Vitamin D-Deficiency Rickets in Two Breast-Fed Infants Who Were Not Receiving Vitamin D Supplementation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66491/2/10.1177_000992287701600411.pd

Literature overview highlights lack of paediatric donation protocols but identifies common themes that could guide their development

Aim: Paediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Most countries use protocols for organ and tissue donation to ensure optimal care for the donor and family, but these mainly focus on adults. However, the donation process for children differs from adults in many ways. An overview of the literature was performed to identify protocols for the paediatric population. Methods: PubMed, Web of Science, EMBASE and the Internet were searched up to March 2016 for papers or other sources in English related to specific organ and tissue donation protocols for children and neonates. This comprised title, abstract and then full-text screening of relevant data. Results: We included 12 papers and two electronic sources that were mainly from North America and Europe. Most discussed donations after cardiac death. The recurring themes included identifying potential donors, approaching parents, palliative care and collaboration with organ procurement organisations. Most papers called for paediatric donation policies to be standardised. Conclusion: Scientific publications in English on paediatric donation protocols are very scarce. No comprehensive paediatric donation protocol was found. We identified several recurring themes in the literature that could be used to develop such protocols

Putting Families First: How the Opioid Epidemic is Affecting Children and Families, and the Child Welfare Policy Options to Address It

Abstract: Opioids and Child Welfare Across the country, placements in foster care are rising. In 2016, the U.S. Department of Health and Human Services reported that 273,539 children in the U.S. entered foster care. In 34 percent of those cases, parental drug abuse was one of the factors leading to the child’s removal from their family. Additionally, the U.S. Substance Abuse and Mental Health Services Administration estimates that 400,000 births nationally are affected by prenatal exposure to alcohol and illicit drugs, which represents 10 percent of all live births. As the opioid epidemic continues, increasing numbers of children are at high risk for developmental and behavioral disorders because of their prenatal substance and alcohol exposure. In addition, children who remain at home may endure the challenges and trauma resulting from impaired caregiving due to parental substance use disorders (SUDs). This article explores the intersection of the opioid epidemic and child welfare, examining current research and publicly available data to discuss policy opportunities for better serving families affected by parental SUDs, including: ensuring health and safety for infants prenatally exposed to substances; appropriate identification, diagnosis, and treatment of developmental and behavioral needs; ensuring parents have access to outpatient treatment and services that can allow families to stay together when safe and appropriate; and ensuring sufficient access to inpatient treatment options that can serve parents and children together

Validity and Reliability of the Perceived Readiness for Discharge After Birth Scale

Objective: To assess the psychometric properties of a scale measuring mothers’ perceptions of readiness for discharge after birth. Design: Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge. Setting: Tertiary-level perinatal center in the Midwestern United States. Participants: 1,462 postpartum mothers. Intervention: None. Main Outcome Measures: Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.\u27 Results: Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breast-feeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales. Conclusions: The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers’perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems

Oral health status of rural-urban migrant children in South China

International Journal of Paediatric Dentistry 2011; 21: 58-67 Background. In China, there is a massive rural-urban migration and the children of migrants are often unregistered residents (a 'floating population').Aim. This pilot study aimed to profile the oral health of migrant children in South China's principal city of migration and identify its socio-demographic/behavioural determinants.Design. An epidemiological survey was conducted in an area of Guangzhou among 5-year-old migrant children (n = 138) who received oral examinations according to the World Health Organization criteria. Parents' oral health knowledge/attitude, child practices, and impact of children's oral health on their quality-of-life (QoL) were assessed.Results. The caries rate and mean (SD) dmft were 86% and 5.17 (4.16), respectively, higher than those national statistics for both rural and urban areas (P < 0.05). Oral hygiene was satisfactory (DI-S < 1.0) in 3% of children. Oral health impacts on QoL were considerable; 60% reported one or more impacts. 58% variance in 'dmft' was explained by 'non-local-born', 'low-educated parents', 'bedtime feeding', 'parental unawareness of fluoride's effect and importance of teeth', and 'poor oral hygiene' (all P < 0.05). 'Non-local-born' and 'dmft' indicated poor oral health-related QoL (both P < 0.05), accounting for 32% of variance.Conclusion. Oral health is poor among rural-urban migrant children and requires effective interventions in targeted sub-groups. © 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.postprin

Haemophilus influenzae type B conjugate vaccines

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28583/1/0000390.pd

Length of Stay after Vaginal Birth: Sociodemographic and Readiness-for-Discharge Factors

Background: The impact of reductions in postpartum length of stay have been widely reported, but factors influencing length of hospital stay after vaginal birth have received less attention. The study purpose was to compare the sociodemographic characteristics and readiness for discharge of new mothers and their newborns at 3 discharge time intervals, and to determine which variables were associated with postpartum length of stay. Methods: The study sample comprised 1,192 mothers who were discharged within 2 postpartum days after uncomplicated vaginal birth at a tertiary perinatal center in the midwestern United States. The sample was divided into 3 postpartum length-of-stay groups: group 1 (18–30 hr), group 2 (31–42 hr), and group 3 (43–54 hr). Sociodemographic and readiness-for-discharge data were collected by self-report and from a computerized hospital information system. Measures of readiness for discharge included perceived readiness (single item and Readiness for Discharge After Birth Scale), documented maternal and neonatal clinical problems, and feeding method. Results: Compared with other groups, the longest length-of-stay group was older; of higher socioeconomic status and education; and with more primiparous, breastfeeding, white, married mothers who were living with the baby’s father, had adequate home help, and had a private payor source. This group also reported greater readiness for discharge, but their newborns had more documented clinical problems during the postbirth hospitalization. In logistic regression modeling, earlier discharge was associated with young age, multiparity, public payor source, low socioeconomic status, lack of readiness for discharge, bottle-feeding, and absence of a neonatal clinical problem. Conclusions: Sociodemographic chracteristics and readiness for discharge (clinical and perceived) were associated with length of postpartum hospital stay. Length of stay is an outcome of a complex interface between patient, provider, and payor influences on discharge timing that requires additional study. Including perceived readiness for discharge in clinical discharge criteria will add an important dimension to assessment of readiness for discharge after birth

Prediction of Length of Hospital Stay in Preterm Infants - A Case-Based Reasoning View

The length of stay of preterm infants in a neonatology service has become an issue of a growing concern, namely considering, on the one hand, the mothers and infants health conditions and, on the other hand, the scarce healthcare facilities own resources. Thus, a pro-active strategy for problem solving has to be put in place, either to improve the quality-of-service provided or to reduce the inherent financial costs. Therefore, this work will focus on the development of a diagnosis decision support system in terms of a formal agenda built on a Logic Programming approach to knowledge representation and reasoning, complemented with a case-based problem solving methodology to computing, that caters for the handling of incomplete, unknown, or even contradictory in-formation. The proposed model has been quite accurate in predicting the length of stay (overall accuracy of 84.9%) and by reducing the computational time with values around 21.3%

Simulated medication errors: A means of evaluating healthcare professionals' knowledge and understanding of medication safety

OBJECTIVE: To determine multi-disciplinary perceptions of the clinical significance of medication errors (MEs), the responsible health professional(s), the contributing factors and potential preventive strategies. METHODS: The five simulated ME cases represented errors from five wards at a children's hospital in Australia. Pre-determined answers for each case were developed through consensus among the researchers. The root cause analysis (RCA) was undertaken via a questionnaire disseminated to physicians, nurses and pharmacists at the study hospital to seek their opinions on the ME cases. Agreement model between the participants and pre-determined responses regarding the contributing factors was conducted using general estimating equation (GEE) analysis. RESULTS: Of the 111 RCA questionnaires distributed, 25 were returned. The majority (93%) of respondents rated the significance of the MEs as either 'moderate' or 'life-threatening'. Furthermore, they correctly identified two contributing factors relevant to all cases: dismissal of policies/procedures or guidelines (90%) and human resources issues (87%). GEE analysis revealed varied agreement patterns across the contributing factors. Suggested prevention strategies focused on policy and procedures, staffing and supervision, and communication. CONCLUSION: Simulated case studies had potential use to seek front-line healthcare professionals' understanding of the clinical significance and contributing factors to MEs, along with preventive measures