Background:
During the COVID-19 pandemic, telemedicine use has increased within community pediatrics. This trend runs counter to reluctance to adaptation of the new mode of healthcare that existed ...prior to the pandemic. Little is known about what we can expect after the pandemic: if physicians will opt for telemedicine modalities and if tele-pediatrics will continue to be a significant mode of community pediatric care.
Objective:
The goal of this study was to survey primary pediatric care providers as to their experiences and clinical decision making with telemedicine modalities prior to and during the COVID-19 pandemic, as well as their projected use after the pandemic ends.
Material and methods:
Using the EAPRASnet database we surveyed pediatricians throughout Europe, using a web-based questionnaire. The survey was performed during the COVID-19 pandemic (June–July 2020), assessed telemedicine use for several modalities, prior to and during the pandemic as well as predicted use after the pandemic will have resolved. Participants were also surveyed regarding clinical decision making in two hypothetical clinical scenarios managed by telemedicine.
Results:
A total of 710 physicians participated, 76% were pediatricians. The percentage of respondents who reported daily use for at least 50% of all encounters
via
telemedicine modalities increased during the pandemic: phone calls (4% prior to the pandemic to 52% during the pandemic), emails (2–9%), text messages (1–6%), social media (3–11%), cell-phone pictures/video (1–9%), and video conferencing (1–7%) (
p
< 0.005). The predicted post-pandemic use of these modalities partially declined to 19, 4, 3, 6, 9, and 4%, respectively (
p
< 0.005), yet demonstrating a prospectively sustained use of pictures/videos after the pandemic. Reported high likelihood of remotely treating suspected pneumonia and acute otitis media with antibiotics decreased from 8 to 16% during the pandemic to an assumed 2 and 4% after the pandemic, respectively (
p
< 0.005).
Conclusions:
This study demonstrates an increased utilization of telemedicine by pediatric providers during the COVID-19 pandemic, as well as a partially sustained effect that will promote telemedicine use as part of a hybrid care provision after the pandemic will have resolved.
As the tobacco epidemic has waned, it has been followed by the advent of electronic nicotine delivery devices (ENDS) primarily manufactured by the tobacco industry to try to recruit replacements for ...deceased tobacco addicts. This document sets out the ten recommendations of the European Academy of Paediatrics (EAP) with regard to e-cigarettes and children and young people (CYP). The EAP notes that nicotine is itself a drug of addiction, with toxicity to the foetus, child and adult, and were ENDS only to contain nicotine, their use to create a new generation of addicts would be rigorously opposed. However, e-cigarettes include numerous unregulated chemicals, including known carcinogens, whose acute and long term toxicities are unknown. The EAP asserts that there is incontrovertible evidence that the acute toxicity of e-cigarettes is greater than that of “traditional” tobacco smoking, and a variety of acute pulmonary toxicities, including acute lung injuries, have been recorded due to e-cigarettes usage. The chronic toxicity of e-cigarettes is unknown, but given the greater acute toxicity compared to tobacco, the EAP cannot assume that e-cigarettes are safer in the long term. The high uptake of e-cigarettes by CYP, including under-age children, is partly fuelled by deceitful marketing and internet exposure, which is also unregulated. Although proposed as aids to smoking cessation, there is no evidence that e-cigarettes add anything to standard smoking cessation strategies. In summary, the EAP regards these devices and liquids as very dangerous, and ineluctably opposed to their use, and their direct or indirect marketing.
In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care ...pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.
Human papillomavirus vaccination crisis in Japan Dornbusch, Hans Jürgen; Stiris, Tom; del Torso, Stefano ...
Journal of paediatrics and child health,
12/2015, Letnik:
51, Številka:
12
Journal Article
Recenzirano
The European Academy of Paediatrics (EAP) is gravely concerned about the human papillomavirus (HPV) vaccination crisis in Japan and particularly about the negative position taken by governmental ...authorities. Given that the HPV vaccine is both safe and effective, there is no recognizable reason to date to withhold this lifesaving and cost effective public health measure from a population. Therefore, the EAP strongly encourages the Japanese health authorities to actively support HPV vaccination for the future health of their children and adolescents.
There is a large body of data to support the use of an inhaled corticosteroid (ICS) plus a long‐acting β2‐agonist vs. increasing the dose of ICS in adults, but less data in children. This ...double‐blind, parallel group, non‐inferiority study compared lung function and asthma control, based on Global Initiative for Asthma guidelines, in children receiving either salmeterol/fluticasone propionate (SFC) 50/100 μg bd (n = 160) or fluticasone propionate (FP) 200 μg bd (n = 161) for 12 wks. Change from baseline in mean morning peak expiratory flow increased following both treatments, but was significantly greater in the SFC group compared with FP Adjusted mean change (s.e.) (l/min): SFC: 26.9 (2.13), FP: 19.3 (2.12); treatment difference: 7.6 (3.01); 95% CI: 1.7, 13.5; p = 0.012). Asthma control improved over time in both groups. Mean pre‐bronchodilator maximal‐expiratory flow at 50% vital capacity and percentage rescue‐free days showed significantly greater improvements in the SFC group compared with FP. All other efficacy indices showed comparable improvements in each group. Treatment with SFC 50/100 μg bd compared with twice the steroid dose of FP (200 μg bd), was at least as effective in improving individual clinical outcomes and overall asthma control, in asthmatic children previously uncontrolled on low doses of ICS.
Rare diseases are collectively common, affecting an estimated 6.2% of the world's population 1, but each rare disease affects fewer than 4 to 5 in 10 000 individuals in Europe or less than 200 000 ...individuals in the USA 2. Patients with rare diseases are often disadvantaged by late diagnosis and off-label prescribing of medicines 3. Primary ciliary dyskinesia (PCD) is a genetic disease of impaired motile ciliary function that does not have a unique International Classification of Diseases (ICD)-10 code or licensed treatments, although Q34.8 denoting “other specified malformations of the respiratory tract” including nasopharyngeal atresia has also been applicable to PCD since 2017. The disease is characterised by mucus stagnation leading to chronic airway infection, bronchiectasis, chronic rhinosinusitis, reduced fertility and abnormalities of organ laterality with an associated increased risk of complex congenital heart disease 4. The estimated prevalence of PCD in Europe is around 1 in 10 000 to 1 in 20 000 5. The international PCD cohort (iPCD) includes over 3800 PCD patients ranging in age from under 12 months to over 80 years, from Europe, Northern and Southern America, Australia and Western Asia 6. Under-diagnosis of PCD is due to a lack of awareness among the general public and physicians in general, as well as a lack of diagnostic expertise in some countries 7. Tools to help physicians identify patients needing testing (
e.g.
PICADAR) 8 and the European Respiratory Society (ERS) guidelines for diagnostic testing 9 aim to improve this. In contrast to cystic fibrosis (CF), a monogenic disease, PCD is caused by mutations in one of at least 45 identified genes for which there is no effective mutation-specific therapy; this is likely to be a long way off for most patients 10. Thus, treatment aims to prevent and manage disease complications. Even then, the lack of an evidence base for supportive treatment in PCD means that treatment recommendations are based on expert opinion and extrapolated from CF despite differing pathophysiology 11.
Primary ciliary dyskinesia, a rare disease causing bronchiectasis, lacks a sound evidence base for treatment. @beatpcd proposes 1) forming a PCD European clinical trial network to address this situation and 2) conducting n-of-1 trials to access medication.
https://bit.ly/3j5blfM
Objective
To evaluate differences regarding sigh frequency between noninvasive respiratory support types and to assess regional ventilation distribution, delta Z, and end-expiratory lung impedance ...differences before and after sighs.
Methods
Very low-birth-weight infants with gestational ages less than 32 wk were included in the study. Participants were split into two groups: those receiving continuous positive airway pressure and infants receiving high-flow nasal cannula therapy.
Results
The study enrolled 30 infants. The high-flow nasal cannula therapy group had more sighs per 10-min period than infants receiving continuous positive airway pressure (
p
= 0.016). Ventilation distribution was similar in the anterior and right ventilation distribution compartments pre- and post-sigh (46.30% vs. 45.68% and 54.27% vs. 55.26%, respectively). No statistically significant increase in end-expiratory lung impedance or delta Z was observed in global or separate lung regions (
p
> 0.05).
Conclusion
The study has demonstrated that sighs are more frequent in infants receiving high-flow nasal cannula respiratory support compared to continuous positive airway pressure. Spontaneously occurring sighs on noninvasive respiratory support due to respiratory distress syndrome (RDS) do not increase end-expiratory lung impedance or alter delta Z, and appear to have limited clinical significance.
Trial Registration
Prospectively registered at
www.clinicaltrials.gov
, reg. No. NCT04542096, reg. date 01/09/2020.
Aim
To assess fatigue in children aged 2–17 years with asthma from both child and parent perspectives and describe associated factors.
Methods
Fatigue scores were self‐reported by children aged 5–17 ...years old and proxy‐reported by parents or carers for all children. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale was used. Fatigue scores ranged from 0 to 100, higher scores meant less fatigue.
Results
There were 527 children and parents enrolled. The mean overall fatigue score by self‐report was 72.7 ± 15.8 and by proxy report was 75.8 ± 16.3. Self‐reported fatigue score was lower in children aged 5–7 years (71.5 ± 15.9) compared to proxy‐reported score (76.3 ± 15.5). Proxy and self‐reported fatigue scores were similar between parents and older children. Fatigue scores were lower in association with poor asthma control and receipt of social support. Lower self‐reported, but not proxy‐reported, fatigue score was related to asthma severity. Lower proxy‐reported, but not self‐reported, fatigue score was related to the child being older and having shortness of breath.
Conclusion
Parents underestimated the fatigue of younger children aged 5–7 years, but fatigue scores were similar between parents and older children. Both clinical and social factors are associated with fatigue in children with asthma.
AimTo assess fatigue in children aged 2–17 years with asthma from both child and parent perspectives and describe associated factors.MethodsFatigue scores were self‐reported by children aged 5–17 ...years old and proxy‐reported by parents or carers for all children. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale was used. Fatigue scores ranged from 0 to 100, higher scores meant less fatigue.ResultsThere were 527 children and parents enrolled. The mean overall fatigue score by self‐report was 72.7 ± 15.8 and by proxy report was 75.8 ± 16.3. Self‐reported fatigue score was lower in children aged 5–7 years (71.5 ± 15.9) compared to proxy‐reported score (76.3 ± 15.5). Proxy and self‐reported fatigue scores were similar between parents and older children. Fatigue scores were lower in association with poor asthma control and receipt of social support. Lower self‐reported, but not proxy‐reported, fatigue score was related to asthma severity. Lower proxy‐reported, but not self‐reported, fatigue score was related to the child being older and having shortness of breath.ConclusionParents underestimated the fatigue of younger children aged 5–7 years, but fatigue scores were similar between parents and older children. Both clinical and social factors are associated with fatigue in children with asthma.
In 2021, concentrations of heavy metals (Ba, Cr, Fe, Mn, Pb, Ru, Sr, Zn, Zr) and radiocesium (
137
Cs) were measured in 13 locations in Vilnius in surface samples of walls and facades of buildings ...built of yellow bricks in order to evaluate possible aerosol air pollution due to sandblasting. The activity concentrations of
137
Cs appeared there as a result of global fallout and precipitation of the products of the accident at the Chernobyl Nuclear Power Plant, and the concentration of Pb, as a component of road transport emissions. Other trace elements turned out to be impurities in the material of yellow bricks. In spring 2018, sandblasting of the walls of the building adjacent to the school led to the long-term significant aerosol contamination of school premises (up to 660 µg/m
3
). Due to sandblasting, the surface of the school sport yard was covered with a thin layer of scraped particles, which were transported by gusts of wind into the school premises. Sandblasting of walls and facades can also be a source of aerosols with
137
Cs activity concentrations reaching ~ 40 Bq/kg and Pb — up to 98 ppm. Estimates show that along with
137
Cs, the formation of aerosols with activity concentrations of
239, 240
Pu reaching 1.6 Bq/kg is possible. Isotopes of
239, 240
Pu are analogues of calcium and, when ingested, are deposited in the bones. The ingress of radioactive aerosols into the respiratory tract, especially of children of primary school age, creates additional risks of malignant diseases.
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