Effects Of Treatment In Children Research Articles

Relationship between starting age of cranial-remolding-orthosis therapy and effectiveness of treatment in children with deformational plagiocephaly

The aim of this study was to investigate the optimal age for starting cranial-remolding-orthosis therapy in children with deformational plagiocephaly. Medical records of 310 patients with deformational plagiocephaly were retrospectively reviewed and the initial and final cranial vault asymmetry index (CVAI), age when starting therapy, duration of therapy, mean change of CVAI, improvement rate, and treatment success were analyzed. We compared outcomes according to the groups divided by ages starting therapy. There were no significant differences in improvement rate and duration of cranial-remolding-orthosis therapy among patients starting therapy at the age of 3, 4, and 5months. However, when starting therapy after the age of 6months, the rates of CVAI improvement were significantly lower and the duration of therapy was significantly increased. Considering the spontaneous resolution effect according to the head growth nature, the age 5month is the optimal period to start cranial-remolding-orthosis therapy for deformational plagiocephaly.

ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА КЛІНІЧНОЇ ЕФЕКТИВНОСТІ РІЗНИХ СХЕМ ЛІКУВАННЯ АТОПІЧНОГО ДЕРМАТИТУ У ДІТЕЙ, ОСОБЛИВОСТІ ЗАСТОСУВАННЯ СПЕЦИФІЧНОЇ ІНДУКЦІЇ ІМУНОЛОГІЧНОЇ ТОЛЕРАНТНОСТІ

Мета дослідження:вивчення ефективності та оцінка перспективи застосування алерген-специфічної імунотерапії в поєднанні із пролонгованою пробіотикотерапією при атопічному дерматиті у дітей, як методу індукції імунологічної толерантності, аналіз досвіду клінічної практики та інтерпретація результатів обстежень.Матеріали та методи. В процесі виконання науково-дослідної роботи усім дітям були проведені загально-клінічні методи дослідження: оцінка скарг, анамнестичних даних, об’єктивного статусу пацієнтів із визначенням показників фізичного розвитку, загальні клініко-лабораторні і біохімічні, імунологічні, алергологічні, інструментальні методи дослідження, такі як УЗД шкіри і дерматоскопія. Проводили порівняльну оцінку ефективності традиційної терапії та комплексного лікування атопічного дерматиту із застосуванням алерген-специфічної імунотерапії та пролонгованого курсу пробіотиками у 108 дітей віком від 4 до 18 років, контрольну групу склали 34 дітей аналогічного віку з хворими.Результати дослідження та їх обговорення. В статті представлені дані про перспективи застосування алерген-специфічної імунотерапії в поєднанні із пробіотикотерапією при атопічному дерматиті у педіатрії, а також наведено результати власних досліджень ефективності запропонованої терапії у дітей із атопічним дерматитом віком від 4 до 18 років. Проведено оцінку і порівняння традиційної терапії та алерген-специфічної імунотерапії в поєднанні із пробіотикотерапією при атопічному дерматиті. Контроль якості і ефективності комплексної терапії проводився за даними імунограми, а саме показників клітинної і гуморальної ланок імунітету, цитокінового статусу та рівня сироваткових імуноглобулінів.Висновки.Обгрунтовано доцільність та перспективу застосування алерген-специфічної імунотерапії в поєднанні із пролонгованою пробіотикотерапією у дітей з атопічним дерматитом.

Effects of UGT1A6 and GABRA1 on Standardized Valproic Acid Plasma Concentrations and Treatment Effect in Children With Epilepsy in China.

Valproic acid (VPA) is a widely used antiepileptic drug with acceptable safety and efficacy in treating pediatric patients with various kinds of seizures. However, interindividual variations in plasma concentrations and treatment effects of patients with epilepsy treated with VPA are observed. This study aimed to evaluate the effects of various genetic variations on normalized plasma concentration of VPA (NCVPA) and the treatment response in Chinese children with epilepsy administered with VPA. Pediatric patients (3 months to 18 years old) with epilepsy, taking VPA therapy, were enrolled in the study. Important genetic variations of the pharmacokinetic and pharmacodynamic pathways of VPA were evaluated using the MassARRAY system (Sequenom). The associations of genetic variations with NCVPA/drug response and the mean value of NCVPA in responsive and resistant patients were evaluated using SPSS (17.0) and Plink (1.07) software. A total of 111 children with epilepsy (80 responsive and 31 resistant) were enrolled. rs28898617 (UGT1A6, A > G) was associated with an increase in NCVPA (β = 5.31, 95% confidence interval = 0.78-9.83, P = 0.024); therefore, patients with this variation need a lower dose of VPA. rs2279020 (GABRA1, G > A) was associated with a decreased risk of developing VPA-resistant epilepsy (odds ratio = 0.42, 95% confidence interval = 0.21-0.84, P = 0.014). Similar NCVPA was observed in resistant and responsive patients (P = 0.257). rs28898617 (UGT1A6, A > G) variation was associated with an increase in NCVPA. rs2279020 (GABRA1, G > A) variation was associated with a decreased risk of developing VPA-resistant epilepsy. Resistant and responsive patients to VPA treatment had a similar mean value of NCVPA. The findings may help clinicians to adjust the dose and predict treatment effect for children with epilepsy receiving VPA treatment.

The Effect of Pivotal Response Treatment in Children with Autism Spectrum Disorders: A Non-randomized Study with a Blinded Outcome Measure

Purpose of this quasi-experimental trial was to investigate the effect of Pivotal response treatment (PRT) versus treatment as usual (TAU) on autism symptoms. Children with autism spectrum disorder (ASD), aged 3–8 years, received either PRT (n = 11) or TAU (n = 13). Primary outcome measure was the total score on the Autism Diagnostic Observation Schedule at pre- and posttreatment. Additionally, general problem behavior and parental stress levels were measured. Children in the PRT condition improved on the primary outcome measure compared to the TAU group with a small effect size [partial η2 = 0.22 (95 % CI 0.00–0.46)]. Neither group demonstrated significant changes in the secondary outcomes. This study suggests that PRT may improve autism symptoms in children with ASD over TAU.

The endocrinologic complications in children after anticancer treatment

During last three decades, there is a dramatic improvement in the survival of children and adolescents with cancer. This progress has been possible because of the recent programs of improved therapy (radiotherapy, chemotherapy). There are different toxic effects in patients who have received chemotherapy and radiotherapy. One of the most common late effects of anticancer treatment in children and adolescents is endocrine disorders. Radiotherapy, alkylating agents, high-dose chemotherapy with stem-cell transplantation are the main risk factors of endocrine impairment. All parts of endocrine system are involved in the pathologic process during and after the end of treatment of children and adolescents. Abnormalities in hypothalamo-pituitary function, thyroid function, adrenal function, gonadal function are variably associated with anticancer therapy. Different metabolic disturbances, abnormal sexual development and infertility are caused by the dysfunction of endocrine system. There are immediate (during therapy) and delayed (after the end of treatment) onset late effects of antineoplastic therapy. Early diagnosis and early treatment of complications - as the main factors to improve the results of treatment and quality of life of patients surviving cancer. The aim of this article to analyze the possible range of endocrine disturbance in children and adolescents after anticancer treatment, the necessary intensive follow-up for survivors after the diagnosis of cancer and the treatment of possible endocrine disorders.

The problem of mental disorders and psychological effects of antitumour treatment in children with cancer pathology

Aim – analysis of the problem of psychological and psychiatrical aspects of impact of cancer disease on child and its parents for detection of the main directions of medical and psychological help to this contingent. Results . In the younger age group the most stress factors that provoke the development of psychogenic fears, anxiety states and the derivative mood disorders are the “hospital routine” – limitation of activity (playing, motor), subjectively heavy procedures and manipulations, pain. In the group of elder children and teenagers the main stress stimulus is connected with a fear of social consequences of disease and the fact of mortally dangerous disease is interpreted in mind as a threat to the successful social functioning as something that spread its negative impact on the future life. Reactively caused mood disorders prevail in this age group over the other psychogenic formations. Behavior reactions in these cases are the secondary ones relating to the mood disorders – to the acceptance or rejection the situation of disease (as an anxious hypochondriacal fixation or as an emotional denial and ignoring the possible grave effects of cancer process). Conclusion . The diversity of problems in child psycho-oncology causes the multilevelness and versatility of medical, psychological and psychosocial help and psycho rehabilitation of children and their parents

A Meta-Analysis of Long-Term Outpatient Treatment Effects for Children and Adolescents with Conduct Problems

The present meta-analytic review explored long-term treatment effects in children and adolescents, age ranging from 2 to 17 years, treated because of conduct problems. The presumed mediators were examined. Various treatments, in all 56 studies including 2589 participants, were included. 32 studies involved an untreated control condition, whereas 24 studies did not. The overall weighted effect size (ES) in conduct problems after termination of treatment was a reduction of ES = 0.08 for a mean follow-up period of 8.9 months. Long-term changes on the presumed mediator showed a small deterioration of ES = −0.06. The moderator analysis confirmed that treatment effects in conduct problems and mediators were related. Changes in conduct problems from post-treatment to follow-up were larger in studies with cognitive behavior therapy (CBT) or a combination of behavior therapy (BT) and CBT compared to BT and family therapy. Individual treatments resulted in larger changes in aggressive behaviour as compared to group treatments or a combination of these. Treatment effects for both conduct problems and the presumed mediators seem to last, but changes were small. Few studies included teenagers and knowledge of lasting treatment effects is limited for older children including CBT treatments. More knowledge of the mediators involved in treatment is needed, in particular for cognitive and family therapeutic interventions.

Application comparison between bundle nursing and traditional nursing for children with Kawasaki disease

Objective To compare the application effect of bundle nursing and traditional nursing in children with Kawasaki disease (KD). Methods Totals of 120 KD children had been randomly divided into two groups on average: experimental group and control group. The children were given conventional nursing combined bundle nursing in the experimental group, while the children acquired routine treatment in the control group. Bundle nursing involved service attitude, technical capacity, communication, health education and ward management. The satisfaction degree of nursing job and children clinical index were analyzed. Results The level of the service attitude, technical capacity, communication, health education and ward management were (4.24±0.64), (4.37±0.56), (4.28±0.64), (4.34±0.60) and (4.34±0.64) respectively in the experimental group and that of them in the control group were (3.67±0.83), (3.99±0.81), (3.64±0.81), (3.52±1.10) and (3.55±1.04) (t=4.21, 2.99, 4.80, 5.07, 5.01, respectively; P<0.05). The average time of defervescence, the value of hemameba and C-reactive protein and the days of hospitalization in the experimental group(3.67±1.73)d, (9.17±1.79)×109/L, (30.66±2.81)μg/ml and (7.39±2.65)d respectively, which were lower than that of the control group (t=2.34, 5.72, 10.42, 2.21, respectively; P<0.05). Conclusions The bundle nursing can dramatically improve the treatment effect in children with KD. Key words: Mucocutaneous lymph node syndrome(MCLS); Satisfaction; Bundle nursing; Children

Influence of nursing intervention on treatment effect of children with severe hand, foot and mouth disease

Objective To explore the effect of nursing intervention on children with severe hand, foot and mouth disease. Methotis A total of 60 cases of severe hand, foot and mouth disease children treated in our hospital from 2012 February to 2013 February were randomly divided into the observation group and the control group, the control group was received routine nursing care, the observation group was given comprehensive nursing, nursing effects were compared between the two groups. Results The awareness rate of health knowledge of parents in the observation group was significantly higher than that in the control group, high fever subsided, bleb subsided, into ICU cases, complications, hospitalization time were significantly less than those in the control group, life ability was significantly higher than that in the control group, with statistical significance （ P 〈 0. 05 ）. Quality life grading score in anxiety, living standard, standard body standards in the observation group were significantly higher than those in the control group, with statistical significance （P 〈 0. 05 ） . Conclusions The comprehensive nursing intervention is to make nursing more comprehensive, specific, targeted, it can significantly improve the prognosis of severe hand, foot and mouth disease, shorten treatment time, and reduce the complications. Key words: Nursing intervention; Severe hand, foot and mouth disease; Treatment effect; Comprehensive

How safe is a standard-risk child with ALL?

Treatment of childhood cancer is one of the major success stories of modern medicine, showing the benefits of multidisciplinary, centralised treatment and high-quality supportive care. For acute lymphoblastic leukaemia (ALL)—the most common childhood cancer—overall 5-year survival is now greater than 85%. 1 Pui CH Mullighan CG Evans WE Relling MV Pediatric acute lymphoblastic leukemia: where are we going and how do we get there?. Blood. 2012; 120: 1165-1174 Crossref PubMed Scopus (399) Google Scholar Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohortThe prevalence of adverse long-term outcomes in children treated for standard risk acute lymphoblastic leukaemia according to contemporary protocols is low, but regular care from a knowledgeable primary-care practitioner is warranted. Full-Text PDF

Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort

Treatment of patients with paediatric acute lymphoblastic leukaemia has evolved such that the risk of late effects in survivors treated in accordance with contemporary protocols could be different from that noted in those treated decades ago. We aimed to estimate the risk of late effects in children with standard-risk acute lymphoblastic leukaemia treated with contemporary protocols. We used data from similarly treated members of the Childhood Cancer Survivor Study cohort. The Childhood Cancer Survivor Study is a multicentre, North American study of 5-year survivors of childhood cancer diagnosed between 1970 and 1986. We included cohort members if they were aged 1·0-9·9 years at the time of diagnosis of acute lymphoblastic leukaemia and had received treatment consistent with contemporary standard-risk protocols for acute lymphoblastic leukaemia. We calculated mortality rates and standardised mortality ratios, stratified by sex and survival time, after diagnosis of acute lymphoblastic leukaemia. We calculated standardised incidence ratios and absolute excess risk for subsequent neoplasms with age-specific, sex-specific, and calendar-year-specific rates from the Surveillance, Epidemiology and End Results Program. Outcomes were compared with a sibling cohort and the general US population. We included 556 (13%) of 4329 cohort members treated for acute lymphoblastic leukaemia. Median follow-up of the survivors from 5 years after diagnosis was 18·4 years (range 0·0-33·0). 28 (5%) of 556 participants had died (standardised mortality ratio 3·5, 95% CI 2·3-5·0). 16 (57%) deaths were due to causes other than recurrence of acute lymphoblastic leukaemia. Six (1%) survivors developed a subsequent malignant neoplasm (standardised incidence ratio 2·6, 95% CI 1·0-5·7). 107 participants (95% CI 81-193) in each group would need to be followed-up for 1 year to observe one extra chronic health disorder in the survivor group compared with the sibling group. 415 participants (376-939) in each group would need to be followed-up for 1 year to observe one extra severe, life-threatening, or fatal disorder in the group of survivors. Survivors did not differ from siblings in their educational attainment, rate of marriage, or independent living. The prevalence of adverse long-term outcomes in children treated for standard risk acute lymphoblastic leukaemia according to contemporary protocols is low, but regular care from a knowledgeable primary-care practitioner is warranted. National Cancer Institute, American Lebanese-Syrian Associated Charities, Swiss Cancer Research.

Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions

Objective To evaluate the effectiveness of current medical and psychological interventions for individuals at risk of sexually abusing children, both in known abusers and those at risk of abusing.Design Systematic...

Mechanisms and management of growth impairment in children affected by inflammatory bowel disease

Growth failure is a typical complication of pediatric inflammatory bowel disease. Factors responsible for stunting are multiple, and proinflammatory cytokines such as TNF-α and IL-6 play a pivotal role. Other determinants are disease severity and location, malnutrition, increased nutritional needs, genetics and drugs. The achievement of optimal linear growth and the remission of gastrointestinal symptoms are the principal targets of pediatric inflammatory bowel disease treatment. Thus, it is very important to assess and monitor linear growth at diagnosis and during follow-up of disease until final adult height achievement. The main strategies for management or prevention of growth impairment in these children are aimed to ensure optimal nutrition, obtain a rapid and complete remission of the disease avoiding or minimizing steroid usage and consider surgical resection, in particular in case of localized ileo or ileocecal disease, to achieve remission in early or mid-puberty. In the last few years, some authors have evaluated the effects of recombinant human growth hormone treatment in children and adolescents with inflammatory bowel disease. However, further studies are needed to better assess its efficacy.

Voriconazole Induced Bradycardia

Voriconazole is a triazole antifungal drug that is used to treat invasive fungal infections, especially aspergillus. Here, we report two children who had severe bradycardia associated with voriconazole at a dose of 12 mg/kg per day. Bradycardia resolved in 24 hours in both after decreasing the dose to 10 mg/kg per day. Heart rates were in normal limits on follow-up. Bradycardia may be a side effect of voriconazole treatment in children under immunosuppressive treatment. Heart rate should be monitored in patients receiving voriconazole and other triazole treatments.

Effectiveness of early oseltamivir treatment in children with pandemic 2009 A/H1N1 influenza in the Vilnius University Children Hospital

Background. Oseltamivir is recommended for treatment of pandemic influenza in children. The therapy should be started as soon as possible, however, data on the effectiveness of such a treatment is rather limited. This study was accomplished in order to evaluate the effectiveness of oseltamivir depending on the time of the beginning of treatment. Materials and methods. Medical records of 72 children hospitalised to the Vilnius University Children’s Hospital (VUCH) because of laboratory confirmed pandemic influenza during November–December 2009 were analysed retrospectively. Duration of fever and frequency of complications in children treated with oseltamivir starting on days 1–2 and those who were started to treat ≥day 3 from the beginning of flu symptoms were compared to those who did not receive oseltamivir. Results. 40 patients were treated with oseltamivir: 20 children were commenced on treatment within 48 hours of their illness and the other 20 were started on oseltamivir on day 3 or later. 32 children were not treated with oseltamivir. Fever lasted 2.1 ± 0.8 days if the treatment with oseltamivir was started within 48 hours of illness and 4.1 ± 1.9 days if the treatment was started later (p

3034 – Efficacy of antidepressant and psychotherapeutic treatments in child and adult depression and anxiety

Depressive and anxiety disorders are prevalent psychiatric disorders that often start early in life. Heterotypic association between depression and anxiety has been well documented, with anxiety typically preceding depression in childhood and adolescence, while a more complex pattern of co-occurrence has been described for adult-onset illness. Even when starting early in life, depression and anxiety disorders are associated with poor outcomes, including not only psychiatric, social and vocational outcomes, but also development of physical problems. Although remission rates are high, in most cases episodes tend to recur, with increasing severity with every recurrence. Identification and treatment of these conditions, therefore, is of outmost importance regardless their age of onset. However, therapeutic approaches must take into account the effect of development in their clinical presentation, the differential efficacy of the therapeutic approaches, and the adverse effects profile. Current treatment algorithms for depressive and anxiety disorders include psychotherapeutic and psychopharmachological approaches and their combination. Although up until recently most treatment evidence came from adult studies, recent developments have increased knowledge on efficacy of interventions for younger populations. Treatment effects in children and adolescents are lower than in adults, partially due to the high placebo effect in youth. This presentation will provide an overview of the current approach to the treatment of depression and anxiety. Specificity of treatment at early ages will be stressed out. New promising treatments and their potential utility will be also discussed.

Is there sufficient evidence to consider the use of 11β-hydroxysteroid dehydrogenase type 1 inhibition in children?

Manifestations of the metabolic syndrome [obesity, dyslipidaemia, hypertension, blood glucose derangements including prediabetes or type 2 diabetes mellitus (T2DM)] in juvenile populations are becoming increasingly prevalent throughout the world and are at the point of being a global public health concern. Derangements in cortisol regeneration seem to be involved in the pathophysiology. Treatment with selective 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) inhibitors could be a therapeutic strategy in paediatric patients with manifestations of the metabolic syndrome. Based on preclinical and clinical data regarding development of the 11β-HSD1 enzyme, it appears that maturation occurs within the first year of life. Different changes in biomarkers for assessing the efficacy and safety of 11β-HSD1 inhibitors are to be expected in paediatric patients compared to adults, reflecting differences in metabolism. The effect of 11β-HSD1 treatment in children on bone differentiation and development as well as adrenocorticotropic hormone (ACTH), circulating and local cortisol tissue concentrations, androgens and respective stress response is not yet known. Based on current literature, the concept of inhibition of 11β-HSD1 is considered a potentially effective mean to regulate local cortisol levels in the paediatric population, and 11β-HSD1 inhibitors may provide a valuable target and treatment option for the metabolic syndrome in paediatric patients. However, the uncertainty over effects on the developing skeleton combined with mild increases in adrenal androgen levels raises potential concerns regarding growth as well as onset of puberty as to their future use in children. Future clinical studies are needed to thoroughly assess the risks and benefits of this new class of drugs in the paediatric population.

Parental Factors That Detract From the Effectiveness of Cognitive-Behavioral Treatment for Childhood Anxiety: Recommendations for Practitioners

This article reviews the recent empirical literature on the various parental factors that detract from the effectiveness of cognitive-behavioral treatment for children with anxiety. Interventions such as treating parental anxiety and increasing parental involvement in the therapeutic process may combat these factors. Newer strategies such as parent-training techniques and family cognitive-behavioral therapy offer some promise, though the combined outcomes of randomized clinical trials are admittedly mixed. In integrating the findings of these studies, the consideration of the child's autonomous development becomes paramount. The article concludes with recommendations for practitioners, offered for children, adolescents, and parents presenting with general anxiety-related issues.

Short- and long-term effects of a lactose-restricted diet and probiotics in children with chronic abdominal pain: A retrospective study

ObjectiveTo determine the short- and long-term effect of treatment in children with chronic abdominal pain (CAP). MethodsA database with the results of H2 breath test of children with CAP was created. All children with an abnormal test result were included and classified as small intestinal bacterial overgrowth (SIBO) or lactose intolerant (LTI). SIBO was treated with probiotics and LTI with a lactose-restricted diet. CAP was evaluated 5 months and 15 months after the test. Results37 children (41%) were included. 17 LTI children (94%) improved after 5 months and 11 children (61%) after 15 months (P<0.05). Seven SIBO children improved after 5 months and 4 children after 15 months. In the combination group all 4 children improved after 5 months and 3 children after 15 months. ConclusionChildren with CAP caused by LTI or SIBO had less CAP after 5 months. This positive effect persists only in half of the children.

The effect of nursing intervention on children with functional constipation

Objective To study the effect of nursing intervention on children with functional constipation.Methods A total of 150 cases of children outpatients with functional constipation were selected and divided into two groups randomly. 75 patients in control group were treated with routine nursing and 75 cases in experimental group were treated with nursing intervention according with children and their parents including psychological nursing, the training of defecation habit, nutrition treatment, the guidance of moderate exercise and abdomen massage. The difference of treatment effect was observed.Results There were significant differences on treatment effect comparing two groups.Conclusions The detailed and thorough nursing intervention combined with drug treatment can promote the treatment effect of children with functional constipation. Key words: Children; Functional constipation; Nursing intervention