Children In North Research Articles

Evacuation of “Children of North”: an Attempt to Mitigate Social Problems during Civil War

On the basis of archival sources, the experience of the evacuation of socially disadvantaged children of Karelia to the Kharkov province in 1919—1920 is revealed, the life support system of the “state child” in the Giev colony is analyzed. The study of this specific method of providing social assistance to children, used in the extreme conditions of the Civil War, made it possible to reveal the complexity and riskiness of such activities. The central place in the article is devoted to the study of the food issue, the supply of uniforms and other problems of providing for the colonists. The organizational component of the process of evacuation and re-evacuation of children is characterized, changes in the material base of the colony are shown, problems in the implementation of educational work within the institution are identified. Particular attention is paid to the characteristics of the medical and sanitary services for the inmates of the Giev colony with the definition of the sanitary and hygienic conditions of life in the institution, the availability of personal hygiene items for the children, as well as their examination by doctors. It is shown in the article that the supply of food and clothing for the inmates of the colony almost completely fell on the shoulders of its employees, who had to independently attract additional funding, improve the material living conditions of children, and look for the necessary resources for the development of subsidiary farming and workshops.

P011 Sharing is caring: a regional service development project exploring secondary immunosuppression in children

Abstract Background/Aims The range of approved immunosuppressive and immunomodulatory (IM) agents has grown considerably with an increasing list of indications across paediatric specialties. At present, there is limited evidence supporting best practice for prescribing and monitoring of IM agents in children and young people (CYP). We present a staged service development project exploring cross-specialty prescribing and monitoring of IM agents at a tertiary children’s hospital (Great North Children’s Hospital, GNCH) and data sharing with local hospitals across northeast England. Methods In Phase 1, we searched pharmacy databases and surveyed specialty teams in GNCH to identify clinicians regularly prescribing IM agents to CYP over a twelve-month period. Phase 2 was a cross-specialty retrospective case-notes review of prescribing, monitoring and infection surveillance in a representative sample of CYP on IM agents. Phase 3 explored information sharing with six other hospitals in the region and acute presentations to these sites involving CYP on IM agents. Results Phase 1 identified 9 paediatric and 2 adult specialties prescribing IM agents to 416 CYP. 32 discrete IM therapies were prescribed with significant between-specialty overlap in drugs prescribed but a wide range of prescribing and monitoring practices. Phase 2 assessed 77 CYP on IM agents in detail - 57% were prescribed >1 IM agent, 100% had FBC measured at least once (range once only to weekly), 18% developed lymphopenia at least once and 40% were prescribed prophylactic antibiotics. Previous varicella exposure had been assessed in 70%. Phase 3 data are summarised in Table 1. P011 Table 1:Information sharing and acute presentations to regional hospitals local to immunosuppressed patientsTotal number of patients141Mean age in years (range)11 (2 - 17)NDiagnosisJIA without uveitis108JIA with uveitis9Uveitis alone8Systemic JIA4Period fever4Behçet’s disease2Juvenile dermatomyositis2Scleroderma1Juvenile systemic lupus erythematosus1Mixed connective tissue disease1Granulomatosis with polyangiitis1Immunosuppressive or immunomodulatory agent usedAdalimumab65Methotrexate42Tocilizumab22Mycophenolate mofetil10Etanercept10Infliximab5Sulfasalazine5Prednisolone4Abatacept4Leflunomide4Canakinumab2Colchicine2Anakinra2Rituximab2Cyclophosphamide1Number of immunosuppressive or immunomodulatory agents per patient3 agents52 agents441 agent92Number of acute presentations by diagnosis or presenting complaint (n = 19)Fever4Chickenpox4Viral upper respiratory tract infection2Joint pain2Abdominal pain2Rash2Eye infection1Tonsilitis1Wheeze1Yes (%)No (%)Named local consultant (n = 129)3763Correct diagnosis recorded locally (n = 130)8020Correct immunosuppressive or immunomodulatory agent recorded locally (n = 130)5050Open access for febrile illness (n = 116)4159Reviewed in past 2 years for acute illness (n = 109)1783Note: presented numbers for immunosuppressive or immunomodulatory agents are not mutually exclusive. JIA, juvenile idiopathic arthritis Conclusion IM agents are central to modern paediatric clinical care across a wide range of diseases. This staged project identified significant variation in IM prescribing and monitoring practice between specialties at GNCH. Communication between specialty and local teams is inadequate. Particular areas of concern include limited diagnostic, blood monitoring and medication information sharing and limited local information governing management of intercurrent illness and vaccination. Although different disease processes can necessitate different advice and prescribing practices, sharing examples of good practice will minimise unnecessary variation. We propose the development of a regional immunosuppression working group to improve quality and safety across our region. Disclosure J.L. Bennett: None. C. Tsilifis: None. A. Flinn: None. T. Altmann: None. N. Jansen: None. H. Tumelty: None. K. Aitken: None. S. Bhopal: None. E. Harrison: None. S. Ravenscroft: None. E. Sen: None. E. Williams: None. T. Flood: None. S. Sampath: None. A. Battersby: None. F. McErlane: None.

Can quantitative MRI be used in the clinical setting to quantify the impact of intra-articular glucocorticoid injection on synovial disease activity in juvenile idiopathic arthritis?

BackgroundJuvenile idiopathic arthritis (JIA), the most common chronic rheumatic disease of childhood, is characterised by synovitis. Clinical assessments of synovitis are imperfect, relying on composite and indirect measures of disease activity including clinician-reported measures, patient-reported measures and blood markers. Contrast-enhanced MRI is a more sensitive synovitis assessment technique but clinical utility is currently limited by availability and inter-observer variation. Improved quantitative MRI techniques may enable future development of more stringent MRI-defined remission criteria.The objective of this study was to determine the utility and feasibility of quantitative MRI measurement of synovial volume and vascularity in JIA before and twelve weeks after intra-articular glucocorticoid injection (IAGI) of the knee and to assess the acceptability of MRI to participating families.MethodsChildren and young people with JIA and a new episode of knee synovitis requiring IAGI were recruited from the Great North Children’s Hospital in Newcastle upon Tyne. Quantitative contrast-enhanced MRI was performed prior to and twelve weeks after IAGI, in addition to standard clinical assessment tools, including the three-variable clinical juvenile arthritis disease activity score (cJADAS) and active joint count.ResultsEleven young people (5 male, median age 13 years, range 7–16) with JIA knee flare were recruited and 10 completed follow-up assessment. Following IAGI, the median (interquartile range) cJADAS improved from 8.5 (2.7) to 1.6 (3.9), whilst the median synovial volume improved from 38.5cm3 (82.1cm3) to 0.0cm3 (0.2cm3). Six patients presented with frank synovitis outside normal limits on routine MRI reporting. A further three had baseline MRI reports within normal limits but the quantitative measurements identified measurable synovial uptake. Post-IAGI quantitative measurements highlighted significant improvements in 9 patients.ConclusionsIAGI led to a marked reduction in synovial volume, with quantitative MRI identifying more patients with an improved synovial volume than routine qualitative clinical reporting. Improvements in cJADAS scores were more variable with the patient/parent global assessment component contributing most to the scores. Further work is indicated, exploring the utility of quantitative MRI in the assessment of less accessible joints and comparing the impact of different treatment modalities.

P56 Integrating primary care within paediatric rheumatology: does it work?

Abstract Background Delay in accessing specialist care is well recognised in childhood musculoskeletal conditions including juvenile idiopathic arthritis (JIA). Patients often describe circuitous routes within healthcare prior to diagnosis. In the UK, primary care is the gatekeeper to specialist services; review by a general practitioner (GP) is the first point of contact for the majority of non-emergency health concerns. The paediatric rheumatology service at the Great North Children’s Hospital is the sole provider of paediatric rheumatology care in the North-East of England and North Cumbria seeing >600 new patients per year. Since 2012 the department has hosted an innovative GP integrated training post with a focus on new patient assessment and diagnosis. The success of this led to the appointment of a substantive GP post in 2017, providing independent new patient assessment for one clinic per week. The aim of this service evaluation was to review patient outcomes from this. Methods A mixed-methods approach was used. Quantitative data collected over a 12-month period included number of new patients assessed, time to first appointment, investigations, referrals, diagnosis and follow-up. Qualitative data was collected from patients (patient and parent satisfaction) and the multi-disciplinary paediatric rheumatology team (anonymised). Results 150 patients were assessed over the 12-month period, accounting for 25% of the new patient referrals to the service overall. Management included no investigations (29%), blood tests only (18%), blood tests and imaging (21%) and imaging only (32%). 87% of diagnoses made were non-inflammatory: Hypermobility (35%), mechanical pain (25%) and others (27%). 12% were inflammatory: JIA (4%), suspected connective tissue disease (3%), idiopathic uveitis (1%) and others (4%). 1 patient (1%) was unaccounted for as they failed to attend further appointments. Referrals were made for 59% of patients, the majority to physiotherapy. Mean waiting time to first appointment was 38 days (range 4 – 75). 67% of patients were discharged, with only 1 re-referral which resulted in the same diagnosis and repeated discharge. No complaints were received. Patient satisfaction (n = 19) was very good, excellent or outstanding in all domains and 100% were happy to be seen by a GP who works as a specialty doctor in paediatric rheumatology. Multi-disciplinary team (MDT) feedback was received from medical (n = 5), nursing (n = 2), physiotherapy (n = 1) and administrative staff (n = 2). The majority of domains were rated as excellent to outstanding with unanimously positive additional comments about the GP and trainees working within the service. Conclusion Integrating a GP into the paediatric rheumatology team has provided a significant contribution to new patient assessment and is highly rated by patients and the MDT. Unsurprisingly, the majority of new patient assessments are not diagnosed with inflammatory disease, and by providing our GP with appropriate training and support, such patients are able to be diagnosed and discharged appropriately. Conflicts of Interest The authors declare no conflicts of interest.

P424 Hospital or home: a review of the intravenous antibiotic service within the paediatric cystic fibrosis unit at the Great North Children's Hospital

P424 Hospital or home: a review of the intravenous antibiotic service within the paediatric cystic fibrosis unit at the Great North Children's Hospital

Are two views of the pelvis routinely required in the assessment of the limping child?

Introduction: Atraumatic hip pain presenting with a limp is a common clinical problem in children. It is considered a diagnostic challenge to the physician. Objectives: Aim of this study was to assess the sensitivity of a single view of the pelvis in radiographic imaging of a limping child. Methodology : Retrospective analysis of all paediatric pelvic radiographs performed in Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK from 2004 to 2014 was carried out. 143 cases were recruited, in whom both AP and FL views had been performed at presentation, and a cause for hip pain had been identified based on the radiological report. These 286 radiographs were anonymised and randomly shuffled with 100 age-matched controls (50 AP / 50 frog-lateral) selected from normal radiographs within the same period to avoid bias. The images were independently reviewed by three consultant paediatric radiologists. Results: Perthes/Avascular necrosis (AVN) (n=117) was identified with 94.6% sensitivity on the AP view compared to 94.3% on the frog-lateral view. Sensitivity for Slipped Upper Femoral Epiphysis (SUFE) (n=19) was 75.4% on AP and 100% on frog-lateral. Seven cases of other pathologies were identified with sensitivity of 61.9% on AP and 57.2% on frog-lateral. Conclusion: Frog lateral view is superior to AP view in detection of SUFE and comparable in sensitivity for Perthes to the AP view. We suggest only the frog-lateral view is required in the routine assessment of the limping child.

160 The prevalence of chronic rhinosinusitis in paediatric cystic fibrosis

Chronic rhinosinusitis is an inflammation of the mucous membrane lining the paranasal sinuses, lasting longer than 12 weeks. Symptoms include nasal discharge and congestion, head or facial pain and sleep disturbances. There is evidence of an association between upper and lower airway pathogens. 30–67% of adult cystic fibrosis (CF) patients report symptoms. Incidence in children has not been investigated. Aim To ascertain the prevalence and severity of chronic rhinosinusitis in a paediatric CF population. Method CF patients ≥6 years of age attending the Great North Children's Hospital were asked to complete a validated questionnaire, the Sino Nasal Outcome Test (SNOT-20). Results 58 children participated, mean age 11.3±3.1 years, 22 males. Mean baseline % predicted FEV 1 was 84.6±17.8. Mean SNOT-20 score (maximum 100) was 14.9±16.54, range 0–81. Division in to sub categories of rhinological, ear and facial, sleep function and psychological demonstrated that rhinological symptoms were the most reported. Symptoms were mild in 52% ( Conclusion A significant proportion of paediatric CF patients report symptoms of chronic rhinosinusitis. Regular assessment of the sinuses is recommended and treatment should be instigated in those patients with moderate to severe symptoms. Further research into treatment in the paediatric population is needed.

No association between etanercept and new or worsening atopic dermatitis in children with JIA: an analysis from the BSPAR Etanercept Cohort Study

No association between etanercept and new or worsening atopic dermatitis in children with JIA: an analysis from the BSPAR Etanercept Cohort Study

102 Fungal colonization in the airways of Spanish cystic fibrosis patients: results from a multicenter study

101 Non-tuberculous mycobacterial infection in a large paediatric cystic fibrosis centre: epidemiology and possible transmission event L.R. Nair1, M.F. Thomas1, M. Brodlie1, A. Robb2, A. Perry3, C. O’Brien1. 1Great North Children’s Hospital, Paediatric Respiratory Medicine, Newcastle, United Kingdom; 2Royal Victoria Infirmary, Microbiology, Newcastle, United Kingdom; 3Freeman Hospital, Microbiology, Newcastle, United Kingdom

101 Non-tuberculous mycobacterial infection in a large paediatric cystic fibrosis centre: epidemiology and possible transmission event

101 Non-tuberculous mycobacterial infection in a large paediatric cystic fibrosis centre: epidemiology and possible transmission event L.R. Nair1, M.F. Thomas1, M. Brodlie1, A. Robb2, A. Perry3, C. O’Brien1. 1Great North Children’s Hospital, Paediatric Respiratory Medicine, Newcastle, United Kingdom; 2Royal Victoria Infirmary, Microbiology, Newcastle, United Kingdom; 3Freeman Hospital, Microbiology, Newcastle, United Kingdom

Malnutrition, Overweight, and Obesity among Urban and Rural Children in North of West Azerbijan, Iran

Introduction. Malnutrition is one of the most important causes for improper physical and mental development of children. Childhood obesity is a worldwide public health problem. The increasing prevalence of childhood obesity has become a growing matter of public health concern worldwide. The aim of the current study was to determine the prevalence of malnutrition and obesity in children under 5 years old in Salmas district. Methods. The current study is a cross-sectional study conducted on 902 of children under 5 years old to assess the nutritional status in Salmas district and performed from 16 until 30 October, 2011, with the cooperation of the Office of Community Nutrition Improvement and the United Nations Children's Fund. ENA (Emergency Nutrition Assessment) and Spss software were used for data analysis. Results. 49.6% of children were boys and 50.4% were girls. The prevalence of malnutrition based on underweight, stunting, and wasting was estimated to be 2.3%, 7.3%, and 1.4% among children, respectively. Stunting was more common in rural areas and this difference was significant (P < 0.001). Conclusion. In this area stunting, overweight and obesity were the most important priorities that health officials must pay more attention to. ENA software has a special ability to determine the samples and clusters and is a simple, rapid, and accurate method, especially in epidemiological studies in the country, and can be a convenient tool and its use is suggested for the same studies.

Differences in the Fears of Elementary School Children in North and South America: A Cross-Cultural Comparison

This study compared the fears of North American and South American children in Grades 2–5. Fears were assessed with English and Spanish versions of the American Fear Survey Schedule (FSSC-AM; Burnham 2005). Specific fears and several most common fears differed across the two countries. Overall, the South American children and the girls from both countries had significantly higher fear intensity scores than North American children and the boys. Fear intensity scores also differed significantly across racial backgrounds. Implications for counsellors and directions for future research are considered.

Changes in Malnutrition Among Under 5 Years Old Children in North of Iran

This study was carried out to compare nutritional status among under 5 years old children in the villages of Gorgan districts (North of Iran) during 1997 (stage 1) and 2004 (stage 2). By using cluster and simple sampling, 20 villages were chosen and 20 persons completed the questionnaires and measured cases' weight and height. The sample size was 5497 (stage 1 = 2639 cases and stage 2 = 2858 cases). Data of two stages was merged to the file and was analyzed by spss.win software. NCHS standard was used for comparison. Three anthropometrics indexes used in this study were defined with following scale: Underweight, Stunting and Wasting. The data of two stages was merged in a file and analyzed by sps.win software NCHS standard was used to compare of data and under -2SD from median of it computed as a start paint of malnutrition. The prevalence of malnutrition based on underweight, stunting and wasting were 5.7%, 30.2 and 3.82% in 1997 (stage 1) and 4.3, 14.3 and 2.9% in 2004 (stage 2), respectively. Statistical difference was significant between two stages based on underweight (p = 0.01) and stunting (p = 0.001). Secular growth improvement in boys was better than in girls. Overall, nutritional status was improved during 1997 to 2004 and in comparison with weight, height improvement was better. More researches are necessary to determine what factors contribute to this situation. © 2007 Asian Network for Scientific Information.

NINE YEARS EXAMINATION OF THE HEARING IN SCHOOL CHILDREN IN NORTH TRONDELAG.

A survey is given of the examination of the hearing in schoolchildren in North Trandelag, carried out through nine years (about 30.000 children). Special reference is given to about 6.000 of the children, observed through the whole schooltime of seven years.