Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 7 Articles
Background: As the various systems in the body are inter-connected to form a single structural unit, a pathological\r\ncondition in one area can also affect other areas. There are many known correlations between the visual and motor\r\nsystem. The importance of visual function, particularly the paracentral peripheral field of view, in motor\r\ncoordination, ambulation and the maintenance of balance has been amply demonstrated.\r\nIn line with current medical principles, which are moving towards a more holistic view of the human body, this\r\nstudy aims to investigate, in an interdisciplinary manner, the incidence of dental malocclusions together with\r\nposture and eye convergence disorders.\r\nMethods: Six hundred and five children attending at the 3rd, 4th and 5th years of seven Genoa primary schools\r\nwere examined. Each child underwent the following examinations: (i) dental/occlusal; (ii) orthoptic; and (iii) postural.\r\nOcclusal data concerned the presence of cross-bite, midline deviation with a mandibular shift, bad habits and deep\r\nor open bite.\r\nPostural assessment involved frontal and lateral inspection, investigation during trunk flexion and ambulation, and\r\nnote of any asymmetry in the lower limbs. The recorded orthoptic data included those pertaining to ocular\r\ndominance, a cover test, convergence and the Brock string test.\r\nResults: A prevalence of cases with an unphysiological gait was found in patients with overjet (14.70%) or overbite\r\n(14.87%), while the percentage of patients with normal occlusion that showed an unphysiological gait was 13.08%.\r\nAlso, about 93.8%ââ?¬â??94.2% of children showed normal legs without dysmetry, with no difference in respect to the\r\ntype of occlusion. Subjects with an open bite or deep bite showed a slightly different distribution of right or left\r\ndominant eyes.\r\nConclusion: About 13% of children showed a pathological gait and, among them, vertical anomalies of occlusion\r\n(deep bite or open bite) were prevalent with respect to the other occlusal defects. The vertical dimension of\r\nocclusion revealed a slight relationship with the proper dominant eye. Postural, orthoptic, osteopathic and occlusal\r\nvariables were often clinically associated, and therefore these disorders appear to request a multidisciplinary\r\nmedical approach for their treatment....
Background: The Medical Home model recommends that Children with Special Health Care Needs (CSHCN)\r\nreceive a medical care plan, outlining the child�s major medical issues and care needs to assist with care\r\ncoordination. While care plans are a primary component of effective care coordination, the creation and\r\nmaintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been\r\nstudied. The purpose of this qualitative study was to understand the usefulness and desired content of\r\ncomprehensive care plans by exploring the perceptions of parents and health care providers (HCPs) of children\r\nwith medical complexity (CMC).\r\nMethods: This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15) and\r\nparents (n = 15) of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric\r\nacademic health sciences center. Themes were identified through grounded theory analysis of interview and focus\r\ngroup data.\r\nResults: A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three\r\nintegral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care\r\nplan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were\r\nreported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal\r\ninformation exchange and strengthened relationships. Participants expressed that a standardized template that is\r\nfamily-centered and includes content relevant to both the medical and social needs of the child is beneficial when\r\nintegrated into overall care planning and delivery for CMC.\r\nConclusions: Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These\r\nfindings inform the utility and development of a comprehensive care plan template as well as a model of how and\r\nwhen to best utilize care plans within family-centered models of care....
Background: Otitis media (OM) is a very common condition in children and occurs during years that are critical to\r\nthe development of learning, literacy, and math skills. Therefore, among a large cohort of Danish conscripts, we\r\naimed to examine the association between hospitalisation with OM in early childhood and cognitive function and\r\neducational level in early adulthood.\r\nMethods: We conducted a population-based prevalence study using linked data from healthcare databases and\r\nconscription records of Danish men born between 1977 and 1983. We identified all hospitalisations with OM before\r\n8 years of age. Cognitive function was measured by the Boerge Prien validated group intelligence test (Danish\r\nBÃ?¸rge Prien PrÃ?¸ve, BPP). We adjusted for potential confounders with and without stratification by hearing\r\nimpairment. Furthermore, we examined the association between hospitalisation with OM and the prevalence of\r\nhaving achieved a General Certificate of Secondary Education (GCSE), stratified by quartiles of BPP scores.\r\nResults: Of the 18 412 eligible conscripts aged 18ââ?¬â??25 years, 1000 (5.5%) had been hospitalised with OM before age\r\n8. Compared with conscripts without such a record, the adjusted prevalence ratio (PR) for a BPP score in the\r\nbottom quartile was 1.20 (95% confidence interval [CI]: 1.09ââ?¬â??1.33). There was no major difference in the proportion\r\nof men with a GCSE and those without among those hospitalised with OM in early childhood. For men in the\r\nbottom and upper quartiles of BPP scores, the PRs for early childhood hospitalisation with OM were 0.89 (95% CI:\r\n0.59ââ?¬â??1.33) and 0.96 (95% CI, 0.88ââ?¬â??1.05), respectively. Among men with severe hearing impairment, the proportion\r\nwith a BPP score in the bottom quartile did not differ between those with and without an OM hospitalisation\r\n[PR = 1.01 (95% CI: 0.78ââ?¬â??1.34)].\r\nConclusions: Overall, we found that hospitalisation with OM in early childhood was associated with a slightly\r\nlower cognitive function in early adulthood. Hospitalisation for OM did not seem to influence the prevalence of\r\nGSCE when level of BPP was taken into account....
Making a diagnosis of Kawasaki disease with certainty may be challenging,\r\nespecially since the recognition of cases with incomplete diagnostic criteria and its\r\nconsequences. In order to build the diagnostic case in daily practice, clinicians rely on\r\nclinical criteria established over four decades ago, aided by non specific laboratory tests,\r\nand above all inspired by experience. We have recently studied the diagnostic value of\r\nN-terminal pro B-type natriuretic peptide to improve the diagnostic certainty of cases with\r\ncomplete or incomplete clinical criteria. Our working hypothesis was based on the fact that\r\nmyocarditis is present in nearly all Kawasaki disease patients supported by histology data.\r\nIn this paper, we review these facts and the myocardial perspective from the diagnostic and\r\nthe mechanistic standpoints....
Background: Parasitic infections have been shown to have deleterious effects on host nutritional status. In\r\naddition, although helmintic infection can modulate the host inflammatory response directed against the parasite, a\r\ncausal association between helminths and allergy remains uncertain. The present study was therefore designed to\r\nevaluate the relationship between nutritional status, parasite infection and prevalence of allergy among school\r\nchildren.\r\nMethods: A cross sectional study was performed involving school children in two elementary schools in Gondar,\r\nEthiopia. Nutritional status of these children was determined using anthropometric parameters (weight-for-age,\r\nheight-for-age and BMI-for-age). Epi-Info software was used to calculate z-scores. Stool samples were examined\r\nusing standard parasitological procedures. The serum IgE levels were quantified by total IgE ELISA kit following the\r\nmanufacturerââ?¬â?¢s instruction.\r\nResult: A total of 405 children (with mean age of 12.09.1 Ã?± 2.54 years) completed a self-administered allergy\r\nquestionnaire and provided stool samples for analysis. Overall prevalence of underweight, stunting and thinness/\r\nwasting was 15.1%, 25.2%, 8.9%, respectively. Of the total, 22.7% were found to be positive for intestinal parasites.\r\nThe most prevalent intestinal parasite detected was Ascaris lumbricoides (31/405, 7.6%). There was no statistically\r\nsignificant association between prevalence of malnutrition and the prevalence of parasitic infections. Median total\r\nserum IgE level was 344 IU/ml (IQR 117ââ?¬â??2076, n = 80) and 610 IU/ml (143ââ?¬â??1833, n = 20), respectively, in children\r\nwithout and with intestinal parasite infection (Z = -0.198, P > 0.8). The prevalence of self reported allergy among\r\nthe subset was 8%. IgE concentration was not associated either with the presence of parasitic infection or history of\r\nallergy.\r\nConclusion: The prevalence of malnutrition, intestinal parasitism and allergy was not negligible in this population.\r\nIn addition, there was no significant association between the prevalence of allergy and their nutritional status, and\r\nparasite infection. Further research prospective observational and intervention studies are required to address the\r\nquestion of causality between nutritional factors, parasites, and allergy....
Background: Long-term complications of sympathomimetic drug overdosing have not been adequately\r\ninvestigated in infants and young children. Despite reports discouraging their use in children, these formulations\r\nare frequently administered for ââ?¬Å?cold-like symptomsââ?¬Â. Their frequent adverse events are different forms of\r\narrhythmias, including multifocal atrial tachycardia.\r\nCase presentation: A 3-year-old toddler developed multifocal atrial tachycardia following an iatrogenic overdose\r\nof epinephrine accidentally administered intravenously. His ECG showed wandering atrial pacemaker (p-waves with\r\ndifferent origins and configurations) that persisted for at least one year. This event demonstrated the sensitivity of\r\nyoung children to the sympathomimetic drugs, especially overdosing.\r\nConclusions: Health care providers and parents should be warned of toxicities associated with sympathomimetic\r\ndrug overdosing. Future studies are needed to determine whether wandering atrial pacemaker is a potential\r\nlong-term complication of high-dose sympathomimetics....
Background: Type D personality, or the ââ?¬Å?distressed personalityââ?¬Â, is a psychosocial factor associated with negative\r\nhealth outcomes, although its impact in younger populations is unclear. The purpose of this study was to\r\ninvestigate the prevalence of Type D personality and the associations between Type D personality and\r\npsychosomatic symptoms and musculoskeletal pain among adolescences.\r\nMethods: A population-based, self-reported cross-sectional study conducted in VÃ?¤stmanland, Sweden with a cohort\r\nof 5012 students in the age between 15ââ?¬â??18 years old. The participants completed the anonymous questionnaire\r\nSurvey of Adolescent Life in VÃ?¤stmanland 2008 during class hour. Psychosomatic symptoms and musculoskeletal\r\npain were measured through index measuring the presence of symptoms and how common they were. DS14 and\r\nits two component subscales of negative affectivity (NA) and social inhibition (SI) were measured as well.\r\nResults: There was a difference depending on sex, where 10.4% among boys and 14.6% among girls (p = < 0.001)\r\nwere defined as Type D personality. Boys and girls with a Type D personality had an approximately 2-fold increased\r\nodds of musculoskeletal pain and a 5-fold increased odds of psychosomatic symptoms. The subscale NA explained\r\nmost of the relationship between Type D personality and psychosomatic symptoms and musculoskeletal pain. No\r\ninteraction effect of NA and SI was found.\r\nConclusions: There was a strong association between Type D personality and both psychosomatic symptoms and\r\nmusculoskeletal pain where adolescent with a type D personality reported more symptoms. The present study\r\ncontributes to the mapping of the influence of Type D on psychosomatic symptoms and musculoskeletal pain\r\namong adolescents....
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