Characterisation of RSV infections in children without chronic diseases aged 0-36 months during the post-COVID-19 winter season 2022/2023.

Background: Respiratory syncytial virus (RSV) is one of the leading causes of hospitalisation, morbidity, and mortality due to respiratory infection in the first years of life. This longitudinal prospective study outlines the 2022/23 season's viral patterns in Austria after the epidemiological changes determined by public health measures. We aimed to highlight differences within the RSV subtypes and genotypes in 0-36-month-old children without chronic diseases in the outpatient setting. Methods: From November 2022 to March 2023 children younger than 36 months admitted to Vienna's largest paediatric primary healthcare centre with an acute respiratory infection were enrolled in this study. Nasal swabs and multiplex PCR panels detected 20 viruses including RSV subtypes and genotypes. Clinical presentation, features, and treatment of the participants were documented and analysed using the Modified Tal Score (MTS). Patients were scheduled for a telemedical follow-up one week after the initial appointment. Analysis was done using descriptive statistics, including Cramér V and binominal logarithmic regression. Results: Among the 345 samples from 329 children, RSV was the most common virus (31.9%), followed by influenza (17.5%) and rhinovirus infections (20.58%). Of the RSV positive samples, only 13 cases were RSV subtype A (11.8%), whereas 97 were of subtype B (87.3%); ON1 and BA9 were the only detectable RSV genotypes (ON1: BA9 = 1:9.25). RSV was the main predictor of hospitalisation (OR: 7.5, 95% CI: (1.46-38.40), and age had a significant but smaller effect (OR: 0.89, 95% CI: (0.81-0.99). Almost all patients' clinical status improved within the first days. Conclusion: RSV cases showed a rapid onset in late November 2022, and subtype B was predominant throughout the season. RSV infection was associated with higher hospitalisation rates, even after excluding high-risk patients (preterm and severe chronic diseases population).Further testing in the upcoming winter seasons will improve our knowledge of the dominant subtype and its association with disease severity, especially with the development of novel RSV vaccine candidates.

Second Victims among Austrian Pediatricians (SeViD-A1 Study).

(1) Background: The second victim phenomenon (SVP) plays a critical role in workplace and patient safety. So far, there are limited epidemiological data on the SVP in German-speaking countries. Some studies have been carried out in Germany, but so far, no quantitative studies have been carried out in Austria examining the prevalence, symptom load and preferred support measures for second victims (SVs). This study therefore examines the SVP among Austrian pediatricians. (2) Methods: A nationwide, cross-sectional and anonymous online study was conducted using the SeViD questionnaire (Second Victims in Deutschland) including the Big Five Inventory-10 (BFI-10). Statistical analysis included binary-logistic and multiple linear regression with the bootstrapping, bias-corrected and accelerated (BCa) method based on 1000 bootstrap samples. (3) Results: Of 414 Austrian pediatricians, 89% self-identified as SVs. The main cause of becoming an SV was the unexpected death or suicide of a patient. High neuroticism and extraversion values as well as working in outpatient care positively correlated with having experienced the SVP. A preferred support strategy was access to legal counseling. (4) Conclusions: Austrian pediatricians have the highest SVP prevalence measured with the SeViD questionnaire. Further research should focus on prevention strategies and intervention programs.

The surge of RSV and other respiratory viruses among children during the second COVID-19 pandemic winter season.

Background: The non-pharmaceutical measures in the first Covid-19 winter season significantly impacted respiratory pathogens such as RSV, influenza, or metapneumovirus, which cause respiratory infections, especially in infants and young children. This longitudinal prospective study aimed to determine how less strict measures affect the pathogen profile in the second winter season. Methods: From September 2021 till the end of March 2022, 678 children (0-36 months) admitted to Vienna's largest pediatric center with an acute respiratory infection were enrolled in this study. The researchers performed nasal swabs and tested them by multiplex PCR for 23 respiratory pathogens, chronicled clinical features and treatment, and analyzed the effect of lockdown on the pathogen prevalence. Results: The 815 smears of 678 children revealed the most common pathogens to be rhino-/enterovirus (38.5%), RSV (26.7%), and metapneumovirus (7.2%). The lockdown interrupted the early RSV onset in September [RR 0.367, CI (0.184-0.767), p = 0.003], while no effects on the other pathogens were found. Metapneumovirus started circulating in January. Influenza was only sporadically detected. The hospitalization rate was significantly higher than last season due to RSV [OR 4.089, 95%CI (1.414-11.827), p-adj = 0.05]. Conclusion: With more flexible non-pharmaceutical measures, children aged 0-36 months started presenting again with viral pathogens, such as RSV and metapneumovirus. RSV, associated with a high hospitalization rate, had a very early onset with an abrupt interruption due to the only lockdown.

[Health care structures in outpatient pediatrics]. / Versorgungsstrukturen in der ambulanten Pädiatrie: Status quo und Ausblick.

Background: A reform of the Austrian healthcare system seems inevitable due to the foreseeable financing limits, the no longer up-to-date separation of intramural and extramural services, the increasing shortage of specialist physicians, and the altered requirements of the population with respect to health care. Objective: The aim of this article is to provide the reader with an overview of the current issues in establishing new outpatient structures. Results: The recognizable trend to reduce the length of stay (LOS) in hospitals will increase the demand for outpatient hospital services. Consequently, it is vital to encourage synergy between these two different sectors. De facto, clinics providing more outpatient healthcare services in coordination with hospitals are still insufficient. With progressively fewer small practices and clinics, often addressed as lone fighters in the public debate, the outpatient settings operate without coordinated planning and policies with the larger actual outpatient healthcare system. This reality requires constant adaptation in the development of medical care. An upgrading of the outpatient services should provide new primary facilities; these can function from the side of the provider but presumably not from the aspects of organization, based on the German medical healthcare centers.

Non-prescription treatments for childhood infections: an Austrian, monocentric, cross-sectional questionnaire study.

BACKGROUND: Infectious diseases like the common cold, otitis media, or gastroenteritis frequently occur in childhood. In addition to prescription drugs, parents often use supplementary over-the-counter (OTC) products recommended by pharmacists and other non-medical professionals to relieve their children's symptoms. However, the efficacy of such alternative treatments lacks conclusive evidence. The objective of this study was to investigate the use of OTC products and related active ingredients in children, and the motivations behind this choice. METHODS: The present study included 215 children aged between 1 and 14 years with an acute respiratory tract infection, e.g., common cold, bronchitis, otitis media, tonsillitis, or gastroenteritis. During their visit to the pediatric practice, parents filled in a self-administered questionnaire about their child's diagnosis, additional treatment options, and motivations to integrate supplementary medicinal products after their first visit for acute infection or follow-up examination. Children with chronic illnesses and patients visiting for a routine maternal and child health program check-up were excluded. RESULTS: The study included 111 (51.6%) males and 104 (48.4%) females. Median age was 3.00 (IQR 2.0 - 5.0) years. The most common reason for a visit was a respiratory tract infection (78.6%). Out of 215 parents, 182 (84.7%) resorted to non-prescription remedies to alleviate their child's symptoms. Teas (45.1%), and home remedies (43.3%) were the most popular. At total 133 (74.3%) followed recommendations from friends and family regarding additional medications usage. Parents with previous experience with complementary medicine tended to prefer this approach to treat their children (p.adjust = 0.08). CONCLUSION: The use of non-prescription medicine is increasing as well as the range of related information sources. Evidence-based recommendations in this field might improve pediatric care.

Respiratory Infections in Children During a Covid-19 Pandemic Winter.

Background: The Covid-19 pandemic compelled the implementation of measures to curb the SARS CoV-2 spread, such as social distancing, wearing FFP2 masks, and frequent hand hygiene. One anticipated ramification of these measures was the containment of other pathogens. This prospective, longitudinal study aimed to investigate the spread of 22 common seasonal non-SARS-CoV-2 pathogens, such as RSV and influenza, among children with an acute respiratory infection during a pandemic. Methods: Three hundred ninety children (0-24 months) admitted to Vienna's largest pediatric center with acute respiratory infection (November 2020-April 2021) were included in this study. The researchers tested nasal swabs for 22 respiratory pathogens by Multiplex PCR, documented clinical features and treatment, and evaluated data for a potential connection with the lockdown measures then in force. Results: The 448 smears revealed the most common pathogens to be rhino-/enterovirus (41.4%), adenovirus (2.2%), and coronavirus NL63 (13.6%). While the first two were active throughout the entire season, coronaviruses peaked in the first trimester of 2021 in conjunction with the lift of the lockdown period (OR 4.371, 95%CI 2.34-8.136, P < 0.001). RSV, metapneumovirus, and influenza were absent. Conclusion: This prospective, longitudinal study shows that Covid-19 measures suppressed the seasonal activity of influenza, RSV, and metapneumovirus among very young children, but not of rhino-/enterovirus and adenovirus. The 0-24 month-olds are considered the lowest risk group and were only indirectly affected by the public health measures. Lockdowns were negatively associated with coronaviruses infections.

Self-Care Strategies and Job Satisfaction in Pediatricians: What We Can Do to Prevent Burnout-Results of a Nationwide Survey.

Introduction: Working in the clinical field can be a demanding experience. While reports indicate escalating burnout rates among physicians, further investigation about what physicians can do to prevent burnout is necessary. Our objective was to assess self-care levels among pediatricians and the correlation with job satisfaction in order to subsequently identify protective factors. Methods: In this nationwide, cross-sectional study, a web-based survey was distributed to all Austrian pediatricians via a mailing list of the Austrian Society of Pediatrics. Self-care was measured with a modified Professional Self-Care Scale (PSCS), which consisted of nine items on a four-point Likert scale (from 1, "totally disagree," to 4, "totally agree"). Additional items addressed job satisfaction, peer support, and access to professional coaching. Results: The survey was distributed to 1,450 mailing list contacts, a total of 309 Austrian pediatricians completed the survey (21%). "Family" (M = 3.3) and "Friends" (M = 3.1) were the most highly rated self-care strategies. We found significant differences between pediatricians under 35 years and those aged 50 years and above (z = -4.21, p < 0.001). Peer support appeared to impact job satisfaction substantially. We found differences between pediatricians who frequently talk to colleagues about difficult situations, those who sometimes do so, and those who never do (p < 0.001), with a linear trend indicating increased job satisfaction with more frequent peer support (p < 0.001). Conclusions: Among all self-care strategies, a stable network of family and friends was highest rated, followed by balanced nutrition. Younger, male pediatricians working in hospital showed to be a vulnerable group with regard to overall self-care. Moreover, higher self-care values were found among those pediatricians who reported to receive peer support on a regular basis. We suggest combined organizational and individual interventions to promote pediatricians' well-being. Organizations should provide the possibility to select a well-balanced diet as well as space and time to consume food and cultivate a work environment that enables communication among peers and facilitates professional coaching. On the personal level, we want to encourage pediatricians to talk to trusted colleagues in challenging clinical situations and to consider working with a professional coach.

Effective German and English Language mHealth Apps for Self-management of Bronchial Asthma in Children and Adolescents: Comparison Study.

BACKGROUND: Mobile health (mHealth) apps hold great potential for asthma self-management. Data on the suitability of asthma apps intended for children are insufficient, and the availability of German language apps is still inadequate compared with English language apps. OBJECTIVE: This study aims to identify functional asthma apps for children in German and to compare them with English language apps. In line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the Google Play Store and Apple App Store are systematically searched to preselect the most efficient apps, which are then compared according to a self-compiled criteria catalog. METHODS: Both app stores were screened for the term asthma. Following a PRISMA preselection process, the apps that met the inclusion criteria (ie, available free of charge, German or English language, and suitable for children) were rated by 3 independent persons following a criteria catalog consisting of 9 categories, some conceived for this purpose (availability, child-friendly, learning factor, and range of functions) and some adopted from existing validated catalogs (functionality and design, ease of use, potential for improving asthma self-management, fun factor and incentives, and information management and medical accuracy). The highest rated apps in German and English were compared. RESULTS: A total of 403 apps were identified on the Google Play Store and the Apple App Store. Finally, 24 apps that met the inclusion criteria were analyzed. In the first step of the quality assessment, only 4 available German language asthma apps were compared with 20 English language asthma apps. The 4 German language apps were then compared with the 4 highest rated English language apps. All selected apps, independent of the language, were comparable in the following categories: availability, functionality and design, ease of use, and information management and medical accuracy. The English language apps scored significantly higher in the following categories: potential for improving self-management, child-friendly, fun factor, learning factor, and range of function. English language apps (mean total points 34.164, SD 1.09) performed significantly better than German language asthma apps (mean total points 22.91, SD 2.898; P=.003). The best rated English language app was Kiss my asthma (36/42 points), whereas the best rated German language app Kata achieved only 27.33 points. CONCLUSIONS: The recommended English language apps are Kiss my asthma, AsthmaXcel, AsthmaAustralia, and Ask Me, AsthMe!, whereas the only recommended German language app is Kata. The use of apps plays an increasingly important role in patients' lives and in the medical field, making mHealth a staple in the future of asthma treatment plans. Although validated recommendations on rating mHealth apps have been published, it remains a challenging task for physicians and patients to choose a suitable app for each case, especially in non-English-speaking countries.

Risk of infection in the first year of life in preterm children: An Austrian observational study.

Newborns, especially preterm infants, have an immature immune system, which, in combination with the required medical interventions necessary for keeping the neonate alive may lead to an increased risk of infection. Even after reaching stability and adapting to the environment, preterm infants have adverse prognoses regarding infections and long-term outcomes compared to their full-term counterparts. The objective of this study was to research differences in the number and severity of infections between preterm and full-term infants during their first year of life. To answer this question, a monocentric prospective study was conducted in a pediatric practice in Vienna, including 71 full-term infants and 72 preterm infants who were observed during their first year of life regarding occurring infections. In respective samples, there was a significantly higher total number of infections in preterm (mean 6.01 ± 3.90) compared to full-term infants (3.85 ± 1.72) during the observation period of one year. Particularly the count of respiratory and severe infections was considerably higher in preterm infants. Otorhinolaryngeal infections were the most frequent of all types of infections in both groups. The pregnancy period, number of siblings, and length of the postnatal hospital stay, were observed as significantly influencing factors which affected the total number of infections. The group of early term infants (37+0 weeks to 38+6) was not significantly different to late term babies (>39+0). The acquired knowledge about the increased risk of infections should lead to a more extensive care for preterm infants, with the objective of reducing the rates of complications, morbidity and mortality in this vulnerable age group in the future.

Vaccination status of resident pediatricians and the potential risk for their patients - a cross-sectional questionnaire study in pediatric practices in Vienna.

BACKGROUND: Pediatricians are advised by the Austrian ministry of health to be vaccinated against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, varicella, hepatitis A, hepatitis B, meningococcus ACWY and meningococcus B, pneumococcus and seasonal influenza. As they take care of a vulnerable patient group including newborns and infants, who have not been vaccinated yet, it is important that they have a positive immunization status in order to protect their patients. This cross-sectional study aims to investigate the vaccination status of pediatricians and their assistants in practices in Vienna. METHODS: All 196 resident pediatricians in Vienna were invited to participate in this cross-sectional, questionnaire-based study. They had to specify their sex, medical profession, self-reported vaccination status for the respective vaccine preventable diseases and the type of practice they are working in (private versus government funded practice). RESULTS: High vaccination rates above 90% were found for measles, poliomyelitis, pertussis and hepatitis B, whereas seasonal influenza, meningococcus and pneumococcus were the least accepted vaccinations in this cohort. No significant differences were observed for male and female vaccination habits. Influenza and pneumococcus vaccines were more frequently received by pediatricians than their assistants. Health care workers (HCW) of private practices had significantly lower hepatitis B vaccination rates compared to those working in practices covered by the Vienna health insurance fund. CONCLUSION: Resident pediatricians in Vienna reveal rather high vaccination rates for some but not all of the recommended immunizations, which puts their pediatric patients at risk. Measures for higher vaccination rates are needed especially for this medical professional group.

Quality of life in children and adolescents with migraine: an Austrian monocentric, cross-sectional questionnaire study.

BACKGROUND: Migraine is a disabling primary headache disorder that occurs in about 10 % of children and might lead to a lower quality of life. There are several possible migraine triggers in a patient's environment, which should be avoided where possible. The objective of this Austrian monocentric study was to identify migraine triggers and the areas, in which children and adolescents with migraine have a lower quality of life than healthy, headache-free children. METHODS: In this cross-sectional, questionnaire study, 76 children from ages 8 to 17 years were included. Thirty-seven were classified as migraineurs, 39 as non-migraineurs. Participants filled in a questionnaire surveying the areas of physical, socio-economic and school functioning. Migraineurs further answered migraine-specific questions. RESULTS: The study included 33 (43.4%) males and 43 (56.6%) females. Median age was 13.00 (10.00-16.00) years. Average age of onset for migraine was 9.22 ± 3.34 years. Non-migraineurs skipped trendwise fewer meals (p.adjust = 0.108) and exercised more often (p.adjust = 0.108). In socio-economic functioning, the father's nationality being Austrian might be related to migraine (p.adjust = 0.108). Children with migraine had a significantly lower quality of life in school functioning (PedsQL 4.0 questionnaire, p.adjust = 0.04) and had significantly less often "good" grades than children without migraine (p.adjust = 0.048). CONCLUSION: Children with migraine show a reduced quality of life in the areas of physical, socio-economic and school functioning.

Occurrence of patients compared in a pediatric practice and pediatric hospital outpatient clinic.

The frequency of consultations and the waiting times in pediatric hospital outpatient clinics are steadily increasing. The aim of this study was to compare the occurrence of patients in a large pediatric group practice and a hospital-based general pediatric outpatient clinic. Primary parameters were the most common reasons for consultation, the waiting times and the reasons for selecting a certain institution. Most frequent diagnoses in the pediatric practice were upper respiratory tract infections (22.7% (n = 141/621)), otitis media (5.2% (n = 32/621)), and viral pharyngitis (3.9% (n = 24/621)). Most common reasons for consultation in the hospital outpatient clinic were upper respiratory tract infections (18.4% (n = 121/658)) and bacterial pharyngitis (17.9% (n = 118/658)). In the pediatric practice, bacterial pharyngitis was only diagnosed in 3.1% (n = 19/621) of the cases. Only slight differences exist between the two institutions regarding the observed entities, which mainly comprise mild to moderate acute illnesses. It can be concluded from this that the majority of patients might as well be treated in the nonhospital setting. Facilitating the communication and coordination between practices and hospitals might allow a better utilization of capacities. Thereby, waiting times, unnecessary reexaminations, and costs in the health-care system could be reduced.

Noise levels in general pediatric facilities: A health risk for the staff?

This study was initiated to investigate noise levels in general pediatric facilities. Although occupational noise limits of 85dBA for LAeq,8h (daily noise exposure) and 140dBC for LCpeak (peak sound level) have proven to prevent hearing loss, even low levels of continuous noise (45dBA and above) can cause adverse health effects (ISO = International Organization for Standardization, A = Austrian VOLV). The sound level measurements of LAeq (equivalent sound level) and LCpeak were conducted with a decibel meter in the examination rooms (EXR) and waiting rooms (WR) of 10 general pediatric practices and outpatient clinics in the city of Vienna, Austria. LAeq,8h was calculated from LAeq, and independent variables with a potential influence on noise levels were also examined. In EXR, the random sample consisted of 5 to 11 measuring periods per facility (mean: 7.1 ± 1.9) with a total duration between 43.85 and 98.45 min. (total: 10:19:04). With LAeq ranging from 67.2 to 80.2dBA, specific recommended limits were exceeded considerably (ISO: 45dBA; A: 50dBA). In WR, the random sample comprised 5 to 18 measurements per facility (mean: 13.7 ± 5.0) with a total duration ranging from 25 to 90 min. (total: 11:25:00). The values for LAeq were between 60.6dBA and 67.0dBA. All of these significantly exceeded recommended limits of 55dBA (ISO) and 5 out of 10 exceeded 65dBA (A). LCpeak reached 116.1dBC in WR and 114.1dBC in EXR. The highest calculated daily noise exposure of pediatricians (LAeq,8h) was 79dBA. Although no significantly increased risk for hearing loss can be concluded from our findings, it must be assumed that noise levels in general pediatrics have the potential to cause stress and associated health issues. Further research is necessary to foster the recognition of noise-related health impairments of pediatric staff as occupational diseases.

Ultrasound of the infant hip: manual fixation is equivalent to Graf's technique regarding image quality-a randomized trial.

BACKGROUND: In Middle Europe ultrasonography is the standard method used to screen for developmental dysplasia of the hip in infants. Our aim was to determine whether manual fixation of the child is equivalent to Graf's technique regarding image quality. METHODS: This randomized trial was conducted at a free-standing general pediatric outpatient clinic in Vienna, Austria. Healthy infants in the 1st and between the 6th and 8th week of life with no hip malalignment were included. After randomization, Group 1 was examined using Graf's fixation device and participants in Group 2 were fixated on the examination couch by their parents. In a second step, all images underwent a blinded evaluation. RESULTS: A total of 117 babies (Group 1: n = 62, Group 2: n = 54, excluded: n = 1) were examined and 230 images (Group 1: n = 122, Group 2: n = 108) were evaluated, of which 225 were sonographically normal. Two images, showing a type IIa right hip and a type IIa + left hip respectively, were excluded. One participant had to be excluded as the respective images showed two pathologic hip joints. Two images in Group 1 and three in Group 2 were not evaluable. No statistical association between image quality (11 quality criteria and overall evaluability) and fixation technique (0.12 ≤ p ≤ 1.0 or constant) was found. CONCLUSIONS: Considering sonographically normal hip joints, we found no evidence that manual fixation differed from Graf's technique regarding image quality. In future studies, hip pathologies should be included and discomfort of infants and parents during the examination should be addressed. TRIAL REGISTRATION: German Clinical Trials Register, ID: DRKS00015694 ), registered retrospectively on October 7th, 2018.

Overweight in children and its perception by parents: cross-sectional observation in a general pediatric outpatient clinic.

BACKGROUND: Childhood overweight is a growing problem in industrialized countries. Parents play a major role in the development and the treatment of overweight in their children. A key factor here is the perception of their child's weight status. As we know of other studies, parental perception of children's weight status is very poor. This study aimed to determine factors associated with childhood overweight and parental misperception of weight status. The height and weight of children, as reported by parents were compared with measured data. METHODS: The study was conducted at a general pediatric outpatient clinic in Vienna, Austria. A total of 600 children (aged 0-14 years) participated in the study. Collection of data was performed by means of a questionnaire comprising items relating to parental weight and social demographics. The parents were also asked to indicate their children's weight and height, as well as the estimated weight status. Children were weighed and measured and BMI was calculated, allowing a comparison of estimated values and weight categories with the measured data. RESULTS: Parental BMI, parental weight and a higher birth weight were identified as factors associated with childhood overweight. No association with the parents' educational status or citizenship could be proven. We compared parents' estimations of weight and height of their children with measured data. Here we found, that parental estimated values often differ from measured data. Using only parental estimated data to define weight status leads to misclassifications. It could be seen that parents of overweight children tend to underestimate the weight status of their children, compared to parents of children with normal weight. CONCLUSIONS: Pediatricians should bear in mind that parental assessment often differs from the measured weight of their children. Hence children should be weighed and measured regularly to prevent them from becoming overweight. This is of particular importance in children with higher birth weight and children of overweight parents. TRIAL REGISTRATION: Study was not registered. The study was approved by the Ethic committee of the city of Vienna. (EK 13-146-VK).

Internet use of parents before attending a general pediatric outpatient clinic: does it change their information level and assessment of acute diseases?

BACKGROUND: Before seeing a pediatrician, parents often look online to obtain child health information. We aimed to determine the influence of IUC (internet use regarding the reason for consultation) on their subjective information level, their assessment of acute diseases and the change in this assessment. Secondary objectives were to identify the most commonly used online resources and factors with an influence on IUC. METHODS: This cross-sectional observational study was conducted at a general pediatric outpatient clinic located in Vienna, Austria. An anonymous, voluntary and 14-items-containing questionnaire served to gather all data. A total number of 500 questionnaires were collected. RESULTS: Of the parents attending the outpatient clinic, 21 % use the internet before the appointment (= IUC). Most common online resources utilized for this purpose are websites run by doctors (61.3 %), the outpatient clinic's homepage (56.3 %), Google (40 %), Wikipedia (32.5 %), health advisory services provided by doctors (28.7 %), health portals (21.3 %) and health forums and communities (18.8 %). The information level in terms of the reason for consultation is rated as good by 50.6 %, as average by 46.7 % and as insufficient by 2.7 % (internet users: 42.7 %, 55.3 %, 1.9 %). Acute diseases of the children are estimated to be mild by 58.4 %, to be moderate by 41.1 % and to be severe by 0.5 % (internet users: 54.9 %, 45.1 %, 0 %). After having used any source of information, this assessment is unchanged in 82.8 %, acute diseases are rated as more severe in 13.8 % and as less severe in 3.4 % (internet users: 79.2 %, 16.7 %, 4.2 %). Internet users and non-users do not differ with respect to their information level (p = 0.178), the assessment of acute diseases (p = 0.691) and the change in this assessment (p = 0.999). A higher education level of parents (mothers: p = 0.025, fathers: p = 0.037), a young age of their children (p = 0.012) and acute diseases of their children (p = 0.046) predispose to IUC. CONCLUSIONS: Against the common perception that online health information might fuel panic-mongering, we could not determine a link between IUC and the assessment of acute diseases. The information level of internet users and non-users does not differ either. Further research is needed to clarify causes for high and low IUC.

Internet health seeking behaviour of parents attending a general paediatric outpatient clinic: A cross-sectional observational study.

INTRODUCTION: Our aim was to examine the internet health seeking behaviour of parents attending a general paediatric outpatient clinic. For this purpose, the proportion of parents going online to obtain child health information, the most commonly used online resources, and factors having an influence on internet usage were identified. METHODS: This cross-sectional observational study was conducted at a general paediatric outpatient clinic in Vienna, Austria. Data collection was done by means of an anonymous questionnaire containing 14 items. A total number of 500 questionnaires were collected. RESULTS: Among parents visiting the outpatient clinic, 94.4% use the internet to obtain child health information in general and 21% to be informed about the reason for consultation. Most commonly used online resources are Google (91.4%), websites run by doctors (84.8%), Wikipedia (84.7%), health portals (76.4%), the outpatient clinic's homepage (76.4%), as well as health forums and communities (61.9%). Younger parents (p = 0.022) and parents of younger children (p < 0.01) display a higher tendency to use the internet for child health information purposes. Mothers and fathers (p = 0.151) as well as parents with different completed educational levels (mothers: p = 0.078; fathers: p = 0.388) do not differ in this behaviour. DISCUSSION: Important reasons for high internet use might be the inexperience of young parents regarding child health as well as the frequent infections, vaccinations, and preventive check-ups which are associated with young age of children. In contrast to former findings relating to health seekers in general, internet usage of parents is independent of their sex and educational level.

Coronary hemodynamics and myocardial oxygen consumption during support with rotary blood pumps.

Mechanical support offered by rotary pumps is increasingly used to assist the failing heart, although several questions concerning physiology remain. In this study, we sought to evaluate the effect of left-ventricular assist device (VAD) therapy on coronary hemodynamics, myocardial oxygen consumption, and pulmonary blood flow in sheep. We performed an acute experiment in 10 sheep to obtain invasively measured coronary perfusion data, as well as pressure and flow conditions under cardiovascular assistance. A DeBakey VAD (MicroMed Cardiovascular, Inc., Houston, TX, USA) was implanted, and systemic and coronary hemodynamic measurements were performed at defined baseline conditions and at five levels of assistance. Data were measured when the pump was clamped, as well as under minimum, maximum, and moderate levels of assistance, and in a pump-off condition where backflow occurs. Coronary flow at the different levels of support showed no significant impact of pump activity. The change from baseline ranged from -10.8% to +4.6% (not significant [n.s.]). In the pulmonary artery, we observed a consistent increase in flow up to +4.5% (n.s.) and a decrease in the pulmonary artery pressure down to -14.4% (P = 0.004). Myocardial oxygen consumption fell with increasing pump support down to -34.6% (P = 0.008). Left-ventricular pressure fell about 52.2% (P = 0.016) as support was increased. These results show that blood flow in the coronary arteries is not affected by flow changes imposed by rotary blood pumps. An undiminished coronary perfusion at falling oxygen consumption might contribute to cardiac recovery.