Browsing by Author "Swingler, George"

Now showing 1 - 8 of 8
  • Thumbnail Image
    Item
    Open Access
    Bedding covers for people with allergic rhinitis
    (2005) Swingler, George
    A patient comes to you asking whether using a mattress cover would help her allergic rhinitis. You know that she is allergic to house-dust mites and you know also that bedding covers have been widely recommended for allergic rhinitis, not least by several clinical guidelines. You have also heard however that some doubt has been cast on the evidence supporting these recommendations. With your interest raised, you determine to try to find out for yourself..
  • Thumbnail Image
    Item
    Open Access
    Children in reviews: Methodological issues in child-relevant evidence syntheses
    (BioMed Central Ltd, 2005) Cramer, Kristie; Wiebe, Natasha; Moyer, Virginia; Hartling, Lisa; Williams, Katrina; Swingler, George; Klassen, Terry
    BACKGROUND:The delivery of optimal medical care to children is dependent on the availability of child relevant research. Our objectives were to: i) systematically review and describe how children are handled in reviews of drug interventions published in the Cochrane Database of Systematic Reviews (CDSR); and ii) determine when effect sizes for the same drug interventions differ between children and adults. METHODS: We systematically identified all of the reviews relevant to child health in the CDSR 2002, Issue 4. Reviews were included if they investigated the efficacy or effectiveness of a drug intervention for a condition that occurs in both children and adults. Information was extracted on review characteristics including study methods, results, and conclusions. RESULTS: From 1496 systematic reviews, 408 (27%) were identified as relevant to both adult and child health; 52% (213) of these included data from children. No significant differences were found in effect sizes between adults and children for any of the drug interventions or conditions investigated. However, all of the comparisons lacked the power to detect a clinically significant difference and wide confidence intervals suggest important differences cannot be excluded. A large amount of data was unavailable due to inadequate reporting at the trial and systematic review level. CONCLUSION: Overall, the findings of this study indicate there is a paucity of child-relevant and specific evidence generated from evidence syntheses of drug interventions. The results indicate a need for a higher standard of reporting for participant populations in studies of drug interventions.
  • Thumbnail Image
    Item
    Open Access
    Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours
    (BioMed Central Ltd, 2013) Horn, Alan; Swingler, George; Myer, Landon; Linley, Lucy; Raban, Moegammad; Joolay, Yaseen; Harrison, Michael; Chandrasekaran, Manigandan; Rhoda, Natasha; Robertson, Nicola
    BACKGROUND: An early clinical score predicting an abnormal amplitude-integrated electroencephalogram (aEEG) or moderate-severe hypoxic ischemic encephalopathy (HIE) may allow rapid triage of infants for therapeutic hypothermia. We aimed to determine if early clinical examination could predict either an abnormal aEEG at age 6 hours or moderate-severe HIE presenting within 72 hours of birth. METHODS: Sixty infants [greater than or equal to] 36 weeks gestational age were prospectively enrolled following suspected intrapartum hypoxia and signs of encephalopathy. Infants who were moribund, had congenital conditions that could contribute to the encephalopathy or had severe cardio-respiratory instability were excluded. Predictive values of the Thompson HIE score, modified Sarnat encephalopathy grade (MSEG) and specific individual signs at age 3-5 hours were calculated. RESULTS: All of the 60 infants recruited had at least one abnormal primitive reflex. Visible seizures and hypotonia at 3-5 hours were strongly associated with an abnormal 6-hour aEEG (specificity 88% and 92%, respectively), but both had a low sensitivity (47% and 33%, respectively). Overall, 52% of the infants without hypotonia at 3-5 hours had an abnormal 6-hour aEEG. Twelve of the 29 infants (41%) without decreased level of consciousness at 3-5 hours had an abnormal 6-hour aEEG (sensitivity 67%; specificity 71%). A Thompson score [greater than or equal to] 7 and moderate-severe MSEG at 3-5 hours, both predicted an abnormal 6-hour aEEG (sensitivity 100 vs. 97% and specificity 67 vs. 71% respectively). Both assessments predicted moderate-severe encephalopathy within 72 hours after birth (sensitivity 90%, vs. 88%, specificity 92% vs. 100%). The 6-hour aEEG predicted moderate-severe encephalopathy within 72 hours (sensitivity 75%, specificity 100%) but with lower sensitivity (p = 0.0156) than the Thompson score (sensitivity 90%, specificity 92%). However, all infants with a normal 3- and 6-hour aEEG with moderate-severe encephalopathy within 72 hours who were not cooled had a normal 24-hour aEEG. CONCLUSIONS: The encephalopathy assessment described by the Thompson score at age 3-5 hours is a sensitive predictor of either an abnormal 6-hour aEEG or moderate-severe encephalopathy presenting within 72 hours after birth. An early Thompson score may be useful to assist with triage and selection of infants for therapeutic hypothermia.
  • Thumbnail Image
    Item
    Open Access
    Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial
    (BioMed Central Ltd, 2007) Zwarenstein, Merrick; Bheekie, Angeni; Lombard, Carl; Swingler, George; Ehrlich, Rodney; Eccles, Martin; Sladden, Michael; Pather, Sandra; Grimshaw, Jeremy; Oxman, Andrew
    BACKGROUND:Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice. METHODS: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices.Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention. RESULTS: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms. CONCLUSION: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting.
  • Thumbnail Image
    Item
    Open Access
    Inhuman shields — children caught in the crossfire of domestic violence
    (2004) Fieggen, A Graham; Wiemann, Martin; Brown, Carla; Van As, Sebastian; Swingler, George; Peter, Jonathan C
    Background. Child abuse is a worldwide scourge. One of its most devastating manifestations is non-accidental head injury (NAHI). Methods. This is a retrospective chart review of children presenting to the Red Cross Children’s Hospital trauma unit with a diagnosis of NAHI over a 3-year period. Results. Sixty-eight children were included in the study and 2 different groups were identified. Fifty-three per cent of the children were deliberately injured (median age 2 years), while 47% were allegedly not the intended target of the assailant (median age 9 months). The assailant was male in 65% of the intentional assaults and male in 100% of the unintentional assaults, with the intended adult victim female in 85% of the latter cases. Overall, 85% of the assaults were committed in the child’s own home. Conclusions. The high proportion of cases in which a young child was injured unintentionally suggests that these infants effectively become shields in assaults committed by adults. In this context any attempts to deal with child abuse must also address the concurrent intimate partner violence.
  • Thumbnail Image
    Item
    Open Access
    Observer variation in detecting lymphadenopathy on chest radiography
    (2003) Du Toit, Lionel George; Swingler, George
    Objective. To assess inter- and intra-observer agreement in the detection of lymphadcnopathy on chest radiography in children at risk for tuberculosis. Methods Dianostic test. Chest radiography using antero-posterior and lateral films. Observers. Four paediatric pulmonologists independently viewing the radiographs. Alain outcome measures. Inter- and intra-observer agreement on the presence or absence of lymphadenopathy, reported as present, absent or equivocal, and expressed as weighted Kappa statistics. Results. Weighted Kappa for the six pairs of observers ranged from 0.14 (95% Cl 0.02-0.30) to 0.52 (95% CT 0.35-0.69). After a 3-month interval intra-observer agreement ranged from 0.44 (95% Cl 0.25-0.62) to 0.71 (95% CI 0.56-0.87). Average weighted Kappa for inter-observer agreement was 0.33. Average intra-observer Kappa was 0.55. Conclusions. There was "fair" inter- and 'moderate" intra-observer agreement among paediatric pulmonulogists in detecting lymphadcnopathy on chest radiography in children. Caution is necessary when basing clinical decisions on the presence of lymphadenopathy on chest radiography.
  • Thumbnail Image
    Item
    Open Access
    Some public health associations with specific enteropathogens in childhood diarrhoea in Cape Town
    (2009) Moeng, Helimamy; Swingler, George
    Background: Diarrhoea remains one of the leading causes of mortality in young children. After dehydration and malnutrition, electrolytes disturbances are an important complication of diarrhoea. In Cape Town, fluctuation of plasma sodium and potassium has been observed in childhood diarrhoea and were seasonal in their occurrence. A study conducted at Red Cross Children's Hospital found that seasonal fluctuations of plasma sodium and potassium were associated with specific enteropathogens but did not identify associations that suggested potential public health interventions that could target the electrolytes disturbances. It is possible that by identifying association with the enteropathogens directly, one could identify public health interventions to avoid seasonal electrolyte disturbances. Objectives: To identify clinical, nutritional, socio-economic, socio-demographic and seasonal associations with childhood diarrhoea caused by the enteropathogens Shigella, Salmonella, enterotoxigenic E. coli, enteropathogenic E.coli, Cryptosporidium, rotavirus or Campylobacter. Methods: This study was a secondary analysis of a cross-sectional study of infants less than 2 years old admitted to the Rehydration Unit of the Red Cross Children's Hospital with diarrhoea. Data were obtained through routine medical records and a questionnaire. Multiple logistic regression was performed to identify determinants of the diarrhoea-associated electrolytes disturbances. Results: Height for age was negatively associated with enteropathogenic E.coli (OR: 0.82, p-value: 0.039), Campylobacter (OR: 0.87, p-value: 0.082) and Salmonella (OR: 0.79, 0-value: 0.029) in the bi-variate analysis. Weight forheight and height for age were associated respectively to rotavirus (OR: 1.24, p-value: 0.011) and enterotoxigenic E.coli (OR: 1.16, p-value: 0.064 ). Water source was positively associated with Enteropathogenic E. coli, Campylobacter and inversely associated with rotavirus. Toilet was positively associated with enteropathogenic E. coli and Salmonella. Average temperature was positively associated with Enteropathogenic E. coli, Enterotoxigenic E. coli, Salmonella and Shiga/la. In the multivariate analysis breast feeding was negatively associated with Cryptosporidium infection (OR: 0.13; 95% Cl 0.20-0.62) while average humidity was positively associated with Cryptosporidium infection (OR: 1.1 O; 95% Cl 1.05-1.16). Enteropathogenic E. coli infection was positively associated with average ambient temperature (OR: 1.16, 95% Cl 1.03- 1.30).The child's age was a determinant of Campylobacter, (OR: 1.05; 95% Cl 1.00-1.11 ). Formula feeding, (OR: 0.45; 95% Cl 0.20-0.99) average temperature (OR: 0.87; 95% Cl 0.81-0.95) and humidity (OR: 0.91; 95% Cl 0.80-0.94) were all protective of rotavirus infection. None of the socioeconomic variables were associated with specific enteropathogens. Discussion: The only determinant associated with Enteropathogenic E coli identified in this study was average temperature. This concurs with its summer isolation. No significant determinant was identified for Enterotoxigenic E. coli in this analysis. For Cryptosporidium, in the multivariate analyses were duration of diarrhoea, breast-feeding and average humidity were identified as significant determinants. With the exception of breast-feeding, none of these determinants could be amended through public health intervention. For Campylobacter, age and adequacy of drinking were identified as significant determinants during the multivariate analysis. Adequacy of drinking was the only significant determinant associated with Salmonella. Formula feeding, plasma pH, average humidity and average temperature were associated with rotavirus while associations identified with Shiga/la were duration of vomiting, plasma pH and average temperature. As above, none of the identified determinants could be changed to modify the occurrence of these enteropathogenic diarrhoea. Conclusion: Although associations with specific enteropathogens were identified, none of the associations identified suggest public health interventions to avoid seasonal electrolyte disturbances.
  • Thumbnail Image
    Item
    Open Access
    A systematic review of existing national priorities for child health research in sub-Saharan Africa
    (BioMed Central Ltd, 2005) Swingler, George; Irlam, James; Macharia, William; Tietche, Felix; Meremikwu, Martin
    BACKGROUND:We systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them. METHODS: Collaborators from a purposive sample of 20 WHO-AFRO Region countries, assisted by key informants from a range of governmental, non-governmental, research and funding organisations and universities, identified and located potentially eligible prioritisation documents. Included documents were those published between 1990 and 2002 from national or nationally accredited institutions describing national health research priorities for child health, alone or as part of a broader report in which children were a clearly identifiable group. Laboratory, clinical, public health and policy research were included. Two reviewers independently assessed eligibility for inclusion and extracted data. RESULTS: Eight of 33 potentially eligible reports were included. Five reports focused on limited areas of child health. The remaining three included child-specific categories in reports of general research priorities, with two such child-specific categories limited to reproductive health. In a secondary analysis of Essential National Health Research reports that included children, though not necessarily as an identifiable group, the reporting of priorities varied markedly in format and numbers of priorities listed, despite a standard recommended approach. Comparison and synthesis of reported priorities was not possible. CONCLUSION: Few systematically developed national research priorities for child health exist in sub-Saharan Africa. Children's interests may be distorted in prioritisation processes that combine all age groups. Future development of priorities requires a common reporting framework and specific consideration of childhood priorities.