Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol.

BACKGROUND: Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN: This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION: The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

Doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty

Objective To identify the main doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty. Method Cross-sectional study carried out in a reference hospital, between September and November 2012. The sample was composed of 50 individuals divided in two groups, of which 25 caregivers of children submitted to cheiloplasty, and 25 of children submitted to palatoplasty. The doubts were identified by an interview applied during the preoperative nursing consultation and were then categorized by similarity. Descriptive statistics was used for analysis of the outcomes. Results Concerning cheiloplasty, the doubts were related to feeding (36%), hygiene and healing (24% each), pain and infection (8% each). With regard to palatoplasty, the doubts were related to feeding (48%), hygiene (24%), pain (16%), bleeding (8%) and infection (4%). Conclusion The study evidenced the concern of caregivers in relation to feeding and care of the postoperative wound.

Living with pain: the experience of children and adolescents in palliative care

A qualitative study was conducted with semi-structured interviews with the aim of understanding the experience of children and adolescents under palliative care when managing pain daily and how they describe the intensity, quality and location of pain. We used Piaget’s theory of cognitive development as a theoretical framework and oral history as a methodological framework. We found four themes: describing pain; seeking a life closer to normality, despite pain and disease; using a variety of alternatives for pain control; and living with damaged physical appearance. Although pain is a limiting factor in the lives of children and adolescents, we found that they faced their daily pain and still had a life beyond pain and illness. In addition, we highlight the relevance of nurses’ understanding that effective management of pain in children is essential for a normal life and less suffering.

Understanding the experiences of caregivers of children with tuberculosis in directly observed therapy

Objective To understand the situations and communications experienced by caregivers of children with tuberculosis (TB) with regard to directly observed therapy (DOT). Method A descriptive exploratory study with a qualitative approach was applied and developed in the ambulatory of Programa Einstein na Comunidade de Paraisópolis (PECP). The data were collected using semi-structured interviews of 13 caregivers of children with TB in DOT. The Collective Subject Discourse (CSD) method was used to analyze the data. Results Seven CSDs were identified and grouped into four categories: "Living in a difficult situation", "Changing the family routine", "Responsibility almost always fall son the mother", and "Adapting to the DOT". Conclusions The difficulties faced by the caregiver of the child at the beginning of DOT significantly changed the familiar routine. The responsibility for its continuity was assigned to the mother, who must adapt to the demands of the treatment and face the situation.

MIBG scintigraphy for the diagnosis and follow-up of children with neuroblastoma.

Neuroblastoma (NBL) is the commonest extra-cranial solid tumor in children and the leading cause of cancer related deaths in childhood between the age of 1 to 4 years. NBL may behave in very different ways, from the less aggressive stage 4S NBL or congenital forms that may resolve without treatment in up to 90% of the children, to the high-risk disseminated stage 4 disease in older children with a cure rate of 35 to 40%. Initial staging is crucial for effective management and radiolabeled metaiodobenzylguanidine (MIBG) with iodine-123 is a powerful tool with a sensitivity around 90% and a specificity close to 100% for the diagnosis of NBL. MIBG scintigraphy is used routinely and is mandatory in most investigational clinical trials both for the initial staging of the disease, the evaluation of the response to treatment, as well as for the detection of recurrence during follow-up. With respect to outcome of children presenting disseminated stage 4 NBL, the role of post-therapeutic [(123)I]MIBG scan has been investigated by several groups but so far there is no consensus whereas a complete or very good partial response as assessed by MIBG may be of prognostic value. NBL needs a multimodality approach at diagnosis and during follow-up and MIBG scintigraphy keeps its pivotal role, in particular with respect to bone marrow involvement and/or cortical bone metastases.

Needs of psychopedagogical training for the care of children with chronic disease: perceptions of hospital nursing

OBJECTIVE To identify the psychopedagogical training needs of the pediatric nurses in the largest public hospital of the Balearic Islands, Spain. METHOD This study was developed with a quantitative and qualitative design, where 78 nurses (97.5% of the service) answered a questionnaire, and 15 participated in interviews that were analyzed via content analysis. RESULTS The quantitative results show gaps in the knowledge and psychopedagogical skills of the staff. These aspects could facilitate the development of tasks tailored to the personality and the psychoevolutional time of children with chronic diseases, as well as to the emotional state of families. The qualitative data was organized into four categories: family support; hospital and education; psychopedagogical training and difficulties in practice. The little communication between nurses and teachers is evident. CONCLUSION The data reinforces the need to implement training strategies and interdisciplinary work among health professionals, educators and families.

KINDERGARTEN TEACHERS’ ATTITUDES TOWARDS INCLUSIVE EDUCATION OF CHILDREN WITH DISABILITIES IN THE REGULAR CLASSROOM IN WUHAN, CHINA

After the international trends towards inclusive education, Chinese legislations mandate the inclusion of students with disabilities into the regular education classroom. The purpose of this study was to investigate the kindergarten teachers’ attitudes towards inclusive education of children with disabilities in the regular classroom, in Wuhan, China, as well their sense of responsibility to include children with disabilities in regular classroom. Ninety kindergarten teachers from public and private kindergartens in Wuhan participated in this study. Descriptive analysis demonstrated that, in general, kindergarten teachers we studied have negative or contradictory attitudes towards inclusive education of children with disabilities in regular classroom. Statistically non-significant differences were found between teachers’ attitudes towards inclusion and teachers’ demographic variables (age, education degree, teaching experience, experience teaching children with disabilities, time experience with children with disabilities and training in special education). Significant correlation was found between teachers’ attitudes towards inclusive education and their sense of responsibility to include children with disabilities in regular classroom. The results allowed the identification of some crucial aspects necessary to achieve the inclusive education

The rise and decline of children's labour participation levels during the early stages of industrialisation. Catalonia (1850-1925)

This article aims to analyse the reasons for the intensive use of childlabour in the 19th century and its subsequent decline in the first thirdof the 20th century in the context of an economy with a highly flexiblelabour supply like that of Catalonia. During the second half of the 19thcentury,factors relating to family economies, such as numerous familiesand low wages for adults, along with the technologies of the time thatrequired manual labour resources, would appear to explain the intensiveuse of child labour to the detriment of schooling. The technologicalchanges that occurred during the first third of the 20th century, thedemographic transition and adult wage increase (for both men and women)explain the schooling of children up to the age of 15 and theconsequent practical abolition of child labour in that new era ofeconomic modernisation.

The debates of the Constitutional Convention of the state of Iowa, assembled at Iowa City, Monday, January 19, 1857. Being a full and complete report of the debates and proceedings, by authority of the Convention; accompanied, for purposes of reference, by a copious index of subjects, and remarks of members thereon. W. Blair Lord, reporter.

The two volume record of the debates that occured during the thirty-nine days it took to draft the third constitution of the State of Iowa.

Incidence and types of illness when travelling to the tropics : a prospective controlled study of children and their parents

RESUME De plus en plus de familles se rendent vers des destinations tropicales, s'exposant à des agents infectieux et des maladies tropicales qu'ils ne rencontrent pas chez eux. Nous avons étudié 157 enfants (0-16 ans) et leurs parents partant pour les tropiques, qui ont tous consulté une clinique pré-voyage et qui étaient généralement compliants aux conseils prodigués. Les taux d'incidence de maladies communes chez les enfants et les adultes étaient respectivement de 16.9 (14.3-19.7) et 15.1 (12.7-17.8) épisodes/ 100 personnes-semaines. La diarrhée, les douleurs abdominales et la fièvre représentaient les plaintes les plus fréquentes. Il n'y avait pas de différence significative d'incidence des épisodes morbides entre les enfants et les adultes sauf pour la fièvre (plus fréquente chez les enfants). La plupart des épisodes avaient lieu dans les dix premiers jours du voyage. L'incidence de morbidité similaire chez les enfants et les adultes ainsi que l'aspect bénin des épisodes remet en question l'opinion selon laquelle il n'est pas sage de voyager avec des jeunes enfants.

Incidence and types of illness when traveling to the tropics: a prospective controlled study of children and their parents.

Increasingly, families travel to tropical destinations exposing them to infectious agents and tropical diseases not encountered at home. We studied 157 children (0-16 years) and their adult relatives traveling to the tropics, who attended a pretravel clinic and were generally adherent to prescribed advice. Incidence rates of common illness in children and adults were respectively 16.9 (14.3-19.7) and 15.1 (12.7-17.8) episodes/100 person-weeks. Diarrhea, abdominal pain, and fever were the most frequent complaints. There was no significant difference in the incidence of morbid episodes between children and adults, except for fever (more frequent in children). Most episodes occurred in the first 10 days of travel. The similar incidence of morbidity in children and adults and the episodes' mildness challenge the view that it is unwise to travel with small children.

Correlation of Der p 2 T-cell responses with clinical characteristics of children allergic to house dust mite.

BACKGROUND: An understanding of the mechanisms responsible for the development and maintenance of allergic inflammation and their clinical implications is needed to develop specific and successful treatment for allergy. OBJECTIVES: To characterize in vitro T-cell responses to Der p 2, one of the major allergens of house dust mite (HDM), and investigate potential correlations between clinical and laboratory parameters. METHODS: Forty-two patients monosensitized to HDM and 10 age-matched, healthy children were studied. Dendritic cells pulsed with Der p 2 were used to stimulate autologous CD14(-) cells. Der p 2-specific T-cell activation markers, proliferation, and cytokine production profiles were examined. RESULTS: Der p 2-specific T-cell activation markers, proliferation, and T(H)2 cytokine production were significantly higher in HDM patients compared with healthy controls. Moreover, a significant correlation between proliferation and T(H)2 cytokine production was observed. Within the allergic group, skin reaction to HDM was significantly stronger in patients with a Der p 2-specific T-cell response. Levels of HDM-specific IgE directly correlated with interleukin 5 and interleukin 13 levels and with skin prick test results and, ultimately, with the patient's family history of allergy. Furthermore, the presence of atopic march correlated with T-cell proliferation. CONCLUSION: We found that, in HDM patients, Der p 2-specific T(H)2 responses, promoted by autologous dendritic cells in vitro, correlate with clinical parameters.

Fragments of the Debates of the Iowa Constitutional Conventions of 1844 and 1846, 1900.

This publication contains fragments of the debates of the Iowa Constitutional Conventions of 1844 and 1846 as preserved in several Iowa newspapers; The Iowa Standard, The Capital Reporter and The Bloomington Herald. These fragments include parts of the debates, press comments and other related materials.