Care Of Sick Children Research Articles

The use of complementary and alternative health care practices among children

Introduction: The purposes of this descriptive study were to: (a) describe the use of complementary and alternative medicine (CAM) practices for children as reported by their parents, and (b) to develop a CAM screening tool. Method: A convenience sample of 191 parents was obtained from 3 primary care settings within a midwestern, metropolitan area. The questionnaire consisted of: (a) seven screening questions, (b) a list of specific CAM therapies used by children and by parents, (c) six open-ended questions about sick child care, and (d) a demographic section. Results: Thirty-three percent of parents reported using CAM for their child within the past year, most commonly citing infant massage, massage therapy, vitamin therapy, and botanical products. Analysis revealed that White parents who used CAM for themselves and had children school-age and older were significantly more likely to provide CAM for their child. Chi-square analyses between the responses to selected screening questions and use of CAM were statistically (P =.001) significant but identified only 24% of the parents who used CAM for their children. Discussion: Pediatric nurses should ask parents and children about CAM use in an open manner that promotes discussion. Further refinement of the screening tool is needed. J Pediatr Health Care. (2003). 17, 58-63.

Prevalence of childhood illnesses and care-seeking practices in rural Uganda.

There is a declining trend of child health indicators in Uganda despite intensified program efforts to improve child care. For example, the infant mortality rate increased from 81/1,000 in 1995 to 88/1,000 in the year 2000. This paper presents results of a study that assessed factors responsible for this trend. The objectives were to assess the prevalence of childhood illnesses and care-seeking practices for children with fever, diarrhea, and upper respiratory tract infections (URTI) in the Sembabule district of Central Uganda. A cross-sectional survey, using a WHO 30 cluster-sampling technique, was used to obtain data from 300 women with children aged less than 2 years. Prevalence of childhood illnesses and care-seeking practices were obtained using a structured questionnaire supplemented by in-depth interviews. The results showed that the 300 women interviewed had 323 children of whom 37.9% had an episode of fever 2 weeks before the survey, 40.3% had diarrhea, 37.4% had URTI, and 26.8% were fully immunized. Most of the women, 82.7%, perceived fever as the most serious health problem to their children. URTI, diarrhea, and measles were perceived as serious by a lower proportion of women. Although this study showed high perceptions of childhood diseases, the proportion of mothers seeking care for sick children was low, indicating that there are barriers to accessing care. For example, 44.7% of women sought care when their children had fever, 35.0% when children had URTI, and 31.3% when children had diarrhea. However, most children with fever, diarrhea, and URTI were treated at home and taken to health units only when they developed life-threatening symptoms. This late referral to health units was complicated by high costs of care, long distances to health units, poor attitude of health workers, lack of drugs at health units, and limited involvement of fathers in care of the children.The results of this study showed that although the perceptions of childhood diseases were high, the care-seeking practices were poor. In order to improve child care in this district, there is a need to address barriers to quality of care and to conduct further research to assess the role of cultural factors and male involvement in child care.

Helping children speak up in the health service

This paper reports the main findings of a study undertaken to investigate children's perceptions of health-care professionals, the environment in which they are cared for and their information needs when sick. The main focus of the investigation was 6-10-year-old chronically sick children (predominantly with cancer). A group of healthy school children were used as a comparison in order to highlight similarities and differences. The draw and write technique and an open-ended stimulus task were presented to a total of 99 children (50 hospital, 49 community). Trent NHS Executive and the South Bank University funded the project through Action for Sick Children (formerly NAWCH). The purpose of this paper is to describe how children appear to view care environments including comments on the sorts of information they want and from whom this might be obtained. A wealth of valuable qualitative data, in the form of pictures and comments were collected and are discussed here alongside a selection of the pictures. The researchers also make certain recommendations for the care of sick children, which were drawn directly from their pictures, responses and comments. A previous paper evaluated the draw and write technique and open-ended stimulus task as a tool for gaining information from a child's perspective and as a possible aid to the construction of audit tools (Bradding & Horstman 1999). A full report of this study, published by South Bank University, is available from the authors. This detailed report includes an extended range of drawings, which can be used for teaching and discussion purposes.

Investigation and initial management of suspected metabolic disease

Inherited metabolic disease commonly presents acutely in infants and children. For those involved with care of sick children, it is important to know when to suspect such disorders, the appropriate investigations and how to initiate treatment. This paper serves as an introduction to this topic and updates an article published in 1997.

Contemporary issues in the care of sick children and their families.

This article considers the response of children's nurses to contemporary change in the management of sick children and their families throughout the last decade. In recognizing the rich and diverse history of children's nursing the impact of those factors which have led to the development of operational strategies to manage children's services will be considered. The quest, not always successful, to coordinate care as a seamless web of services to children and their families will be investigated, as will the role dimensions encompassed by specialist children's nurses and their interface with interprofessional colleagues. A range of nurse-led services in a variety of contemporary child health settings will be explored.

Child Care Providers' Experiences Caring For Sick Children: Implications For Public Policy

This study examines the experiences of preschool and school-age child care providers regarding sick child care. In-depth, semi-structured interviews were conducted of child care providers at every city-sponsored preschool and afterschool program in an urban area in the United States. In addition, random sampling was used to identify home-based child care providers from a list obtained through a child care resources center. In spite of rules requiring that sick children be kept home, child care providers repeatedly described sick children whose health problems made it impossible to provide adequate care for the sick child at the same time as caring for the well children in their care. Problems arose for a range of reasons, including inability to provide sufficient attention to the sick child-s needs, inability to keep a sick child clean and well hydrated in the case of vomiting and diarrhea, spread of infectious diseases, and inability to care for healthy children adequately when meeting the needs of sick children. International public health policy implications for child care and paid family leave are discussed.

Integrated Management of Childhood Illness (IMCI): a robust strategy.

Integrated Management of Childhood Illness (IMCI), a strategy fostering holistic approach to child health and development, is built upon successful experiences gained from effective child health interventions like immunization, oral rehydration therapy, management of acute respiratory infections and improved infant feeding. The core intervention of IMCI is integrated management of the five most important causes of childhood deaths-acute respiratory infections, diarrheal diseases, measles, malaria and malnutrition. Using a set of interventions for the integrated treatment and prevention of major childhood illnesses, the IMCI strategy aims to reduce death as well as the frequency and severity of illness and disability, thus contributing to improved growth and development. In health facilities, the IMCI strategy promotes the accurate identification of childhood illness (es) in the outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caretakers and the provision of preventive services, and speeds up the referral of severely ill children. The strategy also aims to improve the quality of care of sick children at the referral level. It also creates a scientifically sound link between the management guidelines at the community level and the management approach in a referral centre. The strategy also envisages actual situations when referral is not possible and offers the best possible options in such circumstances. In the home setting, it promotes appropriate early home care and care-seeking, improved nutrition and prevention, and the correct implementation of prescribed care. In addition to its focus on treatment of illness in the health facility as well as at home, it also provides an opportunity for important preventive interventions such as immunization and improved infant and child nutrition including breastfeeding. The IMCI strategy reduces wastage of resources and avoids duplication of efforts that may occur in a series of separate disease control programs. The essential pillars include improvement in the case management skills of health personnel, improvement in health systems, and improvement in family and community practices. IMCI has been introduced in more than 80 countries and 19 of them have already scaled up IMCI implementation Even though it is too early to relate the decrease in childhood mortality with the introduction of IMCI in these countries, there are several indirect indicators which endorse its validity as a comprehensive and effective strategy. IMCI has helped countries to revise and update their child health policies, streamline the essential drug lists for children, increase service utilization, improve quality of care and nutritional counselling, improve health systems and improved family and community practices.

Welfare to Work: The Effect of a Health-Care Program in Child-Care Centers

Welfare reform has increased pressure on welfare recipients to enter the labor force. When they become employed, former recipients often do not have paid leave that can be used to care for their young children when they are sick. We wished to determine whether an on-site health-care program in child-care centers serving low-income families affected the amount of time parents took off of work to care for mildly ill children. We surveyed parents in 6 child-care centers with an on-site health-care program and in 2 comparison centers without such a program. To analyze survey results, a regression model including demographic and other variables was used to determine which, if any, variables were associated with time taken by parents from work to care for sick children. Analyzing the variables of employer leave policy, poverty level, age of child, and enrollment in the health-care program, only the variable of health-care program enrollment was associated with taking less time from work to care for sick children. Health-care programs in child-care settings can help parents meet the health needs of their children while reducing absenteeism from work, thereby contributing to job stability.

This issue of JAN

This issue of <i>JAN</i>

School Absenteeism, Parental Work Loss, and Acceptance of Childhood Influenza Vaccination

Influenza causes school absenteeism and may cause parents to miss work to care for sick children. However, it is not known whether these factors influence parental acceptance of childhood vaccination. A survey was mailed to parents of 1,805 children attending 3 elementary schools. It included questions about school absenteeism and employment status for adults who stayed home to care for an ill child. Parents were asked if they would consider vaccinating their child against a common wintertime respiratory virus. Of the 972 surveys returned (54% return rate), 954 could be analyzed. Only 13% of respondents stated that they would not consider vaccination for their child. Sixty-nine percent of children had been absent from school because of a nonasthma respiratory illness, with an average of 2.54 days missed per child. Among respondents whose child had missed any school, 33% would definitely consider vaccination compared with 24% of respondents whose child had not missed school (P < 0.01). As children missed more school days, vaccine acceptance increased. In 53% of families, an adult had to miss work to care for the ill child. Vaccine acceptance was higher if an adult caretaker had to lose time from work because of a child's illness (35% versus 25% for non-working caretakers, P < 0.01). Vaccine acceptance was closely linked with the amount of absenteeism caused by respiratory illness in the previous year. Parents who had to miss work to care for an ill child were more accepting of the vaccine than were other parents.

Models of community children's nursing.

Many reports on the care of sick children, from The Platt Report in 1959 (MoH) to the more recent Select Committee Report in 1997 (House of Commons), have recommended that children should have access to a community nursing service similar to that provided to adults. Community children’s nursing services in the UK have developed rather slowly but the literature describing them is developing, suggesting that there has been a surge. Recent trends and developments in the field of community children’s nursing have led to a rise in interest in implementing different models and on evaluating them to enable practice to be based on best evidence. The aim of most community children’s nursing teams is to reduce the length of stay in hospital or avoid admission altogether, and to provide a service which is of high quality and which is cost effective. Children Paediatric nursing Children services Community nursing The six different models that have evolved for delivering CCN services are discussed by Nicola Eaton

Quality of hospital care for seriously ill children in less-developed countries

Improving the quality of care for sick children referred to hospitals in less-developed countries may lead to better outcomes, including reduced mortality. Data are lacking, however, on the quality of priority screening (triage), emergency care, diagnosis, and inpatient treatment in these hospitals, and on aspects of these potential targets that would benefit most from interventions leading to improved health outcomes. We did a qualitative study in 13 district hospitals and eight teaching hospitals in seven less-developed countries. Experienced paediatricians used a structured survey instrument to assess initial triage, emergency and inpatient care, staff knowledge and practices, and hospital support services. Overall quality of care differed between countries and among hospitals and was generally better in teaching hospitals. 14 of 21 hospitals lacked an adequate system for triage. Initial patient assessment was often inadequate and treatment delayed. Most emergency treatment areas were poorly organised and lacked essential supplies; families were routinely required to buy emergency drugs before they could be given. Adverse factors in case management, including inadequate assessment, inappropriate treatment, and inadequate monitoring occurred in 76% of inpatient children. Most doctors in district hospitals, and nurses and medical assistants in teaching and district hospitals, had inadequate knowledge and reported practice for managing important childhood illnesses. Strengthening care for sick children referred to hospital should focus on achievable objectives with the greatest potential benefit for health outcome. Possible targets for improvement include initial triage, emergency care, assessment, inpatient treatment, and monitoring. Priority targets for individual hospitals may be determined by assessing each hospital.

Improving private practitioner care of sick children: testing new approaches in rural Bihar.

Private practitioners are a major source of care for childhood illnesses in developing countries, but the care they provide is often of poor quality. This study tested the effectiveness of two new methods for improving the quality of private practitioner care of sick children: the verbal case review (VCR) and INFECTOM. The VCR is a method for evaluating private providers' quality of care based on mothers' reports and INFECTOM is a package of interventions for improving private providers' quality of care. The study was conducted in 110 villages of Bihar State, India, by three local non-governmental organizations (NGOs). First, the VCR was used for interviews with mothers of approximately 600 children sick with diarrhoea, ARI or fever in the past 2 weeks. The VCR identified practitioners consulted for the treatment of the sick children and recorded providers' case management practices as reported by the mothers. Based on the results of the VCR, the INFECTOM intervention was carried out. This consisted of INformation sessions for the providers regarding standard case management guidelines for ARI, diarrhoea and fever, FEedback to providers on their performance based on the results of the VCR, ConTracting with practitioners to gain their commitment to practice specific guidelines, and Ongoing Monitoring of practitioners' practices with feedback of the results to the practitioners and the community. Seven months after the interventions were initiated, another cross-sectional VCR survey of approximately 300 sick children was carried out to evaluate the impact of the activities on practitioners' case management practices. The results of the study show statistically significant improvements in private practitioners' history taking, examination and counselling practices for ARI, diarrhoea and fever. It was concluded that the VCR and INFECTOM were feasible for implementation by community-based NGOs, and were effective in improving the technical quality of care provided by private health practitioners in rural India.

Children's community nursing services: models of care delivery. A review of the United Kingdom literature.

A review of the United Kingdom literature Children's community nursing (CCN) services in the United Kingdom (UK) have slowly become recognized as an important component in the care of sick children. However, as yet not every child has access to a CCN scheme should the need arise. In the literature there are many descriptions of CCN schemes set up in various parts of the United Kingdom based on a variety of models. This article describes six models of CCN and discusses the main components considered important when implementing or evaluating those models. Components include qualifications of the members of the team, communication between members of the multidisciplinary team, clinical responsibility, resources, willingness and ability of parents to provide care, and accessibility of services. The benefits and limitations of the models are also considered.

98年経済危機以降のロシアの失業問題

After the financial crisis, the unemployed people gradually increased in Russia. The number of them was over 10 millions in spring and summer in 1999. After the crisis, the many banks and financial companies were bankrupted. So, particularly the women who worked in banks lost their works. But the industries in Russia have developed gradually and the sphere of construction needed many workers. But they were mainly physical works, so it is hard for young people who graduated university to find their jobs. Now, many workers in Russia do not get regularly their salaries in their companies. So, unemployed women and many workers have to do second jobs. What kind of jobs they do? The unemployed women sell various goods in streets, or take care of sick people, old people and children. Or they translate foreign languages or teach them to children in home. These jobs are mostly works in black economy. In result, workers have gone away from the labor market. In future, the companies have to get more stable capitals. If so, workers in Russia will move into the normal labor market.

The new emergency medical technician-paramedic and emergency medical technician-intermediate curricula: History, changes, and controversies

In recent years there has been considerable change and improvement in pediatric prehospital education. The evolution of ENIS (emergency medical services) for children has paralleled the evolution of EMS hat with a laf of several years. The most recent advance has been the release of the new paramedic and emergency medical technician intermediate (EMT-I) national standard curricula. The new curricula represent a major improvement in the training of EMTs and paramedics in the care of sick or injured children. In fact, what this new curriculum represents is the incorporation of the many continuing medical education efforts that have been developed, produced, and taught by the emergency medical services for children community over the past 15 years. This new curriculum now focuses on assessment-haled medicine that is in-line with the rest of emergency care. In addition, this new curriculum now provides an educational fornmt similar to that undertook by most pediatric continuing medical education courses in an effort to overcome common educational barriers. This curriculum provides significant hands-on training through both skill, practice , and casebased learning. This will hopefully give paramedics basic knowledge, an understanding of disease processes of the child and skills that will allow them to provide care for ill and injured children with confidence. The curriculum also provides a more directed focus on the importance of maintaining an airway and breathing in the child and that a deficiency in these are usually the root of most pediatric emergencies. In addition, it covers relevant topics in pediatric care as well as topics which are of concern to the paramedic student. Although the new curriculum incorporates changes in all we know about pediatric care, to further overcome barriers in pediatric education there trust he better teaching modalities for the EMT and the paramedic, an increase in their experience in dealing with sick and injured children from a multitude of settings, and development of better training models.

Promoting medical self-care: evaluation of a family intervention implemented in the primary health care by pharmacies.

Medical self-care is the range of behaviours undertaken by people to promote or restore health when dealing with a medical problem. The aim of the study was to evaluate medical self-care effects of a family intervention implemented in primary health care by pharmacies, in terms of non-professional and professional involvement. The intervention was implemented in one of two primary health care areas during a 4-month period and involved consecutive families acting as an intervention (IG, n = 94) or a control (CG, n = 93) group. Eight telephone interviews were conducted with each family. The families were asked about complaints of illness, how long they prevailed and how they were treated. The results showed (P < 0.05-0.0001) that the IG had more medical problems (931 versus 621) compared with the CG, were less hospitalized (4 versus 10), stayed at home more to take care of sick children (84 versus 40), read more medical brochures (121 versus 31), tried more non-medical treatments (228 versus 116), and had fewer visits to the department of paediatrics but more visits to primary health care (69 and 98 versus 90 and 68). Due to the non-randomization procedure, some caution with regard to generalization of the results must be taken, but they are in concordance with established knowledge of the usefulness of medical self-care. The results indicate that a brief intervention for families can change the use of health authorities. It therefore seems meaningful to implement the intervention in a more comprehensive way in the primary health care setting, while at the same time trying to implement it as a large-scale randomized experimental study, comprising aspects such as the individual's need for care, the use of the right organization level and the assessment of economic costs and savings.

Integrated approach to child health in developing countries

This article focuses on the integrated approach to child health in developing countries. The Integrated Management of Childhood Illness (IMCI) is a strategy developed by ten programs of WHO working with UN International Childrens Emergency Fund and many other agencies institutions and individuals. IMCI focuses on the disease of childhood that causes the greatest global burden while allowing for the content to be adapted to an individual countrys needs. An integrated approach is justified by good clinical practice and most importantly treating the child as a whole and not simply his or her most obvious disease. The strategy involves not only curative care but also interventions to promote healthy growth and development and prevent diseases. In health facilities the IMCI strategy promotes the accurate identification of childhood illnesses in outpatient settings ensures appropriate combined treatment of all major illnesses strengthens the counseling of caretakers and the provision of preventive services and speed up the referral of severely ill children. The strategy also aims to improve the quality of care of sick children at the referral level. In the home setting it promotes appropriate early home care and care seeking improved nutrition and prevention and the correct implementation of prescribed care. Through improving the coordination and quality of services provided by existing child health and other programs the IMCI strategy will help increase the effectiveness of care and in time reduce recurrent costs.

Charles Dickens' work to help establish Great Ormond Street Hospital,London

When teaching our students about the medical ramifications of poverty and the importance of child advocacy, we could do no better than to point them in the direction of Charles Dickens (figure 1), England's celebrated novelist and social reformer. The reading of just a few of his novels, and the biting essays he composed for his weekly magazines, Household Words (1850–58) and All the Year Round (1859–70), shows that rarely have children had a more eloquent or effective proponent. Here I shall discuss one example of Dickens' broad-based activism on behalf of children—the establishment of London's Great Ormond Street Children's Hospital. 1 Kosky J Mutual friends. Charles Dickens and the Great Ormond Street Children's Hospital. St Martin's Press, New York1989 Google Scholar I choose this episode from his life because it exemplifies so well his deep sense of civic responsibility, his love of children, and his keen understanding of the need for a special place to care for sick children. It is also an exemplary model of conduct in health-care advocacy for today's medical professional.

An Investigation of the Medical Care Utilization of Children with Severe Asthma According to Their Type of Insurance

A comparison of the medical care utilization of children with severe asthma according to insurance type was performed. Subjects were grouped by which type of insurance they had: capitated, fee for service, or Medicaid insurance. Medical records were coded into utilization categories, by presenting complaint, sick- or well-child visit, and if a generalist or specialist provided care during the visit. The Medicaid group had less specialist, sick-child care than the groups with capitated or fee for service insurance. The Medicaid group also had more emergency room visits than the other two groups. The three groups had a similar amount of total physician/clinic visits. Even though similar care was shown to be available for those with Medicaid insurance, this low resource group often uses expensive emergency room care.