Worried Parents Research Articles

Pattern of pathological cutaneous lesions of neonates in neonatal care unit of a peripheral tertiary institution in West Bengal

Background: A variety of cutaneous disorders have been found in neonatal period. These disorders may be physiological or pathological, temporary or permanent, congenital or acquired. Most of the skin lesions are benign, transient and physiological. Aims and Objectives: To study the incidence of pathological cutaneous disorders of neonates in the neonatal care unit and compare these with other studies in India and also the world. Materials and Methods: It was a hospital based observational, descriptive study. Study duration was one year. Study population was the all admitted neonates in neonatal care unit in peripheral tertiary institution. The study sample size was 108 neonates. We used Chi-square test to evaluate the P value. P value of less than 0.05 was accepted as statistically significant. Results: We found 47 neonates (43.52%) as infective skin disorders, 21 cases (19.44%) as naevi and other developmental disorders, 10 cases each (9.26%) as keratinization disorder and eczematous conditions. 19 neonates (17.59%) were put into miscellaneous group. Among the infective disorders, we found 21 cases of bacterial infections, 18 cases of fungal infections, 6 cases of viral infections. Other important findings were of six aplasia cutis congenita cases, five cases of collodion babies, one harlequin baby, two cases of unilateral digital gangrene of upper limb etc. None of the neonatal dermatosis had shown significance (P > 0.05). Inadequate sample size was the possible cause for these results. Conclusion: The pattern of pathological dermatoses was evaluated. An effective knowledge about these dermatoses will be helpful to the Dermatologists and also Pediatricians for proper treatment and to assure the worried parents.

Speaking of Sterilization: Rumors, the Urban Poor, and the Public Sphere in Greater Mexico City

Abstract In 1974, rumors spread that the Mexican government and foreign doctors were colluding to sterilize schoolchildren. The allegations sparked panic across the Valley of Mexico and prompted popular protests and school closures. Public officials and mainstream journalists portrayed worried parents as ignorant pawns in a conservative conspiracy. Ordinary residents and leftist groups, meanwhile, accused the government of using family planning to uproot opposition or even to eliminate the poor. This article analyzes the epistemological contests that surfaced in response to the rumors. Contrary to the claims of cultural and political elites, hearsay was not opposed to informed engagement but rather an integral component of it. As literacy, readerships, and political consciousness increased, so too did the efforts to understand and influence the news by talking about it. At the center of Mexico City's protracted political opening were debates over what counted as legitimate knowledge production.

A Uniquely Abnormal Stool Specimen: A Case Report

BackgroundAutoamputation of the appendix is a condition associated with the Ladd's procedure, a pediatric surgical technique for correction of intestinal malrotation. A 4-year-old male patient with a history of a Ladd's procedure performed as a newborn was brought in by his mother for “passing intestine” just prior to arrival. She reported that for several weeks her son had intermittent, crampy abdominal pain that resolved after the unusual-appearing bowel movement. After reviewing an image of the bowel movement, and in consultation with pediatric surgery, it was concluded that the patient had passed a devascularized appendix in his stool immediately prior to arrival. Case ReportA 4-year-old boy with a past medical history of heterotaxy syndrome (inversion of the thoraco-abdominal organs), a double outlet right ventricle, and Ladd's procedure presented to the Emergency Department (ED) after “passing intestine” in his stool. Close examination of the photo demonstrated a tubular structure with taenia, consistent with an appendix. Why Should an Emergency Physician Be Aware of This?Autoamputation of the appendix is an uncommon presentation in the ED. Passing a devascularized appendix is a benign condition and can present with weeks of intermittent abdominal pain that resolves with passage of appendix in the stool. Remnants of the appendix can remain within the intestinal lumen years after the Ladd's procedure. Emergency physicians with a general awareness of this rare phenomenon can confidently make the diagnosis and reassure worried parents.

Unnecessary Brain CT scan of Traumatic Pediatric Patients; How to Reduce the Numbers?

There are considerable rates of pediatrics trauma referring emergency department following a traumatic event. The worried parents are requesting for the most sensitive diagnostic test, so emergency physicians ask them to underwent brain computed tomography (CT) scan. Lower threshold of decision making regarding use of brain CT scan results in huge number of normal imaging. On the other hand, radiation exposer of the child may accompanied with lots of side effects in future. It may highlight a question that “how to reduce the numbers of unnecessary brain CT scan of traumatic pediatric patients?”

In Search of an Answer

In Search of an Answer

The science of persuasion.

Vaccines save lives. But what is the most effective way to convince worried parents?

English

Time is a major theme in John Green's young adult and romantic novel, The Fault in our Stars (2012). Green spent ten years trying to write the book. Even though Hazel and Gus experience typical teenage problems, as well as extreme physical hardships and psychological conflicts due to their cancer disease, they still manage to have a great time together. They fall in love with one another, meet their favorite author, and share a common interest in reading books. They decide to live a life that could be short overflowing with content, notwithstanding their impending death, breathing tubes and worried parents. In this paper, I choose to approach the notion of time that passes in the narrative and how it plays out through the structure of TFIOS based on the narrative theory of time by Paul Ricoeur in his book Narrative and Time (1984). Ricoeur’s 'unfolding representative stages' are called threefold mimesis—prefiguration (pre-understanding), configuration (emplotment), and refiguration (embedded contextuality)—all three are used to create a triadic bridge model of structural relations between narrative and time. However, it is Green himself who offers the greatest insight into his work. Through his readings, writings, the Vlogbrothers channel and interviews, he provides the readers with tools to share his imaginative vision and empathetic character portrayals. A major influence on the development of TFIOS was Esther Earl, a concrete case of a girl who died of cancer at the age of 16. The structural time devices in TFIOS are not always linear, but also synoptic conveying the narrative formations of time. Elements like flashbacks and flashforwards are employed. Green deals with time as duration, both chronological and psychological, the time it takes a reader to actually read and time as an organizational device. Time is also a subject both Green and the characters speculate about, particularly in their fear of oblivion and their need to be remembered after death. The author presents how time passes and how a disease like cancer affects young adolescents in real life. Key words: 21st-Century young adult literature, romantic narrative, time, John Green, TFIOS, life and death, cancer disease, teenage issues.

The Health Centre Community.

The greatest burden of malaria is borne by the children of rural sub-Saharan Africa. Each year nearly 90% of all malaria-related deaths occur in these remote areas, far from lifesaving medical care. In the Bugoye sub-county of rural Western Uganda, most families subsist on small plots of staple crops carved into the hillsides. Lacking transportation, worried parents carry their sick children down the narrow mountain paths to the health centre in search of care (Figure 1). The Level III Health Centre in Bugoye is the only facility in the sub-county—an area spanning more than 40 villages and nearly 60 km—equipped to treat cases of severe malaria. During the high season, hundreds of malaria-stricken children come to the health centre each week for diagnosis and treatment (Figure 2). Like many public health facilities in rural sub-Saharan Africa, the Bugoye Health Centre faces many challenges, including drug shortages, unreliable electrical power and inadequate staffing. The health centre is not shiny or new. There are no private rooms. The unfinished cement floors are cracked, the paint is peeling, the thin foam mattresses are worn and tattered and most of the equipment is decades old (Figure 3). What Bugoye does have, however, is a vibrant sense of community. In many ways, the health centre has the atmosphere of a bustling village unto itself. It is the heart of the sub-county. Entire families inhabit the wards, providing food, linen and clothing for their sick loved ones (Figures 4 and 5).The bright colours of children in church clothes dot the yard and groups of women gather behind the clinic, preparing meals over open fires (Figure 6). Village officials, health centre staff and local tradesmen sit on the benches at the front to wave to friends, chat about

Manchester Triage System: main flowcharts, discriminators and outcomes of a pediatric emergency care

ABSTRACTObjetive: to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender), main flowcharts, discriminators and outcomes in pediatric emergency Method: cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. Results: 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%), aged between 29 days and two years (44.5%). There was a prevalence of the urgent risk category (43.6%). The main flowchart used in the care was worried parents (22.4%) and the most prevalent discriminator was recent event (15.3%). The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. Conclusion: worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital.

Rampage Killings on Campus

Abstract Despite the exceptionally low rate of homicide on college and university campuses, a few high-profile murder sprees have altered the once care-free sense of safety for many students along with their worried parents. In this article, we examine the common characteristics of multiple-victim campus homicides, particularly shootings, analyzing the right-skewed age distribution of the perpetrators, as well as the overrepresentation of current and former graduate and professional students among the assailants. Finally, responses to the perceived threat are evaluated for effectiveness.

Upper Respiratory Tract Infections.

1. Benjamin Weintraub, MD* 1. *Marblehead Pediatrics, Marblehead, MA. 1. 1. Revai K, 2. Dobbs LA Incidence of Acute Otitis Media and Sinusitis Complicating Upper Respiratory Tract Infections: The Effect of Age. Revai K, Dobbs LA. Pediatrics. 2007;119e:1408–1412 [OpenUrl][1][CrossRef][2] 2. 1. Hersh AL, 2. Jackson MA Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics. Hersh AL, Jackson MA. Pediatrics. 2013;132:1146–1152 [OpenUrl][3][Abstract/FREE Full Text][4] 3. 1. Wald ER, 2. Guerra N Upper Respiratory Tract Infections in Young Children: Duration of and Frequency of Complications. Wald ER, Guerra N. Pediatrics. 1991;87:129–133 [OpenUrl][5][Abstract/FREE Full Text][6] 4. 1. Pickering LK, 2. Baker CJ, 3. Kimberlin DW, 4. et al. Red Book: 2012 Report of the Committee on Infectious Diseases. Pickering LK, Baker CJ, Kimberlin DW, et al., eds. Elk Grove Village,IL: American Academy of Pediatrics; 2012:220–222; 533–535; 609–618; 619–620 Every day worried parents bring their children to clinicians for evaluation of coughs, runny noses, and sore throats. Most of these children have a simple cold and only require reassurance. However, clinicians must remain vigilant to not overlook a more severe possibility, such as secondary bacterial infection, an asthma exacerbation, or perhaps a foreign body. After ruling out a more severe issue, the most likely possibility is an everyday viral infection. These upper respiratory tract infections (URIs) and pharyngeal infections have many causes, but their presentations tend to follow similar patterns, which allow clinicians to reassure and advise worried parents. On average, children are infected with two to eight URIs annually in the first 2 years after birth; those who attend day care may have as many as 14 annually. Even older children and adults may experience three to six URIs a year. In the United States, infants in the first year after birth experience an estimated 12 to 32 million URIs annually, and older children as many as 200 million. These viral illnesses result in millions of office visits and more than 10 million antibiotic prescriptions every year. The risk of secondary bacterial infections with URIs has been estimated at 0.5% up to as high as 5% to 10% for acute bacterial sinusitis. For acute otitis media, the estimated risk is up to 36% in infants younger than 1 year of age, decreasing to 15% for children 2 to 3 years old. Unfortunately, for the more than 2 million cases of acute bronchitis diagnosed annually in children, approximately 70% result in a prescription for an antibiotic, despite the lack of any … [1]: {openurl}?query=rft.jtitle%253DPediatrics.%26rft.volume%253D119%26rft.spage%253D1408%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.2006-2881%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1542/peds.2006-2881&link_type=DOI [3]: {openurl}?query=rft.jtitle%253DPediatrics.%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.2013-3260%26rft_id%253Dinfo%253Apmid%252F24249823%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=132/6/1146&atom=%2Fpedsinreview%2F36%2F12%2F554.atom [5]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.aulast%253DWald%26rft.auinit1%253DE.%2BR.%26rft.volume%253D87%26rft.issue%253D2%26rft.spage%253D129%26rft.epage%253D133%26rft.atitle%253DUpper%2BRespiratory%2BTract%2BInfections%2Bin%2BYoung%2BChildren%253A%2BDuration%2Bof%2Band%2BFrequency%2Bof%2BComplications%26rft_id%253Dinfo%253Apmid%252F1987522%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=87/2/129&atom=%2Fpedsinreview%2F36%2F12%2F554.atom

Upper Respiratory Tract Infections

Upper Respiratory Tract Infections

Invited Commentary: When the Doctor Becomes the Father of the Patient

Perhaps the most difficult of times for a physician is when we or our loved ones are the patient. The system in which we have so much experience can become a black hole of confusion, miscommunication, incompetence, and misinformation. The following is a description of my own path as I transitioned from a skilled physician to a worried parent to a traumatized parent. Fortunately, this story appears to be resolving well, making it easier to share with my colleagues. I hope this affords you a better understanding of our patients and their families' journeys in the morass of diagnostic dilemmas and treatment options. This narrative represents what some unfortunate patients go through. As treating physicians we would benefit to better acquaint ourselves with our patient’s path to our front door.

Female Circumcision and Clitoridectomy in the United States: A History of a Medical Treatment

For Americans who think that female genital cutting is a barbarity confined to darkest Africa and parts of the Islamic world, Sarah Rodriguez's detailed history of female circumcision in the United States will come as a revelation and perhaps a shock. In her impressively researched study the author considers the social rationale of such practices and their relationship with changing theories of anatomy, physiology, sexual behaviour and gender relations. In pursuit of these themes four types of circumcision are examined in detail: clitoridectomy; excision of all or part of the clitoral hood (female prepuce); removal of accumulated smegma beneath the hood; and breaking down the adhesions between the hood and the clitoris. These procedures were performed for three basic reasons: to discourage masturbation; to correct homosexuality or “hypersexuality”; or to enhance the capacity for orgasm during intercourse. Introduced in the late nineteenth century at the height of the childhood masturbation scare, clitoridectomy had a brief and limited respectability, usually performed on girls at the behest of worried parents, though occasionally at the request of adult women. There is not much evidence that clitoridectomy was widely employed to treat lesbianism or hypersexuality, though there are certainly cases of parents wanting the “large” clitorises of their daughters trimmed down to a “normal” size. Among professionals, there was much indecisive debate about whether lesbians and African women had abnormally large genitals (i.e. larger than those of white middle class Americans), but the conclusion of the gynaecologist whom Rodriguez regards as the most reliable authority on such questions (Robert Dickinson) seems to have been that there was wide variation among women of all races and that no firm standards could be set.

FIX FREDDIE! – PULLING STRINGS TO REDUCE PRESSURE ON MINORS

Objectives & BackgroundEmergency and urgent care workload is becoming unsustainable.1 2NW London has higher than average use of unscheduled care;3significant proportion with low acuity conditions.2 4 5As a paediatric emergency care provider, Imperial College Healthcare (ICHT) recognise a need to become proactive in tackling this challenge. ICHT collaborated with a professional puppet company to produce Fix Freddie!6A pilot tour ran in NW London March and April 2014. Objectives included:better understanding of how local community accesses unscheduled caregathering professionals across the whole system to support families in feeling confident to navigate system and care for their children's health needsreducing pressures on unscheduled care systemMethodsPilot tour explored different settings and workshop styles. Audience 484 children, 134 adults(image1)Parents and carers asked to complete pre show questionnaire about child health and services. After the show issues raised explored in various ways:small parent focus groupsclassroom-based discussionfete style event promoting conversations with professionalsFeedback obtained with Post-It comments on “Freddie Feedback” poster(image 2).Filmed to capture impact of events on children, parents, professionals.Leaflet distributed with information about how to seek advice, self management and local services.Results:Pre show questionnaireCompleted by 46 parents of 85 children. 53% white british; 47% diverse ethnicies.Chart A -How they seek child health advice(image 3)Chart B -Services use when worried(image 3)Parents consistently worried by fever: 52% would seek GP review 41% would go to ED.Attended ED and the GP with similar illnesses.26% reported issues in accessing care, primarily lack of same day GP appointments.Key themes surfaced from Fix Freddie! Feedback(image 4)Better understanding of local services, notably 111Improved confidence managing minor ailmentsPositive feedback for puppet show and eventsImmediate impact captured on film, currently being analysed. Short documentary being produced by June 2014.ConclusionFix Freddie! has provided a fun and engaging way to make connections across the whole system, facilitating co-design of local solutions to problems of healthcare accessibility and confidence in self management. Local CCG commissioners are keen to fund a wider local tour and we are looking at next steps to broaden the reach of events.

It's Just a Virus! Viral Etiologies of Fever Without a Source

Colvin JM, Muenzer JT, Jaffe DM, et al. Detection of viruses in young children with fever without an apparent source. Pediatrics. 2012; 130(6): e1455-e1462; doi: 10.1542/peds.2012-1391Investigators from Washington University, St. Louis and Biological Mimetics, Inc., Frederick, MD conducted a study to better understand the viral etiologies of fever without an apparent source (FWS) in young children. Children aged 2 to 36 months who presented to the emergency department (ED) at St. Louis Children’s Hospital with a temperature of ≥38°C without an apparent source and who had blood obtained for clinical management were enrolled. Children with symptoms suggestive of a viral respiratory infection or who had a positive rapid test for influenza were excluded. Two comparison groups of children were also enrolled: (1) children aged 2 to 36 months who presented to the ED with a temperature of ≥38°C but had a probable or definite bacterial infection, and (2) afebrile children aged 2 to 36 months who were having an ambulatory surgical procedure. Blood and/or nasopharyngeal (NP) specimens were collected from study children. Polymerase chain reaction (PCR) testing was used to identify viruses. The main outcome was the type and frequency of viruses detected in each study group. Secondary outcomes were antibiotic utilization among children with FWS and demographic and clinical variables associated with viral infection.A total of 206 children were enrolled: 75 with FWS, 15 with fever and a probable or definite bacterial infection, and 116 who were afebrile. All children with bacterial infection and 29% of children with FWS were hospitalized. Viruses were detected in 76% of children with FWS, 40% with bacterial infection, and 35% who were afebrile (P < .001). The viruses identified most frequently in children with FWS were adenovirus, human herpesvirus-6 (HHV-6), and enterovirus. Each was detected significantly more frequently in those with FWS (identified in 57%) than in those with bacterial infection (13%) or who were afebrile (7%). Epstein-Barr virus was the most commonly detected virus in children with bacterial infection (23%) and rhinovirus was the most commonly detected in afebrile subjects (16%). Children with FWS were significantly more likely to have >1 virus identified and to have a virus detected from their blood or NP specimen than children in the bacterial or control groups. Among children with FWS, 45% received antibiotics, including 91% of those who had adenovirus. The only significant demographic or clinical characteristic of children who had adenovirus, HHV-6, or enterovirus infection compared to children with no virus detected was that the white blood count was more likely to be >15,000 cells/mm3 in children who had adenovirus (P = .003).The authors conclude that viruses are frequently detected in children aged 2 to 36 months with FWS and that use of blood specimens for virus detection could increase virus identification and decrease empiric antibacterial treatment.This important study has several limitations. First, the investigators did not enroll all eligible children with FWS but only those who presented to the ED when study personnel were working. This introduces selection bias. Second, the inclusion criterion requiring that blood work be ordered by the treating provider as part of the clinical work-up introduces additional bias, as those with FWS for whom no blood work was ordered were excluded. Third, detection of a virus does not mean that the virus was responsible for the child’s fever, although the viruses most frequently identified in the febrile children are typically thought to be pathogenic (and many of those found in the afebrile cohort are thought to have low pathogenicity). Finally, virus detection was limited to blood and NP specimens in this study. Notably, stool specimens, which may increase virologic yield, were not included.The management of FWS has evolved along with the vaccination landscape: occult bacteremia has essentially disappeared in highly-vaccinated populations.1 Increasingly, febrile infants and young children with an unrevealing physical examination may have either a urinary tract infection2 or “a virus.” While worried parents may balk at the “it’s just a virus” diagnosis, this study gives it credence. Of note, the yield of virus-specific diagnoses increased from 49% with the use of PCR on NP specimens (which is the standard of care in most pediatric hospitals) to 76% when both NP and blood were assayed by PCR. These findings suggest, among other things, that the application of new technologies will improve our ability to render a specific diagnosis for febrile illnesses in young children. (See also AAP Grand Rounds, June 2012;27[6]:65.3)

Parents’ experiences of their child’s first anaesthetic in day surgery

Parents play an important part in their child's anaesthesia. When a child has to receive anaesthesia, it is of great importance that parents are there by his/her side as children depend on them for support. Many parents worry and experience fear before their child's anaesthesia and studies show that there is a correlation between a worried parent and a worried child. The purpose of this study was to illustrate the meaning of being a parent at one's child's first anaesthesia in day surgery. Six parents were interviewed and data were analysed using a descriptive qualitative approach inspired by phenomenology. The phenomenon, 'a child's first anaesthesia in day surgery as experienced by parents' is based on the following components: ambivalence between worry and relief, a feeling of losing control, needing to be prepared, being able to be present and a need of emotional support. Specific individually-adapted information with a compulsory preoperative visit, presence and participation from, if possible, both parents at their child's anaesthesia but also designated staff from the anaesthetic team to focus solely on supporting the parents at their child's anaesthesia induction can improve the conditions for security.

Sleep, fatigue, depression, and quality of life in survivors of childhood acute lymphoblastic leukemia

With the improved survival of childhood acute lymphoblastic leukemia (ALL), the effect of treatment on psychosocial well-being becomes increasingly relevant. Literature on sleep and fatigue during treatment is emerging. However, information on these subjects after treatment is sparse. This cross-sectional study examined sleep and fatigue in relation to depression and quality of life (QoL) after treatment for childhood ALL. Sleep, fatigue, depression, and QoL were evaluated by parent proxy and/or child self-reports of the Children's Sleep Habits Questionnaire, the PedsQL™ multidimensional fatigue scale, the Children's Depression Inventory and the Child Health Questionnaire. All total scores were compared to Dutch norm references. Sixty-two children were included, being 36 (interquartile range 22-62) months after finishing treatment. Parents rated the ALL survivors as having more disturbed sleep, more fatigue and poorer physical QoL compared to the Dutch norm. ALL survivors themselves reported less sleep problems, less depressive symptoms, and better psychosocial QoL than the Dutch norm. More sleep disturbances and fatigue correlated with more symptoms of depression and a worse QoL. Differences in parental and self-reports, including worse parental ratings, might be explained by worried parents and/or the adaptive style of the children. Impaired sleep and fatigue correlated with more depressive symptoms and a worse QoL.

Burnout among Workers in a Pediatric Health Care System

Burnout among health care workers is recognized as an organizational risk contributing to absenteeism, presenteeism, excessive turnover, or illness, and may also manifest as decreased patient satisfaction. Pediatric health care may add stressors including worried parents of ill or dying children, child custody issues, child abuse, and workplace violence. The purpose of this study was to measure burnout among workers in a regional pediatric health care system and report whether burnout in a pediatric health care system is different from previously published data on human service workers. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Copenhagen Burnout Inventory (CBI) were used to measure burnout. Pediatric health care workers expressed significantly less burnout as compared to published MBI-HSS scores and client-related CBI scores. Personal burnout CBI scores were not different, but work-related CBI scores were significantly higher than normative scores.

Varicella immunity and vaccine response in children with juvenile idiopathic arthritis treated with DMARD

Background There is a risk of developing serious complications of varicella zoster infection (VZI) in juvenile idiopathic arthritis (JIA) patients receiving disease modifying antirheumatic drugs (DMARD) including methotrexate and biologic agents [1,2]. Varicella zoster (VZ) immune status should therefore be checked in all children before starting such therapy. Seronegative children mostly receive varicella zoster vaccine (VZV). Vaccination may prevent worried parents and reduce the need for VZ immunoglobulin, intravenous acyclovir treatment and hospitalization.