Prevalence of serious bacterial infections and management of febrile infants ≤60 days in Swedish Pediatric Emergency Departments

BACKGROUND. The reported prevalence of serious bacterial infections (SBI: urinary tract infection (UTI), bacteremia, and meningitis) among febrile infants ≤60 days of age varies from 8% to 23%. There are indications that the prevalence of infections differs between the sexes. Infants with fever at home but afebrile at the pediatric emergency department (PED) might have a lower risk of SBIs. Furthermore, the management of febrile infants and adherence to guidelines varies among PEDs. There is a paucity of knowledge regarding how physicians decide whether to follow management recommendations. AIM. To describe the age- and sex-specific prevalence of SBIs in infants aged ≤60 days with fever without source (FWS) at four PEDs in Sweden. To evaluate whether there is a difference in the prevalence between infants with reported fever at home who are afebrile at the PED and those who are still febrile. To describe the clinical management and outcomes of febrile infants. To investigate physicians’ decision-making process when managing febrile infants aged ≤60 days and to describe the factors that influenced this decision.METHOD. This thesis is comprised of 2 separate projects. The first is a retrospective cross-sectional study in previously healthy, full-term febrile infants ≤60 days with FWS who presented at 4 PEDs in 2014-2020. The second is a qualitative study with a phenomenographic approach based on focus group discussions with physicians active in 2 of the PEDs. RESULTS. There were included 2237 febrile infants aged ≤60 days with FWS. The prevalence of SBIs was 12.6% (95% CI, 11.0-14.3), of UTI 11.0% (95% CI, 9.5-12.6), of bacteremia 1.5% (95% CI, 1.0-2.2), and of meningitis 0.5% (95% CI, 0.2–0.9). In infants aged ≤28 days, the prevalence of meningitis did not differ (p=1.000) between girls 0.8% (95% CI, 0.1-2.9) and boys 0.9% (95% CI, 0.2-0.2.7). Similarly, there was no difference in the risk of meningitis between infants aged ≤28 days with reported fever at home who were febrile at the PED and those still febrile, with a risk ratio (RR) of 1.05 (95% CI, 0.18–6.23). In infants aged ≤28 days, lumbar puncture (LP) was performed in 13% (95% CI, 11–16), blood culture in 40% (95% CI, 36–40), broad-spectrum antibiotics were administered in 30% (95% CI, 26–34), and 67% (95% CI,63–71) were hospitalized. Of the infants who did not receive antibiotics at the initial approach, 0.3% (95% CI, 0.1–0.8) were diagnosed with meningitis or bacteremia. Three main factors influenced the decision-making process on whether to perform an LP:1) a possible focus of infection that could explain the origin of the fever; 2) questioning whether the temperature at home reported by the parents was a fever, especially if it was ≤38.2°C; and 3) the infant’s general condition and questioning the need for LP in case of well-appearing infants.CONCLUSIONS. The prevalence of meningitis and bacteremia was low in infants aged ≤60 days with FWS. A different meningitis risk estimation is not justified for infants aged ≤28 days with reported fever at home afebrile at the PED. The management of febrile infants aged ≤28 days did not constitute of routine LP, blood culture, antibiotic treatment, and hospitalization but was not associated with increased adverse outcomes. Such management should be investigated further since it could reduce unnecessary investigations, antibiotic treatments, and hospitalizations. The primary factors that influenced physicians to omit performing LP were general appearance, presence of fever, and possible focus of infection

The Student – Educator Relationship as a Prevention and Management Tool for School Violence and Bullying

Abstract School violence and bullying are forms of aggressive behavior which as a rule are deliberate and harmful. In some cases, they are persistent and may continue for long periods of time such as months or even years. Most of the times the individuals who are subjected to school bullying are quite difficult to defend themselves. Aggressive behaviors and cases of violence and bullying constitute elements of a daily school reality. The intensity of such incidents and the scientific interest led to it becoming a research target for many fields such as psychology, sociology, pedagogy and political science, bringing to the surface at the same time the complexity and composite nature of the issue. The target of this research study is the qualitative examination of the educators’ and the students’ aspects concerning the role – tool of good interpersonal relationships and the prevention and management of incidents of school violence and bullying

Are Group Psychotherapeutic Treatments Effective for Patients with Schizophrenia? A Systematic Review and Meta-Analysis

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Different psychotherapeutic treatments for schizophrenia are delivered in groups. However, little is known about the effectiveness of these group therapies for people with schizophrenia across different treatments with varying therapeutic orientations. This review aimed to (1) estimate the effect of different group psychotherapeutic treatments for schizophrenia and (2) explore whether any overall ‘group effect' is moderated by treatment intensity, diagnostic homogeneity and therapeutic orientation. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; A systematic search of randomised controlled trials exploring the effectiveness of group psychotherapeutic treatments for people with schizophrenia was conducted. Random-effect meta-analyses on endpoint symptom scores compared group psychotherapeutic treatments with treatment as usual and active sham groups. Findings on social functioning were described narratively, and meta-regression analyses on group characteristics were carried out. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Thirty-four eligible trials were included. A weak-to-moderate significant between-group difference in favour of group psychotherapeutic treatments was found for negative symptom scores (standard mean difference = -0.37, 95% confidence interval -0.60, -0.14; p &lt; 0.01, I&lt;sup&gt;2&lt;/sup&gt; = 59.8%) only when compared to treatment as usual and not to active sham groups. Improved social functioning was reported as a treatment outcome in the majority of studies compared to treatment as usual. The ‘group effect' on negative symptoms was positively related to ‘treatment intensity' (β = 0.32, standard error = 0.121; p &lt; 0.05). &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Group psychotherapeutic treatments can improve negative symptoms and social functioning deficits in the treatment of schizophrenia. The effect occurs across different treatments and appears to be non-specific. Future research should identify the underlying mechanisms for the positive effect of participating in groups and explore how they can be maximised to increase the therapeutic benefit.</jats:p

Is BMI alone a sufficient outcome to evaluate interventions for child obesity?

BACKGROUND: BMI is often used to evaluate the effectiveness of childhood obesity interventions, but such interventions may have additional benefits independent of effects on adiposity. We investigated whether benefits to health outcomes following the Mind, Exercise, Nutrition…Do It! (MEND) childhood obesity intervention were independent of or associated with changes in zBMI. METHODS: A total of 79 obese children were measured at baseline; 71 and 42 participants were followed-up at 6 and 12 months respectively, and split into four groups depending on magnitude of change in zBMI. Differences between groups for waist circumference, cardiovascular fitness, physical and sedentary activities, and self-esteem were investigated. RESULTS: Apart from waist circumference and its z-score, there were no differences or trends across zBMI subgroups for any outcome. Independent of the degree of zBMI change, benefits in several parameters were observed in children participating in this obesity intervention. CONCLUSION: We concluded that isolating a single parameter like zBMI change and neglecting other important outcomes is restrictive and may undermine the evaluation of childhood obesity intervention effectiveness

Clinical Assays in Sepsis: Prognosis, Diagnosis, Outcomes, and the Genetic Basis of Sepsis

Sepsis is the most widespread medical disorder of the intensive care unit (ICU) and the most common cause of death in hospitalized patients. Several endothelium-related molecules have been investigated as potential biomarkers for early diagnosis and/or prognosis of sepsis, providing different results depending on study designs. Therefore, it seems that we are still far from the right combination of sepsis markers to be used in clinical practice. It is more probable that a panel of diverse biomarkers will be more efficient in clinical practice. More recently, the potential use of genetic biomarkers for prognostic purposes started emerging for sepsis, in the form of genome-wide association studies. The successful use of modern molecular diagnostics could enable rapid identification of particularly susceptible or less susceptible individuals, leading to tailored therapeutic treatments