Child Health Unit Research Articles

Incidence of abortion and related complications in Brong Ahafo Region of Ghana, 2011-2015

Introduction : complications from abortion contribute significantly to maternal mortality in sub-Saharan Africa, including Ghana. Globally, at least 15 out of1000 women in their reproductive age experience induced abortion. This figure might be higher in Ghana since stigmatization leads to under reporting. Brong Ahafo Regional Reproductive and Child Health Unit (RCH) as part of the national strategy, routinely collects data on facility reported abortions but analysis of this data is limited. We analyzed five-year data on abortion in the region to determine trends and key indicators for programme planning. Methods : we reviewed 2011-2015 abortion surveillance data from midwifery form A. reports of the Brong Ahafo Regional Health Directorate. We extracted data on age, abortion method, type of abortion, abortion complication and family planning (FP) acceptors. Data was analyzed with Microsoft Excel and Epi Info 7 and expressed as frequencies and proportions. Results : a total of 25,818 abortions were recorded for 2011-2015, and this represented 5.2% of the expected pregnancies from the region. The mean age was 26 years with age group 20-24 reporting the highest incidence 6569 (25.4%). The teenage (10-19 years) abortion incidence was 5586 (21.6%). The proportion of spontaneous abortion was highest 12725 (51.5%), followed by induced 10388 (41.9%) and elective 1669 (6.7%). Method used by the health facilities were Dilation & Curettage (50.6%), Manual Vacuum Aspiration (48.7%) and medical (0.7%). Abortion clients that accepted FP was 57%. About 603 (2.4%) resulted in complications from haemorrhage (58%), sepsis (35%), and perforation (7%). Conclusion : the proportion of teenagers in the region who abort is high. Hemorrhage and sepsis are the major complications associated with these abortions. The high level of induced abortions suggests unmet needs for family planning and comprehensive abortion care and therefore place them at a high risk for maternal mortality. Targeted programs aimed at preventing unwanted pregnancies must be enhanced.

Risk Factors for Postpartum Septic Pelvic Thrombophlebitis: A Multicenter Cohort.

Objective The objective of this study was to identify risk factors associated with the development of septic pelvic thrombophlebitis (SPT). Study Design This is a secondary case–control study of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network Cesarean Registry. SPT was defined as suspected infectious thrombosis of the pelvic veins, often persistent febrile illness in the setting of antibiotic therapy for endometritis. Women with SPT were compared with those without SPT using descriptive statistics. Logistic regression models estimated the association between selected risk factors and SPT. Results Of 73,087 women in the cohort, 89 (0.1%) developed SPT. Women with SPT were more likely to be < 20 years old (33.7 vs. 10.6%, p < 0.001), black race (58.4 vs. 29.1%, p < 0.001), and nulliparous (51.1 vs. 23.3%, p < 0.001). Hypertensive disorders of pregnancy (32.6 vs. 11.8%, p < 0.001) and multiple gestation (12.5 vs. 7.4%, p = 0.03) were also more common in women with SPT. In the multivariable regression model, maternal age < 20, black race, multiple gestation, and preeclampsia were all significantly associated with increased odds of SPT (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [CI]: 1.22, 3.14; aOR: 2.6, 95% CI: 1.68, 4.02; aOR: 2.10, 95% CI: 1.13, 3.88; aOR: 2.91, 95% CI: 1.86, 4.57). Conclusion SPT is a rare pregnancy complication. Our analysis confirmed known risk factors (e.g., infections, cesarean delivery), and identified novel ones, including black race, young age, preeclampsia, and multiple gestation.

A baseline mixed-methods study on postpartum care among health professionals in Tanzania

Background: Globally, postpartum care (PPC) is a neglected part of maternal and neonatal health, despite 50% of maternal deaths occuring in the first weeks after childbirth. Aim: The study aimed to assess knowledge, attitudes and practices among providers of PPC in government institutions in two low-resource suburbs of Dar es Salaam: Ilala and Temeke. Methods: Health professionals (n=149) at all levels of care completed a knowledge and attitudes questionnaire. A checklist was used to observe 25 health professionals at reproductive and child health units, and 38 mothers were interviewed on exit. χ2- and logistic regression tests were used to analyse the outcomes. Field notes were analysed qualitatively. Findings: Overall, 64% of health professionals had high knowledge and most had positive attitudes towards PPC. Level of education was found to be positively associated with positive attitudes towards PPC (OR=2.5 CI 95% 1.03–6.13). PPC consultations with mothers and newborns during the first week after childbirth were found to be few or nonexistent. Mothers who came with newborns for BCG immunisation were mostly satisfied with the services. Conclusion: Quality improvement is required at the structure and process levels of the health system in order to provide holistic PPC consultations.

Group Work Intervention for the Parents of Children with Mental Health Issues Admitted in the Tertiary Care Center.

Objectives:The objective of this study was to develop a structured curriculum for a group-based parenting program for parents/caregivers of children or adolescents treated in the inpatient child and adolescent mental health unit of a national health institute.Methods:Data from group session reports of 3 years of conducting group-based parenting programs in the same setting were analyzed and prominent themes of discussions were shortlisted before finally arriving at a six-session group parenting program module.Results:A six-session intervention module was designed by psychiatric social workers experienced in group work. The content followed combination of various theoretical approaches and methodologies ultimately aiming in improving the overall knowledge and understanding of parents or caregivers on various child and adolescent mental health issues, and enhancing their skills and competence in dealing with various emotional and behavioral problems in children.Conclusion:Group-based parenting programs are found to be effective in improving the over psychosocial health of parents and the emotional and behavioral problems of children and adolescents as a result of better parenting. Development and standardization of culture appropriate group intervention curriculums would help in the development of this cost effective method as a medium of change.

Trastorno por Déficit de Atención e Hiperactividad (TDAH), ¿se mantiene el diagnóstico de sospecha realizado en Atención Primaria en la Unidad de Salud Mental Infanto- Juvenil?

Introducción: El TDAH es uno de los trastornos del neurodesarrollo más frecuentes. Los pediatras de Atención Primaria (AP) reciben a menudo pacientes que presentan síntomas cardinales de esta entidad.
 Objetivos: Analizar la concordancia entre la sospecha diagnóstica realizada en AP y el diagnóstico emitido en la Unidad de Salud Mental Infanto-Juvenil (USMIJ).
 Material y métodos: Estudio observacional descriptivo prospectivo en el que se reclutaron 374 pacientes menores de 16 años, derivados a la USMIJ del área sanitaria de Pontevedra durante el año 2016. Se analizó el índice Kappa global y específico para los diferentes diagnósticos.
 Resultados: De los 374 pacientes, 233 fueron remitidos con sospecha de TDAH, confirmándose el diagnóstico en 102 pacientes. El índice kappa global de concordancia es de 0.29. En general para la mayoría de los diagnósticos la concordancia fue débil. La concordancia fue buena para el Trastorno del espectro autista (0.61) y muy buena para el Trastorno de conducta alimentaria (1.00). En relación al TDAH, la sensibilidad fue del 95.33% (índice de confianza (IC) 95% 90.86-99.79), la especificidad del 50.94% (IC95% 44.75-57.12), valor predictivo positivo del 43.78% (IC95% 37.19-50.36), y valor predictivo negativo del 96.45% (IC95% 93.05-99.86).
 Conclusiones: La concordancia obtenida entre AP y la USMIJ es baja en nuestra área sanitaria. La correlación diagnóstica medida con el índice kappa es débil para el TDAH, sin embargo, es buena tanto para el diagnóstico del Trastorno del espectro autista como para los trastornos de conducta alimentaria. La validez diagnóstica para TDAH es moderada, con una sensibilidad alta y una especificidad baja.

Attempted operative vaginal delivery vs repeat cesarean in the second stage among women undergoing a trial of labor after cesarean delivery

It is not well-characterized whether attempting operative vaginal delivery is a safe and effective alternative among women who undergo a trial of labor after cesarean delivery who are unable to complete second-stage labor with a spontaneous vaginal delivery. The purpose of this study was to compare maternal and neonatal outcomes that are associated with attempted operative vaginal delivery with those that are associated with second-stage repeat cesarean delivery without an operative vaginal delivery attempt among women who undergo a trial of labor after cesarean delivery. This is a retrospective secondary analysis of data from Cesarean Registry of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Women who underwent a trial of labor after cesarean delivery who were at least 36 weeks gestation were eligible for analysis if they had a live, singleton, nonanomalous gestation in cephalic presentation and reached second-stage labor (defined as complete cervical dilation) with a fetal station of at least+2. The data for women who had an attempted operative vaginal delivery with either forceps or vacuum were compared with those of women who underwent second stage repeat cesarean delivery without operative vaginal delivery attempt. Outcomes of maternal and neonatal complications were compared between groups with bivariable and multivariable analyses. Of 1230 women whose cases were eligible for analysis, 945 women (76.8%) had an attempted operative vaginal delivery. Of those who underwent attempted operative vaginal delivery, 914 women (96.7%) achieved a vaginal delivery. Women who attempted operative vaginal delivery had a lower mean body mass index (30.4±6.0 vs 31.8±5.9 kg/m2; P=.001) and gestational age (39.5±1.3 vs 39.8±1.2 weeks; P=.012) at delivery and were more likely to be of non-Hispanic black race (30.0% vs 22.1%; P=.002), to have had a previous vaginal delivery (34.9% vs 20.4%; P<.001), and to have fetal descent greater than+2 station at complete dilation (55.6% vs 16.8%; P<.001) and were less likely to have chorioamnionitis (6.8% vs 19.3%; P<.001). The frequency of endometritis was significantly lower among women who had an attempted operative vaginal delivery compared with those who had repeat cesarean delivery (2.5% vs 9.1%; P<.001). However, other serious maternal or neonatal adverse outcomes were not statistically different between the groups. These findings persisted after adjustment for potential confounders. In the setting of a trial of labor after cesarean delivery in the second stage with a fetal station of at least+2, attempted operative vaginal delivery resulted in a vaginal birth after cesarean delivery in most women and was not associated with increased adverse maternal and neonatal outcomes but was associated with a reduced frequency of endometritis compared with repeat cesarean delivery without operative vaginal delivery attempt.

Lessons learned from the PMTCT program in Swaziland: challenges with accepting lifelong ART for pregnant and lactating women - a qualitative study.

BackgroundSwaziland has one of the highest HIV prevalence rates in sub-Saharan Africa, 26 % of the adult population is infected with HIV. The prevalence is highest among pregnant women, at 41.1 %. According to Swaziland’s prevention of mother-to-child transmission (PMTCT) guidelines, approximately 50 % of pregnant women are eligible for antiretroviral therapy (ART) by CD4 criteria (<350 cells/ml). Studies have shown that most mother-to-child transmission and postnatal deaths occur among women who are eligible for ART. Therefore, ensuring that ART eligible women are initiated on ART is critical for PMTCT and for mother and baby survival. This study provides insight into the challenges of lifelong ART initiation among pregnant women under Option A in Swaziland. We believe that these challenges and lessons learned from initiating women on lifelong ART under Option A are relevant and important to consider during implementation of Option B+.MethodsHIV-positive, treatment-eligible, postpartum women and nurses were recruited within maternal and child health (MCH) units using convenience and purposive sampling. Participants came from both urban and rural areas. Focus group discussions (FGDs) and structured interviews using a short answer questionnaire were conducted to gain an understanding of the challenges experienced when initiating lifelong ART. Seven FGDs (of 5–11 participants) were conducted, four FGDs with nurses, two FGDs with women who initiated ART, and one FGD with women who did not initiate ART. A total of 83 interviews were conducted; 50 with women who initiated ART and 33 with women who did not initiate. Data collection with the women was conducted in the local language of SiSwati and data collection with the nurses was done in English. FGDs were audio-recorded and simultaneously transcribed and translated into English. Analysis was conducted using thematic analysis. Transcripts were coded by two researchers in the qualitative software program MAXqda v.10. Thematic findings were illustrated using verbatim quotes which were selected on the basis of being representative of a specific theme. The short-answer interview questionnaire included specific questions about the different steps in the woman’s experience initiating ART; therefore the responses for each question were analyzed separately.ResultsFindings from the study highlight women feeling overwhelmed by the lifetime commitment of ART, feeling “healthy” when asked to initiate ART, preference for short-course prophylaxis and fear of side effects (body changes). Also, the preference for nurses to determine on an individual basis the number of counseling appointments a woman needs before initiating ART, more information about HIV and ART needed at the community level, and the need to educate men about HIV and ART.ConclusionWomen face a myriad of challenges initiating lifelong ART. Understanding women’s concerns will aid in developing effective counseling messages, designing appropriate counseling structures, understanding where additional support is needed in the process of initiating ART, and knowing who to target for community level messages.

Knowledge, attitude and practices on the care of the newborn in postnatal mothers delivering at a tertiary care centre in Nepal

Introduction: Neonatal mortality rate per thousand live births in Nepal is 24.2, and the majority of neonates die during the early neonatal period. Objective: To determine the knowledge, attitudes and practices of mothers regarding care of the newborn after delivery at a tertiary teaching hospital in Nepal. Method: A cross-sectional study employing both quantitative and qualitative study approaches was conducted in the Maternal and Child Health (MCH) unit of a tertiary hospital in East Nepal for a period of three months. Using a convenient sampling technique 65 postpartum mothers admitted in MCH unit were enrolled in the study. Structured interview questionnaires were used to collect data. Data was analyzed using descriptive statistics by SPSS 20. Results: Sixty five mothers who delivered at the tertiary care centre were interviewed. Age of mothers ranged from 16 to 40 years, 63% were primipara and 18.4% were illiterate. Whilst 95% of mothers knew about immunisation, few had acquired knowledge regarding cord care, signs of illness in newborn and newborn feeding during antenatal checkups. Maternal knowledge about newborn danger signs was low. Breast feeding practice as observed by interviewer was not satisfactory. Maternal knowledge on newborn hygiene care was unsatisfactory. Conclusion: Maternal knowledge, attitudes and practices regarding care of the newborn after delivery at the tertiary teaching hospital in Nepal requires improvement.

Does Space Matter? An Exploratory Study for a Child-Adolescent Mental Health Inpatient Unit.

The aim of this study is to explore design elements and spaces as a contributing influence to behavior and well-being for patients, staff, and families in a child-adolescent mental health unit. The University of Minnesota Masonic Children's Hospital Child-Adolescent Mental Health Inpatient Unit embarked on a renovation project to relocate the hospital's child and adolescent mental health units. Evidence-based strategies were employed for the design of the new unit to enhance the experience for patients, staff, and families and to support changes in operational and procedural strategies. A mixed-methods approach was utilized to explore the influence of several design strategies intended to induce calm feelings for patients, staff, and families. A comprehensive literature review informed the design process and study design. Methods include patient image surveys (PIS; n = 188), online staff surveys (n = 48), and face-to-face staff interviews (n = 25). Several design elements and spaces were identified through the image survey as influential in eliciting feelings of calm among patients. Additionally, staff were also influenced by the new unit design, generating feelings of calm, safety, and pride in the work environment. Results suggest that design features in which patients have choice and control offer greater perceptions of calm during their stay in the unit. Staff were positively influenced by the colors and artwork throughout the unit as well as the upgraded security and safety features. Findings also show the space has a positive influence on families, demonstrated by its welcoming character and features that help to facilitate better interaction with patients.

Chorioamnionitis and Neurocognitive Development at Age 2 Years.

To evaluate whether chorioamnionitis is associated with decreased Bayley II scores at age 2 years. We conducted an observational cohort study of women and their offspring enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Development's Maternal-Fetal Medicine Units Network multicenter, randomized controlled trial of magnesium for cerebral palsy prevention in pregnancies at high risk for early preterm delivery. We included nonanomalous singleton gestations and excluded pregnancies missing outcome or exposure data. Our primary exposure was chorioamnionitis, defined by the clinical diagnosis of chorioamnionitis and a maternal fever greater than 100°F. Our primary outcome was a Bayley II Mental Developmental Index score less than 70 or Psychomotor Developmental Index score less than 70 assessed at age 2 years. We also assessed Mental Developmental Index or Psychomotor Developmental Index score less than 85. We conducted bivariate analyses and fit a log-linear regression model, adjusting for related to Mental Developmental Index or Psychomotor Developmental Index score less than 70 or less than 85 with a detectable effect size estimated at a relative risk of 1.5 or greater. Of 1,574 patients in our analysis, 194 (12%) had chorioamnionitis and 1,366 (87%) had preterm premature rupture of membranes. The mean gestational age at delivery was 29 3/7 weeks. There were no significant differences in Mental Developmental Index score less than 70 (37 [19.1%] compared with 233 [17%], P=.45) or Psychomotor Developmental Index score less than 70 (29 [15%] compared with 195 [14%] P=.76) for children born to mothers with or without chorioamnionitis, respectively. After adjusting for confounders, there remained no difference in the proportion of abnormal scores in either group. However, neonates diagnosed with sepsis were found to have significantly decreased Mental Developmental Index scores. Exposure to chorioamnionitis was not associated with neurocognitive defects as measured by abnormal Bayley II scores.

Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures

Theoretically, integration of vertically organized services is seen as an important approach to improving the efficiency of health service delivery. However, there is a dearth of evidence on the effect of integration on the technical efficiency of health service delivery. Furthermore, where technical efficiency has been assessed, there have been few attempts to incorporate quality measures within efficiency measurement models particularly in sub-Saharan African settings.This paper investigates the technical efficiency and the determinants of technical efficiency of integrated HIV and sexual and reproductive health (SRH) services using data collected from 40 health facilities in Kenya and Swaziland for 2008/2009 and 2010/2011. Incorporating a measure of quality, we estimate the technical efficiency of health facilities and explore the effect of integration and other environmental factors on technical efficiency using a two-stage semi-parametric double bootstrap approach.The empirical results reveal a high degree of inefficiency in the health facilities studied. The mean bias corrected technical efficiency scores taking quality into consideration varied between 22% and 65% depending on the data envelopment analysis (DEA) model specification. The number of additional HIV services in the maternal and child health unit, public ownership and facility type, have a positive and significant effect on technical efficiency. However, number of additional HIV and STI services provided in the same clinical room, proportion of clinical staff to overall staff, proportion of HIV services provided, and rural location had a negative and significant effect on technical efficiency.The low estimates of technical efficiency and mixed effects of the measures of integration on efficiency challenge the notion that integration of HIV and SRH services may substantially improve the technical efficiency of health facilities. The analysis of quality and efficiency as separate dimensions of performance suggest that efficiency may be achieved without sacrificing quality.

Effects of Designed Educational Program about Reproductive Health on Nurses Knowledge

Reproductive health is an essential part of human health and development for women, particularly during their reproductive years. The aim of the study: To evaluate the effects of a designed educational program about reproductive health and on nurses‘ knowledge. Design: A pre- post- test, non- equivalent design was used. Setting: The study was conducted at 16 primary health care units and Maternal and child health units in Qena governorate. Sample purposive Convenient samples of 100 nurses working in the selected setting. Tools of data collection1-Interview sheet to collect demographic data about nurses age ., Residence, and years of experience 2--: A structured test that was developed by the investigators to collect nurses knowledge about reproductive health pre and post test. The program: The nurses were divided into 4 groups (25 nurses in each). The training program was conducted over a period of 12 days; 3 days per group for 3 sessions per day for three months and post-test after six months covering all information and practices of the program. Results: the improves the level of knowledge of adequate level increased from 28% before the health education program to 98% and a significant difference in knowledge. Between Nurses working for 10 years or more than those working less than 10 years Conclusion: The education program markedly improves the level of knowledge of those with adequate level increased from 28% before the health education program to 98% after the program.

Respiratory viruses associated with community-acquired pneumonia in children: matched case–control study

BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of death in children worldwide and a substantial proportion of childhood CAP is caused by viruses. A better understanding of the role of...

Group drumming as a burnout prevention initiative among staff members at a child and adolescent mental health care facility

Work-related stress and burnout is pervasive within the public mental health sector in South Africa. This study aimed to identify the subjective experiences of staff members at a child and adolescent mental health unit, who participated in a drumming group aimed at reducing burnout, and to establish from participants’ experiences whether group drumming had potential as a burnout reduction intervention. This retrospective study was conducted using a semi-structured questionnaire and followed an interpretive approach. The study population consisted of all the team members who participated in the staff drumming group (30 staff members). Qualitative methods of data collection were employed. Data were analysed by means of thematic analysis. Responses from participants ( N = 17) indicated that taking part in the drumming group encouraged emotional expression, represented a distraction from vicarious trauma, helped to level hierarchical structures, increased energy and productivity, induced relaxation, improved mood states, created feelings of accomplishment, and fostered a sense of belonging. A discussion of these findings in relation to the challenges within the public mental health sector in the Western Cape is also included. Based on the findings, the authors support previous studies, and conclude that drumming and recreational music-making groups may represent a potentially powerful and cost-effective burnout reduction strategy, particularly within the context of public mental health in South Africa. Due to the qualitative methods utilised in this study, further quantitative studies are recommended.

Does sustained involvement in a quality network lead to improved performance?

The purpose of this paper is to explore the effects of prolonged investment in one quality improvement method, which are uncertain. The authors aim to examine the extent to which sustained involvement in a quality network over five years led to improved performance against standards, and whether improvement was achieved in areas where service staff could exercise direct control. A prospective cohort design was used to examine data from 48 UK inpatient child and adolescent mental health units between 2005/2006 and 2009/2010, which had been Quality Network for In-patient CAMHS members for two years. These were selected to remove the initial marked increase in compliance identified in an earlier study. The main outcome measure was compliance with organisation process standards. Units meeting "excellent" quality status across all standards rose from seven (14.6 per cent) to 18 (37.5 per cent). Standards for Environment and Facilities and Access, Admission and Discharge improved the most. Units meeting the "excellent" quality status for criteria over which staff had direct control criteria rose from 17 (35.4 per cent) to 29 (60.4 per cent) over the five-year period. The unit modal quality status categorisation for criteria where staff had no direct control in 2005/2006 was "poor" (n=25; 52.1 per cent) but had progressed to "good" in 2009/2010 (n=24; 50.0 per cent). The authors provide evidence that sustained investment in one QI method raises service compliance against standards. Trends showed improvement for direct control standards from "good" to "excellent" levels and improvement for no direct control from "poor" to "good".

Induction of labor versus expectant management for women with a prior cesarean delivery

Previous studies of induction of labor in the setting of trial of labor after cesarean have compared women undergoing trial of labor after cesarean to those undergoing spontaneous labor. However, the clinically relevant comparison is to those undergoing expectant management. The objective of this study was to compare obstetric outcomes between women undergoing induction of labor and those undergoing expectant management ≥39 weeks of gestation. This was a secondary analysis of data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Cesarean Registry that included women with singleton gestations at a gestational age of ≥39 weeks and a history of 1 low transverse cesarean delivery. Outcomes of induction at 39, 40, and 41 weeks were compared to expectant management beyond each gestational age period using univariable and multivariable analyses. Women with scheduled repeat cesarean deliveries done for the indication of prior cesarean delivery were excluded from the analysis. In all, 12,676 women were eligible for analysis. The rate of vaginal birth after cesarean (VBAC) was higher among women undergoing induction of labor at 39 weeks compared to expectant management (73.8% vs 61.3%, P < .001). The risk of uterine rupture also was higher among women undergoing induction of labor at 39 weeks compared to expectant management (1.4% vs 0.5%, P = .006, respectively). In multivariable analysis, induction of labor at 39 weeks remained associated with a significantly higher chance of VBAC and uterine rupture (odds ratio, 1.31; 95% confidence interval, 1.03-1.67; and odds ratio, 2.73; 95% confidence interval, 1.22-6.12, respectively). Induction of labor at 39 weeks, when compared to expectant management, was associated with a higher chance of VBAC but also of uterine rupture.

Reliability and Validity of the NIMHANS Index of Specific Learning Disabilities

The present study, aims to establish the reliability and validity of the NIMHANS Index for Specific Learning Disabilities (SLD) for a sample of children with SLD. The NIMHANS Index for Specific Learning Disabilities was initially developed by Kapur, John, Rozario and Oommen in 1991 in the Department of Clinical Psychology, NIMHANS, Bangalore. The study was conducted on a sample of 40 children selected from the Child and Adolescent Mental Health Unit, (CAMHU), NIMHANS after meeting the inclusion criteria of the study. Each child was individually assessed using MISIC and NIMHANS SLD index. The parents were also seen separately and administered the DPCL. They were also asked to bring the Checklist for School Report completed by the class teacher. Out of the 40 children tested, 35 children were confirmed as having Specific Learning Disability and five did not SLD as per the NIMHANS Index for SLD. There was significant correlation between teachers rating and clinical rating when compared with the presence of SLD. There was moderate association found between severities of SLD as assessed on the NIMHANS Index Specific Learning Disabilities with the Parental rating on the Learning Difficulties subscale of the DPCL.

Monitoring of physical health parameters for inpatients on a child and adolescent mental health unit receiving regular antipsychotic therapy.

Physical health monitoring of patients receiving antipsychotics is vital. Overall it is estimated that individuals suffering with conditions like schizophrenia have a 20% shorter life expectancy than the average population, moreover antipsychotic use has been linked to a number of conditions including diabetes, obesity, and cardiovascular disease.[1–4]The severity of possible adverse effects to antipsychotics in adults has raised awareness of the importance of monitoring physical health in this population. However, there is little literature available as to the adverse effects of these medications in the child and adolescent community, which make physical health monitoring in this predominantly antipsychotic naïve population even more important.An expert group meeting in the UK has laid down recommendations in regards to screening and management of adult patients receiving antipsychotics, however no specific guidelines have been put in place for the child and adolescent age group.[5]The aim of this audit was to establish whether in-patients receiving antipsychotics had the following investigations pre-treatment and 12 weeks after treatment initiation: body mass index, hip-waist circumference, blood pressure, ECG, urea and electrolytes, full blood count, lipid profile, random glucose level, liver function test, and prolactin. This is in addition to a pre-treatment VTE risk assessment. These standards were derived from local trust guidelines, NICE guidelines on schizophrenia [6] and The Maudsley Prescribing Guidelines.[7]We retrospectively reviewed 39 electronic case notes in total, of which 24 cases were post intervention. Intervention included the use of a prompting tool. This tool was filed in the physical health files of all patients receiving antipsychotics which was intended as a reminder to doctors regarding their patient's need for physical health monitoring. Professionals involved in the monitoring of such parameters were educated in the importance and purpose of its use. Following this intervention re-audit occurred after 6 and 16 months of the initial audit to establish whether the use of the prompting tool caused any significant change in clinical practice.Overall performance in monitoring physical health parameters was initially poor, however we were able to demonstrate that with the help of a single prompt sheet there was a significant improvement following post intervention audit for the majority of parameters being monitored.

The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

There are significant issues associated with the use of restrictive measures, such as seclusion and restraint, in child and adolescent mental health care. Greater understanding of how restrictive measures are used is important for informing strategies to reduce their use. In this brief report we present a 12-month audit (1/1/2010–31/12/2011) of the use of restrictive measures (seclusion, physical restraint) in one child and adolescent acute inpatient mental health unit in Australia. The study highlights the need for continued efforts to reduce the use of restrictive measures in child and adolescent mental health services.

Thyroid screening in pregnancy

The adverse impact of overt hypothyroidism that complicates pregnancy outcomes is well-established and not debated. For more than a decade, however, endocrinologists and obstetricians have been debating whether screening for subclinical thyroid disorders during pregnancy should be routine or should continue to be based on symptoms and risk factors. Several observational studies have suggested that offspring of women with asymptomatic thyroid dysfunction were at increased risk for impaired neurodevelopment. Other studies have suggested that pregnant women with subclinical thyroid disease, particularly those identified with an elevated thyroid-stimulating hormone (TSH) level may be at increased risk for pregnancy complications such as fetal death, preterm birth, or placental abruption. These data have prompted both obstetric and endocrinologic professional societies to draft recommendations regarding screening for thyroid disease during pregnancy, some of which are not entirely based on available evidence. The prevalence of overt thyroid disease is estimated to be 1-2 per 1000 pregnancies and historically has not been considered high enough to justify routine screening. Lower TSH thresholds (>2.5 mU/L) for the diagnosis of hypothyroidism have been promoted, and women with subclinical thyroid dysfunction commonly are included in estimates of thyroid disease during pregnancy, both of which exaggerate prevalence rates. The most compelling recent evidence on this issue has come from the Controlled Antenatal Thyroid Screening trial. After almost 22,000 pregnant women were screened for either isolated high TSH or isolated low free thyroxine level, 390 children of treated women with either diagnosis were compared with 404 children of similar women who were not treated during pregnancy. Treatment had no effect on mean offspring IQ at age 3 years or the number of children with an IQ <85. Authors of this landmark study concluded that antenatal screening and maternal treatment for women with subclinical thyroid dysfunction did not result in improved cognitive function. An ongoing intervention trial conducted by the Eunice Kennedy-Shriver National Institute of Child Health and Human Development's Maternal-Fetal Medicine Units Network will provide further clarity to this important question. In the interim, the debating authors have concluded, after careful review of the currently published literature, that routine screening for subclinical thyroid dysfunction during pregnancy is not currently warranted at this time.