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。

BACKGROUND & AIMS: -2

背景与目标： -2

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。

BACKGROUND & AIMS: -2

背景与目标： -2

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。

BACKGROUND & AIMS: Examinations are an essential element of medical education, which generates vehement debate but unfortunately a relative lack of rigorous critical analysis. There appears to be a background anxiety that research findings that might suggest an examination has been less than fair will lead to endless arguments with candidates who have failed that examination. It is a major responsibility of all those involved in examining to seek evidence of the fairness, reliability, and validity of the methods and the organisation of the tests. Computers have made analysis of results much easier. Access to shared banks of all types of questions and answer sheets should allow examiners to select the subject first and the assessment tool second but from a range of tested and continually modified questions which allow comparison of candidates' performance both in time and between institutions. The creation of examination materials and their evaluation must be considered as valuable an activity as research in academic life. There is little point in child health research if the advances in knowledge and skills that this generates cannot be shown to have been acquired eventually by present and future paediatricians.

背景与目标： 考试是医学教育的基本要素，它引起了激烈的辩论，但不幸的是，相对缺乏严格的批判性分析。似乎有一种背景焦虑，即可能表明考试不公平的研究结果将导致与考试不及格的候选人无休止的争论。所有参与检查的人员的主要责任是寻求方法的公正性，可靠性和有效性以及测试的组织的证据。计算机使分析结果变得容易得多。访问所有类型的问题和答题纸的共享银行应允许考官首先选择主题，其次选择评估工具，但要从一系列经过测试和不断修改的问题中进行选择，这些问题可以比较候选人在时间和机构之间的表现。考试材料的创建及其评估必须被视为学术生活中的一项有价值的活动。如果现在和将来的儿科医生最终无法证明这种知识和技能的进步，那么儿童健康研究就没有意义了。

BACKGROUND & AIMS: OBJECTIVE:To determine the prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa. DESIGN:Cross-sectional retrospective review of otoscopy results obtained during a school health screening campaign conducted between March and June 2015. Descriptive statistics through percentages and frequency tables were used to analyse the data. Logistic regression was used to determine associations between age, gender and pathologies observed. STUDY SAMPLE:Medical folders of 1089 pupils. RESULTS:Forty-nine percent had normal otoscopy results. A significant 36% (n = 392) had impacted cerumen. Furthermore, 45% of those with impacted cerumen were bilaterally impacted. Additionally, 4% presented with foreign bodies and a further 8% had otitis externa and otitis media. The remaining 3% had tympanic membrane perforations. The odds of developing outer and middle ear pathologies were higher in pupils below 6 years of age (p = 0.046). CONCLUSION:This study highlights a high prevalence of outer and middle ear pathologies in paediatrics in Limpopo and therefore recommends comprehensive baseline and periodic screenings; to identify children with outer and middle ear pathologies and need further management, and consequently prevent the complications of these pathologies. Additionally, this report highlights a rising need for large-scale research to provide comprehensive analysis of these pathologies.

背景与目标：

BACKGROUND & AIMS: :Drug prescribing for paediatric inpatients at a teaching hospital serving a developing community was investigated. A list of 695 patient record numbers was randomly generated from the 7637 children admitted over the period examined (9.1%). Prescribed drugs were computer-categorized and counted. Antibacterials (30.0%), vitamins, iron preparations and dietary supplements (20.0%), electrolytes (18.8%), analgesics (12.2%) and respiratory drugs (7.1%) comprised the most frequently-prescribed groups. The main (admitting) diagnoses of the sample were also classified. Infective diseases (42.0%), respiratory conditions (18.2%), perinatal disorders (14.9%) and nutritional deficiencies (9.9%) predominated. Data for individual drugs in the four dominant drug groups are presented. The margins between the top one or two drugs and the others in each therapeutic category are notable. Few drugs are extensively used. They include ampicillin, paracetamol, multivitamin syrup and Darrow's preparations. The implications of this picture in therapeutics are discussed.

背景与目标： : 调查了为发展中的社区服务的教学医院儿科住院患者的药物处方。在检查期间 (9.1%)，从收治的7637名儿童中随机生成了695名患者记录编号的列表。处方药是计算机分类和计数的。抗菌剂 (30.0%)，维生素，铁制剂和膳食补充剂 (20.0%)，电解质 (18.8%)，镇痛药 (12.2%) 和呼吸系统药物 (7.1%) 是最常用的处方组。对样本的主要 (承认) 诊断也进行了分类。感染性疾病 (42.0%)，呼吸系统疾病 (18.2%)，围产期疾病 (14.9%) 和营养缺乏 (9.9%) 占主导地位。提供了四个主要药物组中单个药物的数据。在每种治疗类别中，前一两种药物与其他药物之间的边缘都很明显。很少有药物被广泛使用。它们包括氨苄西林，扑热息痛，多种维生素糖浆和Darrow的制剂。讨论了这张图片在治疗中的意义。

BACKGROUND & AIMS: :This first out of three articles reviews general psychological aspects and problems of the child with chronic illness and handicap and of his parents and healthy siblings.

背景与目标： : 这三篇文章中的第一篇回顾了慢性病和残障儿童及其父母和健康的兄弟姐妹的一般心理方面和问题。

BACKGROUND & AIMS: :Expertise in a variety of fields is required for the diagnostic process of epilepsies in children and adolescents as well as for their treatment with anticonvulsants. Patients benefit in the process from the cooperation of different health care professionals. It is of critical importance for risks to be minimised and for the efficacy shown in controlled clinical trials to be maintained in routine conditions. In the first instance, drug prescription procedures, including the choice of anticonvulsants and combinations of drugs and dosing, have to be considered. The administration of drugs has, of course, also to be taken into account. Only if patients are given their anticonvulsants appropriately, the intended success of the therapy can be accomplished. Strategies aimed at improving drug administration have to be directed not only at nurses but also at parents, children and adolescents themselves, as well as caregivers in schools and children's day-care facilities. By providing theoretical teaching, practical training, and routinely including pharmacists in the therapeutic team, drug-related problems that may result in limited effectiveness and increased risks are prevented. As a result, drug (therapy) safety is not only qualitatively improved, but the degree of participation and quality of life of patients and families is improved as well. :Für die Diagnostik von Epilepsien im Kindes- und Jugendalter und deren Behandlung mit Antikonvulsiva ist Expertise in unterschiedlichen Bereichen nötig. Der Patient profitiert dabei vom Zusammenwirken verschiedener Berufsgruppen. Risiken müssen reduziert und die in klinischen Studien gezeigte Wirksamkeit auch in eine möglichst gute Effektivität unter Routinebedingungen umgesetzt werden. Dabei sollten zunächst Aspekte der Arzneimittelverschreibung durch den Arzt berücksichtigt werden, wie etwa die Auswahl, Kombination und Dosierung der Antikonvulsiva. Dabei sollte die Arzneimittelanwendung nicht vergessen werden. Erst, wenn ein Antikonvulsivum richtig angewendet wird, kann der vom verordnenden Arzt gewünschte Therapieerfolg auch erreicht werden. Dabei sollten sich Maßnahmen nicht nur auf den Pflegedienst, sondern auch auf die Eltern, die Kinder und Jugendlichen selbst sowie Betreuer in Schulen und Kindertageseinrichtungen erstrecken. Durch theoretische Schulungen, praktische Übungen und regelmäßige Einbindung von Apothekern ins interdisziplinäre Behandlungsteam wird vermeidbaren arzneimittelbezogenen Problemen, die zu mangelnder Effektivität und dem Auftreten erhöhter Risiken führen können, vorgebeugt. Auf diese Weise wird nicht nur die Arzneimittel(therapie)sicherheit qualitativ verbessert, sondern auch die Teilhabe und Lebensqualität der Patienten und deren Familien positiv beeinflusst.

背景与目标：

BACKGROUND & AIMS: :In the last few years, there has been increasing pressure to use fluoroquinolones in paediatric patients, since these antibiotics offer the advantage of an oral treatment regimen on an out-patient basis. However, even although this class of antibiotics generally remains well-tolerated, the restriction of fluoroquinolone use in children on a compassionate basis, which derives from their potential to cause cartilage toxicity, limits the safety data in this population and suggests a cautious use. This review reports the data of the literature on the safety of fluoroquinolones in different districts, focusing on the side effects in children and drug interactions. Moreover, data available in the literature with regards to side effects in children are reported, with particular attention to their potential in arthropathy.

背景与目标： : 在过去的几年中，在儿科患者中使用氟喹诺酮类药物的压力越来越大，因为这些抗生素提供了门诊口服治疗方案的优势。然而，尽管这类抗生素通常仍然具有良好的耐受性，但在儿童中使用氟喹诺酮的限制 (源于它们可能引起软骨毒性)，限制了该人群的安全性数据，并建议谨慎使用。这篇综述报告了不同地区氟喹诺酮类药物安全性的文献数据，重点是儿童的副作用和药物相互作用。此外，报告了文献中有关儿童副作用的数据，尤其要注意其在关节病中的潜力。