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Paediatric Services (paediatric + services)
Selected AbstractsWhat is the perceived nature of parental care and support for young people with cystic fibrosis as they enter adult health services?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2010Nicola Iles RN MSc Abstract The majority of those diagnosed with cystic fibrosis (CF) now live to adulthood. In response to increased survival age, transition services have been developed to ensure smooth transfer from paediatric to adult specialist healthcare, although the majority of treatment and care continues to be delivered in the home. However, little is known about how young adults and staff conceptualise the nature of the parental role after young people have left paediatric care. The aim of this study is to explore the nature of parental support that is perceived to be available at this time. As part of a larger study of transitional care, semi-structured interviews were conducted with 50 young people with CF aged 13,24 years (32 with experience of transition and/or adult CF services) and 23 specialist healthcare professionals (14 working in adult care) across two CF centres in Southeast England. Interviews took place in young people's homes or within CF services, using a topic guide and were recorded, transcribed and analysed thematically. Four domains of perceived parental support were identified by the young people interviewed, with varying degrees of continuity into adult care: (1) Providing non-clinical practical and emotional support; (2) Acting as ,troubleshooters' in times of health-related crisis; (3) Working in partnership with offspring in ongoing disease management in the home and clinic; (4) Acting as ,protectors' of their children. Young people and service staff expressed tensions in managing parental involvement in post-paediatric consultations and the degree to which parents should be aware of their offspring's deteriorating health and social concerns. Parental anxiety and over-involvement was perceived by many young people and staff as unsupportive. We suggest that although health and social care providers are mindful of the tensions that arise for those leaving paediatric services, the place of parental support in adult care is currently contentious for these ,new' ageing populations. [source] The possible role of endocrine disrupting chemicals in the aetiology of cryptorchidism and hypospadias: a population-based case,control study in rural SicilyINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 1 2007P. Carbone Abstract This was an open case,control study of the possible association between parental occupational and domestic exposures to potential endocrine disrupting chemicals (EDC) assessed by questionnaire and cryptorchidism and hypospadias in their offspring in the agricultural area of Ragusa. Cases of infants born between 1998 and 2002 with either of these two malformations (n = 90), and controls (n = 203), were recruited through the paediatric services (for cases) and a random sample of healthy infants attending the same services born in the same period of time (for controls). Data on occupational and environmental exposures of parents prior to and during the index case (or control), were collected through interviews with both parents. Concerning occupational exposures, we did not find a statistically significant increase in risk among parents directly involved in agricultural work. We did find a non-statistically significant increase in risk for cryptorchidism in mothers employed in agriculture [adjusted odds ratios (OR) 2.97; 95% confidence interval (CI) 0.77,11.47] and with probable exposure to pesticides (adjusted OR 2.74; 95% CI 0.72,10.42). Fathers who had indirect contact with agricultural products (transport and retail) had an increased risk (not statistically significant) for cryptorchidism (adjusted OR 2.45; 95% CI 0.63,9.59) and hypospadias and cryptorchidism combined (adjusted OR 2.24; 95% CI 0.67,7.48). Increases in risk of the two malformations pooled were also observed in relation to the mother's age below 25 (adjusted OR 1.99; 95% CI 0.97,4.09), to the presence of genital disease of the father (adjusted OR 2.41; 95%C I0.94,6.17), and the mother (adjusted OR 3.47;95% CI1.34,8.99), to low birth weight of the infant (adjusted OR 4.49; 95% CI 1.23,16.31). Increased risk was also observed for mothers consuming alcohol during pregnancy (adjusted OR 3.09; 95% CI 0.98,9.66), and for couples who conceived while using condoms (adjusted OR 2.12; 95% CI 1.02,4.41). The study therefore provides only limited support to the hypothesis of a possible association between the risk of cryptorchidism and hypospadias and the occupational exposure to EDC and agricultural work. [source] The Interface Between Physical and Mental Health Problems and Medical Help Seeking in Children and Adolescents: A Research PerspectiveCHILD AND ADOLESCENT MENTAL HEALTH, Issue 4 2004M. Elena Garralda This paper addresses child and adolescent psychopathology as it presents to general practitioners and paediatricians, and explores psychosocial aspects of unexplained medical symptoms in children and adolescents. High rates of psychopathology have been identified amongst children and adolescents attending general practice and paediatric services, most of it ,,hidden'' at presentation and emotional in nature. It is often linked to poor physical well being and to maternal stress focused on the child. It may be of special relevance to medical help seeking in socio-economically advantaged areas. Co-morbid psychopathology, mainly emotional disorders, is common amongst children with unexplained medical symptoms. However, there are specific psychosocial aspects that differentiate these children from those with emotional disorders. They involve disease beliefs, illness behaviour and predicament. The latter may be characterised by special reactivity to stress in children with personality vulnerability, in a context of parents with high levels of mental distress, unexplained medical symptoms and emotional over-involvement with the child. There is comparatively little interface work between CAMHS and primary health care. An important research priority would seem to lie in the development of interventions that can be adapted for use by primary care staff. Similarly, there are few dedicated CAMHS paediatric liaison teams. Their more extensive development should help attend in a more informed and focused way than at present to children and adolescents suffering from unexplained physical symptoms and disorders. Further research is needed into vulnerability mechanisms and maintaining factors, health beliefs, treatment engagement and interventions. [source] Towards integrated paediatric services in the Netherlands: a survey of views and policies on collaboration in the care for children with cerebral palsyCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2007B. 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] The needs of physically disabled young people during transition to adult servicesCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2004B. Ko Abstract Objectives, The needs and provisions for health service and housing adaptation of a cohort of school leavers with physical disabilities in two inner city London health districts are described in this cross-sectional study. Methods, Fourteen young people were assessed by two consultant community paediatricians during their last year at school, using a structured proforma that includes the British Association of Community Child Health standards of functional levels. Results, Great difficulty was encountered in identifying the subjects, partly because of inadequate information systems. Only 16 were identified out of over 12 000 school leavers. Important discrepancies were found between the needs assessed and the services provided. For the total sample, the need for 49 potential referrals to adult specialist services was identified, but 17 were not made as such services did not exist, in contrast to what had been available within paediatric services. Adult physiotherapy and occupational therapy services were particularly under-provided for young people with physical disabilities. Only a minority were eligible for housing adaptations. Conclusions, Suggestions are made for improvements in information systems, the transition process, revised provision of services and closer involvement of general practitioners. [source] | ||||||||||