Psychosocial Implications of Limb Lengthening and Reconstruction Orthopedic Surgery: A Literature Review

A fervent interest in improving patient care, quality of life, and outcomes in adolescent patients undergoing limb Lengthening/ Reconstruction Surgeries (LLRS) has guided the exploration of how psychosocial markers in adolescence may be viewed as crucial to achieving enhanced healthcare delivery. This systematic literature review stems from a retrospective pilot study which investigated the importance of psychosocial aspects in the care of children, adolescents, and young adults who have undergone multiple LLRS. It was determined that such patients value psychosocial support given by their surgeons and caregivers, further promoting psychosocial maturation [1]. Currently, prospective investigation is in the process of being explored as yet another outgrowth of this seminal pilot study. Specifically, the current review seeks to explore the literature relevant to aspects of psychosocial development fundamental to enhancing outcomes of a chronic, orthopedic medical condition. The dearth of studies applying a biosocial lens to this subspecialized field of orthopedic surgery and care supports the need for such expanded investigation.

Remote Implementation of a Health Promotion Program in an Underserved High School during COVID-19: Lessons Learned

Background: This study examined the impact of remote implementation of a school-based health promotion program on health beliefs and behaviors of adolescent participants from an underserved high school during the COVID-19 pandemic. Methods: As part of the program, Family Medicine residents trained healthy 10th grade high school students from a vulnerable community in California to become health coaches for family members with diabetes. Five of eight onehour weekly sessions were delivered remotely after shelter in place was mandated. Students completed online pre and post-participation surveys including questions on health beliefs and behaviors and experience with remote learning. We explored factors associated with the likelihood of attending the remote classes, and we used paired T-tests to compare pre-and post-scores of health beliefs and behaviors, and qualitative analysis of open-ended questions to assess differences between those who completed in person sessions only and those who attended remote sessions. Results: 45 participants completed pre-surveys and 26 of those completed postsurveys. 14 of those 26 attended remote program sessions. The 14 who attended the additional remote sessions demonstrated significant improvements in health mindsets (belief that body has self-healing properties p=.045; belief that illness is an opportunity p=.028); consumption of fruits and vegetables (p=.054); consumption of sugary drinks (p=.047); understanding of how to improve their health (p=.055); and frequency of talking about health with their families (p=.057). Participants who did not attend remote sessions did not show significant improvements in these areas. Non-attendees were more likely to be Hispanic and male. Conclusions: These findings suggest that remote health promotion programs could support the health and well-being of adolescents in underserved communities. Yet, more research is essential to ensure all adolescents can participate.

Early Childhood Caries Experience Associated with Upper Respiratory Infection in US Children: Findings from a Retrospective Cohort Study

Introduction: Both Early Childhood Caries (ECC) and Upper Respiratory Infection (URI) are infectious diseases. The oral cavity is considered a potential reservoir of respiratory pathogens due to the anatomical proximity between the oral cavity and respiratory system, which implies a potential association between ECC and URI. Hence, this study aimed to evaluate the association between ECC experience and URI incidence in preschool children. Methods: This retrospective cohort study collected data via electronic health records. The exposure was ECC before 3 years of age. The dependent variable was the incidence of URI between 4-6 years of age. To analyze the factors associated with the time-to-event of URI, we used log-rank tests and Cox regression models to compare the survival of URI between the ECC and Caries- Free (CF) groups, adjusting factors including demographic-socioeconomic characteristics and medical conditions. To analyze factors associated with the number of URI episodes, we used negative binomial regression models adjusting for factors mentioned above. Results: A total of 497 US preschool children were included, with 117 ECC and 380 CF children. More children with ECC (58.1%) developed URI than the CF group (47.6%) during the follow-up period (4-6 years of age) (p=0.04). The ECC children were at 1.6 times higher risk to develop URI than the CF children even after accounting for other URI risk factors (Hazard Ratio 1.57 (1.13, 2.10), p=0.007). Conclusions: Our study suggests a potential association between ECC and URI, with an inference that early life ECC experience could be used as a predictor for developing URI in preschool age. The causal relationship between ECC and URI incidence in young children needs to be investigated through future studies.

Assessment of Essential Newborn Care Practices in the Squatter Settlements of Islamabad Capital Territory in Pakistan

Background: While Pakistan has shown progress in reducing child mortality, significant challenges exist in reducing neonatal mortality rate. WHO recommends a package of “essential newborn care” practices based on effective coverage to improve newborn survival. Aim: To assess the coverage of Essential Newborn Care (ENC) as defined by WHO guidelines, in the squatter settlements of Islamabad Capital Territory (ICT). Methods: This cross-sectional survey gathered community-based data on newborn care practices from 416 eligible mothers within randomly selected squatter settlements of ICT. Three composite outcomes (safe cord care, optimal thermal care and good neonatal feeding) were generated by combining individual practices from a list of WHO recommended ENC practices. ENC was considered when all practices within each domain of safe cord care, ideal thermal care and good neonatal feeding were fulfilled. Results: Only 2.9% of newborns received all components of WHO recommended ENC. Seventeen percent newborns received safe cord care, 40.4% received optimal thermal care and 28.8% followed WHO recommended neonatal feeding practice. Various cultural and societal misconceptions were reported which translate into harmful practices for newborn care. Conclusion: The study highlighted an extremely low coverage level of effective essential newborn care. Pakistan needs to address issues of quality care for newborns through policy and programs which focus on Maternal, Newborn, and Child Health (MNCH) continuum of care. It needs a concerted effort at the grass root level, especially training front line workers to educate mothers on various cultural and societal misconceptions that translate into harmful practices for newborns.

Neonatal Sepsis: A Review of the Literature

Neonatal sepsis contributes significantly to neonatal morbidity and mortality and is a major public health challenge around the world. Depending on the mode of occurrence, a distinction is made between maternal-transmitted infection and that acquired in the postnatal period. Although the etiologies maternally transmitted diseases are well understood, those of postnatal acquired infections are variable depending on the epidemiology of each hospital environment. On the one hand, risk factors for maternal-transmitted infections are maternal sepsis, prolonged premature rupture of membranes, chorioamnionitis, and bacteriuria in the mother during pregnancy. On the other hand, risk factors for postnatal acquired infections are prematurity, low birth weight, lack of hygiene, and invasive therapeutic interventions. The diagnosis is based on a series of anamnestic, clinical and biological features. Although the positive diagnosis is based on the isolation of the germ by culture on a body sample (blood, cerebrospinal fluid, urine, etc.); its low sensitivity leads to the use of markers of the acute phase of inflammation such as C-reactive protein, procalcitonin and interleukins. New molecular biology techniques are promising and offer precise diagnosis with rapid results. Empirical management is a function of microbial ecology while definitive treatment is guided by the results of microbial culture. This article presents the essential elements for understanding neonatal sepsis and discusses new diagnosis and therapeutic management. It offers a thorough reading based on the issue of infections in newborns.

Ultrasound-Guided Caudal Epidural Block for Bilateral Testicular Ectopy and Circumcision in Child above 6 Years with Joubert Syndrome

Background: Abnormal respiratory control has been clearly documented in infants and children with Joubert Syndrome (JS) by polygraphic recordings, characterized by episodes of apnea, tachypnea, and/or hyperpnea and the risk of recurrence of these episodes increase probably in perioperative period. In those cases, the choice of anesthesia technique and postoperative pain protocol, constitute a challenge for anesthesiologists. Case: We describe a case of successful ultrasound-guided Caudal Epidural Block (CEB) for children above 6 years with Joubert Syndrome undergoing bilateral testicular ectopy and circumcision avoiding opioid-use. Conclusions: Despite the difficulty to achieve CEB in child above 6 years, the ultrasound-guided can increase the success providing effective analgesia in-patient with a high-risk of respiratory failure as child with JS.