Repercussions of the COVID-19 pandemic on child and adolescent mental health: A matter of concern—A joint statement from EAP and ECPCP

COVID-19 pandemic and the consequent rigid social distancing measures implemented, including school closures, have heavily impacted children's and adolescents' psychosocial wellbeing, and their mental health problems significantly increased. However, child and adolescent mental health were already a serious problem before the Pandemic all over the world. COVID-19 is not just a pandemic, it is a syndemic and mentally or socially disadvantaged children and adolescents are the most affected. Non-Communicable Diseases (NCDs) and previous mental health issues are an additional worsening condition. Even though many countries have responded with decisive efforts to scale-up mental health services, a more integrated and community-based approach to mental health is required. EAP and ECPCP makes recommendations to all the stakeholders to take action to promote, protect and care for the mental health of a generation

Management of cryptorchidism: a survey of clinical practice in Italy

<p>Abstract</p> <p>Background</p> <p>An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.</p> <p>Methods</p> <p>Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from <it>Associazione Culturale Pediatri </it>(ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.</p> <p>Results</p> <p>Overall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.</p> <p>Conclusions</p> <p>Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.</p

Pediatric primary care and emergency: Patient's parent's needs and expectations [L'urgenza pediatrica: I bisogni e le aspettative dell'utente]

Emergency department utilization has been increasing worldwide in recent years: in the city of Padova the access rate to paediatric emergency department has been 240/1000, 0-14 year population. A "consumer" survey was carried out by 9 practising paediatrician among 385 families, in collaboration with the University of Padova Pediatric Department. The aim was to evaluate parents' needs and expectations with regard to emergency department utilization patterns, also in order to plan possible educational and organizative interventions inside and outside the hospital. In about 2/3 of cases children were brought to emergency department without previous contact with the paediatric practitioner, mainly due to problems occurring in out-of-office hours and days together with perceived urgency. Improved access and continuity of care, to be achieved mainly through extension of paediatric group practices, appears as the most effective strategy to reduce the inapproriate use of the emergency department

A strategic pediatric alliance for the future health of children in Europe.

European health care systems need to adapt to ongoing financial pressures, while at the same time evolving better to suit changing health care needs of children as chronic conditions become increasingly dominant problems.2 For example, in response to current global economic pressures, many countries are considering changing from a pediatriciandelivered primary care system to a general practitioner model as a cost-cutting exercise, rather than in response to evidence about quality. Different possible “extreme scenarios” have been described1 in response to the likelihood that substantial changes in health care will unfold for European healthcare in the next 20 years. Three of these scenarios include: (1) European nations joining forces to create a single pan-European healthcare system; (2) preventive medicine taking precedence over acute care for sick patients; and (3) European healthcare systems focusing on vulnerable members of society. These scenarios are proposed and analyzed in this article by the strategic pediatric alliance for the future health of children in Europe consortium (SPA

Non-invasive assessment of pulmonary blood supply after staged repair of pulmonary atresia.

Radionuclide studies were performed to determine pulmonary blood flow in six children who had undergone surgery for pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary arteries with or without major aortopulmonary collateral arteries. Lung blood flow was assessed from both particle perfusion lung scans and the pulmonary and systemic phase of a radionuclide dynamic flow study. Five patients had perfusion defects identified on the particle perfusion lung scan. In three of these, abnormal areas were perfused only during the systemic phase of the flow study, a combination of findings that indicate the presence of perfusion by collateral arteries. In one patient no systemic perfusion was noted and in one an initial particle perfusion study indicated the presence of a lung segment perfused by a collateral artery. In this last patient the particle perfusion scan after total correction showed a reduction in the size of the lung perfusion defect and no evidence of lung perfusion during the systemic phase of the flow study. The particle perfusion lung scan in the sixth patient showed pronounced asymmetry in blood flow to the lungs with no segmental perfusion defect on the particle perfusion scan and no abnormalities on the systemic flow study. It is concluded that radionuclide lung perfusion and flow studies provide useful information on lung perfusion and merit further evaluation to define their role in the management of these patients

Digitalis toxicity and digoxin blood levels in children [Tossicità digitalica e digitalemia in età pediatrica]

Digoxin serum levels in 41 children with clinical and/or ECG symptoms of digitoxicity were determined by radioimmunoassay and compared to the normal values. 54% of the cases showed a good relationship between clinical and/or ECG signs of toxicity and digoxin levels; on the contrary, 29% of patients exhibited only clinical and/or ECG signs of toxicity with normal digoxin levels and 17% of patients had high digoxin levels without signs of toxicity. The significance and possible causes of this relative discrepancy are discussed

A Strategic Pediatric Alliance for the future helath of children in Europe

European health care systems need to adapt to ongoing financial pressures, while at the same time evolving better to suit changing health care needs of children as chronic conditions become increasingly dominant problems.2 For example, in response to current global economic pressures, many countries are considering changing from a pediatriciandelivered primary care system to a general practitioner model as a cost-cutting exercise, rather than in response to evidence about quality. Different possible “extreme scenarios” have been described1 in response to the likelihood that substantial changes in health care will unfold for European healthcare in the next 20 years. Three of these scenarios include: (1) European nations joining forces to create a single pan-European healthcare system; (2) preventive medicine taking precedence over acute care for sick patients; and (3) European healthcare systems focusing on vulnerable members of society. These scenarios are proposed and analyzed in this article by the strategic pediatric alliance for the future health of children in Europe consortium (SPA