The predictive value of preoperative B-type natriuretic peptide in children undergooing heart surgery.

Introduction: Low cardiac output syndrome is frequent in childrenafter heart surgery for congenital heart disease and may result in pooroutcome and increased morbidity. In the adult population, preoperativebrain natriuretic peptide (BNP) was shown to be predictive of postoperative complications. In children, the value of preoperative BNP onpostoperative outcome is not so clear. The aim of this study was todetermine the predictive value of preoperative BNP on postoperativeoutcome and low cardiac output syndrome in children after heartsurgery for congenital heart disease.Methods: We examined, retrospectively, the postoperative course of97 pediatric patients (mean age 3.7 years, range 0-14 years old) whounderwent heart surgery in a tertiary care pediatric intensive caresetting. NTproBNP was measured preoperatively in all patients(median 412 pg/ml, range 12-35'000 pg/ml). Patients were divided intothree groups according to their NTproBNP levels (group 1: 0-300 pg/ml, group 2: 300-600 pg/ml, group 3: >600 pg/ml) and then,correlations with postoperative outcomes were examined.Results: We found that patients with a high preoperative BNP requiredmore frequently prolonged (>2 days) mechanical ventilation (33%vs 40% vs 61%, p = 0.045) and stayed more frequently longer than6 days in the intensive care unit (42% vs 50% vs 71%, p = 0.03).However, high preoperative BNP was not correlated with occurrenceof low cardiac output syndrome.Conclusion: Preoperative BNP cannot be used, in children, as areliable and sole predictor of postoperative low cardiac outputsyndrome. However it may help identify, before surgery, those patientsat risk of having a difficult postoperative course.

Lessons learned after 2 full scale disaster exercises in a Swiss pediatric hospital

Introduction: Following a disaster, up to 50% of mass casualties are children. The number of disaster increases worldwide, including in Switzerland. Following national order, the mapping of the various risks of disaster in Switzerland will be completed by the end of 2012. Pre-hospital disaster drills and plans are well established and regularly tested. In-hospital disaster plans are much less frequently tested, if only available. Pediatric in-hospital full scale disaster exercises have never been reported in Switzerland. Based on our local constraints, we set up and evaluated a disaster plan during two full scale exercises. Methods: In a university hospital treating more than 35 000 pediatric emergencies per year, two exercises involving mock victims of a disaster aged 9 to 14 years old were successively set up over a period of 3 years. The exercises were planned during the day, without modification of the normal emergency room activities. The hospital staff was informed and trained in advance. Variables such as the alarm timing and transmission, triage set-up and function, special disaster medical records utilization, communication and victims' identification were assessed. Family members participated in the second exercise. An evaluation team observed and record exercises activities, identifying strength and weaknesses. Results: On two separate occasions, a total of 44 mock patients participated, were triaged, admitted and treated in the hospital according to usual standards of care. Alarm transmission was not appropriate during the first exercise. Triage overload occurred on one occasion. In-hospital communication needed readjustment. Identification and in-hospital tracking of the children remained problematic. Hospital employees showed great enthusiasm and stressed the positive effect of full scale exercises on their knowledge of the hospital disaster plan. Conclusions: Performing real life disaster exercises in a pediatric hospital was very beneficial. The disaster plan was adapted to local needs and updated accordingly. An alarm transmission protocol was elaborated and tested. Triage set-up was adapted and tested. A hospital identification plan for injured children was created and tested. Full scale hospital exercises evaluating disaster plans revealed several weaknesses in the system. Practice readjustments based on local experience were made. A tested pediatric disaster plan adapted to local constraints could minimize chaos, optimize care and support in the event of a real disaster. Children's identification and family reunification following a disaster remains a challenge.

Couple conjugal et couple co-parental: quelle articulation lors de la transition à la parentalité ?

La venue d'un premier enfant implique d'importants remaniements. Le couple conjugal est mis à rude épreuve et la littérature anglo-saxonne fait état d'une baisse de la satisfaction conjugale durant la période de transition à la parentalité. De plus, au couple conjugal s'ajoutent le couple co-parental (relations entre les parents à propos de leur enfant) et les dyades parentales (parent/enfant). L'articulation entre les sous-systèmes conjugal, co-parental et parental va varier d'une famille à l'autre : prépondérance du parental ou du conjugal, présence d'un co-parentage soutenant ou non, etc. La baisse de la satisfaction conjugale lors de la transition à la parentalité est confirmée dans une étude réalisée en Suisse et présentée dans cet article. Des vignettes cliniques de jeux familiaux illustrent ensuite les différentes articulations possibles du conjugal, du co-parental et du familial. The birth of a first child implies important reorganizations. The marital relationship is under stress and Anglo-Saxon literature shows that there is a decrease of the marital satisfaction during the transition to parenthood. Moreover, when partners become parents, coparenting (relationship between the parents regarding their child) and parental dyads (parent-infant) are added to the marital relationship. The articulation between the conjugal, coparental and parental sub-systems varies from one family to the other : preponderance of the parental or the conjugal subsystem, presence of a supportive co-parenting or not, etc. The decrease of the marital satisfaction during the transition to parenthood is confirmed in a Swiss study and described in this article. Descriptions of family games illustrate then the different possible articulations of the conjugal, coparental and parental subsystems.

La qualité des soins dans les consultations ambulatoires pédopsychiatriques du canton de Vaud: résultats d'une enquête de satisfaction

It is common knowledge that patients' satisfaction influences their compliance with the proposed treatment and their future use of health services, and that the therapeutic alliance represents a recognised factor in the success of psychotherapeutic management. In May and June 2011 we conducted an enquiry in all the paedopsychiatric outpatient units of the Canton of Vaud in Switzerland, from which we gathered 1261 questionnaires from consulting children and their parents. The questions covered inter alia overall satisfaction concerning the quality of the care on off er, perception of the therapeutie alliance and the helpfulness of the varions types of treatment. The instruments used are recognised and validated internationally (HAQII and CSQS). The results reve al a high degree of satisfaction and a good perception of the therapeutic alliance's quality: an average of 4.9 for children and 5.9 for parents concerning the therapeutic alliance, on a scale from 1 (totally disagree) to 6 (totally agree), and concerning patient satisfaction an average of 3.2 for children and 3.4 for parents on a scale of 1 to 4. Regarding perception of the benefit derived from different forms of treatment, individual and family interviews were overwhel~ningly approved (3.2 out of 4), while compliance with drug treatment was less recognised as helpful to children (2.3 out of 4).

Statewide Assessment Instrument, June 15, 2010

The Iowa Department of Human Services (IDHS) has responsibility for Iowa’s child welfare system. Iowa’s child welfare system focuses on children that have been or are at risk of being abused or neglected, as well as children that are determined by the Juvenile Court to be a child in need of assistance (CINA). The child welfare system is focused on three major results that are safety, permanency, and child and family well-being.

Secondhand smoke exposure in children is associated with common carotid artery intima-media thickness

Objective: To investigate the association between common carotid artery intima-media thickness (cIMT) and exposure to secondhand smoke (SHS) in children. Methods: Data were available at baseline in the Quebec Adiposity and Lifestyle investigation in Youth (QUALITY) study, an ongoing longitudinal investigation of Caucasian children aged 8e10 years at cohort inception, who had at least one obese parent. Data on exposure to parents, siblings and friends smoking were collected in interviewer-administered child, and self-report parent questionnaires. Blood cotinine was measured with a high sensitivity ELISA. cIMTwas measured by ultrasound. The association between blood cotinine and cIMT was investigated in multivariable linear regression analyses controlling for age, body mass index, and child smoking status. Results: Mean (SD) cIMT (0.5803 (0.04602)) did not differ across age or sex. Overall 26%, 6% and 3% of children were exposed to parents, siblings and friends smoking, respectively. Cotinine ranged from 0.13 ng/ml to 7.38 ng/ml (median (IQR)¼0.18 ng/ml)). Multivariately, a 1 ng/ml increase in cotinine was associated with a 0.090 mm increase in cIMT (p¼0.034). Conclusion: In children as young as age 8e10 years, exposure to SHS relates to cIMT, a marker of pre-clinical atherosclerosis. Given the wide range of health effects of SHS, increased public health efforts are needed to reduced exposure among children in homes an private vehicles.

Access Management Awareness Program Phase II Report, TR-402, 1997

This report presents the results of a number of detailed Iowa access management case studies. Case studies were selected to provide a cross-section of locations and community sizes in Iowa as well as a variety of project types. Generally, access management projects completed during the mid-1990s were chosen as case studies. Projects ranging from driveway consolidation to full raised medians were analyzed on a before and after basis in terms of traffic safety, traffic operations, and adjacent business vitality. Sources of information used for the case study analysis included: road project files; traffic accident records; state sales tax records; and personal interviews of business owners, business customers, and local officials. The case study results from Iowa essentially confirm results of previous access management research from around the nation. Recent access in Iowa had significant, positive impacts in terms of traffic safety. The average reduction of annual accidents and accident rates on improved roadways was approximately 40%. Improvements in access management also led to significantly better roadway operations for most case studies. Although a small number of individual businesses do report sales losses and/or customer complaints once projects have been completed, access management projects in Iowa have not had an adverse impact on the majority of businesses located along them. In fact, some access management projects in Iowa seem to have contributed to an improved business environment along the corridors that have been improved. The results from the Iowa case studies presented in this report will be used to develop access management education materials for Iowa transportation professionals and other audiences interested in the impacts of access management.

Parents living with HIV in a high-income country: do patients need specific support?

The number of HIV-infected persons with children and caregiving duties is likely to increase. From this statement, the present study was designed to establish how HIV infected caregivers organise their parenting routines and to determine their support needs. A further aim was to ascertain caregivers' perception of conspicuous behaviours displayed by their children. Finally, it sought to determine the extent to which the caregivers' assessment of their parenting activity is influenced by the required support and their children's perceived conspicuous behaviours. The study design was observational and cross-sectional. Sampling was based on the 7 HIV Outpatient Clinics associated with the national population-based Swiss HIV Cohort Study. It focused on persons living with HIV who are responsible for raising children below the age of 18. A total of 520 caregivers were approached and 261 participated. An anonymous, standardised, self-administered questionnaire was used for data collection. The data were analysed using descriptive statistical procedures and backward elimination multiple regression analysis. The 261 respondents cared for 406 children and adolescents under 18 years of age; the median age was 10 years. The caregivers' material resources were low. 70% had a net family income in a range below the median of Swiss net family income and 30% were dependent on welfare assistance. 73% were undergoing treatment with 86% reporting no physical impairments. The proportion of single caregivers was 34%. 92% of the children were living with their HIV infected caregivers. 80% of the children attended an institution such as a school or kindergarten during the day. 89% of the caregivers had access to social networks providing support. Nevertheless, caregivers required additional support in performing their parenting duties and indicated a need for assistance on the material level, in connection with legal problems and with participation in the labour market. 46% of the caregivers had observed one or more conspicuous behaviours displayed by their children, which indicates a challenging situation. However, most of these caregivers assessed their parenting activity very favourably. Backward elimination multiple regression analysis indicated that a smaller number of support needs, younger age of the eldest child and fewer physical impairments on the part of the caregiver enhance the caregivers' assessment of their parenting activity. Physicians should speak to caregivers living with HIV about their parenting responsibilities and provide the necessary scope for this subject in their consultation sessions. Physicians are in a position to draw their patients' attention to the services available to them.

CenterLines, Fall 2014

CenterLines for Families, the newsletter of the Center for Disabilities and Development at the University of Iowa Children’s Hospital, is published four times a year. It provides families with current information on child and adult development, issues affecting people with disabilities, and CDD resources available to them and their families.

CenterLines, Summer 2014

CenterLines for Families, the newsletter of the Center for Disabilities and Development at the University of Iowa Children’s Hospital, is published four times a year. It provides families with current information on child and adult development, issues affecting people with disabilities, and CDD resources available to them and their families.