BACKGROUND & AIMS: :Professor George P. Chrousos, Professor Emeritus of Paediatrics and Endocrinology at the University of Athens School of Medicine, in Athens, Greece, is the most distinguished Professor of Paediatrics in the modern history of Hellenic Paediatrics and among the 100 most prominent clinical investigators worldwide. According to Professor Chrousos, viruses frequently interact with the host endocrine signaling pathways, while stress triggers acutely an early inflammatory response termed 'neurogenic inflammation'. Soon after, however, stress suppresses innate immunity and causes a shift from T-helper 1- to T-helper 2- driven immunity. The natural history of the response to a viral infection is for immune and stress changes to take place in a highly coordinated process that results in the full return to the basal health state. He believes that over the past decades, our armamentarium against viruses has increased significantly as novel anti-viral agents, monoclonal antibodies and vaccines, have been and are continually being developed. Professor Chrousos declares that Paediatrics is a very broad scientific field, where paediatric trainees have many avenues to follow beyond clinical practice and into basic, preclinical, translational, clinical, applied, or epidemiologic research. He supports that researching and producing new knowledge to the benefit of humanity is a product of practicing Aristotle's ancient Greek virtues and a worthy cause of life's meaning. He completes our interview calling young paediatricians to 'listen to their minds and hearts' to select a life course that would lead them to acquire personal wisdom and eudaimonia.

背景与目标： : 希腊雅典雅典大学医学院儿科和内分泌学名誉教授George P. Chrousos教授是希腊现代儿科历史上最杰出的儿科教授，也是全球100位最杰出的临床研究者之一。根据Chrousos教授的说法，病毒经常与宿主内分泌信号通路相互作用，而压力会严重触发称为 “神经源性炎症” 的早期炎症反应。然而，不久之后，压力会抑制先天免疫，并导致从T辅助1-转向T辅助2驱动的免疫。对病毒感染的反应的自然史是在高度协调的过程中发生免疫和压力变化，从而导致完全恢复到基础健康状态。他认为，在过去的几十年中，随着新型抗病毒剂，单克隆抗体和疫苗的不断发展，我们的抗病毒军械库已大大增加。Chrousos教授宣称，儿科是一个非常广泛的科学领域，儿科受训者有许多途径可以超越临床实践，进入基础，临床前，转化，临床，应用或流行病学研究。他支持研究和生产造福人类的新知识是实践亚里士多德古希腊美德的产物，也是生命意义的重要原因。他完成了我们的采访，呼吁年轻的儿科医生 “倾听他们的思想和心灵”，以选择一条生活路线，使他们获得个人智慧和eudaimonia。

BACKGROUND & AIMS: :Community paediatrics strives to integrate the biology of health into the social and psychological worlds within which children grow and develop. Consumer demand for limited community paediatric clinical services is increasing and medico-legal pressures escalate professional and personal concern. Meanwhile, the profession, through training and professional support, has struggled to keep up. Research into community paediatrics and its integration into policy and clinical practice remains limited, raising the perception that it is a 'soft' science. Our viewpoint is that necessary progress in this field requires leadership, apprenticeship and research. We argue that to build firm foundations for the future requires structures to enable clinical specialisation and continuing professional development in this area.

背景与目标： : 社区儿科致力于将健康生物学纳入儿童成长和发展的社会和心理世界。消费者对有限的社区儿科临床服务的需求正在增加，法律压力加剧了专业和个人的关注。同时，通过培训和专业支持，该行业一直在努力跟上。对社区儿科及其与政策和临床实践的整合的研究仍然有限，这使人们认为这是一门 “软” 科学。我们的观点是，在这一领域取得必要的进步需要领导、学徒和研究。我们认为，要为未来奠定坚实的基础，就需要结构来实现该领域的临床专业化和持续的专业发展。

BACKGROUND & AIMS: :Inhalation of aerosols in the mainstay of treatment of asthma and can be useful in treating children with cystic fibrosis. The most efficient method of delivering aerosol to children depends on the age and clinical condition of the child. The most rational dosage schedule for nebulized drugs appears to be to weight-correct the dose added to the nebulizer solution.

背景与目标： : 吸入气溶胶是治疗哮喘的主要手段，可用于治疗儿童囊性纤维化。向儿童输送气雾剂的最有效方法取决于儿童的年龄和临床状况。雾化药物最合理的剂量计划似乎是对雾化溶液中添加的剂量进行重量校正。

BACKGROUND & AIMS: :The interaction of the heart and lungs is probably the most important aspect of life and survival. Fortunately, it is not difficult to understand the fundamentals. The purpose of the lungs and their ventilation is to present oxygen to the circulation via the alveoli and to receive carbon dioxide from the circulation and then expel it. The relations of the heart and lungs and the matching of blood flow to the various organs with ventilation and lung perfusion may be disrupted by a variety of congenital or acquired heart malformations. They include those giving rise to an increased or reduced pulmonary blood flow, elevated pulmonary venous pressure or external physical pressure on the airways or lung parenchyma. Respiratory disorders which compromise cardiac function include states with reduced alveolar ventilation, those with a barrier to ventilation or perfusion, ventilation/perfusion mismatch and pulmonary vascular disease. There is also a fascinating group in which congenital disorders of the heart and lung co-exist to produce very particular modes of abnormal cardiopulmonary interaction.

背景与目标： : 心脏和肺部的相互作用可能是生命和生存中最重要的方面。幸运的是，了解基本面并不难。肺及其通气的目的是通过肺泡向循环提供氧气，并从循环中接收二氧化碳，然后将其排出。各种先天性或后天性心脏畸形可能会破坏心脏和肺的关系以及通过通气和肺灌注与各个器官的血流匹配。其中包括引起肺血流量增加或减少，肺静脉压力升高或气道或肺实质的外部物理压力。损害心脏功能的呼吸系统疾病包括肺泡通气减少，通气或灌注障碍，通气/灌注不匹配和肺血管疾病的状态。还有一个令人着迷的群体，其中心脏和肺的先天性疾病并存，产生异常心肺相互作用的非常特殊的模式。

BACKGROUND & AIMS: :The topic of consent in paediatrics is made more difficult, and at the same time more interesting, by the complexity of the issues involved and the consequent diversity of viewpoints. In a teaching session for senior medical students on consent in paediatrics it proved necessary to reinstate previous learning from a range of disciplines. Philosophical medical ethics, developmental psychology, communication skills and the appropriate legal definitions all contributed to a proper understanding of the cases presented. The two most important additional components appeared to be a) a basic knowledge of cognitive development and how to apply it, and b) an awareness of the need to balance an individual child's rights or best interests, with those of the family unit, as well as the wider society.

背景与目标： : 由于所涉及问题的复杂性和随之而来的观点的多样性，儿科的同意主题变得更加困难，同时也变得更加有趣。在针对高级医学生的儿科同意的教学课程中，事实证明有必要恢复以前从各个学科中学习的知识。哲学医学伦理学，发展心理学，沟通技巧和适当的法律定义都有助于正确理解所提出的案例。两个最重要的附加组成部分似乎是: a) 认知发展的基本知识及其应用方法，b) 意识到需要平衡儿童个人的权利或最大利益，以及家庭单位的权利或最大利益，以及更广泛的社会。

BACKGROUND & AIMS: CONTEXT:Empathy is vital to the physician-patient relationship. It promotes patient compliance and increases treatment efficacy. Studies evaluating the loss of empathy as residents advance through training curricula have generated inconsistent claims. Those considering diverse resident populations have supported a decline, whereas the few studies focused on paediatrics note stable empathy scores during training, which, indeed, exceed those of the general population. To better understand the issue as it pertains to paediatrics trainees, this study aimed to explore the state, and map a trajectory, of empathy in paediatrics residents, to identify factors influencing the learning and retention of empathy. METHODS:This qualitative descriptive study was conducted at an urban children's hospital in Canada. A total of 10 participants were recruited for semi-structured interviews via a purposeful sampling strategy. The institutional research ethics board approved the project. RESULTS:Senior residents (R3 and R4) reported increased empathy, attributable to greater knowledge regarding paediatric illnesses, according them a fuller sense of the impact on families. Challenges to sustained empathy correlated with published literature: time constraints, compassion fatigue and burnout with poor coping, and the hidden curriculum. Empathy was learned from peers, preceptors and other health care providers. Resident resilience, borne out of personal adversity, was protective against the loss of empathy. Residents advocated for increased autonomy and responsibility for patient care, and increased exposure to longitudinal care, including the patient's social context and home life, to increase resident empathy. CONCLUSIONS:Curriculum development committees could consider the inclusion of these encounters and experiences in residency training, although similar descriptive research in other specialty contexts would be needed to refine understanding.

背景与目标：

BACKGROUND & AIMS: :Recent studies have suggested that paediatric influenza is a greater medical problem than usually thought because it can cause excess hospitalisations, medical visits, and antibiotic prescriptions even in healthy children, especially those under 2 years. Furthermore, influenza in otherwise healthy children may have substantial socioeconomic consequences for the children and their household contacts. These findings have led many experts to encourage the more widespread use of influenza vaccine in childhood. Although the immunogenicity of the available vaccines is good and they are safe, well-tolerated, and highly effective in preventing influenza and its complications, economic data support universal vaccination only when indirect effectiveness is considered. However, infants aged 6-23 months, children with recurrent acute otitis media or respiratory-tract infections, and healthy children attending day-care centres or elementary schools should be included among the paediatric groups requiring vaccination.

背景与目标： : 最近的研究表明，儿科流感是一个比通常认为的更大的医疗问题，因为即使在健康的儿童中，尤其是2岁以下的儿童，它也会导致过多的住院，就诊和抗生素处方。此外，其他健康儿童的流感可能会对儿童及其家庭接触者产生重大的社会经济影响。这些发现使许多专家鼓励在儿童时期更广泛地使用流感疫苗。尽管现有疫苗的免疫原性良好，并且它们安全，耐受性良好且在预防流感及其并发症方面非常有效，但经济数据仅在考虑间接有效性时才支持通用疫苗接种。但是，需要接种疫苗的儿科人群应包括6-23个月大的婴儿，患有复发性急性中耳炎或呼吸道感染的儿童以及在日托中心或小学上学的健康儿童。

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BACKGROUND & AIMS: This paper describes the benefits gained and the organizational and practical considerations involved in establishing a relatively low-cost telematic support network for paediatric care and research. It is based on a case study in north-east England, where such a system has been implemented, supporting multimedia conferencing and reference facilities, postgraduate education and management information. The role of this type of service in regional health-care provision is discussed, for paediatrics and other disciplines.

背景与目标： 本文介绍了为儿科护理和研究建立相对低成本的远程信息处理支持网络所获得的收益以及组织和实际考虑因素。它基于英格兰东北部的一个案例研究，在那里实施了这样一个系统，支持多媒体会议和参考设施、研究生教育和管理信息。针对儿科和其他学科，讨论了此类服务在区域医疗保健中的作用。

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BACKGROUND & AIMS: :Currently, a gold standard for distinguishing between infectious, inflammatory, auto-immune diseases and malignancy in infants and children is not available. The combination of biomarkers with clinical features and other diagnostic tests could help clinicians in the diagnostic process. Ideally, a biomarker should have high sensitivity, specificity, and predictive value, as well as being easily obtained also in preterm babies and infants, requiring a small amount of blood and being quickly measured. The available literature agrees on the fact that a “perfect” biomarker is not currently available in paediatric practice. Thus, clinicians must consider time by time the balance between marker characteristics and their sensitivity and specificity in different conditions. The development of new tests with higher sensitivity and specificity in distinguishing different pathological situations is auspicable. Moreover, future efforts should be focused on validating also in children the recently developed biomarkers including CD64, IL-27 and IL-8.

背景与目标： : 目前，尚无区分婴儿和儿童感染，炎症，自身免疫性疾病和恶性肿瘤的金标准。生物标志物与临床特征和其他诊断测试相结合可以帮助临床医生进行诊断过程。理想情况下，生物标志物应具有高灵敏度，特异性和预测价值，并且在早产婴儿和婴儿中也容易获得，需要少量血液并且可以快速测量。现有文献同意这样一个事实，即目前儿科实践中没有一个完美的生物标志物。因此，临床医生必须在不同条件下逐次考虑标志物特征及其敏感性和特异性之间的平衡。在区分不同病理情况时，开发具有更高敏感性和特异性的新测试是可以的。此外，未来的努力应该集中在验证儿童最近开发的生物标志物，包括CD64、IL-27和IL-8。

BACKGROUND & AIMS: OBJECTIVES:To determine the frequency and characteristics of paediatric emergency department attendances associated with drug-related problems (DRP) at three Victorian hospitals. METHODS:All paediatric medical patients attending the emergency department of the Royal Children's Hospital, Geelong Hospital or Box Hill Hospital were considered for inclusion. The investigator and attending medical practitioners screened eligible patients. A multidisciplinary panel reviewed collated data. Causality, preventability and clinical significance classifications were established by the panel. RESULTS:Combining data from the three hospitals, over 18 weeks of data collection, a total of 8601 patients met the eligibility criteria. Of these, 280 (3.3%, 95% CI 2.9-3.7%) were determined to have emergency department attendances associated with DRP. Of the 187 cases assessed for preventability, 51.3% were judged to be preventable. CONCLUSIONS:Emergency department attendances are associated with DRP in paediatrics. Given that the need to prevent DRP in adults is recognized, it is now time to act to reduce the consequences of DRP in paediatrics.

背景与目标：

BACKGROUND & AIMS: Childhood mortality and morbidity patterns in the English-speaking Caribbean have changed significantly over the past 40 years. Acute respiratory illness, physical injury and conditions originating in the perinatal period have replaced malnutrition, gastroenteritis and other infectious diseases as major causes of illness and death in Caribbean children. Although population growth has slowed down, about one-third of the population of the English-speaking Caribbean remains under the age of 15 years. Infant mortality rates have also fallen but the major contributor to this decline has been a reduction in post-neonatal deaths. The decrease in mortality and morbidity from infectious diseases has led to a prominence of disorders originating in the perinatal period, psychosocial problems and chronic childhood disorders. Adverse economic conditions are held culpable for the re-emergence of protein energy malnutrition (PEM) and pulmonary tuberculosis in some territories. There is an urgent need to focus attention on the areas of perinatal and adolescent health, childhood disability, accidental and non-accidental injury, sexual abuse and human immunodeficiency virus (HIV) infection. Immunization programmes also require continuing support and expansion. These tasks cannot be accomplished without meaningful long term investment of financial and human resources in the health and educational services of the region.

背景与目标： 在过去的40年中，讲英语的加勒比地区的儿童死亡率和发病率模式发生了重大变化。围产期的急性呼吸道疾病，身体伤害和状况已取代营养不良，肠胃炎和其他传染病，成为加勒比儿童疾病和死亡的主要原因。尽管人口增长放缓，但讲英语的加勒比地区约有3分之1的人口年龄仍在15岁以下。婴儿死亡率也有所下降，但造成这种下降的主要原因是新生儿后死亡人数的减少。传染病死亡率和发病率的下降导致围产期疾病、社会心理问题和慢性儿童疾病的突出。在某些地区，蛋白质能量营养不良 (PEM) 和肺结核的再次出现是不利的经济条件。迫切需要将注意力集中在围产期和青少年健康，儿童残疾，意外和非意外伤害，性虐待和人类免疫缺陷病病毒 (HIV) 感染等领域。预防接种方案还需要持续的支持和扩大。如果不对该地区的卫生和教育服务进行有意义的长期财政和人力资源投资，就无法完成这些任务。

BACKGROUND & AIMS: :Introduction: Antibiotics have saved and are still saving countless human lives from the burden of infectious diseases. However, as with all other drugs, they can cause adverse events. Generally, these are uncommon, mild and spontaneously resolving. However, in some cases, they can cause relevant clinical problems. Compared with adults, children, particularly in the first years of life, have a higher risk of antibiotic-related adverse events for several reasons. Areas covered: In this paper, the conditions that can contribute to the elevated risk of antibiotic-related adverse events in children are discussed. Expert opinion: Antibiotic stewardship can be a solution to limit antibiotic abuse and misuse and consequently the incidence of antibiotic-related adverse events in children. Moreover, most of the antibiotic-associated adverse events can be avoided with more extensive pre-marketing medicine investigations, improved postmarket safety surveillance system, increased transparency throughout the clinical research enterprise, increased training of clinical pharmacologists and paediatric researchers, expanded pool of paediatric patients, and providing additional funding and incentives for paediatric drug development.

背景与目标： : 简介: 抗生素已经挽救了，并且仍在挽救无数人的生命，摆脱传染病的负担。然而，与所有其他药物一样，它们可能导致不良事件。通常，这些是不常见的，温和的且自发解决的。但是，在某些情况下，它们可能会导致相关的临床问题。与成人相比，儿童，尤其是生命的最初几年，由于多种原因，发生抗生素相关不良事件的风险更高。涉及的领域: 本文讨论了可能导致儿童抗生素相关不良事件风险升高的条件。专家意见: 抗生素管理可以是一种解决方案，以限制抗生素的滥用和误用，从而限制儿童抗生素相关不良事件的发生率。此外，大多数抗生素相关的不良事件可以通过更广泛的上市前医学调查，改进的上市后安全监测系统，提高整个临床研究企业的透明度，增加临床药理学家和儿科研究人员的培训，扩大儿科患者库，并为儿科药物开发提供额外的资金和激励措施。

BACKGROUND & AIMS: :Estimates of childhood overweight and obesity for the Province of Trento provided by the 2014 "OKkio alla SALUTE" survey (Italian national surveillance system for weight and nutrition in children) were compared with estimates provided by paediatric health forms. The Province of Trento is the only region that makes use of the information gathered through these forms, which are completed by primary care paediatricians as part of the 6-year health evaluation. OKkio alla SALUTE data for children, obtained from students enrolled in the third year of primary school in 2014 (845 children aged 8-9 years), were compared with data collected at the age of 6 for cohorts born in 2006, evaluated in 2012-2013 (3101 subjects). The following prevalence figures were obtained from OKkio alla SALUTE and the 6-year paediatrician evaluation respectively: overweight, 17.4% vs 11.7%; obese, 4.1% vs 4.5%; severely obese, 1.4% vs 1.0%. The two information sources provide similar estimates, suggesting the potential for their integrated use.

背景与目标： : 将2014 “OKkio alla SALUTE” 调查 (意大利国家儿童体重和营养监测系统) 提供的特伦托省儿童超重和肥胖估计数与儿科健康表格提供的估计数进行了比较。特伦托省是唯一利用通过这些表格收集的信息的地区，这些表格由初级保健儿科医生完成，作为6年健康评估的一部分。从小学2014年第三年入学的学生 (845名8-9岁的儿童) 获得的OKkio alla SALUTE儿童数据与6岁时收集的出生2006年队列数据进行了比较，在2012-2013 (3101名受试者) 中进行了评估。以下患病率分别从OKkio alla SALUTE和6年儿科评估中获得: 超重，17.4% vs 11.7%; 肥胖，4.1% vs 4.5%; 严重肥胖，1.4% vs 1.0%。这两个信息来源提供了相似的估计，表明了它们综合使用的潜力。