Relationship Between Waiting Time, Anxiety and Sleep Disturbances Among Saudi Parents of Children Admitted to Pediatric Intensive Care Unit

Parents of children admitted to PICU experience extreme level of anxiety. It is an extremely difficult process for parents to make a transition from parents of well-child to parents of acutely ill child. Aim: To identify the relationship between waiting time, anxiety and sleep disturbances among saudi parents of children admitted to pediatric intensive care unit. Methods: A cross sectional descriptive correlational study design was employed to conduct this study on a convienience sample of 115 adult parents of children admitted to the PICU. Participants were asked to complete three questionnaire survey including participant’s demographic background, Spielberger State-Trait Anxiety Inventory, and a parental sleep disturbance questionnaire. An explanation about the purpose and the nature of the study was offered for each individual potential participant. Subjects were assured about the confidentiality of the collected data and that it will be only used by the researcher for the purpose of the current study. Data were analyzed using SPSS version 22. Results: More than half of the participants (62.6%) scored 12 and above reflecting considerable levels of anxiety. A very significant precentage (92.7%) of the parents reported sleep problems. Three quarters of the participants (73.2%) mentioned that sleep problems affected them negatively. There was a highly statistically significant difference between groups with different educational background in relation to anxiety, as well Unemployed participants experienced significantly higher anxiety. Conclusion: The findings of this exploratory study indicate considerable levels of anxiety and changes in sleep pattern of parents of children admitted to paediatric intensive care unit. During this period, identifying the parental needs and the causes of anxiety might contribute to parents' mental health. Keywords: PICU, Parental Anxiety, waiting time, sleep disturbances DOI: 10.7176/JHMN/71-11 Publication date: February 29th 202

Comparison of Two Methods of Pediatric Triage Education

Introduction. The majority of pediatric emergency patients are seen in mixed-age emergency departments and triaged by general emergency nurses. Educational methods for teaching pediatric triage education to general emergency nurses have not been well studied, and previous studies of the use of the Emergency Severity Index in children have been performed primarily in centers that are high volume for pediatrics. Methods. A repeated measures, randomized crossover study comparing two different methods of pediatric triage education was conducted. Participants were general emergency triage nurses recruited from a general emergency department that is classified as low volume for pediatrics. Each participant was exposed to both educational methods: paper case studies and high fidelity simulation. Results. All participants had substantial improvement in pediatric triage accuracy as measured by a standardized set of pediatric cases. The previously reported trend towards undertriage of the pediatric patient was observed despite a mean triage agreement rate of 73% at the end of the study period. No differences were observed between groups; the order of the educational intervention did not result in statistically significant differences in triage accuracy. Discussion. A combined approach of paper case studies and high fidelity simulation was effective at improving pediatric triage accuracy among a group of general emergency department nurses with limited exposure to pediatric patients. Persistent trends in undertriage should be studied further

Enhancing linkage to HIV care in the "universal test and treat" era: barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa

Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the 'Universal Test and Treat' (UTT) strategy - initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients' perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the feldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identifed. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefciency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and efective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and fnancial support.

Reducing vision impairment in children through health system assessment and strengthening approach in Papua New Guinea.

Doctoral Degree. University of KwaZulu-Natal, Durban.ABSTRACT A strong and efficient integrated health system is able to contribute to the reduction of vision impairment among children by ensuring preventive measures are implemented and timely access to care is done in case of morbidity. Children in Papua New Guinea presenting late for congenital cataract surgery, incurring avoidable eye injuries, living with uncorrected refractive error and some presenting with advanced retinoblastoma were of concern to the researcher. The overall aim of the study was to assess how the current health system in Papua New Guinea is addressing child eye health using Port Moresby General Hospital and Goroka hospital as case studies. It is envisaged that a health strengthening approach benefits children’s eye health in the community. Methods Both quantitative and qualitative methods were employed. Retrospective medical records review of children seen at the eye clinic in Port Moresby and Goroka Hospitals from January 2015 to December 2017 was conducted. In the qualitative method service providers and caregivers were interviewed to obtain their perspectives regarding performance of the health system. Results At Port Moresby General Hospital trauma, conjunctivitis and corneal ulcers accounted for 21.6%, 18.9% and 9% respectively of all the diagnoses among children. Trauma was in the ratio of 1:1 (p= 0.264) male to female. And 7.3% (n=51) of the children were blind (according to the WHO definition). Among the blind children optic nerve disorders accounted for 20.5 %( n=14) followed by both un-operated cataracts and uncorrected refractive error each at 13.2% (n=9). Retinoblastoma presented at mean age 5.869 (SD4.5) and 6.02(SD 2.4) years for girls and boys respectively. The main causes of ocular morbidity observed at Goroka Hospital were corneal ulcers (24.9%), uveitis (9.3%) and foreign bodies (9.2%). Service provider interviews revealed lack of policy on child eye health, shortage of health personnel and limited community eye health services. But among care givers lack of eye health information in the community, concerns about long waiting time at the hospitals and inadequate explanation about conditions affecting the children featured prominently. Conclusion Findings show a higher percentage of blind children compared to similar hospital based studies elsewhere. To achieve universal eye health coverage, raising awareness about child eye health needs among leaders in health is urgent. Successes registered in the past in Papua New Guinea in other child health efforts like immunisation suggest that a consistent and focused health system strengthening approach with greater integration may contribute to reduction of vision impairment among children. A proposed child eye health strategy based on the findings from this study is included in this thesis

A systematic review of game technologies for pediatric patients

[EN] Children in hospital are subjected to multiple negative stimuli that may hinder their development and social interactions. Although game technologies are thought to improve children's experience in hospital, there is a lack of information on how they can be used effectively. This paper presents a systematic review of the literature on the existing approaches in this context to identify gaps for future research. A total of 1305 studies were identified, of which 75 were thoroughly analyzed according to our review protocol. The results show that the most common approach is to design mono-user games with traditional computers or monitor-based video consoles, which serve as a distractor or a motivator for physical rehabilitation for primary school children undergoing fearful procedures such as venipuncture, or those suffering chronic, neurological, or traumatic diseases/injures. We conclude that, on the one hand, game technologies seem to present physical and psychological benefits to pediatric patients, but more research is needed on this. On the other hand, future designers of games for pediatric hospitalization should consider: 1. The development for kindergarten patients and adolescents, 2. Address the psychological impact caused by long-term hospitalization, 3. Use collaboration as an effective game strategy to reduce patient isolation, 4. Have purposes other than distraction, such as socialization, coping with emotions, or fostering physical mobility, 5. Include parents/caregivers and hospital staff in the game activities; and 6. Exploit new technological artifacts such as robots and tangible interactive elements to encourage intrinsic motivation.This work is supported by the Spanish Ministry of Economy and Competitiveness and the European Development Regional Fund (EDRF-FEDER) with Project TIN2014-60077-R.El Jurdi, S.; Montaner-Marco, J.; García Sanjuan, F.; Jaén Martínez, FJ.; Nácher-Soler, VE. (2018). A systematic review of game technologies for pediatric patients. Computers in Biology and Medicine. 97:89-112. https://doi.org/10.1016/j.compbiomed.2018.04.019S891129

Family-centred care for hospitalised children aged 0-12 years (Review)

This is an update of the Cochrane systematic review of family-centred care published in 2007 (Shields 2007). Family-centred care (FCC) is a widely used model in paediatrics, is thought to be the best way to provide care to children in hospital and is ubiquitous as a way of delivering care. When a child is admitted, the whole family is affected. In giving care, nurses, doctors and others must consider the impact of the child's admission on all family members. However, the effectiveness of family-centred care as a model of care has not been measured systematically. To assess the effects of family-centred models of care for hospitalised children aged from birth (unlike the previous version of the review, this update excludes premature neonates) to 12 years, when compared to standard models of care, on child, family and health service outcomes. In the original review, we searched up until 2004. For this update, we searched: the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library, Issue 12 2011); MEDLINE (Ovid SP); EMBASE (Ovid SP); PsycINFO (Ovid SP); CINAHL (EBSCO Host); and Sociological Abstracts (CSA). We did not search three that were included in the original review: Social Work Abstracts, the Australian Medical Index and ERIC. We searched EMBASE in this update only and searched from 2004 onwards. There was no limitation by language.\ua0We performed literature searches in May and June 2009 and updated them again in December 2011. We searched for randomised controlled trials (RCTs) including cluster randomised trials in which family-centred care models are compared with standard models of care for hospitalised children (0 to 12 years, but excluding premature neonates). Studies had to meet criteria for family-centredness. In order to assess the degree of family-centredness, we used a modified rating scale based on a validated instrument, (same instrument used in the initial review), however, we decreased the family-centredness score for inclusion from 80% to 50% in this update. We also changed several other selection criteria in this update: eligible study designs are now limited to randomised controlled trials (RCTs) only; single interventions not reflecting a FCC model of care have been excluded; and the selection criterion whereby studies with inadequate or unclear blinding of outcome assessment were excluded from the review has been removed. Two review authors undertook searches, and four authors independently assessed studies against the review criteria, while two were assigned to extract data. We contacted study authors for additional information. Six studies found since 2004 were originally viewed as possible inclusions, but when the family-centred score assessment was tested, only one met the minimum score of family-centredness and was included in this review. This was an unpublished RCT involving 288 children post-tonsillectomy in a care-by-parent unit (CBPU) compared with standard inpatient care.The study used a range of behavioural, economic and physical measures. It showed that children in the CBPU were significantly less likely to receive inadequate care compared with standard inpatient admission, and there were no significant differences for their behavioural outcomes or other physical outcomes. Parents were significantly more satisfied with CBPU care than standard care, assessed both before discharge and at 7 days after discharge. Costs were lower for CPBU care compared with standard inpatient care. No other outcomes were reported. The study was rated as being at low to unclear risk of bias. This update of a review has found limited, moderate-quality evidence that suggests some benefit of a family-centred care intervention for children's clinical care, parental satisfaction, and costs, but this is based on a small dataset and needs confirmation in larger RCTs. There is no evidence of harms. Overall, there continues to be little high-quality quantitative research available about the effects of family-centred care. Further rigorous research on the use of family-centred care as a model for care delivery to children and families in hospitals is needed. This research should implement well-developed family-centred care interventions, ideally in randomised trials. It should investigate diverse participant groups and clinical settings, and should assess a wide range of outcomes for children, parents, staff and health services

Long-term outcome of oral health in uncooperative young patients with caries treated under general anaesthesia

Εισαγωγή Τα πολύ μικρά παιδιά και τα παιδιά με ειδικές ανάγκες με εκτεταμένες τερηδονικές βλάβες συχνά έχουν μειωμένη δυνατότητα συνεργασίας στον οδοντίατρο με αποτέλεσμα να μην λαμβάνουν ποιοτική οδοντιατρική θεραπεία. Πολύ συχνά η θεραπεία κάτω από γενική αναισθησία αποτελεί θεραπεία επιλογής γι’ αυτές τις ομάδες παιδιών (Vermeulen et al 1991). Δυστυχώς ένα πολύ συχνό εύρημα στα μικρά παιδιά τα οποια λεμβανουν οδοντιατριτρικη θεραπεια κάτω απο Γ.Α. είναι η επανεμφάνιση της τερηδόνας (Almeida et al 2000, Gizani et al 2001) παρόλες τις συχνές επανεξετάσεις και το προληπτικό πρόγραμμα (νέες τερηδονικές βλάβες: 37-52% των παιδιών, 6 μήνες μετά την Γ.Α., Graves et al. 2004, Berkowitz et al. 2011). Υπάρχουν πολύ λίγες μελέτες που αφορούν την αξιολόγηση της στοματικής κατάστασης των παιδιών μετά την Γ.Α. και ακόμα λιγότερες όσον αφορά την αξιολόγηση της κλινικής κατάστασης χρόνια μετά την Γ.Α. Έτσι οργανώσαμε μια μελέτη με σκοπό να καταγραφούν τα δεδομένα της στοματικής κατάστασης και της οδοντιατρικής συμπεριφοράς μη συνεργάσιμων παιδιών τόσο υγιών όσο και ατόμων με ειδικές ανάγκες αρκετά χρόνια μετά από οδοντιατρική θεραπεία κάτω από γενική αναισθησία. Επιπλέον καταγράψαμε τις δυσκολίες που προέκυψαν στην εκπόνηση μιας τέτοιας μελέτης. Υλικά και Μέθοδος Το δείγμα της μελέτης αρχικά αποτελούταν από 120 ασθενείς της Μεταπτυχιακής Κλινικής της Παιδοδοντιατρικής (ΕΚΠΑ) οι οποίοι υποβλήθησαν σε γενική αναισθησία για οδοντοθεραπεία από το 2005 μέχρι το 2017, στο νοσοκομείο Παίδων «Αγία Σοφία». Οι κύριοι λόγοι που η οδοντιατρική θεραπεία πραγματοποιήθηκε κάτω από γενική αναισθησία ήταν η μη συνεργασία των παιδιών σε συνδυασμό με τις εκτεταμένες τερηδονικές βλάβες και τα προβλήματα υγείας των παιδιών. Τα παιδιά θα έπρεπε να είναι μικρότερα από 18 ετών την περίοδο της έρευνας. Το πρωτόκολο εγκρίθηκε από την επιτροπή Ηθικής και Δεοντολογίας της Οδοντιατρικής Σχολής Αθηνών και έντυπο συγκατάθεση υπεγράφει τόσο από τα παιδιά όσο και από τον νόμιμο κηδεμόνα τους. Πληροφορίες αρχικά συλλέγθησαν από τα αρχεία του Πανεπιστημίου, που αφορούσαν την οδοντιατρική κατάσταση των ασθενών κατά την πρώτη τους επίσκεψη καθώς και την θεραπεία που έλαβαν κάτω από γενική αναισθησία. Η επαφή με τους γονείς έγινε τηλεφωνικώς από την γραμματεία της μεταπτυχιακής κλινικής της παιδοδοντιατρικής, μεταξύ Ιανουαρίου 2019 και Οκτωβρίου 2020. Όταν το νούμερο δεν ήταν διαθέσιμο ή δεν ήταν ενεργό, γινόταν αναζήτηση του τρέχοντος αριθμού στον τηλεφωνικό κατάλογο ή στο διαδίκτυο. Τέλος όταν η επιοινωνία ήταν αδύνατη ο ασθενής αποκλειόταν από την μελέτη. Όσοι ασθενείς κατάφεραν να εντοπιστούν, κλήθηκαν να συμπληρώσουν ένα ερωτηματολόγιο και να προς΄λεθουν στο πανεπιστήμιο για κλινική εξέταση, καθαρισμό και φθορίωση. Χρησιμοποιώντας ένα ερωτηματολόγιο 44 ερωτήσεων, συγκεντρώθηκαν πληροφορίες για τα δημογραφικά και κοινωνικο-οικονομικά χαρακτηριστικά της οικογένειας, όπως και πληροφορίες που αφορούσαν το ιατρικό ιστορικό, τις συνήθειες στοματικής υγιεινής και τις διατροφικές συνήθειες των ασθενών. Τέλος μέσω του ίδιου ερωτηματολογίου συλλέχτηκαν στοιχεία που αφορούσαν την επισκεψιμότητα των ασθενών στον οδοντίατρο μετά την ολοκλήρωση της θεραπείας κάτω από γενική αναισθησία. Στους ασθενείς που αρνήθηκαν να προσέλθουν στην μεταπτυχιακή κλινική, πραγματοποιήθηκε συνέντευξη με τις ίδιες ερωτήσεις τηλεφωνικώς. Κατά τη διάρκεια του ραντεβού και πριν την κλινική εξέταση, κάθε ασθενής ερωτήθηκε να υποδείξει, με την βοήθεια των γονέων όποτε αυτό κρινόταν απαραίτητο, μια από τις πέντε εικόνες της κλίμακας the facial image scale που θεωρούταν η πιο αντιπροσωπευτική του άγχους του για τον οδοντίατρο την συγκεκριμένη στιγμή (Buchanan et al. 2002). Η στοματική υγιεινή καταγράφηκε με την βοήθεια το δείκτη καθαρότητας (Lindhe 1982), και στις τέσσερις επιφάνειες όλων των υπαρχώντων δοντιών χρησιμοποιώντας περιοδοντική μύλη και χωρίς αποκαλυπτικό διάλυμα. Στην συνέχεια πραγματοποιούταν καθαρισμός και καταγραφή της τερηδονικής εμπειρίας σε κάθε παιδί χρησιμοποιώντας τα κριτήρια του ICDAS II (Ismail et al., 2007). Το DMF σκορ υπολογιζόταν στην συνέχεια για κάθε συμμετέχοντα, όπου η παράμετρος D αντιστοιχούσε στα ICDAS 3, 4, 5. Αποτελέσματα Δείγμα - Από τους 120 ασθενείς που πληρούσαν τα κριτήρια της μελέτης, 79 ασθενείς προσεγγίστηκαν τηλεφωνικώς. Από αυτούς, μόνο 10 αρνήθηκαν να συμπληρώσουν το ερωτηματολόγιο κυρίως λόγω έλλειψης ενδιαφέροντος για την μελέτη. Επομένως το τελικό δείγμα της μελέτης ήταν 69 ασθενείς [26 κορίτσια και 43 αγόρια με μέσο όρο ηλικίας 11.63 (SD 3.57)]. Από αυτούς, το 63.77% ήταν ειδικοί ασθενείς (SNP) ενώ το 36.23% ήταν υγιή παιδιά (HC). Τα πιο συχνά προβλήματα υγείας των ειδικών ασθενών ήταν: νοητική υστέρηση (50%), συνδρομικές/χρωμοσωμικές ανωμαλίες (41.91%) και αυτισμός (29.54%). Ο μέσος όρος ηλικίας των υγιών παιδιών την στιγμή της Γ.Α. ήταν 3.2 χρόνια (SD 0.8) και για τους ειδικούς ασθενείς ήταν 5.82 χρόνια (SD 2.43) εκείνη τη στιγμή. Οι περισσότεροι από τους ασθενείς ήταν νεότεροι από 5 ετών την στιγμή της Γ.Α. 37 ασθενείς (19 αγόρια και 18 κορίτσια) από τους 69, με μέσο όρο ηλικίας 10.47 χρόνια (SD 3.43) συμφώνησαν να προσέλθουν στην μεταπτυχιακή κλινική. Όταν οι ασθενείς που δεν συμφώνησαν, ρωτήθηκαν για τον λόγο που δεν ήθελαν να προσέλθουν για κλινική εξέταση η πιο συχνή απάντηση ήταν λόγω απόστασης (28.12%) και λόγω της πανδημίας (28.12%). Ερωτηματολόγιο - Από τους 69 ασθενείς, οι 37 συμπλήρωσαν το ερωτηματολόγιο από κοντά ενώ οι υπόλοιποι τηλεφωνικώς μέσω συνέντευξης. Μετά την Γ.Α., η πλειοψηφία των ασθενών (71.01%) ανέφεραν οτι βουρτσίζουν τουλάχιστον μια φορά την ημέρα (SNP: 72.73% και HC: 96%). Η χρήση φθοριούχου οδοντόκρεμας αναφέρθηκε από όλους τους ασθενείς. Όσον αφορά την διατροφή των παιδιών, οι μισοί συμμετέχοντες (50.72%) ανέφεραν καθημερινή κατανάλωση γλυκών. Η πλειοψηφία των συμμετεχώντων (82.61%) ανέφερε τουλάχιστον μια επίσκεψη στον οδοντίατρο τον χρόνο πριν την τωρινή έρευνα. Είναι ιδιαίτερα ενδιαφέρον το γεγονός ότι το 13.04% δεν πήγε στον οδοντίατρο καθόλου μετά την θεραπεία κάτω από Γ.Α. Σχεδόν οι μισοί από τους συμμετέχοντες (50.72%) είχαν επισκεφθεί τον οδοντίατρο για καθαρισμό και φθορίωση, ενώ το 18.84% λόγω πόνου. Among the rest of them which received dental treatment, extractions and/or restorations were most often provided. Κλινική εξέταση - Ο μέσος όρος του δείκτη καθαρότητας ήταν 32.93% (SD 0.2) (HC: μέσος όρος 34.29, SD 20.78 και SNP: μέσος όρος 32%, SD 19.78). Όσον αφορά την τερηδονική εμπειρία την στιγμή της μελέτης, ο μέσος όρος του DMFS ήταν 9.66 (SD 9.27) και του dmfs 29 (SD: 15.91). Μόνο 3 ασθενείς δεν είχαν καμία τερηδονική βλάβη. Ειδικότερα οι υγιείς ασθενείς είχαν ένα μέσο όρο DMFS 6.39 (SD 4.99) [FS: 1.54 (SD 3.27)] ενώ ο μέσος όρος του DMFS για τους ειδικούς ασθενείς ήταν σχεδόν διπλάσιος 12.95 (SD 13.29). Όταν οι παράμετροι του DMFS εξετάστηκαν ανεξάρτητα, την υψηλότερη τιμή είχε η παράμετρος DS για τους HC 4.92 (SD 5.08) και η παράμετρος FS ακολουθούμενη απο την DS, για τους SNP DS 5.41 (SD: 6.26), FS 6.18 (SD 6.17). Οι ασθενείς εξετάστηκαν σε χώρο κλινικής. Όταν εξετάστηκε ο χρόνος που μεσολάβησε μεταξύ της Γ.Α. και της κλινικής εξέτασης, οι ασθενείς που θεραπεύτηκαν πριν από 2-5 χρόνια είχαν μέσο όρο DMFS 6.64 (SD 9.33). Εκείνοι που θεραπεύτηκαν κάτω από γενική αναισθησία πριν από 5-10 χρόνια είχαν μέσο όρο DMFS 11.67 (SD9.27). Μόνο δύο ασθενείς δήλωσαν πολύ λυπημένοι για την επίσκεψή τους στην κλινικής μας ενώ 6 άτομα δεν μπόρεσαν να επιλέξουν κάποια εικόνα λόγω σοβαρής νοητικής υστέρησης.. Conclusion Επιβεβαιώθηκε ότι είναι πολύ δύσκολη η επικοινωνία με την αυτή την κατηγορία των ασθενών. Ο υψηλός κίνδυνος για κακή στοματική υγιεινή και εμφάνιση τερηδονικών βλαβών παραμένει ένα πρόβλημα τόσο για τους υγιείς όσο και για τους ειδικούς ασθενείς μετά την γενική αναισθησία τόσο στα νεογιλά όσο και στα μόνιμα δόντια. Ο κίνδυνος αυτός είναι υψηλότερος μετά την πάρόδο 5 ετών από την διενέργεια της Γ.Α.. Επιπλέον είναι εμφανής η ανάγκη για μακροχρόνιες επανεξετάσεις στους ασθενείς που υποβάλλονται σε γενική αναισθησία οι οποίες θα είναι προσαρμοσμένες στις ανάγκες του κάθε ασθενή. Όσο μεγαλύτερο είναι το διάστημα μεταξύ των επανεξετάσεων γι αυτούς τους ασθενείς τόσο αυξάνεται ο κίνδυνος εμφάνισης νέων τερηδονικών βλαβών και στις δύο ομάδες.Introduction Young children and patients with special needs (SNP) with extensive caries often have limited abilities to cooperate and receive quality dental care. For this reason, general anaesthesia (GA) is often required for the dental treatment in these groups (Vermeulen et al 1991). Unfortunately caries recurrence is a common finding especially in children with early childhood caries (ECC) who receive dental rehabilitation under GA (Almeida et al 2000, Gizani et al 2001) despite the frequent recalls and preventive programs (new caries lesions: 37-52% of children, 6 months after the initial GA treatment, Graves et al. 2004, Berkowitz et al. 2011). Few long term studies reported an evaluation after GA in ECC children while even fewer, long term studies reported the clinical findings in. Therefore the aim of the present study is to report data on the long term oral health and dental behavior of uncooperative children after dental rehabilitation under GA and to highlight the difficulties involved in the set-up of such a study. Material and method The study sample originally consisted of 120 patients of the Postgraduate clinic of Paediatric Dentistry (NKUA) who received dental treatment under general anesthesia, between 2005 and 2017, at the Children’s Hospital “Paidon Agia Sophia”. The main reasons for their admission were extensive caries/no cooperation and special needs. The children should be not older than 18 years of age at present. The protocol was approved by the Ethics Committee of the Dental School and informed consent was obtained from the children and their legal guardians. From the university’s dental archives, information was gathered about the dental situation of the patients at their initial dental visit and the treatment provided under GA. The parents were contacted from the secretary of the postgraduate clinic of paediatric dentistry by telephone, between January 2019 and October 2020. When no telephone number was available, or the number was no longer active, their current number was searched for in the telephone book or online. When communication was not possible the patients were excluded. Subjects reached via the phone were invited to attend the dental clinic for an examination, professional tooth cleaning and fluoride application. They also completed a questionnaire about the oral health and dietary habits and dental attendance during the period between GA and present. Any changes in the medical history were registered while demographic and socio-economic data of the family were obtained from the records of the dental clinic. Subjects, who were not willing to attend the dental clinic, were interviewed over the phone. During their appointment and before the clinical examination, each patient was asked to indicate, with parental help, if necessary, one of the images of the facial image scale which was considered to be the most representative of his/her dental anxiety at that moment (Buchanan et al. 2002). Oral hygiene was registered using the Hygiene index (Lindhe 1982), on four surfaces of all teeth using a periodontal dental probe and without a discoloration agent. After tooth cleaning, caries experience was recorded using the criteria of the International Caries Detection and Assessment System (ICDAS) (Ismail et al., 2007). DMFS and dmfs scores were used to indicate the caries experience for each person (DS=ICDAS 1, 2, 3). Results Study sample - The group of patients that could be contacted was 79 out of 120. From these, only 10 individuals refused to complete the questionnaire mainly due to lack of interest for the study. Therefore the final study sample was 69 [26 females and 43 males with mean age 11.63 (SD 3.57)]. From these, 63.77% were SNP while 36.23% were Healthy children (HC). The most frequent health disorders were: mental disorders (50%), Syndrome/chromosomal disorders (41.91%) and autism (29.54%). The mean age of HC at the time of GA was 3.2 yrs (SD 0.8) and SNP was 5.82 yrs (SD 2.43) at that time. Most of the patients were younger than 5 yrs old at the time of GA. Some 37 patients (19 males and 18 females) out of 69, with mean age of 10.47 years (SD 3.43) agreed to attend the dental clinic. The reasons for the patient who did not want to have a clinical examination were mainly the distance (28.12%) or concerns due to Covid-19 pandemic (28.12%). Questionnaire - From the 69 individuals, 37 completed the questionnaire on site while the rest of them, at the phone by interview. Since GA, most of the subjects (71.01%) reported tooth brushing at least once per day (SNP: 72.73% and HC: 96%). Use of fluoride toothpaste was reported by all patients. Regarding their diet, half of the participants (50.72%) reported daily consumption of sweet snacks. The majority of the subjects (82.61%) reported at least one visit to the dentist in the previous year of the present study. Interestingly, 13.04% had never been to the dentist since the treatment under dental GA. Approximately half of them (50.72%) consulted the dentist for professional tooth cleaning and fluoride application, while 18.84% visited him/her due to pain. Among the rest of them which received dental treatment, extractions and/or restorations were most often provided. Clinical examination - The overall mean oral hygiene index was 32.93% (SD 0.2) (SNP: mean 32%, SD 19.78 and HC: mean 34.29, SD 20.78). Considering their caries experience at the present, the mean DMFS was 9.66 (SD 9.27) and dmfs 29 (SD: 15.91). Only 3 patients were caries free. More specifically HC patients had mean DMFS 6.39 (SD 4.99) [FS: 1.54 (SD 3.27)] while the mean DMFS of SNP was almost double 12.95 (SD 13.29). The largest component was DS for HC 4.92 (SD 5.08) and FS followed by DS, for the SNP 5.41 (SD: 6.26), FS 6.18 (SD 6.17). Patients were treated in daily dental routine setting. When the elapsed time between GA and the examination was considered, patients that were treated 2-5 years ago had mean DMFS 6.64 (SD 9.33). For them for which the elapsed time was longer (5-10), the mean DMFS score was 11.67 (SD9.27). Only two children reported that very sad about their visit to the dentist (face image scale). Conclusion Uncooperative children with caries in the primary dentition at the time of GA are susceptible to developing caries in their permanent dentition as well as new caries in the primary teeth, especially in 5 years afterwards. Oral hygiene is a problem for all children. Absence of regular follow ups of the patients with dental rehabilitation after GA is an important parameter while difficulties in getting contact with them is a great challenge for this study

Paediatric surgery in Uganda : burden of disease and barriers to quality of care

Background: In recent years there has been an increased awareness of surgical conditions within global health. A special emphasis is needed for children which constitute a large proportion of the populations in many countries. Many surgical conditions affect children, and an estimated 85% of all children in LMIC aged 15 will require surgery. Also, life-threatening conditions such as incarcerated hernias can be successfully corrected by surgical intervention. There is compelling evidence that the quality of basic surgical care for children is compromised in hospitals especially in low-resourced countries in Sub-Saharan Africa. This widespread quality gap suggests a potential for improved health systems to cater for children with surgical need at all levels of care. Uganda with a population of 20 million children has enormous unmet need for paediatric surgical care. There are numerous obstacles to increasing children’s surgical capacity in Uganda. How far surgical services for children in Uganda are affected has not been investigated. Aim: The overall aim of the work reported in this thesis was to address knowledge gaps in paediatric surgery in Uganda. This included the prevalence of paediatric surgical conditions, the burden of paediatric surgical disease, identifying barriers and solutions to surgical care, and, finally, assessing the impact of covid-19 on the access to surgical care for children. Methods: Four studies were undertaken: Study I was a cross-sectional, cluster-based study of the prevalence of paediatric surgical conditions in eastern Uganda. It was conducted at a Health Demographic Surveillance Site (HDSS): Study II was a nationwide facility-based study with retrospective data collection. It sought to determine the volumes and type of surgical procedures done for children in Uganda. 3. Study III was a qualitative, interview-based exploration of the barriers and potential solutions for improved surgical care for children with hernia in eastern Uganda. 4: Study IV was a mixed-method study combining quantitative registry-hospital data and qualitative interview-based data to investigate the impact of Covid- 19 on access to paediatric surgery in the Teso sub-region in Eastern Uganda. Results: I) the overall prevalence of paediatric surgical conditions was high at 16%, unmet need was 6.3%, and 10.1% had some degree of disability verified by physical examination. II) The average annual rate of 22.0 of major surgical procedures per 100,000 paediatric population in Uganda was assessed in 2013-2014. The rate varied between the four regions from 12 per 100 000 children in Northern Uganda to 27.7 per 100 000 children in Central Uganda. The most common conditions were congenital (n=3111, 39%), infections (n=2264, 28.7%) and trauma (n =1210,15.3%). Specialist surgeons performed 60% (n=4758) of the procedures, and anaesthesia was administered by specialist physician anaesthetists in 11.6%, n =917. III) Traditional beliefs and gender inequalities were considered major issues; others included lack of funds, transport, long distance and mistrust in the health system care. Possible solutions included partnering with the local community leaders to increase knowledge and acceptability in the community in general and by the parents. Another solution was capacity building for the health workers. IV) Total procedures for children increased by 24% between 2019 (n= 1407) and 2021 (n=1751). Procedures performed for pregnancy-related conditions increased most (58.3%). Some 12 parents and 25 health workers participated in the interviews. Using reflexive thematic analysis, two themes emerged, i) conflicts between reality and perception of the situation during the pandemic, and ii) lessons learned and a way forward. Conclusion: The prevalence of paediatric surgical conditions in Uganda is high with a huge unmet need for paediatric surgery. Procedures are performed in the country in a fairly decentralized manner, but with variation in the four regions, especially the northern region being underserved. Health-policy makers should promote programmes that are geared to the training and retention of a surgical workforce evenly distributed throughout the country. It is key to improve infrastructure and ensure regular supply of equipment and medicines. In partnership with non-governmental organizations the Government need to introduce programmes geared to empowering the country’s youth with skills for survival

The Quality of Paediatric Nursing Care - Children’s Perspective

Hoitotyön laatu - lasten näkökulma Tämän kolmivaiheisen tutkimuksen tarkoituksena oli kuvailla lasten odotuksia ja arviointeja lasten hoitotyön laadusta sekä kehittää mittari kouluikäisille sairaalassa oleville lapsille laadun arviointiin. Perimmäisenä tavoitteena oli lasten hoitotyön laadun kehittäminen sairaalassa. Ensimmäisessä vaiheessa 20 alle kouluikäistä (4-6v) sekä 20 kouluikäistä (7-11v) lasta kuvailivat odotuksiaan lasten hoitotyön laadusta. Aineisto kerättiin haastattelulla ja lasten piirustusten avulla, sekä analysoitiin sisällön analyysilla. Lasten odotukset lasten hoitotyön laadusta kohdistuivat hoitajaan, hoitotyön toimintoihin ja ympäristöön, fyysinen ympäristö korostui piirustuksissa. Ensimmäisen vaiheen tulosten, aikaisemman kirjallisuuden sekä Leino-Kilven “HYVÄ HOITO” mittarin pohjalta kehitettiin “Lasten Hoidon Laatu Sairaalassa” (LHLS) mittari ja testattiin sen psykometrisiä ominaisuuksia tutkimuksen toisessa vaiheessa. Mittaria kehitettiin ja testattiin kolmen vaiheen kautta. Aluksi asiantuntijapaneeli (n=7) arvioi mittarin sisältöä. Seuraavaksi mittari esitestattiin kahdesti kouluikäisillä sairaalassa olevilla lapsilla (n=41 ja n=16), samassa vaiheessa myös viiden lastenosaston hoitajat (n=19) yhdessä arvioivat mittarin sisältöä sekä 8 lasta. Lopuksi mittaria testattiin kouluikäisillä lapsilla (n=388) sairaalassa sekä hoitajat (n=198) arvioivat mittarin sisällön validiteettia. Mittarin kehittämisen aikana päälaatuluokkien: hoitajan ominaisuudet, hoitotyön toiminnot ja hoitotyön ympäristö Cronbachin alfa kertoimet paranivat. Pääkomponentti analyysi tuki mittarin hoitotyön toimintojen ja ympäristön alaluokkien teoreettista rakennetta. Kolmannessa vaiheessa “Lasten Hoidon Laatu Sairaalassa” (LHLS III, versio neljä) mittarilla kerättiin aineisto Suomen yliopistosairaaloiden lastenosastoilta kouluikäisiltä 7-11 -vuotiailta lapsilta (n=388). Mittarin lopussa lapsia pyydettiin lisäksi kuvailemaan kivointa ja ikävintä kokemustaan sairaalahoidon aikana lauseen täydennystehtävänä. Aineisto analysoitiin tilastollisesti sekä sisällön analyysilla. Lapset arvioivat fyysisen hoitoympäristön, hoitajien inhimillisyyden ja luotettavuuden sekä huolenpidon ja vuorovaikutustoiminnot kiitettäviksi. Lapset arvioivat hoitajien viihdyttämistoiminnot kaikkein alhaisimmiksi. Lapsen ikä ja sairaalantulotapa olivat yhteydessä lasten saamaan tiedon määrään. Lasten kivoimmat kokemukset liittyivät ihmisiin ja heidän ominaisuuksiinsa, toimintoihin, ympäristöön sekä lopputuloksiin. Ikävimmät kokemukset liittyivät potilaana oloon, tuntemuksiin sairauden oireista sekä erossaoloon, hoitotyön fyysisiin toimintoihin sekä ympäristöön. Tutkimuksen tulokset osoittavat lasten olevan kykeneviä arvioimaan omaa hoitoaan ja heidän näkökulmansa tulisi nähdä osana koko laadun kehittämisprosessia parannettaessa laatua käytännössä todella lapsilähtöisemmällä lähestymistavalla. “Lasten Hoidon Laatu Sairaalassa” (LHLS) mittari on mahdollinen väline saada tietoa lasten arvioinneista lasten hoitotyön laadusta, mutta mittarin testaamista tulisi jatkaa tulevaisuudessaThe purpose of this three-phase study was to describe children’s expectations and evaluations concerning the quality of paediatric nursing care and to develop a quality instrument for hospitalized school-age children. The aim of the study was to improve the quality of paediatric nursing in hospital. In the first phase, data were collected through theme interviews and children’s drawings from 20 preschool-age children (4 to 6 years) and 20 school-age children (7 to 11 years). The data were analysed by using content analysis. The children’s expectations concerning the quality of nursing care were related to the nurse, nursing activities and environment; the physical environment was emphasized in drawings. On the basis of the results of the first phase, as well as earlier literature and Leino-Kilpi’s “Good Nursing Care” Scale, the instrument “Child Care Quality at Hospital” (CCQH) was developed and its psychometrics tested in the second phase. First, an expert panel (n=7) assessed the content of the instrument. Second, the instrument was pilot-tested twice by collecting data from hospitalized school-age children (n=41 and n=16); in the same step the content validity of the instrument was assessed by nurses (n=19) from five wards together and by children (n=8). Finally, the instrument was tested with hospitalized school-age children (n=388), and nurses (n=198) assessed the content validity of the instrument. During the development process of the instrument, the main quality categories - nurse characteristics, nursing activities, and nursing environment Cronbach’s alpha values - improved. The principal component analysis supported the theoretical construct of the subcategories in nursing activities and environment. In the third phase, data were collected with the CCQH III (version four) from the paediatric clinics of the five university hospitals in Finland from school-age children (n=388) aged 7 to 11. At the end of the instrument there were two sentence completions in which children were asked to describe their best and worst experiences during hospitalization. The data were analysed using statistical methods and content analysis. The children rated the physical nursing environment, nurses’ humanity and trustworthiness, and caring and communication as excellent. They gave the lowest ratings to nurses’ entertainment activities. The age of the child and type of admission were both related to the amount of information they received. Children’s best experiences were related to people, their characteristics, activities, environment and outcomes. The worst experiences were related to being a patient, feelings related to symptoms of illness and separation, the physical care and treatment activities of nursing and to environment. The study showed that children are capable of evaluating their care, and their perspectives should be seen as part of the entire quality development process to improve quality in practice with a more genuinely child-centred approach. The instrument CCQH is a potential tool for obtaining knowledge about children’s evaluations of the quality of paediatric nursing care, but more testing should be done in the future. Keywords: paediatric nursing, quality of nursing care, quality of health care, child, instrumentSiirretty Doriast