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Biomedical subjects

T Nolan

Publications and source records attributed to T Nolan.

At least 73 records · Page 4Linked to original sources
PubMed1995

Head injuries in helmeted child bicyclists.

OBJECTIVE: To determine the characteristics and the severity of head and facial injuries to helmeted child bicyclists, and whether the helmet contributed to the injury, and to study factors related to bicycle accidents. DESIGN: Retrospective review of two case series. Children sustaining head injury while not wearing helmets were studied as a form of reference group. SETTING: Large paediatric teaching hospital. SUBJECTS: 34 helmeted child bicyclists and 155 non-helmeted bicyclists, aged 5-14 years. MAIN OUTCOME MEASURES: Number of injuries, type of injuries, injury severity score, deaths, and accident circumstances. RESULTS: 79% of the head injuries of the helmeted child group were mild and two thirds of these had facial injuries. Children in the helmet group were in a greater proportion of bike-car collisions than the no helmet group and at least 15% of the helmets were lost on impact. There were no injuries secondary to the helmet. CONCLUSIONS: Most of the head injuries sustained by the helmeted children were of mild severity and there was no evidence to suggest that the helmet contributed to injury. Nevertheless, consideration should be given to designing a facial protector for the bicycle helmet and to improvement of the fastening device.

Accidents, Traffic↗
PubMed1995

Non-intentional asphyxiation deaths due to upper airway interference in children 0 to 14 years.

OBJECTIVE: This study was undertaken to identify avoidable, contributing factors associated with non-intentional asphyxiation deaths due to upper airway interference in children 0 to 14 years. DESIGN: Historical population based incidence study. METHODS: All postneonatal and childhood deaths by asphyxiation from 1985 to 1994, using appropriate ICD-9-CM codes, were compiled from the Victorian government legislated paediatric mortality surveillance system. Recent cases were identified from the State Coroner's Office. Case definition included children under 15 years who died from upper airway interference such as facial occlusion, head and neck entrapment, rope or cord strangulation, or foreign body. RESULTS: Of the identified 42 deaths, eight (19%) were caused by a foreign body in the airway, five (12%) were due to facial occlusion, 16 (38%) were due to ropes and similar material (seven were homemade rope swings), and 13 (31%) were caused by entrapment (seven were in cots or beds). The average annual rate for asphyxiation deaths by all causes for children 0 to 14 years was 4.7 million. Infants under 1 year had a rate of 20.1/million, while the rate for 10 to 14 year olds dropped to 2.0/million. CONCLUSION: Rope swings and rope material are inherently dangerous and frequently prove fatal, especially for older children. For infants, environmental factors are important; in particular food and bedding. Prevention strategies need to be developed that include obligatory standards for the design and manufacture of products for children, appropriate labelling and warnings, and education for children, their carers, and health care professionals.

Accidents, Home↗
PubMed1995

Sonographic measurement of renal enlargement in children with acute pyelonephritis and time needed for resolution: implications for renal growth assessment.

OBJECTIVE: Failure of a kidney to grow satisfactorily in childhood is evidence of renal disease. Because kidneys may enlarge during an episode of acute pyelonephritis, concomitant renal length measurements cannot be used as baselines for growth assessment. This study was designed to determine the degree of renal enlargement in children with acute pyelonephritis and the time the enlargement takes to resolve after treatment is started to find the optimum time for obtaining baseline measurements. SUBJECTS AND METHODS: In a cohort study, 180 children younger than 5 years old with their first proven acute urinary tract infection, with or without pyelonephritis, had renal scintigraphy and sonography within 15 days of starting treatment. The presence of cortical defects on scintigrams indicated pyelonephritis. The lengths of kidneys with and without scintigraphic defects (i.e., with and without pyelonephritis) were compared, adjusting for age and sex, and the length of kidneys with defects was related to time elapsed between the start of treatment and sonography. RESULTS: Ninety-nine kidneys (28%) in 77 children (43%) had scintigraphic defects. Kidneys with defects were an average of 3.2 mm longer than kidneys without defects. Length and time interval between treatment and sonography in kidneys with defects correlated negatively, with mean length approaching that of kidneys without defects by 10-11 days. CONCLUSION: Kidneys with acute pyelonephritis initially increase in length but return to normal on average by the 11th day of treatment. If poor renal growth is used as an indication of renal disease, sonography should be delayed or repeated at least 2 weeks after the start of treatment to determine the length of the uninflamed kidney.

Acute Disease↗
PubMed1995

Adverse outcomes of bacterial meningitis in school-age survivors.

OBJECTIVE: To determine the outcomes of bacterial meningitis in school-age survivors. DESIGN: Prospective cohort study. SETTING: Teaching pediatric hospital. CHILDREN: During 1983 through 1986, 158 meningitis survivors, ages 3 months to 14 years, treated at a single center were enrolled. Between 1991 and 1993, 130 children, 82% of the original cohort, were evaluated at a mean age of 8.4 years and a mean of 6.7 years after their meningitis. OUTCOME MEASURES: Blinded neurologic, neuropsychologic, audiologic, behavior, and socio-demographic assessments were compared with those from grade- and sex-matched control children. Multivariate analyses adjusted for age at testing and socio-demographic variables. RESULTS: There was a systematic increase in risk of abnormality or poorer functioning for children with meningitis, compared with control children, across all categories tested, which was significant for fine motor function, Intelligence quotient (IQ) scores, and tests of school behavior, neuropsychologic function, and auditory figure-ground differentiation. Eleven children who had experienced meningitis (8.5%) had major deficits (IQ < 70, seizures, hydrocephalus, spasticity, blindness, or severe to profound hearing loss); a further 24 (18.5%) cases and 14 (10.8%) control children had minor deficits (IQ 70 to 80, inability to read, mild to moderate hearing loss, abnormalities in speech discrimination, or school behavior problems). Overall, children who had meningitis were at greater risk (26.9%) for disability. Children with acute neurologic complications had more adverse outcomes than those with uncomplicated meningitis and control children (39% vs 18% vs 11%, respectively). CONCLUSIONS: One in four school-age meningitis survivors has either serious and disabling sequelae or a functionally important behavior disorder, neuropsychologic or auditory dysfunction adversely affecting academic performance. As a group, survivors function less well than their classroom peers, and risk is greatest for, but not confined to, those who had acute neurologic complications. All survivors require careful follow-up, at least until school age.

Adolescent↗
PubMed1994

Attitudes of Victorian vaccine providers to pertussis vaccine.

OBJECTIVES: To assess the attitudes of Victorian vaccine providers to the pertussis component of the diphtheria-tetanus-pertussis vaccine (DTP), and to examine differences between kinds of health professionals. Also, to assess vaccine providers' understanding of National Health and Medical Research Council (NHMRC) guidelines on childhood immunisation with DTP. METHODS: We conducted a postal survey of 765 randomly selected Victorian health professionals involved in childhood vaccination, including medical officers of health (MOHs), general practitioners (GPs), maternal child health nurses (MCHNs), paediatricians and environmental health officers (EHOs). RESULTS: Most (83%) knew that the pertussis component was most frequently responsible for adverse effects of DTP. Thirty-four per cent of all respondents (9% MCHNs, 23% paediatricians, 24% MOHs, 34% EHOs and 39% GPs) believed that pertussis vaccine causes permanent brain damage, 34% did not, and 32% were unsure; 39% believed it causes encephalopathy. Only 9% described vaccination practices entirely in accordance with NHMRC guidelines. Up to 58% of respondents would give diphtheria-tetanus vaccine (DT) in situations when DTP was indicated, and up to 54% would give DTP when it is clearly contraindicated. There was no correlation between knowledge of the safety of DTP and vaccination practices. CONCLUSION: Victorian vaccine providers have doubts about the safety of pertussis vaccine. There is a need to ensure the availability and clarity of immunisation guidelines for health workers, to educate them about the use of pertussis vaccine, and to ensure that this knowledge is put into practice.

Attitude of Health Personnel↗
PubMed1994

Impact of cyanotic heart disease on school performance.

Surgical correction greatly decreases the mortality and cardiac morbidity of cyanotic congenital heart disease, but children remain at risk of long term difficulties in other areas. A historical cohort study was conducted to determine the relation between heart disease and school performance in 29 children aged 7 to 12 years old with simple transposition of the great arteries or tetralogy of Fallot. All children had surgical correction of their lesion before 2.5 years of age. Those at greater risk of school difficulties because of recognised complications of their heart disease or for reasons other than directly attributable to the heart disease were excluded. Comparison was made with 36 children who had presented with cardiac murmurs at a similar age, but who did not require treatment. Children with cyanotic disease showed significantly poorer performance in all academic areas assessed by the Wide Range Achievement Test-Revised; the difference in group mean score (adjusted for differences in maternal education, sex, and parental occupational prestige) for reading was 10.3 points (confidence interval (CI) 1.25 to 19.34), for spelling 7.8 (CI 1.11 to 14.52), and for arithmetic 6.8 (CI 0.19 to 13.39). The differences in adjusted group means for the Wechsler Intelligence Scale for Children-Revised full scale, performance and verbal IQs were significant, particularly the later at 10.1 points (CI 2.59 to 17.61). Teacher reports indicated significant differences in arithmetic when outcome was dichotomised to 'below grade' or 'not below grade'. There were no significant associations between outcome measures and the medical or perioperative parameters, however, including those related to hypoxia. It is concluded that the increased incidence of academic problems and the nature of the cognitive difficulties in children with uncomplicated corrective cardiac surgery for cyanotic heart disease are not fully explained by chronic hypoxia, or by other factors related to the cardiac surgery.

Child↗
PubMed1994

Measurement of functional severity of asthma in children.

The usefulness of surveys for measuring the severity of asthma in school-age children depends on the availability of reliable and valid questionnaires. The aim of this study was to develop a measure of functional severity of asthma over the previous 12 mo, for use in population studies and in investigating treatment regimens. Of 10,198 children surveyed, 9,192 (90%) in school Years 2, 7, and 10 (mean ages 8, 13, and 16 yr) in Melbourne were screened for wheeze. The parents of the 1,267 children with wheeze were interviewed. Symptoms and restriction of activity due to asthma were analyzed using factor analysis and the partial credit version of the item response theory measurement model. The result was a continuous severity scale that was highly consistent with the data, and with goodness of fit statistics indicating the severity of 97% of children was well described by the scale. The scale correlated significantly with school absence due to wheeze (r = 0.35), functional impairment during the 2 wk before interview (Functional Status II-R [FSII-R], r = 0.30), visits to medical care for wheeze (r = 0.22), and amount of medication (r = 0.36). For descriptive purposes, a simple index with four bands of severity was developed from the continuous severity scale: low severity (47% of children with wheeze), moderate (30%), mild (18%), and high (5%). The scale and index facilitate standardized description of the impact of asthma on daily life on the basis of responses to six survey questions.

Absenteeism↗
PubMed1993

Australian Rules football injuries in children and adolescents.

OBJECTIVE: To ascertain the incidence, severity, risk factors, and outcomes of injuries in children and adolescents playing Australian Rules football. DESIGN SETTING AND SUBJECTS: A prospective cohort study of football injuries in children and adolescents playing community football. We studied a stratified random sample of 54 teams and clinics (18 under-15 teams, 18 under-10 teams and 18 Vickick clinics for children under 10 years) from the Melbourne metropolitan area. Football exposure, injuries and associated risk factors were recorded for 1253 players during the 1992 football season. RESULTS: Vickick, a modified form of the game, had the lowest rates of injury for all levels of injury severity, with an overall rate of 3.49 injuries per 1000 player-hours. The rate in the under-10 age group was 2.4 times higher (95% confidence interval [CI], 1.5-3.8) than that in Vickick, and the under-15 rate was 1.2 times (95% CI, 0.9-1.6) that of the under-10s. The under-15 age group had significantly more injuries that led to use of health services than the under-10 and Vickick groups, with rates of 3.93 (95% CI, 2.9-4.9), 0.64 (95% CI, 0.2-1.4), and 0.33 (95% CI, 0.1-0.8) injuries per 1000 players-hours respectively. Injuries were largely to soft tissues (sprains 26%, haematomas 25%) and to the lower limb (43%). Very few serious injuries occurred (19 fractures and three injuries with loss of consciousness); nearly all of these were in the under-15s. Rule modifications in under-10 teams and clinics were associated with an injury rate of 5.8 injuries per 1000 player-hours (95% CI, 4.4-7.3) compared with 7.5 injuries per 1000 player-hours (95% CI, 5.2-9.8) when no modification was used. Alterations to the ruck contest, decreased contact, field size and player numbers were significantly associated with lower injury rates, while body size was not. Of the 30% of injuries resulting in a health service consultation, the most common health provider was a medical practitioner. Very few required expensive investigation or treatment. CONCLUSION: Injury rates were low in children under age 10, but higher in adolescents. Most injuries were minor, and did not result in a health professional consultation. Rule modifications were associated with substantially lower injury rates at the under-10 level, and should be promoted as a safe way to learn football skills.

Adolescent↗
PubMed1993

Computer-assisted instruction in Australian medical schools.

OBJECTIVE: To survey the use of computer-assisted instruction (CAI) in undergraduate medical student education in Australia. SETTING AND DESIGN: A postal questionnaire survey of medical school deans, and department heads, in all Australian medical schools. RESULTS: 90% of deans, and 88% of department heads responded to the questionnaires. There were considerable variations between departments and faculties in the use of CAI. Overall, 36% of departments were using CAI and 65% of those not currently using it were either developing CAI or would like to introduce it into their teaching programs. Some medical faculties had well-developed policies for CAI, and provided considerable resources, while others did not. Some departments had large numbers of student work stations (up to 64), and multiple teaching packages (up to 200). CAI packages were generally thought to be popular with students, and to have improved the standard of learning. CONCLUSION: This form of teaching is currently undergoing rapid expansion, but in an uncoordinated manner that is likely to lead to greatly increased overall development costs.

Australia↗
PubMed1993

Role of a children's hospital safety centre in injury control.

Over the past 13 years, child safety centres have been established at several Australian Children's hospitals. In a short time, they have developed an important role in community injury control programmes. These centres provide an efficient conduit for transferring up-to-date injury surveillance and prevention information to families, industry, health and education professionals, and government. The activities of the Child Safety Centre at the Royal Children's Hospital in Melbourne are described, together with ways in which a degree of self-funding can be achieved.

Accident Prevention↗
PubMed1993

New concepts in the management of encopresis.

Persistent fecal incontinence without anatomic abnormality, otherwise known as soiling or encopresis, frequently brings ridicule and shame to the affected child. The disability that it imposes is accentuated by the parental anger, guilt, and helplessness it engenders; by the peer hostility and rejection it promotes; and by the disgust with which it may be greeted by teachers. Home-based pediatric therapy is safe, generally very effective, and rewarding to patient, family, and physician. However, it requires a comprehensive understanding of both the underlying pathophysiology and the integrated therapeutic program of counseling, pharmacotherapy, and behavior modification.

Biofeedback, Psychology↗
PubMed1992

Evaluation of the properties and reliability of a clinical severity scale for acute asthma in children.

The inter-observer agreement (reliability) and validity of a clinical asthma severity scale (ASS) derived from separate scores of wheeze, heart rate and accessory muscle use (each on a 4-point scale) were studied in 60 children aged between 6 months and 17 years (mean 5.4 years). Independent assessments of these clinical parameters were made by two paediatricians, and they also rated patients as having a mild, moderate, severe or very severe acute episode (clinical judgement rating, CJR). Oxygen saturation (SaO2) was measured concurrently by a Biox 3700 pulse oximeter and readings were categorized as mild (SaO2 greater than or equal to 94%), moderate (91-93%) and severe (less than 91%). Agreement between clinicians was assessed by the weighted kappa statistic (kappa W). Agreement for the ASS score compared to the severity grade obtained from SaO2 was slight (kappa W = 0.34) and compared to CJR the kappa W was 0.55. An ASS score of moderate or worse (greater than 3) had sensitivity of 97% and specificity of 50% for prediction of admission. The maximum frequency and duration of nebulizer therapy following admission were significantly greater for severe patients than for moderate patients. Length of hospital stay did not reflect the ASS score in the emergency department but total duration of functional disability increased with ASS score. The substitution of an adjusted heart rate score for the raw heart rate score used in ASS detracted from scale performance. The ASS is an imprecise but reasonable quantitative measure of the severity of an acute episode of asthma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Epidemiology of non-intentional injuries in an Australian urban region: results from injury surveillance.

Injury surveillance provides an opportunity to determine non-intentional injury rates for those injuries which are treated in hospital accident and emergency departments. The first full calendar year of injury surveillance in north-western greater Melbourne was used to calculate incidence rates of a wide range of injury types and causes for 1989. In a population at risk estimated to number 150,604 children aged 0-14 years, the all-cause injury mortality was 10.5/100,000 per year (95% confidence interval [Cl], 5.4-15.8). There were 8207 attendances by children from the denominator area for non-intentional injury at the three hospitals participating in surveillance, representing rates of 6437/100,000 per year (95% Cl, 6258-6616) and 4406/100,000 per year (95% Cl, 4254-4558) for boys and girls respectively, while the rates for admission to hospital were 957/100,000 per year (95% Cl, 888-1025) and 649/100,000 per year (95% Cl, 590-707). The leading causes of hospital attendance were related to injuries involving sports, play equipment, bicycles and poisoning. These rates are substantially lower than those reported from other countries. The possible reasons for this include differences in health care utilization, under-ascertainment of cases, and a real difference in injury risk. Injury Surveillance Information System codes are defined for a standard set of injuries and injury causes which may be used for future comparative studies. Problems related to assessing the reliability of injury ascertainment are discussed, and the importance of integrating injury surveillance into routine hospital information systems is emphasized.

Accidents↗
PubMed1992

Spontaneous seminoma in an owl monkey in captivity.

An adult male Aotus nancymae maintained for breeding purposes was submitted for surgery and the left testicle was removed. The surgically removed mass was about two to three times the size of a normal adult owl monkey testicle. Grossly, on cut surface, the mass was soft, white to pale gray, and bulged above the adjacent tissue. Microscopically, the morphology of the tumor cells was consistent with a seminoma.

Animals↗
PubMed1991

Randomised trial of laxatives in treatment of childhood encopresis.

Primary faecal incontinence (encopresis) in children is usually treated with laxative medication and a behaviour modification programme aimed at promoting regular toileting, but the effectiveness of laxatives has never been adequately investigated. 169 children with encopresis and evidence of stool on plain abdominal radiograph were randomly allocated to receive multimodal (MM) therapy (laxatives plus behaviour modification; n = 83) or behaviour modification alone (BM; n = 86). Mean (SD) follow-up was 55.1 (27.0) weeks and 56.7 (32.0) weeks, respectively. By 12 months' follow-up 42 (51%) of the MM group and 31 (36%) of the BM group (p = 0.079) had achieved remission (at least one 4 week period with no soiling episodes) and 52 (63%) vs 37 (43%) (p = 0.016) had achieved at least partial remission (soiling no more than once a week). MM subjects achieved remission significantly sooner than BM subjects, and the difference in the Kaplan-Meier remission curves was most striking in the first 30 weeks of follow-up (p = 0.012). The patterns of compliance with toileting in the treatment groups were almost identical, although about 1 in 8 children overall did not comply with the sitting programme. After exclusion of the 24 poor compliers, there was no significant difference between BM and MM groups. This study shows a clear advantage overall for the use of laxative medication, although the benefit may not be as great for children who are able to maintain regular toileting.

Adolescent↗