BACKGROUND & AIMS: BACKGROUND:The fourth Millennium Development Goal (MDG) calls for a two-thirds' reduction between 1990 and 2015 in deaths of children younger than five years; achieving this will require widespread use of effective interventions, especially in poor countries. We present the first report of the Child Survival Countdown, a worldwide effort to monitor coverage of key child-survival interventions in 60 countries with the world's highest numbers or rates of child mortality. METHODS:In 2005, we developed a profile for each of the 60 countries to summarise information on coverage with essential child survival interventions. The profiles also present information on demographics, nutritional status, major causes of death in children under 5 years of age, and the status of selected health policies. Progress toward the fourth MDG is summarised by comparing the average annual rate of reduction in under-5 mortality in each country with that needed to achieve the goal. The profiles also include a comparison of the proportions of children in the poorest and richest quintiles of the population who received six or more essential prevention interventions. Each country's progress (as measured by defined indicators of intervention coverage) was put into one of three groups created on the basis of international targets: "on track"; "watch and act"; and "high alert". For indicators without targets, arbitrary thresholds for high, middle, and low performance across the 60 countries were used as a basis for categorisation. FINDINGS:Only seven countries are on track to met MDG-4, 39 countries are making some progress, although they need to accelerate the speed, and 14 countries are cause for serious concern. Coverage of the key child survival interventions remains critically low, although some countries have made substantial improvements in increasing the proportion of mothers and children with access to life saving interventions by as much as ten percentage points in 2 years. Children from the poorest families were less likely than those from wealthier families to have received at least six essential prevention interventions. INTERPRETATION:Our results show that tremendous efforts are urgently needed to achieve the MDG for child survival. Profiles for each country show where efforts need to be intensified, and highlight the extent to which prevention interventions are being delivered equitably and reaching poor families. This first report also shows country-specific improvements in coverage and highlights missed opportunities. The "Countdown to 2015" will report on progress every 2 years as a strategy for increasing accountability worldwide for progress in child survival.

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BACKGROUND & AIMS: :This paper will discuss the challenge of evaluating the efficacy of child bereavement services. Such services are being developed and it is essential that expansion is based on research and evaluation. A literature review details the limited research which has so far been conducted on such interventions. The paper then addresses four key components regarding child bereavement programme evaluation: preliminary evaluation of the Winston's Wish programme; the feasibility and validity of using an experimental method in the evaluation of child bereavement services; the identification of appropriate measures-what are we really attempting to measure with regard to child bereavement interventions; and the importance of measuring the family dynamics of grief-how can we incorporate the Dual Process Model?

背景与目标： : 本文将讨论评估儿童丧亲服务功效的挑战。此类服务正在开发中，扩展必须基于研究和评估。文献综述详细介绍了迄今为止对此类干预措施进行的有限研究。然后，本文讨论了有关儿童丧亲计划评估的四个关键组成部分: 温斯顿愿望计划的初步评估; 在评估儿童丧亲服务中使用实验方法的可行性和有效性; 确定适当的措施-我们真正试图衡量的是关于儿童丧亲干预措施的措施; 以及衡量悲伤的家庭动态的重要性-我们如何纳入双重过程模型？

BACKGROUND & AIMS: :As the conventional histopathologic examination of thymic carcinoma (TC) is nonspecific, immunohistochemical studies along with correlative radiographic investigations are needed for its correct diagnosis. TC commonly occurs in the late 5th to early 6th decades of life but is extremely rare in childhood. It may be incidentally detected from chest radiographs taken as routine or for other reasons. However, most patients present with symptoms such as chest pain, cough, shortness of breath, dysphagia and hoarseness, which are directly attributable to the mediastinal mass. Although TC frequently invades the neighboring organs, pleura and pericardium and metastasizes to the lymph nodes, liver and lung at the time of the first diagnosis, initial or late metastasis to the bone has been seldom reported in adults. Indeed, the English literature revealed no earlier report on initial bony metastasis in a child to date. We report a case of TC in a 12-year-old boy who initially presented with scapular osteolysis masquerading as a primary bone tumor to emphasize the usefulness of combined imaging for staging and histologic studies, particularly for such an unexpected case.

背景与目标： : 由于胸腺癌 (TC) 的常规组织病理学检查是非特异性的，因此需要进行免疫组织化学研究以及相关的影像学检查才能正确诊断。TC通常发生在生命的第5至第6年初，但在儿童时期极为罕见。可能会从常规或其他原因的胸部x光片中偶然发现。然而，大多数患者出现胸痛，咳嗽，呼吸急促，吞咽困难和声音嘶哑等症状，这些症状直接归因于纵隔肿块。尽管TC在首次诊断时经常侵入邻近的器官，胸膜和心包，并转移到淋巴结，肝脏和肺，但在成年人中很少报道初次或晚期骨转移。事实上，英国文献显示，迄今为止，没有关于儿童最初骨转移的早期报道。我们报告了一个12岁男孩的TC病例，该男孩最初表现为肩胛骨骨溶解，伪装成原发性骨肿瘤，以强调联合成像对分期和组织学研究的有用性，尤其是对于这种意外情况。

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BACKGROUND & AIMS: :The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).

背景与目标： : 世界卫生组织欧洲地区是世界上耐多药结核病 (mdr-tb) 发病率最高的地区之一，每年都有许多易受感染的儿童。耐多药结核病暴露后预防性治疗的证据有限，目前的指导意见存在矛盾。进行了基于互联网的调查，以确定该地区的临床实践。来自25个国家的72名临床医生参加了会议。与筛选和决策相关的实践变化很大。刚刚超过一半的人为暴露于耐多药结核病的儿童提供了预防性治疗; 与提供相关的唯一特征是欧盟内部的实践 (调整或4.07，95% CI 1.33-12.5)。

BACKGROUND & AIMS: :We report the fourth observation of Hb Sallanches [alpha104(G11)Cys-->Tyr, TGC-->TAC (alpha2)], an unstable alpha chain variant of intermediate severity in the homozygous state. Heterozygosity occasionally produces mild hypochromia and microcytosis in some patients. A balanced beta/alpha ratio, found in previously reported cases, points to unstable alphabeta dimers formed as a result of the Cys-->Tyr substitution at the alpha1beta1 contact site in this hemoglobin (Hb) variant. Our patient, and the previous two of the three cases reported in patients of Pakistani origin, points to a common population stock, separated by the mass population migration which occurred during the partition of Pakistan and India in 1947.

背景与目标： : 我们报告了Hb Sallanches [alpha104(G11)Cys->Tyr，TGC->TAC (alpha2)] 的第四个观察结果，这是纯合状态中中等严重程度的不稳定 α 链变体。在某些患者中，杂合性偶尔会产生轻度的低色和微囊症。在先前报道的病例中发现的平衡的 β/α 比指出，由于该血红蛋白 (Hb) 变体中alpha1beta1接触位点处的Cys->Tyr取代，形成了不稳定的alphabeta二聚体。我们的患者，以及巴基斯坦裔患者报告的三例病例中的前两例，都指出了一个共同的人口存量，被巴基斯坦和印度1947年分治期间发生的大规模人口迁移所分隔。

BACKGROUND & AIMS: :Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening, adverse effect of heparin therapy. Patients with this complication require an alternative approach to anticoagulation. Bivalirudin is a direct thrombin inhibitor with an efficacy comparable to that of heparin, a short half-life, and reduced bleeding complications in adults. We present the case of a 2-year-old boy with HIT Type II who underwent recanalization of an occluded superior vena cava and stent placement, utilizing bivalirudin as anticoagulant.

背景与目标： 肝素诱导的血小板减少症 (HIT) 是肝素治疗的潜在威胁生命的不良反应。患有这种并发症的患者需要另一种抗凝方法。比伐卢定是一种直接凝血酶抑制剂，其疗效与肝素相当，半衰期短，并减少了成人的出血并发症。我们介绍了一个2岁的II型HIT男孩的病例，该男孩利用比伐卢定作为抗凝剂进行了闭塞的上腔静脉再通和支架置入。

BACKGROUND & AIMS: :Our institution has used the DeBakey VAD Child as a bridge to heart transplantation in select pediatric patients. Pump thrombus is a potentially serious complication with few available treatment options. Only surgical device exchange or the use of tissue plasminogen activator are reported in the literature. We report the use of clopidogrel as an alternative thrombolytic agent in the presence of pump thrombus in an adolescent patient with a DeBakey VAD Child heart pump.

背景与目标： : 我们的机构已将DeBakey VAD儿童用作某些儿科患者进行心脏移植的桥梁。泵血栓是一种潜在的严重并发症，几乎没有可用的治疗选择。文献中仅报道了手术设备交换或组织纤溶酶原激活剂的使用。我们报告了在患有DeBakey VAD儿童心脏泵的青少年患者中，在存在泵血栓的情况下使用氯吡格雷作为替代溶栓剂。

BACKGROUND & AIMS: :We encountered an extremely unusual presentation of proptosis in a 7-yr-old boy due to psammomatoid juvenile ossifying fibroma of frontoethmoidal region. The tumor also led to development of mucocele in the frontal sinus not yet fully developed as on opposite side.

背景与目标： : 我们在一个7岁男孩中遇到了极不寻常的眼球突出现象，这是由于额筛区的类膜样少年骨化纤维瘤所致。肿瘤还导致额窦粘膜囊肿的发展，而另一侧尚未完全发展。

BACKGROUND & AIMS: :Vaccination against hepatitis B virus has rarely been associated with lichen planus. We report a case of this kind in a child from Nepal. A 12-year-old boy had developed generalized itchy violaceous papules and plaques six weeks after the second dose of hepatitis B virus vaccine. Serum HBsAg and HBeAb were negative, but HBsAb was positive. New crops of generalized, similar eruptions developed after the booster dose of vaccine. All the lesions resolved within three months of systemic steroid therapy. There was no recurrence after one year of follow up. Awareness of such an association is necessary, especially in children, because vaccination campaigns are increasing.

背景与目标： : 针对乙型肝炎病毒的疫苗接种很少与扁平苔藓有关。我们报告了一名来自尼泊尔的儿童的此类案件。一名12岁男孩在第二剂乙型肝炎病毒疫苗接种六周后出现了全身发痒的紫红色丘疹和斑块。血清HBsAg和HBeAb均为阴性，但HBsAb为阳性。在加强剂量的疫苗之后，出现了普遍的，类似的爆发的新作物。所有病变在全身类固醇治疗后三个月内消失。随访1年后无复发。对这种关联的认识是必要的，尤其是在儿童中，因为疫苗接种运动正在增加。

BACKGROUND & AIMS: :This investigation examined differences in symptom patterns of two different trauma samples using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). MMPI-2s of 122 male combat veterans seeking outpatient treatment for combat-related PTSD were compared with those of 64 PTSD-diagnosed adults seeking outpatient treatment for the effects of child sexual abuse (CSA). We examined variables related to degree of health concerns, depression, somatization, anger and hostility, masculine-feminine traits, paranoid ideation, anxiety, difficulties thinking and concentrating, elevated mood, and social introversion, as well as test-taking attitude. MANOVAs revealed between-group differences on several variables. However, when analyses controlled for the effect of age, nearly all differences disappeared; the only remaining difference was in a scale measuring anger. Thus, it appears CSA survivors and combat veterans are much more similar than different in their clinical presentation on the MMPI-2. Conceptual issues in the assessment of PTSD are discussed.

背景与目标： : 这项调查使用明尼苏达州多相人格量表-2 (MMPI-2) 检查了两种不同创伤样本的症状模式差异。将122名寻求与战斗相关的PTSD进行门诊治疗的男性战斗退伍军人的MMPI-2s与64名经PTSD诊断为儿童性虐待 (CSA) 的门诊治疗的成年人进行了比较。我们研究了与健康问题程度，抑郁，躯体化，愤怒和敌意，男性女性特征，偏执观念，焦虑，思考和集中注意力的困难，情绪低落，社交内向以及应试态度有关的变量。MANOVAs揭示了几个变量的组间差异。但是，当分析控制了年龄的影响时，几乎所有差异都消失了。唯一剩下的差异是衡量愤怒的量表。因此，看来CSA幸存者和战斗退伍军人在MMPI-2上的临床表现要相似得多。讨论了PTSD评估中的概念问题。

BACKGROUND & AIMS: :Since Amato and Gilbreth's (1999) meta-analysis of nonresident father involvement and child well-being, nonmarital childbirths and nonresident father involvement both have increased. The unknown implications of such changes motivated the present study, a meta-analytic review of 52 studies of nonresident father involvement and child well-being. Consistent with Amato and Gilbreth, we found that positive forms of involvement were associated with benefits for children, with a small but statistically significant effect size. Amounts of father-child contact and financial provision, however, were not associated with child well-being. Going beyond Amato and Gilbreth, we analyzed the associations between different types of fathering and overall child well-being, and between overall father involvement and different types of child well-being. We found that nonresident father involvement was most strongly associated with children's social well-being and also was associated with children's emotional well-being, academic achievement, and behavioral adjustment. The forms of father involvement most strongly associated with child well-being were involvement in child-related activities, having positive father-child relationships, and engaging in multiple forms of involvement. Moderator analyses demonstrated variation in effect sizes based on both study characteristics and demographic variables. We discuss the implications of these findings for policy and practice.

背景与目标： : 自从Amato和Gilbreth (1999) 对非居民父亲参与和儿童福祉的荟萃分析以来，非婚姻分娩和非居民父亲参与均有所增加。这种变化的未知含义促使本研究进行，该研究是对52项非居民父亲参与和儿童福祉研究的荟萃分析综述。与Amato和Gilbreth一致，我们发现积极的参与形式与儿童的益处相关，但影响大小很小，但具有统计学意义。然而，父子之间的接触和财政供应与儿童福祉无关。除了Amato和Gilbreth之外，我们还分析了不同类型的父亲与整体儿童福祉之间的关联，以及父亲的整体参与与不同类型的儿童福祉之间的关联。我们发现，非居民父亲的参与与孩子的社会福祉最密切相关，也与孩子的情感福祉，学业成就和行为适应有关。与儿童福祉最密切相关的父亲参与形式是参与与儿童有关的活动，建立积极的父子关系以及参与多种形式的参与。主持人分析表明，基于研究特征和人口统计学变量，效应大小存在差异。我们讨论了这些发现对政策和实践的影响。

BACKGROUND & AIMS: OBJECTIVES:To determine the association between opioid prescribing rates and substantiated abuse and neglect across Tennessee counties during an 11-year period. METHODS:We adopted a Bayesian spatiotemporal approach to determine the association between opioid prescribing and rates of substantiated child abuse and neglect over and above environmental and population-level covariates. Annual county-level data for Tennessee (2006-2016) included rates of substantiated child abuse and neglect, rates of drug and non-drug crime incidents, racial and Hispanic composition, per capita income, child poverty and teen birth rates, and vacant housing. RESULTS:Higher opioid prescribing rates were associated with greater risk for substantiated child abuse and neglect across Tennessee counties. Risk for substantiated child abuse and neglect was positively associated with vacant housing, child poverty, teen birth rates, and rates of both drug and non-drug criminal incidents - including stimulant arrests. Risk for substantiated child abuse and neglect was negatively associated with percentages of African Americans. CONCLUSIONS:Results underscore the importance of opioid prescribing and crime rates as independent determinants of spatial and temporal variation in risk for substantiated child abuse and neglect. Policies that regulate and reduce opioid prescribing have the potential to reduce risk for child abuse and neglect.

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BACKGROUND & AIMS: :Background: Children with intellectual disability are at risk for anxiety disorders involving intense physiological reactions and risky behavioral responses. Interventions have been identified in this field; however, assessment of underlying anxiety is limited and flawed.Method: We implemented a single-subject case study using differential reinforcement to treat dog phobia in a boy with intellectual disability. We recorded elopement and compliance with goals and measured physiological expressions of stress: galvanic skin response, heart rate variability, temperature, and latency to calm down.Results: After fifteen therapy sessions, the boy decreased elopement and noncompliance considerably and showed dramatic improvements in emotional self-regulation.Conclusions: Future research should examine the utility of including biosensing measures in clinical applications and the relationship between physiological measures of anxiety and traditional questionnaires. Children with intellectual disability at risk for anxiety disorders should be tracked longitudinally to examine the effect of interventions on social-emotional well-being and self-regulation.

背景与目标： 背景: 智力残疾儿童有患焦虑症的风险，包括强烈的生理反应和危险的行为反应。在这一领域已经确定了干预措施; 然而，对潜在焦虑的评估是有限的和有缺陷的。方法: 我们实施了一个单主题案例研究，使用差异强化来治疗智力残疾男孩的狗恐惧症。我们记录了对目标的私奔和依从性，并测量了压力的生理表达: 皮肤电反应，心率变异性，温度和平静的潜伏期。结果: 经过15次治疗后，男孩大大减少了私奔和不依从性，并表现出情绪self-regulation.Conclusions的显着改善: 未来的研究应检查在临床应用中包括生物传感措施的效用，以及焦虑的生理措施与传统问卷之间的关系。应纵向追踪有焦虑症风险的智力残疾儿童，以检查干预措施对社会情感福祉和自我调节的影响。

BACKGROUND & AIMS: BACKGROUND:Preschool child anthropometric status has been assessed nationally in Nepal since 1975, with semi-decadal surveys since 1996, plus several recent, short-interval surveys to track progress toward achieving a World Health Assembly (WHA) goal to reduce stunting to 24% by 2025. OBJECTIVE:We report prevalence of preschool child stunting and wasting from a national survey in 2016 and place findings into the context of national trends and alignment for Nepal to attain its WHA 2025 goal. METHODS:A representative, midyear Policy and Science for Health, Agriculture and Nutrition (PoSHAN) survey was conducted in 2016 on 5479 children <60 months in 4051 households in 21 village development committees. Child weight and height were measured, and sociodemographic factors were assessed. Data from previous surveys (Nepal Demographic Health Surveys, PoSHAN) were also acquired, and rates of stunting (<-2 height-for-age z score) and wasting (<-2 weight-for-height z score) were compared to current World Health Organization standards. Trends were expressed as average annual rates of reduction (AARR). RESULTS:Nationally, in 2016, 34.1% of preschoolers were stunted and 13.7% wasted. Stunting was highest in the Mountains (40.6%) and wasting highest in the Tarai (18.9%). Trend analysis revealed a steady decline (3.8% AARR) in stunting from 2001 to 2013, with virtually no decline from 2013 to 2016. Wasting has been continually high and variable, at ≥8%, since 1975. CONCLUSIONS:Following a steady decline in prevalence, preschool child stunting has plateaued at ∼35% in Nepal, while wasting has changed little over time, offering the opportunity to inform, reassess, and adjust, as needed, efforts to reach WHA 2025 goals.

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