Evaluation of a “tummy time” intervention to improve motor skills in infants after cardiac surgery

Background: Infants who require open heart surgery are at increased risk for developmental delays including gross motor impairments which may have implications for later adaptive skills and cognitive performance. We sought to evaluate the feasibility and efficacy of a tummy time intervention to improve motor skill development in infants after cardiac surgery. Methods: Infants <4 months of age who underwent cardiac surgery were randomly assigned to tummy time with or without outpatient reinforcement or standard of care prior to hospital discharge. The Alberta Infant Motor Scale (AIMS) was administered to each infant prior to and 3 months after discharge. Groups were compared, and the association between parent-reported tummy time at home and change in motor scores at follow-up was examined. Results: Parents of infants (n = 64) who had cardiac surgery at a median age of 5 days were randomly assigned to tummy time instruction (n = 20), tummy time + outpatient reinforcement (n = 21) or standard of care (n = 23). Forty-nine (77%) returned for follow-up. At follow-up, reported daily tummy time was not significantly different between groups (p = 0.17). Fifteen infants had <15 minutes of tummy time daily. Infants who received >15 minutes of tummy time daily had a significantly greater improvement in motor scores than infants with <15 minutes of tummy time daily (p = 0.01). Conclusion: In infants following cardiac surgery, <15 minutes of tummy time daily is associated with increased motor skill impairment. Further research is needed to elucidate the best strategies to optimise parental compliance with tummy time recommendations.

Faktor-Faktor yang Berhubungan dengan Kepatuhan Orang Tua dalam Pemberian Imunisasi Dasar Lengkap

Imunisasi merupakan upaya mengurangi morbiditas dan mortalitas anak, namun masih banyak anak yang belum menerima imunisasi. Angka kematian balita di dunia yang disebabkan oleh penyakit yang bisa dicegah dengan imunisasi (PD3I) mencapai 1,4 juta orang per tahun. Dikhawatirkan PD3I ini dapat menyebar dengan mudah dari anak yang terinfeksi ke anak yang tidak diimunisasi atau tidak memiliki kekebalan terhadap penyakit tersebut. Hal ini berisiko meningkatkan angka mortalitas anak Tujuan Penelitian: Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kepatuhan orang tua, terutama ibu, dalam memberikan imunisasi dasar lengkap kepada bayi. Metode: Penelitian ini merupakan penelitian kuantitatif non eksperimental dengan desain cross sectional. Responden sebanyak 100 orang ibu yang diambil menggunakan teknik purposive sampling. Pengambilan data dilakukan di Kelurahan Meteseh menggunakan kuesioner yang sudah valid dan reliabel. Analisis data dilakukan dengan menggunakan uji Chi-Square. Hasil: Analisis bivariat menunjukkan bahwa usia, pekerjaan, jumlah paritas, agama , dan pengetahuan ibu tentang Kejadian Ikutan Pasca Imunisasi (KIPI) tidak berhubungan dengan kepatuhan orang tua dalam memberikan imunisasi dasar lengkap pada bayi (p>0,05). Diskusi: Penelitian ini membuktikan bahwa kematangan usia ibu tidak selalu berhubungan dengan kepatuhannya dalam memberikan imunisasi dasar. Kepatuhan ini juga tidak berhubungan dengan oleh kesibukan ibu dalam bekerja maupun mengurus anak serta pengalamannya menjadi seorang ibu. Adanya keyakinan pada agama tertentu mengenai imunisasi, serta pengetahuan yang dimiliki ibu mengenai KIPI juga terbukti tidak berhubungan dengan kepatuhan ibu dalam memberikan imunisasi. Kesimpulan: Faktor demografi ibu tidak senantiasa berhubungan dengan kepatuhannya dalam memberikan imunisasi dasar lengkap pada bayi, namun imunisasi ini tetap perlu diberikan sebagai upaya mengurangi risiko bayi tertular PD3I. Kata Kunci: ibu, imunisasi, kepatuhan Factors Correlated with Parental Adherence in Providing Complete Basic Immunization ABSTRACTImmunization is an effort to reduce child morbidity and mortality, but many children still have not received immunizations. The mortality rate for children under five in the world caused by immunization-preventable diseases reaches 1.4 million people per year. It is feared that the immunization-preventable diseases can spread easily from infected children to non-immunized children or have no immunity to the disease. This has the risk of increasing child mortality. Objective: This research aims to reveal the factors related to parents' adherence, especially mothers, in providing complete basic immunization to infants. Methods: This research is a non-experimental quantitative study with a cross-sectional design. Respondents were 100 mothers who were taken using the purposive sampling technique. Data were collected in Meteseh Village using a valid and reliable questionnaire. Data were analyzed using the Chi-Square test. Results: Bivariate analysis indicated that mother's age, occupation, parity, religion, and knowledge of Adverse event following immunization (AEFI) were not correlated with parental compliance in providing complete basic immunization to infants (p>0.05). Discussion: This research proves that mother’s age is not always correlated with adherence to basic immunization. This adherence is also not correlated with the mother's activities in working or taking care of children and her experience of being a mother. Certain religious beliefs regarding immunization and mother’s knowledge about AEFI are also proven not to be correlated with maternal adherence to giving immunizations. Conclusion: Maternal demographic factors are not always correlated with adherence to providing complete basic immunization to infants, but the immunization still needs to be given to reduce the risk of infants contracting immunization-preventable diseases.Keywords: mother, immunization, adherence

Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved?

Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force.Methods: Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before OR time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range).Results: 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30).Conclusions: This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time.

Parental Compliance towards Oral Health Education among Preschoolers with Special Healthcare Needs

Background: Young children with special needs greatly rely on their parents to support their daily living activities; parental compliance may have great impact on the implementation of health promotion activities among those children. This study aimed to investigate the parental compliance towards oral health education (OHE) among children with special healthcare needs (SHCN). Method: The participants were 306 parents whose children had participated in a 24-month OHE program for preschool children with SHCN. The primary outcome of this cross-sectional study was parental compliance towards the OHE program. Parents’ oral health literacy (OHL) was assessed by a validated tool. Parents’ socioeconomic status, attitudes towards OHE topics, perceptions of children’s oral hygiene status, and usefulness of OHE materials were collected via questionnaires. Results: A higher dropout rate was observed among parents who perceived that their children had unfavorable oral hygiene status (p = 0.038), or parents who had poor OHL skills (p = 0.015). Parental noncompliance was more likely to be observed among parents who perceived that the OHE materials were not useful for their children (OR = 3.63, 95% CI 1.56 to 8.47, p = 0.003), or parents whose children had been diagnosed with developmental delays (OR = 5.45, 95% CI 1.59 to18.74, p = 0.007). Conclusion: Non-compliance existed among parents whose children had received OHE intervention. Parental compliance towards OHE intervention might be associated with parents’ OHL skills, usefulness of OHE materials, and children’s developmental conditions. OHE programs should be individually tailored to support children whose parents are at a higher risk of noncompliant behaviors.

The influence of parental compliance to treatment of chronic gastroduodenal pathology in children on patient’s quality of life

The effectiveness of the treatment of chronic gastroduodenal pathology associated with Helicobacter pylori infection consists not only in the successful eradication of the pathogenic microorganism, but also in eliminating dyspeptic and abdominal pain syndrome, as the main clinical criteria for this pathology. Among the main reasons that affect the successful outcome of therapy, it can be distinguished strict adherence to the prescribed drug regimens. The aim of the work was to assess the effect of parental adherence to their child suffering from chronic gastroduodenal pathology, treatment on the patient's quality of life. 80 children of high school age suffering from chronic gastroduodenal pathology associated with Helicobacter pylori were examined. Anti-Helicobacter therapy using clarithromycin, amoxicillin, omeprazole for 14 days was held in all patients. The training of parental compliance in relation to ongoing therapy for their child was conducted before therapy in patients of the comparison group. The special questionnaire developed by us was used to assess the level of parental compliance. In addition, in all patients, the quality of life indices were studied using the SF-36 questionnaire at baseline and one month after the start of therapy. It was revealed that in children with chronic gastroduodenal pathology the initial indicators on all scales of quality of life were significantly lower compared to the children of the control group. It was found that the greater compliance of parents to their child's prescribed therapy leads not only to the successful eradication of Helicobacter pylori infection, but also to positive dynamics, both physical and psychological aspects of health.

How heuristics and cognitive biases affect vaccination decisions

Immunization, the most successful public health intervention to date, can only be effective if eligible individuals or their legal representatives have access to vaccines and subsequently comply with their use. Under-vaccination stems from multiple causes: access, affordability, awareness, acceptance and activation. In this paper, we focus on acceptance and, specifically, on factors pertaining to individual or parental compliance, specifically the psychology of judgment and decision making. We describe how heuristics and cognitive biases - a facet of thoughts and feelings - affect vaccination decision making. Additionally, we address when and how social processes play a role and how attitudes towards vaccines might reflect a more general underlying attitude or ideology. The understanding of how decision making, with regards to vaccines occurs, and the role played by heuristics and cognitive biases can help inform more appropriate public health interventions.

Influence of parental compliance on the effectiveness of treatment of chronic gastroduodenal pathology in children

Introduction: The article focuses on the studies which point to particular difficulties in achieving compliance in pediatrics. A dangerous trend to escalate the number and doses of antibiotics in anti- Helicobacter pylori (HP) schemes, the dosage frequency and course duration of eradication therapy considerably complicates a patient’s compliance to the treatment and contributes to a further growth of HP antibiotic resistance. In the treatment of children, the control of the outpatient therapy largely depends on the patient’s parents. Materials and methods: At the first stage of the study, 103 children with chronic gastroduodenal pathology associated with HP were examined. Diagnosis of the disease was based on the study of complaints, the anamnesis data, and the results of the endoscopic examination. All the patients underwent a course of anti-HP therapy in the outpatient setting. A degree of parental compliance to their child’s therapy was determined in by a questionnaire, which had been developed by us, the families of the children suffering from chronic gastroduodenal pathology. At the second stage, 80 children suffering from peptic ulcer associated with HP were examined. HP was eradicated in the outpatients of both groups, using an anti-HP regimen: omeprazole, clarithromycin, and amoxicillin administered for 14 days. The influence of the measures to improve parental compliance carried out in tandem “doctor – pharmacist” in the families with children suffering from chronic gastroduodenal pathology was studied. Results and discussion: A decrease in parental compliance was observed in more than 2/3 of the families with children suffering from chronic gastroduodenal pathology, associated with HP infection. A higher level of parental compliance was established in the families of children after the ”compliance training”. In the patients of this group, eradication of HP was achieved in 87.5% cases by using a traditional scheme: omeprazole, clarithromycin, and amoxicillin administered for 14 days. Conclusion: It can be concluded that the level of parental compliance to an anti-HP therapy for their children is insufficient. In turn, conducting a “compliance training” in the tandem of ”doctor – pharmacist” before starting the therapy is an important factor in increasing the level of parental compliance, which is reflected in increasing the effectiveness of the treatment. Strict adherence to the regimen and duration of administration of the prescribed drugs in children with ulcer allows achieving a high level of HP eradication – 95.2 %, even when using the traditional anti-HP regimen. The eradication was achieved in 56.5 % of the children with partial parental compliance, and only in 6.7 % of the children with non-compliant parents.

The effectiveness of anti-helicobacter therapy in the treatment of chronic gastroduodenal pathology in children with different levels of compliance

At the present time, the therapy of most diseases requires special attention not only from the treating physician, but also from the patient. In turn, in the treatment of children, the monitoring of compliance with the treatment is carried out not by the patient, but by his parents who control the regimen of taking medications. The aim of the study was to determine the efficiency of traditional anti-H. pylori regimen in the treatment of chronic gastroduodenal pathology in children with various level of parental compliance. 80 children of school age suffering from peptic ulcer disease duodenal ulcer associated with H. pylori from families with different levels of parental compliance were examined. The traditional anti-H. pylori therapy scheme containing omeprazole, clarithromycin lasting 14 days was prescribed for all children with chronic gastroduodenal pathology. It is established that strict adherence to the regimen and duration of administration of prescribed drugs allows achieving a high level of eradication of H. pylori even with the use of the traditional anti-Helicobacter pylori. Conducting a “compliance training” before starting therapy is an important factor that increases the level of parental compliance in patients with inflammatory-destructive diseases of the stomach and duodenum. Establishment of interpersonal relationships in the “doctor-patient-parent” system, working with parents, aimed at explaining the essence of the disease, the consequences of the disease, treatment tactics are an important stage in the therapy of a sick child.