Search

It is often a challenge for a child to communicate their pain, and their possibilities to do so should be strengthened in healthcare settings. Digital self‐assessment provides a potential solution for person‐centered care in pain management and promotes child participation when a child is ill. A child's perception of pain assessment differs when it is assessed using digital or analog formats. As we move into the digital era, there is an urgent need to validate digital pain assessment tools, including the newly developed electronic Faces Thermometer Scale (eFTS). This study protocol describes three studies with the overall aim to evaluate psychometric properties of the eFTS for assessing pain in children 8–17 years of age. A multi‐site project design combining quantitative and qualitative methods will be used for three observational studies. Study 1: 100 Swedish‐speaking children will report the level of anticipated pain from vignettes describing painful situations in four levels of pain and a think‐aloud method will be used for data collection. Data will be analyzed with phenomenography as well as descriptive and comparative statistics. Study 2: 600 children aged 8–17 years at pediatric and dental settings in Sweden, Denmark, Iceland, and USA will be included. Children will assess their pain intensity due to medical or dental procedures, surgery, or acute pain using three different pain Scales for each time point; the eFTS, the Faces Pain Scale Revised, and the Coloured Analogue Scale. Descriptive and comparative statistics will be used, with subanalysis taking cultural context into consideration. Study 3: A subgroup of 20 children out of these 600 children will be purposely included in an interview to describe experiences of grading their own pain using the eFTS. Qualitative data will be analyzed with content analysis. Our pilot studies showed high level of adherence to the study procedure and rendered only a small revision of background questionnaires. Preliminary analysis indicated that the instruments are adequate to be used by children and that the analysis plan is feasible. A digital pain assessment tool contributes to an increase in pain assessment in pediatric care. The Medical Research Council framework for complex interventions in healthcare supports a thorough development of a new scale. By evaluating psychometric properties in several settings by both qualitative and quantitative methods, the eFTS will become a well‐validated tool to strengthen the child's voice within healthcare. [ABSTRACT FROM AUTHOR]

Abstract. Henriksson F, Agardh C-D, Berne C, Bolinder J, Lönnqvist F, Stenström P. Östenson C-G, Jönsson B (Centre for Health Economics, Stockholm; Department of Endocrinology, University Hospital MAS, Malmö; Department of Internal Medicine, Uppsala University Hospital; Centre for Metabolism and Endocrinology and SmithKline Beecham Pharmaceuticals AB, Karolinska Institute; Diabetes Prevention Unit, Karolinska Hospital, Stockholm, Sweden). Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 2000; 248: 387–396. Objectives. To estimate the total direct medical costs to society for patients with type 2 diabetes in Sweden and to investigate how different factors, for example diabetic late complications, affect costs. Design. Cross-sectional data regarding health care utilization, clinical characteristics and quality of life, were collected at a single time-point. Data on resource use cover the 6-month period prior to this time point. Setting. Patient recruitment and data collection were performed in nine primary care centres in three main regions in Sweden. Subjects. Only patients with an age at diabetes diagnosis ≥ 30 years (type 2 diabetes) were included (n = 777). Results. The total annual direct medical costs for the Swedish diabetes type 2 population were estimated at about 7 billion SEK (Swedish Kronor) in 1998 prices, which is about 6% of the total health care expenditures and more than four times higher than the former Swedish estimate obtained when using diabetes as main diagnosis for calculating costs. The annual per patient cost was about 25 000 SEK. The largest share of this cost was hospital inpatient care. Costs increased with diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycaemic drugs or with life style modification only. Patients with both macro- and microvascular complications had more than three times higher costs compared with patients without such complications. Conclusions. Type 2 diabetes is a serious and expensive disease and the key to reducing costs seems to be intensive management and control in order to prevent and delay the associated late complications. [ABSTRACT FROM AUTHOR]

The article assesses the potential for leaching of glyphosate and aminomethylphosphonic acid (AMPA) in agricultural soils. Glyphosate adsorption, glyphosate degradation, and the formation of AMPA and its degradation are determined using topsoil and subsoil samples. It was found that glyphosate adsorption gives slow degradation rate in the clay soil and the degradation rate of AMPA can be faster than that of glyphosate. Glyphosate and AMPA residues have low mobility as they constitute up to 59 percent of the glyphosate added in the topsoil.

The article presents a study that investigates the hygienic barrier efficiency and related health risks of an on-site wastewater treatment system exceeding its design capacity for five years. The wastewater treatment system comprises a pressure-dosed biofilter, septic tank, and up-flow filter unit. The system was analyzed for both bacteria and virus removal with potential health risk assessment using Escherichia coli and Salmonella typhimurium for bacterial and viral indicators respectively. Findings suggest that although a decrease in the removal of E. coli during the first three years of operation occured, risks of rotavirus infection and disease were higher from the acceptable level based on the standards of World Health Organization.

The article attempts to identify the main sources of variation in pesticide losses at field and catchment scales using the dual permeability macropore flow model MACRO. Stochastic simulations of the leaching of the herbicide 4-chloro-2-methylphenoxyacetic acid (MCPA) were compared with seven years of measured concentrations in a stream draining a small agricultural catchment and one year of measured concentrations at the outlet of a field located within the catchment. MACRO was parameterized from measured probability distributions accounting for spatial variability of soil properties and local pedotransfer functions derived from information gathered in field- and catchment-scale soil surveys. At the field scale, a single deterministic simulation using the means of the input distributions was also performed. The deterministic run failed to reproduce the summer outflows when most leaching occurred, and greatly underestimated pesticide leaching. In contrast, the stochastic simulations successfully predicted the hydrologic response of the field and catchment and there was a good resemblance between the simulations and measured MCPA concentrations at the field outlet.

Examines the long-term fate of the fungicide triticonazole (TTZ) applied at a normal field dose via seed treatment, which is the normal alternative in practice. Percentages of the total TTZ applied which remained in the soil and seed treatments, with corresponding half-lives of 27- and 29-days; Number of days before the microbial biomass returned to its normal levels after soil treatment.

Aim: Information about healthy children's urinary tract symptoms is scarce but would be helpful in children with congenital urinary tract conditions. The aim of this study was to develop and evaluate a Lower Urinary Tract Dysfunction (LUTD) questionnaire., Methods: A 15-item questionnaire based on definitions by the International Children's Continence Society (ICCS) about urinary tract function, was given to children 4-15 years old with no gastrointestinal or urinary tract conditions. The study was approved ethically., Results: The response rate was 82% (311/377), 50% (n = 155) were girls. Children were of the age groups 3.5-7 years (n = 136), 8-12 years (n = 127), and 13-15 years (n = 48). More girls than boys reported urinary tract infections (20% vs 3%, p < 0.001), while prevalences of incontinence and enuresis were equivalent in both sexes. In the youngest age group, enuresis was the most frequently reported symptom (11%), then daytime incontinence (10%). The older children more frequently reported previous urinary tract infections (12% and 17% in respective groups) and daytime incontinence (9% and 6%, respectively)., Conclusion: A LUTD questionnaire is developed and evaluated within this study. Daytime urinary incontinence is the overall most common lower urinary tract symptom and girls report infections more frequently than boys., (© 2021 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: Hirschsprung's disease is a congenital disorder requiring surgery. Most children operated on for Hirschsprung's disease experience postoperative bowel dysmotility. Although various food is known to influence bowel motility, evidence of diet's role and dietary guidelines in treatment of bowel dysfunction in Hirschsprung's disease is lacking. The aim was to explore parental experiences of dietary effects on bowel function in children with Hirschsprung's disease., Methods: A qualitative study including three focus groups with ten parents of children with Hirschsprung's disease at a national Hirschsprung's disease centre. Data were analysed through content analysis., Results: Parents emphasised diet as a strong influencer on their child's bowel function in Hirschsprung's disease. They expressed great concerns about their responsibility and strived hard to explore and adjust dietary habits to control the child's bowel function. Families' daily and social lives were influenced by the child's diet and bowel function. The parents desired dietary support and guidelines to improve their confidence in self-treatment of Hirschsprung's disease., Conclusion: Dietary habits play a key role in parental self-treatment of bowel function in their children with Hirschsprung's disease. Dietary guidelines for patients with Hirschsprung's disease are anticipated., (©2021 The Authors. Acta Paediatrica Published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: We evaluated bowel function in healthy children with regard to gender and age., Methods: The study was carried out in 2016 at a tertiary children's hospital. Healthy children aged 3.5 years to 15 years who were admitted to the hospital, siblings to patients or offspring of staff members were included. Validated self-report questionnaires and internally developed questions regarding obstructive outlet- and gas-related symptoms were used., Results: A total of 310 participants (50% girls) were included, which corresponded to a 94% answer frequency. Respondents were divided into a younger age group (3.5 years to seven years), consisting of 135 children, and an older age group (eight years to 15 years), consisting of 175 children. Younger children reported more foul odours than older children (50% vs. 29%, p = 0.001) and more obstructive symptoms (21% vs. 10%, p = 0.01). There was no difference between the age groups regarding constipation (19% vs 16%, NS). Overall, 55% of those with constipation had no treatment for the condition, although they reported abdominal pain (51%) and problems with foul odours (57%)., Conclusion: Healthy children frequently reported constipation, abdominal pain and gas-related problems, but treatment was rare. Overall, bowel function seemed to improve during childhood, although constipation remained largely untreated., (©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)