Actitudes de los médicos de un hospital pediátrico de tercer nivel ante la muerte / Attitudes of physicians in a tertiary care children's hospital in the face of death

Introducción. La muerte involucra, para los médicos, un análisis complejo que determina su actitud hacia el paciente, principalmente los comportamientos en situaciones de diagnóstico, tratamiento y la relación médico-paciente. Objetivos. 1) Describir las actitudes del personal médico de un hospital pediátrico ante la muerte. 2) Explorar si existen factores asociados a esas actitudes. Población y métodos. Estudio transversal, por encuesta. Se invitó a los médicos de un hospital pediátrico de tercer nivel de la Ciudad Autónoma de Buenos Aires, Argentina, a completar el Cuestionario de actitud ante la muerte (CAM). Se investigaron variables sociodemográficas, categoría profesional y área laboral, haber presenciado la muerte de pacientes, autopercepción de actitud positiva ante la muerte y actitud ante la muerte según CAM. Resultados. Entre el 01 de junio de 2021 y el 01 de junio de 2022 se incluyeron 362 participantes, con edad media de 39,88 (± 11,56) años y experiencia médica asistencial de 14,06 (± 11,97) años. Presentaron actitud positiva 35 (9,67 %). Encontramos significancia estadística para mayor probabilidad de actitud positiva en edad ≥ 40 años (p = 0,02, IC95 % 1,1-3,9), experiencia médica asistencial ≥ 14 años (p = 0,042, IC95 % 1-4,1), creencia religiosa (p = 0,003, IC95 % 1,4-10,5), práctica religiosa activa (p <0,001, IC95 % 1,6-6,9) y autopercepción positiva ante la muerte (p = 0,002, IC95 % 1,7-30,8). Conclusiones. El 9,67 % de los encuestados presentó actitud positiva ante la muerte. Los factores asociados a ella fueron edad ≥ 40 años, experiencia médica asistencial ≥ 14 años, creencia religiosa, práctica religiosa activa y la autopercepción personal de actitud positiva ante la muerte.

Introduction. For physicians, death involves an intricate analysis that determines their attitude towards the patient. Objectives. 1) To describe the attitudes towards death among medical staff working at a children's hospital. 2) To explore factors associated with such attitudes. Population and methods. Cross-sectional, survey study. The physicians working at a tertiary care children's hospital completed the Questionnaire of attitudes towards death (QAD). Sociodemographic variables, professional category, work setting, having witnessed the death of patients, self-perception of a positive attitude towards death, and attitude towards death according to the QAD were studied. Results. Between June 1st, 2021 and June 1st, 2022, 362 participants were included; mean age: 39.88 years (± 11.56), health care experience: 14.06 years (± 11.97). A positive attitude was observed in 35 (9.67%). A statistical significance was observed for a greater probability of a positive attitude among those who were ≥ 40 years old (p = 0.02, 95% CI: 1.1­3.9), had health care experience for ≥ 14 years (p = 0.042, 95% CI: 1­4.1), had a religious belief (p = 0.003, 95% CI: 1.4­10.5), actively practiced their religion (p < 0.001, 95% CI: 1.6­6.9), and had a positive self-perception in the face of death (p = 0.002, 95% CI: 1.7­30.8). Conclusions. A positive attitude towards death was observed in 9.67% of surveyed participants. Associated factors were age ≥ 40 years, health care experience for ≥ 14 years, religious belief, active religious practice, and self-perception of a positive attitude towards death.

Rehabilitation Medical Services for Children with Spina Bifida at Children's Hospitals and Related Institutions in Japan / The Japanese Journal of Rehabilitation Medicine

Spina bifida is a disease that requires cross-disciplinary treatment for each life stage from the neonatal period to adulthood. Various rehabilitation therapies are required depending on the life stage of patients. In this study, we aimed to clarify the current status of rehabilitation services at children's hospitals in order to improve quality of rehabilitation care for children with spina bifida. We performed a survey targeted at the Japanese Association of Children's Hospitals and Related Institutions. The framework of the cross-disciplinary co-operation of medical treatments for spina bifida existed in 67% of children's hospitals surveyed. In most of these hospitals, the departments of rehabilitation medicine participated in these frameworks. In the medical treatment for children with spina bifida, acute phase rehabilitation after orthopaedic surgery was adequately provided in children's hospitals. However, convalescent and community-based phase rehabilitation therapies, and the co-operation with education institutions or habilitation/rehabilitation facilities for children were determined to be inadequate. Regarding general paediatric rehabilitation, convalescent and community-based phase rehabilitation therapies were mainly provided outside children's hospitals：habilitation/rehabilitation facilities for children mainly provided convalescent and community-based phase rehabilitation therapies and were considered to be the desirable setting for such therapies. To improve paediatric rehabilitation, including the rehabilitation for children with spina bifida, several factors need to be considered. These include the construction of appropriate frameworks for medical services (such as personnel training and the recruitment of rehabilitation doctors, therapists, and related staff), and co-operation with regional education institutions or habilitation/rehabilitation facilities for children.

Rehabilitation Medical Services for Children with Spina Bifida at Children's Hospitals and Related Institutions in Japan / The Japanese Journal of Rehabilitation Medicine

Spina bifida is a disease that requires cross-disciplinary treatment for each life stage from the neonatal period to adulthood. Various rehabilitation therapies are required depending on the life stage of patients. In this study, we aimed to clarify the current status of rehabilitation services at children's hospitals in order to improve quality of rehabilitation care for children with spina bifida. We performed a survey targeted at the Japanese Association of Children's Hospitals and Related Institutions. The framework of the cross-disciplinary co-operation of medical treatments for spina bifida existed in 67% of children's hospitals surveyed. In most of these hospitals, the departments of rehabilitation medicine participated in these frameworks. In the medical treatment for children with spina bifida, acute phase rehabilitation after orthopaedic surgery was adequately provided in children's hospitals. However, convalescent and community-based phase rehabilitation therapies, and the co-operation with education institutions or habilitation/rehabilitation facilities for children were determined to be inadequate. Regarding general paediatric rehabilitation, convalescent and community-based phase rehabilitation therapies were mainly provided outside children's hospitals：habilitation/rehabilitation facilities for children mainly provided convalescent and community-based phase rehabilitation therapies and were considered to be the desirable setting for such therapies. To improve paediatric rehabilitation, including the rehabilitation for children with spina bifida, several factors need to be considered. These include the construction of appropriate frameworks for medical services (such as personnel training and the recruitment of rehabilitation doctors, therapists, and related staff), and co-operation with regional education institutions or habilitation/rehabilitation facilities for children.

Nationwide Survey of Rehabilitation Medical Services at Children's Hospitals and Related Institutions in Japan / The Japanese Journal of Rehabilitation Medicine

Children's hospitals and related institutions, along with habilitation/rehabilitation facilities for children with disabilities, practice pediatric rehabilitation medicine. However, the status of rehabilitation medical services at children's hospitals has not been examined. To help improve pediatric rehabilitation medicine, we aimed to clarify it with this study. We performed a nationwide survey targeting the Japanese Association of Children's Hospitals and Related Institutions. The median numbers of full-time rehabilitation doctors, board-certified rehabilitation doctors, and board-certified instructors per institution were one, zero, and zero, respectively. The median numbers of full-time physical therapists, occupational therapists, speech-language-hearing therapists, and clinical psychologists were nine, five, three, and two, respectively. Demand for increasing the number of rehabilitation staff members was high across all specialties. Only about half the institutions surveyed were certified as training facilities by the Japanese Association of Rehabilitation Medicine. Some institutions did not meet the health insurance system's higher-level criteria for rehabilitation facilities. The construction of an appropriate medical service framework and an increase in hospital services, including staff assignment, will be needed to improve pediatric rehabilitation and to expand research and education in this field.

Nationwide Survey of Rehabilitation Medical Services at Children's Hospitals and Related Institutions in Japan / The Japanese Journal of Rehabilitation Medicine

Children's hospitals and related institutions, along with habilitation/rehabilitation facilities for children with disabilities, practice pediatric rehabilitation medicine. However, the status of rehabilitation medical services at children's hospitals has not been examined. To help improve pediatric rehabilitation medicine, we aimed to clarify it with this study. We performed a nationwide survey targeting the Japanese Association of Children's Hospitals and Related Institutions. The median numbers of full-time rehabilitation doctors, board-certified rehabilitation doctors, and board-certified instructors per institution were one, zero, and zero, respectively. The median numbers of full-time physical therapists, occupational therapists, speech-language-hearing therapists, and clinical psychologists were nine, five, three, and two, respectively. Demand for increasing the number of rehabilitation staff members was high across all specialties. Only about half the institutions surveyed were certified as training facilities by the Japanese Association of Rehabilitation Medicine. Some institutions did not meet the health insurance system's higher-level criteria for rehabilitation facilities. The construction of an appropriate medical service framework and an increase in hospital services, including staff assignment, will be needed to improve pediatric rehabilitation and to expand research and education in this field.

Perfil de la demanda espontánea de niños de hasta 30 días de vida en un hospital pediátrico de alta complejidad / Profile of spontaneous demand for services among infants younger than 30 days old at a children's tertiary care hospital

En los últimos años, la aceptación de recién nacidos (RN) críticos al Área de T erapia Intensiva Neonatal del Hospital Garrahan (HG) se ha limitado, debido al ingreso de menores de 30 días a través de la demanda espontánea. Esta situación posiblemente multifactorial tiene, entre sus causas, la falta de regionalización, que determina el uso inadecuado de los recursos o distorsiona el uso de recursos pensados para la mayor complejidad. El objetivo de este estudio fue determinar el perfil de los RN que concurren espontáneamente para su atención al HG y evaluar el nivel de complejidad requerido según su patología. Material y métodos. Estudio de corte transversal. Se evaluaron todos los niños ≤ 30 días que consultaron al HG en un período de 12 meses. De cada RN, se analizaron las características clínicas, las consultas previas, la motivación de los padres a consultar al HG y se evaluó sí podrían haber sido asistidos en instituciones de menor complejidad. Resultados. Se analizaron 307 consultas, edad X 18 días ± 7,6. Requirió hospitalización el 78%. El motivo de internación más frecuente fue la infección respiratoria aguda. El 35% tenía cobertura social; 54% consultó en más de una oportunidad a otro centro. Solo 15% de los neonatos presentaban una patología de alta complejidad pasible de ser resuelta en el HG. Conclusión. El análisis del perfil de RN que concurre por demanda espontánea al HG mostró una alta necesidad de internación de patología de mediana y baja complejidad.

In recent years, admission of critical newborn infants (NBIs) to the neonatal intensive care unit of Hospital Garrahan (HG) has been limited due to the hospitalization of infants younger than 30 days old through spontaneous demand for services. This is probably a multifactorial situation, and one of its causes is a lack of regionalization, which results in an inadequate use of resources or a distorted use of resources intended for more complex care. The objective of this study was to establish the profile of NBIs who make a spontaneous demand for services at HG and to assess the level of care required based on their medical condition. Material and methods. Cross-sectional study. All infants ≤ 30 days old who sought care at HG in a period of 12 months were assessed. The analysis included clinical characteristics of NBIs, prior visits, parental reason for consultation at HG, and whether NBIs could have been seen at a primary or secondary care facility. Results. A total of 307 consultations were analyzed; NBI age was 18 days ± 7.6. Of these, 78% required hospitalization. The most common reason for hospitalization was acute respiratory tract infection. Thirty-five percent had health insurance coverage; 54% had sought care more than once at a different facility. Only 15% of NBIs had a highly complex condition that should have actually been solved at HG. Conclusion. Based on the analysis of NBIs seen at HG through spontaneous demand for services, a high requirement of hospitalization for low and medium complexity pathologies was observed.

Anxiety and depression among the medical staff of a children's hospital / 中华物理医学与康复杂志

Objective To explore the prevalence of anxiety and depression among the medical staff of a children's hospital, and to understand their relationship with age, gender, educational background, family income, family harmony, position, marital status, experience, title, work pressure, weekly working hours, chronic diseases and stressful events.Methods The medical staff of a children's hospital were evaluated using Zung's self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The scores were correlated with age, gender, educational background, family income, family harmony, position, marriage, working years, title, work pressure, weekly working hours, chronic diseases, and stressful events data collected about the same respondents.Results There were 320 respondents suffering from anxiety disorders and 392 experiencing depression among the 677 medical staff surveyed.There were 288 who suffered from anxiety associated with depression.There was a significant difference between the males and the females.Marital status, family harmony, chronic disease and stress events were all significant predictors of anxiety or depression.A univariate analysis showed that neither education nor family income had significant predictive power, but age, professional title,working years, working pressure and working in different departments were all significant predictors.Medical staff with different weekly working hours showed significantly different average levels of anxiety, but position had no such effect.Position was, though, significantly correlated with depression score, while weekly working hours were not.Multivariable logistic regression models showed that educational background, working pressure, family harmony, chronic disease and stressful events were all significant predictors of anxiety.Working pressure, family harmony and chronic disease were related to depression.Conclusion Significant anxiety and depression were observed among the medical staff of this children's hospital.Working pressure, family harmony and chronic disease are strong predictors of anxiety and depression.

Prevalence and Risk Factors of Very Low Birth Weight in Infants Born at the Maternity and Children Hospitals in Jeddah, Saudi Arabia during 2012-2013.

Background: The prevalence of low birth weight in infants which is associated with a large number of risk factors is increasing worldwide and is a major cause of infant morbidity and mortality. Objective: This study aims to describe demographic, clinical and anthropometric profile of VLBW in infants, its prevalence, associated risk factors and maternal medical complications in three Maternity and Children Hospitals in Jeddah City, Saudi Arabia. Methods: Two study designs used in this research selected two convenient samples of VLBW infants for collecting cross-sectional retrospective and prospective data. The clinical records of VLBW infants [n=387] were reviewed retrospectively for estimating the one year prevalence rate while for identifying the possible risk factors of VLBW infants, the medical files of actively admitted patients [n=61] were daily examined for a period of Original Research Article British Journal of Medicine & Medical Research, 4(27): 4553-4569, 2014 4554 four months. Results: Beside socio demographic, clinical and anthropometric characteristics of VLBW infants, this study estimated the prevalence of VLBW infants to be 3.3% along with underlying risk factors of VLBW, its comorbidities, and maternal medical complications. Conclusion: The prevalence of VLBW infants is constantly increasing not only in Saudi Arabia but also worldwide and VLBW is associated with a variety of possible risk factors. There is a need to conduct a nationwide community-based study on the prevalence and risk factors of VLBW infants in Saudi Arabia.

Percepción de movimiento coherente en pacientes con glaucoma y estrabismo / Coherent motion perception in patients with glaucoma and strabismus

Se realizó una investigación analítica y prospectiva, de casos y controles, de los niños con glaucoma o estrabismo, o ambos, atendidos en la consulta de Oftalmología del Hospital Infantil Sur de Santiago de Cuba, de enero a junio del 2011, a fin de evaluar la percepción visual del movimiento coherente en ellos. El grupo de casos incluyó 72 pacientes escogidos de forma aleatoria, y el de controles, igual cantidad de integrantes que presentaban toda su capacidad visual. Se determinó que los niños con afecciones en la visión cometían más errores, omisiones y menos aciertos, además de ser menos rápidos en la solución de los ensayos orientados, pues tuvieron mayor tiempo de reacción para ejecutarlos.

A prospective analytic case-control study was carried out in children with glaucoma or strabismus or both, treated at the Department of Ophthalmology of the Southern Children Hospital in Santiago de Cuba, from January to June 2011, with the purpose of assessing the visual perception of coherent motion in them. The case group included 72 randomly selected patients, and control group with the same number of members who had all their vision. It was determined that children with visual disorders made more errors, omissions and fewer hits, besides being less rapid in solving oriented tests, as they had longer reaction time to do them.

Nesidioblastosis: hipoglucemia hiperinsulínica persistente en un recién nacido / Nesidioblastosis: persistent hyperinsulinemic hypoglycemia in a newborn

Se presenta el caso clínico de un recién nacido a término por parto distócico (cesárea), debido a una toxemia gravídica, con antecedente de polihidramnios, que manifestó dificultad respiratoria a los pocos minutos del nacimiento y fue ingresado en el Hospital Infantil Norte Dr Juan de la Cruz Martínez Maceira de Santiago de Cuba. Le fueron detectadas cifras de glucemia muy bajas que, evolutivamente, trajeron aparejadas convulsiones tónico-clónicas generalizadas, cuyas frecuencias no se lograban disminuir. Se le diagnosticó una hipoglucemia hiperinsulínica persistente (nesidioblastosis) y fue trasladado a La Habana para recibir tratamientos clínico y quirúrgico definitivos. Actualmente es atendido por un equipo médico multidisciplinario

The case of a term infant by dystocia (cesarean section) due to pregnancy toxemia with history of polyhydramnios is presented, who had respiratory distress a few minutes after birth and he was admitted to Dr Juan de la Cruz Martínez Maceira Northern Children Hospital of Santiago de Cuba. Very low blood glucose levels were detected that progressively caused tonic-clonic seizures, which frequencies could not be reduced. He was diagnosed with persistent hyperinsulinemic hypoglycemia (nesidioblastosis) and was transferred to Havana to receive definitive clinical and surgical treatments. Currently, he is treated by a multidisciplinary medical team

Rehabilitación de niños y adolescentes con síndrome de Guillain- Barré / Rehabilitation of children and adolescents with Guillain - Barré syndrome

Se realizó un estudio descriptivo y transversal de 20 pacientes con síndrome de Guillain-Barré atendidos en el Hospital Infantil Docente Sur de Santiago de Cuba, de enero del 2002 a diciembre del 2010, con vistas a caracterizarles según algunas variables clinicoepidemiológicas de interés y así definir el proceso de rehabilitación en ellos. Predominaron el sexo masculino, el grupo etario de 0-9 años, la polineuropatía aguda ascendente como forma clínica de presentación, y las infecciones respiratorias agudas y enfermedades diarreicas agudas como fenómenos precedentes. Se observó que los tratamientos médico y rehabilitador precoces fueron determinantes en el grado de defecto motor y funcional al egreso, en tanto la inmediatez y el mantenimiento de las medidas de recuperación integrales resultaron indispensables en el logro de la autonomía y una mejor calidad de vida de los pacientes. Pudo concluirse que los niños y adolescentes de la casuística evolucionaron favorablemente, lo cual estuvo dado en una combinación terapéutica adecuada y temprana.

A descriptive and cross-sectional study was carried out in 20 patients with Guillain-Barré syndrome attended in the Southern Teaching Children Hospital of Santiago de Cuba, from January 2002 to December 2010, in order to characterize them according to some clinical and epidemiological variables of interest and to define the rehabilitation process in these patients. Male sex, age group of 0-9 years, acute ascending polyneuropathy as a clinical presentation, and acute respiratory infections and acute diarrheal diseases as precedent phenomena were predominant. It was observed that early medical treatment and rehabilitation were crucial for the degree of motor and functional defect at discharge, while the immediacy and maintaining comprehensive recovery measures were essential in achieving autonomy and a better quality of patients' life. It could be concluded that children and adolescents of the case material made good progress due to an early and appropriate therapeutic combination.

Características epidemiológicas y clinicoterapéuticas en pacientes ingresados a causa de enfermedad diarreica persistente / Clinical therapeutic and epidemiological characteristics in patients admitted due to persistent diarrheal disease

Se realizó un estudio descriptivo, longitudinal y prospectivo de 62 lactantes con enfermedad diarreica persistente, ingresados en el Servicio de Enfermedades Diarreicas Agudas del Hospital Infantil Docente Sur de Santiago de Cuba, de enero a diciembre del 2010, con vistas a caracterizarles según algunas variables epidemiológicas, clínicas y terapéuticas. La mayoría de los integrantes de la serie eran del sexo masculino (66,1 %), procedían de áreas rurales (53,2 %), y presentaban género de vida regular (51,7 %) y antecedentes de un episodio diarreico (53,2 %). Asimismo, el uso de antimicrobianos previo al ingreso resultó elevado (74,1 %), con prevalencia del metronidazol (32,2 %), la complicación más frecuente fue el déficit enzimático de disacaridasas (67,7 %) y la totalidad de los pacientes no recibió lactancia materna exclusiva, lo cual pudo contribuir al incremento de la frecuencia de la afección.

A descriptive, longitudinal and prospective study was conducted in 62 infants with persistent diarrheal disease, admitted to the Department for Acute Diarrheal Diseases of Southern Teaching Children Hospital in Santiago de Cuba from January to December 2010 to characterize them according to some epidemiological, clinical and therapeutic variables. Most members of the series were males (66.1%), they were from rural areas (53.2%), and had regular living conditions (51.7%) and history of diarrhea (53.2%). Also, the use of antimicrobials before admission was high (74.1%), with prevalence of metronidazole (32.2%), the most frequent complication was the disaccharidase deficiency (67.7%) and the total of the patients did not receive exclusive breastfeeding, which could contribute to increasing the frequency of the condition.

Perfil cirúrgico otorrinolaringológico em um hospital pediátrico de Curitiba / Profile ENT surgery in a pediatric hospital in Curitiba

Introdução: As cirurgias otorrinolaringológicas são muito comuns dentro das cirurgias pediátricas e os otorrinolaringologistas contam com uma vasta gama de procedimentos cirúrgicos, sendo a adenoamigdalectomia o procedimento mais realizado, seguido pelos otológicos. A complicação mais frequente das adenoamigdalectomias é o sangramento. Apesar de ser a complicação mais temida, apenas uma pequena parcela de pacientes necessita de intervenção cirúrgica para parar o sangramento. Objetivo: Avaliar o perfil cirúrgico otorrinolaringológico em hospital pediátrico de Curitiba. Método: Estudo Retrospectivo das cirurgias registradas. Resultados: Do total de 2020 procedimentos realizados no centro cirúrgico no ano de 2009, 9,26% (187) foram exames e 90,74% (1833) cirurgias, sendo 65,14% (1316) realizadas pelo SUS, 32,47% (656) por convênio e 2,39% (48) particulares. A distribuição quanto ao sexo foi 1106 meninos e 914 meninas. A adenoidectomia com ou sem amigdalectomia correspondeu a 62,5% (1146). Destas, apenas 0,96% (11) foram submetidas à revisão em centro cirúrgico. Em 2º lugar aparecem as cirurgias otológicas, sendo a timpanotomia, com ou sem tubo de ventilação, a mais prevalente. Conclusão: Os otorrinolaringologistas têm a possibilidade de realizar diversos tipos de procedimento cirúrgico. A cirurgia otorrinolaringológica mais realizada na faixa etária pediátrica no hospital Pequeno Príncipe é a adenoamigdalectomia, com taxa de revisão similar a encontrada na literatura. Meninos são mais submetidos a procedimentos do que meninas. A maior parte dos procedimentos otorrinolaringológicos realizados nesse hospital no ano de 2009 foram realizados pelo SUS. Isso mostra a importância da cirurgia de adenoamigdalectomia na pratica diária do otorrinopediatra, sendo que o peso desse problema entre os usuários do SUS é grande...

Introduction: ENT procedures are very common in the pediatric surgery and otolaryngologists have a wide range of surgical procedures, and adenotonsillectomy most performed procedure, followed by otological. The most common complication is bleeding from tonsillectomies. Despite being the most feared complication, only a minority of patients need surgical intervention to stop the bleed. Objective: To evaluate the surgical profile in hospital pediatric otolaryngology Curitiba. Method: Retrospective Study of registered surgeries. Results: A total 2020 procedures performed in the operating room in 2009, 9.26% (187) and tests were 90.74% (1833) surgeries, being 65.14% (1316) performed by the SUS,% 32.47 (656) by covenant and 2.39% (48) individuals. The gender distribution was 1106 boys and 914 girls. Adenoidectomy with or without tonsillectomy corresponded to 62.5% (1146). Of these, only 0.96% (11) underwent revision surgery center. In second place comes the otological surgery, with results of tympanostomy, with or without ventilation tube, the most prevalent. Conclusion: The otolaryngologists are able to perform various types of ENT surgical. A procedure most frequently performed in pediatric hospital in Little Prince is adenotonsillectomy, with revision rate similar to that reported in the literature. Boys are more subjected to procedures than girls. Most ENT procedures performed in this hospital in 2009 were performed by the SUS. This shows the importance of adenotonsillectomy in the daily practice of pediatric ENT, and the weight of this problem among users of SUS is great...