Lecture Pediatry as a science of the healthy and sick child its place in general medicine. Main historical stages of pediatry in Ukraine. Organization.

• Lecture

• Pediatry as a science of the healthy and sick child its place in general medicine. Main historical stages of pediatry in Ukraine.  Organization principle and methods of organization work for children in Ukraine.

• Doc.Nykytyuk S

Nil Filatov (1847 - 1902) – father of clinical pediatry .

Prof of Moscov university.Wrote manual “Semiotic and diagnostic of children disease”.У 1885 р.spots of measels on the mucous Clinic of infection mononucleosis

Nykolay Gundobin (1860 - 1908)

prof of military academy of st Peterburg

• The first pediatrics that decided physiology perculiarities of child organism.

• Wrote perculiarities of child organism. “perculiarities of child organism. ” (1906 р.).

• Estimated “units of fighting with a child deathin Russia “ (1904 year.)

Іvan Тroizkuy

• One of the first pediatrics in Ukraineі;• Worked in Kiev 1885 years, Charkiv universities • Developed dosages of drugs for children according there

physiological perculiarities

He studied clinics of parotites.• Used experimental medicine as a methods of clinical medicine.• Social factors in estimation of healthy and morbidity.• Prophylactic of disease.• Studied disorders of digestive system, nervous system.

The first departments of pediatry in Ukraine:

• В.Е. Chernov – in Kiev (1889 р.)

• V.F. Jakubovich – in Odessa (1903 р.)

A child’s developmental level is the end result of a wide variety of factors, namely: prenatal, perinatal and postnatal.

The World Health organisation

• Since 1948, The World Health organisation has defined health as the complete physical, mental and social well being and not only as the absence of disease or infirmity.

More than a century ago

• pediatrics emerged as a medical specialty in response to increasing awareness that the health problems of children differ from those of adults and that a child's response to illness and stress varies with age. In 1959, the United Nations issued the Declaration of the Rights of the Child, articulating the universal presumption that children everywhere have fundamental needs and rights. Virtually all nations have practicing pediatricians and most medical schools across the globe have departments of pediatrics or child health.

• The health problems of children and youth vary widely between and within populations in the nations of the world

Depending on a number of often interrelated factors

• These factors include (1) economic considerations (economic disparities);

• (2) educational, social, and cultural considerations; • (3) the prevalence and ecology of infectious agents and

their hosts• (4) climate and geography;• (5) agricultural resources and practices (nutritional

resources);• (6) stage of industrialization and urbanization; • (7) the gene frequencies for some disorders; • (8) the health and social welfare infrastructure available

within these countries

• The efforts of pediatricians, scientists, and pioneers in public health have led to a better understanding of the origin and management of diseases of childhood such that, in the past half century, the infant mortality rate in the Ukraine has decreased .

General birth rate of the population, ‰=

• The number of people which were born alive during one year×1000

• Mid-annual population

General mortality rate of the population, ‰=

• The number died during one year ×1000

• Mid-annual population

Infant mortality rate, ‰ =

• Number of infant which were born alive and under the age of one year×1000

• The common number of infant which were born alive for a year

Neonatal mortality rate, ‰=

• Number of infant which were born alive and have died on the first month of a life×1000

• The common number of infant which were born alive during one year

Early neonatal mortality rate, ‰=

• The number of infant which were born alive and have died in the first 6 days×1000

• The common number of infant which were born alive during one year

Stillbirth rate, ‰=

• The number of infant which were born dead after 28 weeks of pregnancy×1000 The number of infant which were born alive and dead during one year

Health indices

Demographically indices (birth rate, mortality rate, neonatal mortality rate , early neonatal mortality rate , still birth rate, infant mortality rate ).

• Morbidity indices (primary, general, according to preventive services, hospital morbidity, morbidity with temporary disability ).

• Invalidity indices (primary, general).• Indices of physical development.

Healthy People 2010 Goals:

• To increase the quality and years of healthy life

• To eliminate health disparities between ethnic groups

10 leading health indicators

• Physical activity• Overweight and obesity• Tobacco use• Substance abuse• Responsible sexual behavior• Mental health• Injury and violence• Environmental quality• Immunizations• Access to health care

The main indicators of health status

• infant mortality rate (IMR),

• child mortality,

• immunization rates.

Current Status of Children’s Health

Healthy People 2010: National Health Promotion and Disease Prevention Objectives (US Department of Health and Human Services – DHHS):

28 focus areas

467 objectives

Racial Differences

• High rate of low birth weight (LBW) infantsborn to minority mothers

• Decrease in the overall health status or health care access of minority women

• IMRs were also higher for infants whose mothers were teenagers or 40 years of age or older, did not complete high school, were unmarried, began prenatal care after the first trimester of pregnancy or smoked during pregnancy

Low Birth Weight

• One reason for the racial disparity in IMRs and theranking of the United States is the high rate of LBW (weight less than 2,500 grams, or 5 pounds 8 ounces)

• The rate of LBW was 7.6% in 1998, up from 7.5% in 1997.

• Infants with a LBW have a six times higher risk of death during first year of life.

• Those weighing less than 1,500 grams have an 89 times higher risk of death than do babies havingnormal birth weight.

Low Birth Weight: Health Risk?

• LBW babies are at risk for impaired health, developmental delay, neurosensory deficits, cognitive delays, and school and behavioral difficulties.

• The most common major neurologic abnormality seen in these infants is cerebral palsy, which increases with decreasing birth weight.

Reflective thinking

• The Cost of Keeping LBW Infants Alive• Hospitals and health care delivery systems have

poured substantial amounts of money into neonatal intensive care units to care for LBW infants. These babies are usually technology dependent and often require expensive medical equipment and nursing care in their homes.

• How do you feel about this emphasis on high-tech solutions versus allocating some resources to preventive services?

Immunization Rates

• The reduction in incidence of vaccine-preventable diseases is one of the most significant public health achievements of the 20th century.

• The global eradication of smallpox in 1977 is anillustration of this success (DHHS, 1999).

• Not only are immunized individuals themselves protected from developing a potentially serious illness, but, also if enough of the population is immunized, transmission of the disease in acommunity may be interrupted.

Immunization Rates

• In 1999, the highest rates of childhood immunization were achieved.

• Three vaccines – polio, measles, and Haemophilus influenza type b (Hib)—had a coverage rate at/or above 90%

USA UKRAINE

Birth

1 month

2 month

3 month

4 month

5 month

6 month

12-15 month

18 month

3 years

4-6 years

7 years

11-12 years

14 years

15 years

16 years

18 years

Hepatitis B

Hepatitis B

IPV, DTaP, Hib

----------------------------

IPV, DTaP, Hib

----------------------------

Hepatitis B,IPV, DTaP, Hib

Hib, MMR

DTaP, Varicella zoster

----------------------------

IPV, DTaP, MMR

----------------------------

MMR(if not administered at 4-6 years)

----------------------------

----------------------------

Td

----------------------------

Hepatitis B

tuberculosis

----------------------------

----------------------------

Hepatitis B, IPV, DTaP

IPV, DTaP

Hepatitis B, IPV, DTaP

----------------------------

MMR

IPV, DTaP

OPV

DTaP, OPV, MMR

Tuberculosis

DTaP, OPV, tuberculosis

Rubella

----------------------------

Td

Immunization Rates

• Rates are for 19-35-month-old children who have received at least four doses of DTP (diphtheria, tetanus, pertussis), three polio, one MMR (measles, mumps, rubella), three Hib, and three hepatitis B.

• The Healthy People 2010 target is 90%coverage for all recommended vaccines in all populations.

Immunization requirements

• All 50 states have immunization requirements for entrance into school; however, some groups are seeking changes in these state laws.

• Exceptions are allowed from immunization requirements for medical reasons in all states and for religious reasons in 48 states, and 15 states allow exemptions for philosophical reasons

Injury

• Injury is defined as damage or harm to an individual resulting in destruction of health, disability, or death

• Intentional and unintentional

Intentional injuries

• Homicide

• Suicide

• Rape

• Assault and battery

• Domestic violence

• Child abuse and neglect

• Any other injury caused on purpose

Unintentional Injuries

• Injuries due to motor vehicles

• Bicycle injuries• Boating injuries• Choking and

suffocation• Falls• Drowning• Near-drowning• Fires and burns

• Poisoning• Firearm injury• Occupational injuries• Farm injuries• Sports injuries• Injuries due to toys and

recreational equipment• Any other injury that

was not intended to harm the victim

Unintentional Injuries

• Among children aged 1-19, unintentional injuries are responsible for more deaths each vear than homicide, suicide, congenital anomalies, cancer, heart disease,respiratoryillness, and HIV combined

• Unintentional injuries are the leading cause of death for all children over 1 year of age

Unintentional Injuries

• One-half of an unintentional injury-related deaths occur in the 15-19-year-old group due to motor vehicle-related injuries.

• Common subcategories ot motor vehicle injuries include – (1) occupant (drivers and passengers), – (2) bicycle-related, – (3) motorcycle, and – (4) pedestrian injuries.

Unintentional Injuries for children under 1 years of age

• Suffocation is the leading cause of unintentional injury-related death, followed by motor vehicle occupant injury, choking, drowning, and fires or burns.

• Some suffocation deaths in infants are due to entrapment of the head and neck in cribs.

• Another cause is choking on food or an object, leading to airwav obstruction

Unintentional Injuries for children aged 1-4 years

• Drowning is the leading cause of injury death, followed by motor vehicle occupant injury, fires or burns, and airway obstruction.

• Infants often drown in bathtubs, usually as a result of poor supervision or neglect

• Toddlers and young children fall into a body of water such as a swimming pool, lake, or river, usually while unsupervised.

Unintentional Injuries for children aged 5-14 years

• motor vehicle occupant-related injury isthe leading cause of death, followed by drowning, pedestrian injury (i.e., motor vehicle collisions with the child), bicycle injury, and fires or burns

Unintentional Injuries for children aged 14-19 years

• Motor vehicle occupant injuries are the primary cause of injury-related deaths

• Driver inexperience and alcohol use are key contributors to the high rate of fatal crashes in adolescents

What are the key approach to reduce Unintentional Injuries?

• Prevention!

• Education

• Changes in the environment and in products

• Legislation or regulation (35 states – no bicycle helmet law)

• Role of pediatric nurses

Access to Health Care

• Lack of health insurance

• The number of uninsured children has been growing at an alarming rate.

• In 1999 11.9 million children (one in seven) under the age of 19 lacked health insurance

• Ethnic minority children are overrepresented among the uninsured.

Access to Health Care

• Those from higher-income families are more likely to have private health insurance (90%) than from lower-income families (40%)

• Uninsured children in low-income families experience substantial difficulties in accessing health care

• They tend to lack (1) the usual sources of routine and sick care, (2) a primary care provider, and (3)recent visits to health care providers.

• Uninsured children are more likely to be underimmunized and to go without needed medical services due to the costs of care

SCHIP

• State Children's Health Insurance Program (SCHIP) as part of the Balanced Budget Act of 1997.

• The purpose of SCHIP is to provide health insurance for children through 18 years of age who are uninsured or ineligible for Medicaid.

• More than 40 billion in federal grants will be allocated to states over a 10-year period

• More than 3 million children are enrolled in SCHIP

• Role of nurses

Patterns of health care• vary widely around the globe, reflecting differences in the geography

and wealth of the country, the priority placed on health care vs other competing needs and interests, philosophy regarding prevention vs curative care, and the balance between child health and adult health care needs. The significant declines in infant and child mortality enjoyed in many of the developing countries in the past 3 decades have occurred in the context of support from international agencies like UNICEF, WHO, and the World Bank, bilateral donors (the aid provided from one country to another), and nongovernmental agencies to develop integrated, universal primary pediatric care with an emphasis on primary (vaccination) and selected secondary (oral rehydration solution [ORS], treatment of pneumonia and malaria) prevention strategies

DEFINITION OF TERMS

•Growth – process by which a living being and any of its parts increase in size and mass, either by multiplication or by enlargement of component parts

•quantitative

•Development – enhancement of function, skills and maturation

•qualitative

Biologic Influences

• Genetics

• Role of Teratogens

• Postpartum illnesses

• Exposure to hazardous substances

• Maturation

Psychologic Influences

• Attachment – tendency of a young child to seek proximity with the parent during times of stress– Also refers to the relationship that alows securely

attached children to use their parents to reestablish a sense of well-being after a stressfull experience

• Contingency – when adult caregivers pay attention to the verbal and non-verbal cues of children and respond to them accordingly

Social Factors

• Family Systems – role of parents; parent-child dyad

• Ecologic Model – parent-child dyad at the center with the larger society at the periphery

Thank you