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Problems associated with perishability and distribution of local milk and milk products by small-scale producers in the Adamawa province of Cameroon, justified development of an easy process for producing pressed-dough cheese and flavoured whey. Production from raw milk was technically profitable with mean cheese and flavoured whey yields of 8.9 and 85,6% (w/w), respectively. The cheese and whey comprise 50 and 45.7 % (w/w), respectively, of the milk initial dry matter and were highly appreciated by about 90% of panellists. The profitability of a small-scale production unit was established based on 562 kg of treated milk per month. An initial investment of about US $6,205 generates a monthly profit margin of US $237, which gives a profit of 45.8%.Key words: Adamawa, milk, cheese, whey, feasibility, profitability.

Background: Although it is known that differences in paediatric primary care (PPC) are found throughout Europe, little information exists as to where, how and who delivers this care. The aim of this study was to collect information on the current existing situation of PPC in Europe. Methods: A survey, in the form of a questionnaire, was distributed to the primary or secondary care delegates of 31 European countries asking for information concerning their primary paediatric care system, demographic data, professionals involved in primary care and details of their training. All of them were active paediatricians with a broad knowledge on how PPC is organised in their countries. Results: Responses were received from 29 countries. Twelve countries (41%) have a family doctor/general practitioner (GP/FD) system, seven (24%) a paediatrician-based system and 10 (35%) a combined system. The total number of paediatricians in the 29 countries is 82 078 with 33 195 (40.4%) working in primary care. In only 15 countries (51.7%), paediatric age at the primary care level is defined as 0-18 years. Training in paediatrics is 5 years or more in 20 of the 29 countries. In nine countries, training is less than 5 years. The median training time of GPs/FDs in paediatrics is 4 months (IQR 3-6), with some countries having no formal paediatric training at all. The care of adolescents and involvement in school health programmes is undertaken by different health professionals (school doctors, GPs/FDs, nurses and paediatricians) depending on the country. Conclusions: Systems and organisations of PPC in Europe are heterogeneous. The same is true for paediatric training, school healthcare involvement and adolescent care. More research is needed to study specific healthcare indicators in order to evaluate the efficacy of different systems of PPC.

Objective To investigate Belgian pediatric intensive care nurses' involvement in and attitudes toward medical end-of-life decisions with a possible or certain life-shortening effect. Methods Questionnaires were distributed to 141 nurses working in 5 of the 7 pediatric intensive care units in Belgium. Nurses were asked to recall the last child in their care whose treatment involved an end-of-life decision and to describe anonymously their involvement in the decision. Attitudes were ascertained by means of statements and a Likert scale. Results Questionnaires were completed by 89 nurses (63%). During the preceding 2 years, 76 (85%) had cared for at least 1 child for whom a medical end-of-life decision had been made. Nurses were involved in initiating the decision in 17% of cases, participated in decision making in 50%, and played a role in carrying out the decision in 90%. Only 6% of nurses found it always ethically wrong to hasten the death of a child by administering lethal drugs; most nurses (78%) reported they were prepared to cooperate in administering life-ending drugs in some cases. Most (89%) favored adapting the law, making life termination of children legally possible in certain cases. Conclusions Belgian pediatric intensive care nurses are often involved in carrying out medical end-of-life decisions, including administration of life-ending drugs, whereas their participation in decision making is more limited. Most think that the current euthanasia law should be extended to minors so that administering life-ending drugs would be possible for terminally ill children in specific circumstances.

Inleiding Medische beslissingen aan het levenseinde met een mogelijk of zeker levensverkortend effect (MBLs) komen voor op pediatrische intensieve zorgafdelingen. Het is echter niet duidelijk in hoeverre verpleegkundigen hierin worden betrokken. Onderzoeksvraag In hoeverre worden verpleegkundigen geconfronteerd met MBLs en betrokken in het initiëren, de besluitvorming en de uitvoering ervan, en wat zijn hun attitudes tegenover MBLs? Methoden In een vragenlijst werden verpleegkundigen (N=141) gevraagd het meest recente kind te herinneren bij wie een MBL werd genomen en hun rol in de beslissing te noteren. Hun attitudes werden bevraagd d.m.v. uitspraken met een Likert-schaal. Resultaten Respons was 63% (N=89). De meeste verpleegkundigen (86%) hebben zorg gedragen voor een kind bij wie MBL werd genomen. Ze hebben deze beslissing geïnitieerd in 17%, deelgenomen in de besluitvorming in 50% en een taak gehad in de uitvoering ervan in 90% van dergelijke beslissingen. In 61% waren verpleegkundigen betrokken in de toediening van levensbeëindigende middelen in aanwezigheid van de arts en in 31% zonder diens aanwezigheid. Enkele verpleegkundigen (6%) zouden nooit deelnemen aan enige vorm van levensbeëindiging bij een kind, terwijl de meeste (78%) bereid waren mee te werken aan het toedienen van levensbeëindigende middelen. Een grote meerderheid (89%) vindt ook dat de wetgeving moet aangepast worden om levensbeëindiging bij kinderen in sommige gevallen mogelijk te maken. Conclusies Pediatrische intensieve zorg verpleegkundigen worden vaak betrokken in de uitvoering van medische beslissingen aan het levenseinde, zelfs in het toedienen van levensbeëindigende middelen, terwijl hun deelname in de besluitvorming eerder gering is. Ze vinden dat levensbeëindiging bij terminaal zieke kinderen wettelijk geregeld moet worden.

Objective Nurses working at a pediatric intensive care unit are likely to be confronted with end-of-life decisions with a possible or certain life-shortening effect. The aim of this study is to investigate the role of nurses in the initiation, decision-making and implementation of end-of-life decisions and to explore their attitudes towards those decisions. Method Anonymous questionnaires were distributed to all nurses working at five of the seven pediatric intensive care units in Belgium willing to cooperate in the study (N=141). Nurses were asked to recall the most recent child they have cared for and for whom an end-of-life decision had been taken and to describe their role in the initiation, decision-making and implementation of this end-of-life decision. Attitudes towards different end-of-life decisions were asked by means of statements and using a Likert-scale. Results: Response rate was 63% (N=89). Most nurses (86%) had personally cared for a child for whom an end-of-life decision with a possible or certain life-shortening effect was taken. Nurses initiated the decision in 17%, participated in the decision-making process in 50%, and had a particular role in the implementation in 90% of all end-of-life decisions. In 61% of all cases where life-ending drugs were used nurses were involved in the administration of these drugs with the presence of teh physician and in in 31% of these cases nurses did so without the presence of the physician. Few nurses (6%) would not participate in any form of life termination in children and most nurses (78%) were prepared to cooperate in the administering of life-ending drugs. The majority of nurses (89%) is also in favor of an adaptation of the law, making termination of life legally possible in some cases. Conclusions Nurses working at Belgian pediatric intensive care units are often involved in the implementation of medical end-of-life decisions, even in administering life-ending drugs, while there participation in the decision-making process is rather limited. They think life-termination among terminally ill children must be possible and legally regulated in certain circumstances. Given their crucial role, those nurses should be involved more actively in the discussion about these decisions. Guidelines underlying good collaboration and communication in end-of-life decisions and promoting a clearer assignment of responsibilities in the performance of end-of-life decisions in pediatric intensive care units are needed., Objective: Nurses working at a pediatric intensive care unit are likely to be confronted with end-of-life decisions with a possible or certain life-shortening effect. The aim of this study is to investigate the role of nurses in the initiation, decision-making and implementation of end-of-life decisions and to explore their attitudes towards those decisions. Method: Anonymous questionnaires were distributed to all nurses working at five of the seven pediatric intensive care units in Belgium willing to cooperate in the study (N=141). Nurses were asked to recall the most recent child they have cared for and for whom an end-of-life decision had been taken and to describe their role in the initiation, decision-making and implementation of this end-of-life decision. Attitudes towards different end-of-life decisions were asked by means of statements and using a Likert-scale. Results: Response rate was 63% (N=89). Most nurses (86%) had personally cared for a child for whom an end-of-life decision with a possible or certain life-shortening effect was taken. Nurses initiated the decision in 17%, participated in the decision-making process in 50%, and had a particular role in the implementation in 90% of all end-of-life decisions. In 61% of all cases where life-ending drugs were used nurses were involved in the administration of these drugs with the presence of teh physician and in in 31% of these cases nurses did so without the presence of the physician. Few nurses (6%) would not participate in any form of life termination in children and most nurses (78%) were prepared to cooperate in the administering of life-ending drugs. The majority of nurses (89%) is also in favor of an adaptation of the law, making termination of life legally possible in some cases. Conclusions: Nurses working at Belgian pediatric intensive care units are often involved in the implementation of medical end-of-life decisions, even in administering life-ending drugs, while there participation in the decision-making process is rather limited. They think life-termination among terminally ill children must be possible and legally regulated in certain circumstances. Given their crucial role, those nurses should be involved more actively in the discussion about these decisions. Guidelines underlying good collaboration and communication in end-of-life decisions and promoting a clearer assignment of responsibilities in the performance of end-of-life decisions in pediatric intensive care units are needed.

Invasive sino-nasal aspergillosis: a case report. A case of invasive sino-nasal aspergillosis in an immunocompromised child is reported. Prognosis of this fulminant disease is usually poor. This paper reviews the early symptoms, clinical manifestions, risk factors, diagnosis and treatment. Awareness of the disease and early diagnosis by histological examination is essential. Treatment should consist of early administration of IV Amphotericin B of IV Amphotericin B and extensive surgical debridement.

Reversible cardiac failure in an adolescent after prolonged CO-exposure

“Breath-holding spells” and “reflex anoxic seizures” in children are sometimes misdiagnosed as epilepsy. Paroxysmal events may however be vagally-mediated. Initiation of the vagal reflex follows usually a sudden and unexpected fright or pain. The purpose of this study was to evaluate the strength of the vagal reflexes in children with various forms of paroxysmal events. Subjects and methods: 57 infants, aged 5 months to 5 years, with a history of at least two episodes on non-epileptic paroxysmal events were retained for this study. Great care was provided in the parental history. Based on anamnestic data, each subject was assigned to a group. Group I: Blue breath-holding spells (BBHS =18); Group II: Reflex anoxic seizures (RAS=17); Group III: Sobbing spasms (SS=14); Group IV : Mixed spasms (MS=8). An ocular compression test (OCT) was performed according to previously described technique (Ramet Ped Res 1988). Following parameters were measured : control RR interval; longest RR interval; vagal escape; % RR (= longest RR interval / control RR interval) × 100. Results : The highest values for the longest RR obtained in the RAS group, differed significantly from those obtained in the BBHS group. - The mean and SD values for % RR were respectively for groups I, II, III and IV 354 + 207 %, 601 + 164%, 524 + 256% and 611 + 260%. % RR was significantly higher in the RAS group than in the BBHS group. Quite unexpectedly, we found that the % RR in the SS and in the mixed groups were significantly higher than in the BBHS. We can assume that the clear-cut dissociation between “vagally-mediated” RAS and “vagally independent” BBHS seems incorrect. However, we demonstrated that vagal reactivity plays a certain role in SS. Our results sustain the importance of performing an O.C.T. not only in RAS but also in BBHS and SS as well as in the MS group. The classical description between “blue” and “white breath holding spells” depending on the absence or presence of an increased vagal reactivity is, according to our present data, no longer fully applicable.