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Biomedical subjects

R K Oates

Publications and source records attributed to R K Oates.

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

Herpes simplex virus infections in the neonate.

OBJECTIVE: To review the experience of the Camperdown Children's Hospital with neonatal herpes simplex viral (HSV) infections between 1960 and 1992. DESIGN: A retrospective record review of all cases of HSV infection. RESULTS: Fifteen proven HSV infections were found. Only three cases had a definite history of HSV infection during pregnancy. Six were delivered at 36 weeks gestation or earlier. Seven weighed 2500 g or less. Forty-three per cent developed physical signs within 7 days of birth. Three cases were confined to skin, eyes and mouth, five were generalized, six had encephalitis with or without skin lesions, and one had pneumonitis. The mortality rate comprising the five with generalized infection was 47%, one with encephalitis and the one with pneumonitis. Four of the eight survivors have persisting neurological impairment. Those with disseminated infection and encephalitis did poorly regardless of antiviral treatment. CONCLUSION: A high index of suspicion of HSV infection is important so that antiviral treatment can be commenced early, particularly for those infections localized to skin, eye and mouth where there may be a good prognosis.

Adult↗
PubMed1995

Self esteem, depression, behaviour and family functioning in sexually abused children.

Eighty-four sexually abused children and their families, were compared with controls to look at short-term effects of sexual abuse. The abuse group had more marital breakdown, unemployment, communication problems within the family and poor marital mental health. The abused children had more depression, low self-esteem and behaviour disorder. There was no relationship between intrafamilial abuse and depression, self-esteem or behaviour disorder. More severe abuse was related to low self-esteem and children's negative perceptions of their mothers. In planning treatment the child's relationship to the perpetrator may need less emphasis, with more on self-esteem, depression, family functioning and the child's perceptions of the family.

Adolescent↗
PubMed1995

Intellectual function and age of repair in cyanotic congenital heart disease.

Eighty one children, comprising 51 with tetralogy of Fallot and 30 children with transposition of the great arteries (TGA) were assessed using the Wechsler intelligence scale for children--revised, and a battery of neuropsychological measures. They were compared with a group of 33 children who had surgery for ventricular septal defect. All children were aged over 10 years when reviewed and were in good health, attending normal schools. No significant negative correlation was found between any component or subtest of the IQ scores and operating age. There was no evidence of a detrimental effect of older age at operation in the children who had cyanotic heart disease as assessed by neuropsychological measures. Delaying surgery for children with TGA or tetralogy of Fallot does not appear to adversely affect their intellectual development. This finding may provide reassurance in cases where surgery has to be delayed for medical, social, or economic reasons.

Age Distribution↗
PubMed1995

Stress and mental health in neonatal intensive care units.

The views of 34 neonatologists (a 78% response rate) and 192 neonatal intensive care nurses (a 66% response rate) were obtained on work, stress, and relationships in neonatal intensive care units. The survey was conducted by post and included Goldberg's General Health Questionnaire (GHQ). A comparison of the responses of neonatologists and nurses to 21 identical statements showed significant differences in 12. Most neonatologists felt that they involved nurses in critical patient care decisions, provided adequate pain relief for their patients, gave nurses adequate information on patients' progress after discharge, and were aware of little doctor-nurse conflict. However, the nurses' responses differed significantly in these areas, suggesting that the neonatologists may have a more rosy view of life in the neonatal intensive care unit than their nurse colleagues. Twenty seven per cent of neonatologists and 32% of nurses had GHQ scores indicating psychological dysfunction. The neonatologists who had dysfunctional scores differed from their colleagues in only one area surveyed--a higher proportion experienced conflict between the demands of their work and their personal lives.

Humans↗
PubMed1994

Stability and change in outcomes for sexually abused children.

OBJECTIVE: To evaluate sexually abused children and their families at intake and 18 months later, in comparison with a control group. METHODS: Eighty-four sexually abused children aged 5 to 15 years were assessed at intake, with 64 being able to be reassessed at 18 months, the assessment using measures of self-esteem relevant to their age; the Children's Depression Inventory, and the Achenbach Child Behavior Checklist. Parents were assessed with the McMaster Family Assessment Device and the General Health Questionnaire. Control children and families were similarly assessed. Additional measures at follow-up were a structured interview with the parents, the Indices of Coping Responses, and the Newcastle Child and Family Life Events Schedule. Therapists were contacted to obtain information on type and duration of therapy. RESULTS: While the control children's self-esteem, depression, and behavior scores showed little change over time, the abused children's scores were more likely to move toward the normal range although 56% remained in the dysfunctional range for self-esteem, 48% for behavior, and 35% for depression. Improvement in child behavior was related to improvement in family function. While there was no direct relationship between child outcome and the relationship of the abuser to the child, family dysfunction, which was related to child outcome, did correlate with the closeness of the abuser to the child. Sixty-five percent of abused children had received therapy for an average of 9 months. No relationship was found between therapy and outcome. CONCLUSIONS: The major variable relating to improvement in sexually abused children appears to be adequacy of family functioning. There is a need for increased emphasis on the evaluation of treatment.

Adaptation, Psychological↗
PubMed1994

Parent and teacher perceptions of child behaviour following cardiac surgery.

To determine if parents whose children had undergone successful cardiac surgery perceived their children any differently from parents of children who had not undergone surgery, we used the Achenbach Child Behaviour Checklist (CBCL) to compare parent and teacher perceptions in these two groups. Subjects included 168 children who had undergone cardiac surgery 4 to 8 years previously and 51 controls. On the behaviour scale of the CBCL, the teacher's mean t scores showed no significant difference between the cardiac and control groups, in contrast to the parents' scores where parents perceived a higher degree of behavioural problems in children who had undergone cardiac surgery. On the social competence scale of the CBCL, the parents scored their children who had undergone cardiac surgery as less socially competent than did the parents of the controls. Teachers' scores showed no difference between groups.

Adolescent↗
PubMed1993

Variations in the treatment of childhood asthma.

OBJECTIVE: To survey the assessment and management of childhood asthma by paediatricians, general practitioners, and respiratory physicians, and compare these findings with the Australian and New Zealand Consensus Statement guidelines on asthma management in children. SETTING AND DESIGN: A six-item postal questionnaire designed to cover assessment, management of acute and mild asthma, use of prophylaxis and methods of delivery of medication. PARTICIPANTS: A random sample of 100 paediatricians, 300 general practitioners and 100 respiratory physicians. RESULTS: Response rates were: paediatricians, 88%; general practitioners, 66%; and respiratory physicians 51%. There was agreement between all three groups in most aspects of asthma management. Deviations from the Consensus Statement guidelines included: between 38% and 49% not using oxygen as one of the first-line treatments for acute asthma; a higher use of orally administered beta 2-agonists by general practitioners (up to 40% for children between one and three years compared with 17% of paediatricians and 12% of respiratory physicians); a tendency to use intravenously administered aminophylline before corticosteroids (20% of paediatricians, 40% of general practitioners and 30% of respiratory physicians); a preference among general practitioners and respiratory physicians to prescribe inhaled corticosteroids rather than sodium cromoglycate for prophylaxis in older children; and a low incidence of use of spacer devices in older children. CONCLUSIONS: If currently published recommendations on managing asthma in children are followed, there should be: more education and emphasis on the value of oxygen and short courses of orally administered corticosteroids in acute asthma management; less reliance on intravenously administered aminophylline; decreased use of orally administered beta 2-agonists coupled with a more wide-spread use of spacer devices; and an increased emphasis on sodium cromoglycate as first-line daily prophylaxis.

Acute Disease↗
PubMed1993

Hospital admissions and attendances for asthma--a true increase?

OBJECTIVE: To compare the ratio of hospital admissions for asthma to total hospital admissions and to admissions for non-asthma respiratory conditions, over an 11-year period, to see if there has been a true increase in admissions for asthma or merely a change in diagnostic labelling. A similar comparison was made for presentations with asthma and non-asthma respiratory conditions to the accident and emergency department. DESIGN AND SETTING: A case review of all patients with a confirmed diagnosis of respiratory disease admitted to hospital or attending the accident and emergency department at the Camperdown Children's Hospital between 1979 and 1989. RESULTS: There was a 98% increase in the number of patients admitted with a confirmed diagnosis of asthma. While the ratio of admissions for asthma to total admissions increased from 0.053 in 1979 to 0.09 in 1989, the ratio of admissions for non-asthma respiratory conditions to total admissions remained relatively constant. The ratio of attendances for asthma to total accident and emergency attendances rose from 0.017 in 1979 to 0.072 in 1989, whereas the ratio of attendances for non-asthma respiratory conditions to total accident and emergency attendances had a maximum variation of 0.065 to 0.09. CONCLUSIONS: These results suggest that there has been a major increase in the number of cases of asthma being treated at this hospital and that this is a true increase, perhaps representing increased severity, rather than a change in diagnostic labelling.

Adolescent↗
PubMed1993

Extrapulmonary tuberculosis in children.

OBJECTIVE: To investigate an apparent increase in the number of children admitted to the Royal Alexandra Hospital for Children with extrapulmonary tuberculosis (TB). Further, to highlight both the seriousness of this disease and the difficulty of its diagnosis, and to draw attention to factors such as ethnic origin in identifying children at risk. DESIGN: Clinical and microbiological data were collected for all children admitted to the hospital with a confirmed diagnosis of TB. A standardised incidence ratio (SIR) was used to analyse the number of children admitted with extrapulmonary TB in 1990-1991 compared with 1982-1989, and in 1987-1991 compared with 1982-1986. RESULTS: Eleven children (five of these in 1990 and 1991) had extrapulmonary TB (4, central nervous system; 3, osteomyelitis; 2, cervical lymphadenitis; 2, abdominal). One was Aboriginal and 10 were from families of overseas origin. Twenty-one others had pulmonary TB and 17 of these were from families of overseas origin. The apparent increase in the number of admissions for extrapulmonary TB was not statistically significant. CONCLUSION: There has been a recent increase in the number of children hospitalised with extrapulmonary TB but when this is compared with the increase in children hospitalised for all causes, the increase is not significant. Immigration and the continuing contact of children with infected adults appear to account for most cases of TB in this series.

Adolescent↗
PubMed1993

Child homicide--the extreme of child abuse.

OBJECTIVE: To review cases of fatal child abuse, looking for any characteristic features of these cases. DESIGN AND SETTING: A case review of all childhood deaths at The Children's Hospital, Camperdown, between January 1976 and December 1990. Cases with a definite diagnosis of child abuse were extracted. Cases where there was only a suspicion of child abuse as the cause of death were not included. SUBJECTS: Seventeen cases of fatal child abuse were reviewed with emphasis on autopsy findings and sociological data. RESULTS: All children who died were less than three years of age; nine were under one year. Seventy-six per cent died from head injury and 24% from asphyxia or strangulation. In addition to their fatal injuries, 41% had multiple bruises on the trunk and limbs. Thirty-five per cent had evidence of previous physical abuse. CONCLUSIONS: The commonest age for fatal child abuse is the first year of life. When physical abuse occurs in children under three years, and particularly under one year, a thorough assessment, follow-up and institution of appropriate supportive services are essential, as the abuse may be an early warning of a subsequent fatal episode of abuse. The introduction of a process of review of child deaths may increase awareness of and help prevent fatal child abuse.

Airway Obstruction↗
PubMed1993

Clinical diagnosis of pyloric stenosis: a declining art.

OBJECTIVE: To assess whether diagnostic imaging of pyloric stenosis has made a difference in rapidity of diagnosis, duration of pre-operative hydration, and length of stay in hospital. DESIGN: Chart review of infants with confirmed diagnosis of pyloric stenosis. SETTING: Paediatric teaching hospital. SUBJECTS: 215 infants with a confirmed diagnosis of pyloric stenosis seen during 1974-7 and 187 infants with pyloric stenosis seen during 1988-91. MAIN OUTCOME MEASURES: State of hydration on admission, time between presentation to hospital and a definite diagnosis, techniques used to make the diagnosis, whether a pyloric mass was felt before or after an imaging procedure, time between presentation and surgery, and length of stay in hospital. RESULTS: The average age at presentation was 40 days in both groups. A pyloric mass was palpated either without or before an imaging study in 87% (187/215) of cases during 1974-7 but in only 49% (91/187) during 1988-91. The use of barium meal examination and ultrasonography increased from 20% (42/215) of cases during 1974-7 to 61% (114/187) during 1988-91. There were no significant differences between the two groups in the time taken to establish a diagnosis, the mean duration of preoperative treatment, or the length of stay in hospital (after allowance for the decline in average length of stay of all hospital patients between the two periods). CONCLUSIONS: An increased use of diagnostic imaging for pyloric stenosis did not lead to earlier diagnosis or better management. While imaging is important in identifying pyloric stenosis in difficult cases, increasing reliance on imaging has reduced doctors' skills in diagnosing pyloric stenosis clinically.

Age Factors↗
PubMed1993

Clinical severity of respiratory syncytial virus group A and B infection in Sydney, Australia.

Respiratory syncytial virus (RSV) has two major antigenic groups, A and B. There is disagreement as to whether or not there is a difference in the clinical severity of disease caused by the two RSV groups. This 3-year prospective study of infants and children with RSV-positive bronchiolitis examines the relative virulence of RSV Groups A and B and assesses the role that breast-feeding may have in modifying the clinical severity of infection. Clinical severity was graded I (ventilated, severe), II (oxygen therapy, moderate), III (no ventilation or oxygen, mild). RSV serogrouping was performed. After exclusion of 60 subjects with known predisposing factors for severity, 444 infants and children were studied (Group A, 337; Group B, 107). The difference in proportion of subjects with severity grade I and II with Group A compared with Group B infection was 6% (95% confidence interval, 4.7 to 16.7). For infants 0 to 6 months of age this difference was 5.6% (95% CI, 7.3 to 18.4). Nineteen cases were nosocomially transmitted. There was a predominance of Group A RSV infection but no difference in severity between Group A and Group B infection.

Age Factors↗
PubMed1993

Who participates in child sexual abuse research?

This paper stems from a prospective case control study of the effects of child sexual abuse and explores issues of sampling bias resulting from non-participation in research. Despite similarities in family demographics and in the level of abuse experienced, differences between the study participants and non-participants emerged. The more dysfunctional families were less likely to participate, the research was not a passive experience for the families and finally, non-participants were offered less therapy following clinical assessment. The implications of these differences for the main prospective study will be explored.

Adolescent↗
PubMed1993

Falling out of bed: a relatively benign occurrence.

OBJECTIVE: To determine the likelihood of injuries occurring to infants and children who fall out of bed. METHODS: A review of hospital records where children were documented to have fallen from a crib or bed and where the children were immediately assessed and examined following the fall. PATIENTS: Two hundred seven children younger than 6 years of age. One hundred twenty-four falls were from cribs and 83 from beds. The heights of the falls were 25 inches from beds or 41 inches when the child climbed over the bed rails and then fell, and 32 inches from cribs or 54 inches for those who fell after climbing the crib rails. RESULTS: There were 29 superficial injuries such as contusions or minor lacerations. One simple skull fracture was noted incidentally on skull roentgenogram and there was one fractured clavicle. There were no serious, multiple, visceral, or life-threatening injuries. Calculation of the momentum of impact between the injured and noninjured showed no significant difference. CONCLUSIONS: Because falls from short distances are unlikely to produce serious injury, the reliability of the history should be questioned when a child has significant injuries said to have resulted from a short fall.

Accidental Falls↗
PubMed1992

Childhood poisoning--a changing profile with scope for prevention.

OBJECTIVES: To study the pattern of poisoning in children admitted to the Children's Hospital between 1983 and 1988; to compare this pattern with the last study of poisoning in childhood from this institution, done in 1956; and to survey knowledge of a sample of general practitioners and pharmacists about common childhood poisonings. DESIGN: A retrospective review of 407 medical records of children admitted after poisoning and a postal questionnaire to 150 randomly selected pharmacists and 150 randomly selected general practitioners. RESULTS: Poisoning accounted for one in 200 admissions to the Children's Hospital. The pattern of poisoning has changed since 1956 when the main agents were kerosene, pesticides, aspirin and digoxin. Now they are the benzodiazepines, iron preparations, paracetamol and anticonvulsants. There were four deaths due to the ingestion of quinine, caustic soda, ferrous sulphate and an arsenic-based weed killer respectively. Five per cent of the admissions resulted in significant morbidity. Sixty-five per cent of general practitioners and 45% of pharmacists responded to the questionnaire. The high toxicity of quinine, anticonvulsants, iron preparations and digoxin was not widely appreciated by over 50% of the general practitioners while over 60% of the pharmacists were not aware of the high toxicity of anticonvulsants and paracetamol. CONCLUSIONS: Although the pattern of childhood poisoning has changed, it remains a significant but largely preventable cause of mortality and morbidity.

Australia↗
PubMed1990

Methodological considerations in research on child sexual abuse.

Child sexual abuse research presents practical, methodological and statistical challenges. This paper examines some recent literature about the incidence and effects of child sexual abuse. Researchers who use epidemiological studies to attempt to ascertain the prevalence of different forms of abuse should be aware of the different populations studied, different methodologies used, diverse definitions of sexual abuse and practical limitations on participants' memories. Common problems in retrospective and prospective studies into the effects of child sexual abuse include the use of atypical populations, inappropriate statistical analyses, the use of unvalidated psychometric instruments and limited sources of information on child functioning. Attention must also be paid to potentially confounding demographic and family variables. A thorough understanding of, and attention to, these problem areas in child sexual abuse research will give a clearer picture of the prevalence and effects of abuse, thus indicating the most appropriate forms of prevention and treatment.

Child↗
PubMed1989

Readability of health care literature.

A sample of health care literature produced for parents was analysed, using the Flesch method, for readability and human interest. As a comparison, the readability and human interest scores were also calculated for Sydney daily newspapers. It was found that the pamphlets produced by government agencies were more readable than those produced by non-government agencies. Those pamphlets written with input from parents were the most readable of all. Similar results were found for the human interest level of the pamphlets. The readability and the human interest scores of the government-produced pamphlets were similar to those of the larger circulation daily newspapers. Health care literature for parents needs to be good quality and easily understood. The involvement of parents in their production may improve the effectiveness of these leaflets.

Persons with Disabilities↗