Care For Children (care + for_children)

Distribution by Scientific Domains

Selected Abstracts

Geriatric Emergency Medicine and the 2006 Institute of Medicine Reports from the Committee on the Future of Emergency Care in the U.S. Health System

Scott T. Wilber MD
Abstract Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue. [source]

Pain, Normality, and the Struggle for Congruence: Reinterpreting Residential Care for Children and Youth

Anne M. Prouty Lyness
No abstract is available for this article. [source]

Hospital Disaster Preparedness in Los Angeles County

Amy H. Kaji MD
Background There are no standardized measures of hospital disaster preparedness or hospital "surge capacity." Objectives To characterize disaster preparedness among a cohort of hospitals in Los Angeles County, focusing on practice variation, plan characteristics, and surge capacity. Methods This was a descriptive, cross-sectional survey study, followed by on-site verification. Forty-five 9-1-1 receiving hospitals in Los Angeles County, CA, participated. Evaluations of hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity (assessed by monthly emergency department diversion status, available beds, ventilators, and isolation rooms), decontamination capability, and pharmaceutical stockpiles were assessed by survey. Results Forty-three of 45 hospital plans (96%) were based on the Hospital Emergency Incident Command System, and the majority had protocols for hospital lockdown (100%), canceling elective surgeries (93%), early discharge (98%), day care for children of staff (88%), designating victim overflow areas (96%), and predisaster "preferred" vendor agreements (96%). All had emergency medical services,compatible radios and more than three days' worth of supplies. Fewer hospitals involved law enforcement (56%) or had mutual aid agreements with other hospitals (20%) or long-term care facilities (7%). Although the vast majority (96%) conducted multiagency drills, only 16% actually involved other agencies in their disaster training. Only 13 of 45 hospitals (29%) had a surge capacity of greater than 20 beds. Less than half (42%) had ten or more isolation rooms, and 27 hospitals (60%) were on diversion greater than 20% of the time. Thirteen hospitals (29%) had immediate access to six or more ventilators. Less than half had warm-water decontamination (42%), while approximately one half (51%) had a chemical antidote stockpile and 42% had an antibiotic stockpile. Conclusions Among hospitals in Los Angeles County, disaster preparedness and surge capacity appear to be limited by a failure to fully integrate interagency training and planning and a severely limited surge capacity, although there is a generally high level of availability of equipment and supplies. [source]

The cost of quality improvements due to integrated management of childhood illness (IMCI) in Uganda

David Bishai
Abstract The goal of this paper is to measure the marginal change in facility-level costs of medical care for children under five due to an increase in service quality achieved through the integrated management of childhood illness (IMCI) strategy. Since the beneficial effects of IMCI training on child health outcomes are due to IMCI's effects on service quality, costs of IMCI are regressed against measures of service quality in this paper. Our model shows that quality, as measured by a WHO-index of integrated child assessment is 44% higher in facilities with at least one health worker trained in IMCI as compared to facilities with no health workers trained in IMCI, adjusting for facility utilization as well as type of facility ownership. Our marginal analysis that tied IMCI training to quality and quality to costs shows that on the margin, investing in IMCI training at a primary facility level can yield a significant 44.3% improvement in service quality for a modest 13.5% increase in annual facility costs. Copyright 2007 John Wiley & Sons, Ltd. [source]

A mixed logit model of health care provider choice: analysis of NSS data for rural India

Bijan J. Borah
Abstract In order to address the persistent problems of access to and delivery of health care in rural India, a better understanding of the individual provider choice decision is required. This paper is an attempt in this direction as it investigates the determinants of outpatient health care provider choice in rural India in the mixed multinomial logit (MMNL) framework. This is the first application of the mixed logit to the modeling of health care utilization. We also use the multiple imputation technique to impute the missing prices of providers that an individual did not visit when she was ill. Using data from National Sample Survey Organization of India, we find the following: price and distance to a health facility play significant roles in health care provider choice decision; when health status is poor, distance plays a less significant role in an adult's provider choice decision; price elasticity of demand for outpatient care varies with income, with low-income groups being more price-sensitive than high-income ones. Furthermore, outpatient care for children is more price-elastic than that for adults, which reflects the socio-economic structure of a typical household in rural India where an adult's health is more important than that of a child for the household's economic sustenance. Copyright 2006 John Wiley & Sons, Ltd. [source]

Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance

Winnie Yip
Abstract Governments are constantly faced with competing demands for public funds, thereby necessitating careful use of scarce resources. In Egypt, the School Health Insurance Programme (SHIP) is a government subsidized health insurance system that targets school children. The primary goals of the SHIP include improving access and equity in access to health care for children while, at the same time, ensuring programme sustainability. Using the Egyptian Household Health Utilization and Expenditure Survey (1995), this paper empirically assesses the extent to which the SHIP achieves its stated goals. Our findings show that the SHIP significantly improved access by increasing visit rates and reducing financial burden of use (out-of-pocket expenditures). With regard to the success of targeting the poor, conditional upon being covered, the SHIP reduced the differentials in visit rates between the highest and lowest income children. However, only the middle-income children benefitted from reduced financial burden (within group equity). Moreover, by targeting the children through school enrollment, the SHIP increased the differentials in the average level of access between school-going children and those not attending school (overall equity). Children not attending school tend to be poor and living in rural areas. Our results also indicate that original calculations may underestimate the SHIP financial outlays, thereby threatening the long run financial sustainability of the programme. Copyright 2001 John Wiley & Sons, Ltd. [source]

A survey of specialist paediatric dental services in Sweden: results from 2003, and trends since 1983

Summary. The child population in Sweden has changed dramatically during the last 20 years. Changes have also occurred within the Public Dental Service (PDS), regarding the provision of dental care to children and adolescents. All these changes may affect the referral pattern and provision of specialist dental care for children and adolescents. Objectives., The primary aim of this study was to survey the services provided by specialists in paediatric dentistry in Sweden during 2003. A secondary aim was to compare the results with previous surveys. Methods., A Web-based survey was sent to all 34 specialist paediatric dentistry clinics and was answered by all clinics. Data were compared with results from the surveys performed in 1983, 1989, and 1996. Results., The number of paediatric dentists had been relatively constant over the last 20 years, whereas the number of children referred to paediatric dentists had increased by 28% since 1983. It was estimated that 13% of all children in Sweden are treated at a specialist paediatric dental clinic in 2003. Dental treatment need in combination with behaviour management problems (BMP) was the main reason for referral and occurred in 37% of all referrals. The proportion of medically compromised children/children with disabilities had increased from 6% in 1983 to 22% in 2003. The number of patients treated using sedation and general anaesthesia had increased since 1983, and particularly since 1996. Conclusions., Despite improvements in dental health among children and adolescents in Sweden during the last 20 years, an increasing number of children are referred for specialist paediatric dental treatment. There is an urgent need to increase the number of specialist paediatric dentists in Sweden in order to ensure the continuation of high quality of dental care for children and adolescents. [source]

Pediatric Short Bowel Syndrome: Pathophysiology, Nursing Care, and Management Issues

Louise D. Jakubik
ISSUES AND PURPOSE. A comprehensive overview of the etiology, pathophysiology, nursing care, and medical and surgical management of the child with short bowel syndrome (SBS), which follows massive anatomical or functional loss of the small intestine. CONCLUSIONS. The outlook for children with SBS has improved due to recent advances in parenteral and enteral nutrition, pharmacologic interventions, and surgical options. PRACTICE IMPLICATIONS. Nurses whose practice reflects an in-depth knowledge of the etiology, pathophysiology, medical and surgical management, nursing interventions, and complications of SBS will be equipped to provide quality care for children and families affected by SBS. [source]

Lawyers at Mid-Career: A 20-Year Longitudinal Study of Job and Life Satisfaction

John Monahan
This study is the first to our knowledge to simultaneously measure the predictors of lawyers' satisfaction with their careers and the predictors of lawyers' satisfaction with their lives more broadly. One class of the University of Virginia School of Law was studied between their matriculation in 1987 and their graduation in 1990. All 360 living graduates of this class were contacted in 2007, with a response rate of 72.2 percent. Descriptive information was obtained and empirically validated measures of both career satisfaction and life satisfaction were administered. Respondents were found to have taken many diverse career paths, with most (85 percent) having changed jobs at least once, and half having changed jobs at least twice. Gender differences in the personal and professional lives of respondents were pervasive. Women graduates were far more likely than men to interrupt or forego full-time employment (39 percent vs. 1 percent), mainly in order to care for children, and were also more likely to have a spouse or partner employed full time outside the home (77 percent vs. 24 percent). Working conditions at large private law firms emerged as a significant problem for many respondents; half of those who started their careers in large firms left to go to a different type of employer. Finally, both career satisfaction and life satisfaction were found to be high, with 81 percent of the respondents satisfied with their decision to become a lawyer, and 86 percent satisfied with their lives more broadly. [source]

Eclecticism in health services for developmental disorders

M McDowell
Abstract: The term ,eclectic', as applied to health care for children with developmental disorders, portrays an individualized, adaptive service response to local constraints and pressures. While this may appear appropriate for the local setting, the end result is a broad diversity of health care approaches. This paper discusses three separate processes that interact at a local level, increasing the likelihood of an eclectic local model of health care for this population of children. The first process draws from the direct clinical work. Variable training, knowledge and skills among health care providers, in combination with differing beliefs around the nature of the problems and their management leads to health care which directly reflects the attributes of the local clinicians. A separate, second process fuelling variability is the differing models of departmental responsibility across Australia , which Government departments fund which aspect of care for children with disabilities. The final process relates to funding streams for health care. State public health, federal Medicare and private insurance all support health services for children with disabilities, with the financial incentives (budgets compared to fee-for-service) driving a divergence of practice. This paper concludes that the external political, administrative and financial frameworks within which health care is constructed will continue to promote clinical eclecticism to a degree that would probably be considered unacceptable in other areas of child health care. The solution can only arise from within the clinical work itself, with greater clarity of understanding around the nature of the disorders, the outcomes for which health care takes responsibility, and an increasing focus on an evidence based set of approaches towards achieving these. [source]

Differential effects of high-quality child care

Jennifer Hill
In policy research a frequent aim is to estimate treatment effects separately by subgroups. This endeavor becomes a methodological challenge when the subgroups are defined by post-treatment, rather than pre-treatment, variables because if analyses are performed in the same way as with pre-treatment variables, causal interpretations are no longer valid. The authors illustrate a new approach to this challenge within the context of the Infant Health and Development Program, a multisite randomized study that provided at-risk children with intensive, center-based child care. This strategy is used to examine the differential causal effects of access to high-quality child care for children who would otherwise have participated in one of three child care options: no non-maternal care, home-based non-maternal care, and center-based care. Results of this study indicate that children participating in the first two types of care would have gained the most from high-quality center-based care and, moreover, would have more consistently retained the bulk of these positive benefits over time. These results may have implications for policy, particularly with regard to the debate about the potential implications of providing universal child care. 2002 by the Association for Public Policy Analysis and Management. [source]

Using School Staff to Establish a Preventive Network of Care to Improve Elementary School Students' Control of Asthma

Jean-Marie Bruzzese
To address these problems, Columbia University and the New York City Department of Education and the New York City Department of Health and Mental Hygiene undertook a randomized controlled trial to test the efficacy of a comprehensive school-based asthma program. In this intervention, school nurses were trained to facilitate the establishment of a preventive network of care for children with asthma by coordinating communications and fostering relationships between families, PCPs, and school personnel. PCPs also received training regarding asthma management. There was limited support for this model. While case detection helped nurses identify additional students with asthma and nurses increased the amount of time spent on asthma-related tasks, PCPs did not change their medical management of asthma. Few improvements in health outcomes were achieved. Relative to controls, 12-months posttest intervention students had a reduction in activity limitations due to asthma (,35% vs ,9%, p < .05) and days with symptoms (26% vs 39%, p = .06). The intervention had no impact on the use of urgent health care services, school attendance, or caregiver's quality of life. There were also no improvements at 24-months postintervention. We faced many challenges related to case detection, training, and implementing preventive care activities, which may have hindered our success. We present these challenges, describe how we coped with them, and discuss the lessons we learned. (J Sch Health. 2006;76(6):307-312) [source]

Mothers' Decision-Making Processes Regarding Health Care for Their Children

Gloria Jean Gross Ph.D.
This research study explored mothers' decision-making processes regarding health care for their children. Identifying how decisions are made by mothers about health care for their children will assist health care professionals to be appropriate advocates for mothers, to improve quality of life, and to contain costs of health care for children. A sample of 114 rural mothers (51 with one child, 63 with more than one child) completed questionnaires identifying demographics, social support, client and professional interaction elements, self-determinism, competence in problem-solving skills, and relationships to responses to health care scenarios. Qualitative data were also gathered by structured in-depth interviews of 7 subjects. ANOVA, correlations, and factor analysis were completed to analyze data. Most of the mothers' decisions were based on the perceived degree of seriousness, mother's degree of fear of the child's condition, attitude of the health care provider, previous experience with the situation, and social support for the mother. There were no significant differences in decision-making processes by first time mothers and by mothers with more than one child. Implications include teaching mothers assessment skills to identify serious versus nonserious situations and to utilize other social supports. [source]

The role of the adult urologist in the care of children: findings of a UK survey

D.F.M. Thomas
Objective To document the current role of adult urologists in the care of children in the UK and to consider the future provision of urological services for children within the context of published national guidelines. Methods A detailed postal questionnaire was sent to all 416 consultant urologists listed as full members of the British Association of Urological Surgeons and resident in the UK. The range of information sought from each urologist included details of personal paediatric training, scope of personal practice, and information about facilities and provision of urological services for children in their base National Health Service hospital. Results The response rate was 69%; most consultant urologists (87%) in District General Hospitals (DGHs) undertake paediatric urology, mainly routine procedures of minor or intermediate complexity. Of urologists in teaching hospitals, 32% treat children but their involvement is largely collaborative. Consultants appointed within the last 10 years are less willing to undertake procedures such as ureteric reimplantation or pyeloplasty than those in post for ,10 years. Currently, 18% of DGH urologists hold dedicated children's outpatient clinics and 34% have dedicated paediatric day-case operating lists. Almost all urologists practise in National Health Service hospitals which meet existing national guidelines on the provision of inpatient surgical care for children. Conclusion Urologists practising in DGHs will retain an important role as providers of routine urological services for children. However, the tendency for recently appointed consultants to limit their practice to the more routine aspects of children's urology is likely to increase. Training and intercollegiate assessment should focus on the practical management of the conditions most commonly encountered in DGH practice. The implementation of national guidelines may require greater paediatric subspecialization at DGH level to ensure that urologists treating children have a paediatric workload of sufficient volume to maintain a high degree of surgical competence. [source]

Attention Deficit Hyperactivity Disorder: New Ways of Working in Primary Care

Gill Salmon
Children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and prescribed pharmacotherapy require ongoing regular follow-up for many years. Recent literature outlining the role of primary care in the ongoing medication monitoring of children and young people with ADHD is reviewed. We propose that a General Practitioner with a Specialist Interest (GPwSI) model could be developed in relation to ADHD to ensure that shared care arrangements between CAMHS and primary care for children with ADHD are in place. Clinical materials to support GPs in this new role are described. [source]

,Jumping through hoops': parents' experiences with seeking respite care for children with special needs

J. L. Doig
Abstract Background Respite care may act as a means to reduce stress and fatigue in people caring for a dependent who has a disability. Despite this, a variety of barriers may exist to obtaining such services. This study explored caregivers' experiences seeking respite care for their children with special needs within a province in Canada. Methods Caregivers were recruited from two agencies providing respite care for children with fetal alcohol spectrum disorders and other mental health and developmental difficulties. In total, 10 caregivers participated in in-depth individual interviews. A constructivist grounded theory approach was employed in the design and analysis of the data. Results Caregivers discussed their frustrations with the process of finding and obtaining respite care, a course of action described as ,jumping through hoops'. This construct was composed of subcategories emphasizing the complexity of ,navigating the system', the bidirectional process of ,meeting the requirements' and the challenges of ,getting help'. Conclusions The collective experiences of these caregivers point to the need for more flexibility and co-ordination of respite care services for children with special needs. [source]

Towards integrated paediatric services in the Netherlands: a survey of views and policies on collaboration in the care for children with cerebral palsy

B. J. G. Nijhuis
Abstract Aim, Worldwide, family-centred and co-ordinated care are seen as the two most desirable and effective methods of paediatric care delivery. This study outlines current views on how team collaboration comprising professionals in paediatric rehabilitation and special education and the parents of children with disabilities should be organized, and analyses the policies of five paediatric rehabilitation settings associated with the care of 44 children with cerebral palsy (CP) in the Netherlands. Methods, For an overview of current ideas on collaboration, written statements of professional associations in Dutch paediatric rehabilitation were examined. The policy statements of the five participating settings were derived from their institutional files. Documents detailing the collaborative arrangements involving the various professionals and parents were evaluated at the institutional level and at the child level. Involvement of the stakeholders was analysed based on team conferences. Results, Also in the Netherlands collaboration between rehabilitation and education professionals and parents is endorsed as the key principle in paediatric rehabilitation, with at its core the team conference in which the various priorities and goals are formulated and integrated into a personalized treatment plan. As to their collaborative approaches between rehabilitation centre and school, the five paediatric settings rarely differed, but at the child level approaches varied. Teams were large (averaging 10.5 members), and all three stakeholder groups were represented, but involvement differed per setting, as did the roles and contributions of the individual team members. Conclusion, Collaboration between rehabilitation and education professionals and parents is supported and encouraged nationwide. Views on collaboration have been formulated, and general guidelines on family-centred and co-ordinated care are available. Yet, collaborative practices in Dutch paediatric care are still developing. Protocols that carefully delineate the commitments to collaborate and that translate the policies into practical, detailed guidelines are needed, as they are a prerequisite for successful teamwork. [source]