Journal of paediatrics and child health最新文献

Aim: This review aimed to evaluate the impact of school-based hand hygiene interventions on infectious disease outcomes in school populations.

Methods: A PROSPERO registered review (CRD42024620293) followed by Cochrane methodology MEDLINE, Embase, PubMed and ERIC formed the databases that received the search. The study included English-language research from 2014 to the present that examined school children in educational settings with quantifiable hand hygiene-disease relationships. The screening process and appraisal followed the Critical Appraisal Skills Programme (CASP) checklist.

Results: The search produced 4345 records from which 33 studies qualified for inclusion. The interventions included educational programmes and handwashing facilities together with hand sanitiser distribution and Water, Sanitation and Hygiene (WASH) programmes that combined multiple components. Education-only interventions reduced upper respiratory infection-related absences by up to 50%. Soap and water handwashing combined with sanitiser reduced acute gastroenteritis absences by 36%. Integrated WASH programmes lowered diarrhoea and respiratory illness absences. Parental involvement further enhanced effectiveness.

Conclusions: Hand hygiene programmes are most effective when combining education, resources and behaviour change. Their success depends on context, infrastructure and delivery. While reducing disease and absenteeism, challenges like dermatitis and non-compliance remain. Tailored, inclusive approaches and policy-level investment are needed to ensure sustainable, evidence-based impact in schools.

Empathy abounds in paediatrics and is deemed a valuable trait that enhances child and family care. Concurrently, research indicates there has been a decline in paediatric training applications, both medical and nursing, and there are challenges to workforce retention related to empathy exhaustion. While the cause is unclear and likely multifactorial, there may be a correlation with empathy levels, requiring analysis by policy makers and governing bodies. Empathy is a disposition, generally understood as cognitive or affective, and I propose here that clinician empathy exists on a continuum. At the affective extreme, there may be an intense emotional transference or pathological empathy response-I use the portmanteau 'empathological' to describe this. Further, that this response may be associated with negative sequelae, and compromise child and family care when complexity, uncertainty, and tragedy co-occur. Identifying the appropriate empathy dose and duration is therefore key to mitigate harm to all parties. Developing strategies to harness empathy by judiciously employing reason and moral theory could be protective. To help understand empathy bounds and balance, I outline the moral foundations of clinical empathy and weigh its benefits and burdens in clinical settings. I conclude that reasoned empathy, which draws on specific elements of Paul Bloom's analysis of rational compassion, allows for engaging empathetically with children and families without paralysing moral action by overly deeply relating to tragic circumstances. Attending to a form of reasoned empathy could ultimately inform healthcare staff selection and training to sustain a healthier paediatric workforce, and lead to better care for sick children.

Objective: The Victorian Virtual Emergency Department (VVED) is a statewide virtual emergency service in Victoria, Australia providing real-time online audio-visual consultations for patients with non-life-threatening conditions. This study aims to explore the utilisation and impact of the paediatric arm of the VVED (VVED-Kids).

Study design: This was a retrospective analysis of routinely collected data from the VVED. Data was extracted from the VVED data warehouse on patients aged 0-17 years presenting to VVED-Kids during the initial two-year period of the dedicated paediatric department (March 2023-February 2025). Outcome variables included sociodemographic data, referral source, recommended disposition and diagnosis (ICD code). Descriptive statistics were used to report patient demographics and service-related characteristics of presentations.

Results: During the two-year period, there were 130 821 presentations to VVED-Kids. The median patient age was 3 years, 53.1% of presentations were in males, and 73% of presentations were from children living in metropolitan areas. The most common referral source was self-referral (64.1%), followed by Nurse-on-Call (20.0%) and paramedic consultations (6.5%). Over half of VVED-Kids presentations comprised viral infections, including fevers, gastroenteritis or respiratory illnesses. The majority of presentations were managed without requiring transfer to a physical ED (85.6%).

Conclusions: Based on discharge disposition, VVED-Kids appears to divert patients from attending physical EDs, preserving in-person care for higher acuity patients who need it most. Partnerships with key healthcare providers such as Nurse-on-Call and Ambulance Victoria can support more families in avoiding the physical ED and receiving care in their own homes.