Abstract Background. Fever in children is common and mostly caused by self-limiting infections. However, parents of febrile children often consult in general practice, in particular during out-of-hours care. To improve management, it is important to understand experiences of GPs managing these consultations. Objective. To describe GPs’ experiences regarding management of childhood fever during out-ofhours care. Methods. A descriptive qualitative study using purposeful sampling, five focus group discussions were held among 37 GPs. Analysis was based on constant comparative technique using open and axial coding. Results. Main categories were: (i) Workload and general experience; (ii) GPs’ perceptions of determinants of consulting behaviour; (iii) Parents’ expectations from the GP’s point of view; (iv) Antibiotic prescribing decisions; (v) Uncertainty of GPs versus uncertainty of parents and (vi) Information exchange during the consultation. GPs felt management of childhood fever imposes a considerable workload. They perceived a mismatch between parental concerns and their own impression of illness severity, which combined with time–pressure can lead to frustration. Diagnostic uncertainty is driven by low incidences of serious infections and dealing with parental demand for antibiotics is still challenging. Conclusion. Children with a fever account for a high workload during out-of-hours GP care which provides a diagnostic challenge due to the low incidence of serious illnesses and lacking longterm relationship. This can lead to frustration and drives antibiotics prescription rates. Improving information exchange during consultations and in the general public to young parents, could help provide a safety net thereby enhancing self-management, reducing consultations and workload, and subsequent antibiotic prescriptions.
Background: Poor motor skill competence may influence energy balance with childhood overweight as a result. Our aim was to investigate whether the age of motor milestone achievement has changed over the past decades and whether this change may contribute to the increasing trend observed in childhood overweight. Methods: Motor skill competence was assessed in children from the Young Netherlands Twin Register born between 1987 and 2007. Follow-up ranged from 4 up to 10 years. Weight and height were assessed at birth, 6 months, 14 months, and 2, 4, 7, and 10 years. Results: Babies born in later cohorts achieved their motor milestones ‘crawling’, ‘standing’, and ‘walkingunassisted’ later compared to babies born in earlier cohorts (N = 18,514, p <0.001). The prevalence of overweight at age 10 was higher in later cohorts (p = 0.033). The increase in overweight at age 10 was not explained by achieving motor milestones at a later age and this persisted after adjusting for gestational age, sex, and socioeconomic status. Conclusion: Comparing children born in 1987 to those born in 2007, we conclude that children nowadays achieve their motor milestones at a later age. This does not however, explain the increasing trend in childhood overweight.
Heritable Connective Tissue Disorders (HCTD) show an overlap in the physical features that can evolve in childhood. It is unclear to what extent children with HCTD experience burden of disease. This study aims to quantify fatigue, pain, disability and general health with standardized validated questionnaires.METHODS: This observational, multicenter study included 107 children, aged 4-18 years, with Marfan syndrome (MFS), 58%; Loeys-Dietz syndrome (LDS), 7%; Ehlers-Danlos syndromes (EDS), 8%; and hypermobile Ehlers-Danlos syndrome (hEDS), 27%. The assessments included PROMIS Fatigue Parent-Proxy and Pediatric self-report, pain and general health Visual-Analogue-Scales (VAS) and a Childhood Health Assessment Questionnaire (CHAQ).RESULTS: Compared to normative data, the total HCTD-group showed significantly higher parent-rated fatigue T-scores (M = 53 (SD = 12), p = 0.004, d = 0.3), pain VAS scores (M = 2.8 (SD = 3.1), p < 0.001, d = 1.27), general health VAS scores (M = 2.5 (SD = 1.8), p < 0.001, d = 2.04) and CHAQ disability index scores (M = 0.9 (SD = 0.7), p < 0.001, d = 1.23). HCTD-subgroups showed similar results. The most adverse sequels were reported in children with hEDS, whereas the least were reported in those with MFS. Disability showed significant relationships with fatigue (p < 0.001, rs = 0.68), pain (p < 0.001, rs = 0.64) and general health (p < 0.001, rs = 0.59).CONCLUSIONS: Compared to normative data, children and adolescents with HCTD reported increased fatigue, pain, disability and decreased general health, with most differences translating into very large-sized effects. This new knowledge calls for systematic monitoring with standardized validated questionnaires, physical assessments and tailored interventions in clinical care.
The growing use of digital media has led to a society with plenty of new opportunities for knowledge exchange, communication and entertainment, but also less desirable effects like fake news or cybercrime. Several studies, however, have shown that children are less digital literate than expected. Digital literacy has consequently become a key part within the new national educational policy plans titled Curriculum.nu and the Dutch research and policy agendas. This research project is focused on the role the game sector can play in the development of digital literacy skills of children. In concrete, we want to understand the value of the use of digital literacy related educational games in the context of primary education. Taking into consideration that the childhood process of learning takes place through playing, several studies claim that the introduction of the use of technology at a young age should be done through play. Digital games seem a good fit but are themselves also part of digital media we want young people to be literate about. Furthermore, it needs to be taken into account that digital literacy of teachers can be limited as well. The interactive, structured nature of digital games offers potential here as they are less dependent on the support and guidance of an adult, but at the same time this puts even more emphasis on sensible game design to ensure the desired outcome. The question is, then, if and how digital games are best designed to foster the development of digital literacy skills. By harnessing the potential of educational games, a consortium of knowledge and practice partners aim to show how creating theoretical and practical insights about digital literacy and game design can aid the serious games industry to contribute to the societal challenges concerning contemporary literacy demands.
The clubfoot deformity is one of the most common congenital orthopaedic “conditions”. Worldwide approximately 100,000 children are born with unilateral or bilateral clubfoot every year. In the Netherlands the incidence is approximately 175 every year. This three dimensional deformity of the foot involves, equinus, varus, adductus, and cavus . Left untreated the clubfoot leads to deformity, functional disability and pain. Physical impairments of children with clubfoot might lead to limitations in activities and therefore impede a child’s participation. In clinical practice, the orthopaedic surgeon and physiotherapists are regularly consulted by (parents of) clubfoot patients for functional problems such as impaired walking and other daily activities. This does not only affect long-term and physical health of a child, it will also affect the development of social relationships and skills as well. Since walking is a main activity in children to be able to participate in daily life, our previous study (financially supported by SIA Raak Publiek) focussed on gait differences between children with clubfoot and controls. However, differences in gait characteristics do not necessarily lead to functional limitations and restricted participation. Therefore, providing insight in participation and a child’s performance in other activities than walking is necessary. Insight in a child’s participation will also indicate the functional outcome of the treatment, which on its turn could provide essential information concerning a possible relapse.. Early identification of a relapse is important since it could prevent the need for major surgical interventions. The occurrence of a relapse clubfoot will probably also lead to functional differences in the foot as well as problems during activity and participation. Therefore, the main focus of this study is the functional outcomes of physical activities and the characterisation of participation of children with clubfeet in daily activities of childhood.
Het succesvol integreren van eHealth-innovaties, is van vitaal belang voor het verbeteren van de zorgkwaliteit en toegankelijkheid. Thuismeten is een van de innovaties die kan bijdragen aan een efficiëntere zorgverlening en een betere toegankelijkheid. Onderzoek toont aan dat digitaal thuis meten aanzienlijke voordelen biedt, waaronder een betere patiëntervaring, meer regie over het zorgproces, verbeterde veiligheid en kostenbesparingen. Juveniele dermatomyositis (JDM), een zeldzame ziekte bij kinderen, zou aanzienlijke voordelen kunnen halen uit thuismeten. Momenteel zijn monitoringtools zoals de Childhood Myositis Assessment Scale (CMAS) alleen beschikbaar in gespecialiseerde medische centra, wat frequente monitoring moeilijk maakt. Een veelbelovende ontwikkeling is het gebruik van AI-gebaseerde oplossingen voor real-time analyse van videobeelden. Deze ontwikkeling roept echter nog vragen op over acceptatie en betrouwbaarheid en inzetbaarheid. Daarom heeft Zuyd Hogeschool (Lectoraat Dataintelligence) samen met de kennis en praktijk partners Kinderfysiotherapie (Hogeschool Rotterdam), het Wilhelmina Kinderziekenhuis en eerstelijns kinderfysiotherapeuten het afgelopen jaar vooronderzoek gedaan naar deze praktijk problemen om tot de volgende vraagstelling te komen, die we met behulp van deze RAAK-publiek subsidie hopen te kunnen beantwoorden: Hoe kunnen we de implementatie van betrouwbare AI-gebaseerde thuismetingsoplossingen bevorderen om meer frequente en consistente ziekte monitoring mogelijk te maken, de fysiotherapeutische behandeling te optimaliseren en daarmee de kwaliteit van zorg voor kinderen met JDM te verbeteren? De beantwoording van deze vraag vereist een duidelijke co-creatieaanpak, nauwe betrokkenheid van zorgprofessionals en richtlijnen om de kansen en uitdagingen van thuismeten met behulp van AI in de praktijk te adresseren.
