Parental stress in paediatric day-case surgery

Day-case surgery involves a considerable amount of stress not only for the children who undergo surgery but also for their parents. In a prospective survey analysis performed in 1995/1996, we identified the following main factors influencing the amount of stress experienced by parents: feelings of insufficient preparation and problems with postoperative pain at home. As a consequence, measures were taken regarding information and pain management, including the creation of an interactive CD-ROM. We then analysed the consequences of our interventions regarding parental stress. In this study we collected the data of all patients who underwent day-case surgery during two additional 13-month periods in 1997/1998 and 1999/2000. The methods of data collection remained unchanged for all three periods and included a questionnaire for the parents. In total, 1,490 questionnaires were analysed. Comparing the three time periods, parents' feelings of being well-informed improved significantly (91% vs. 98% vs. 97%, P<0.0001). However, the percentage of those experiencing moderate to severe stress did not change substantially (16% vs. 9% vs. 19%, not significant). Analgaesics were given more frequently over the years in a general as well as a prophylactic manner (20% vs. 35% vs. 43%, P<0.0001). Nevertheless, problems with pain control at home remained unchanged (33% vs. 23% vs. 29%, not significant). Despite considerable efforts to improve information, parental stress did not significantly decrease. It cannot be assessed yet whether wrong information was given or whether a certain degree of stress cannot be prevented. There is some evidence that improvements in coping with pain-related problems might be a promising next ste

Pediatric Epstein-Barr Virus Carriers With or Without Tonsillar Enlargement May Substantially Contribute to Spreading of the Virus

Background. Human-to-human transmission of the persistent infection establishing Epstein-Barr virus (EBV) occurs via saliva. Tonsils act as important portal of entry and exit of EBV. The contagiousness of pediatric EBV carriers and the role played by tonsillar enlargement (TE) are not known. Methods. We compared EBV shedding in mouthwash samples from pediatric EBV carriers with or without TE to that in mouthwash samples from pediatric patients with infectious mononucleosis (IM), the symptomatic form of primary infection if delayed after the age of 5 years. EBV DNA was quantified by polymerase chain reaction, and contagiousness was assessed using the cord lymphocyte transformation assay. Results. EBV carriers with TE shed EBV DNA at an almost similar frequency (although in lower amounts) as pediatric patients with acute IM but more frequently (P ! .001) and in higher amounts (Pp.038) than EBV carriers without TE. EBV DNA levels in mouthwash samples from EBV carriers with TE mirrored levels in tonsils and gradually declined after tonsillectomy. Almost half of the mouthwash samples from pediatric EBV carriers contained infectious EBV. Conclusions. Pediatric EBV carriers-in particular, those with TE-may considerably contribute to the spreading of EBV in industrialized countrie

Editorial 1/2019: Medien und frühe Bildung

Editorial 1/201

Risk factors for invasive reptile-associated salmonellosis in children

Abstract Reptile-associated salmonellosis (RAS) in children has been reported primarily due to direct contact with turtles, but recently also due to indirect contact with more exotic reptiles, causing disease in infants. To evaluate risk factors for RAS, we reviewed the RAS cases published in the literature since 1965. A case was defined as a child ≤18 years of age with an epidemiological link by identification of Salmonella enterica in cultures from both the affected child and the exposed reptile. We identified a total of 177 otherwise healthy children (median age 1.0 years, range 2 days to 17.0 years). RAS manifested mainly with gastrointestinal disease, but 15% presented with invasive RAS, including septicemia, meningitis, and bone and joint infection. The children with invasive RAS were significantly younger than children with noninvasive disease (median age 0.17 and 2.0 years, p<0.0001). RAS is most frequently seen after exposure to turtles (42%). However, children with invasive RAS had been exposed more often (p≤0.001) to reptiles other than turtles, including iguanas, bearded dragons, snakes, chameleons, and geckos. Children exposed to those latter reptiles usually kept indoors were younger than children exposed to turtles mostly kept outdoors (p<0.0001). RAS in children is significantly associated with invasive disease at young age, in particular infants <6 months of age. Exposure to reptiles, other than turtles, kept indoors is associated with RAS at younger age and more invasive disease. This finding is helpful for recognizing or even preventing invasive RAS in young infants that are at highest risk

Determinants of legacy effects in pine trees - implications from an irrigation-stop experiment

Tree responses to altered water availability range from immediate (e.g. stomatal regulation) to delayed (e.g. crown size adjustment). The interplay of the different response times and processes, and their effects on long-term whole-tree performance, however, is hardly understood. Here we investigated legacy effects on structures and functions of mature Scots pine in a dry inner-Alpine Swiss valley after stopping an 11-yr lasting irrigation treatment. Measured ecophysiological time series were analysed and interpreted with a system-analytic tree model. We found that the irrigation stop led to a cascade of downregulations of physiological and morphological processes with different response times. Biophysical processes responded within days, whereas needle and shoot lengths, crown transparency, and radial stem growth reached control levels after up to 4 yr only. Modelling suggested that organ and carbon reserve turnover rates play a key role for a tree's responsiveness to environmental changes. Needle turnover rate was found to be most important to accurately model stem growth dynamics. We conclude that leaf area and its adjustment time to new conditions is the main determinant for radial stem growth of pine trees as the transpiring area needs to be supported by a proportional amount of sapwood, despite the growth-inhibiting environmental conditions.Peer reviewe