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  Subjects -> HEALTH AND SAFETY (Total: 1424 journals)
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    - HEALTH AND SAFETY (641 journals)
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HEALTH AND SAFETY (641 journals)                  1 2 3 4 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
Acta Informatica Medica     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 1)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 25)
African Health Sciences     Open Access   (Followers: 3)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 7)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Ageing & Society     Hybrid Journal   (Followers: 43)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 16)
American Journal of Health Education     Hybrid Journal   (Followers: 32)
American Journal of Health Promotion     Hybrid Journal   (Followers: 31)
American Journal of Health Sciences     Open Access   (Followers: 9)
American Journal of Health Studies     Full-text available via subscription   (Followers: 12)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 28)
American Journal of Public Health     Full-text available via subscription   (Followers: 245)
American Journal of Public Health Research     Open Access   (Followers: 28)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 5)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5)
Annales des Sciences de la Santé     Open Access  
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 10)
Annals of Health Law     Open Access   (Followers: 4)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 13)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences: Interface And Interaction     Open Access   (Followers: 3)
Apuntes Universitarios     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 10)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 4)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 9)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 4)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 3)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 7)
Autism & Developmental Language Impairments     Open Access   (Followers: 10)
Behavioral Healthcare     Full-text available via subscription   (Followers: 7)
Bijzijn     Hybrid Journal   (Followers: 1)
Bijzijn XL     Hybrid Journal  
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
Birat Journal of Health Sciences     Open Access  
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 8)
BMC Pregnancy and Childbirth     Open Access   (Followers: 22)
BMJ Simulation & Technology Enhanced Learning     Hybrid Journal   (Followers: 9)
Boletin Médico de Postgrado     Open Access  
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 19)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 11)
Canadian Family Physician     Partially Free   (Followers: 13)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 11)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 2)
Canadian Journal of Public Health     Hybrid Journal   (Followers: 23)
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 1)
Carta Comunitaria     Open Access  
Case Reports in Women's Health     Open Access   (Followers: 4)
Case Studies in Fire Safety     Open Access   (Followers: 23)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access   (Followers: 2)
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia y Salud Virtual     Open Access  
Ciencia, Tecnología y Salud     Open Access   (Followers: 2)
Clinical and Experimental Health Sciences     Open Access   (Followers: 1)
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
Clocks & Sleep     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 2)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 3)
Conflict and Health     Open Access   (Followers: 7)
Contraception and Reproductive Medicine     Open Access   (Followers: 1)
Cuadernos de la Escuela de Salud Pública     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 10)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 4)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 13)
Diversity of Research in Health Journal     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Open Access   (Followers: 2)
Duazary     Open Access   (Followers: 1)
Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi / Journal of Duzce University Health Sciences Institute     Open Access  
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 21)
East African Journal of Public Health     Full-text available via subscription   (Followers: 4)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 22)
EcoHealth     Hybrid Journal   (Followers: 4)
Education for Health     Open Access   (Followers: 6)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 3)
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 5)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics & Human Research     Hybrid Journal   (Followers: 3)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 6)
Ethiopian Journal of Health Development     Open Access   (Followers: 7)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
Eurasian Journal of Health Technology Assessment     Open Access  
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 4)
European Medical, Health and Pharmaceutical Journal     Open Access   (Followers: 1)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 8)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 9)
Family & Community Health     Hybrid Journal   (Followers: 13)
Family Medicine and Community Health     Open Access   (Followers: 9)
Family Relations     Partially Free   (Followers: 13)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Finnish Journal of eHealth and eWelfare : Finjehew     Open Access  
Food and Public Health     Open Access   (Followers: 16)
Food Quality and Safety     Open Access   (Followers: 1)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access   (Followers: 1)
Ganesha Journal     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Challenges     Open Access  
Global Health : Science and Practice     Open Access   (Followers: 7)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 10)
Global Journal of Public Health     Open Access   (Followers: 13)
Global Medical & Health Communication     Open Access   (Followers: 2)
Global Mental Health     Open Access   (Followers: 8)
Global Reproductive Health     Open Access  
Global Security : Health, Science and Policy     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 6)
Hacia la Promoción de la Salud     Open Access  
Hastane Öncesi Dergisi     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 4)
HCU Journal     Open Access  
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 6)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 10)
Health and Human Rights     Free   (Followers: 10)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 58)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 3)
Health Care Analysis     Hybrid Journal   (Followers: 16)
Health Equity     Open Access  
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 24)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 45)
Health Policy and Technology     Hybrid Journal   (Followers: 5)
Health Professional Student Journal     Open Access   (Followers: 4)
Health Promotion International     Hybrid Journal   (Followers: 22)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 8)
Health Promotion Practice     Hybrid Journal   (Followers: 16)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 52)
Health Psychology Bulletin     Open Access   (Followers: 1)
Health Psychology Research     Open Access   (Followers: 20)
Health Psychology Review     Hybrid Journal   (Followers: 42)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 15)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access   (Followers: 1)
Health Sciences and Disease     Open Access   (Followers: 2)
Health Security     Hybrid Journal  
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 5)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 13)
Health, Risk & Society     Hybrid Journal   (Followers: 14)
Health, Safety and Environment     Open Access   (Followers: 31)
Healthcare     Open Access   (Followers: 3)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 9)

        1 2 3 4 | Last

Similar Journals
Journal Cover
Number of Followers: 2  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2227-9067
Published by MDPI Homepage  [222 journals]
  • Children, Vol. 5, Pages 44: Diagnosis, Evaluation and Treatment of
           Pulmonary Arterial Hypertension in Children

    • Authors: Benjamin Frank, D. Ivy
      First page: 44
      Abstract: Pulmonary Hypertension (PH), the syndrome of elevated pressure in the pulmonary arteries, is associated with significant morbidity and mortality for affected children. PH is associated with a wide variety of potential underlying causes, including cardiac, pulmonary, hematologic and rheumatologic abnormalities. Regardless of the cause, for many patients the natural history of PH involves progressive elevation in pulmonary arterial resistance and pressure, right ventricular dysfunction, and eventually heart failure. In recent years, a number of pulmonary arterial hypertension (PAH)-targeted therapies have become available to reduce pulmonary artery pressure and improve outcome. A growing body of evidence in both the adult and pediatric literature demonstrates enhanced quality of life, functional status, and survival among treated patients. This review provides a description of select etiologies of PH seen in pediatrics and an update on the most recent data pertaining to evaluation and management of children with PH/PAH. The available evidence for specific classes of PAH-targeted therapies in pediatrics is additionally discussed.
      Citation: Children
      PubDate: 2018-03-23
      DOI: 10.3390/children5040044
      Issue No: Vol. 5, No. 4 (2018)
  • Children, Vol. 5, Pages 45: From the Child’s Word to Clinical
           Intervention: Novel, New, and Innovative Approaches to Symptoms in
           Pediatric Palliative Care

    • Authors: Katharine Brock, Joanne Wolfe, Christina Ullrich
      First page: 45
      Abstract: Despite vast improvements in disease-based treatments, many children live with life-threatening disorders that cause distressing symptoms. These symptoms can be difficult to comprehensively assess and manage. Yet, frequent and accurate symptom reporting and expert treatment is critical to preserving a patient’s physical, psychological, emotional, social, and existential heath. We describe emerging methods of symptom and health-related quality-of-life (HRQOL) assessment through patient-reported outcomes (PROs) tools now used in clinical practice and novel research studies. Computer-based and mobile apps can facilitate assessment of symptoms and HRQOL. These technologies can be used alone or combined with therapeutic strategies to improve symptoms and coping skills. We review technological advancements, including mobile apps and toys, that allow improved symptom reporting and management. Lastly, we explore the value of a pediatric palliative care interdisciplinary team and their role in assessing and managing distressing symptoms and minimizing suffering in both the child and family. These methods and tools highlight the way that novel, new, and innovative approaches to symptom assessment and management are changing the way that pediatrics and pediatric palliative care will be practiced in the future.
      Citation: Children
      PubDate: 2018-03-28
      DOI: 10.3390/children5040045
      Issue No: Vol. 5, No. 4 (2018)
  • Children, Vol. 5, Pages 46: Risk Factors for Brachial Plexus Birth Injury

    • Authors: Emily Louden, Michael Marcotte, Charles Mehlman, William Lippert, Bin Huang, Andrea Paulson
      First page: 46
      Abstract: Over the course of decades, the incidence of brachial plexus birth injury (BPBI) has increased despite advances in healthcare which would seem to assist in decreasing the rate. The aim of this study is to identify previously unknown risk factors for BPBI and the risk factors with potential to guide preventative measures. A case control study of 52 mothers who had delivered a child with a BPBI injury and 132 mothers who had delivered without BPBI injury was conducted. Univariate, multivariable and logistic regressions identified risk factors and their combinations. The odds of BPBI were 2.5 times higher when oxytocin was used and 3.7 times higher when tachysystole occurred. The odds of BPBI injury are increased when tachysystole and oxytocin occur during the mother’s labor. Logistic regression identified a higher risk for BPBI when more than three of the following variables (>30 lbs gained during the pregnancy, stage 2 labor >61.5 min, mother’s age >26.4 years, tachysystole, or fetal malpresentation) were present in any combination.
      Citation: Children
      PubDate: 2018-03-29
      DOI: 10.3390/children5040046
      Issue No: Vol. 5, No. 4 (2018)
  • Children, Vol. 5, Pages 47: The Nuts and Bolts of Food Immunotherapy: The
           Future of Food Allergy

    • Authors: Sara Anvari, Katherine Anagnostou
      First page: 47
      Abstract: Food allergies are on the rise and have a major impact on the quality of life of the food allergic child and their family. Currently, the mainstream treatment for food allergies is strict avoidance and elimination of the allergenic food(s) from the patient’s diet in order to prevent an allergic reaction. However, recent advances in research have presented new therapeutic options for food allergic patients that are potentially becoming promising alternatives to traditional treatment. Food immunotherapy is the most popular of these new emerging interventions and has been studied intensively over the last decade for various foods. In this review, we discuss this exciting new development that is aspiring to become part of the mainstream therapy for food allergy.
      Citation: Children
      PubDate: 2018-04-04
      DOI: 10.3390/children5040047
      Issue No: Vol. 5, No. 4 (2018)
  • Children, Vol. 5, Pages 48: Reliability and Validity of the European Child
           Environment Questionnaire (ECEQ) in Children and Adolescents with Cerebral
           Palsy: Persian Version

    • Authors: Mahyar Salavati, Roshanak Vameghi, Seyed Hosseini, Ahmad Saeedi, Masoud Gharib
      First page: 48
      Abstract: The aim of this study was to assess the reliability and validity of the Persian version of the European Child Environment Questionnaire (ECEQ) in the Iranian context. In total, 332 parents (20.2% fathers and 79.8% mothers) of children and adolescents with cerebral palsy (CP) with an average age of 12.33 years (min 7.08 to max 18.08) from three provinces in Iran participated in the study. The original version of the questionnaire was translated and back-translated. Confirmatory construct validity was assessed by factor analysis and reliability was evaluated by Cronbach’s alpha (N = 332) and after two weeks’ test–retest reliability (n = 51) using an intraclass correlation coefficient (ICC). Eleven questions were dropped as they did not fit well into domains in the Persian version (p > 0.05). Cronbach’s alpha and intraclass correlation coefficient in all domains and overall were acceptable (higher than 0.70) and significant (p > 0.05). The Persian version of the ECEQ is suitable for assessing the needs and availability of environmental factors and is reliable and valid for children with CP, as reported by their parents.
      Citation: Children
      PubDate: 2018-04-09
      DOI: 10.3390/children5040048
      Issue No: Vol. 5, No. 4 (2018)
  • Children, Vol. 5, Pages 49: Ponseti Technique for the Management of
           Congenital Talipes Equinovarus in a Rural Set-Up in India: Experience of
           356 Patients

    • Authors: Rohit Malhotra, Ashutosh Mohapatra, Geetika Arora, Priyam Choudhury, Hitesh Joshi, Pranav Patel
      First page: 49
      Abstract: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person’s mobility by making it difficult and painful to walk. Worldwide, 80% of children born with clubfoot are in low- and middle-income countries. The management of clubfoot has a long history. Non-operative management did not become popular, as an increasing number of orthopaedists started leaning towards surgical treatment. The late Dr. Ignacio Ponseti developed a method of clubfoot correction that successfully realigns clubfoot in infants without extensive and major surgery. The aim of the study was to assess the functional outcome of CTEV management by the Ponseti technique, to study the severity of CTEV deformity using the Pirani score, and to evaluate the cost-effectiveness of the technique. A total of 356 cases with 402 feet with CTEV were treated by the Ponseti method. The average age of the children and the number of casts applied before full correction were 4.03 months and 6.91, respectively. There was a good functional outcome in 95.45% of cases (score > 30) at the last follow up. The management of CTEV by the Ponseti technique provides a good functional and cosmetic outcome. In a developing country like India, this technique is a safe, easy, economical method of clubfoot management.
      Citation: Children
      PubDate: 2018-04-10
      DOI: 10.3390/children5040049
      Issue No: Vol. 5, No. 4 (2018)
  • Children, Vol. 5, Pages 50: Comparison of the Effect of Toothbrushing
           Education Via Video, Lecture and Pamphlet on the Dental Plaque Index of
           12-Year-Old Children

    • Authors: Javad Ramezaninia, Mohammad Mehdi Naghibi Sistani, Zohreh Ahangari, Hemmat Gholinia, Iman Jahanian, Samaneh Gharekhani
      First page: 50
      Abstract: The aim of this study was to compare the effect of different modes of toothbrushing education (lecture, video and pamphlet) on the dental plaque index (PI) of adolescents. The cluster randomized intervention was performed on 128 participants aged 12 years, who were allocated into four groups based on the type of intervention. Group 1: no intervention; and groups 2, 3, 4: education via lecture, video, and pamphlet, respectively (n = 32). Their plaque index was measured at the baseline, 24 h and two months later. Data were analyzed by repeated measures analysis of variance (ANOVA), one-way ANOVA, independent and paired t-test. The plaque indices of groups 2, 3, 4 at 24 h (p values < 0.001) and two months (p values < 0.001) showed a significant reduction when compared to the baseline. The lowest PI score was observed in the pamphlet, video and lecture groups at 24 h, respectively. After 2 months, the lowest score of PI was measured in lecture, video and pamphlet groups, respectively; however, these differences were non-significant. Therefore, toothbrushing education via lecture, video and pamphlet reduced the dental plaque index with the same effectiveness.
      Citation: Children
      PubDate: 2018-04-14
      DOI: 10.3390/children5040050
      Issue No: Vol. 5, No. 4 (2018)
  • Children, Vol. 5, Pages 32: Emerging Methodologies in Pediatric Palliative
           Care Research: Six Case Studies

    • Authors: Katherine Nelson, James Feinstein, Cynthia Gerhardt, Abby Rosenberg, Kimberley Widger, Jennifer Faerber, Chris Feudtner
      First page: 32
      Abstract: Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.
      Citation: Children
      PubDate: 2018-02-26
      DOI: 10.3390/children5030032
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 33: The Relationship Between Sleep and Cognition
           in Children Referred for Neuropsychological Evaluation: A Latent Modeling

    • Authors: Adrian Svingos, Sarah Greif, Brittany Bailey, Shelley Heaton
      First page: 33
      Abstract: Children with conditions affecting cognitive processes experience high levels of sleep disturbance, which may further compound the cognitive ramifications of their disorders. Despite this, existing studies in this area have been primarily confined to only particular diagnostic groups and/or a limited scope of sleep and cognitive parameters. The current study characterized the nature of sleep problems and examined the relationship between a wide range of sleep-related problems and cognitive functioning in a large (N = 103) diagnostically heterogeneous sample of youth (aged 6–16) referred for neuropsychological assessment. Structural equation modeling was used to examine the relationship between sleep-related problems (i.e., daytime sleepiness, sleep onset latency, sleep fragmentation, sleep time variability, sleep debt) and cognitive performance (i.e., executive functioning, sustained attention, memory, processing speed). Sleep fragmentation emerged as the most prominent sleep-related problem in the present sample. Structural equation modeling demonstrated a negative association between sleep-related problems and cognition that did not reach statistical significance (β = −0.084, p = 0.629). The current statistical approach may be used as a conceptual framework for future work examining these multi-dimensional constructs in a parsimonious fashion.
      Citation: Children
      PubDate: 2018-02-28
      DOI: 10.3390/children5030033
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 34: Impact of Supplemental Oxygen on Obstructive
           Sleep Apnea of Infants

    • Authors: Piyush Das, Rahul Kashyap, Suresh Kotagal
      First page: 34
      Abstract: Treatment options may be limited for infants with obstructive sleep apnea when there is no surgically correctable upper airway lesion. We therefore evaluated, retrospectively, the efficacy of low-flow oxygen as a therapeutic option for infant obstructive sleep apnea. We reviewed the medical charts of 23 infants who had undergone a therapeutic trial of low-flow oxygen during polysomnography. Split-night polysomnography was used in 21/23 subjects while 2/23 had undergone two separate, full-night polysomnography sleep architecture and respiratory findings on the baseline polysomnogram segment that was obtained in room air were compared with the segment on low-flow oxygen (0.25–1 L/min). Wilcoxon signed rank or McNemar’s test were used as indicated for comparing apnea hypopnea index and measures of sleep architecture at baseline and with oxygen therapy. The mean (±SD) age of subjects was 4.8 (±2.7) months, with 52% being males. The median apnea hypopnea index fell from a baseline of 18 (range 7–43) to 3 (range 1–19; p = 0.001) on oxygen. The baseline median obstructive/mixed apnea index decreased from 2 (range 1–16) to 1 during oxygen therapy (range 0–1; p = 0.003). Additionally, a significant decrease in central apnea index (median interquartile range (IQR) 1 (0–2) vs. 0 (0–1), p = 0.002) was noted. Sleep efficiency remained unaffected, while O2 saturation (SaO2) average and SaO2 nadir improved on oxygen. We were able to confirm the utility of low-flow oxygen in reducing central, obstructive, and mixed apneas and improving average oxygen saturation in infants with obstructive sleep apnea (OSA).
      Citation: Children
      PubDate: 2018-03-02
      DOI: 10.3390/children5030034
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 35: An Integrated Theatre Production for School
           Nutrition Promotion Program

    • Authors: Robert Bush, Sandra Capra, Selina Box, David McCallum, Stephanie Khalil, Remo Ostini
      First page: 35
      Abstract: In the context of stubbornly high childhood obesity rates, health promotion activities in schools provide a potential avenue to improve children’s nutritional behaviours. Theatre production has a rich history as a health behaviour promotion strategy but lacks sound, outcome-based evaluation. This study evaluated the effect of an integrated, two-part, place-based theatre performance program with 212 students in five schools in a regional urban and semi-rural area. The program included a theatre performance and a healthy eating competition. A brief survey assessed student healthy eating knowledge and attitudes at three time points. Nutrition behaviour was measured by scoring the contents of children’s lunch boxes before, during and up to six weeks after the intervention. Statistical analysis tested change over time on five variables (Knowledge, Attitude, Sometimes foods, Everyday foods, Overall lunch box score). Results showed that both components of the integrated program improved nutrition knowledge and that the theatre performance improved children’s healthy eating attitudes. All three lunch box scores peaked after the integrated program and remained significantly higher than baseline at 4–6 weeks follow-up. Interaction effects were identified for school catchment area on four of the five dependent variables. Evaluation of this integrated theatre production program indicates the potential benefit of taking a “super-setting” approach. It demonstrates an effect from students taking home information they had learned and incorporating it into lunch box preparation. It also showed consistent effects for school geographical catchment. This study suggests that, with careful, theory-based design, theatre productions in schools can improve student nutritional activities.
      Citation: Children
      PubDate: 2018-03-02
      DOI: 10.3390/children5030035
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 36: Trends in Pediatric Complicated Pneumonia in
           an Ontario Local Health Integration Network

    • Authors: Tahereh Haji, Adam Byrne, Tom Kovesi
      First page: 36
      Abstract: Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Three-hundred seventy-one children were included. Subjects had a median age of four years, and 188/370 (50.8%) required a chest tube. Admission rates changed markedly during this time period. The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.
      Citation: Children
      PubDate: 2018-03-03
      DOI: 10.3390/children5030036
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 37: Interdisciplinary Pediatric Palliative Care
           Team Involvement in Compassionate Extubation at Home: From Shared
           Decision-Making to Bereavement

    • Authors: Andrea Postier, Kris Catrine, Stacy Remke
      First page: 37
      Abstract: Little is known about the role of pediatric palliative care (PPC) programs in providing support for home compassionate extubation (HCE) when families choose to spend their child’s end of life at home. Two cases are presented that highlight the ways in which the involvement of PPC teams can help to make the option available, help ensure continuity of family-centered care between hospital and home, and promote the availability of psychosocial support for the child and their entire family, health care team members, and community. Though several challenges to realizing the option of HCE exist, early consultation with a PPC team in the hospital, the development of strategic community partnerships, early referral to home based care resources, and timely discussion of family preferences may help to make this option a realistic one for more families. The cases presented here demonstrate how families’ wishes with respect to how and where their child dies can be offered, even in the face of challenges. By joining together when sustaining life support may not be in the child’s best interest, PPC teams can pull together hospital and community resources to empower families to make decisions about when and where their child dies.
      Citation: Children
      PubDate: 2018-03-07
      DOI: 10.3390/children5030037
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 38: Accuracy of a Wrist-Worn Heart Rate Sensing
           Device during Elective Pediatric Surgical Procedures

    • Authors: Gloria Pelizzo, Anna Guddo, Aurora Puglisi, Annalisa De Silvestri, Calogero Comparato, Mario Valenza, Emanuele Bordonaro, Valeria Calcaterra
      First page: 38
      Abstract: The reliability of wearable photoplethysmography (PPG) sensors to measure heart rate (HR) in hospitalized patients has only been demonstrated in adults. We evaluated the accuracy of HR monitoring with a personal fitness tracker (PFT) in children undergoing surgery. HR monitoring was performed using a wrist-worn PFT (Fitbit Charge HR) in 30 children (8.21 ± 3.09 years) undergoing laparoscopy (n = 8) or open surgery (n = 22). HR values were analyzed preoperatively and during surgery. The accuracy of HR recordings was compared with measurements recorded during continuous electrocardiographic (cECG) monitoring; HRs derived from continuous monitoring with pulse oximetry (SpO2R) were used as a positive control. PFT-derived HR values were in agreement with those recorded during cECG (r = 0.99) and SpO2R (r = 0.99) monitoring. PFT performance remained high in children < 8 years (r = 0.99), with a weight < 30 kg (r = 0.99) and when the HR was < 70 beats per minute (bpm) (r = 0.91) or > 140 bpm (r = 0.99). PFT accuracy was similar during laparoscopy and open surgery, as well as preoperatively and during the intervention (r > 0.9). PFT–derived HR showed excellent accuracy compared with HRs measured by cECG and SpO2R during pediatric surgical procedures. Further clinical evaluation is needed to define whether PFTs can be used in different health care settings.
      Citation: Children
      PubDate: 2018-03-08
      DOI: 10.3390/children5030038
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 39: Some Socioeconomic Factors and Lifestyle
           Habits Influencing the Prevalence of Obesity among Adolescent Male
           Students in the Hail Region of Saudi Arabia

    • Authors: Awfa Alazzeh, Eyad AlShammari, Majdi Smadi, Firas Azzeh, Bandar AlShammari, Suneetha Epuru, Shahidah Banu, Rafia Bano, Shadi Sulaiman, Jerold Alcantara, Syed Ashraf, Samir Qiblawi
      First page: 39
      Abstract: A cross-sectional study was conducted to investigate the effect of some socioeconomic factors and lifestyle habits on the prevalence of obesity among adolescent male students in the Hail region, Saudi Arabia. A questionnaire was filled by 1495 male adolescents distributed among 12 schools in the Hail region. Body weight and height were taken, and the Z-score of students was measured using Anthroplus software with a cutoff 1–2 and +2 standard deviations to determine overweight and obesity, respectively. The study revealed that 21.3% of students were overweight and 27% were obese, respectively. There was a negative association between family size of >8 and obesity (OR: 0.68, CI: 0.48–0.92, p = 0.05). Family income of <5000 SR was negatively associated with obesity (OR: 0.59, CI: 0.36–0.97, p = 0.03). Whether a subject’s mother worked (odds ratio (OR): 1.43, confidence interval CI: 1.03–1.99, p = 0.03) as well as the subject’s mother’s education—whether she can read and write, has a middle school degree, or has done postsecondary studies—were positively associated with obesity. Exercise, regardless of the duration, was negatively associated with obesity. In addition, sleeping <6 h/day had a positive association with obesity. Conclusion: a >8 family size and a low family income were negatively associated with obesity, while having an educated and working mother was positively associated with obesity.
      Citation: Children
      PubDate: 2018-03-09
      DOI: 10.3390/children5030039
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 40: Communicating Effectively in Pediatric Cancer
           Care: Translating Evidence into Practice

    • Authors: Lindsay Blazin, Cherilyn Cecchini, Catherine Habashy, Erica Kaye, Justin Baker
      First page: 40
      Abstract: Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills.
      Citation: Children
      PubDate: 2018-03-11
      DOI: 10.3390/children5030040
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 41: Assessment of the Baby Friendly Hospital
           Initiative Implementation in the Eastern Mediterranean Region

    • Authors: Ayoub Al-Jawaldeh, Azza Abul-Fadl
      First page: 41
      Abstract: The Baby-Friendly Hospital Initiative (BFHI) is a global program for promoting support and protection for breastfeeding. However, its impact on malnutrition, especially in countries of the Eastern Mediterranean region (EMR) that are facing the turmoil of conflict and emergencies, deserves further investigation. Having said that, this paper aims to discuss the status and challenges to BFHI implementation in the EMR countries. Data on BFHI implementation, breastfeeding practices, and nutritional status were collected from countries through structured questionnaires, personal interviews, and databases. The 22 countries of the EMR were categorized as follows: 8 countries in advanced nutrition transition stage (group I), 5 countries in early nutrition transition stage (group II), 4 countries with significant undernutrition (group III), and 5 countries in complex emergency (group IV). The challenges to BFHI implementation were discussed in relation to malnutrition. BFHI was not implemented in 22.7% of EMR countries. Designated Baby-Friendly hospitals totaled 829 (group I: 78.4%, group II: 9.05%; group III: 7.36%; group: IV5.19%). Countries with advanced nutrition transition had the highest implementation of BFHI but the lowest breastfeeding continuity rates. On the other hand, poor nutritional status and emergency states were linked with low BFHI implementation and low exclusive breastfeeding rates but high continuity rates. Early initiation and longer duration of breastfeeding correlated negatively with overweight and obesity (p < 0.001). In countries with emergency states, breastfeeding continues to be the main source of nourishment. However, suboptimal breastfeeding practices prevail because of poor BFHI implementation which consequently leads to malnutrition. Political willpower and community-based initiatives are needed to promote breastfeeding and strengthen BFHI in the region.
      Citation: Children
      PubDate: 2018-03-11
      DOI: 10.3390/children5030041
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 42: Serum Zinc Level in Asthmatic and
           Non-Asthmatic School Children

    • Authors: Atqah AbdulWahab, Aseel Zeidan, Tony Avades, Prem Chandra, Ashraf Soliman
      First page: 42
      Abstract: Asthma is one of the most common chronic disorders among children. Zinc (Zn) is an essential dietary antioxidant and may have a special role in assisting the airways of asthmatic subjects. The primary objective of this study was to measure serum Zn levels among asthmatic school children and to compare this to the serum Zn level in non-asthmatic children. The secondary objective was to investigate the relationship between Zn levels and the degree of asthma control. A cross-sectional study following forty asthmatic children and forty matched non-asthmatic children of both genders was conducted. Weight, height, body mass index (BMI), BMI Z-scores, serum Zn, hemoglobin, total protein, and albumin concentrations were measured in both groups. Serum immunoglobulin E (IgE) levels, the forced expiratory volume in 1 second (FEV1), and dosage of inhaled steroids were measured in asthmatic school children. The results show the mean Zn level among asthmatic children was 12.78 ± 1.8 μmol/L. Hypozincemia was detected in four asthmatic children. Asthma and control groups were matched in age, gender, and BMI Z score (p > 0.05). No significant difference was observed in Zn levels, hemoglobin, albumin, and total protein between both groups (p > 0.05). Among asthmatics, Zn levels were not significantly associated with the degree of asthma control (well controlled, mean Zn = 12.9 ± 1.5, partially controlled, mean Zn = 11.9 ± 1.6, and uncontrolled, mean Zn = 3.62 ± 2.2) (p = 0.053). The Zn level was not correlated with the FEV1 Z score. There was no significant association between Zn level and the dosage of inhaled steroids or IgE concentrations (p > 0.05). The findings show that Zn may not play a major role in the degree of asthma control. Larger studies are needed to confirm these results.
      Citation: Children
      PubDate: 2018-03-16
      DOI: 10.3390/children5030042
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 43: Pediatric Melanoma and Drug Development

    • Authors: Klaus Rose, Jane Grant-Kels
      First page: 43
      Abstract: Importance—Pediatric melanoma occurs, albeit rarely. Should patients be treated by today’s medical standards, or be subjected to medically unnecessary clinical studies' Observations—We identified international, industry-sponsored pediatric melanoma studies triggered by regulatory demands in and further pediatric melanoma studies demanded by European Union pediatric investigation plans. We retrieved related regulatory documents from the internet. We analyzed these studies for rationale and medical beneficence on the basis of physiology, pediatric clinical pharmacology and rationale. Regulatory authorities define children by chronological age, not physiologically. Newborns’ organs are immature but they develop and mature rapidly. Separate proof of efficacy in underage patients is justified formally/regulatorily but lacks medical sense. Children—especially post-puberty—and adults vis-a-vis medications are physiologically very similar. Two adolescent melanoma studies were terminated in 2016 because of waning recruitment, while five studies in pediatric melanoma and other solid tumors, triggered by European Union pediatric investigation plans, continue recruiting worldwide. Conclusions and Relevance—Regulatory-demanded pediatric melanoma studies are medically superfluous. Melanoma patients of all ages should be treated with effective combination treatment. Babies need special attention. Children need dose-finding and pharmacokinetic studies but adolescents metabolize and respond to drugs similarly to adults. Institutional Review Boards/ethics committees should suspend ongoing questionable pediatric melanoma studies and reject newly submitted questionable studies.
      Citation: Children
      PubDate: 2018-03-20
      DOI: 10.3390/children5030043
      Issue No: Vol. 5, No. 3 (2018)
  • Children, Vol. 5, Pages 14: The Value of Food Allergy Prevention in
           Clinical Practice in Pediatrics: Targeting Early Life

    • Authors: Katherine Anagnostou, Jordan Orange
      First page: 14
      Abstract: Food allergies are common and increasing in prevalence, representing a major health concern in many countries around the world. In an effort to diminish the burden of food allergy, many research studies have focused on prevention, and recent findings have revolutionized the way we introduce allergenic foods in early life. We discuss the role of early allergenic food introduction and the value of food allergy prevention in this manuscript.
      Citation: Children
      PubDate: 2018-01-23
      DOI: 10.3390/children5020014
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 15: Acknowledgement to Reviewers of Children in

    • Authors: Children Editorial Office
      First page: 15
      Abstract: Peer review is an essential part in the publication process, ensuring that Children maintains high quality standards for its published papers [...]
      Citation: Children
      PubDate: 2018-01-23
      DOI: 10.3390/children5020015
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 16: A Review of Apps for Calming, Relaxation, and
           Mindfulness Interventions for Pediatric Palliative Care Patients

    • Authors: Taelyr Weekly, Nicole Walker, Jill Beck, Sean Akers, Meaghann Weaver
      First page: 16
      Abstract: Patients and families increasingly use mobile apps as a relaxation and distraction intervention for children with complex, chronic medical conditions in the waiting room setting or during inpatient hospitalizations; and yet, there is limited data on app quality assessment or review of these apps for level of engagement, functionality, aesthetics, or applicability for palliative pediatric patients. The pediatric palliative care study team searched smartphone application platforms for apps relevant to calming, relaxation, and mindfulness for pediatric and adolescent patients. Apps were reviewed using a systematic data extraction tool. Validated Mobile Application Rating Scale (MARS) scores were determined by two blinded reviewers. Apps were then characterized by infant, child, adolescent, and adult caregiver group categories. Reviewer discussion resulted in consensus. Sixteen of the 22 apps identified were included in the final analysis. The apps operated on either iOS or Android platforms. All were available in English with four available in Spanish. Apps featured a relaxation approach (12/16), soothing images (8/16), and breathing techniques (8/16). Mood and sleep patterns were the main symptoms targeted by apps. Provision of mobile apps resource summary has the potential to foster pediatric palliative care providers’ knowledge of app functionality and applicability as part of ongoing patient care.
      Citation: Children
      PubDate: 2018-01-26
      DOI: 10.3390/children5020016
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 17: Utility of Non-Invasive Monitoring of Cardiac
           Output and Cerebral Oximetry during Pain Management of Children with
           Sickle Cell Disease in the Pediatric Emergency Department

    • Authors: Pradeep Padmanabhan, Chikelue Oragwu, Bibhuti Das, John Myers, Ashok Raj
      First page: 17
      Abstract: Pain crisis in children with sickle cell disease (SCD) is typically managed with intravenous fluids and parenteral opioids in the pediatric emergency department. Electrical cardiometry (EC) can be utilized to measure cardiac output (CO) and cardiac index (CI) non-invasively. Near-infrared spectroscopy (NIRS) measuring cerebral (rCO2) and splanchnic regional (rSO2) mixed venous oxygenation non-invasively has been utilized for monitoring children with SCD. We studied the value and correlation of NIRS and EC in monitoring hemodynamic status in children with SCD during pain crisis. We monitored EC and NIRS continuously for 2 h after presentation and during management. Forty-five children participated in the study. CO (D = 1.72), CI (D = 1.31), rSO2 (D = 11.6), and rCO2 (D = 9.3), all increased over time. CO max and CI max were achieved 1 h after starting resuscitation. rCO2 max attainment was quicker than rSO2, as monitored by NIRS. CI max correlated with rCO2 max (r = −0.350) and rSO2 max (r = −0.359). In adjustment models, initial CI significantly impacted initial rCO2 (p = 0.045) and rCO2 max (p = 0.043), while initial CO impacted rCO2 max (p = 0.030). Cardiac output monitoring and NIRS monitoring for cerebral and splanchnic oxygenation were feasible and improved the monitoring of therapeutic interventions for children with SCD during pain crisis.
      Citation: Children
      PubDate: 2018-01-29
      DOI: 10.3390/children5020017
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 18: Current Government Actions and Potential
           Policy Options for Reducing Obesity in Queensland Schools

    • Authors: Naser Alsharairi
      First page: 18
      Abstract: School nutrition policies provide promising avenues towards the improvement of children’s eating habits and the prevention of obesity. Childhood obesity rates and related chronic diseases are increasing in Queensland, in part as a result of unhealthy eating habits and lack of physical activity. There is a very high investment by the Queensland government in maintaining healthy weight and promoting nutrition and physical activity among schoolchildren through delivering a range of initiatives across the state. However, there is a lack of evidence concerning the effectiveness of nutrition/physical education and parental involvement programs addressing obesity delivered in Queensland schools. This paper can be used to guide government and policy-makers regarding the most effective policy options that will promote healthy eating and physical activity among Queensland schoolchildren. The aim of this paper is to: (i) summarize current evidence on Queensland government responses to obesity; and (ii) discuss potential policy options that could support healthy eating and regular physical activity, and examine the evidence base for each option and suggest new areas for future research.
      Citation: Children
      PubDate: 2018-01-29
      DOI: 10.3390/children5020018
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 19: Effects of Combining Medication and Pivotal
           Response Treatment on Aberrant Behavior in Children with Autism Spectrum

    • Authors: Mohammad Rezaei, AliReza Moradi, Mehdi Tehrani-Doost, HamidReza Hassanabadi, Reza Khosroabadi
      First page: 19
      Abstract: : The purpose of this study was to investigate the effects of combined risperidone (RIS) and pivotal response treatment (PRT) on children with autism spectrum disorder (ASD). A total of 34 children diagnosed with ASD according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) (mean age of 12.36 years) were randomly assigned to either of two groups; the first group (n = 17) received combined PRT–RIS while the second group (n = 17) received RIS only. Behavioral problems were evaluated with the Aberrant Behavior Checklist (ABC), whereas global improvement (GI) was measured with the Clinical Global Impressions (CGI). Assessment of ABC was performed before intervention, after intervention (12 weeks), and following 3 months of the intervention (follow-up). Total ABC scores were seen to decrease in both groups after 3 months, as compared with the scores prior to the interventions. Also, in both groups, mean scores of behavioral problems after the intervention were not significantly different from those prior to the intervention, in all subscales but the inappropriate speech (p < 0.001). However, both groups showed significant differences in mean scores of ABC subscales in both of the post-intervention evaluation stages. It was concluded that the combination of behavioral and drug interventions can further improve behavioral problems, ultimately improving patient’s communication and social skills.
      Citation: Children
      PubDate: 2018-01-30
      DOI: 10.3390/children5020019
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 20: A Sleep Questionnaire for Children with Severe
           Psychomotor Impairment (SNAKE)—Concordance with a Global Rating of Sleep

    • Authors: Larissa Dreier, Boris Zernikow, Markus Blankenburg, Julia Wager
      First page: 20
      Abstract: Sleep problems are a common and serious issue in children with life-limiting conditions (LLCs) and severe psychomotor impairment (SPMI). The “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen, SNAKE) was developed for this unique patient group. In a proxy rating, the SNAKE assesses five different dimensions of sleep(-associated) problems (disturbances going to sleep, disturbances remaining asleep, arousal and breathing disorders, daytime sleepiness, and daytime behavior disorders). It has been tested with respect to construct validity and some aspects of criterion validity. The present study examined whether the five SNAKE scales are consistent with parents’ or other caregivers’ global ratings of a child’s sleep quality. Data from a comprehensive dataset of children and adolescents with LLCs and SPMI were analyzed through correlation coefficients and Mann–Whitney U testing. The results confirmed the consistency of both sources of information. The highest levels of agreements with the global rating were achieved for disturbances in terms of going to sleep and disturbances with respect to remaining asleep. The results demonstrate that the scales and therefore the SNAKE itself is well-suited for gathering information on different sleep(-associated) problems in this vulnerable population.
      Citation: Children
      PubDate: 2018-02-01
      DOI: 10.3390/children5020020
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 21: Pediatric Palliative Care in Infants and

    • Authors: Brian Carter
      First page: 21
      Abstract: The application of palliative and hospice care to newborns in the neonatal intensive care unit (NICU) has been evident for over 30 years. This article addresses the history, current considerations, and anticipated future needs for palliative and hospice care in the NICU, and is based on recent literature review. Neonatologists have long managed the entirety of many newborns’ short lives, given the relatively high mortality rates associated with prematurity and birth defects, but their ability or willingness to comprehensively address of the continuum of interdisciplinary palliative, end of life, and bereavement care has varied widely. While neonatology service capacity has grown worldwide during this time, so has attention to pediatric palliative care generally, and neonatal-perinatal palliative care specifically. Improvements have occurred in family-centered care, communication, pain assessment and management, and bereavement. There remains a need to integrate palliative care with intensive care rather than await its application solely at the terminal phase of a young infant’s life—when s/he is imminently dying. Future considerations for applying neonatal palliative care include its integration into fetal diagnostic management, the developing era of genomic medicine, and expanding research into palliative care models and practices in the NICU.
      Citation: Children
      PubDate: 2018-02-07
      DOI: 10.3390/children5020021
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 22: A Case of Spontaneous Pneumomediastinum with
           Subcutaneous Emphysema in Children

    • Authors: Said Benlamkaddem, Mohamed Berdai, Smael Labib, Mustapha Harandou
      First page: 22
      Abstract: Spontaneous pneumomediastinum is defined as free air or gas contained within the mediastinum, which almost invariably originates from the alveolar space or the conducting airways. It is rare in pediatric patients; however, occasional cases are reported to result from forced Valsalva’s maneuver due to cough, emesis, a first attack of wheeze, or asthma exacerbations. We report the case of a 7-year-old previously healthy girl, with a history of persistent dry cough one day before, who was brought to our unit with face, neck and chest swelling. The chest X-ray and computed tomography (CT) scan showed subcutaneous emphysema with pneumomediastinum and pneumopericardium without evidence of the origin of this air leak. Laboratory tests and the bronchoscopy were normal. The patient was admitted in the pediatric critical care and received noninvasive monitoring, analgesia, oxygen, and omeprazole as a prophylaxis for a gastric ulcer. The patient improved, subcutaneous emphysema resolved, and she was discharged on the third day.
      Citation: Children
      PubDate: 2018-02-07
      DOI: 10.3390/children5020022
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 23: Unintentional Childhood Injuries in Urban and
           Rural Ujjain, India: A Community-Based Survey

    • Authors: Aditya Mathur, Love Mehra, Vishal Diwan, Ashish Pathak
      First page: 23
      Abstract: Injuries are a major global public health problem. There are very few community-based studies on childhood injury from India. The objective of this cross-sectional, community-based survey was to identify the incidence, type, and risk factors of unintentional childhood injuries. The study was done in seven villages and ten contiguous urban slums in Ujjain, India. World Health Organization (WHO) tested tools and definitions were used for the survey, which included 2518 households having 6308 children up to 18 years of age, with 2907 children from urban households and 3401 from rural households. The annual incidence of all injuries was 16.6%, 95% Confidence Interval 15.7–17.5%, (n = 1049). The incidence was significantly higher among boys compared to girls (20.2% versus 12.7%, respectively), was highest in age group 6–10 years of age (18.9%), and in urban locations (17.5%). The most commonly identified injury types were: physical injuries (71%), burns (16%), poisonings (10%), agriculture-related injuries (2%), near drowning (2%), and suffocations (2%). The most common place of injury was streets followed by home. The study identified incidence of different types of unintentional childhood injuries and factors associated with increased risk of unintentional injuries. The results can help in designing injury prevention strategies and awareness programs in similar settings.
      Citation: Children
      PubDate: 2018-02-08
      DOI: 10.3390/children5020023
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 24: Social Determinants of Perceived
           Discrimination among Black Youth: Intersection of Ethnicity and Gender

    • Authors: Shervin Assari, Cleopatra Howard Caldwell
      First page: 24
      Abstract: Most of the existing sociological and epidemiological literature has focused on the protective effects of high socioeconomic status (SES) on population health through reducing exposure to risk factors and increasing human and material resources that can mitigate adversities. Recent studies, however, have documented poor mental health of high SES Blacks, particularly African American males and Caribbean Black females. The literature also shows a link between perceived discrimination and poor mental health. To better understand the extra costs of upward social mobility for minority populations, this study explored ethnic by gender variations in the associations between SES indicators and perceived discrimination in an ethnically diverse national sample of Black youth. This study included 810 African American and 360 Caribbean Black youth who were sampled in the National Survey of American Life—Adolescent supplement (NSAL-A). Three SES indicators (financial hardship, family income, and income to needs ratio) were the independent variables. The dependent variable was perceived (daily) discrimination. Age was the covariate. Ethnicity and gender were the focal moderators. Linear regressions were used for data analysis in the pooled sample and also based on the intersection of ethnicity and gender. Considerable gender by ethnicity variations were found in the patterns of the associations between SES indicators and perceived discrimination. Financial hardship was a risk factor for perceived discrimination in African American males only. High family income and income to needs ratio were associated with high (but not low) perceived discrimination in African American males and Caribbean Black females. SES indicators were not associated with perceived discrimination for African American females or Caribbean Black males. When it comes to Black youth, high SES is not always protective. Whether SES reduces or increases perceived discrimination among Black youth depends on the intersection of ethnicity by gender. Additional research is needed to understand why and how high SES increases exposure and vulnerability to discrimination for some groups of Black youth.
      Citation: Children
      PubDate: 2018-02-15
      DOI: 10.3390/children5020024
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 25: Autism Treatment Evaluation Checklist (ATEC)
           Norms: A “Growth Chart” for ATEC Score Changes as a Function of Age

    • Authors: Shreyas Mahapatra, David Vyshedsky, Samantha Martinez, Benjamin Kannel, Julia Braverman, Stephen Edelson, Andrey Vyshedskiy
      First page: 25
      Abstract: Most early-intervention Autism Spectrum Disorder (ASD) clinical trials are limited by the availability of psychometric technicians who assess each child’s abilities before and after therapeutic intervention. If parents could administer regular psychometric evaluations of their children, then the cost of clinical trials will be reduced, enabling longer clinical trials with the larger number of participants. The Autism Treatment Evaluation Checklist (ATEC) was designed nearly two decades ago to provide such a tool, but the norms on the longitudinal changes in ATEC in the “treatment as usual” population were lacking. Here we report the norms of the observational cohort who voluntarily completed ATEC evaluations over the period of four years from 2013 to 2017.
      Citation: Children
      PubDate: 2018-02-16
      DOI: 10.3390/children5020025
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 26: Palliative Care for Children in Hospital:
           Essential Roles

    • Authors: Ross Drake
      First page: 26
      Abstract: Palliative care for children in pediatric hospitals is a vital part of the network of services supporting children with severe illness. This has been recognized, with a trend over the past decade for an increased number of pediatric palliative care (PPC) services established in pediatric hospitals. The inpatient team is in the unique position of influencing the early identification of children and their families, across the age and diagnostic spectrum, which could benefit from palliative care. These services have an opportunity to influence the integration of the palliative approach throughout the hospital, and in so doing, have the capacity to improve many aspects of care, including altering an increasingly futile and burdensome treatment trajectory, and ensuring improved symptom (physical and psychological) management.
      Citation: Children
      PubDate: 2018-02-19
      DOI: 10.3390/children5020026
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 27: Paediatric Palliative Care in Resource-Poor

    • Authors: Julia Downing, Sue Boucher, Alex Daniels, Busi Nkosi
      First page: 27
      Abstract: There is a great need for paediatric palliative care (PPC) services globally, but access to services is lacking in many parts of the world, particularly in resource-poor settings. Globally it is estimated that 21.6 million children need access to palliative care, with 8.2 needing specialist services. PC has been identified as important within the global health agenda e.g., within universal health coverage, and a recent Lancet commission report recognised the need for PPC. However, a variety of challenges have been identified to PPC development globally such as: access to treatment, access to medications such as oral morphine, opiophobia, a lack of trained health and social care professionals, a lack of PPC policies and a lack of awareness about PPC. These challenges can be overcome utilising a variety of strategies including advocacy and public awareness, education, access to medications, implementation and research. Examples will be discussed impacting on the provision of PPC in resource-poor settings. High-quality PPC service provision can be provided with resource-poor settings, and there is an urgent need to scale up affordable, accessible, and quality PPC services globally to ensure that all children needing palliative care can access it.
      Citation: Children
      PubDate: 2018-02-19
      DOI: 10.3390/children5020027
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 28: Pediatric Palliative Care for Children with
           Progressive Non-Malignant Diseases

    • Authors: Harold Siden
      First page: 28
      Abstract: A substantial number of children cared for by pediatric palliative care physicians have progressive non-malignant conditions. Some elements of their care overlap with care for children with cancer while other elements, especially prognosis and trajectory, have nuanced differences. This article reviews the population, physical-emotional and social concerns, and trajectory.
      Citation: Children
      PubDate: 2018-02-20
      DOI: 10.3390/children5020028
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 29: Distress Responses in a Routine Vaccination
           Context: Relationships to Early Childhood Mental Health

    • Authors: Nicole M. Racine, Hannah G. Gennis, Rebecca Pillai Riddell, Saul Greenberg, Hartley Garfield
      First page: 29
      Abstract: Social and emotional competencies, such as distress regulation, are established in early childhood and are critical for the development of children’s mental health and wellbeing. Routine vaccinations in primary care provide a unique opportunity to relate responses to a universal, relatively standardized, distress regulation paradigm (i.e., pain-related distress) to key developmental outcomes. The current study sought to examine distress regulation during routine vaccination in infancy and preschool as predictors of outcomes related to socioemotional competence in preschool. It was hypothesized that children with poorer distress regulation abilities post-vaccination would have lower socioemotional development. Furthermore, it was hypothesized that insensitive parenting would exacerbate this relationship for children with poor distress regulation abilities. As part of an ongoing longitudinal cohort, 172 parent–child dyads were videotaped during vaccinations in infancy and preschool, and subsequently participated in a full-day psychological assessment in a university lab. Videotapes were coded for child pre-needle distress (baseline distress), immediate post-needle pain-related distress reactivity (immediate distress reactivity), and pain-related distress regulation (distress regulation). Parent sensitivity during the preschool vaccination was also coded. Baseline distress prior to vaccination predicted greater externalizing problems and behavioral symptoms. Parent sensitivity did not moderate the association between any child distress behaviors and socioemotional development indicators. Child distress behaviors prior to injection, regardless of parent behavior, during the vaccination context may provide valuable information to health care professionals about child socioemotional functioning in the behavioral and emotional domains.
      Citation: Children
      PubDate: 2018-02-21
      DOI: 10.3390/children5020029
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 30: The Sitting-Height Index of Build, (Body
           Mass)/(Sitting Height)3, as an Improvement on the Body Mass Index for
           Children, Adolescents and Young Adults

    • Authors: Richard Burton
      First page: 30
      Abstract: The body mass index (BMI) is unsatisfactory in being affected by both relative leg length and height, and, for use with children and adolescents, therefore needs to be interpreted in relation to age. The sitting-height index of build (body mass)/(sitting height)3, is largely free of these disadvantages. Furthermore, because that index is independent of relative leg length, the latter can be treated as a separate indicator of nutritional history and health risks. Past studies on white children and adults have shown body mass to be approximately proportional to (sitting height)3. Moreover, multiple regression of (body mass)1/3 on sitting height and leg length, using year-by-year averages, has indicated that leg length is an insignificant predictor of body mass. The present study used data for individuals, namely 2–20 years old males and females, black as well as white. Regression analysis as above again showed leg length to be an insignificant predictor of body mass, but only above the age of about nine years. However, sitting height is still a stronger predictor of body mass than leg length at all ages. The advantages of the sitting-height index of build for use with young people are confirmed.
      Citation: Children
      PubDate: 2018-02-22
      DOI: 10.3390/children5020030
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 31: Children’s Environmental Health in the
           Digital Era: Understanding Early Screen Exposure as a Preventable Risk
           Factor for Obesity and Sleep Disorders

    • Authors: Candice Wolf, Seth Wolf, Miriam Weiss, Gustavo Nino
      First page: 31
      Abstract: The quantity, accessibility and focus on child-targeted programming has exponentially increased since it entered American households in the early 1900s. It may have started with the television (TV), but technology has evolved and now fits in our pockets; as of 2017, 95% of American families own a smartphone. Availability and child-tailored content has subsequently led to a decrease in the age at initial screen exposure. The negative effects that accompany the current culture of early screen exposure are extensive and need to be considered as technology continues to enter the home and inundate social interactions. Increased levels of early screen exposure have been associated with decreased cognitive abilities, decreased growth, addictive behavior, poor school performance, poor sleep patterns, and increased levels of obesity. Research on the adverse effects of early screen exposure is mounting, but further epidemiological studies are still needed to inform prevention and regulation policies.
      Citation: Children
      PubDate: 2018-02-23
      DOI: 10.3390/children5020031
      Issue No: Vol. 5, No. 2 (2018)
  • Children, Vol. 5, Pages 6: The Effect of Detectable HIV Viral Load among
           HIV-Infected Children during Antiretroviral Treatment: A Cross-Sectional

    • Authors: Visal Moolasart, Suthat Chottanapund, Jarurnsook Ausavapipit, Sirirat Likanonsakul, Sumonmal Uttayamakul, Don Changsom, Hatairat Lerdsamran, Pilaipan Puthavathana
      First page: 6
      Abstract: The RNA viral load of human immunodeficiency virus (HIV) is initially used to determine the status of the HIV infection. The goal of therapy following treatment failure is to achieve and maintain virologic suppression. A detectable viral load may relate to the progression of HIV infection. A cross-sectional survey was conducted from January 2013 to December 2014 at the Bamrasnaradura Infectious Diseases Institute, Thailand. The aim was to determine the prevalence of detectable HIV viral load (dVL) and analyze the factors associated with post-dVL conditions that occur independently of a switch to a new antiretroviral agent. The prevalence of dVL was 27% (27 of 101). The mean ages of dVL and non-dVL children were 12.0 and 12.3 years, respectively. Age, sex, body mass index for age z-scores, previous tuberculosis disease history and parental tuberculosis history of both groups were not significantly different (p > 0.05). The prevalence of poor adherence (<95%), influenza-like illness (ILI) and opportunistic infections were higher in dVL than non-dVL children (p < 0.05). The mean nadir CD4 cell count during the study was lower in dVL than non-dVL children (646 compared to 867, respectively; p < 0.05). Other factors were not significant (all p > 0.05). In multivariable analysis, dVL was significantly associated with ILI (odds ratio (OR) = 9.6, 95% confidence interval (CI) = 1.3–69.4), adherence (OR = 0.195, 95% CI = 0.047–0.811) and nadir CD4 during the study (OR = 1.102, 95% CI = 1.100–1.305). The prevalence of dVL was 27% with this dVL among HIV-infected children found to be associated with ILI, poor adherence and lower nadir CD4 during the study.
      Citation: Children
      PubDate: 2018-01-01
      DOI: 10.3390/children5010006
      Issue No: Vol. 5, No. 1 (2018)
  • Children, Vol. 5, Pages 7: Use of Pleuroperitoneal Shunt in Chylothorax
           Related to Central Line Associated Thrombosis in Sickle Cell Disease

    • Authors: Elizabeth Spiwak, Chad Wiesenauer, Arun Panigrahi, Ashok Raj
      First page: 7
      Abstract: Central vein thrombosis as a cause of chylothorax is uncommon, and in a few cases in the literature was related to thrombotic complications of central venous access devices (CVAD). Superior vena cava (SVC) occlusion-induced chylothorax has been described in adult sickle cell disease (SCD) in a setting of chronic indwelling CVAD. There are limited reports on chylothorax induced by central venous thrombosis secondary to chronic CVAD in children with SCD. We describe an 8-year-old male patient, with a history of SCD, maintained on long term erythrocytapheresis for primary prevention of stroke, and whose clinical course was complicated by chylothorax which was successfully treated with a pleuroperitoneal shunt.
      Citation: Children
      PubDate: 2018-01-02
      DOI: 10.3390/children5010007
      Issue No: Vol. 5, No. 1 (2018)
  • Children, Vol. 5, Pages 8: Factors Associated with Not Breastfeeding and
           Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi

    • Authors: Firas Azzeh, Awfa Alazzeh, Haifa Hijazi, Haneen Wazzan, Monya Jawharji, Abdelelah Jazar, Amira Filimban, Ali Alshamrani, Mai Labani, Taghreed Hasanain, Ahmad Obeidat
      First page: 8
      Abstract: The objective of the study was to find the determinants related to not breastfeeding (BF) and others related to the delay in the early initiation of BF in the Mecca region, Saudi Arabia. A cross-sectional study in the Maternity and Children Hospital and primary healthcare centers was performed. A questionnaire was filled by dietitians to 814 asymptomatic Saudi mothers. Determinants related to not BF and the delay in the early initiation of BF were determined by binary logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were determined. Significant factors associated with not BF were not rooming-in infants in the mother’s room (OR: 2.37; 95% CI: 1.66–3.41) and using a pacifier (OR: 1.62; 95% CI: 1.13–2.33). The most significant determinant of the early initiation of BF was the initiation of bottle feeding (OR: 18.16; 95% CI: 10.51–31.4), followed by not rooming-in infants in the mother’s room (OR: 2.2; 95% CI: 1.52–3.18), initiation of partial feeding (OR: 1.89; 95% CI: 1.3–2.74), uninformed mothers regarding the importance of BF (OR: 1.56; 95% CI: 1.04–2.35), and cesarean sections (OR:1.42; 95% CI: 1.02–1.98). Risk factors affecting BF and the early initiation of BF in Mecca City should be highlighted in national campaigns to increase mothers’ awareness and promote BF practice.
      Citation: Children
      PubDate: 2018-01-03
      DOI: 10.3390/children5010008
      Issue No: Vol. 5, No. 1 (2018)
  • Children, Vol. 5, Pages 9: A Retrospective Review of Resuscitation
           Planning at a Children’s Hospital

    • Authors: Jean Kelly, Jo Ritchie, Leigh Donovan, Carol Graham, Anthony Herbert
      First page: 9
      Abstract: Resuscitation plans (RP) are an important clinical indicator relating to care at the end of life in paediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children’s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65%) had a life limiting condition and 43 medical records (69%) contained a documented RP. This study demonstrated that both the underlying condition (life-limiting or life-threatening) and the setting of care (Pediatric Intensive Care Unit or home) influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC) service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU) had a RP that was documented within the last 48 h of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration, particularly involving PICU and PPC services, in developing protocols of how to manage this difficult but inevitable clinical scenario.
      Citation: Children
      PubDate: 2018-01-04
      DOI: 10.3390/children5010009
      Issue No: Vol. 5, No. 1 (2018)
  • Children, Vol. 5, Pages 10: Esophageal Web in a Down Syndrome
           Infant—A Rare Case Report

    • Authors: Nirmala Thomas, Roy Mukkada, Muhammed Abdul Jalal, Nisha Narayanankutty
      First page: 10
      Abstract: We describe the rare case of an infant with trisomy 21 who presented with recurrent vomiting and aspiration pneumonia and a failure to thrive. Infants with Down’s syndrome have been known to have various problems in the gastrointestinal tract. In the esophagus, what have been described are dysmotility, gastroesophageal reflux and strictures. This infant on evaluation was found to have an esophageal web and simple endoscopic dilatation relieved the infant of her symptoms. No similar case has been reported in literature.
      Citation: Children
      PubDate: 2018-01-11
      DOI: 10.3390/children5010010
      Issue No: Vol. 5, No. 1 (2018)
  • Children, Vol. 5, Pages 11: Current Evidence on Vitamin D Deficiency and
           Metabolic Syndrome in Obese Children: What Does the Evidence from Saudi
           Arabia Tell Us'

    • Authors: Asma Alaklabi, Naser Alsharairi
      First page: 11
      Abstract: Obesity and vitamin D deficiency represent major health problems among Saudi children, and have been linked to chronic diseases. Obese children are at risk of developing vitamin D deficiency, which appears to have negative influences on energy homeostasis, impeded bone mineralisation, insulin resistance and inflammation. Evidence supporting the association between vitamin D deficiency of obese children and metabolic syndrome has not specifically been studied in early childhood. The mechanisms through which vitamin D deficiency is associated with metabolic syndrome in obese children needs further elucidation. This commentary aims to (i) summarise current knowledge of the association between vitamin D deficiency and metabolic syndrome in obese children; and (ii) discuss current evidence for the association among Saudi Arabian children.
      Citation: Children
      PubDate: 2018-01-15
      DOI: 10.3390/children5010011
      Issue No: Vol. 5, No. 1 (2018)
  • Children, Vol. 5, Pages 12: A Child’s Concept of Pain: An International
           Survey of Pediatric Pain Experts

    • Authors: Joshua Pate, Julia Hush, Mark Hancock, G. Moseley, David Butler, Laura Simons, Verity Pacey
      First page: 12
      Abstract: A child’s ‘concept of pain’ refers to how they understand what pain actually is, what function pain serves, and what biological processes are thought to underpin it. We aimed to determine pediatric pain experts’ opinions of: (1) the importance and usefulness of assessing a child’s concept of pain in clinical and/or research settings; (2) the usefulness of the content of items within currently published adult-targeted resources for assessing a child’s concept of pain; and (3) important domains of a child’s concept of pain to assess. Forty-nine pediatric pain experts (response rate = 75.4%) completed an online survey. Descriptive statistics and frequency of responses were analyzed. Experts from all included disciplines reported that assessing a child’s concept of pain is important and useful both clinically and in a research setting (>80% reported very or extremely useful for each item). Experts considered that the content of 13 items from currently published adult-targeted resources was useful, but the wording was too complex for children aged 8–12 years. Experts considered that all seven of the proposed domains of a child’s concept of pain was important to assess. The findings can be used to inform the development of an assessment tool for a child’s concept of pain.
      Citation: Children
      PubDate: 2018-01-15
      DOI: 10.3390/children5010012
      Issue No: Vol. 5, No. 1 (2018)
  • Children, Vol. 5, Pages 13: ‘Total Pain’ in Children with
           Severe Neurological Impairment

    • Authors: Timothy Warlow, Richard Hain
      First page: 13
      Abstract: Many children with palliative care needs experience difficulty in managing pain. Perhaps none more so than those with severe neurological impairment. For many years; behaviours in these children were misunderstood. As a result; pain was poorly recognised and inadequately managed. Significant advances have been made in the assessment and management of pain in this challenging group of patients. We summarise these advances; drawing on our own experience working with infants; children and young adults with palliative care needs within a UK tertiary paediatric palliative care service. We expand on the recent understanding of ‘Total Pain’; applying a holistic approach to pain assessment and management in children with severe neurological impairment.
      Citation: Children
      PubDate: 2018-01-18
      DOI: 10.3390/children5010013
      Issue No: Vol. 5, No. 1 (2018)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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