Psychosocial problems in pre-school children: Recognition and strategy applied by doctors and nurses in child health care objective. Abstract

Psychosocial problems in pre-school children: recognition and strategy applied by doctors and nurses in child health care Objective. To assess the degree to which preventive child health professionals (CHPs) identify and manage psychosocial problems among pre-school children in the general population, and to determine its association with parent-reported behavioral and emotional problems, socio-demographic factors and (mental) health history of children. Design. Descriptive. Method. In sixteen Child Healthcare Services across the Netherlands, providing well-baby clinics to nearly all pre-school children on a regular basis, CHPs examined the child and interviewed parents and child during their routine health assessments. The 'Child Behavior Checklist' (CBCL) was completed by the parents. Out Of 2,354 children aged 1.75 to 4 years, eligible for a routine health assessment, 2,229 (95%) participated. Results. CHPs identified psychosocial problems in 9% of all children. Forty-one per cent of these children were referred for further diagnosis and treatment. identification of psychosocial problems and subsequent referral were much more likely in children with an increased CBCL total problems score than in others: identification: 29% versus 7%; odds ratio: 5.40 (95% CI: 3.45-8-47); referral: 15% versus 3%; odds ratio: 6.50 (95% Cl: 3.69-11-46). Conclusion. CHPs frequently identified psychosocial problems in preschool children, but they missed many cases of parent-reported problems as measured by a clinical CBCL score. improvement of the early identification of psychosocial problems appears to be feasible by strengthening the role of well-baby clinics in the care of children with psychosocial problems

Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years

BACKGROUND: Over the last two decades, improvements in medical care have been associated with a significant increase and better outcome of very preterm (VP, < 32 completed gestational weeks) and very low birth weight (VLBW, < 1500 g) infants. Only a few publications analyse changes of their short-term outcome in a geographically defined area over more than 10 years. We therefore aimed to investigate the net change of VP- and VLBW infants leaving the hospital without major complications. METHODS: Our population-based observational cohort study used the Minimal Neonatal Data Set, a database maintained by the Swiss Society of Neonatology including information of all VP- and VLBW infants. Perinatal characteristics, mortality and morbidity rates and the survival free of major complications were analysed and their temporal trends evaluated. RESULTS: In 1996, 2000, 2004, and 2008, a total number of 3090 infants were enrolled in the Network Database. At the same time the rate of VP- and VLBW neonates increased significantly from 0.87% in 1996 to 1.10% in 2008 (p < 0.001). The overall mortality remained stable by 13%, but the survival free of major complications increased from 66.9% to 71.7% (p < 0.01). The percentage of infants getting a full course of antenatal corticosteroids increased from 67.7% in 1996 to 91.4% in 2008 (p < 0.001). Surfactant was given more frequently (24.8% in 1996 compared to 40.1% in 2008, p < 0.001) and the frequency of mechanical ventilation remained stable by about 43%. However, the use of CPAP therapy increased considerably from 43% to 73.2% (p < 0.001). Some of the typical neonatal pathologies like bronchopulmonary dysplasia, necrotising enterocolitis and intraventricular haemorrhage decreased significantly (p ≤ 0.02) whereas others like patent ductus arteriosus and respiratory distress syndrome increased (p < 0.001). CONCLUSIONS: Over the 12-year observation period, the number of VP- and VLBW infants increased significantly. An unchanged overall mortality rate and an increase of survivors free of major complication resulted in a considerable net gain in infants with potentially good outcome

Living with a Crucial Decision: A Qualitative Study of Parental Narratives Three Years after the Loss of Their Newborn in the NICU

BACKGROUND: The importance of involving parents in the end-of-life decision-making-process (EOL DMP) for their child in the neonatal intensive care unit (NICU) is recognised by ethical guidelines in numerous countries. However, studies exploring parents' opinions on the type of involvement report conflicting results. This study sought to explore parents' experience of the EOL DMP for their child in the NICU. METHODS: The study used a retrospective longitudinal design with a qualitative analysis of parental experience 3 years after the death of their child in four NICUs in France. 53 face-to-face interviews and 80 telephone interviews were conducted with 164 individuals. Semi-structured interviews were conducted to explore how parents perceived their role in the decision process, what they valued about physicians' attitudes in this situation and whether their long-term emotional well being varied according to their perceived role in the EOL DMP. FINDINGS: Qualitative analysis identified four types of perceived role in the DMP: shared, medical, informed parental decision, and no decision. Shared DM was the most appreciated by parents. Medical DM was experienced as positive only when it was associated with communication. Informed parental DM was associated with feelings of anxiousness and abandonment. The physicians' attitudes that were perceived as helpful in the long term were explicit sharing of responsibility, clear expression of staff preferences, and respectful care and language toward the child. INTERPRETATION: Parents find it valuable to express their opinion in the EOL DMP of their child. Nonetheless, they do need continuous emotional support and an explicit share of the responsibility for the decision. As involvement preferences and associated feelings can vary, parents should be able to decide what role they want to play. However, our study suggests that fully autonomous decisions should be misadvised in these types of tragic choices

Very preterm birth is a risk factor for increased systolic blood pressure at a young adult age

Children born very prematurely who show intrauterine growth retardation (IUGR) are suggested to be at risk of developing high blood pressure as adults. Renal function may already be impaired by young adult age. To study whether very preterm birth affects blood pressure in young adults, we measured 24-h ambulatory blood pressure (Spacelabs™ 90207 device) and renin concentration in 50 very premature individuals (<32 weeks of gestation), either small (SGA) or appropriate (AGA) for gestational age (21 SGA, 29 AGA), and 30 full-term controls who all were aged 20 years at time of measurement. The mean (standard deviation) daytime systolic blood pressure in SGA and AGA prematurely born individuals, respectively, was 122.7 (8.7) and 123.1 (8.5) mmHg. These values were, respectively, 3.6 mmHg [95% confidence interval (CI) −0.9 to 8.0] and 4.2 mmHg (95% CI 0.4−8.0) higher than in controls [119.6 (7.6)]. Daytime diastolic blood pressure and nighttime blood pressure did not differ between groups. We conclude that individuals born very preterm have higher daytime systolic blood pressure and higher risk of hypertension at a young adult age

The effect of a severe disaster on the mental health of adoloscents: a controlled study

Background: Disasters greatly affect the mental health of children and adolescents, but quantification of such effects is difficult. Using prospective predisaster and postdisaster data for affected and control populations, we aimed to assess the effects of a severe disaster on the mental health and substance use of adolescents. Methods: In January, 2001, a fire in a café in Volendam, Netherlands, wounded 250 adolescents and killed 14. In the 15 months before the disaster, all grade 2 students (aged 12-15 years) from a school in Volendam (of whom 31 were in the café during the fire), and from two other schools, had been selected as controls for a study. 124 Volendam students and 830 from the other two schools had provided data for substance use, and completed the youth self-report (YSR) questionnaire about behavioural and emotional problems. 5 months after the disaster, we obtained follow-up data from 91 (response rate 73.4%) Volendam adolescents and 643 (77.5%) controls from the other two schools. The primary outcome measures were changes in score in YSR categories of total problems, alcohol misuse, smoking, and substance use. We compared changes in scores between groups using logistic regression. Findings: Volendam adolescents had larger increases in clinical scores than controls for total problems (odds ratio 1.82, 95% CI 1.01-3.29, p=0.045) and excessive use of alcohol (4.57, 2.73-7.64, p<0.0001), but not for smoking or use of marijuana, MDMA (ecstasy), and sedatives. Increases in YSR scores were largest for being anxious or depressed (2.85, 1.23-6.61), incoherent thinking (2.16, 1.09-4.30), and aggressive behaviour (3.30, 1.30-8.36). Intention-to-treat analyses showed significantly larger for increases in rates of excessive drinking and YSR symptom subscales in Volendam adolescents than controls. Effects were mostly similar in victims and their classmates. Interpretation: Mental health interventions after disasters should address anxiety, depression, thought problems, aggression, and alcohol abuse of directly affected adoloscents and their peer group. Chemicals/CAS: 3,4 methylenedioxymethamphetamine, 42542-10-9; alcohol, 64-17-5; cannabis, 8001-45-4, 8063-14-