An intervention using a single home visit to improve the extent to which families use safety measures was found to be insufficient to influence the long-term adoption of home safety measures, but was effective to decrease the overall occurrence of injuries. Future programs should target a few, well-focused, evidence-based areas including the evaluation of high-risk groups and the effect of repeated visits on outcome.

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A literature search for the past 15 years was conducted using the MEDLINE database, and by reviewing the bibliographies of the retrieved articles. Of particular interest were the prospective longitudinal cohort studies in which mothers were recruited during their pregnancy or postpartum period, and the children were assessed at regular intervals.

Background: Young children may sustain injuries when exposed to certain hazards in the home. To better understand the relation between several childproofing strategies and the risk of injuries to children in the home, we undertook a multicentre case-control study in which we compared hazards in the homes of children with and without injuries. Methods:We conducted this case-control study using records from 5 pediatric hospital emergency departments for the 2-year period 1995-1996. The 351 case subjects were children aged 7 years and less who presented with injuries from falls, burns or scalds, ingestions or choking. The matched control subjects were children who presented during the same period with acute non-injury-related conditions. A home visitor, blinded to case-control status, assessed 19 injury hazards at the children's homes. Results:Hazards found in the homes included baby walkers (21% of homes with infants), no functioning smoke alarm (17% of homes) and no fire extinguisher (51% of homes). Cases did not differ from controls in the mean proportion of home hazards. After controlling for siblings, maternal education and employment, we found that cases differed from controls for 5 hazards: the presence of a baby walker (odds ratio [OR] 9.0, 95% confidence interval [CI] 1.1-71.0), the presence of choking hazards within a child's reach (OR 2.0, 95% CI 1.0-3.7), no child-resistant lids in bathroom (OR 1.6, 95% CI 1.0-2.5), no smoke alarm (OR 3.2, 95% CI 1.4-7.7) and no functioning smoke alarm (OR 1.7, 95% CI 1.0-2.8).Interpretation: Homes of children with injuries differed from those of children without injuries in the proportions of specific hazards for falls, choking, poisoning and burns, with a striking difference noted for the presence of a baby walker. In addition to counselling parents about specific hazards, clinicians should consider that the presence of some hazards may indicate an increased risk for home injuries beyond those directly related to the hazard found. Families with any home hazard may be candidates for interventions to childproof against other types of home hazards. CMAJ 2006;175(8):883-7 Published at www.cmaj.ca on Sept. 21, 2006. Abstract

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Hepatitis C virus (HCV) quasispeciation was studied in two children vertically coinfected with HCV and human immunodeficiency virus type 1 (HIV-1). HCV quasispecies diversification and liver injury were more significant in patient C1, who was immunocompetent with anti-HIV therapy, than in patient C2, who was immunosuppressed, in consistency with modulation of HCV quasispeciation and liver injury by immunocompetence in coinfected children.To characterize the evolution of hepatitis C virus (HCV) disease and the influence of human immunodeficiency virus type 1 (HIV-1) and antiretroviral therapy (ART) (17), longitudinal sequence analysis of E2 envelope gene hypervariable region 1 (HVR1) was undertaken for two male Caucasian children (C1 and C2), who acquired HCV and HIV-1 infection by mother-to-child transmission.Patient C1, born in 1996, was treated from birth with zidovudine, which was complemented with lamivudine when HIV-1 cocultures became positive at 6 weeks of age. Early HIV-1 viremia correlated with a rise in CD8 cell counts, a sharp decline in CD4 counts, and an inversion of the CD4:CD8 ratio, consistent with acute HIV-1 infection ( Fig. 1A and B) (3). HIV-1 viral load decreased and stabilized at the end of the first year of life, while CD4 counts remained within the normal range. At 1.16 years of age, combination ART (lamivudinestavudine-ritonavir) was introduced, resulting in a further decline in HIV-1 viral load and a rise in CD4 counts (Fig. 1). Levels of alanine (ALT) and aspartate (AST) aminotransferases peaked 36 days later, followed by a decline over the following weeks without a change in treatment (Fig. 1C). Infection with HCV-1b (21) at 1.77 years of age was confirmed by PCR. Stored plasma samples were used retrospectively to measure HCV RNA levels, which were not influenced by ART (Fig. 1B). Between the ages of 3 and 6, HIV-1 levels declined but remained detectable, HCV viral load was stable, ALT and AST levels remained at twice normal or less, and CD4 counts declined but remained within the normal range ( Fig. 1) (3). A liver biopsy performed at 5.83 years of age showed chronic hepatitis characterized by distorted lobular architecture together with mild, diffuse lobular inflammation with occasional nodular lymphoid infiltrate and prominent macro-and microvesicular steatosis. Portal tracts were expanded with mononuclear cell infiltrates, and interface hepatitis was present in the majority. Mild periportal and sinusoidal fibrosis was observed.At 4.5 months later, changes in ART brought the HIV-1 viral load to Ͻ50 copies/ml and raised CD4 counts. Common clinical complications related to pediatric HIV infection were not seen. HCV RNA was extracted from plasma and was amplified using previously described primers and conditions (8,9). Strict PCR precautions were adopted. A total of 115 independent subclones were sequenced. Multiple alignments were performed using Clustal X version 1.81 (30). Overall, accumulation of nucleotide substitutions was observed within HVR1 (nucleotides 1482 to 1562), while f...

St-Laurent-Gagnon T, Bernard-Bonnin AC, Villeneuve E. Pain evaluation in preschool children and their parents. Acta Paediatr 1999; 88: 422-7. Stockholm. ISSN 0803-5253 The accurate assessment of pain in children constitutes a challenge for health professionals and, in the case of young children, parents are generally the main source of information. The objective of this study was to validate and to compare three pain scales in preschool children and their parents. A total of 104 children between 4 and 6 y of age and their parents participated in the study while undergoing an immunization procedure in the outpatient department of a tertiary pediatric care hospital. Three pain scales were used, the McGrath Facial Affective Scale (FAS), the Hester Poker Chip Tool (HPCT) and the Multiple Size Poker Chip Tool (MSPCT). There were 47 (45%) boys and 57 (55%) girls, with 54 (52%) 4-y-olds, 34 (33%) 5-y-olds and 16 (15%) 6-y-olds. Twentyeight children (27%) had memories of pain experienced during a former hospitalization. Correlations were very high both in children (r = 0.78) and their parents (r = 0.96) when comparing immunization pain scores obtained from the HPCT versus the MSPCT. Correlations between McGrath's FAS and HPCT or MSPCT ranged from r = 0.34-0.43 in children and r = 0.38-0.39 in parents. There was a good correlation between parents and children during the immunization procedure on all three scales, with the highest correlation using the FAS (r = 0.76), followed by the MSPCT (r = 0.69), and the HPCT (r = 0.66). Subgroup analyses based on the criteria of age, sex and previous hospitalization showed no consistent relationship. Parents tended to underestimate their child's pain when using HPCT or MSPCT. It seems that both HPCT and MSPCT measure a similar dimension of pain, whereas the FAS addresses a different aspect of pain. Although parents play an important role in their child's pain assessment, they tend to underestimate the intensity of pain when using HPCT or MSPCT. & Assessment, children, pain, parents

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