Prevalence and time course of acute mountain sickness in older children and adolescents after rapid ascent to 3450 meters

OBJECTIVE: Acute mountain sickness is a frequent and debilitating complication of high-altitude exposure, but there is little information on the prevalence and time course of acute mountain sickness in children and adolescents after rapid ascent by mechanical transportation to 3500 m, an altitude at which major tourist destinations are located throughout the world. METHODS: We performed serial assessments of acute mountain sickness (Lake Louise scores) in 48 healthy nonacclimatized children and adolescents (mean +/- SD age: 13.7 +/- 0.3 years; 20 girls and 28 boys), with no previous high-altitude experience, 6, 18, and 42 hours after arrival at the Jungfraujoch high-altitude research station (3450 m), which was reached through a 2.5-hour train ascent. RESULTS: We found that the overall prevalence of acute mountain sickness during the first 3 days at high altitude was 37.5%. Rates were similar for the 2 genders and decreased progressively during the stay (25% at 6 hours, 21% at 18 hours, and 8% at 42 hours). None of the subjects needed to be evacuated to lower altitude. Five subjects needed symptomatic treatment and responded well. CONCLUSION: After rapid ascent to high altitude, the prevalence of acute mountain sickness in children and adolescents was relatively low; the clinical manifestations were benign and resolved rapidly. These findings suggest that, for the majority of healthy nonacclimatized children and adolescents, travel to 3500 m is safe and pharmacologic prophylaxis for acute mountain sickness is not needed.

Outcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration

OBJECTIVES: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. DESIGN AND SETTING: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. SUBJECTS: ART-naive children (< or = 16 years) who commenced treatment with > or = 3 antiretroviral drugs before March 2008. OUTCOME MEASURES: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox proportional hazards models stratified by site. Immune status, virological suppression and growth were described in relation to duration of ART. RESULTS: The median (interquartile range) age of 6 078 children with 9 368 child-years of follow-up was 43 (15 - 83) months, with 29% being < 18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (< 400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Together with young age, all markers of disease severity (low weight-for-age z-score, high viral load, severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. CONCLUSIONS: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.

Children's and adolescent's self - assessment of metabolic control versus professional judgment: a cross-sectional retrospective and prospective cohort study

BACKGROUND Morbidity and mortality in T1DM depend on metabolic control, which is assessed by HbA1c measurements every 3-4 months. Patients' self-perception of glycemic control depends on daily blood glucose monitoring. Little is known about the congruence of patients' and professionals' perception of metabolic control in T1DM. OBJECTIVE To assess the actual patients' self-perception and objective assessment (HbA1c) of metabolic control in T1DM children and adolescents and to investigate the possible factors involved in any difference. METHODS Patients with T1DM aged 8 - 18 years were recruited in a cross-sectional, retrospective and prospective cohort study. Data collection consisted of clinical details, measured HbA1c, self-monitored blood glucose values and questionnaires assessing self and professionals' judgment of metabolic control. RESULTS 91 patients participated. Mean HbA1c was 8.03%. HbA1c was higher in patients with a diabetes duration > 2 years (p = 0.025) and in patients of lower socioeconomic level (p = 0.032). No significant correlation was found for self-perception of metabolic control in well and poorly controlled patients. We found a trend towards false-positive memory of the last HbA1c in patients with a HbA1c > 8.5% (p = 0.069) but no difference in patients' knowledge on target HbA1c between well and poorly controlled patients. CONCLUSIONS T1DM patients are aware of a target HbA1c representing good metabolic control. Ill controlled patients appear to have a poorer recollection of their HbA1c. Self-perception of actual metabolic control is similar in well and poorly controlled T1DM children and adolescents. Therefore, professionals should pay special attention that ill controlled T1DM patients perceive their HbA1c correctly.

Toiling children in India : the gender dimension

Child labour in several low income households is rather pursued for gaining experience and at times for meagre incomes, which are possibly spent on household food expenditure. Though the contribution made by the child labour to the overall wellbeing does not turn out to be substantial, without child labour these households would have been much worse off than the households which can afford not to have child labour. The probability of working is higher for a male child compared to a girl child. This is because the girl children are often engaged in household activities and even when they are engaged in income earning jobs they are shown as helpers. Parents' income as such may not be having a positive impact on child's education rather it is the educational level of the parents which matters in determining whether the child would go to school and continue her/his education. To substantiate the gender bias, the probability of falling ill among the girl children is found to be higher compared to the boys. Parents' educational attainments beyond a certain level again tend to reduce the probability of falling ill.

Managers and missionaries : library services to children and young adults in the information age /

"Papers presented at the Allerton Park Institute, sponsored by University of Illinois, Graduate School of Library and Information Science, cosponsored by the Youth Divisions of the American Library Association: American Association of School Librarians (AASL), Association for Library Service to Children (ALSC), Young Adult Services Division (YASD); held November 14-16, 1986, Chancellor Hotel & Conference Center ... Champaign, Illinois."

Bird children : the little playmates of the flower children /

Includes index.

Letters from a cat : published by her mistress for the benefit of all cats and the amusement of little children /

Gilt illustration on title of cat with pen and ink inditing "Your Aff[ectionate] Pussy".

A method of measuring the development of the intelligence of young children,

"The article here translated appeared in the Bulletin de la Société libre pour l'étude psychologique de l'enfant,' April 1911." --Translator's pref.

Speech reading--Jena method ; a textbook with lesson plans in full development for hard-of-hearing adults and discussion of adaptations for deaf and hard-of-hearing children,

Includes music.

40 years of stewardship-- where are we headed? : a report on the 40th Anniversary Symposium of the Illinois Department of Children and Family Services, December 2004.

"December 2004."

A Parents' guide : the educational rights of handicapped children /

"Funded in part by the Office of Special Education and Rehabilitation Services P.L. 94-142."

A study of the feasibility of establishing a health insurance plan for Illinois children : final report /

"June 30, 1992."

Accidental poisoning control program : (children twelve years of age and under) /

Description based on: Jan. 1-Dec. 31, 1967; title from caption.

An Act creating the Illinois Department of Children and Family Services : amended through November, 1975.

Cover title.

An Act creating the Department of Children and Family Services : amended to November 1, 1969.

Cover title.