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AIMS/PURPOSE To investigate Leber congenital amaurosis (LCA) patients' expectations, decision-making processes and gene therapy-related concerns. METHODS Using a qualitative approach, we explored perceptions of gene therapy and clinical trials among individuals with LCA. Young adults with a clinical diagnosis of LCA were recruited through the Ocular Genetics Programme at the Hospital for Sick Children. Semi-structured interviews were conducted with ten patients and analysed following the principles of qualitative description. RESULTS Study participants were aware of ongoing gene therapy research trials and actively sought information regarding advances in ophthalmology and vision restoration. The majority of participants would enrol or were enrolled in a gene-replacement therapy trial, while a minority was ambivalent or would not enrol if provided an opportunity. Participants attributed different values to clinical trials, which influenced their willingness to participate. Intrinsic factors related to coping, adaptation to vision loss and resilience also influenced decision-making. DISCUSSION This study highlights the complex factors involved in gene-therapy-related decision-making and acts as a proponent for adopting patient-centred care strategies when counselling individuals considering gene therapy or clinical trial participation.

Report 1 presented the definition of numismatics as a historical science, aspects of the study of its components (coins, medals, plaques), the images of common international symbols of pediatrics (Har-pa-Khered, or Harpocrates, a pelican feeding its chicks, and Florentine Infant), it was emphasized the role of prominent scientists and doctors who made an invaluable contribution to the development of pediatrics and they were provided on numismatic materials, their biographies were briefly highlighted. The insufficient modern usage of numismatics facilities in perpetuating the memory of famous pediatricians was emphasized. Report 2 considers the questions of the history of pediatric surgery based on numismatic materials, lists the specialized medical institutions in Argentina, Hungary, Germany, Latvia, Lithuania, Poland, Portugal, Russia, the USA, Uruguay, France, where surgical interventions for sick children are carried out, and scientific forums for children surgeons (congresses, congresses, conferences, symposia) are clarified.

Objective: Hospitalization is a fearful negative experience for children and families. The aim of this study is to learn the feelings and thoughts of school age children hospitalized in the hospital about “illness and hospital”. Material and Method: The study was carried out with 100 children hospitalized in the pediatric ward of a state hospital. In this qualitatively planned study, a sentence completion test was applied with the creative play method aiming to reveal the illness and hospital-related thoughts of hospitalized school-age children. In the sentence completion test, the themes and categories were created by content analysis by the researchers. Ethics committee and necessary permissions were obtained for the study. Results: The Health-illness perception for children consists of four categories, being hospital experience, concerns, and expectations from the hospital. Sick children defined health as feeling good and strong, illness as feeling bad, leaving family, friends and school, and being unable to do anything. They reported staying in the hospital as a bad, sad feeling and a terrible experience. They stated that they regret being separated from their family, school, friends, and teachers in the hospital, and they missed their lessons. Some of the expectations of the children in the hospital are toys in the room, a large playground in the hospital, and an opportunity to follow the lessons they missed at school from their room. Conclusion: In our study, it was determined that the most important concern of school-age children who were hospitalized was their separation from family, school, friends, and lessons.

Background We have shown that Ethiopian primary healthcare providers refer only half of the severely sick children who, according to guidelines, should get an urgent referral. Frequently parents of referred ill children don’t bring their children to the next level. We aimed to describe the referral of severely ill Ethiopian children based on primary healthcare register reviews and explore health care providers’ and parents’ perceptions regarding factors that hinder or enhance referral. Methods A mixed-methods study was conducted in 11 districts and a town administration of the Hadiya zone in Ethiopia’s Southern region from May to June 2019. Data collection included interviews and focus group discussions with healthcare providers, key informant interviews with parents of sick children who had been referred, and reviewing registers of sick children treated during the last 12 months at health posts and health centres. We analysed the association between healthcare providers’ and sick children’s characteristics and providers’ compliance with referral guidelines for sick children 0–59 months old. Content analysis was undertaken to explore the perceived factors that influenced referral and adherence to referral from providers’ and parents’ perspectives. Results Healthcare providers did not refer nearly half of the severely ill children that should have been referred, according to guidelines. Providers who had received in-service training on child healthcare were more likely to adhere to referral guidelines. The severity of the child’s illness and mobile phone communication and transport availability were perceived to be positively associated with adherence to referral guidelines. Lack of knowledge of treatment guidelines and skills, and high health worker workload, were among the factors perceived to be linked to lower adherence to guidelines. The healthcare providers considered parents of referred sick children as having low compliance with the referral advice. In contrast, parents had the opinion that compliance with a referral for sick children was high. Perceived awareness of severity of the child’s illness, ability to afford referral costs, and availability of transport or ambulance services were perceived to motivate parents to take their children to the referral facility. Traditional illness perceptions, lack of confidence in the referral site’s medical care, and a long distance were perceived to hurdle caregivers’ referral compliance. Conclusions We found that the healthcare providers’ adherence to referral guidelines was not optimal. Care providers and parents had divergent opinions on parents’ compliance with referral advice. Factors related to the health system, family economy, and available ambulance services influence whether care providers and parents pursued severely ill children’s referral. Adequate referral of sick children is an aspect of primary healthcare quality that is essential to avoid unnecessary under-five deaths.

SummaryUntil 2018 only adults had access to rehabilitation in Austria, but since then 5 centers for pediatric rehabilitation with different indications have been established with the goal of improving the health of sick children and young adults. The pediatric rehabilitation center “Leuwaldhof”, which is located south of Salzburg, is the only pediatric oncologic rehabilitation center in Austria. It offers rehabilitation and recovery for pediatric patients who suffered from malignancies, as well as for their families and siblings, but also for acute or chronic disease in metabolism or digestion. Cancer and its treatment significantly decrease the quality of life (QoL) of pediatric patients and their families. Families often have to split up during the months of chemotherapy if there are siblings in the family and very often it is the mother who stays with the sick child in the hospital. To facilitate recovery for the families in these difficult times, interdisciplinary and family-oriented inpatient rehabilitation has recently been implemented in Austria. To evaluate the improvements during the rehabilitation, the QoL of the patients and families has been routinely assessed since the opening of the center. In a specifically designed ‘life app’, patients and families complete the Pediatric Quality of Life Inventory (PedsQL; generic score and cancer module) before and after rehabilitation on their own electronic devices. Data of 98 patients and 124 parents between June 2018 and December 2019 show significant improvements in QoL. Our goal is to support the children and their families to help them return to normal life. Our results show rehabilitation helps achieve this important goal.

Epilepsy is a many-sided disease that manifests itself as seizures of various kinds and origin, which can start at any age, often in childhood. The nursing, training and treatment of a sick child have serious implications for the whole family. The most significant factor becomes the ability of a nurse to impart existing professional knowledge to a patient and his or her family and to teach about disease control measures. More informed patients and their families feel more in control of their illness than less informed patients and their relatives. People with epilepsy and the general public lack general information about the condition, knowledge about care and how to deliver it, and access to services. Educating loved ones is a key tool in disease control and prevention.The research was conducted in October and November of 2019 in one of the city hospitals in Vilnius. The analysis of questionnaire data before the training revealed that parents whose children suffer from epilepsy have lack of information about the disease. The questionnaire data after the training showed that parents acquired more knowledge and the results improved. The majority of parents whose children suffer from epilepsy is well informed about the disease. However, they have a lack of knowledge in relation to the factors provoking epileptic seizures. Besides, they are not aware when it is necessary to call the ambulance and when to use first aid medicines. The parents are interested in innovations related to epilepsy, treatment and care of a sick child. All the parents have a need to gain knowledge about the disease. The comparison of parents’ awareness of the disease before and after the training showed that parents had learnt to provide aid correctly during seizures. The training was effective.

Introduction: Severely sick-children presenting at primary healthcare facilities need referral to higher level facilities for better care. Adherence to referrals and quality of care received by those referred could serve as critical steps towards their survival.Objective: To describe experiences with severely sick children referred to higher-level health facilities for care and reasons for non-adherence to referral; to explore healthcare provider’s perspectives to referral.Methods: Referrals among 3046 young children were followed for adherence. Assessment of children referred from a PHC facility adhering to referral advice and reasons for non-adherence to referral was determined. Agreement on reported diagnoses at PHC centres and health-facilities receiving patients was assessed. Perspectives of healthcare providers were assessed.Results: 212 children were referred from PHC centres to various hospitals with 14.2% non-adherence. Reasons given: 48.3% of carers adhering felt child’s condition was severe; 43.3% complied with healthcare provider directive. The main reasons for non-adherence to referral were no money for transport (50%) and child condition not serious (30.0%). 69.0% of anaemia cases diagnosed at PHC facilities and hospitals. 65.7% fever diagnosed at a PHC centres were confirmed as malaria at the hospitals. Healthcare providers referred patients for severity, perceivedcomplication and non-response to treatment.Conclusion: Adherence was generally good. The level of agreement in diagnosis of common diseases such as malaria and anaemia at PHC centres and district hospitals was high and low for rarer diseases. Capacity should be provided at PHC levels for adequate management of cases presented to reduce referrals carers have to make

BACKGROUND: The role of mother with HIV/AIDS in caring for their children has its own complexities. The mother plays a role in taking care of the family as well as being the caregiver for her children. Mothers with HIV-AIDS need to take care of themselves and their children who are either infected or not. Mothers can do multiple roles if their partner leaves them. AIM: The purpose of this study was to determine the life experiences of mothers with HIV-AIDS in childcare. METHODS: A phenomenological study was chosen as a design to explore the phenomenon of mothers with HIV-AIDS in parenting their children using in-depth interviews. Participants were drawn based on a purposive sample of seven people. The participant’s considerations were the wife who was diagnosed with HIV-AIDS positive and was registered as a patient managed by the HIV-AIDS program at the Serang City Health Center; the participants received ARV treatment, good general condition, able to communicate well, and cooperatively. The data analysis used was Colaizzi. RESULTS: The results of the study generate four new themes: Expectation of negative status of the loved ones, lamentations of wives with People Living With HIV/AIDS (PLWHA) status, management of sick child care and HIV testing, tendencies of authoritarian, and permissive parenting in children. CONCLUSION: Therefore, it is important to increase peer group counseling on the process of disease acceptance, management of sick children management, and implementation of HIV testing that can be accessed by family members of PLWHA.

Dr Rodney Franklin is the focus of our third in a planned series of interviews in Cardiology in the Young entitled, “Global Leadership in Paediatric and Congenital Cardiac Care.” Dr Franklin was born in London, England, spending the early part of his childhood in the United States of America before coming back to England. He then attended University College London Medical School and University College Hospital in London, England, graduating in 1979. Dr Franklin would then go on to complete his general and neonatal paediatrics training in 1983 at Northwick Park Hospital and University College Hospital in London, England, followed by completing his paediatric cardiology training in 1989 at Great Ormond Street Hospital for Children in London, England. During this training, he additionally would hold the position of British Heart Foundation Junior Research Fellow from 1987 to 1989. Dr Franklin would then complete his training in 1990 as a Senior Registrar and subsequent Consultant in Paediatric and Fetal Cardiology at Wilhelmina Sick Children’s Hospital in Utrecht, the Netherlands. He subsequently obtained his research doctorate at University of London in 1997, consisting of a retrospective audit of 428 infants with functionally univentricular hearts.Dr Franklin has spent his entire career as a Consultant Paediatric Cardiologist at the Royal Brompton & Harefield Hospital NHS Foundation Trust, being appointed in 1991. He additionally holds honorary Consultant Paediatric Cardiology positions at Hillingdon Hospital, Northwick Park Hospital, and Lister Hospital in the United Kingdom, and Honorary Senior Lecturer at Imperial College, London. He has been the Clinical Lead of the National Congenital Heart Disease Audit (2013–2020), which promotes data collection within specialist paediatric centres. Dr Franklin has been a leading figure in the efforts towards creating international, pan European, and national coding systems within the multidisciplinary field of congenital cardiac care. These initiatives include but are not limited to the development and maintenance of The International Paediatric & Congenital Cardiac Code and the related International Classification of Diseases 11th Revision for CHD and related acquired terms and definitions. This article presents our interview with Dr Franklin, an interview that covers his experience in developing these important coding systems and consensus nomenclature to both improve communication and the outcomes of patients. We additionally discuss his experience in the development and implementation of strategies to assess the quality of paediatric and congenital cardiac care and publicly report outcomes.

Childhood epilepsy is one of the disease groups with the highest disease burden in society. This study aimed to guide researchers for new studies by determining the most compelling studies and current issues through a bibliometric analysis of scientific outputs about childhood epilepsy between 1980 and 2018. The literature review was conducted using the Web of Science (WoS) database. Epilepsy and status epilepticus were used as search keywords in WoS, and the search was performed only in the title section of the publications. Only publications in the research field of pediatrics were included in the study and were analyzed bibliometrically. Linear regression analysis was used to estimate the number of publications in the coming years. It was seen that the number of articles on pediatric epilepsy has been increasing with a linear trend. A total of 3424 publications were found. Of these publications, 2197 (64.2%) articles were analyzed bibliometrically. The top two most productive countries were the USA(654) and Italy (199). The first two most active institutions were The Hospital for Sick Children (40, 1.8%) and Tel Aviv University (38, 1.7%). The top three journals that published the most were Journal of Child Neurology (422, 19.2%), Pediatric Neurology (335, 15.2%), and Developmental Medicine and Child Neurology (201, 9.1%). In this bibliometric study on childhood epilepsies, a data summary of 2197 articles published between 1980 and 2018 is presented. We hope that this article will be a useful literature review and guide researchers working on pediatric epilepsy.

Background: Parental attitude is an important area to study in order to improve services to families of children affected by leprosy , as it plays a major role in the diagnosis and treatment of the sick child. This study examines parents’ attitudes towards their children affected by leprosy. Methods: This field-based study sample consisted of 100 couples who had registered their children for treatment at a tertiary care hospital. Parental attitude towards their children's illness was measured using the Parents Attitude Towards Children Illness Scale (PATCIS). Results: One hundred couples were interviewed, these being the parents of 60 male and 40 female children with leprosy. Of these children, 67 were diagnosed as multibacillary. Almost all of them had a skin patch as the first symptom: 46 children noticed the patch themselves and 51 were noticed by the parents. Forty-nine cases had started treatment within six months after noticing the patch. The overall mean score of the study participants was 4.19 ± 3.44 , showing that most of them had a positive attitude towards the disease of their children. Conclusion: This is the first study to investigate the parents’ attitude towards their children affected by leprosy. The study showed that the parents had a positive attitude towards their child’s disease.

The purpose of this study was to obtain a picture of the treatment of diarrhea performed in children in the Community Health Center. This study uses a qualitative research design with a case study approach. There were 8 participants in this study, namely 2 nurses who treated diarrhea children and 6 diarrhea children who were seeking care at the community health center. Participants were considered valid as informants because the 2 nurses already had experience in treating diarrhea while 6 diarrhea children were considered valid as informants at the time of participatory observation. Data from interviews, observations and documentation were analyzed according to miles and huberman including reduction, presentation and verification. It was concluded that to overcome the problem of readiness to improve fluid balance, hypovolemia and nutritional deficits in diarrhea patients given Paracetamol syrup 120 mg each 5ml, Neo Kaolana syrup 120 ml, zinc syrup and oralit. Paracetamol is given as a heat-lowering, Neo kaolana as a medicine for diarrhea, absorbs bacteria, toxins in the digestive tract and zinc also functions to treat diarrhea and oralit to relieve dehydration.

Length of stay (LOS) is an important issue for many healthcare organizations. In-patients with extreme LOS account for a disproportionately large percentage of hospital costs. Our analysis of over 15,000 pediatric hospital discharges at The Hospital for Sick Children (Toronto, Canada) between 2015 and 2016 revealed that the vast majority of patients with extreme LOS were discharged directly home, with only a minority receiving home-based services. Patients with the greatest LOS were accounted for by primarily four subspecialty services. Although this report outlines an analysis of pediatric in-patients, our findings and implications are relevant for all jurisdictions and populations as many acute care hospitals often "hold" patients with complex, chronic illness as in-patients for extended periods because alternate appropriate services may not exist or be available. Our case study highlights three key areas to improve quality of care for patients with extreme LOS: alternate levels of care, system resources and transitions to home.

Emergency triage assessment, Management of shock in children with severe malnutrition, Coma and convulsions, The sick young infant, Neonatal notes, Low birth weight and prematurity, Perinatal asphyxia/hypoxic ischaemic encephalopathy, Neonatal infection

Over 50% of sick children are treated by private primary-level facilities, but data on patient referral processes from such facilities are limited. We explored the perspectives of healthcare providers and child caretakers on the referral process of children with common childhood infections from private low-level health facilities in Mbarara District. We carried out 43 in-depth interviews with health workers and caretakers of sick children, purposively selected from 30 facilities, until data saturation was achieved. The issues discussed included the process of referral, challenges in referral completion and ways to improve the process. We used thematic analysis, using a combined deductive/inductive approach. The reasons for where and how to refer were shaped by the patients’ clinical characteristics, the caretakers’ ability to pay and health workers’ perceptions. Caretaker non-adherence to referral and inadequate communication between health facilities were the major challenges to the referral process. Suggestions for improving referrals were hinged on procedures to promote caretaker adherence to referral, including reducing waiting time and minimising the expenses incurred by caretakers. We recommend that triage at referral facilities should be improved and that health workers in low-level private health facilities (LLPHFs) should routinely be included in the capacity-building trainings organised by the Ministry of Health (MoH) and in workshops to disseminate health policies and national healthcare guidelines. Further research should be done on the effect of improving communication between LLPHFs and referral health facilities by affordable means, such as telephone, and the impact of community initiatives, such as transport vouchers, on promoting adherence to referral for sick children.

Aim This study aimed at assessing the referral of sick young infants and children from the community, health posts and health centres to higher levels. Methods A cross‐sectional survey was conducted in four of the largest Ethiopian regions from December 2016 to February 2017. Referral practices were assessed at each level in 46 districts of these regions. Interviews were supplemented by reviews of registers at health posts and health centres. Results The women's development group leaders, who do not provide health services, referred half of the sick children they visited in the community to the health posts. The health extension workers referred 16% of the sick young infants and 6% of older infants and children to higher levels. From health centres, the health workers referred 6% of sick young infants and 1% of older infants and children to hospital. Many cases of possible severe bacterial infection were not referred to higher levels. A functional ambulance was available for a bit more than a third of the health centres. Conclusion Referral practices of sick young infants and children at all levels were weak that may threaten the continued reduction of child mortality in Ethiopia. Referral logistics were insufficient, which partly could explain the missing referrals of severely ill infants and children.

Thalasemia adalah kelainan darah yang diturunkan dari orangtuanya, anak dengan thalasemia harus melakukan tranfusi darah secara rutin yang mengakibatkan kelebihan zat besi, selain itu juga harus mengomsumsi obat kelasi besi untuk mengurangi kelebihan zat besi akibat keseringan tranfusi darah yang dilakukan seacra rutin dan jangka waktu lama. Adanya perawatan tranfusi dengan secara rutin. sehingga sangat perlu ibu mendampingi anaknya. Ibu tidak hanya melakukan aktivitas sehari-hari saja melainkan ibu sebagai perawat dimana merawat anak-anaknya yang sakit. sehingga sangat perlu ibu Selama perawatan dan Pengetahuan mengenai thalasemia sangat penting Metode yang digunakan pada penelitian ini adalah kualitatif dengan metode fenomologi dekriptif ini, bertujuan untuk mengeksplor pengalaman ibu merawat anak thalasemia. Hasil penelitian menunjukan 5 tema yaitu 1) Perasaan Ibu pertama mengetahui anaknya Thalasemia (kaget, syok, tidak menerima,menerima), 2) Upaya ibu Mengobati Anak, 3), kendala ibu merawat anak thalasemia, 4) Menerima kenyataan setelah melakukan pengobatan 5) Dukungan yang diperoleh ibu. Kesimpulan Diharapkan tenaga kesehatan termasuk perawat anak dapat memberikan pengetahuan dalam perawatan dan pengetahuan kepada keluarga terutama ibu yang mendampingi anaknya sealama perawatan.

Acute respiratory viral infections (ARVI) are diseases that have important medico-social importance since they are associated with a wide distribution among the population, the risk of complications, reduced quality of life of patients, and high total cost of treatment. Aim. To assess the quality of pharmacotherapy: the frequency of prescribing drugs for children with ARVI in the health­care institution of the Poltava region and the correspondence of drug prescriptions to clinical protocols for providing medical care and the State Formulary of Medicines of Ukraine (SFMU). Materials and methods. The quality assessment of pharmacotherapy of children with ARVI was performed using auxiliary clinical and economic methods – the frequency and formal VEN-analyses. Results. The main directions of pharmacotherapy of children with ARVI in one of the healthcare institution of the Pol­tava region correspond to the unified clinical protocol of the primary care for adults and children with ARVI and clinical protocols for pharmacotherapy of concomitant diseases. Using the formal VEN-analysis it has been determined that the majority of INN drugs prescribed are recommended by clinical protocols for pharmacotherapy of the main (ARVI) and associated diseases registered in patients, and are available in the SFMU (87.50 and 54.69 %, respectively). Conclusions. The formal VEN analysis has shown that the ARVI pharmacotherapy correction is needed in the health­care institution of the Poltava region studied since a significant part of the INN drugs prescribed is absent in the SFMU (45.31 %) and in clinical protocols for the primary pharmacotherapy (ARVI) and associated diseases (17.19 %). In both medical and technological documents there are no 12.50 % of INNs prescribed. For them 11.74 % of funds (4808.81 UAH) were spent by parents of sick children; they were prescribed 8.74 % times (38 prescriptions) of the total number of prescriptions – 431.

Aims: The western region in Kenya is holoendemic to malaria and experience stable P. falciparum malaria transmission. The use of health care options has a direct influence on the outcome of severe malaria. As such, the current study will assess the health care seeking behavior among caregivers of sick children who had severe malarial anaemia (SMA) in western Kenya. Study Design: Cross section study. Place and Duration of Study: The study was conducted at Jaramogi Odinga Oginga Teaching and Referral Hospital (JOOTRH) between September 2014 to July 2015. Methodology: It was open to all children ≤10 years (n=271) admitted and diagnosed with SMA (hemoglobin

ObjectiveDelays in seeking medical attention for childhood pneumonia may lead to increased morbidity and mortality. This study aimed at identifying the drivers of delayed seeking of treatment for severe childhood pneumonia in rural Bangladesh.MethodsWe conducted a formative study from June to September 2015 in one northern district of Bangladesh. In-depth interviews were conducted with 20 rural mothers of children under 5 years with moderate or severe pneumonia. We analysed the data thematically.ResultsWe found that mothers often failed to assess severity of pneumonia accurately due to lack of knowledge or misperception about symptoms of pneumonia. Several factors delayed timely steps that could lead to initiation of appropriate treatment. They included time lost in consultation with non-formal practitioners, social norms that required mothers to seek permission from male household heads (eg, husbands) before they could seek healthcare for their children, avoiding community-based public health centres due to their irregular schedules, lack of medical supplies, shortage of hospital beds and long distance of secondary or tertiary hospitals from households. Financial hardships and inability to identify a substitute caregiver for other children at home while the mother accompanied the sick child in hospital were other factors.ConclusionsThis study identified key social, economic and infrastructural factors that lead to delayed treatment for childhood pneumonia in the study district in rural Bangladesh. Interventions that inform mothers and empower women in the decision to seek healthcare, as well as improvement of infrastructure at the facility level could lead to improved behaviour in seeking and getting treatment of childhood pneumonia in rural Bangladesh.

ObjectivesChildren accessing healthcare systems represent a vulnerable population with risk factors for poor health outcomes, including vaccine-preventable diseases. We aimed to quantify missed vaccination opportunities among hospitalised children in India, and identify vaccination barriers perceived by caregivers and healthcare providers.DesignCross-sectional study.SettingTwo public-sector tertiary-care hospitals in northern India, during November 2018 and March 2019.ParticipantsWe tracked 263 hospitalised children aged 1–59 months through hospital discharge, to assess vaccination status, and document catch-up vaccinations given during the hospital stay. We interviewed caregivers and healthcare providers to assess their perceptions on vaccination.OutcomesProportion of hospitalised children considered under-vaccinated for their age; proportion of missed opportunities for vaccination among under-vaccinated children who were eligible for vaccination; and vaccine coverage by antigen.ResultsWe found that 65.4% (172/263) of hospitalised children were under-vaccinated for their age when they presented to the hospital. Among under-vaccinated children, 61.0% were less than 4 months old, and 55.6% reported prior contact with a health facility for a sick visit. The proportion of under-vaccinated children in hospitals were higher compared with the general population as indicated by regional vaccination coverage data. Among under-vaccinated children who were tracked till discharge, 98.1% (158/161) remained incompletely vaccinated at discharge and were considered ‘missed opportunities for vaccination’. Perceived vaccination contraindications that are not part of established contraindications included in national and international guidelines was the most common reason for healthcare providers not to vaccinate children during hospital stay. Among caregivers of under-vaccinated children, 90.1% reported being comfortable having their children vaccinated while they were sick, if recommended by the healthcare provider.ConclusionThis pilot study confirmed that hospitalised sick children had substantial missed vaccination opportunities. Addressing these opportunities through concerted actions involving caregivers, healthcare providers and healthcare systems can improve overall vaccination coverage.

AIMS. The aim of the research was assessment of the medical and social losses due to socially significant diseases (malignant neoplasms and diseases of the circulatory system) in population living in the ecologically unfavorableregion of Kazakhstan (East Kazakhstan Region (EKR)). MATERIALS AND METHODS.The materials for the research were provided by the Department of Statistics, the Republican Center of Electronic Health Care and the Regional Oncology Center for 5 years depth (2011-2015 yy.). Statistical data of the entire population of the region was analyzed. Years of Life Lost (YLL), YLL due to death integral indicators were calculated according to the standardized methodology recommended by the World Health Organization (WHO). RESULTS AND CONCLUSION. Significant premature loss of years due to socially significant diseases in the study region was observed in the research group of 45-69 years with a gender prevalence in male. The fraction of direct economic loss as a result ofhealth losses due to circulatory system diseases and malignant neoplasms averaged about 5% of the Gross Domestic Product (GDP). The medical and social losses of years depend on a number of social and economic factorsin the region (environmental pollution, population income, centralized water supply and the fraction of economically active population).

Background Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. Methods We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. Results Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. Conclusion Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.

Article Type: News and Views: Groundbreaking Discoveries in ImmunologyTitle: Emollients for the prevention of atopic dermatitisAuthors: Akash Kothari1(https://orcid.org/0000-0003-1980-161X), Arielle Locke2,Thomas Eiwegger1,3,4(https://orcid.org/0000-0002-2914-7829)1Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada2Department of Medicine, National University of Ireland, Galway, Ireland3Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada4Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaCorrespondence to: Thomas Eiwegger, MD, Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, Canada, E-mail: thomas.eiwegger@sickkids.ca, Tel.: +1 416-813-7654 ext. 1862Conflicts of Interest: AK and AL have nothing to disclose. TE reports to act as local PI for company sponsored trials by DBV and sub-investigator for Regeneron, holds grants from Innovation Fund Denmark, CIHR outside the submitted work. He is Co-Investigator or scientific lead in three investigator initiated oral immunotherapy trials supported by the Food Allergy and Anaphylaxis Program SickKids and serves as associate editor for Allergy. He/his lab received unconditional/in-kind contributions from Macro Array Diagnostics and an unrestricted grant from ALK. He holds advisory board roles for ALK.Financial support: This work was supported by The Hospital for Sick Children, The Food Allergy and Anaphylaxis Program at The Hospital for Sick Children, and The Dr Lorus J And Dr Margery J Milne Scholarship from Victoria University at the University of Toronto.Statement of Author Contribution: All authors critically reviewed the original articles (references 6 and 7) and wrote the News & Views: Groundbreaking discoveries in Immunology article. All authors contributed, revised, edited, and approved the final version of the manuscript as submitted and agreed to be accountable for all aspects of the work.Keywords: emollient, atopic eczema, infancyAbbreviations : food allergy, FA; filaggrin gene, FLG; atopic dermatitis, AD; transepidermal water loss, TEWL; Barrier Enhancement for Eczema Prevention, BEEP; Preventing Atopic Dermatitis and Allergies, PreventADALL

Background Mothers and fathers are severely challenged when providing care for their terminally ill child at end of life. Caregiving needs have been studied predominantly in mothers. Differences in caregiving needs between mothers and fathers during their child’s end of life have not, however, been explored so far. This knowledge is of importance to best meet individual parental needs in paediatric end-of-life care. Methods Secondary analysis of a quantitative survey on parental needs during their child’s last 4 weeks of life, collected in the Swiss multicentre “Paediatric End-of-Life Care Needs” (PELICAN) study. Caregiving needs of mothers and fathers (parental dyad) who had lost a child due to a cardiological, neurological or oncological disease or during the neonatal period in the years 2011–2012 were retrospectively assessed using a questionnaire representing six evidence-based quality domains of paediatric palliative and end-of-life care. Results Seventy-eight parental dyads were included in this analysis. Differences between mothers and fathers were mostly found around needs to be supported as a family. In all, 28 out of 34 needs-related questionnaire items were scored higher by mothers than by fathers, indicating higher importance for that need to be met. The results indicate that these differences might relate to different caregiving roles and gender-specific coping strategies. Conclusions To best meet parental needs in paediatric end-of-life care, particular attention should be paid to both mothers and fathers and their specific caregiving roles, as differences in these roles might influence their needs in this exceptional situation. Therefore, healthcare professionals should identify how parental dyads mutually navigate care for their sick child to best meet their needs in support. Additionally, mothers and fathers should be supported in their individual coping strategies.

Sick children can be a reason a mother is absent from work or does not work optimally. This study aims to look at the relationship between exclusive breastfeeding practices and frequency of sick children and the productivity of health-care provider mothers. This quantitative study was done using a sample of 160 health-care provider mothers from hospitals in cities and districts in Samarinda, Indonesia. Data analysis was approached using Chi-square test for categorical variables. There is a significant relationship between the practice of exclusive breastfeeding and the frequency of sick children and the productivity of health-care provider mothers (p = 0.002). The results showed that the scores of OR on the frequency variable of sick children and maternal-productivity variables are 3.22 and 2.99, respectively. The practice of exclusive breastfeeding can reduce the frequency of sick children and the productivity of health-care provider mothers. The health-care provider mothers play a role in promoting exclusive breastfeeding and as role models in providing support for the application of the Baby-Friendly Hospital Initiative with "Ten Steps to Successful Breastfeeding". There is a need for regulations regarding maternity and breastfeeding leave regardless of employment status.

Background: Home care service (HCS) for sick children is a complex healthcare service, which can be organised in various models. Despite the possibility to support family everyday life, the accessibility and utilisation may still be limited. The aim of this study was to (i) determine characteristics in referrals to county-based HCS, (ii) determine characteristics of referred children and (iii) assess acceptability of parents and children in county-based HCS. Methods: Data on characteristics of referrals and referred children were collected from medical records of children 0–17 years of age, referred to eight HCS units during 2015–2018. Data on parental and child overall experience, satisfaction of, safety with, and preference for care, were collected from parents by a questionnaire. Descriptive and comparative statistics were used to analyse the data. Results: Three hundred and fifty-five referrals led to one or more periods of HCS for 171 children in various ages with a wide range of illnesses. Children with cancer (30%) composed the largest group and administration of intravenous antibiotics accounted for 56% of the care tasks. Seven per cent of the referrals were to palliative home care. Thirty-eight referrals of 34 children were refused. There was an uneven distribution of the indication for referral, acceptance rate and diagnoses of children among HCS units. Parents reported their and their child's experience with the HCS visit as highly positive and preferred home care to hospital care in over 96% of the HCS in 212 visits. Conclusion: County-based HCS constitutes a supplement to hospital care for sick children with various illnesses through different stages of acute and long-term illness and at end of life, with high levels of acceptability. Few referrals and variation in referral characteristics and acceptance rate of referrals between HCS units led to unequal and inequitable accessibility and utilisation of HCS.

Background Quality of care depends on system, facility, provider, and client-level factors. We aimed at examining structural and process quality of services for sick children and its association with client satisfaction at health facilities in Ethiopia. Methods Data from the Ethiopia Service Provision Assessment Plus (SPA+) survey 2014 were used. Measures of quality were assessed based on the Donabedian framework: structure, process, and outcome. A total of 1908 mothers or caretakers were interviewed and their child consultations were observed. Principal component analysis was used to construct quality of care indices including a structural composite score, a process composite score, and a client satisfaction score. Multilevel mixed linear regression was used to analyze the association between structural and process factors with client satisfaction. Result Among children diagnosed with suspected pneumonia, respiratory rate was counted in 56% and temperature was checked in 77% of the cases. A majority of children (92%) diagnosed with fever had their temperature taken. Only 3% of children with fever were either referred or admitted, and 60% received antibiotics. Among children diagnosed with malaria, 51% were assessed for all three Integrated Management of Childhood Illnesses (IMCI) main symptoms, and 4% were assessed for all three general danger signs. Providers assessed dehydration in 54% of children with diarrhea with dehydration, 17% of these children were admitted or referred to another facility, and Oral Rehydration Solution was prescribed for 67% while none received intravenous fluids. The number of basic amenities in the facility was negatively associated with the clients’ satisfaction. Private facilities, when the providers had got training for care of sick children in the past 2 years, had higher client satisfaction. There was no statistical association between structure, process composite indicators and client satisfaction. Conclusion The assessment of sick children was of low quality, with many missing procedures when comparing with IMCI guidelines. In spite of this, most clients were satisfied with the services they received. Structural and process composite indicators were not associated with client’s satisfaction. These findings highlight the need to assess other dimensions of quality of care besides structure and process that may influence client satisfaction.

Background: Despite the stability of global vaccination coverage, over 19 million children worldwide do not currently receive basic vaccines. Over the past several years, there has been a dramatic drop in the number of vaccinated children worldwide. The implementation of the vaccination program and the scope of protection depend on the parents or legal guardians, who decide whether to vaccinate their child or not. Studies were conducted to assess parents&rsquo, knowledge, attitudes, and beliefs about vaccines, as well as the role of healthcare providers in parents&rsquo, decisions. Methods: A population survey was conducted in 2018&ndash, 2019. Parents or legal guardians of the children were invited to participate in the study during their visits to the clinic for healthy or sick children. The method used in the research was a diagnostic survey. Results: According to the conducted research, men and women constituted 45% and 55% of participants, respectively. The average age of men was 44, while, for women, it was 41. Internal research showed that as much as 71% of parents declared the need for vaccination, although 41% of parents vaccinated their children according to the vaccination calendar. The most frequently mentioned concerns included the possibility of adverse vaccination reactions (22%), the occurrence of autism (7%), and child death (6%). General practitioners had, by far, the greatest impact on the use of protective vaccination in children (73% women and 80% men), although there were cases of discouraging the performance of compulsory vaccinations (41%), and mentioning a doctor (38%) or nurse (3%). Conclusions: Modifiable determinants of the negative attitude toward vaccinations are caused mainly by the lack of knowledge. These obstacles in vaccinations can be overcome by improving health education in terms of the vaccination program.

Background: This study aimed to determine the effectiveness of 36 hospital learning centers for the continued education of sick children using electronic distance learning television (eDLTV), parents’ attitudes toward their child’s illnesses and education, and service satisfaction of the centers. Methods: The sample included 4,430 children aged 4-18 years old with common illnesses, chronic illnesses and developmental disorders, as well as 4,430 parents who had taken care of the child for at least 6 months. The methods included attitude surveys, which were analyzed using chi-square tests and t-tests. Results: The factors associated with education continuation of the children were illness types (parents were less worried about children with common illness and more concerned about education of children with chronic diseases and children with disabilities), distance from home to school, transportation type, parents’ education level, marital status, and family income. About 99.8% of patients with common illnesses continued their education, followed by 99.3% of disabled children, and 95.9% of chronic patients. Satisfaction score towards the services at the learning centers were high (mean scores: 4.28 and 4.43 respectively, out of 5 = strongly satisfied). Conclusion: After completing an education program through eDLTV at a center, a total of 97.7% of children continued their education and were highly satisfied with the service at the center. Parents had positive attitudes towards their child’s illnesses and education.

OBJECTIVEThere has been an increasing interest in the quantitative analysis of publishing within the field of neurosurgery at the individual, group, and institutional levels. The authors present an updated analysis of accredited pediatric neurosurgery training programs.METHODSAll 28 Accreditation Council for Pediatric Neurosurgery Fellowship programs were contacted for the names of pediatric neurosurgeons who were present each year from 2011 through 2015. Faculty names were queried in Scopus for publications and citations during this time period. The 5-year institutional Hirsch index [ih(5)-index] and revised 5-year institutional h-index [ir(5)-index] were calculated to rank programs. Each publication was reviewed to determine authorship value, tier of research, clinical versus basic science research, subject matter, and whether it was pediatrics-specific. A unique 3-tier article classification system was introduced to stratify clinical articles by quality and complexity, with tier 3 being the lowest tier of publication (e.g., case reports) and tier 1 being the highest (e.g., randomized controlled trials).RESULTSAmong 2060 unique publications, 1378 (67%) were pediatrics-specific. The pediatrics-specific articles had a mean of 15.2 citations per publication (median 6), whereas the non–pediatrics-specific articles had a mean of 23.0 citations per publication (median 8; p < 0.0001). For the 46% of papers that had a pediatric neurosurgeon as first or last author, the mean number of citations per publication was 12.1 (median 5.0) compared with 22.5 (median 8.0) for those in which a pediatric neurosurgeon was a middle author (p < 0.0001). Seventy-nine percent of articles were clinical research and 21% were basic science or translational research; however, basic science and translational articles had a mean of 36.9 citations per publication (median 15) compared with 12.6 for clinical publications (median 5.0; p < 0.0001). Among clinical articles, tier 1 papers had a mean of 15.0 citations per publication (median 8.0), tier 2 papers had a mean of 18.7 (median 8.0), and tier 3 papers had a mean of 7.8 (median 3.0). Neuro-oncology papers received the highest number of citations per publication (mean 25.7). The most common journal was the Journal of Neurosurgery: Pediatrics (20%). MD/PhD faculty members had significantly more citations per publication than MD faculty members (mean 26.7 vs 14.0; p < 0.0001) and also a higher number of publications per author (mean 38.6 vs 20.8). The median ih(5)- and ir(5)-indices per program were 14 (range 5–48) and 10 (range 5.6–37.2), respectively. The mean ir(5)/ih(5)-index ratio was 0.8. The top 5 fellowship programs (in descending order) as ranked by the ih(5)-index corrected for number of faculty members were The Hospital for Sick Children, Toronto; Children’s Hospital of Pittsburgh; University of California, San Francisco Benioff Children’s Hospital; Seattle Children’s Hospital; and St. Louis Children’s Hospital.CONCLUSIONSAbout two-thirds of publications authored by pediatric neurosurgeons are pediatrics-specific, although non–pediatrics-specific articles averaged more citations. Most of the articles authored by pediatric neurosurgeons are clinical, with basic and translational articles averaging more citations. Neurosurgeons with PhD degrees averaged more total publications and more citations per publication. In all, this is the most advanced and informative analysis of publication productivity in pediatric neurosurgery to date.

Children with Pierre Robin sequence (PRS) have a complex clinical presentation and requires many health-care providers. Thus, multiple clinical pathways have been proposed on how to manage this population, with some opting for conservative measures while others opting for a surgical approach. However, no consensus has been reached on the most appropriate protocol.To present the treatment protocol for PRS at the Hospital for Sick Children. This will be evaluated through a qualitative examination of the approach from the patient's perspective, and a micro-costing analysis of the financial aspects of providing care.A retrospective cohort study was conducted to evaluate infants who were admitted with PRS and failure to thrive from January 2004 to December 2015. This was followed by a micro-costing analysis to evaluate the cost of the management protocol. Finally, a qualitative evaluation of the parent's perspective was done.Eighty-nine patients were admitted with failure to thrive during the study period. Fourteen patients underwent surgical management. Fourteen patients required readmission for airway or feeding issues secondary to PRS. The average cost per patient was Can$105 996. With regard to the qualitative evaluation, key themes that were generated included stress upon hospital admission, variable methods of understanding PRS, good level of communication with the team, excellent hospital process, and challenging transition home.These results will aid in the continual evolution of a protocol and provide important information on PRS to both families and centers that manage these children.Les enfants ayant un syndrome de Pierre-Robin (SPR) ont une présentation clinique complexe, qui exige l’apport de nombreux professionnels de la santé. Ainsi, de multiples trajectoires cliniques sont proposées pour prendre cette population en charge. Certains optent pour des mesures prudentes et d’autres pour une approche chirurgicale. Cependant, il n’y a pas de consensus quant au protocole le mieux adapté.Présenter le protocole de traitement du SPR utilisé auLes chercheurs ont mené une étude de cohorte rétrospective pour évaluer les nourrissons qui avaient été hospitalisés à cause d’un SPR et d’un retard staturopondéral entre janvier 2004 et décembre 2015. Ils ont ensuite effectué une analyse pour évaluer le coût du protocole de prise en charge et ont terminé par une évaluation qualitative du point de vue des parents.Pendant la période de l’étude, 89 patients ont été hospitalisés à cause d’un retard staturopondéral, dont 14 ont subi une opération. De plus, 14 patients ont été réhospitalisés à cause de problèmes respiratoires ou alimentaires liés au SPR. Le coût moyen par patient s’élevait à 105 996 Can$. Dans le cadre de l’évaluation qualitative, les principaux thèmes soulevés étaient le stress à l’hospitalisation, la méthodologie variable pour comprendre le SPR, le bon niveau de communication avec l’équipe, l’excellent processus hospitalier et une transition difficile à la maison.Les présents résultats contribueront à l’évolution d’un protocole et fournissent de l’information importante sur le SPR, à la fois pour les familles et les centres qui prennent ces enfants en charge.

Background: Hospitalisation is a stressful situation especially for children. Health care providers (HCPs) play an important role in caring for the sick children. Objective: To assess the health care providers’ collaboration and satisfaction about care decisions and parents’ satisfaction about care provided to the patients admitted in Pediatric Intensive Care Unit. Materials and Methods: This was a descriptive study conducted among 32 HCPs working in PICU and 50 parents of children admitted to the PICU of a tertiary care teaching and referral hospital in India. The subjects were selected by total enumeration sampling method. Information profile details and data related to parental satisfaction were gathered using a structured interview schedule. Data related to HCPs’ collaboration and satisfaction about care decisions were gathered using a structured questionnaire. The data were analyzed using SPSS (Version 20.0). Results: Majority of the parents were highly satisfied (92%) with the care provided by the HCPs. More than two-third (87.5%) of the HCPs were highly satisfied with the collaboration among them related to care decisions. Conclusion: Majority of the parents of children admitted to PICU, were highly satisfied with the care provided to their children. Furthermore, most HCPs showed a high level of collaboration among themselves and were satisfied with the care decisions related to the PICU children.

Background: In low and middle income countries (LMICs) teachers send home children found sick in class devolving subsequent care to parents; where malaria is endemic, morbidity is high as the most parents fail to access WHO-endorsed rapid diagnostic testing (RDT and prompt treatment with artemisinin combination therapy (ACT). Consequently malaria is the principal reason a child misses school; so, we trained teachers to use RDT to evaluate all sick pupils and give ACT promptly to those positive.Aims: Pre, intra and post intervention evaluation of impact of using the WHO Health Promoting School (HPS) model to empower teachers to provide RDT and ACT and engage and inform pupils about malaria in 4 schools in rural Uganda.Methods: Documenting duration of absence from school as a surrogate measure for morbidity and change in children’s knowledge and reported behaviors regarding malaria. Pre-intervention (year 1) baseline evaluation of days of absence and children’s malaria knowledge/behavior; Intervention (year 2) trained teachers administered RDT in all sick children and treated those positive with ADT; Post-intervention (end of year 3) after schools independently continued RDT/ACT and education on malaria.Results: Pre-intervention

In 2020, the World Health Organization is revising the Pocketbook of Hospital Care for Children,1 and we need your input. The Pocketbook of Hospital Care for Children contains guidelines for the management of common childhood illnesses. The target audience is non-specialist or junior doctors or clinical officers, paediatric and general nurses and other healthcare workers who find themselves providing care for sick children in settings such as at district or provincial hospitals in low-income and middle-income countries. It is not a textbook of paediatrics, but an evidence-based practical clinical guideline. We want to know what you like about the book, where there are gaps, whether new diseases or conditions should be included, and whether any differences in formatting or structure or companion resources would make it easier to use. We seek your input on what, when and for whom a physical book is still useful, and for what needs it might be better to provide online content. In 2005, the first edition of the Pocketbook of Hospital Care for Children was published. This followed a guideline book called Management of a Child with Serious Infection or Severe Malnutrition, published in …

BackgroundCare-seeking for sick children at the Ethiopian primary health care level is low. This problem may partly be due to unfavorable community perceptions of the quality of care provided. There is, however, limited knowledge on the quality of the clinical assessment and management provided by the health extension workers at the health posts. This study aimed to examine the quality of clinical assessment, classification and management provided to sick under-five children by health extension workers in four regions of Ethiopia.MethodsClinical observations of 620 consultations of sick children by health extension workers were conducted from December 2016 to February 2017. A clinical pathway analysis was performed to analyze whether sick children were appropriately assessed, classified and managed according to the integrated Community Case Management guidelines.ResultsMost sick children presented with complaints of cough (58%), diarrhea (36%), and fever (26%).Three quarters of children with respiratory complaints had their respiratory rate counted (74%, 95% CI 69-78), while a third (33%, 95% CI 27-40) of children with diarrhea were assessed for dehydration. Half (53%, 95% CI 49-57) of the sick children were assessed for general danger signs, while a majority (89%, 95% CI 86-92) had their arm circumference measured for malnutrition. Half of the sick children received some treatment and less than one-fifth were referred according to the integrated Community Case management guidelines. Comprehensive counseling was provided to 38% (95% CI 35-42) of the caregivers.ConclusionThe Ethiopian health extension workers' clinical assessment, classification and management of sick children did to a large extent not follow the clinical guidelines. This lack of adherence could lead to misdiagnoses and lack of potentially life-saving treatments.

“Integrated care” is often used to describe concepts such as coordinated and seamless care instead of the often fragmented and episodic care that patients receive.1 Integrated care reflects the aspirations of modern health care systems and receives significant academic attention. A PubMed search yields >53 000 articles, including >7000 publications about children

Background: Hospitalization of children is one of the main causes of anxiety and concern for families. Mothers of sick children need emotional support to provide effective care and adequate support for their children. Objectives: Thus, the present study was conducted to investigate the relationship between parental concerns and nursing support of hospitalized children. Methods: This descriptive cross-sectional study was conducted on 150 mothers of children admitted to the Pediatric Ward of Baqiyatallah Al-Azam Hospital in Ali Abad Katoul, Golestan province, Iran, in 2018. The children were hospitalized for at least 24 h, and were selected by the convenience sampling method. Concerns of mothers were measured by the Parental Concerns Questionnaire and nursing support was assessed by the Nursing Support of Parents Questionnaire through individual interviews. Data were analyzed by SPSS version 21 software at a significance level of 5%. Results: The mean scores of mothers’ concerns and nursing support were 16.6 ± 5.6 and 72.01 ± 16.52, respectively. Pearson correlation coefficient showed a significant relationship between nursing support and mothers’ concerns (r = -0.22, P = 0.004). Conclusions: Mothers’ concerns are decreased by increasing nursing support. By identifying factors effective in decreasing mothers’ concerns, the treatment team members, especially nurses, can play an important role in providing nursing care and support for mothers of hospitalized children. Therefore, increasing self-confidence of mothers and providing nursing support for them will increase the quality of care and satisfaction of patients and their caregivers, especially the mothers.

There is an increasing demand for medical provision systems that are friendly for working mothers with sick children in Japan. The aim of this cross-sectional, observational study was to analyze the demographic characteristics of pediatric patients presenting to a convenient care clinic, which was located in a large railway station and offered primary care with after-hours accessibility in a metropolitan area of Tokyo. We analyzed anonymous data for patients who had visited the pediatric department at a clinic between August 2013 and June 2016. Data regarding patients’ sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and addresses were collected from electronic health and billing records. Overall, 8091 patients visited the department 45,388 times. The numbers of visits by patients who resided within 2, 5, and 10 miles of the clinic were 37,160 (84.6%), 42,336 (96.4%), and 43,399 (98.8%), respectively. No seasonal variation in the number of visits was observed. Male patients visited the clinic 23,742 times (52.3%) and the patients’ median age was 3 years (interquartile range, 1–6). Most visits occurred on Mondays, and 5643 (15.2%) and 4790 (12.9%) patients visited the clinic when consultations began at 10 am and 3 pm, respectively. Approximately 20% of weekday visits occurred after 6 pm, when other pediatricians’ offices were typically closed. Children older than 7 years of age visited the clinic more frequently after 6 pm. The overall median waiting time was 650 seconds (interquartile range, 429–1020). The 3 most common diagnoses were upper respiratory tract infection (27,173), asthmatic bronchitis (23,744), and allergic rhinitis (10,556). The number of individuals who were referred to other medical institutions was 284 (0.6%). The majority of patients were children aged 1 to 4 years living near the clinic and 80% of visits were during the daytime. However, children older than 7 years of age visited the clinic more frequently after 6 pm. The convenience of the clinic contributed to the fulfillment of the medical needs of children with mild illnesses whose mothers were in full-time employment.

Aim Manually counting respiratory rate (RR) is commonly practiced by community health workers to detect fast breathing, an important sign of childhood pneumonia. Correctly counting and classifying breaths manually is challenging, often leading to inappropriate treatment. This study aimed to determine the usability of a new automated RR counter (ChARM) by health extension workers (HEWs), and its acceptability to HEWs, first‐level health facility workers (FLHFWs) and caregivers in Ethiopia. Methods A cross‐sectional study was conducted in one region of Ethiopia between May and August 2018. A total of 131 HEWs were directly observed conducting 262 sick child consultations after training and 337 after 2 months. Usability was measured as adherence to the WHO requirements to assess fast breathing and device manufacturer instructions for use (IFU). Acceptability was measured through semi‐structured interviews. Results After 2 months, HEWs were shown to adhere to the requirements in 74.6% consultations; an increase of 18.6% after training (P

The Society of Obstetricians and Gynaecologists of Canada (SOGC) is hoping to create a resource similar to Motherisk, the program recently shut down by The Hospital for Sick Children (SickKids) in Toronto. Motherisk provided information on the safety of medications and substances during pregnancy.

Background: Over the last several decades, the prevalence of Autism Spectrum Disorder (ASD) has continued to increase, creating a unique challenge for general physicians who are likely to encounter these patients in their practice. The primary aim of this cross-sectional study design was to identify potential knowledge gaps that were present among medical students and pediatric trainees (interns, residents, and fellows) particularly during the management of a sick child with ASD. Methods: A 23-question online survey was developed and distributed to medical students and pediatric trainees at a tertiary children's hospital affiliated with a medical school. Results: Medical students and pediatric trainees reported a low general knowledge of ASD and were unfamiliar with sensory issues that are often present in these children. Increased discomfort and insufficient didactic and clinical training for providing care to children with ASD during an acute illness were also identified. Both medical students and trainees reported the need for increased education and training, preferentially via patient interaction and small group-based learning. We found that as education/training levels increased, participants perceived increased comfort, and knowledge in managing an ill child with ASD. Conclusions: A perceived knowledge gap and discomfort is present amongst medical students and pediatric trainees on the management of children with ASD. Across all education levels, awareness for sensory dysregulation in ASD children is low. Education programs using direct patient interaction and small group learning were the preferred training modalities to learn how to provide optimal care for children with ASD.

Objective: To evaluate the use and benefits of social networking sites (SNS) and mobile applications (MA) in young patients with kidney disease (KD). Background: Pediatric KD is prevalent. The Internet is increasingly being used to communicate rapid healthcare information to children about acute and chronic diseases with greater medical care satisfaction. There is lack of data on social media (SM) utility in pediatric KD. Materials and Methods: A descriptive, observational and cross-sectional study was conducted on a national level. Data were collected from 4 different centers through a reviewed questionnaire. Results: 83.9% of the 428 participants were Lebanese. The average age was 11.4 years (± 7.1). 69.9% had chronic KD out of which 17.4% had undergone a kidney transplant while 9% were on dialysis. 69.6% of our participants affirmed the need of SM for the health of the sick child while only 9.8% are participating in a scientific forum and 4.7% used SM to find a potential organ donor. Some study variables were statistically associated with the participants’ age, nationality and stage of KD. Conclusions: SM are important for the support and management of pediatric KD. We believe that SNS and MA will play a leading role in the lives of our patients in the future and will push the physician to play a central role in the evolution of communication networks. To identify the potential role and the efficacy of SM in enhancing communication between patients and health professionals, further stratified studies are needed.