ABSTRACT
OBJECTIVES: To assess whether ultrasonography alone is adequate for routine screening of childhood urinary infection, whether clinical features determine the need for further investigations, and which investigations are most appropriate. DESIGN: Prospective survey of children with proved urinary infection and a preinvestigation record of clinical features. Ultrasonography and intravenous urography were routine, with choice of further studies determined by ultrasonographic findings. SETTING: A children's hospital and two district general hospitals in Mersey region. MAIN OUTCOME MEASURES: Sensitivity and specificity of ultrasonography both generally and in relation to clinical features. Accuracy of intravenous urography compared with radioisotope examinations. RESULTS: Specificity of ultrasonography was good (99% (95% confidence interval 96% to 100%)) but sensitivity modest (43% (32% to 55%)), principally with respect to detecting vesicoureteric reflux and renal scarring. Among older children (aged 2-10 years) with positive ultrasound results and fever or vomiting the sensitivity in detecting reflux (with and without renal scarring) was 78% (62% to 89%) and the specificity 69% (60% to 78%); in detecting renal scarring (with and without reflux) the sensitivity was 100% (80% to 100%) and specificity 65% (56% to 74%). Renal scarring and obstructive uropathies were better assessed by radioisotope examinations than by intravenous urography. CONCLUSIONS: Ultrasonography alone is inadequate for routine screening of childhood urinary infection. Though further investigations remain advisable in infants, in older children they can be restricted to a minority who have positive ultrasound examinations or have had fever or vomiting. Radioisotope examinations largely eliminate the need for intravenous urography.
Subject(s)
Urinary Tract Infections/diagnostic imaging , Urinary Tract/diagnostic imaging , Child , Child, Preschool , Cicatrix/diagnostic imaging , Female , Humans , Infant , Kidney Diseases/diagnostic imaging , Male , Prospective Studies , Radiography , Radionuclide Imaging , Recurrence , Sensitivity and Specificity , Ultrasonography , Vesico-Ureteral Reflux/diagnostic imagingABSTRACT
A pilot study is reported in which 18 children in end-stage renal failure, undergoing either haemodialysis or continuous ambulatory peritoneal dialysis were assessed with regard to adherence to their treatment regime. Measures were used to assess level of depression, locus of control and social desirability. Adherent behaviour was significantly related to high social desirability, and a shorter length of time on dialysis. There was no relationship between adherence and depression or locus of control.
Subject(s)
Kidney Failure, Chronic/psychology , Patient Compliance , Renal Dialysis/psychology , Adjustment Disorders/psychology , Adolescent , Child , Female , Humans , Internal-External Control , Male , Social DesirabilityABSTRACT
Thirty-two children diagnosed as suffering from renal failure, their parents and siblings were the subjects of this study. Anxiety, depression and psychosomatic complaints were examined in the parents and behaviour problems in the child and siblings using standardised tests. The personality characteristics (EPQ) of the child and the child's view of the family (modified family relations test) were also ascertained. Parents showed greater levels of anxiety and depression than a normal sample and more psychosomatic problems than a control group consisting of parents of children with other chronic physical conditions. Siblings and the sick child did not have more behaviour problems at school than a normal control group. Positive correlations were found between age on diagnosis of renal failure and fathers' depression and anxiety scores. Mothers' anxiety and depression scores were also positively correlated with those of father. Negative correlations were found between age on diagnosis of renal failure and lie scores on the EPQ.
