Comparison of the medical burden of COVID-19 with seasonal influenza and measles outbreaks.

AIM: To examine and compare the medical burden of measles, influenza and COVID-19 outbreaks in the city of Bnei Brak, Israel. METHODS: The study was conducted during 2018-2021. The numbers of hospitalisations for these infections and their complications were recorded. Hospitalisation rates were determined by using the number of children residing in Bnei Brak and hospitalised with these infections during the study period as the numerators. The denominators were the estimated paediatric cases of measles, influenza and COVID-19 in Bnei Brak and were calculated under both pragmatic and conservative assumptions. RESULTS: A total of 247, 65 and 32 children were hospitalised with influenza, COVID-19 and measles respectively. Complication rates were higher following measles than after influenza and SARS-CoV-2 infections. Hospitalisation rates were 10% for measles, 0.6%-1.2% for influenza and 0.15% - 0.25% for COVID-19 infections. Relative risks (RR) with 95% confidence intervals (CI) for hospitalisation following measles compared with COVID-19 ranged from 42 (26.3-67.3) to 70.1 (43.8-112.1), while the relative risks for influenza hospitalisation ranged from 2.5 (1.83-3.41) to 8.2 (6.0-11.2), compared with COVID-19 infection. CONCLUSION: Hospitalisation rates and direct medical burdens of measles and influenza were significantly higher than those of COVID-19 infection in children.

Child abuse and neglect: reporting by health professionals and their need for training.

BACKGROUND: For health professionals who interact professionally with children, adequate awareness and training regarding the clinical indicators of child abuse and neglect, as well as subsequent reporting and procedures, are essential. OBJECTIVES: To study Israeli health professionals experiences with identification and reporting of suspected cases of child abuse and neglect, and their perceived training needs in this area. METHODS: The study group was a convenience sample comprising 95 Israeli health professionals (physicians, nurses, social workers, psychologists, etc.) attending workshops on medical aspects at a national conference on child abuse and neglect. In this cross-sectional survey, the health professionals were asked to complete an anonymous structured questionnaire on their experience with child abuse and neglect and on their training needs. RESULTS: The participants in the survey had relatively high levels of involvement with child protection. Nevertheless, they strongly expressed their need for training, especially in mastering practice skills. The need for training was greater for professionals with less experience in child protection, and there were different needs according to profession. CONCLUSIONS: Despite their prior extensive experience in dealing with child abuse and neglect, most of the health professionals participating in the conference reported the need for training in certain areas.

[Medical child abuse, another name for Munchausen's syndrome by proxy].

Medical child abuse or its better known name, Munchausen's Syndrome by Proxy, is a form of child maltreatment combining physical and emotional abuse as well as child neglect. As in other forms of child abuse and neglect that pediatricians encounter, the diagnosis is medical and is based on the existence of actual or potential harm to the child. A high index of suspicion is necessary when the medical team is faced with inexplicable findings as well as repeated treatment failure. There is extensive variability in the manifestation of this syndrome as well as a wide range of severity including the risk to the patient's life. In this article we describe medical child abuse and the means of diagnosing the syndrome. It is also stressed that, as in the case of any other form of child maltreatment, reporting is mandatory.

[The pediatrician's role in the field of child maltreatment].

Pediatricians have a direct linkage towards child maltreatment. Certain health conditions are sometimes risk factors for abusive behavior or neglect towards children, moreover, injuries, certain diseases and development problems can be the direct results of child abuse and neglect. It is therefore important that child maltreatment will be considered as a major health problem by pediatricians. This article reviews a variety of professional tasks that pediatricians should undertake concerning the treatment of victims of child abuse and neglect in dealing with child maltreatment phenomena. The review includes a wide range of activities and responsibilities, beginning with the immediate and routine role of the diagnostician and healer, while identifying the unique emphases, which are the result of the nature of the trauma, through to the conventional actions of the pediatrician. In the case of child abuse and neglect, this role is significantly more important and requires more attention, such as the manner of conversing with the child and recording documentation. This may encompass numerous unconventional tasks such as being an expert witness in court and participating in committees, task forces and organizations to promote and spread knowledge and policy change.

Lessons learned from chlorine intoxications in swimming pools: the challenge of pediatric mass toxicological events.

INTRODUCTION: The classical doctrine of mass toxicological events provides general guidelines for the management of a wide range of "chemical" events. The guidelines include provisions for the: (1) protection of medical staff with personal protective equipment; (2) simple triage of casualties; (3) airway protection and early intubation; (4) undressing and decontamination at the hospital gates; and (5) medical treatment with antidotes, as necessary. A number of toxicological incidents in Israel during the summer of 2005 involved chlorine exposure in swimming pools. In the largest event, 40 children were affected. This study analyzes its medical management, in view of the Israeli Guidelines for Mass Toxicological Events. METHODS: Data were collected from debriefings by the Israeli Home Front Command, emergency medical services (EMS), participating hospitals, and hospital chart reviews. The timetable of the event, the number and severity of casualties evacuated to each hospital, and the major medical and logistical problems encountered were analyzed according to the recently described methodology of Disastrous Incident Systematic Analysis Through-Components, Interactions, Results (DISAST-CIR). RESULTS: The first ambulance arrived on-scene seven minutes after the first call. Emergency medical services personnel provided supplemental oxygen to the victims at the scene and en route when required. Forty casualties were evacuated to four nearby hospitals. Emergency medical services classified 26 patients as mildly injured, 13 as mild-moderate, and one as moderate, suffering from pulmonary edema. Most children received bronchodilators and steroids in the emergency room; 20 were hospitalized. All were treated in pediatric emergency rooms. None of the hospitals deployed their decontamination sites. CONCLUSIONS: Event management differed from the standard Israeli toxicological doctrine. It involved EMS triage of casualties to a number of medical centers, treatment in pediatric emergency departments, lack of use of protective gear, and omission of decontamination prior to emergency department entrance. Guidelines for mass toxicological events must be tailored to unique scenarios, such as chlorine intoxications at swimming pools, and for specific patient populations, such as children. All adult emergency departments always should be prepared and equipped for taking care of pediatric patients.

Atopy in children and adolescents with insulin-dependent diabetes mellitus.

BACKGROUND: Insulin-dependent diabetes mellitus is dominated by a Th1 response whereas atopic diseases such as asthma, eczema and allergic rhinitis are characterized by a Th2 response. Because it is known that Th1 and Th2 cells reciprocally counteract each other, it can be speculated that the prevalence of Th2-mediated diseases is lower in patients with a Th1-mediated disease. OBJECTIVES: To compare the prevalence of atopic diseases among children with IDDM and age-matched controls. METHODS: The study group comprised 65 children with IDDM attending the pediatric endocrinology clinic at the Wolfson Medical Center. The control group consisted of 74 non-diabetic children who presented at the emergency room due to an acute illness (burns, abdominal pain, fever, head trauma). Patients were asked to complete a detailed questionnaire on their history of personal and familial atopic and autoimmune diseases. In addition, a total serum immunoglobulin E concentration and the presence of IgE antibodies to a panel of relevant inhalant allergens were analyzed. RESULTS: Children with IDDM and their first-degree relatives had a significantly higher prevalence of other autoimmune diseases such as thyroiditis and celiac as compared to controls. The two groups had a similar prevalence of atopic diseases with respect to history, total serum IgE, or the presence of IgE antibodies to a panel of relevant inhalant allergens. CONCLUSIONS: The prevalence of atopic diseases in IDDM patients was similar to that in the normal population. Our results suggest that the traditional Th1/Th2 theory to explain the complexity of the immune response is oversimplified.

Oropharyngeal injuries in children.

BACKGROUND: Oral cavity and oropharyngeal injuries are common among pediatric patients seen in emergency rooms for head and neck trauma. The appropriate treatment of such injuries is often controversial. PATIENTS AND METHODS: Audit of 6 months' admissions to the pediatric emergency room in a secondary care referral center. Sixty-four patients were treated for various injuries. Charts were reviewed for relevant data. RESULTS: Description of distribution of types and sites of injuries and discussion of treatment recommendations. CONCLUSIONS: Most of oropharyngeal injuries heal without any intervention and therefore can be left untreated after being diagnosed. However, in certain injuries, treatment is indicated for better outcome results.

Ketamine increases opening cerebrospinal pressure in children undergoing lumbar puncture.

Intravenous ketamine, often administered concomitantly with midazolam, is one of the most commonly used drugs for procedural sedation in children. Although it is considered safe for use in children, ketamine can increase intracranial pressure. Hence, this study was carried out to determine whether adding ketamine to midazolam prior to performing lumbar puncture would be associated with a higher cerebrospinal fluid opening pressure in children with suspected aseptic meningitis. Thirty-nine children aged 6 months to 14 years were included: 26 in group A (intravenous midazolam plus ketamine) and 13 in group B (intravenous midazolam only). Mean cerebrospinal fluid opening pressure in group A was 24.4 cm H2O (median 23 cm H2O) compared with 20 cm H2O (median 19.8 cm H2O) in group B (P = .011). Intravenous ketamine prior to performing lumbar puncture is associated with a significantly higher lumbar cerebrospinal fluid opening pressure in children with aseptic meningitis. However, no outcome differences have been found between the two groups.

Social phobia symptoms: prevalence, sociodemographic correlates, and overlap with specific phobia symptoms.

BACKGROUND: Social phobia (SP) is a highly prevalent disorder in Western countries, but is rather rare in Eastern societies. Prevalence rates range from 0.5% in Eastern samples up to 16% in Western studies. Its prevalence in Israel, an Asian state characterized by Western culture, has not yet been studied. The present study aimed to assess the prevalence of SP symptoms in a nonclinical sample of Israeli adolescents, to characterize sociodemographic correlates of SP symptoms and to evaluate comorbidity with specific phobia symptoms. METHODS: Participants included 850 young soldiers from the Israel Defense Forces. Measures included the Liebowitz Social Anxiety Scale (LSAS; self-report version), a questionnaire on specific fears and phobias, and a sociodemographic questionnaire. Clinical and demographic correlates of SP were also examined. RESULTS: Probable SP (LSAS >or=80) was present in 4.5% of the sample. Overall, SP symptoms were reported by a great percentage of the subjects, as displayed by the rather high mean LSAS scores (29; SD = 23.79) in this nonclinical sample. The following variables were accompanied by higher LSAS scores according to our regression model: inability to perform command activities, receiving psychotropic medication before army service, having less than two friends, shy family members, and treatment during military service. Subjects with probable SP had a rate of comorbidity with specific phobia symptoms of 44%. CONCLUSIONS: Our findings corroborate those from other studies in Western countries, both regarding the high prevalence of SP symptoms and its demographic and clinical correlates, as well as regarding the high overlap rate with specific phobia symptoms.

Successful multidisciplinary treatment in an adolescent case of rumination.

Rumination is a rare and complex disorder to treat. It involves repeated regurgitation, rechewing and reswallowing of food and occurs mainly among infants and mentally retarded children. Among adolescents and adults it is rather rare, but still might cause significant sequelae (depression, other eating disorders and social problems). We provide a detailed psychodynamic formulation in a non-retarded adolescent with rumination (over a four year period). A multidisciplinary approach involving individual insight-oriented psychotherapy, group therapy, pharmacological therapy and a nutritional intervention has proved successful in abating the patient's symptoms. We propose that among adolescents and adults, childhood issues of neglect and feeding problems may be reactivated through the rumination symptom. The focus of this report is to address the importance of rumination, as well as the role of a multidisciplinary approach to such cases.

Attitudes towards malingering: a study among general practitioners and mental health officers in the military.

OBJECTIVE: The authors assessed the attitudes of military physicians and mental health officers regarding the phenomenon of malingering. METHOD: Questionnaires on attitudes regarding malingering and possible cues indicative of deception were sent to 115 general practitioners (GPs) and mental health officers (MHOs) in the Israel Defense Forces (IDF). RESULTS: 91 responses were received--a response rate of 80%. All the respondents claimed that they had seen cases of malingering. They estimated that every fourth soldier is malingering. GPs claimed that they had seen more cases of malingering as compared to MHOs. Those who estimated that malingering is very frequent in the military, also had higher estimates of malingering in their civil work. The most indicative clues of malingering among soldiers were inconsistency, flamboyant complaints, exaggeration of symptoms and accentuation of secondary gain. CONCLUSIONS: Among IDF GPs and MHOs, there currently appears to be moderate consensus regarding the frequency of malingering and its characteristic signs. The study provides further support to the notion that malingering is an important clinical phenomenon. We believe that the issue merits further research and scrutiny.