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Biomedical subjects

J R Sibert

Publications and source records attributed to J R Sibert.

At least 37 records · Page 2Linked to original sources
PubMed1995

Child health surveillance: development of a multicentre course and its evaluation.

With increasing numbers of general practitioners wishing to provide child health surveillance during the 1980s and the expected further increase with the 1990 General Practice Contract, a course in child health surveillance was developed. The content of the course was determined by a needs assessment of Welsh general practitioners in combination with the expectations of paediatricians already involved in educating doctors in community child health. A multicentre course with prepared materials was developed. Teaching methods reflected adult learning needs, included practical clinical competencies and was centred in small groups each led by local tutors. The course was held annually on three occasions, with 220 participants in total. The materials and teaching methods were highly acceptable to the participants, and evaluation demonstrated a significant increase in knowledge and confidence. All participants reached the required clinical competence, six after further teaching. The content, teaching methods, and evaluation methods were altered in the light of feedback, resulting in a 'stand alone' course with built-in evaluation, which is now being provided by local tutors. This study has demonstrated the feasibility of providing a course for large numbers of doctors, using predominantly small-group teaching and discussion with local tutors. We are grateful to all the participants and especially the tutors.

Child↗
PubMed1995

Suffocation, choking, and strangulation in childhood in England and Wales: epidemiology and prevention.

The causes, classification, and prevention of mechanical asphyxial death in children were examined. The Office of Population Censuses and Surveys (OPCS) identified children, under 15 years of age, who had died as a result of choking, suffocation, or strangulation in England and Wales during the years 1990 and 1991. Cases in the International Classification of Diseases (ICD) codes of E911-3, E953, E963, and E983 were selected and case details from HM coroners' records and the death certificates were extracted. The OPCS identified 136 children (99 boys, 37 girls) in the two year period, 65% were under 3 years of age. The children were classified as dying from choking (21 cases), aspirating gastric contents (39 cases), suffocation (29 cases), strangulation (11 cases), and hanging (36 cases). The strangulation cases could be further subdivided into a group of 12 younger children who were suspended from ligatures around the home and a group of 21 boys (8-14 years) who died of self initiated hanging. Overall, 11 children were deliberately killed and 31 children died in beds or cots. Children whose deaths are classified as being due to aspiration of vomit appear to be cases of the sudden infant death syndrome or background medical conditions. This study suggests the need for advice on maintaining a safe sleeping environment. Only one child choked on a toy and European Standards for Toy Safety appear to have been successful. The prevention of hanging in the group of older boys needs further exploration.

Adolescent↗
PubMed1994

Accidents and child abuse in bathtub submersions.

Non-accidental bath drowning is an infrequently reported form of child abuse. Details of 44 children who suffered from drowning or near drowning in the bath were analysed from a two year (1988-9) UK study to investigate factors that might point to abuse. Cases of near drowning were notified through the British Paediatric Surveillance Unit inquiry system and drowning cases from the Office of Population Censuses and Surveys, the Scottish Government Record Office, and the Northern Ireland Office. In 28 cases the story was of accidental submersion with a baby of modal age 9 months being left unsupervised in a bath. Two other neonates briefly slipped from the parents arms while having a bath. Four bathtub drownings were related to epilepsy. In contrast 10 cases (six drowning and four near drowning) had stories very suggestive of abuse with inconsistent histories, previous history of abuse, and late presentation for medical care. A diagnosis of abuse should be considered in the differential diagnosis of atypical bathtub immersions in the absence of epilepsy and developmental delay.

Accidents, Home↗
PubMed1994

Patterns of scald injuries.

OBJECTIVES: To describe common patterns of bath water scald injuries in children, to examine differences between accidental and non-accidental bath water scalds in children, and to examine potential for prevention. DESIGN: A two year six month retrospective analysis of admissions to a specialist burns unit. SETTING: The Burns Unit, St Lawrence Hospital, Chepstow serving children from south and west Wales. SUBJECTS: Sixty eight children attending the Burns Unit for treatment of bath related scald injuries. RESULTS: Bath scalds in children under 5 years of age was the cause of 14.7 per 100,000 children being admitted to the specialist burns unit in a year. The majority of the children were injured by falling in the bath but the tap was turned on by seven children themselves and by 10 siblings. Six children put hands in the hot water and two children were accidentally put into bath water that was too hot and were quickly withdrawn. Four children suffered probably non-accidental immersion scald injuries from hot water. They were characterised by a clear tide mark, a story that did not fit the injuries, associated injuries, and by symmetrical lesions. Accidental scalds were irregular geographical injuries and were asymmetrical. CONCLUSIONS: Bath scalds are a significant problem in children under 5 years. Their prevention should be part of an injury control programme on a local and national level. The best way to achieve this would be by reducing the temperature in domestic hot water tanks. The recognition of non-accidental bath scalds can be assisted by the pointers outlined and should be done in a multidisciplinary way with plastic surgeons, paediatricians, and social workers working together.

Accidents, Home↗
PubMed1994

Patterns of injuries to children on public playgrounds.

The incidence and pattern of injuries to children in public playgrounds presenting to the accident and emergency department were reviewed over two six month summer periods in Cardiff. A total of 178 children (mean age 7.5 years) attended with a playground injury representing 1.1% of all the children attending. One hundred and five children fell from equipment, of which the commonest was the climbing frame; 125 children had playground surface related injuries, 86 on bark and 30 on concrete. The pattern of injuries on the playground surfaces was different: fractures and sprains were more common on bark surfaces and lacerations and abrasions on concrete surfaces. Comparison of total injury rates showed there were fewer injuries on modernised playgrounds than expected but these differences were not significant. Modernised playgrounds are more popular, have new exciting equipment, and offer good play opportunities for children. However, the high fracture rate on modernised bark playgrounds is concerning and requires further research.

Accidents↗
PubMed1993

Epilepsy in children and the risk of drowning.

To clarify the risks of drowning for children with epilepsy we have studied the records of the 306 children who drowned or nearly drowned in the UK in 1988 and 1989. Ten children with incidents related to epilepsy presented over the study period, four of whom drowned. Children with epilepsy had a higher incidence of submersion accidents but no child participating in supervised swimming drowned. Two children died in the bath. Five children had special needs. We conclude that children with epilepsy can enjoy swimming with a friend in a lifeguard supervised swimming pool. They should be encouraged to shower in a non-glass cubicle rather than have a bath. The bathroom should remain unlocked. Children with poorly controlled epilepsy or associated learning difficulties are at a higher risk from all accident trauma. They need a very high level of supervision while swimming and advice should be given on an individual basis according to what is considered realistic for that child.

Adolescent↗
PubMed1992

Physiological and behavioural thermoregulation in bigeye tuna (Thunnus obesus).

Tuna are unique among teleost fishes in being thermoconserving. Vascular counter-current heat exchangers maintain body temperatures above ambient water temperature, thereby improving locomotor muscle efficiency, especially at burst speeds and when pursuing prey below the thermocline. Because tuna also occasionally swim rapidly in warm surface waters, it has been hypothesized that tuna thermoregulate to accommodate changing activity levels or ambient temperatures. But previous field experiments have been unable to demonstrate definitively short-latency, mammalian-type physiological thermoregulation. Here we show using telemetered data that free-ranging bigeye tuna (Thunnus obesus) can rapidly alter whole-body thermal conductivity by two orders of magnitude. The heat exchangers are disengaged to allow rapid warming as the tuna ascend from cold water into warmer surface waters, and are reactivated to conserve heat when they return into the depths. Combining physiological and behavioural thermoregulation expands the foraging space of bigeye tuna into otherwise prohibitively cold, deep water.

Animals↗
PubMed1992

Farm accidents in children.

OBJECTIVE: To examine the problem of accidental injury to children on farms. DESIGN: Prospective county based study of children presenting to accident and emergency departments over 12 months with injuries sustained in a farm setting and nationwide review of fatal childhood farm accidents over the four years April 1986 to March 1990. SETTING: Accident and emergency departments in Aberystwyth, Carmarthen, Haverfordwest, and Llanelli and fatal accidents in England, Scotland, and Wales notified to the Health and Safety Executive register. SUBJECTS: Children aged under 16. MAIN OUTCOME MEASURE: Death or injury after farm related accidents. RESULTS: 65 accidents were recorded, including 18 fractures. Nine accidents necessitated admission to hospital for a mean of two (range one to four) days. 13 incidents were related to tractors and other machinery; 24 were due to falls. None of these incidents were reported under the statutory notification scheme. 33 deaths were notified, eight related to tractors and allied machinery and 10 related to falling objects. CONCLUSIONS: Although safety is improving, the farm remains a dangerous environment for children. Enforcement of existing safety legislation with significant penalties and targeting of safety education will help reduce accident rates further.

Accidents↗
PubMed1992

Drowning and near drowning in children in the United Kingdom: lessons for prevention.

OBJECTIVES: To determine the pattern of drowning and near drowning of children in Britain and identify means of prevention. DESIGN: Study of drowned and nearly drowned children under 15 years old. SETTING: United Kingdom, 1988 and 1989. SUBJECTS: Children under 15 years either drowning or admitted to hospital after a submersion incident. MAIN OUTCOME MEASURES: Number of nearly drowned children, obtained from consultant paediatricians returning monthly notification cards through the British Paediatric Surveillance Unit. Number of drowned children notified by the Office of Population Censuses and Surveys and other national epidemiological offices; information from coroners. RESULTS: 306 children had confirmed submersion incidents: 149 died and 157 survived after near drowning. The annual incidence in England and Wales was 1.5/100,000, and mortality 0.7/100,000. Mortality was lowest in public pools 6% (2/32) and highest in rivers, canals, and lakes (78%, 56/73). Most of the children (263, 83%) were unsupervised at the time of the accident. 208 (68%) children were under 5 years old. CONCLUSIONS: Drowning and near drowning of children are problems in the British Isles. Appropriate supervision and safety barriers seem important for preventing such accidents. Improving information on dangers of drowning given to parents through the child surveillance programmes, encouraging fencing or draining of garden ponds and domestic swimming pools, and increasing supervision of swimming in lakes, rivers, and beaches should reduce the number of accidents.

Adolescent↗
PubMed1991

Outcome in children who nearly drown: a British Isles study.

OBJECTIVE: To determine the outcome in nearly drowned children in the British Isles and identify factors that might predict a poor prognosis. DESIGN: Study of drowned and of nearly drowned children aged less than or equal to 14. Information on nearly drowned children admitted to hospital obtained from consultant paediatricians returning monthly notification cards through the British Paediatric Surveillance Unit. Information on drowned children obtained from Office of Population Censuses and Surveys and other national epidemiological offices. SETTING: British Isles, 1988 and 1989. SUBJECTS: 330 children who had confirmed submersion incidents. 142 died before admission to hospital and 188 children were admitted after nearly drowning. MAIN OUTCOME MEASURES: Death, full recovery, or degree of handicap after near drowning and signs on admission to hospital. RESULTS: All of the children who were conscious on admission fully recovered. Of the 64 children unconscious on admission, 31 had normally reactive pupils and all but three (all of whom had severe preexisting neurological disease) recovered fully. Of the 33 children with fixed dilated pupils on admission, 10 fully recovered, 13 died, and 10 had severe neurological deficit. Spontaneous respiratory effect on admission was associated with normal survival. Pupils that remained dilated six hours after admission and fits continuing 24 hours after admission predicted a poor outcome. CONCLUSION: Children can survive normally after near drowning in the British Isles, particularly if they have been hypothermic. Resuscitation should not be abandoned in nearly drowned children until they have been rewarmed.

Adolescent↗
PubMed1991

Assessment of locomotor function in young boys with Duchenne muscular dystrophy.

Thirty-three young boys (mean age 3.42 years) with Duchenne muscular dystrophy (DMD) and 21 normal control boys (mean age 3.51 years) were studied prospectively to determine whether it is possible to objectively assess locomotor function in young boys with DMD so that they can be included in treatment trials. An initial reproducibility study using a hand-held myometer demonstrated that this method was not useful. The Hammersmith Motor Ability Score demonstrated an increase in developmental abilities with age which was markedly different from normal. The locomotor quotient of the Griffiths' Scales demonstrated a deterioration of quotient scores and is a useful method of assessment that could be used in treatment trials involving young boys with DMD. Sample size planning for treatment trials is discussed.

Child↗
PubMed1991

Bittering agents in the prevention of accidental poisoning: children's reactions to denatonium benzoate (Bitrex).

The responses of young children to Denatonium Benzoate (Bitrex) were observed, in order to assess the potential of this bittering agent in the prevention of accidental poisoning. Thirty-three children aged 17-36 months were offered orange juice containing Bitrex (in a concentration of 10 parts per million). Of the 30 children who took some of this juice, only seven were willing to take more than 10 gm. A variety of negative verbal and non-verbal responses were noted. It is suggested that the highly unpalatable nature of Bitrex makes this compound a useful additive that could well prevent accidental poisoning from household products of mild to moderate toxicity.

Accidents, Home↗
PubMed1990

Early development of boys with Duchenne muscular dystrophy.

Thirty-three boys with Duchenne muscular dystrophy (DMD) and a mean age of 3.4 years were assessed with the Griffiths Developmental Scales, the Reynell Language Scales and the British Picture Vocabulary Scales at six-monthly intervals over a one-year period. The boys showed developmental delay, which was most severe in the locomotor and language areas. The locomotor quotients deteriorated over time, but the other quotients did not. Maternal intelligence, home environment and social class had little effect on the aetiology of the developmental delay, and the behavioural problems seen in young boys with DMD may be secondary to it.

Child, Preschool↗