of sleep problems reported at age 8 were continued. Both current and persistent sleep disturbances were associated with the broad range of mental health problems reported by teachers. However, multivariate modeling suggested that especially current sleep problems were associated with an increased risk for psychiatric problems (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.20-4.99), particularly emotional problems (OR 2.92; 95% CI 1.58-5.38).     

Caring for Children of Parents with Mental Health Problems — A Venture into Historical and Cultural Processes in Europe

Parental mental health disorders present a major risk for children's psychiatric disorders and intergenerational chain of social exclusion. Work Package 5 (WP5) in the CAMHEE programme was an initiative on the European level to bring children and families with parental mental illness onto the European agenda. Partners in WP5 came from Austria, Bulgaria, Finland, Lithuania, Norway and Romania. The WP5 experiences emphasise that it is important for every country to learn what the legal, human rights, and service and life situation is for these children and families and to take preventive and promotion action. To avoid further stigmatisation, awareness campaigns and training of professionals are to capitalise on resilience and support for children and parenting rather than on risks. Psychiatric services for adults are to respond to the needs for care and support of the patients’ children. Changes in all levels of the society are needed, including redirecting legislation from restrictive measures towards promotion and prevention.