Outpatient Children Research Articles

Drug use in French children: a population-based study

Background and objectiveTo provide an overview of drug use in outpatient children in France, a population-based study using a national reimbursement claims database representative of 90% of the French population...

Molecular characterization and multiple infections of rotavirus, norovirus, sapovirus, astrovirus and adenovirus in outpatients with sporadic gastroenteritis in Shanghai, China, 2010-2011.

Rotavirus (RV), norovirus (NoV), sapovirus (SaV), human astrovirus (HAstV) and human adenovirus (HAdV) are significant because they are the most common pathogens that cause diarrhea in young children. The aim of this study was to investigate the genetic characteristics and compare the roles of these five viruses in outpatient children with diarrhea in Shanghai. A total of 436 fecal samples were collected from pediatric patients with acute gastroenteritis from January 2010 to December 2011. The selected samples were subjected to reverse transcription PCR (RT-PCR) or PCR to detect and genotype RV, NoV, SaV, HAstV and HAdV. RV (43.3 %, 189/436) was the most prevalent virus, followed by NoV (28.9 %, 126/436), HAdV (7.1 %, 31/436). HAstV (1.8 %, 8/436) and SaV (0.5 %, 2/436). The percentage of multiple infection cases was 14.9 % (65/436), and RV + NoV was the predominant mixed infection. The RV genotype combinations of P[8]G3 (52/189, 27.5 %), P[8]G1 (51/189, 26.9 %) and P[8]G9 (48/189, 25.4 %) occurred most frequently. The predominant NoV genotype was GII.4 (73.0 %, 92/126), and the majority of GII.4 clustered as GII.4-2006b (65.2 %, 60/92). Two of the SaV cases were identified as GI.2 and GII.1. All HAstV-positive samples belonged to HAstV-1. The predominant HAdV type was HAdV-41 (45.2 %, 14/31). This study clearly shows the diversity of the viral causative agents of acute gastroenteritis in outpatient children in Shanghai, which will provide baseline information for future vaccination strategies and development in this area.

Clinical and etiologic features of diarrheagenic Escherichia coli-associated diarrhea in children

Objective To investigate the pathotypes, epidemiological characteristics and antimicrobial resistance of diarrheagenic Escherichia coli (DEC) in children with acute bacterial diarrhea in Shanghai. Methods A total of 2 071 outpatient children with probable acute bacterial diarrhea referred to the enteric clinic of Children′s Hospital of Fudan University during June 2012 to June 2014 were enrolled in our study. The stool samples were processed for routine microbiologic and biochemistry tests to identify enteric bacteria, including enteropathogenic Escherichia coli (EPEC), enterotoxigenic Escherichia coli (ETEC), enteroinvasive Escherichia coli(EIEC) and enterohemorrhagic Escherichia coli (EHEC). Kirby-Bauer method was used to identify the antibiotic sensitivity. Difference of means between groups was compared by chi-square test. Results Of 2 071 enrolled children, DEC were identified in 145 (7.0%) cases. 148 strains were isolated with three of mix infection strains. All DEC isolates in this study included 106 (71.6%) EPEC, 24 (16.2%) ETEC, 16(10.8%) EIEC and 2(1.4%) EHEC. The median ages of diarrheal children with DEC infections were 14 months (range: 3 months to 13 years) and 62.8% of them were <2 years. Among 125 DEC isolates tested for antimicrobial susceptibility, the rates of resistance to ampicillin, trimethoprim-sulfamethoxazole, cefotaxime, cefepime, gentamicin, ceftazidime, amoxicillin-clavulanate, ciprofloxacin, and ofloxacin in a descending order were 55.2%, 35.2%, 28.0%, 27.2%, 23.2%, 8.8%, 5.6%, 4.0% and 4.0%, respectively. Resistance rates of EIEC to cefotaxime, cefepime and ceftazidime were 50.0%, 43.8% and 25.0%, respectively, which were higher than those of EPEC, ETEC and EHEC. Conclusion DEC is the important enteric bacteria that causes bacterial diarrhea in children in this study. Key words: Diarrhea; Diarrheagenic Escherichia coli; Epidemiology; Child; Drug resistance, microbial

Rhinovirus is an important pathogen in upper and lower respiratory tract infections in Mexican children

BackgroundMost of the studies characterizing the incidence of rhinovirus (RV) have been carried out in hospitalized children and in developed countries. In those studies, RV-C has been associated with more severe respiratory tract infections than RV species A and B. In this study we determined the frequency and diversity of RV strains associated with upper and lower respiratory tract infections (URTI, LRTI) in Mexico, and describe the clinical characteristics of the illness associated with different RV species.MethodsA prospective surveillance of 526 and 250 children with URTI and LRTI was carried out. Respiratory samples were analyzed by RT-PCR for viruses. The 5′ untranslated region of the RV genome was amplified and sequenced.ResultsIn the case of URTI, 17.5% were positive for RV, while this virus was found in 24.8% of LRTI. The RV species was determined in 73 children with URTI: 61.6% were RV-A, 37% RV-C and, 1.4% RV-B; and in 43 children with LRTI: 51.2% were RV-A, 41.8% RV-C, and 7% RV-B. No significant differences in clinical characteristics were found in patients with RV-A or RV-C infections. A high genetic diversity of RV strains was found in both URTI and LRTI.ConclusionsBoth RV-A and RV-C species were frequently found in hospitalized as well as in outpatient children. This study underlines the high prevalence and genetic diversity of RV strains in Mexico and the potential severity of disease associated with RV-A and RV-C infections.

Risperidone Versus Methylphenidate in Treatment of Preschool Children With Attention-Deficit Hyperactivity Disorder.

Background:Attention Deficit Hyperactivity Disorder (ADHD) is a common psychiatric diagnosis among preschool children.Objectives:The aim of this study was to examine the Risperidone treatment compared to Methylphenidate (MPH) in preschool children with ADHD.Patients and Methods:Thirty three outpatient preschool children, aged 3-6 years, diagnosed with ADHD (The diagnosis of ADHD was established by two child and adolescent psychiatrists according to the DSM-IV-TR criteria), participated in a 6-week, double-blind clinical trial with risperidone (0.5-1.5 mg/d) and methylphenidate (5-20 mg/d), in two divided doses. Treatment outcomes were assessed using the Parent ADHD Rating Scale and Conners Rating Scale. Patients were assessed by a child psychiatrist at baseline, 2, 4 and 6 weeks after the medication started. Side effects were also rated by side effects questionnaire.Results:There were no significant differences between the two protocols on the Parent ADHD Rating Scale scores (P > 0.05) and Parent Conners Rating Scale scores (P > 0.05). Both groups showed a significant improvement in ADHD symptoms over the 6 weeks of treatment for parent ADHD Rating Scale (P < 0.001) and Parent Conners Rating Scale (P < 0.001). The most common adverse effects seen with risperidone were daytime drowsiness and anorexia (20%), and with methylphenidate it was anorexia (55%).Conclusions:Results of this study show that risperidone may be effective and well tolerated for ADHD in preschool children, but more researches are needed to clarify the potential benefits and adverse effects in long term use and comorbid conditions.

The prevalence of community-associated methicillin-resistant Staphylococcus aureus among outpatient children in a tertiary hospital: A prospective observational study in Riyadh, Saudi Arabia.

Background and objectivesThe emergence of methicillin-resistant Staphylococcus aureus (MRSA) infections among previously healthy persons in community settings, without exposure to health care facilities, has been noted recently. Colonization rates of community-associated MRSA (CA-MRSA) have been reported to range from 0 to 9.2 percent. The nose and open skin areas are considered the most important sites for colonization. The aim of our study was to assess the prevalence and to describe the antibiotic susceptibility pattern of CA-MRSA among outpatient children.Patients and methodsWe prospectively screened every third consecutive child presenting to our pediatric emergency department of King Saud Medical City, a 275 bed tertiary care teaching hospital in Riyadh, Saudi Arabia, from March through July 2015.ResultsWe analyzed a total of 830 screening results (n = 478 males, 57.6%). Most of the screened patients were from Riyadh (n = 824, 99.3%). A total of 164 (19.8%) were found to be colonized with S. aureus, and of these 38 (4.6%) with MRSA. Thus, the MRSA rate amongst all S. aureus carriers was 23.2%. All MRSA were susceptible to vancomycin, (94.7%) were susceptible to linezolid, (65.8%) to clindamycin, and (89.5%) to trimethoprim/sulfamethoxazole.ConclusionThe rate of MRSA carriage among children in Riyadh province was within the range reported internationally. As the MRSA rate among S. aureus infected children was 23.2%, empirical MRSA coverage should be considered in children with suspected S. aureus infections.

Ophthalmic Features of Outpatient Children Diagnosed with Intracranial Space-Occupying Lesions by Ophthalmologists.

Introduction:Brain tumors in children often involve the visual system, but most retrospective series are by neurologists or oncologists. In this study we highlight the ophthalmic findings of outpatient children with visual complaints and/or strabismus who, based on ophthalmic examination, were suspected to and confirmed to harbor intracranial space-occupying lesions by magnetic resonance imaging (MRI).Materials and Methods:Retrospective case series of children (less than 18 years) who for visual complaints and/or strabismus underwent cranial MRI at a referral eye hospital (2005–2012), which revealed intracranial space-occupying lesions. Exclusion criteria were known preexisting orbital or ocular trauma, ocular tumor, or neurological disease.Results:For 26 patients (3 months-17 years; mean 7 years; median 9 years; and 14 boys), the most common clinical presentation was decreased vision with disc pallor (10) or swelling (three). Other presentations were strabismus with disc pallor or swelling (four; two of which were left sixth nerve palsies), acquired esotropia with diplopia (three; one bilateral and two left sixth nerve palsies), acquired exotropia (four; two of which were bilateral third nerve palsies, one of which was left partial third nerve palsy, and one of which was associated with headache), nystagmus (one), and disc swelling with headache (one). Most lesions were in the sellar/suprasellar space (10), posterior fossa (six), or optic nerve/chasm (four).Conclusions:The majority of outpatient children diagnosed by ophthalmologists with intracranial space-occupying lesions presented with disc swelling or pallor in the context of decreased vision or strabismus. Two strabismus profiles that did not include disc swelling or pallor were acquired sixth nerve palsy and acquired exotropia (with ptosis (third nerve palsy), nystagmus, or headache).

Pattern and factors associated with hemoglobin genotype testing among children attending a University Teaching Hospital in Lagos, Nigeria

Background: Sickle cell disorders are chronic debilitating genetic disorders affecting the red cells. Sickle cell disorders were originally found in the tropics and subtropics but are now common worldwide due to migration of people from tropical to temperate zones. Objective: The objective was to describe pattern and factors associated with hemoglobin (Hb) genotype testing among children attending a University Teaching Hospital in Lagos, Nigeria. Methodology: The study was conducted at the General Children Outpatient Clinics of Lagos State University Teaching Hospital, Ikeja, Lagos in South west Nigeria. It is a cross-sectional study using research administered questionnaire to obtain information from caregivers. Results: A total of 202 subjects aged 6 months to 15 years were conveniently recruited. Overall, the Hb genotype uptake rate was 17.8%. The overall prevalence of Hb disorders was 25.8%. One-ninth of the subjects with known Hb genotype status at commencement of the study had their Hb genotype status confirmed before the age of 1 year. First birth order and upper social stratum were significantly associated with younger age at Hb genotype uptake. Conclusion: Fewer children had Hb genotype uptake during infancy and this underscores the need for early Hb genotype testing of infants. This screening can be during the prenatal, neonatal or at most in infancy during immunization, and infant welfare clinics visit.

Cross-sectional study on differences in pain perception and behavioral distress during venipuncture between italian and chinese children.

Venipuncture is perhaps the scariest aspect of hospitalization for children as it causes pain and high levels of behavioral distress. Pain is a complex experience which is also influenced by social factors such as cultural attitudes, beliefs and traditions. Studies focusing on ethnic/cultural differences in pain perception and behavioral distress show controversial results, in particular with regards to children. The aim of this paper is to evaluate differences in pain perception and behavioral manifestations between Italian and Chinese children undergoing a venipuncture, through a cross-sectional study. Behavioral distress and self-reported pain were measured in Chinese and Italian outpatient children during a standardized blood-drawing procedure, using the Observational Scale of Behavioral Distress (OSBD) and pain scales. We observed 332 children: 93 Chinese and 239 Italian. Chinese children scored higher than Italians on pain scales – mean scores 5.3 (95%CI 4.78-5.81) vs. 3.2 (95%CI 2.86-3.53) – but lower mean OSBD scores – mean 4.1 (95%CI 3.04-5.15) vs. 8.1 (95%CI 7.06-9.14). Our data suggest that Chinese children experience higher levels of pain than their Italian peers, although they show more self-control in their behavioral reaction to pain when experiencing venipuncture.

Is there still room for novel viral pathogens in pediatric respiratory tract infections?

Viruses are the most frequent cause of respiratory disease in children. However, despite the advanced diagnostic methods currently in use, in 20 to 50% of respiratory samples a specific pathogen cannot be detected. In this work, we used a metagenomic approach and deep sequencing to examine respiratory samples from children with lower and upper respiratory tract infections that had been previously found negative for 6 bacteria and 15 respiratory viruses by PCR. Nasal washings from 25 children (out of 250) hospitalized with a diagnosis of pneumonia and nasopharyngeal swabs from 46 outpatient children (out of 526) were studied. DNA reads for at least one virus commonly associated to respiratory infections was found in 20 of 25 hospitalized patients, while reads for pathogenic respiratory bacteria were detected in the remaining 5 children. For outpatients, all the samples were pooled into 25 DNA libraries for sequencing. In this case, in 22 of the 25 sequenced libraries at least one respiratory virus was identified, while in all other, but one, pathogenic bacteria were detected. In both patient groups reads for respiratory syncytial virus, coronavirus-OC43, and rhinovirus were identified. In addition, viruses less frequently associated to respiratory infections were also found. Saffold virus was detected in outpatient but not in hospitalized children. Anellovirus, rotavirus, and astrovirus, as well as several animal and plant viruses were detected in both groups. No novel viruses were identified. Adding up the deep sequencing results to the PCR data, 79.2% of 250 hospitalized and 76.6% of 526 ambulatory patients were positive for viruses, and all other children, but one, had pathogenic respiratory bacteria identified. These results suggest that at least in the type of populations studied and with the sampling methods used the odds of finding novel, clinically relevant viruses, in pediatric respiratory infections are low.

Genetic diversity and clinical impact of human rhinoviruses in hospitalized and outpatient children with acute respiratory infection, Argentina

BackgroundHuman rhinoviruses (HRV) are recognized as a cause of upper and lower acute respiratory infections (ARI). The circulating species and their clinical impact were not described in Argentina. ObjectivesTo describe the molecular epidemiology of HRV in children and to determine the association of HRV species with outcome and severity.Study design: Hospitalized and outpatients children <6 years old with ARI without comorbidities (n=620) were enrolled (2008–2010). Demographic, clinical data and outcome were analyzed. HRV were identified by RT-PCR. Phylogenetic analysis and demographic reconstruction for HRV were performed in selected samples. ResultsHRV were detected in 252/620 (40.6%) of children; 8.5% in viral coinfection. Bronchiolitis (55%) and pneumonia (13%) were the most frequent clinical diagnosis. Of 202 inpatients with HRV: 72% required oxygen supplementation, 11% intensive care unit and 3% mechanical ventilation. HRV were identified as a risk factor for hospitalization (OR: 2.47).All three HRV species were detected being HRV-A (55%) and HRV-C (43%) the most frequent; HRV-B was infrequent (2%). Of 44 sequenced HRV, 30 genotypes were detected. Seven of them were the most prevalent and circulated during limited periods of time. The demographic reconstruction revealed a constant population size and a high turnover rate of genotypes. Demographic and clinical outcome were similar for HRV-A and HRV-C infections. ConclusionThis study highlights the clinical impact of HRV in children without comorbidities as a cause of lower ARI and hospitalization. The high frequency of HRV infections may be associated with the simultaneous circulation of genotypes and their high turnover rate.

A Randomized Double-Blind Placebo-Controlled Clinical Trial of Adjuvant Buspirone for Irritability in Autism

BackgroundThe brain serotonin level is decreased in individuals with autism. Buspirone is a 5-HT(1A) receptor agonist with antiaggressive effects increasing prosocial behaviors. MethodsWe conducted an 8-week randomized double-blind placebo-controlled clinical trial. Participants included 40 outpatient children and adolescents with autism. The patients took buspirone plus risperidone or risperidone plus placebo during 8 weeks. The patients were assessed at baseline, week 4, and week 8 using the Aberrant Behavior Checklist-Community Rating Scale. ResultsEighteen patients in the placebo group and 16 patients in the buspirone group completed this trial. The mean dose of buspirone was 6.7 (SD 2.7) mg/day. Irritability subscale score significantly decreased during this trial in both groups (buspirone group: declined from 25.7 [SD 5.7] to 16.3 [SD 8.5]; placebo group: declined from 24.7 [SD 7.6] to 18.2 [SD 7.7]). The Cohen d effect size was .45. Thirteen (81.2%) of 16 patients in the buspirone group and 7 (38.9%) of 18 patients in the placebo group showed a ≥30% decline in irritability score. The relative risk for treatment was 2.1. There were no serious adverse effects. The most common adverse effects in the buspirone group were increased appetite, drowsiness, and fatigue. ConclusionThis clinical trial supports that low dose buspirone plus risperidone is more effective than risperidone plus placebo for treating irritability in individuals with autism.

PO-1041a A Retrospective Analysis Of The 21134 Cases Children Allergens Screening Testing And Its Clinical Significance

Objective To analyse the sensitisation status to common inhalant allergens of suspected allergic children in Beijing Childrens’ Hospital in the year of 2013. Methods Between January 2013 and January 2014, there are a total of 21134 cases conducted the allergen screening testing (Medswiss AllergyScreen allergen testing system, Germany). According to the department at first visit of outpatient children and the major clinical diagnostic information of the inpatient children, the out-patient children or the in-patient children could be further divied into subgroups accordingly. A comparison in the differences of allergen sensitisation pattern between ward patients and outpatients was performed. Results In the out-patient subjects, the positive rate of sIgE was 45.99% (8266/17974 cases),the top three positive rate of inhalant allergen were mould (18.57%), dog hair (16.54%) and dust mites (15.69%). However, in the outpatients, the positive rate of sIgE was 29.34% (927/3160 cases)and the top three positive detection rate were dust mites (10.95%), dog hair (8.48%), and the mould (7.95%) in turn. It was also found that the positive ratio of children suffering from the nose or eye disease (from ear-nose-throat, head and neck surgery and ophthalmology out-patient: 2092/3126 cases, 66.92%; from ear-nose-throat of head and neck surgery and ophthalmology ward: 14/26 cases, 53.85%) were significantly higher than the others. Besides, it was considered that the Henoch-Schonlein purpura (HSP)is one kind of disease that closely related with the sensitisation condition. In this study, the positive rate to inhaled allergens in HSP childrens was significantly higher than that in non-HSP childrens (HSP: 520/1375 cases, 37.80%; non-HSP: 407/1782 cases, 22.80%, p Conclusion The allergen screening testing is not only useful in the rapid assessment of body sensitisation state, but also play a positive role in the providing rational allergen avoidance advise. Therefore, it should be to pay more attention in the combination and translation between the allergen screening results and the clinical information.

PO-0010 The Physicians Approach To Community-acquired Pneumonia In Childhood

Background and aims Diagnosis and treatment guidelines for community-acquired pneumonia (CAP) are prepared to avoid differences for the diagnosis and management of CAP between physicians. We investigated the approaches of physicians to diagnosis, laboratory findings, treatment and the compatibility with guidelines for CAP. Method A total of 322 doctors were interviewed face to face and a 12 item-questionary incluiding diagnosis, investigation, treatment criteria and drug choices was filled by the physician. Results Contrarily to the guidelines 6.9% of physicians preferred auscultation and chest radiographygraphy (CXR) and did not use the symptoms for diagnosis. Only 11.8% preferred symptoms and diagnostic investigations. 58.8% did not use CXR, CBC and CRP, 24.5% did not use CXR, CBC, CRP and ERS and 4.9% of them did not prefer any investigations. Also routine CXR to confirm CAP in outpatient setting children is not recommended by guidelines physicians preferred CXR at high percentage. Physicians did not preferred Amoksisilin for mild CAP between 3 months - 2 years old children, 55% preferred parenteral treatment with ampisilin/sulbactam. Parenteral Seftriakson was preferred for hospitalised patients (>5 years) with severe pneumonia. 49.7% of physicians preferred ten day duration of therapy, 17.1% stopped treatment after disappearance of symptoms and auscultation findings, 13.7% completed the treatment after improvement of CXR. Conclusion Physicians applied different approaches to the diagnosis and treatment of CAP in infants and children. According to our findings, we suggested that physicians should be educated about approaches for treatment of CAP according to guidelines.

O-151 Attitudes Of Mothers About Medication Safety Of Chidren

Background and aims Unintentional medication misuse can lead harm and additional healthcare costs. Children are vulnerable to mistakes in taking medications. Parents and caregivers administering medications can easily be confused by different instructions for use based on the child’s age, weight, and other medical conditions. The aim of the study is to determine mother attitudes about medication safety of chidren. Methods A descriptive quantitative approach was used in study. The data were obtained from 396 mothers at outpatient children clinic, by socio-demographic properties and medication safety questionnaire which was designed by researcher. Data was evaluated using the descriptive statistics available in the Statistical Package for Social Sciences Software (SPSS 16.0). Results Most of the mothers were (46,4%) between 20–29, high-school graduate (30.3%) and housewife (84.1%). (77.0%) of children didn’t have a chronic illness but (60,1%) followed up by a physician once a mounth. Mother attitudes about medication safety are; if the illness was known before (47.5%) buy and use the medicines of previous experiences. If they recognised the illness firstly, use the prescribed medication (99%). (81,6%) gave up medication when side effects occur. (99.0%) of them obey the medication dosage, (96.5%) of them reported the ineffectiveness of medication to physician. Residual medicines thrown down (74,5%) and if nessesary stored at high places (85,6%). If they forgot to schedule of medication, they waited until the next dose (60%). Conclusion Most of the mothers pay attention and perform true attitude for medication safety.

Russian

russian

Cardiometabolic Phenotype in Children with Obesity

To investigate the anthropometric and metabolic correlates of different patterns of left ventricular (LV) geometry in a cohort of outpatient children with high prevalence of obesity. Anthropometric measures, lipid profile, blood pressure (BP), fasting plasma glucose (FPG), and echocardiographic variables were evaluated in 281 white children (6-16 years), of whom 105 were obese and 105 were morbidly obese. Patterns of LV geometry were defined as follows: normal geometry, eccentric LV hypertrophy (LVH), concentric LV remodeling, and concentric LVH. One hundred forty-eight children exhibited normal LV geometry, 53 eccentric LVH, 36 concentric LV remodeling, and 44 concentric LVH. The 4 groups differed in body mass index, waist circumference, waist-to-height ratio, triglycerides/high-density lipoprotein cholesterol ratio (Tg/HDL-C), and BP (P < .05-.0001). A statistically significant impairment of diastolic function (expressed as greater E/E', P < .002) was observed across patterns of LV geometry. Among anthropometric measures, waist-to-height ratio showed better performance in relation to LVH, with an optimal cut-point of 0.58, compared with body mass index and waist circumference. Children with concentric LVH exhibited the worst metabolic risk profile, with greater prevalence of visceral obesity, high Tg/HDL-C, high BP, and high-normal FPG, than children with normal LV geometry. In children with high levels of obesity, an unfavorable "cardiometabolic phenotype" can be identified, which includes concentric LVH, visceral obesity, high BP, high Tg/HDL-C, and high-normal FPG.

Genetic variation of human respiratory syncytial virus among children with fever and respiratory symptoms in Shanghai, China, from 2009 to 2012

Human respiratory syncytial virus (HRSV) of genus Pneumovirus is one of the most common pathogens causing severe acute lower respiratory tract infection in infants and children. No information on the genotype distribution of HRSV is available in East China (e.g. Shanghai). From August 2009 to December 2012, 2407 nasopharyngeal swabs were collected from outpatient children with fever and respiratory symptoms in Shanghai. HRSV infection was determined using a multiplex RT-PCR assay. The second hypervariable region (HVR2) of G protein gene of HRSV was amplified and sequenced from HRSV positive samples. Genotypes were characterized by phylogenetic analyses. Of 2407 nasopharyngeal samples, 184 (7.6%) were tested as HRSV positive. From 160 positive subjects with sufficient nasopharyngeal samples, 69 HVR2 sequences were obtained by RT-PCR and sequencing. Three HRSV epidemic seasons were observed from August 2009 to December 2012, and an extreme outbreak of HRSV occurred in the 2009–2010 epidemic season. A genotype shift of predominant HRSV strains from B group in the 2009–2010 epidemic season to group A in the subsequent epidemic seasons was observed. Ten HRSV genotypes, including four group A genotypes NA1, NA3, NA4, and ON1, and six group B genotypes BA9, BA10, SAB4, CB1, BAc, and BA?, were detected in Shanghai. Seven genotypes (NA1, BA9–10, SAB4, CB1, BAc and BA?) were found in the 2009–2010 epidemic season. The co-circulation of multiple genotypes was associated with the extreme outbreak of HRSV among children with fever and respiratory symptoms in the 2009–2010 epidemic season.

Three-Year Study of Viral Etiology and Features of Febrile Respiratory Tract Infections in Japanese Pediatric Outpatients

For most febrile respiratory tract infections (RTIs) in children, the causative pathogen is never identified. We sought to identify the causative pathogen in individual cases of pediatric outpatient with RTIs and to determine whether particular clinical features of RTIs are associated with particular viruses. Over 3 years, we prospectively collected nasopharyngeal aspirate specimens from individual pediatric outpatients with an RTI accompanied by persistent fever (>3 days, ≥38.0°C) and peak temperature ≥39.0°C. Two methods-(1) viral culture for respiratory viruses and (2) real-time polymerase chain reaction (PCR) assays identifying 9 different respiratory viruses and 2 respiratory bacteria-were used to test specimens. For 495 specimens, viral culture and real-time PCR assays together identified at least 1 pathogen in 83.0% and ≥1 viruses alone in 79.4%. These 2 methods identified 138 children with respiratory syncytial virus, 66 with human metapneumovirus, 73 with parainfluenza viruses, 124 with adenovirus, 23 with rhinovirus, 38 with enterovirus, 11 with influenza type C virus, 15 with Mycoplasma pneumoniae and 3 with Chlamydophila pneumoniae; the coinfection rate was 19.7% among all infections. Among the patients with single-pathogen infections, the rate of lower RTI was 37.6% for respiratory syncytial virus, 40.7% for human metapneumovirus, 18.2% for parainfluenza viruses and 2.2% for adenovirus (P < 0.01). Viral culture and real-time PCR assays were used together to identify causative pathogens in 83% of febrile outpatient children with RTI; specific viruses were associated with particular clinical diagnoses.

Ethnic Background, Socioeconomic Status, and Problem Severity as Dropout Risk Factors in Psychotherapy with Youth

BackgroundDropout from child and adolescent psychotherapy is a common phenomenon which can have negative consequences for the individual later in life. It is therefore important to gain insight on dropout risk factors.ObjectiveSeveral potential risk factors [ethnic minority status, a lower socioeconomic status (SES), and higher problem severity] were analyzed in present study. Innovations are that these risk factors were examined for children and adolescents separately, and a distinction was made in termination status between referred patients, dropouts and completers.MethodsFor ethnic majority and minority outpatient children (age 5–11, n = 399) and adolescents (age 12–20, n = 352) problem severity, ethnic background, SES, and treatment termination status (completer, dropout, referral) were specified. Multinomial logistic regression models were used as main method of analysis.ResultsFor children, a Moroccan/Turkish ethnicity and higher externalizing scores were risk factors for being referred. For adolescents, a Surinamese/Antillean ethnicity, being female, being older, and lower parental SES occupation levels were risk factors for dropout.ConclusionsDifferent dropout risk profiles emerged for children versus adolescents, and for dropouts versus referrals. Also, it depended on the specific ethnic background whether ethnic minority status was a predictor for dropout, and the relationship between SES and termination status differed by whether parental SES occupation or parental SES education were used as SES indicator. Professionals should thus be aware of these potential risk factors for dropout or referral when treating children and adolescents.