To support children with chronic diseases, reference values to measure developmental changes in self-perception and self-esteem are considered a useful yardstick. To develop reference values to measure self-perceived competence and self-esteem in Japanese children, the Children’s Perceived Competence Scale (CPCS) was administered to 768 children of elementary school grade 1 (6 years) to grade 6 (11 years) at four public schools in Japan, from November to December 2012. After excluding 74 with chronic diseases and/or incomplete responses, 694 children were included. CPCS measures children’s self-perceived competence in cognitive, social, physical domains, and general self-worth, namely self-esteem. There was a tendency for scores of cognitive and general self-worth to decrease with increasing grade. Scores among grade 5 respondents were significantly lower than those among grade 4 respondents for both social and physical domains. Scores among boys and girls differed significantly, with boys scoring higher for physical domain in grades 3 and 6 and for general self-worth domain in grade 6. The CPCS reference values to measure self-perceived competence and self-esteem in Japanese children were developed in this study. These reference values are useful to inform practitioners supporting children with psychological or psychiatric problems or those with chronic diseases.
Abstract Objectives: The early administration of immunoglobulin in Kawasaki disease occasionally results in treatment failure. However, whether this is because severe cases are diagnosed and treated early or due to other factors remains unclear. In this study, we examined the timing of initial immunoglobulin administration and immunoglobulin resistance in cases classified by severity of illness. Methods: This study was a single-hospital, retrospective cohort study of 608 patients who received immunoglobulin within 4 (Early-treatment group, n=225) or between 5 and 7 days (Late-treatment group, n=383) following treatment onset. Cases were classified into four groups: high (n=55), moderate (n=96), low (n=197), and very-low (n=260) risk, based on the Kobayashi score, modified to exclude the day of illness factor. Within each risk group, immunoglobulin resistance was compared between the early- and late-treatment groups. Results: The early-treatment group showed greater immunoglobulin-resistance than the late-treatment group. After severity classification, the cases of high and moderate-risk in the early-treatment group were more immunoglobulin-resistant than in late-treatment group, with odds ratios (95% CI) of 6.7 (1.6-28) and 3.7 (1.6-8.5), respectively. There was no difference in the low and very-low-risk groups. Conclusion: Earlier illness day was a risk factor of immunoglobulin resistance in severe cases.
Abstract Background Persistent low‐grade fever has been observed in some patients during intravenous immunoglobulin (IVIG) therapy for Kawasaki disease (KD); however, smoldering fever (SF) has not previously been reported in patients with KD. This study aimed to clarify the clinical characteristics of SF in patients with KD. Methods A single‐center retrospective cohort study, which included a total of 621 patients who received IVIG therapy, was conducted. Patients with a fever of 37.5–38°C lasting ≥3 days after 2 days of the initial‐IVIG were defined as the SF group. Patients were divided into four groups according to the fever course: SF ( n = 14), biphasic fever (BF, n = 78), non‐fever after initial‐IVIG (NF, n = 384), and persistent fever (PF, n = 145). The clinical features of SF were described and compared between the groups. Results The median duration of fever in the SF group was 16 days, which was longer than that in any other group. The neutrophil fraction after IVIG therapy in the SF group was higher than that in the BF and NF groups but similar to that in the PF group. Repeated IVIG administration in the SF group resulted in increased IgG levels but decreased serum albumin levels. In the SF group, 29% of the patients had coronary artery lesions at 4 weeks. Conclusions The frequency of SF in KD was 2.3%. Patients with SF continued to have moderate inflammatory responses. Repeated administration of IVIG doses was not effective in treating SF, and acute coronary artery lesions were occasionally observed. Active therapeutic intervention was needed.
Three neonates with type A interrupted aortic arch were successfully repaired through a median sternotomy incision during profound hypothermia and circulatory arrest in the past one year. Two aortic cannulas, a small plastic one (Cardicorp) in the ascending aorta and a long one inserted through the pulmonary artery and patent ductus arteriosus into the descending aorta. Two Pacifico's venous cannulas were inserted into superior and inferior vena cavae respectively. No dissection and encircling were required around three major branches from the aortic arch and both right and left pulmonary arteries. During a cooling phase a large ventricular septal defect was closed followed by circulatory arrest. It was possible to resect a patent ductus arteriosus and mobilize the descending thoracic aorta for anastomosis to the side of the ascending aorta without removal of the aortic cannula in the aorta. New instruments and development of cardiopulmonary bypass could bring a successful one-stage repair of interrupted aortic arch with ventricular septal defect more safely and easily than before.
ABSTRACT We report the first case of neonatal Legionnaires' disease associated with water birth in a spa bath at home. Legionella pneumophila serogroup 6 was detected from postmortem lung tissue.
Abstract Background The purpose of this study was to predict which patients would require plasma exchange therapy (PEX) using laboratory findings during intravenous immunoglobulin (IVIG) therapy in Kawasaki disease. Methods A retrospective, single‐center, cohort study was conducted. Of the 621 IVIG‐treated patients, 166 patients who received a second IVIG dose on the second day after initiation of IVIG were included. The endpoint was PEX. Participants were divided into two groups: 10 patients who received PEX and 156 patients who did not. The variables were C‐reactive protein (CRP), white blood cell count (WBC), and neutrophil fraction (NEUT) at three time points: pre‐initial IVIG, pre‐second IVIG, and post‐second IVIG. The change ratio (post‐IVIG value/pre‐IVIG value) of each variable, with each IVIG dose, was calculated. Receiver operating characteristic analysis determined the area under the curve (AUC) and cut‐off values. Results The variables with an AUC > 0.9 were CRP (post‐second IVIG), change ratio of CRP (CRP value post‐second IVIG/CRP value pre‐second IVIG), NEUT (pre‐second IVIG), and NEUT (post‐second IVIG). Among these, the variables with high sensitivity were CRP (post‐second IVIG) and the change ratio of CRP (second IVIG), with cut‐off values of 9.52 mg/dL and 0.99, respectively. The sensitivity and specificity of these variables were 100% and 91%, and 100% and 80%, respectively. The combined sensitivity and specificity (95% confidence intervals) of these two variables were 100% (59–100) and 94% (89–97). Conclusion High CRP levels and the change ratio of CRP after the second IVIG dose were associated with PEX.
