Birth characteristics and recurrent otitis media with effusion in young children.

Contains fulltext : 47807.pdf (publisher's version ) (Closed access)OBJECTIVE: To study the association between birth characteristics and the recurrence of otitis media with effusion (OME). METHODS: Prospective cohort study on 136 children aged 2-7 years, who received tympanostomy tubes for bilateral otitis media with effusion. Checkups were planned 1 week after tube insertion and once every 3 months thereafter. An otologist examined the ear status to assess tube extrusion and otitis media with effusion recurrence. Outcome measure was the recurrence of otitis media with effusion within 6 months after documentation of spontaneous tube extrusion. Birth characteristics were investigated in relation with the recurrence of otitis media with effusion in 90 children with known clinical outcome. RESULTS: No statistically significant associations were found between various birth characteristics and the recurrence of otitis media with effusion. Multivariate analyses showed positive but fairly weak associations between recurrence of otitis media with effusion and low birth weight (<2500 g) and/or low gestational age (<37 weeks) and/or a history of incubator care (odds ratio (OR) 1.95, 95% confidence interval (CI): 0.21-18.2), male sex (OR 1.85, 95% CI: 0.56-6.13) and maternal medication use during pregnancy (OR 4.80, 95% CI: 0.57-40.72). A remarkable finding was the asymmetrical distribution of certain birth characteristics within the group of children with recurrence of otitis media with effusion: children with unilateral recurrence had a relatively lower gestational age, lower birth weight, lower 'birth length to birth weight' ratio than the children with bilateral recurrence. CONCLUSION: These findings suggest that determination of birth characteristics cannot help us in the treatment strategy for recurrent otitis media with effusion in childhood

Meconium-stained amniotic fluid is not a risk factor for otitis media.

Item does not contain fulltextIt has recently been hypothesised that large amounts of amniotic fluid cellular content (AFCC) in the middle ear may lead to chronic inflammation and predispose young children to recurrent middle ear infections. Because children born with meconium-stained amniotic fluid (MSAF) have higher AFCC in the middle ear, we performed a retrospective cohort study to determine whether children born with MSAF had a higher risk of OM during infancy. Children born between May 1998 and April 2000 formed two groups based on the absence or presence of MSAF at birth as documented in the hospital birth records. In April 2002, home visits were made to take tympanometric measurements and administer a questionnaire on OM history and possible confounders. Logistic regression models were constructed to assess odds ratios (OR) as a measure of the effect of MSAF on OM and to adjust for potential confounders. There were no differences in the point prevalence of a type-B tympanogram at the home visit (OR 0.81; 95% confidence interval: 0.38-1.76). Also, no statistically significant association was found between the proportion of children with OM diagnosed in the 1st year of life (OR 0.86, 95% confidence interval: 0.27-2.73) and in the proportion of children that had ever been diagnosed with OM (OR 0.91, 95% confidence interval: 0.40-2.91). It can be concluded that children born with MSAF do not constitute a high-risk group for OM in early childhood. A long-term OM effect, especially in severe MSAF cases, cannot be excluded

Routine patient-reported experience measurement of shared decision-making in the USA: a qualitative study of the current state according to frontrunners

Contains fulltext : 221003.pdf (publisher's version ) (Open Access)OBJECTIVES: To identify and describe instances of routine patient-reported shared decision-making (SDM) measurement in the USA, and to explore barriers and facilitators of routine patient-reported SDM measurement for quality improvement. SETTING: Payer and provider healthcare organisations in the USA. PARTICIPANTS: Current or former adult employees of healthcare organisations with prior SDM activity and that may be conducting routine SDM measurement (n=21). OUTCOMES: Qualitative interview and survey data collected through snowball sampling recruitment strategy to inform barriers and facilitators of routine patient-reported SDM measurement. RESULTS: Three participating sites routinely measured SDM from patients' perspectives, including one payer organisation and two provider organisations-with the largest measurement effort taking place in the payer organisation. Facilitators of SDM measurement included SDM as a core organisational value or strategic priority, trialability of SDM measurement programmes, flexibility in how measures can be administered and existing momentum from payer-mandated measurement programmes. Barriers included competing organisational priorities with regard to patient-reported measurement and lack of perceived comparative advantage of patient-reported SDM measurement. CONCLUSIONS: Payers have a unique opportunity to encourage emphasis on SDM within healthcare organisations, including routine patient-reported measurement of SDM; however, provider organisations are currently best placed to make effective use of this type of data

Why are NICU infants at risk for chronic otitis media with effusion?

Item does not contain fulltextNewborns in a Neonatal Intensive Care Unit (NICU) and even later have a high incidence of otitis media with effusion (OME). It is unclear which aspects play a role in the incidence of chronic OME during infancy. In order to investigate the effect of nasally-placed tubes, cranial growth, immune system, and neuromotor function on the occurrence of chronic OME, 83 NICU patients were observed prospectively for middle ear status. Duration and type of treatment with nasal tubes were obtained from the NICU notes. At the NICU, and 1 and 2 years of age the cranial circumference and neuromotor function were assessed. As a proxy for disturbed local immune system parental reports of snoring, mouth breathing and common cold were used. Multivariate analysis revealed that infants treated with nasotracheal and nasopharyngeal tubes showed a marginally significant increased risk for chronic OME (OR=3.2 [95% CI 0.5--21.2]). Treatment with nasogastric tubes appeared to have a lower risk for chronic OME (OR=1.5 [95% CI 0.1--25.1]). No significant effect was found for cranial circumference. Signs of disturbed local immunity during the first 6 months of life (OR=1.4 [95% CI 0.4--4.7]), as well as impaired neuromotor function (OR=1.9 [95% CI 0.5--6.8]), showed also a marginally significant increased risk for chronic OME. The cohort of NICU patients might be relatively too small in order to find significant effects. Although the results of this study should be interpreted cautiously, it is suggested that nasally-placed tubes for ventilatory assistance, disturbed local immunity and impaired neuromotor function are associated with chronic OME