Archives of Disease in Childhood最新文献

Introduction: After a child is discharged home following an emergency admission to hospital, little is known about contact with emergency departments (ED) or out-of-hours (OOH) general practice. Here, we report the number of contacts with ED and OOH in the week after discharge from hospital in Scotland during 2015-2017, including the number of contacts which result in a readmission.

Methods: Databases containing routinely collected details from hospital admissions for an acute medical condition and subsequent presentation to ED or OOH were linked using a unique personal identifier and the date of discharge.

Results: Of 171 039 urgent admissions, the source of referral was identified for 97 177 (57%) including 92 148 referred by ED or OOH. In the week following discharge, 11 025 (11%) children had a total of 11 497 contacts with ED and/or OOH. The daily number of contacts with ED and/or OOH fell from 2560 on the day after discharge to 1008 1 week after discharge. There were 3892 (35%) children readmitted following contact with ED and/or OOH. An additional 7133 children had a total of 7605 contacts with ED and/or OOH in the week postdischarge but were not readmitted.

Conclusion: Many families seek medical assistance for their child from ED and/or OOH in the week after discharge from hospital, and the majority are not managed by or referred back to paediatric services. Clearer discharge planning could reduce the burden on ED, OOH and parents.

Varicella, known as chickenpox, is caused by the varicella zoster virus (VZV), with an estimated 84 million cases annually. It primarily affects children, for most of whom it is a self-limiting illness. However, there are an estimated 950 000 disability-adjusted life years attributed to VZV annually, disproportionately affecting lower-income settings. Children with impaired immunity and neonates are particularly at risk for severe varicella. Epidemiology varies between tropical and temperate regions with infections occurring at an earlier age in temperate climates.Varicella is a vaccine-preventable disease and over 40 countries have a universal one-dose or two-dose paediatric immunisation programme, either administered alone or combined with the measles, mumps and rubella vaccination (MMRV). The UK's Joint Committee on Vaccination and Immunisation recommended the introduction of MMRV in November 2024. The vaccine, whether monovalent or MMRV, is effective in reducing varicella cases and hospital admissions, and two-dose regimens have further reduced breakthrough infections of shingles, a recognised concern in varicella vaccination programmes. Long-term data on shingles incidence in later life are not yet available and may be mitigated through paired universal shingles vaccination programmes for adults.Cost-effectiveness studies in high-resource settings support vaccination due to reduced hospitalisations and societal costs, such as missed caregiver employment. However, more research is needed for lower-resource regions to determine whether universal vaccination is feasible and cost-effective. While global varicella elimination is unlikely without sterilising immunity, vaccination can significantly reduce the disease burden, depending on regional epidemiology and available resources.

A toxicologic syndrome, or toxidrome, is a distinct pattern of effects of poisoning. Well-defined toxidromes are the opioid, anticholinergic, cholinergic and sympathomimetic, and an additional described toxidrome is GABAergic. These toxidromes are named for the receptor effects causing their specific clinical findings, and knowledge of toxidromes allows rapid pattern recognition of specific poisonings. In this review, toxidromes and the initial assessment and general approach to management of acute poisoning are discussed. This article details the receptor-level effects of the poisoning, key clinical signs and symptoms and the role antidotes play in treatment. Clinical resources such as Toxbase and others exist to provide detailed guidance on clinical management of poisoning.

Objective: Parents of children with a chronic condition (CC) have a high prevalence of mental health (MH) difficulties. It is not known whether establishing screening programmes in paediatric clinics to identify parental MH difficulties increases detection or referrals to support services. We aimed to identify approaches to routine screening programmes for parents of children with a CC attending hospital outpatient clinics (aim 1); associated prevalence of MH symptoms (aim 2); and whether screening impacted referrals to, and uptake of, MH services (aim 3).

Design: Medline, Embase, PsycINFO, CINAHL and PubMed databases were searched between January 2000 and December 2023. Studies were selected if they conducted routine screening of MH of parents of children with CCs (aged <18 years). Study characteristics, population demographics and information on screening tools, MH symptoms and referral pathways were extracted.

Results: Eight articles met the inclusion criteria from 8673 screened. The prevalence of elevated parental MH symptoms ranged between 9.6% and 62.9% for anxiety and 7.7% and 57.0% for depression. Two studies using the Distress Thermometer for Parents found 3.3%-57.0% had elevated levels of 'clinical distress'. There was limited detail on referral pathways, referrals made and uptake.

Conclusions: Elevated MH symptoms are common in parents of children with CCs, but there is wide variability in outcomes. More research is required to understand this and how best to identify and screen for and support parents with referrals to and uptake of services for their MH.

Prospero registration number: CRD42023438720.

Objective: To investigate the moderating effects of socio-demographic social determinants of health (SDH) in the relationship between types of childhood hospitalisation (ie, none, injury, non-injury, injury+non-injury) and academic performance.

Design, setting and patients: Children residing in Wales 2009-2016 (N=369 310). Secure Anonymised Information Linkage databank linked Tagged Electronic Cohort Cymru (five data sources) from the Wales Electronic Cohort for Children.

Main outcome measure: Binary educational achievement (EA) measured across three key educational stage time points: grade 6 (mean age 11 years, SD 0.3), 9 (mean age 14 years, SD 0.3) and 11 (mean age 16 years, SD 0.3).

Results: Of the 369 310 children, 51% were males, 25.4% of children were born in the lowest two Townsend deciles. Females were more likely to meet EA than males (adjusted risk ratio (aRR) (95% CI): 1.047 (1.039, 1.055)). EA was lower for injury admissions in males and any admission type in females (interactions: female×non-injury 0.982 (0.975, 0.989); female×injury+non-injury 0.980 (0.966, 0.994)). Children born into a more deprived decile were less likely to achieve EA (0.979 (0.977, 0.980)) and worsened by an injury admission (interactions: townsend×injury 0.991 (0.988, 0.994); Townsend×injury+non-injury 0.997 (0.994, 1.000)). Children with special educational needs (SEN) were less likely to meet EA (0.471 (0.459, 0.484) especially for an injury admission (interactions: SEN×injury 0.932 (0.892, 0.974)).

Conclusion: SDH moderated the impact of hospital admission type on educational outcomes prompting future investigation into the viability of in-hospital routine screening of families for SDH and relevant post-hospital interventions to help reduce the impact of SDH on educational outcomes post-hospitalisation.