Roma living in marginalised communities are among the most disadvantaged groups in Slovakia. Socioeconomic disadvantage is associated with higher hair cortisol concentrations (HCC), including in ...parents. The aim of this study is therefore to assess differences in HCC, reflecting the levels of stress, between mothers living in MRCs and from the majority population, to assess the association of socioeconomic disadvantage with HCC, and whether disadvantage mediates the MRC/majority differences in HCC. Participants were mothers of children aged 15–18 months old living in MRCs (N=61) and from the Slovak majority population (N=90). During preventive paediatric visits, visits at community centres and home visits, hair samples and data by questionnaire were collected. HCC differed significantly between mothers living in MRCs and mothers from the majority population, with the mean HCC value being twice as high in mothers living in MRCs (22.98 (95% confidence interval, CI, 15.70–30.30) vs. 11.76 (8.34–15.20), p<0.05). HCC was significantly associated with education, household equipment and household overcrowding, but not with billing, socioeconomic stress and social support. The difference in HCC between mothers living in MRCs and mothers from the majority population was partially mediated by poor house equipment, such as no access to running water, no flushing toilet or no bathroom (the indirect effect of B=7.63 (95% CI: 2.12–13.92)). Practitioners and policymakers should be aware of high stress levels among mothers living in MRCs and aim at enhancing their living and housing conditions.
•Roma living in marginalized communities are among the most disadvantaged groups.•Socioeconomic disadvantage causes higher hair cortisol concentrations (HCC) in parents.•HCC differed significantly between MRC mothers and majority mothers.•Mean HCC was twice as high in MRC mothers compared to majority mothers.•The difference in HCC was partially mediated by poor house equipment, such as no access to running water or no toilet.
Introduction
Robotic surgery has seen increasing use in the field of pediatric surgery. Our clinical experience suggested instrument size can impact on the surgical ability. This study aimed to ...compare the performance of robot-assisted laparoscopic skills in confined spaces using either 5 or 8 mm instruments.
Methods
A preclinical randomized crossover study design was implemented. 24 assessors performed three different reproducible drill procedures (M1: peg transfer, M2: circle cutting, M3: intracorporeal suturing). To assess surgical proficiency in confined working spaces, these exercises were performed with 5 and 8 mm instruments of the da Vinci
®
Surgical Systems Si in a cubic box with 60 mm-sized edges. Each performance was recorded and evaluated by two reviewers using both objective structured assessment of technical skills (OSATS) and global evaluative assessment of robotic skills (GEARS) scores. Parietal iatrogenic impacts and instrument collisions were specifically analyzed using a dedicated scoring system.
Results
Regardless of their experience, trainees performed significantly better when using 8 mm instruments in terms of OSATS scores (20.5 vs. 18.4;
p
< 0.01) and GEARS scores (23.4 vs. 21.9;
p
< 0.01) for most items, except for “depth perception” and “autonomy.” The 8 mm performances involved significantly less parietal box damage (4.1 vs. 3.4;
p
< 0.01), and tool collisions (4.1 vs. 3.2;
p
< 0.01).
Conclusions
In light of the better performances with 8 mm tools for specific tasks and parietal sparing constraints in restricted spaces, this study indicates that 5 mm instruments can be deemed to be less effective for reconstructive procedures in small children.
We herein report our single center experience of safety and efficacy of device closure of large sized ostium secundum atrial septal defects (OS ASD) in small children with less than 2 years of age ...performed over the period of 10 years from 2009 to 2019.148 symptomatic children with ASD size of more than 8 mm were included in our study. We obtained a high rate of successful deployment (98 %) with no major complications.
Hematopoietic progenitor cells‐apheresis (HPC‐A) collection is now a routine procedure for autologous hematopoietic stem cell transplantation. Here we present our 25 years' experience of HPC‐A ...collection in children weighing 8 kg or less, with a focus on the evolution of our standard operating procedures, and the safety limits for these young patients, in the Pediatric Apheresis Unit of Clermont‐Ferrand University Hospital (France). Fifteen children weighing 8 kg or less underwent 26 HPC‐A collections over 25 years. Median CD34+ cell yield by leukapheresis was 4.4 106/kg. No procedure‐related complications were encountered during or after the collection. No patient had profound thrombocytopenia or anemia that needed post‐collection transfusions. Our experience in pediatric oncology patients who underwent HPC‐A collections shows that this procedure can be performed even in the smallest of children with no increase in toxicity provided all precautions are taken to ensure that the procedure is carried out under the ideal conditions.
Background
Atrioventricular nodal reentrant tachycardia (AVNRT) does not commonly present during infancy. Although relative safety of catheter ablation of AVNRT has been demonstrated in pediatrics, ...this procedure is rarely indicated in children <15 kg.
Methods
Retrospective review of seven cases of AVNRT that presented in children younger than 1 year of age and required catheter ablation for definitive management. Electrophysiology (EP) study was planned with two or three catheters. Area of ablation determined by voltage mapping, propagation sinus wave collision and slow pathway potential location. Ablation performed with cryothermal energy. No fluoroscopy was used.
Results
Presentation ranged from 36 weeks of gestation to 11 months of age. Two presented in fetal life and two in the neonatal period. The median age of ablation was 20 months (range 17–31 months). The median weight at ablation was 11.4 kg (range 8.9–14.9 kg). Median follow‐up time was 16 months. All had typical AVNRT. The median tachycardia cycle length was 216 ms. 100% successful rate using cryoablation. No complications. No recurrence of tachycardia during the follow‐up period.
Conclusion
Slow AV nodal pathway cryoablation may be safely performed, with good short and medium‐term outcomes in patients under 15 kg.
Background
In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics ...and predictors of long-term outcomes of patients < 15 kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT).
Methods
Patients with history of paKST (CKRT, HD, PD) weighing < 15 kg and ≥ 6 months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit.
Results
109 patients (57 females) were included. Median age at paKST was 10.1 months (IQR: 2–27 months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3 days (IQR: 2–9.5 days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1 years, 34 patients were evaluated at mean age 4.7 ± 2.4 years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13–0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m
2
and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had ≥ 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90 ml/min/1.73m
2
, and/or proteinuria) at last visit. Among 28 patients on paKST < 32 months, 21 had ≥ 1 risk factor (75%), whereas among 6 patients who had paKST ≥ 32 months, one patient had ≥ 1 risk factor (16.7%), (p = 0.014).
Conclusions
Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information
This study conducted an empirical investigation of life satisfaction of residents living in super high-rise housings. We investigated life satisfaction of residents, and households with small ...children and elderlies who live on upper floors. Depending on the residential floors, home satisfaction, health status, and stress frequency differ. The degree of life satisfaction of child-rearing households is influenced by "the home satisfaction", "view from home", "health condition" and other factors. Elderly people's life satisfaction is influenced by "the home satisfaction", "view from home", "health condition", "stress frequency", and "the long chat time" has a negative effect.
In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older ...children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure.
We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up.
We identified 40 patients meeting inclusion criteria with a median (interquartile range IQR) procedural age of 5 (4-7) years and median (IQR) weight of 14 (12-18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%- I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt.
In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.
PDF
