Perhaps no one is more worried than a parent with a sick child in the hospital. But families are doing more than just venting their fears and frustrations when they complain about the care their child is receiving, a new Canadian study suggests.

It found that relatives were much more likely to officially report problems than hospital staff, and that their complaints often had merit. Almost half of parents' complaints were legitimate patient-safety concerns, "not merely reports of dissatisfaction," the study found. The study was published Monday in the Canadian Medical Association Journal.

British Columbia researchers tested whether having a system for family members to report "adverse events" — incidents that negatively affected the recovery or health of their child — while in hospital would affect the rate at which health-care providers reported the incidents. The findings revealed just 2.5 per cent of the adverse events reported by families were also reported by health-care providers.

"Parents are often much more aware of things that go wrong because they're there at the bedside with one patient all the time," said Dr. Mark Ansermino, senior author of the study. "Whereas the health-care provider has multiple patients to look after and may not have the same vested interested in looking after that patient. . . . Parents are much better observers of that individual subject than multiple health-care providers will be."

Many hospitals in Canada have set up systems for health-care providers to report errors in a patient's care to help prevent similar mistakes from happening again.

However, for a variety of reasons, including time pressures and heavy patient loads, health-care providers don't always take advantage of those reporting systems. Accepting that mistakes happen, the researchers set out with a goal of finding a way to reduce their frequency.

"We really felt that finding ways to engage patients as champions of safety would be a great way to move this forward," explained Ansermino. "(The findings confirm that) the more we can engage families and children in their own care, I think we can do a much better job."

In the study, the researchers followed 544 families whose children were admitted to B.C. Children's Hospital in Vancouver between Nov. 1, 2008, and Nov. 30, 2009. When their child was discharged from the hospital, participating families were given a questionnaire asking them about different types of adverse events during the hospital stay.

These instances included problems with medication, such as a bad reaction or incorrect dosage, complications during treatment, equipment problems and miscommunication between staff, or staff and family members. Of the 544 families that submitted questionnaires, 37 per cent, or 201, reported one or more problems during their child's hospital stay.

Miscommunication between staff or between family and staff was the most commonly reported problem. A total of 321 errors in care were found, of which almost half were deemed legitimate patient-safety concerns that had the potential to cause some degree of harm to the patient, the researchers reported. No deaths were reported by the families.

Two independent clinical experts analyzed the questionnaire results to determine how harmful the errors in care could have been to the patient's health. Harm was defined as either a near miss — in which a patient's health was nearly harmed but fortunately avoided through a doctor or nurse catching the mistake at the last minute — or minor, moderate or severe harm— where an error resulted in some degree of harm that was either temporary or resulted in the patient staying in hospital for longer and requiring additional medical treatment.

Health-care providers reported only 2.5 per cent of the same errors reported by families, a marginal increase from the baseline of adverse event reporting before the study began, the authors found. In 139 cases, families received apologies for these incidents.

Ansermino said there are many reasons for the discrepancy, one of which is the grey area surrounding what is considered an adverse event from one health-care provider to another. "One of the things we found out is that communication is one of the big things that could be considered a safety event, and that's obviously very difficult to judge from someone else's perspective," he said.

Another barrier to reporting adverse events is a culture of "blame and shame," in which health-care providers are concerned about liability, said Ansermino. Some health-care providers also don't see a benefit of reporting adverse events, as they believe the report "goes into some black hole somewhere," said Ansermino, filed away and rarely looked at again.

"These are not bad people," said Ansermino. "(The study was not about) 'We're going to find out what people did wrong.' These are learning opportunities to find out what we did wrong, and how to actually make our system safer."

Ansermino said the creation of reporting systems for health-care providers is helping to improve the situation. "The concerns about liability and blame are significant barriers, but . . . I think the culture has really changed in the last five years," he said.

The authors acknowledged that the study's results could have been skewed by selection bias — if families looking to "vent their frustration with the system were inclined to participate."

Ansermino said they hope to expand the questionnaire to other hospitals in B.C. to see if similar results are reported. The goal now is finding a way to prevent the same hospital-care errors from reoccurring, said Ansermino.

In pediatrics, previous studies have estimated that one per cent of children in hospital experience an adverse event and 60 per cent of these are preventable. "It's all very well identifying these events, but you need to actually do something about them," he said. "I think we are learning how to do that, but I think we've got a long way to go."

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Randi Calbert worries that kids today are becoming too sedentary for their own good. That’s why she brought her 7-year-old son to the American Heart Association’s Healthy Family Training Camp at the KFC YUM! Center.

“Nowadays, all kids want to do is sit around and play video games,” she said. “I brought him to teach him the benefits of healthy eating and exercise.”The free event was expected to draw about 650, which included giveaways for the kids, activities and free tickets to the University of Louisville women’s basketball game against Xavier University.

Matt Rountree, a spokesman for the American Heart Association’s Louisville affiliate, said the event was intended to raise awareness of heart health. The group partnered with U of L’s athletic department, which provided dozens of student athletes to run events for the children.

Rountree said numerous U of L teams were represented there, including the tennis, lacrosse, swimming and baseball teams. Calbert, of Middletown, said her family history includes diabetes and high blood pressure and she wants her son to start focusing on his health now while he is young.

Courtney Burge, the event coordinator, said last year’s inaugural Healthy Family Training Camp drew only about 80 people. She said the attendance spiked this year because of several businesses promoted it, the partnership with U of L and the lure of free game tickets as well as free t-shirts for the first 250 children.

According to the heart association, nearly 70 percent of American adults are overweight and 30 percent are obese, which often leads to heart problems. Rountree said that more Americans die annually of heart disease than from all types of cancer combined.

Fans at yesterday’s basketball game were asked to “go red for women” to raise awareness of the health risk women face and how to reduce women’s risk of heart disease. According to the heart association, heart disease is the number one killer of women over 20 and stroke is number four. Burge said people can cut down on their risk simply by eating a more healthy diet and engaging in routine exercise.

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Bullying Children

Kids who make frequent trips to the nurse may not be sick – they may simply be bullied, says recent research from the University of Kansas. In the study, the children who were bullied made the most trips to the nurse’s office. The study’s authors believe the stress of the bullying may make them get frequent headaches or stomachaches.

Pregnancy ?weight training

Want to lower your blood pressure and look fit and toned while pregnant? A new study finds that it’s now completely safe — and even beneficial — to lift weights while pregnant. Just make sure the weights aren’t too heavy, and check with your doctor before starting any new exercise regimen.

Allergy-free formula

If you or your husband have a history of food allergies, you may want to avoid regular formula, according to the FDA. It now suggests that you switch your infant to a 100 percent whey protein partially-hydrolyzed formula, such as Gerber Good Start. The FDA suggests this because the proteins in the whey protein formula are easier to digest, which can minimize your baby’s risk of atopic dermatitis.

Take a nap

Any parent knows how precious sleep is for adults and children alike. So when it comes to taking a nap, do it correctly. Researchers at Loughborough University in the United Kingdom find that sleeping for 20 minutes is the perfect length to avoid waking up drowsy. Before you slip under the covers, drink a cup of coffee. Since the caffeine will take 20 minutes to take effect, you’ll be wide awake as soon as you get out of bed.

Car seat safety

Your child may be more dexterous than you think, according to a new study from Yale University researchers. The study finds that babies and toddlers as young as 1 year old can unbuckle their own car seats. Prevent this from happening by making sure the straps are tight and the latch is secure.

Sick or scarred

Fifty-eight percent of pregnant women say they’d prefer to have morning sickness during their pregnancy than have stretch marks, according to a survey by Bio-Oil. But since you can’t entirely prevent either, you’re stuck with the symptoms and effects that you’re given.

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Obesity and mental-health issues among schoolchildren continue to be the focus of initiatives to promote an all-rounded education system here. And efforts by the Ministry of Education (MOE), such as increasing physical-education (PE) curriculum time to keep obesity rates low, have been effective, said Senior Parliamentary Secretary for Education and Manpower Hawazi Daipi.

For instance, 10.9 per cent of schoolchildren here are overweight, compared to about 23 per cent for the rest of South- east Asia, he noted. Mr Hawazi was speaking yesterday at the 3rd Educating For Health Conference held at Republic Polytechnic, which was attended by over 900 teachers, parents and health-care professionals.

He added that not only do overweight children have a higher propensity for chronic health problems, but they are also generally more likely to experience a lower quality of life physically, emotionally and socially. These aspects are "critical in contributing to the total well-being of our children", he stressed. Currently, MOE has several programmes that seek to ensure the mental health of both teachers and students.

Preschoolers will also have an early start on mental wellness with a giant storybook entitled Colin Cool Goes To School. It was released to all preschools last month and aims to mentally prepare children for entering Primary 1. "MOE will...focus on promoting mental wellness at an early age to ensure our children have the skills to go through different life stages," he said.

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A new analysis of federal data provides a dismal picture of children's cardiovascular health that suggests the current generation of teenagers could be at risk of increased heart disease.

The study, which examined children between 12 and 19 years old in the National Health and Nutrition Examination Survey conducted by the U.S. Centers for Disease Control and Prevention, found that the adolescents performed poorly overall on a set of seven criteria set by the American Heart Association for ideal cardiovascular health.Diet in particular was a problem, with not one of the 5,450 children randomly selected for the survey from the U.S. population meeting the standards for diet. Taking out the diet measure, still just 16.4% of boys and 11.3% of girls were rated ideal on all of the other six criteria, which included smoking, exercise, weight, cholesterol, blood pressure and blood sugar.

"In this country, essentially all of us are born with ideal cardiovascular health, but we lose it very quickly," said Donald Lloyd-Jones, chief of preventive medicine at Northwestern University Feinberg School of Medicine and senior author of the report.

The findings, presented Wednesday at the annual scientific meeting of the heart association here, come amid continuing concern about the implications of obesity and other factors on the health of children. Just last week, the National Heart, Lung and Blood Institute called for all children between 9 and 11 years old to get a cholesterol test in an effort to detect heart risk at an early age.

The new study provides an unusually comprehensive look at the issue. The results are specific to these AHA standards, and it isn't known what the assessment would be if some other standards were applied.

Cholesterol and especially blood-sugar levels can be naturally elevated during puberty and level out in adulthood, and how that phenomenon might affect the results isn't fully understood. But researchers note that the ideal benchmarks in the seven categories have been shown to be associated with reduced risk of heart disease.

"Often, we just take an isolated focus on one of the risk factors," Dr. Lloyd-Jones said. "The package is much more powerful than any single measure."

Veronique Roger, head of health-sciences research at the Mayo Clinic in Rochester, Minn., called the findings "staggering."

The seven criteria for ideal cardiovascular health are the backbone of a public-health initiative recently launched by the heart association. The goal is to get 20% of all American adults within optimal range on all seven measures.

The focus on children reflects growing awareness that while heart attacks and other consequences of cardiovascular disease typically strike later in life, the biological processes that lead to them begin in childhood. Dr. Lloyd-Jones said some studies indicate that "by six months, you can already see a worsening of cholesterol and blood pressure" because of diet and other factors.

The National Health and Nutrition Examination Survey is conducted by the CDC periodically among a nationally representative sample of Americans to track health issues. The new report, funded by the National Heart, Lung and Blood Institute, is based on an analysis of three different surveys of adolescents aged 12 to 19 between 2003 and 2008, including a sampling intended to accurately represent minorities. The children in the study included 4,157 kids aged 12 to 17.

Researchers found that kids performed best on blood pressure, with more than 90% in the ideal range, and in smoking, where about 80% of those 17 and under had never smoked. (The performance fell to 60% to 70% for those 18 and 19, possibly reflecting legalized sales of tobacco for people 18 and older.)

The toughest measure to hit was healthy diet, said Christina Shay, a researcher at the University of Oklahoma Health Sciences Center, Oklahoma City, and first author of the study. Not one adolescent reported meeting recommended targets on five different nutrition categories: at least 4½ servings of fruits and vegetables a day; three whole-grain servings a day; two or more servings of fish a week; less than 1,500 milligrams of sodium daily; and less than 36 ounces of sugar-sweetened drinks a week.

Indeed, only about 20% of the adolescents met recommendations on two or three of the nutrition factors—considered an intermediate score.

For exercise, 50% of boys and 60% of girls didn't regularly exercise for more than 60 minutes a day, the optimal target. Between 10% and 20% reported getting no exercise. About 30% to 45% had less-than-ideal cholesterol, while about one-third were either overweight or obese.

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The National Heart, Lung, and Blood Institute (NHBLI), a government panel that’s part of the National Institutes of Health, has issued new recommendations on reducing the risk for cardiovascular disease in children. Parts will be non-controversial—recommending low-fat or non-fat milk and stressing the importance of regular daily exercise. But pediatricians and parents may find one part a little more difficult to get used to: all children, starting at age nine, should have blood tests to check their cholesterol levels.
Cardiovascular disease (including heart attacks and strokes) is the leading cause of death in the developed world. It rarely kills children, of course. The risk of these diseases is related to blood vessels in the heart and brain getting narrow and filled with gunk, which almost always causes symptoms in older adults. But there is indirect evidence that the risks for these diseases starts in youth, and that changing lifestyles and health habits early on ought to help prevent these problems as we age.

In the world of medicine, the best evidence that something really works is the double-blind, placebo controlled study. Take a bunch of people, give half of them the medicine, give half the placebo. Don’t tell anyone which is which. Wait and see. Did one group do better than the other? A well-designed study like this is the “gold standard.” But this kind of evidence just isn’t available when you look at the relationship between what kids are doing and what their risks of heart attacks are when they’re older. You’d have to study these children for 50 years to really assess the impact of your interventions, and that’s just not possible.

Instead, the NHBLI panel used best available information from basic science studies and epidemiology to back up their recommendations. They’re probably right. Increasing exercise and decreasing the risks of obesity, hypertension, and elevated cholesterol in children will almost certainly prolong and improve the lives of adults. And almost all of their recommendations are common-sense things that could only help. What’s the harm?

Which brings us back to the one part of the recommendations that I believe is going to be problematic: Drawing blood to test cholesterol on all nine-year-olds is not an entirely benign procedure. It will be scary. It will be expensive. And for almost all of the children with elevated cholesterol, the advice will be to improve dietary and exercise habits. Which is already being recommended for all children. So what’s the point of the universal testing?

Testing will pick up the < 1% of children with extremely high cholesterols who should certainly have early medical therapy (these kids will almost always come from families who have experienced heart disease in young adults, so they should come to medical attention anyway.) Testing may also serve as an additional “wake up call” for some families. Faced with a child with a genuinely elevated cholesterol, perhaps some families will be even more motivated to make a change.

However, the opposite is also true. Most children will not have an elevated cholesterol level. Does that mean they’re at not risk for heart attacks later, and that they’re free to ignore all of the other health advice in the recommendation? Of course not. But it’s certainly possible that many families will become even less motivated to live healthy lives when faced with a normal cholesterol test.

One other aspect of the report is going to raise a few eyebrows. There were 14 members of the expert panel tasked with reviewing the best science and writing the report. Of the 14 experts, eight have significant financial ties with drug manufacturers, including many that produce and sell cholesterol-lowering drugs. The report itself does not endorse widespread use of these drugs in children. Yet with more testing done, far more attention will be paid to those numbers. What will doctors do when lifestyle and diet changes don’t lower cholesterol values? The prescription pad is sitting right there. It will be tempting.

The document is hefty, 125 pages, and is the result of a review of thousands of studies that began in 2006. It’s been endorsed by the American Academy of Pediatrics, which means that it is now the “official” recommendation of the largest community of pediatricians in the world. There’s plenty here that everyone can agree with, and I hope the media’s focus on the new cholesterol screening recommendation doesn’t distract from the overall message: there is good science supporting parents who take steps to improve their children’s cardiovascular risks. Improved diet and exercise habits, along with identifying and treating diabetes and high blood pressure, can save lives. It isn’t all about the cholesterol.

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The new guidelines, published in the journal Pediatrics, are an effort to prevent the burden of cardiovascular disease that starts in youth through early intervention.

The authors write: "Atherosclerosis begins in youth, and this process, from its earliest phases, is related to the presence and intensity of the known cardiovascular risk factors. Clinical events such as myocardial infarction, stroke, peripheral arterial disease, and ruptured aortic aneurysm are the culmination of the lifelong vascular process of atherosclerosis."

Screening is recommended between ages 9 and 11 and then again between 18 and 21 years. Unless there are risk factors for heart disease, routine non-HDL cholesterol screening can be done, which doesn’t require children to fast.

Children whose parents or other close relatives - parents, grandparents, aunts or uncles - have had heart trouble should first cut down on cholesterol intake. Plant sterols, found in some margarines might be effective short-term to bringing down cholesterol levels in children who don’t respond to dietary changes.

Children whose LDL levels are 190 mg/dL or above, who are at least 10 years old and haven't responded after six months of diet and lifestyle changes, or whose LDL is 160 to 189 mg/dL with risk factors, should be treated with statins. The goal is to lower LDL – the ‘bad’ cholesterol- to less than 130mg/dL.

Recommendations for maintaining healthy cholesterol levels in children and young adults include avoidance of tobacco – first or second-hand, breastfeeding and a low saturated fat diet after age 1 plenty of physical activity.

Blood pressure checks should begin at age 3 and glucose testing is recommended between age 9 and 11. Children who are considered overweight at age 4 and fail to lose weight to height after 6 months should be referred to a registered dietician.

The new guidelines recommend all kids be screened for high cholesterol, twice, before reaching age 21, regardless of risk factors. According to the report,: "Combined evidence from autopsy studies, vascular studies, and cohort studies strongly indicates that abnormal lipid levels in childhood are associated with increased evidence of atherosclerosis."

Children who don’t respond to dietary interventions and have close relatives with heart disease should be considered for cholesterol lowering medication therapy.

The authors of the report say heart disease risks should be tracked starting in childhood; into adulthood. The expert panel concludes checking cholesterol in kids and intervening when indicated will ensure better health in adulthood.

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As Americans — including even young children — continue to get fatter, their risk for heart disease is climbing too. So a panel of experts now is recommending that all kids have their cholesterol checked at least once between ages 9 and 11 and again between 17 and 21.

Although children typically don't have heart attacks and strokes, evidence has been mounting for years that the roots of those diseases begin early in life, and the rising rates of obesity have only fueled the risk.

That means doctors should start looking for signs of future heart disease in all kids, said the authors of a report sponsored by the federal government that is the first comprehensive guide on heart risk management in children.

Such guidelines already exist to address heart disease risk in adults, but until now there has been none outlining what works best for children. Developed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics, the guidelines were welcomed by heart specialists and pediatricians, who said they were long overdue.

"It's a major step forward," said Dr. Alan Lewis, a pediatric cardiologist at Children's Hospital Los Angeles who was not involved in crafting the report. The guidelines were several years in the making, said panel chairman Dr. Stephen R. Daniels, pediatrician-in-chief at Children's Hospital Colorado. Its recommendations, published Friday in the journal Pediatrics, are based on studies on all aspects of childhood risk factors for heart disease, carefully graded on the strength of the evidence, he said. Earlier guidelines for child heart health focused on solitary risk factors, such as high blood pressure or weight.

"Heart disease is the No. 1 cause of death in our society," Daniels added. "We know the process that leads to those deaths begins in childhood. We also know that people who are able to maintain a low risk through childhood and early adulthood have a lower risk.

"If they can reach age 50 with low-risk status, they are very unlikely to have heart disease. That is the payoff here," he said. The report was developed to address the predicted upswing in heart disease rates caused by the obesity epidemic, said Dr. Elaine M. Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center, who was a member of the panel.

About one-third of American children are overweight or obese, nearly triple the rate in 1963, according to the American Heart Assn. Approximately 17% of kids ages 2 to 19 — 12.5 million — are obese.

"This document focuses on the fact that this generation may be the first to have a shorter life expectancy than their parents," Urbina said. The recommendation to screen all children for high cholesterol is a departure from previous guidelines, in place since 1992, which called for screening only in children with a family history of heart disease or high cholesterol.

But the old guidelines were problematic, Lewis said. "Approximately half of the children who would warrant at least dietary — if not medical — management would be missed," he said. "That's an unacceptable amount." Implementing universal cholesterol screening for children should have a sizable ripple effect, experts predicted.

"This doesn't mean we are going to recommend medications for everyone," Urbina said. But both doctors and parents may feel a greater sense of urgency to improve kids' diet and exercise patterns if cholesterol numbers are above normal, she said. "Having a specific number that you can tell a parent is abnormal is a good teaching tool and motivational tool," she said.

Urbina added that it's not enough to simply target cholesterol screenings toward kids who are overweight. Even normal-weight children can have high cholesterol. And not all overweight children have high cholesterol.

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A new study has found that a natural sweetener commonly found in mints and chewing gum may help prevent ear infections in healthy children under the age of 12. In the study at the University of Toronto, healthy children under 12 given eight to ten grams of xylitol daily in the form of chewing gum, mints or lozenges had 25 percent fewer ear infections than children given gum, mints or lozenges containing a different sweetener.

Children too young to chew gum had 30 per cent fewer ear infections when receiving xylitol syrup than children in the control group. Xylitol, also known as birch sugar, is used in chewing gum to prevent cavities and has been shown to have antibacterial properties in lab tests.

The study's lead author, Amir Azarpazhooh, D.D.S., said xylitol appears to work in healthy children by inhibiting bacteria. It concluded that xylitol is a potential alternative for preventing ear infections in children who have problems with antibiotics.

However, review co-author Hardy Limeback, M.D., head of preventive dentistry at the University of Toronto, suggested that more research is needed before firm guidelines regarding the use of xylitol can be developed. The finding appeared in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research.

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Windsor should soon have a one-stop shop for school-aged children's mental health services. Windsor Regional Hospital will integrate its Regional Children's Centre with Glengarda Child & Family Services to better care for youngsters between six and 12.

"We wanted to have the best uses of our current resources, because demand has been growing but resources have stayed pretty much the same," Dr. Mary Broga, vice-president of family mental health services at Windsor Regional Hospital, said Friday. "We're looking at one door into the system for this age group and their families. We're looking to make sure that someone will navigate with them as they journey through their services." Broga said the area has historically not had enough child mental health services, especially considering that families of youngsters six to 12 had to figure out which agencies to use.

Kids younger than six go through Children First for special-needs service. Broga said integrating Windsor Regional and Glengarda will save users time and free up mental-health professionals to work more with six-to 12-year-olds. "There will be more services delivered to this age group," Broga said. "We will streamline the system so that parents don't have to tell their story to a series of workers."

Broga said a transition plan must be approved by the two boards but the new system, run under the Regional Children's Centre, could operate by the end of 2012. The Children's Centre currently serves about 1,000 children annually while Glengarda helps about 400.

Alan Goyette, Glengarda's interim executive director, said a lot of work remains but kids should ultimately receive improved service. "It's a tough time," Goyette said. "There are some transition pieces to it. There's some anxiety.

"But there is a legacy with Glengarda that goes back 76 years in this community, started by the Ursuline nuns. And their legacy has always been about doing what's best for kids and families." Goyette said it's too early to say if layoffs will result from the amalgamation, but he still predicts improved mentalhealth care.

"About 20 per cent of kids between zero and 18 years have significant mental-health issues through their childhood," he said. "And certainly there's never enough service to go around. So we decided to do a little bit of dreaming to figure out how we can serve more kids and serve them in a better fashion."

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