Hospital Admissions In Children Research Articles

Receipt of social services intervention in childhood, educational attainment and emergency hospital admissions: longitudinal analyses of national administrative health, social care, and education data in Wales, UK

BackgroundResearch consistently finds poorer health and educational outcomes for children who have experienced out-of-home care relative to the general population. Few studies have explored differences between those in care and those in receipt of intervention from social services but not in care. Children receiving social services interventions often experience Adverse Childhood Experiences (ACEs), and deprivation, which are known to negatively impact outcomes. We aimed to estimate the association of different social services interventions with educational outcomes and hospital admissions, while adjusting for ACEs and deprivation.MethodsWe linked retrospective, routinely collected administrative records from health, education, and social care to create a cohort via the Secure Anonymised Information Linkage (SAIL) databank in Wales, UK. We analysed data for children and household members (N = 30,439) across four different groups: [1] no social care intervention; [2] children in need but not in care (CIN); [3] children on the Child Protection Register but not in care (CPR); [4] children in care - i.e. removed from the family home and looked after by the local authority (CLA). Our primary outcome was education outcomes at age 16 years. Secondary outcomes were all cause emergency hospital admissions, and emergency admissions for external causes/injuries.ResultsChildren in receipt of social services intervention were more likely to not attain the expected level upon leaving statutory education at age 16 after adjusting for ACEs and other characteristics (for children who had been in out-of-home care (conditional OR: 1·76, (95%CI) 1·25 − 2·48), in need (2·51, 2·00–3·15) and those at risk (i.e., on the child protection register) (4·04, 2·44 − 6·68). For all-cause emergency admissions, all social care groups were at greater risk compared to children in the general population (children in care (conditional HR: 1·31, 1·01–1·68), children in need (1·62, 1·38 − 1·90), and children at risk (1·51, 1·11 − 2·04).ConclusionsAll groups receiving social service intervention experience poorer educational and health outcomes than peers in the general population. Children who remain with their home parents or caregivers but are identified as ‘in need’ or ‘at risk’ by social care practitioners require further research. Integrated support is needed from multiple sectors, including health, educational and social care.

The UK Soft Drinks Industry Levy and childhood hospital admissions for asthma in England

Sugar sweetened beverage consumption has been suggested as a risk factor for childhood asthma symptoms. We examined whether the UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in National Health Service hospital admission rates for asthma in children, 22 months post-implementation of SDIL. We conducted interrupted time series analyses (2012-2020) to measure changes in monthly incidence rates of hospital admissions. Sub-analysis was by age-group (5-9,10-14,15-18 years) and neighbourhood deprivation quintiles. Changes were relative to counterfactual scenarios where the SDIL wasn’t announced, or implemented. Overall, incidence rates reduced by 20.9% (95%CI: 29.6-12.2). Reductions were similar across age-groups and deprivation quintiles. These findings give support to the idea that implementation of a UK tax intended to reduce childhood obesity may have contributed to a significant unexpected and additional public health benefit in the form of reduced hospital admissions for childhood asthma.

Estimated Impact of Nirsevimab on the Incidence of Respiratory Syncytial Virus Infections Requiring Hospital Admission in Children < 1 Year, Weeks 40, 2023, to 8, 2024, Spain.

Data from the sentinel surveillance system of severe acute respiratory infections in Spain were used to estimate the impact of administration of nirsevimab to children born from 1 April 2023 onwards. Estimated RSV hospitalisations in < 1-year-olds during weeks 40, 2023, to 8, 2024, were compared to the number that would be expected after accounting for the background change in RSV circulation in the 2023/24 season, compared to 2022/23. We estimated 9364-9875 RSV hospitalisations less than expected, corresponding to a 74%-75% reduction.

Normal saline for children with bronchiolitis: study protocol for a randomised controlled non-inferiority trial

IntroductionBronchiolitis is one of the most common reasons for hospital admissions in early childhood. As supportive treatment, some treatment guidelines suggest using nasal irrigation with normal saline (NS) to facilitate...

Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis

IntroductionTooth extraction due to dental caries is associated with socioeconomic deprivation and is a major reason for elective childhood hospital admissions in England. Consumption of sugar-sweetened beverages is a risk...

A single centre study of the level of parents' satisfaction with the COVID-19 telemedicine consultation.

Telemedicine is an effective tool for video consultation of COVID-19 patients in the setting of the COVID-19 pandemic. Weprospectively determined the level of parents' satisfaction with the COVID-19 telemedicine consultation. This was asingle centre prospective study. COVID-19 paediatric patients who were seen in the children's emergency department of KK Women's and Children's Hospital, Singapore, and deemed fit for home recovery were discharged with a COVID-19 telemedicine follow-up in two to three days' time. Paediatric patients who were seen in the COVID-19 telemedicine visits were included in the parents' satisfaction survey. We excluded patients who defaulted their telemedicine visits. The telemedicine satisfaction survey was conducted using an online form consisting of 16 Likert scale questions, sent via text messaging. Our primary outcome was telemedicine satisfaction scores. Our secondary outcome was children's emergency department reattendance or hospital admission within 10days after the telemedicine consultation. 1238 patients attended the COVID-19 video consultation clinic from 15 December 2021 till 25 March 2022, out of which 476 parents of the COVID-19 patients completed the survey questionnaire. The mean age of the COVID-19 patients was 3.6years. There was a high level of overall satisfaction among parents of the COVID-19 patients, with a mean score of 6.1 out of 7. 12 out of 16 questions had a positive response (mean score of 6 or more). There was a total of 9 reattendances to children's emergency department, out of which 3 cases needed hospital admission. Conclusion: There was a high level of overall satisfaction with the use of telemedicine in symptomatic COVID-19 paediatric patients. What is Known: • Telemedicine is a cost-effective and feasible mode of delivering health care for conditions such as diabetes, heart disease, and depressive disorder, especially in the setting of the COVID-19 pandemic. What is New: • To gauge the parents' satisfaction with the COVID-19 telemedicine visit, in order to improve the patient and caregiver experience with telemedicine, and to improve the telemedicine service delivery. • Information from this study is crucial in order to prevent unnecessary hospital reattendance due to parental concern from poor telemedicine delivery.

Breastfeeding and impact on childhood hospital admissions: a nationwide birth cohort in South Korea

Benefits of breastfeeding for both the mother and the child are well established, but a comprehensive and robust study to investigate the protective effect of breastfeeding and attenuated time effect stratified by cause of morbidity are lacking. This study is based on the nationwide birth cohort in Korea that includes data on all infants born from 2009 to 2015. Of 1,608,540 children, the median follow-up period was 8.41 years (interquartile range, 6.76-10.06). When compared to children with fully formula feeding, the hospital admission rate was 12% lower in those with partially breastfeeding and 15% lower in those with exclusive breastfeeding. The apparent protective effect of breastfeeding was reduced with increasing age. Our study provides potential evidence of the beneficial association of breastfeeding on subsequent hospital admissions. The protective effect declined over time as the children grew older. Encouraging any breastfeeding for at least the first 6 months among infants is an important public health strategy to improve overall child health.

School building energy efficiency and health: Modelling childhood asthma and hospital admissions in England and Wales

School building energy efficiency and health: Modelling childhood asthma and hospital admissions in England and Wales

Income and immunity: The consequences of a pre- and neo-natal income shock on childhood infection risk

ObjectivesThe experiences and conditions that children are exposed to in utero and early infancy impact their health in adulthood. Understanding the channels through which these effects emerge is important, because this may help us to anticipate which children are at highest risk of adverse effects, and provide early interventions to help. In this paper, we test a new channel linking perinatal experiences to later-life health: immunity.&#x0D; MethodWe use administrative birth records, linked with hospital admissions episodes and primary care consultations for children in the Northern Territory of Australia. This data forms part of the Child and Youth Development Partnership data linkage project. We analyse the impact of a shock to household income in Aboriginal communities, resulting from a change in government transfer policy. We estimate the impact of exposure to this shock in utero or in the first 3 months of life, relative to exposure later in childhood, to isolate the impact of an income shock during this key developmental period.&#x0D; ResultsWe find that children who were exposed to the shock in utero or in their first three months of life were at higher risk of severe infection requiring hospital admission. They spend, on average, 4.5 more days in hospital from birth to their 6th birthday (a 45 percent increase). Most of this impact is concentrated in admissions for infection. Only a small share of the effect can be explained by the immediate impact of the policy on birthweight.&#x0D; ConclusionOur findings are consistent with the explanation that an income shock worsens nutrition, and that worse nutrition during key developmental stages can permanently weaken children’s immune systems. This finding speaks to the importance of attention to key phases in childhood development, when designing policies that affect households’ financial resources. Furthermore, we find birthweight is a poor predictor of childhood hospital admission. However, use of longitudinal administrative data helps us to identify alternative markers of new-born health that are better predictors.

Water fluoridation: what, why, where and when

Dental UpdateVol. 50, No. 6 Guest EditorialWater fluoridation: what, why, where and whenBarry Cockcroft, Simon HearnshawBarry CockcroftChair of the British Fluoridation SocietySearch for more papers by this author, Simon Hearnshawemail: E-mail Address: [email protected]Training Programme Director Health Education England, Coordinator National Community Water Fluoridation NetworkSearch for more papers by this authorBarry Cockcroft; Simon HearnshawPublished Online:13 Jun 2023https://doi.org/10.12968/denu.2023.50.6.475AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Mullen J; European Association for Paediatric Dentistry. History of water fluoridation. Br Dent J 2005 Oct 8; 199(7 Suppl): 1–4. doi: https://doi.org/10.1038/sj.bdj.4812863. PMID: 16215546. Medline, Google ScholarFrom the Centers for Disease Control and Prevention. 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Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/970380/Inequalities_in_oral_health_in_England.pdf (accessed May 2023). Google ScholarOffice for Health Disparities and Improvement. Hospital tooth extractions in 0 to 19 year olds 2022. 2023. Available at: www.gov.uk/government/statistics/hospital-tooth-extractions-in-0-to-19-year-olds-2022/hospital-tooth-extractions-in-0-to-19-year-olds-2022#:~:text=For%20the%20financial%20year%202021%20to%202022%20there%20were%2042%2C180,extractions%20for%20this%20age%20group (accessed May 2023). Google ScholarStennett M, Tsakos G. The impact of the COVID-19 pandemic on oral health inequalities and access to oral healthcare in England. Br Dent J 2022; 232 :109–114. https://doi.org/10.1038/s41415-021-3718-0 Medline, Google ScholarCabinet Office. Advancing our health: prevention in the 2020s. Available at: www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document (accessed May 2023). Google ScholarNHS England. Core20PLUS5 (adults) – an approach to reducing healthcare inequalities. Available at: www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/ (accessed May 2023). Google ScholarAustralian Government, National Health and Medical Research Council. Information Paper. Water fluoridation: dental and other human health outcomes. 2017. Available at: www.nhmrc.gov.au/sites/default/files/documents/reports/fluoridation-info-paper.pdf (accessed May 2023. Google ScholarNew Zealand Ministry of Health. Review of the benefits and costs of water fluoridation in New Zealand. 2016. Available at: www.health.govt.nz/publication/review-benefits-and-costs-water-fluoridation-new-zealand (accessed June 2023). Google ScholarGovernment of Canada. The state of community water fluoridation across Canada. 2022. Available at: www.canada.ca/en/public-health/services/publications/healthy-living/community-water-fluoridation-across-canada.html (accessed June 2023). Google ScholarOffice for Health Improvement and Disparities. Water fluoridation health monitoring report for England 2022. 2022. Available at: www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2022 (accessed May 2023). Google ScholarPublic Health England. Water fluoridation. Health monitoring report for England 2018. Executive summary. 2018. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/692756/EXECUTIVE_SUMMARY_Water_Fluoridation_Health_monitoring_report_for_England_2018_DR.pdf (accessed May 2023). Google ScholarPublic Health England. Return on investment of oral health improvement programmes for 0–5 year olds. 2016. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/560973/ROI_oral_health_interventions.pdf (accessed May 2023). Google ScholarDuane B, Lyne A, Parle R, Ashley P. The environmental impact of community caries prevention – part 3: water fluoridation. Br Dent J 2022; 233: 303–307. https://doi.org/10.1038/s41415-022-4251-5 Medline, Google ScholarLevine RS. Childhood caries and hospital admissions in England: a reflection on preventive strategies. Br Dent J 2021; 230: 611–616. https://doi.org/10.1038/s41415-021-2945-8 Medline, Google ScholarNHS England. What are integrated care systems. Available at: www.england.nhs.uk/integratedcare/what-is-integrated-care/ (accessed May 2023). Google ScholarAssociation of Directors of Public Health. ADPH lead consensus on oral health. 2023 Available at: www.adph.org.uk/2023/03/adph-leads-consensus-on-child-oral-health/ (accessed May 2023). Google ScholarGodlee F, Smith J, Marcovitch H. Wakefield's article linking MMR vaccine and autism was fraudulent. BMJ 2011; 342: c7452. https://doi.org/10.1136/bmj.c7452 Medline, Google ScholarDepartment of Health and Social Care. Statement on water fluoridation from the UK Chief Medical Officers. 2021. Available at: www.gov.uk/government/publications/water-fluoridation-statement-from-the-uk-chief-medical-officers/statement-on-water-fluoridation-from-the-uk-chief-medical-officers (accessed May 2023). Google Scholar FiguresReferencesRelatedDetails 2 June 2023Volume 50Issue 6ISSN (print): 0305-5000ISSN (online): 2515-589X Metrics History Published online 13 June 2023 Published in print 2 June 2023 Information© MA Dentistry Media LimitedPDF download

Effect of Overcrowding on Childhood Hospital Admissions for Acute Respiratory Infection: A Matched Case–Control Study

Objective: To determine the association between in-house overcrowding and acute respiratory infections (ARIs) in children. Methods: This case-control hospital-based study wad conducted in Saidu Teaching hospital from March-2022 to December-2022. For cases we included 80 patients of age 6 to 59 months, who presented with newly diagnosed or relapsed cases of ARI. Controls were age and gender matched individuals who presented to outdoor hospital department for non-ARI evaluation and had no history of ARI since past 2 months. The in-house crowding was defined as &gt;3 persons living in one bedroom in a home. Results: Mean age in this study was 18.3±8.9 months in ARI group and 19.7±7.8 months in control group (p-value 0.41). There were higher number of patients belonging to poor class in ARI group; 36 (45%) versus 21 (26.2%) in controls, 26 (32.5%) patients in ARI and 31 (38.7%) patients in controls were belonging to middle class, 18 (22.5%) patients in ARI and 28 (35.0%) patients in control group were belonging to upper class (p-value 0.03). Majority of patients in ARI group were from rural areas; 53 (66.3%) in ARI and 37 (46.3%) in control group (p-value 0.01). In-house overcrowding was found in 19 (20%) patients in ARI group and in only 9 (11.3%) patients in control group (p-value 0.03). Conclusion: In-house crowding is significantly associated with increased risk of ARI. The issue of overcrowding in rural regions is more serious than in cities. For Pakistani populations, the problem of overcrowded housing needs to be addressed. Keywords: In-house overcrowding, Acute respiratory infections, Rural living, socio-economic status.

Child posttraumatic stress symptoms in an acute injury sample: Patterns of associations among child report, parent report, and child heart rate parameters.

Parent-child agreement on measures of child posttraumatic stress disorder (PTSD) is moderate at best, and understanding of this discrepancy is limited. To address this, we conducted an item-level investigation of parent-child symptom agreement to examine the potential influence of parental posttraumatic stress symptoms (PTSS) on parents' reports of their child's PTSS. We also examined heart rate (HR) indices as possible independent indicators of child PTSD, examining patterns of association with parent versus child report. Parent-child dyads (N = 132, child age: 6-13 years, 91.7% White) were recruited after the child's hospital admission following an acute, single-incident traumatic event. At 1-month posttrauma, questionnaires assessing children's PTSS (self- and parental reports) and parental PTSS were administered. For a subset of participants (n = 70), children's HR recordings were obtained during a trauma narrative task and analyzed. Parent and child reports of child PTSS were weakly positively correlated, r = .25. Parental PTSS were found to be stronger positive predictors of parental reports of child PTSS than the children's own symptom reports, β = 0.60 vs. β = 0.14, and were associated with higher parent-reported child PTSS relative to child reports. Finally, children's self-reported PTSS were associated with HR indices, whereas parent reports were not, βs = -.33-.30 vs. βs = -.15-.01. Taken together, children's self-reported PTSS could be a more accurate reflection of their posttrauma physiological distress than parent reports. The potential influence of parental PTSS on their perceptions of their child's symptoms warrants further consideration.

Adverse Drug Reactions at Nonelective Hospital Admission in Children and Adolescents: Comparison of 4 Causality Assessment Methods.

This study aimed to compare assessment methods to determine adverse drug reactions (ADRs) at nonelective hospital admission in pediatric patients, to investigate the interrater reliability of assessment methods in pediatric care, and to analyze symptoms related to ADRs and (suicidal) drug intoxications. For 1 year, the medical records of nonelective patients admitted to a university pediatric department were evaluated for potential ADRs using 4 assessments methods by 1 experienced rater. Krippendorff α was calculated from a sample of 14 patients evaluated by 4 experienced raters to determine interrater reliability. In 1831 nonelective hospital admissions, 63.4% (1161 of 1831) of patients had received at least one drug before admission. We found a potential causal relationship between drugs and symptoms documented at admission and thus potential ADRs according to Naranjo in 23.3% (271 of 1161) of those patients, World Health Organization - Uppsala Monitoring Centre (WHO-UMC) in 22.5% (261 of 1161), Koh in 21.7% (252 of 1161), and Begaud in 16.5% (192 of 1161). The probability rating of the potential causal relationships varied considerably between the methods (Naranjo-Begaud, P < 0.01; Naranjo-Koh, P < 0.001; Koh-Begaud, P < 0.01; Begaud-WHO-UMC, P < 0.01). Acceptable interrater reliability (α ≥ 0.667) was only obtained for WHO-UMC (α = 0.7092). The most frequently identified definite ADR was sedation in 1.5% of all nonelective patients with medication before hospital admission. In 1.2% (22 of 1831) of all nonelective admissions, we found drug intoxications with suicidal intent. The assessment methods showed a high variability in the determination of a potential causal relationship between drug and documented symptom, in the classification of the probability of ADRs, and suboptimal interrater reliability. Thus, their feasibility in pediatric patients is limited.

Prevalence of Recurrent Hospital Admission in Children with Recurrent Wheezing in Babylon Province

BACKGROUND: Occurring of recurrent wheezing attacks signify a significant healthcare problem and considered one of the most common causes of emergency unit admission and hospitalizations. AIM: The aim of study is to determine the associations of recurrent hospital admissions in children with recurrent wheezing. METHODS: Cross-sectional descriptive study of 102 children with recurrent wheezy chest. Data collected from admitted patients with recurrent wheezing by direct interview with the patients’ families. Patients were 6 months to 5 years old. Data collected including age, gender, place of living whether urban or rural, prematurity, no. of people at home, history of NCU admission, history of ICU admission, exclusive breast feeding for 1st 6 months, anemia, GERD, history of atopy, exposure to smoking, inhaler use, and CXR findings. RESULTS: About 79.41% of children have 1-3 times admission in hospital, significant association between the no. of hospitalization and History of ICU admission, children with more than 3 times admission to hospital present with GERD with significant association. Significant association with more than 3 times admission to hospital have previous history of exposure to smoking, inhaler use and X-ray finding. CONCLUSION: One to three years old children is the most common age they have recurrent wheezing, most children with recurrent wheezy chest have more than 3 times hospitalization, most babies have previous history of ICU admission, GERD and exposure to smoking.

Breastfeeding and Impact on Childhood Hospital Admissions: A Nationwide Birth Cohort in South Korea

Breastfeeding and Impact on Childhood Hospital Admissions: A Nationwide Birth Cohort in South Korea

Preterm birth and Kawasaki disease: a nationwide Japanese population-based study.

Previous studies showed that preterm birth increased the risk for hospital admissions in infancy and childhood due to some acute diseases. However, the risk of preterm children developing Kawasaki disease remains unknown. In the present study, we investigate whether preterm birth increased the morbidity of Kawasaki disease. We included 36,885 (34,880 term and 2005 preterm) children born in 2010 in Japan. We examined the association between preterm birth and hospitalization due to Kawasaki disease using a large nationwide survey in Japan. In log-linear regression models that were adjusted for children's characteristics (sex, singleton birth, and parity), parental characteristics (maternal age, maternal smoking, paternal smoking, maternal education, and paternal income), and residential area, preterm infants were more likely to be hospitalized due to Kawasaki disease (adjusted risk ratio: 1·55, 95% confidence interval: 1.01-2.39). We then examined whether breastfeeding status modified the potential adverse effects of preterm birth on health outcome. Preterm infants with partial breastfeeding or formula feeding had a significantly higher risk of hospitalization due to Kawasaki disease compared with term infants with exclusive breastfeeding. Preterm infants were at a high risk for Kawasaki disease, and exclusive breastfeeding might prevent this disease among preterm infants. Previous studies showed that preterm birth increased the risk for hospital admissions in infancy and childhood due to some acute diseases, however, the risk of preterm children developing Kawasaki disease remains unknown. This Japanese large population-based study showed that preterm infants were at a high risk for Kawasaki disease for the first time. Furthermore, this study suggested that exclusively breastfeeding might prevent Kawasaki disease among preterm infants.

Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison.

ObjectivesTo demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality.MethodsWe used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex.ResultsHospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts.ConclusionsThe large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

Assessment of Variation in Care Following Hospital Discharge for Children with Acute Asthma.

PurposeTo evaluate potential variation in care management pathways following hospital discharge for children with asthma in New South Wales, Australia.MethodsA cross-sectional web-based survey was conducted in emergency departments (EDs) and paediatric units of public hospitals with more than five paediatric beds within New South Wales, Australia, between July 2018 and March 2019. Nursing and medical staff in EDs and paediatric units who had cared for children aged under 18 years with asthma in the preceding 12 months were invited to participate in this study. Outcome measures included use of clinical practice guidelines and asthma action plan (AAP); advice on post-hospitalization follow-up; provision of asthma education for parents/carers; availability of community-based asthma services; communication with schools/childcare services.ResultsA total of 502 participants (236 nursing and 266 medical staff, response rate=22%) from 37 hospitals were included. Overall, the use of AAP was not universal (median=90%; IQR=81–96%) with significant difference across local health districts (LHDs) (88.6%, 95% CI=85.4–91.3) and between EDs and paediatric wards (p=9.4×10−9); and a range of asthma clinical practice guidelines were used. Post-hospitalization follow-up within 2–3 days was recommended by 70% of the respondents, but only 8% reported that hospitals had a system in place to ensure follow-up compliance. Formal asthma education sessions (27% respondents) were seldom provided to parents/carers during hospital stays, especially in EDs (14% respondents). Less than 50% of the respondents were aware of any asthma community services for children and only 4% reported that schools/childcare services were notified about the child’s hospital admission for an asthma flare up.ConclusionThere are marked variations in the post-hospitalization asthma care and community management for children in NSW. An integrated standardized model of care may improve health outcomes in children with asthma.

Acute Hematogenous Osteomyelitis of the Rib in 14 Years Old Child: Clinical Case

Background.Rib osteomyelitis is extremely rare in childhood. This localization of purulent focus represents only 1% of all osteomyelitis cases. The typical manifestations of ribs osteomyelitis are fever, chest or back pain. However, these clinical signs are not always present, and the disease can manifest in other way.Clinical Case Description. Mother with 14 years old child K. have applied to the regional children's hospital admission department. The child had complains of right upper quadrant abdominal pain and in right part of the chest, difficulty in breathing. The disease began 2 days before admission with fatigue, weakness, and pyretic fever (39 °C). Complaints remained over time. The patient was hospitalized with the diagnosis: “Chest impact injury with severe pain syndrome? Right lung contusion?". The ultrasound examination of pleural cavities and the right anterior chest surface has revealed osteomyelitic phlegmon in VII intercostal space on the 3rd day of hospitalization. It was lanced and drained under general anesthesia, about 7 ml of liquid pus were obtained. The child received treatment according to clinical guidelines for the management of patients with such nosology. The final diagnosis was: «Acute hematogenous osteomyelitis of the VII rib, local form. Osteomyelitic phlegmon of VII intercostal space. Right pneumonitis. Bilateral mild hydrothorax». The boy was discharged on the 10th day since surgery in satisfactory condition.Conclusion.The described clinical case is interesting for pediatric surgeons, traumatologists, infectious disease specialist. Particular attention should be paid to the clinical features of the disease and anamnestic information in such unclear clinical cases. It will allow to exclude traumatic injuries and assume the local inflammatory process.

Childhood caries and hospital admissions in England: a reflection on preventive strategies.

Dental caries is a largely preventable disease, yet the extraction of carious teeth is the most common reason for the hospital admission of children in England. This raises concern over the perceived failure of current preventive strategies. Despite a number of national and local preventive strategies, childhood caries remains most prevalent among the lower socioeconomic groups and ethnic minorities, especially in northern England. Often overlooked is the social and emotional impact of caries and dental treatment on the children and their families. More long-lasting can be the emotional, psychological and developmental impact on children of dental treatment and extractions under general anaesthesia, especially in unfamiliar hospital settings. Yet, the number of hospital admissions for the 5-9-year-old age group continues to rise and was 26,000 in England in 2018. The aim of this paper is to review the demographic and socioeconomic factors related to hospital admission of children for dental extractions, focusing on the localities with the highest proportions of hospital admissions. It is suggested that a reappraisal of the caries-preventive strategy in those areas of England with the highest proportion of hospital admissions is now urgently needed and the case is forcefully made for targeted water fluoridation.