ABSTRACT
OBJECTIVE: The Paediatric and Adolescent Gynaecology service (PAG) at Kettering General Hospital is a designated service meeting the needs of children with gynaecological problems. National guidelines reinforce the fact that children should be seen within specific paediatric areas in hospital. We aim to review the role of such a service in the context of a British district general hospital. DESIGN: Retrospective review spanning 15 years. SETTING: The outpatient/inpatient service of a UK district general hospital. POPULATION: A total of 800 patients were included in the study. METHODS: We identified patients attending the PAG clinic between 1994 and 2009. Medical notes were reviewed individually. MAIN OUTCOME MEASURES: Demographics, referral source, presenting symptoms, examination findings, diagnosis, management, admissions and referrals to tertiary centres. RESULTS: In total, 86% of patients were referred from primary care. The age distribution was bimodal at 4 and 15 years of age: the average age was 10 years. Sixty percent of patients were followed-up, giving a total of 2023 appointments. The commonest presentations were vulvovaginitis (18%), labial adhesions (14%), abdominal pain (7%) and precocious puberty (6%). A total of 15% of patients were admitted, largely for planned procedures, of which vaginoscopy was the most frequent. CONCLUSIONS: The PAG service has enabled pathways for care that were previously non-existent, as well as the development of 'best practice'. The British Society for Paediatric and Adolescent Gynaecology has been seeking to develop a network of similar services at secondary and tertiary level throughout the UK. This approach should be encouraged and promoted by those in charge of healthcare policy and provider trusts in general.
Subject(s)
Adolescent Health Services/statistics & numerical data , Child Health Services/statistics & numerical data , Hospitals, District/statistics & numerical data , Hospitals, General/statistics & numerical data , Women's Health Services/statistics & numerical data , Adolescent , Child , Child, Preschool , England , Female , Genital Diseases, Female/therapy , Genitalia, Female/abnormalities , Humans , Infant , Menstruation Disturbances/therapy , Pregnancy , Pregnancy in Adolescence , Puberty, Precocious/therapy , Retrospective Studies , Sex Offenses , Urination Disorders/therapy , Vulvovaginitis/therapyABSTRACT
The purpose of this study was to quantify interrelationships among thigh muscle co-contraction, quadriceps muscle strength, and the aerobic demand of walking in 13 children with spastic hemiplegic cerebral palsy (CP). During Session 1, subjects were familiarized with testing procedures, given five minutes of treadmill walking practice, and completed quadriceps muscle strength testing. In Session 2, subjects performed three 5-min walking bouts on the treadmill at 0.67 m x s(-1) to further accommodate to treadmill ambulation. During Session 3, resting VO2 was measured and subjects walked at 0.67, 0.89, and 1.12 m x s(-1) for five minutes while oxygen uptake (VO2) and thigh muscle co-contraction data were collected. Results demonstrated that no significant relationship existed between net VO2 and measures of thigh muscle co-contraction or quadriceps muscle strength. In addition, thigh muscle co-contraction was not shown to be associated with quadriceps muscle strength. Collectively, thigh muscle co-contraction and quadriceps muscle strength explained 13. 5%, 6.2%, and 2.2% of the variance in VO2 at 0.67, 0.89, and 1.12 m x s(-1), respectively. Viewed in concert, these results suggest that the walking energy expenditure of children with spastic hemiplegic CP is not influenced by the level of thigh muscle co-contraction or quadriceps muscle strength.