Why children die: A pilot study 2006

This is thenfirst report of a national confi dential enquiry specifi cally focussed on child deaths. Confidential enquiries have already contributed to major improvements in obstetrics, neonatal, and perioperative care in the United Kingdom (UK). However they are time consuming and require extensive collaboration between various professional groups as well as the attention of a dedicated full-time research team. Hence, when planning a confidential enquiry in a new patient group, it is pertinent to investigate both feasibility and utility at its outset.ficant contribution to child health in the UK.

Identité et filiation : enfants enlevés-appropriés, adultes restitués dans le contexte de la dernière dictature militaire en Argentine (1976-1983)

Durant la dernière dictature argentine (1976-1983), !a junte militaire organisa le vol de nourrissons, enfants de leurs ennemis, pour qu'ils puissent être élevés dans des familles proches du pouvoir. L'association « Grands-Mères de la Place de Mai » comptabilisa environ 409 vols. Au moment de l'exploration du terrain de récherche, en 2004, une quarantaine avaient été retrouvés dans des familles qui ne connaissaient pas leurs origines tandis qu'une vingtaine étaient dans des familles liées à la junte ; c'est à cette dernière catégorie que s'intéresse ce travail. Durant leur enfance ou à l'âge adulte, ces enfants apprirent un jour la vérité sur leurs origines biologiques et la justice la leur restitua ; c'est pourquoi ils sont dits « restitués ». Cette contribution vise à interroger l'identité individuelle comme une dynamique intime qui s'articule à la filiation et s'insère dans une collectivité, une société. Trois hypothèses l'ont organisée : une première concerne la connaissance des origines biologiques et ses conséquences psychologiques identitaires, qui passe nécessairement par la justice et la société. Une deuxième hypothèse explore les éventelles conséquences traumatiques de l'enlèvement des personnes restituées et de la restitution. Enfin, la troisième hypothèse interroge le rapport de la construction identitaire à la société, qu'elle se fasse par des investissements politiques et associatifs ou par les médias et l'Histoire. Ces hypothèses nourrissent un questionnement sur les liens entre restitution et travail de symbolisation des origines. Sept entretiens semi structurés avec des personnes restituées ont. été menés puis qualitativement analysés dans une perspective que l'on peut référer, de manière large, à une « anthropologique clinique », au croisement d'une psychologie clinique éclairée par la psychanalyse et de l'anthropologie. Au travers d'une analyse approfondie de leur parcours identitaire des personnes enlevées, adoptées et restituées, ce travail se livre à une recherche empirique sur la construction identitaire. Le concept de transmission se trouve mobilisé, qui concerne l'inscription de l'individu dans la subjectivité d'un couple avec le prénom, dans une lignée ou dans un collectif avec le choix professionnel ou les liens avec l'association « Grands-Mères de la Place Mai ». De plus, la thèse apporte une contribution à la compréhension des enjeux du clivage, des blessures primitive et narcissique, des processus d'affiliation et des secrets de famille et propose également de penser, en prolongement, les enjeux de la « défiliation » et de I'« amalgame ». La question du traumatisme, de sa répétition et de son élaboration, ainsi que celle des facteurs de resilience sont également discutées. Ce travail ouvre sur une réflexion plus large du concept d'identité. - During the last dictatorship in Argentina (1976-1983), the military junta organized the kidnapping of infants - children of its enemies - in order to raise them in families close to the authorities. The association "Mothers of the Plaza de Mayo" estimates that approximately 400 children have been kidnapped in this way. During their childhood, or as adults, they have come to learn the truth about their biological origins, restituted to them by justice: They are therefore known as "restituted" children. At the time of the field research in 2004, around 40 children had been found in families unaware of their origins. About 20 other came from families close to the junta. The present work is particularly interested in the latter category. This contribution investigates the individual identity as an intimate dynamics by examining its articulation with filiation and its insertion within a community, a society. It revolves around three hypotheses: the first concerns the knowledge - necessarily transmitted through justice and society - of biological origins and its psychological consequences on the identity. The second explores the eventually traumatic, consequences of kidnapping and restitution among the restituted persons. Finally, the third hypothesis questions the relation between identity construction and society, whether it is made through political and associative involvements, media or History. These hypotheses lead to the examination of affiliations between restitution and symbolization process of the origins. Seven semi-structured interviews with restituted persons have been conducted and qualitatively analyzed in a perspective that can, in a large sense, be referred to as "clinical anthropology": an approach/intersection between clinical psychology, psychoanalysis and anthropology. Through an in-depth analysis of the identity itinerary of the kidnapped, adopted and restituted persons, this work is conducted as an empirical research on identity construction. For that purpose, it uses the concept of transmission to describe an individual's affiliation with the subjectivity of a couple through the first name, with a lineage or a community through professional choices or through his/her connections with the association "Mothers of the Plaza de Mayo". Further, it makes a meaningful contribution to the understanding and implications of the notions of cleavage, of primal and narcissistic wounds, of processes of affiliation and of family secrets. In addition, it also proposes a reflection on and the implication of the notions of "deviation" and "amalgam". The question of trauma, its repetition and elaboration, and of resilience factors are aiso being discussed. This work concludes with results in a iarger consideration of the concept of identity.

Paternity and health services. Qualitative research on men's experiences during pregnancy, delivery and postpartum of theirs partners

Background: Little research has been carried out with regards to the inclusion of men during the birth process. The objective of this paper involves exploring the needs and expectations of the health services manifested by a group of fathers as a result of their experience during the birth process. Methods: Qualitative research was carried out in Granada in 2004 via individual interviews with fathers who showed shared responsibility in the upbringing. The profile is: employment, medium-high educational level, one or more child: 0-6 months of age. The transcript was subsequently submitted to hermeneutic analysis. Results: Some semantic constructs are: 1) Health Services do not concede the women as protagonists, 2) Birth process is depending on the body. Fathers can only support and fight for the relevance of men, 3) Men seem like “invisible”, 4) Health services inhibit their participation, and 5) have dealings with fathers according to their gender roles. The participants address the relationship between expectations of care during the birth process and unsatisfied demands, and the manner in which they employ the obstacles encountered within health services that inhibit their participation as arguments that confirm their separation from the process. Conclusions: This paper draws attention to the limited scope of the provision of healthcare during the birth process in terms of protagonism afforded to fathers. Indeed, despite their requisitory discourse, the interviewees manifest contradictory attitudes in the face of changes that require them to make commitments. We identify elements that could be improved to adapt services to the needs of fathers and vice versa.

Structural Validity of the Wechsler Intelligence Scale for Children (WISC-IV) in a French-speaking Swiss sample

The Wechsler Intelligence Scale for Children-fourth edition (i.e. WISC-IV) recognizes a four-factor scoring structure in addition to the Full Scale IQ (FSIQ) score: Verbal Comprehension (VCI), Perceptual Reasoning (PRI), Working Memory (WMI), and Processing Speed (PSI) indices. However, several authors suggested that models based on the Cattell-Horn-Carroll (CHC) theory with 5 or 6 factors provided a better fit to the data than does the current four-factor solution. By comparing the current four-factor structure to CHC-based models, this research aimed to investigate the factorial structure and the constructs underlying the WISC-IV subtest scores with French-speaking Swiss children (N = 249). To deal with this goal, confirmatory factor analyses (CFAs) were conducted. Results showed that a CHC-based model with five factors better fitted the French-Swiss data than did the current WISC-IV scoring structure. All together, these results support the hypothesis of the appropriateness of the CHC model with French-speaking children.

Rescue treatment with terlipressin in children with refractory septic shock: a clinical study

INTRODUCTION Refractory septic shock has dismal prognosis despite aggressive therapy. The purpose of the present study is to report the effects of terlipressin (TP) as a rescue treatment in children with catecholamine refractory hypotensive septic shock. METHODS We prospectively registered the children with severe septic shock and hypotension resistant to standard intensive care, including a high dose of catecholamines, who received compassionate therapy with TP in nine pediatric intensive care units in Spain, over a 12-month period. The TP dose was 0.02 mg/kg every four hours. RESULTS Sixteen children (age range, 1 month-13 years) were included. The cause of sepsis was meningococcal in eight cases, Staphylococcus aureus in two cases, and unknown in six cases. At inclusion the median (range) Pediatric Logistic Organ Dysfunction score was 23.5 (12-52) and the median (range) Pediatric Risk of Mortality score was 24.5 (16-43). All children had been treated with a combination of at least two catecholamines at high dose rates. TP treatment induced a rapid and sustained improvement in the mean arterial blood pressure that allowed reduction of the catecholamine infusion rate after one hour in 14 out of 16 patients. The mean (range) arterial blood pressure 30 minutes after TP administration increased from 50.5 (37-93) to 77 (42-100) mmHg (P < 0.05). The noradrenaline infusion rate 24 hours after TP treatment decreased from 2 (1-4) to 1 (0-2.5) microg/kg/min (P < 0.05). Seven patients survived to the sepsis episode. The causes of death were refractory shock in three cases, withdrawal of therapy in two cases, refractory arrhythmia in three cases, and multiorgan failure in one case. Four of the survivors had sequelae: major amputations (lower limbs and hands) in one case, minor amputations (finger) in two cases, and minor neurological deficit in one case. CONCLUSION TP is an effective vasopressor agent that could be an alternative or complementary therapy in children with refractory vasodilatory septic shock. The addition of TP to high doses of catecholamines, however, can induce excessive vasoconstriction. Additional studies are needed to define the safety profile and the clinical effectiveness of TP in children with septic shock.

Human Exposure to Endocrine-Disrupting Chemicals and Prenatal Risk Factors for Cryptorchidism and Hypospadias: A Nested Case-Control Study

BACKGROUND. Exposure to xenoestrogens during pregnancy may disturb the development and function of male sexual organs. OBJECTIVE. In this study we aimed to determine whether the combined effect of environmental estrogens measured as total effective xenoestrogen burden (TEXB) is a risk factor for male urogenital malformations. METHODS. In a case-control study, nested in a mother-child cohort (n = 702) established at Granada University Hospital, we compared 50 newborns with diagnosis of cryptorchidism and/or hypospadias with 114 boys without malformations matched by gestational age, date of birth, and parity. Controls did not differ from the total cohort in confounding variables. TEXB and levels of 16 organochlorine pesticides were measured in placenta tissues. Characteristics of parents, pregnancy, and birth were gathered by questionnaire. We used conditional and unconditional regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS. TEXB from organohalogenated compounds was detectable in 72% and 54% of case and control placentas, respectively. Compared with controls, cases had an OR for detectable versus non-detectable TEXB of 2.82 (95% CI, 1.10-7.24). More pesticides were detected in cases than in controls (9.34 +/- 3.19 vs. 6.97 +/- 3.93). ORs for cases with detectable levels of pesticides, after adjusting for potential confounders in the conditional regression analysis, were o,p'-DDT (OR = 2.25; 95% CI, 1.03-4.89), p,p'-DDT (OR = 2.63; 95% CI, 1.21-5.72), lindane (OR = 3.38; 95% CI, 1.36-8.38), mirex (OR = 2.85; 95% CI, 1.22-6.66), and endosulfan alpha (OR = 2.19; 95% CI, 0.99-4.82). Engagement of mothers in agriculture (OR = 3.47; 95% CI, 1.33-9.03), fathers' occupational exposure to xenoestrogens (OR = 2.98; 95% CI, 1.11-8.01), and history of previous stillbirths (OR = 4.20; 95% CI, 1.11-16.66) were also associated with risk of malformations. CONCLUSIONS We found an increased risk for male urogenital malformations related to the combined effect of environmental estrogens in placenta.

Effects of highly active antiretroviral therapy with nelfinavir in vertically HIV-1 infected children: 3 years of follow-up. Long-term response to nelfinavir in children.

BACKGROUND Antiretroviral treatment (ART) in children has special features and consequently, results obtained from clinical trials with antiretroviral drugs in adults may not be representative of children. Nelfinavir (NFV) is an HIV-1 Protease Inhibitor (PI) which has become as one of the first choices of PI for ART in children. We studied during a 3-year follow-up period the effects of highly active antiretroviral therapy with nelfinavir in vertically HIV-1 infected children. METHODS Forty-two vertically HIV-infected children on HAART with NFV were involved in a multicentre prospective study. The children were monitored at least every 3 months with physical examinations, and blood sample collection to measure viral load (VL) and CD4+ cell count. We performed a logistic regression analysis to determinate the odds ratio of baseline characteristics on therapeutic failure. RESULTS Very important increase in CD4+ was observed and VL decreased quickly and it remained low during the follow-up study. Children with CD4+ <25% at baseline achieved CD4+ >25% at 9 months of follow-up. HIV-infected children who achieved undetectable viral load (uVL) were less than 40% in each visit during follow-up. Nevertheless, HIV-infected children with VL >5000 copies/ml were less than 50% during the follow-up study. Only baseline VL was an important factor to predict VL control during follow-up. Virological failure at defined end-point was confirmed in 30/42 patients. Along the whole of follow-up, 16/42 children stopped HAART with NFV. Baseline characteristics were not associated with therapeutic change. CONCLUSION NFV is a safe drug with a good profile and able to achieve an adequate response in children.

Different profiles of immune reconstitution in children and adults with HIV-infection after highly active antiretroviral therapy.

BACKGROUND Recent advances in characterizing the immune recovery of HIV-1-infected people have highlighted the importance of the thymus for peripheral T-cell diversity and function. The aim of this study was to investigate differences in immune reconstitution profiles after highly active antiretroviral therapy (HAART) between HIV-children and adults. METHODS HIV patients were grouped according to their previous clinical and immunological status: 9 HIV-Reconstituting-adults (HIV-Rec-adults) and 10 HIV-Reconstituting-children (HIV-Rec-children) on HAART with viral load (VL) or=500 cells/microL at least during 6 months before the study and CD4+

Differential prefrontal-like deficit in children after cerebellar astrocytoma and medulloblastoma tumor

BACKGROUND This study was realized thanks to the collaboration of children and adolescents who had been resected from cerebellar tumors. The medulloblastoma group (CE+, n = 7) in addition to surgery received radiation and chemotherapy. The astrocytoma group (CE, n = 13) did not receive additional treatments. Each clinical group was compared in their executive functioning with a paired control group (n = 12). The performances of the clinical groups with respect to controls were compared considering the tumor's localization (vermis or hemisphere) and the affectation (or not) of the dentate nucleus. Executive variables were correlated with the age at surgery, the time between surgery-evaluation and the resected volume. METHODS The executive functioning was assessed by means of WCST, Complex Rey Figure, Controlled Oral Word Association Test (letter and animal categories), Digits span (WISC-R verbal scale) and Stroop test. These tests are very sensitive to dorsolateral PFC and/or to medial frontal cortex functions. The scores for the non-verbal Raven IQ were also obtained. Direct scores were corrected by age and transformed in standard scores using normative data. The neuropsychological evaluation was made at 3.25 (SD = 2.74) years from surgery in CE group and at 6.47 (SD = 2.77) in CE+ group. RESULTS The Medulloblastoma group showed severe executive deficit (

BMI group-related differences in physical fitness and physical activity in preschool-age children: a cross-sectional analysis.

In the Ballabeina study, we investigated age- and BMI-group-related differences in aerobic fitness (20 m shuttle run), agility (obstacle course), dynamic (balance beam) and static balance (balance platform), and physical activity (PA, accelerometers) in 613 children (M age = 5.1 years, SD = 0.6). Normal weight (NW) children performed better than overweight (OW) children in aerobic fitness, agility, and dynamic balance (all p <.001), while OWchildren had a better static balance (p < .001). BMI-group-related differences in aerobic fitness and agility were larger in older children (p for interaction with age = .01) in favor of the NW children. PA did not differ between NW and OW (p > or = .1), but did differ between NW and obese children (p < .05). BMI-group-related differences in physical fitness can already be present in preschool-age children.

Improvement in growth after two years of growth hormone therapy in very young children born small for gestational age and without spontaneous catch-up growth: results of a multicenter, controlled, randomized, open clinical trial.

CONTEXT GH treatment is effective in children born small for gestational age (SGA); however, its effectiveness and safety in very young SGA children is unknown. OBJECTIVE The aim was to analyze the outcome of very young SGA children treated with GH and followed for 2 yr. The results after 24 months of treatment, compared with a control group without treatment during 12 months followed by 12 months of treatment, are shown. DESIGN We performed a multicenter, controlled, randomized, open trial. SETTINGS The pediatric endocrinology departments of 14 public hospitals in Spain participated in the study. PATIENTS Seventy-six children, aged 2-5 yr born SGA and without catch-up growth, were studied. INTERVENTION Children received GH at 0.06 mg/kg.d for 2 yr (group I) or were followed for 12 months with no treatment and then treated for 12 months (group II). MAIN OUTCOME MEASURES Age, general health status, pubertal stage, bone age, height, weight, biochemical and hormonal analyses, and adverse side effects were determined at biannual check-ups. RESULTS The mean height sd score gain for chronological age in children treated for 24 months (group I) was 2.10, whereas in those treated only during the last 12 months (group II) was 1.43. In both groups, children under 4 yr of age had the greatest gain in growth velocity. No significant acceleration of bone age or side effects related to treatment was seen. CONCLUSION Very young SGA children without spontaneous catch-up growth could benefit from GH treatment because growth was accelerated and no negative side effects were observed.

Respiratory infection in congenital cardiac disease. Hospitalizations in young children in Spain during 2004 and 2005: the CIVIC Epidemiologic Study.

OBJECTIVES To evaluate the rate of hospitalization for acute respiratory tract infection in children less than 24 months with haemodynamically significant congenital cardiac disease, and to describe associated risk factors, preventive measures, aetiology, and clinical course. MATERIALS AND METHODS We followed 760 subjects from October 2004 through April 2005 in an epidemiological, multicentric, observational, follow-up, prospective study involving 53 Spanish hospitals. RESULTS Of our cohort, 79 patients (10.4%, 95% CI: 8.2%-12.6%) required a total of 105 admissions to hospital related to respiratory infections. The incidence rate was 21.4 new admissions per 1000 patients-months. Significant associated risk factors for hospitalization included, with odds ratios and 95% confidence intervals shown in parentheses: 22q11 deletion (8.2, 2.5-26.3), weight below the 10th centile (5.2, 1.6-17.4), previous respiratory disease (4.5, 2.3-8.6), incomplete immunoprophylaxis against respiratory syncytial virus (2.2, 1.2-3.9), trisomy 21 (2.1, 1.1-4.2), cardiopulmonary bypass (2.0, 1.1-3.4), and siblings aged less than 11 years old (1.7, 1.1-2.9). Bronchiolitis (51.4%), upper respiratory tract infections (25.7%), and pneumonia (20%) were the main diagnoses. An infectious agent was found in 37 cases (35.2%): respiratory syncytial virus in 25, Streptococcus pneumoniae in 5, and Haemophilus influenzae in 4. The odds ratio for hospitalization due to infection by the respiratory syncytial virus increases by 3.05 (95% CI: 2.14 to 4.35) in patients with incomplete prophylaxis. The median length of hospitalization was 7 days. In 18 patients (17.1%), the clinical course of respiratory infection was complicated and 2 died. CONCLUSIONS Hospital admissions for respiratory infection in young children with haemodynamically significant congenital cardiac disease are mainly associated with non-cardiac conditions, which may be genetic, malnutrition, or respiratory, and to cardiopulmonary bypass. Respiratory syncytial virus was the most commonly identified infectious agent. Incomplete immunoprophylaxis against the virus increased the risk of hospitalization.

Developmental changes in lateralized inhibition of symmetric movements in children with and without Developmental Coordination Disorder.

The present study investigates developmental changes in selective inhibition of symmetric movements with a lateralized switching task from bimanual to unimanual tapping in typically developing (TD) children and with Developmental Coordination Disorder (DCD) from 7 to 10 years old. Twelve right-handed TD children and twelve gender-matched children with DCD and probable DCD produce a motor switching task in which they have (1) to synchronize with the beat of an auditory metronome to produce bimanual symmetrical tapping and (2) to selectively inhibit their left finger's tapping while continuing their right finger's tapping and conversely. We assess (1) the development of the capacity to inhibit the stopping finger (number of supplementary taps after the stopping instruction) and (2) the development of the capacity to maintain the continuing finger (changes in the mean tempo and its variability for the continuing finger's tapping) and (3) the evolution of performance through trials. Results indicate that (1) TD children present an age-related increase in the capacity to inhibit and to maintain the left finger's tapping, (2) DCD exhibits persistent difficulties to inhibit the left finger's tapping, and (3) both groups improve their capacity to inhibit the left finger's movements through trials. In conclusion, the lateralized switching task provides a simple and fine tool to reveal differences in selective inhibition of symmetric movements in TD children and children with DCD. More theoretically, the specific improvement in selective inhibition of the left finger suggests a progressive development of inter-hemispheric communication during typical development that is absent or delayed in children with DCD.

Devenir parent : divergences et convergences interindividuelles dans une transition de vie

RésuméLa naissance du premier enfant est un événement normatif à l'origine de nombreux changements dans le parcours de vie des hommes et des femmes. La présente recherche s'intéresse à la transition à la parentalité en tant que moment à l'origine d'un processus de stratification sociale. Trois dimensions dépendantes sont étudiées du point de vue de leur changement: l'insertion professionnelle, le travail domestique et la qualité de la relation conjugale. Les concepts de divergence et de convergence interindividuelle, élaborés à partir de l'hypothèse des dés/avantages cumulatifs et de l'hypothèse alternative des effets compensatoires, sont utilisés pour opérationnaliser le changement qui se produit dans ces trois dimensions lors de la naissance du premier enfant.Les résultats montrent, dans un premier moment, la présence de divergences entre les hommes et les femmes dans chacune de ces trois dimensions. Ces divergences inter-sexe sont associées à des convergences entre les individus de même sexe. Les analyses se focalisent dans un deuxième moment, sur les divergences et convergences ultérieures qui se produisent entre individus du même sexe en fonction des ressources sociales, culturelles et économiques initiales. Quelles sont ainsi, par exemple, les mères qui ne diminuent pas leur taux d'occupation initial? Quels sont les pères qui réduisent moins que les autres leur investissement dans le travail domestique? Quels sont les parents qui connaissent une moindre diminution de la qualité de leur relation conjugale? Les réponses données à ces questions montrent comment le processus de stratification sociale au sein d'une cohorte doit être expliqué en relation avec le changement qui se produit lors d'une transition spécifique et non seulement en tant que résultat du simple passage du temps.AbstractThe birth of the first child is a normative event creating important changes in the life course of men and women. This research analyzes the transition to parenthood as a moment creating social stratification. Three dependent dimensions are studied in their change: the occupational career, the domestic labour and the conjugal relationship's quality. The concepts of interindividual divergences and convergence, conceived from the cumulative dis/advantage hypothesis and the alternative hypothesis of compensatory effects, are used to operationalize the change in these three dimensions after the birth of the first child.Results show that, firstly, divergences take place between men and women becoming parents in the three dependent dimensions. Inter-sex divergences are associated to convergence between same-sex individuals. Secondly, the analyses focus on further di/convergences taking place between same-sex individuals, in relation with the initial social, cultural and economical resources. Who are the mothers who will not reduce their initial occupational rates? Who are the fathers who will reduce less than the others their involvement in the domestic tasks? Who are the parents who will experience a less important reduction in their conjugal relationship's quality? The answers to these questions show how the process of social stratification within a cohort has to be explained in relation with the change taking place during a specific transition and not only as a result of the simple passage of time.

Associations between parental and child attachment representations.

In the present article on intergenerational transmission of attachment representations, we use mothers' and fathers' Adult Attachment Interview classifications to predict a 3-year-old's responses to the Attachment Story Completion Task (ASCT). We present a Q-sort coding procedure for the ASCT, which was developed for children as young as three. The Q-sort yields scores on four attachment dimensions (security, deactivation, hyperactivation, and disorganization). One-way ANOVAs revealed significant mother-child associations for each dimension, although results for the hyperactivation and disorganization dimensions were significant only according to contrast tests. Conversely, no father-child association was found, regardless of the dimension considered. Findings are discussed in terms of the respective part played by each parent in their children's emotional development.