Metal allergy as a late-onset complication of the Nuss procedure in a pediatric patient.

We report the case of a 14-year-old boy with pectus excavatum who developed a metal allergy to stainless steel bar as a late-onset complication after the Nuss procedure. He did not have atopic diathesis. Treatment with oral steroids was effective and the metal bar was successfully removed 2 years later.

[Chronic disease and health condition prevention in childhood--2nd part: emphases from the 14th Symposium of Preventive Pediatrics]. / Prevencija kronicnih bolesti i stanja u djece--2. dio: naglasci s xiv. Simpozija Preventivne Pedijatrije.

Chronically ill children nowdays in developed countries are more prevalent than before, and thanks to modern therapeutic modalities more children are surviving into adulthood. Increased survival cannot be assumed to be associated with increased quality of life. With the chronically ill child holistic approach is important, which incorporates not only realisation of the highest possible standards in diagnostics and treatment, but also special care for disease prevention. All this is very important in so called integrative approach in the care of a chronically ill child, with the aim of achieving as high as possible quality of life and complete social integration. At the 14th Preventive Pediatrics Symposium, which took place in Skrad, June 1' 2013, from preventive standpoint, the following chronic childhood illnesses were discussed: attention deficit hyperactivity disorder--ADHD, migraine, thyroid gland diseases, leukemia, cystic fibrosis, chronic renal disease, chronic inflammatory liver disease, chronic inflammatory bowel disease, juvenile idiopathic arthritis, and chronic otitis media with effusion. It is emphasized that talking about a disease prevention, there are three levels of it--primary, second- ary and tertiary prevention: how to avoid occurrence of disease, how to diagnose and treat existent disease in early stages, before it causes significant morbidity, and finally how to reduce the negative impact of existent disease by restoring function and reducing disease-related complications--how to improve quality of life of children with chronic diseases. Quaternary prevention describes methods to mitigate or avoid results of unnecessary or excessive interventions of the health system. An important process is also transition of care from child-oriented to adult-oriented care. Adults with chronic health conditions should continue to be evaluated periodically for possible late consequences of their childhood illness and previ- ous medical treatments.

[Chronic disease and health condition prevention in childhood: emphases from the 13th Symposium of Preventive Pediatrics]. / Prevencija kronicnih bolesti i stanja u djece: naglasci s XIII. simpozija preventivne pedijatrije.

Chronic diseases in childhood have become an important priority, especially in developed countries, because of higher prevalence, relatively and absolutely. Besides that, inappropriate procedures a chronically ill child can result in child's growth and development disorder. According to literature data, 15-20% of children have chronic disease with the impact on their physical, mental and emotional status. Disease prevention strategies are described at the primary, secondary and tertiary level: how to avoid occurrence of disease, how to diagnose and treat existent disease in early stages, before it causes significant morbidity, and finally how to reduce negative impact of existent disease by restoring function and reducing disease-related complications - how to improve quality of life of children with chronic diseases. The new term of quaternary prevention describes methods to mitigate or avoid results of unnecessary or excessive interventions in the health system. In this paper the authors present recent attitudes about chronic diseases prevention modalities in childhood, which, at the beggining of the 21st century, have become more intriguing and represent a new challenge for pediatric health care. Thus, from preventive standpoint, the following chronic illnesses are discussed: asthma, malignant diseases, autism, epilepsy, cerebral palsy, tuberculosis, diabetes type 1, congenital heart diseases, arterial hypertension, celiac disease, and eating disorders. These emphases are from the 13th Preventive Pediatrics Symposium, which took place in Skrad, June 2nd, 2012. Further activities are planned with the aim of continuation of health care furtherance for children with other chronic illnesses.

Increased arterial stiffness in children treated with anthracyclines for malignant disease.

Survivors of childhood cancer have a significantly higher late morbidity and mortality from cardiovascular diseases. The aim of this study was to determine whether anthracyclines used in childhood could increase arterial stiffness, a well-known independent predictor of cardiovascular diseases. The study included 53 children and adolescents aged 6-20 years having completed anthracycline treatment for a malignant disease according to various protocols at least a year before. The patients were free from clinical or laboratory signs of the underlying disease or cardiac disease. Control group consisted of 45 age- and sex-matched healthy children. Arterial stiffness was determined by measuring aortic pulse wave velocity (PWVao) using oscillometric method (Arteriograph TensioMed device). PWVao value was significantly increased (6.24 +/- 1.34 m/s vs. 5.42 +/- 0.69 m/s; p < 0.001) in patients having received anthracyclines as compared to control group. Increased arterial stiffness was present irrespective of the following parameters: age, sex, body mass index, systolic and diastolic blood pressure, mean arterial pressure and heart rate. It is possible that the effect of anthracycline on increased cardiovascular morbidity and mortality in long-term childhood cancer survivors is associated not only with cardiotoxicity, but also with increased arterial stiffness.

The effect of baby friendly hospital initiative and postnatal support on breastfeeding rates--Croatian experience.

The effects of implementation WHO/UNICEF Breastfeeding Hospital Initiative (BFHI) and community postnatal support on breastfeeding rates were examined during and after the breastfeeding promotion campaign in one county of Croatia. Comparison with a control group indicated increase of breastfeeding prevalence in a period of BFHI implementation (1994-1998) - 68% vs. 87% at infant age 1 mo., 30% vs. 54% at 3 mo., 11.5% vs. 28% at 6 mo., and 2% vs. 3.5% at infant age 11-12 mo. (chi-square test, p < 0.05). More considerable increase has been noticed in period 1999-2000 which is characterized by breastfeeding support groups activity: 68% vs. 87% at infant age 1 mo., 30% vs. 66% at 3 mo., 11.5% vs. 49% at 6 mo., and 2% vs. 23% at infant age 11-12 mo. (chi-square test, p < 0.05). Our conclusion is that activities aiming to promote breastfeeding in maternity hospitals have had limited success. They have resulted in satisfactory increase of breastfeeding prevalence in early infant's period, but for far-reaching effect postnatal support is also required.

[Intergenerational transmission of breastfeeding as a behavioral model]. / Medugeneracijsko prosljedivanje dojenja kao modela ponasanja.

Successful breastfeeding is not an automatism. Like other behavioral models, breastfeeding experience is forwarded from generation to generation. To analyze the influence of previous generation on offspring's breastfeeding. Research was carried out in three general pediatric offices in Croatian towns: Sibenik, Varazdin and Zagreb. Examinees were mothers of preschoolers older than 1 year, and totally 300 mothers were comprised by the questionnaires. Mothers who had been breastfed for longer period (more than 6 mo.) statistically significantly more frequently breastfeed their children over 6 months (chi 2 = 10.4; p = 0.0013), in comparison with mothers who had been breastfed for shorter period (up to 6 mo.). There is no significant difference in children breastfeeding duration (up to 6 mo. vs more than 6 mo.) with regard to whether the mothers lived in autonomous housekeeping, or if they lived in common housekeeping with their mothers, or mothers-in-law (chi 2 = 0.303; p = 0.86; d. f. = 2). The influence of examinees' mothers on decision to breastfeed is more frequently positive (63%) than neutral or negative, while, at the same time, positive influence on decision to breastfeed was exerted by significantly smaller number (40%) of mothers-in-law (chi 2 = 27.87; p < 0.001). The strongest influence on mother's decision to breastfeed was exerted by mass media. In the age of nuclear families, health workers should offer more support to breastfeeding mothers with the aim of achieving successful lactation.