Psychophysiological reactivity of asthmatic children.
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Adolescent↗
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[Herpesvirus 6. What attention does it deserve in general practice?].
The human herpesvirus 6 (HHV6) is a member of the beta-herpes viridae family. The primary infection is usually asymptomatic and commonly occurs during childhood. The clinical form is called exanthema subitum, or roseala infantum or the 6th disease. This biphasic disorder usually runs a benign course and requires no antiviral treatment. However, the HHV6 reactivation can lead to serious systemic diseases, especially encephalopathy, that may be fatal in the immunocompromised or grafted patient. In seronegative pregnant women, a primary HHV6 infection contracted from a child with roseola infantum can lead, in rare instances, to spontaneous abortion during the first trimester, or produce neurological complications in the newborn after HHV6 transplacental infection. Aciclovir, ganciclovir (GCV), foscarnet and cidofovir show anti-HHV6 in vitro efficacy, but GCV is currently the first line agent when of HHV6 infection is diagnosed in the immunocompromised patient.
Family Practice↗
[The anxiety-phobic disorder classification in children].
The study on development regularities and psychopathological structure of anxiety phobic disorders has been conducted in 92 patients, aged 5-15 years. The structure of anxiety-phobic complex is represented. A level of anxiety affect development (primary or secondary, presence and direction of affect cognitive component) and negative effectiveness were emerged in the children as common obligate anxiety-phobic characteristics, which contributed to complex structure stability. Three anxiety-phobic disorder types--situation-dependent, personality-dependent and vital--were distinguished. The first one is characterized by the combination of secondary anxiety with cognitive vector expression, the vector being outside directed, and emotionally unstable negative effectiveness variant (particular sensitivity to negative situations with disability for negative emotion control). The second type is distinguished by secondary anxiety manifestations, the anxiety vector being directed towards the self-ego. In these cases, personality component--rigid variant of negative effectiveness (higher sensitivity to negative events, along with disability for negative emotion modulation) dominates. The third type is defined by the combination of primary anxiety (with vital disturbance, diffusion, psychic activity disorganization in the absence of cognitive component) with rigid variant of negative effectiveness. The types of manifesting anxiety-phobic disorders described correspond to reactive (situation-dependent type), endoreactive (personality-dependent type) and autochthonous (vital type) variants of the disease course.
Adolescent↗
Behavioural psychopathology of child sexual abuse in schoolgirls referred to a tertiary centre: a North London study.
The sexually abused girls in this study were a sub-sample of a group of girls referred to a Regional Centre for Psychotherapy for the whole of London, North Thames. An inclusion criterion was that they were psychologically symptomatic and so it is likely that they were more problematic cases causing concern in their locality. The control clinical group consisted of referrals to local Child and Family consultation services, were an opt-in matched sample and not a total clinic referral sample. In addition, the reasons for referral covered both child disorder and family problems. It is, therefore, important to bear in mind the differences between these two groups. Certain clear cut findings have emerged from this study. No disorders specific to child sexual abuse in girls were identified but the extent and severity of the disturbance in the sexually abused sample was most striking. In these girls an event (CSA), together with referral because of emotional symptoms, was associated with enhanced severity of disorder and comorbidity particularly with reference to a cluster of disorders comprising post-traumatic stress disorder, depressive disorder, anxiety disorders (general and separation), social phobias and reactive attachment disorder. In the community clinic sample the identified disorders were mainly those of separation anxiety disorders and adjustment. Wide comorbidity was common in the sexual abuse sample and also severity of impairment was notable when compared to the clinic sample. However, because of the selected nature of the abuse group the findings are not generalisable beyond the population from which they emerged. The view is advanced that there are strong grounds for exploring the utility of psychodynamic psychotherapy in similar samples of sexually abused girls. These findings are discussed in the light of the current literature.
Adolescent↗
[Some considerations on evaluation of the acutely limping child].
INTRODUCTION: An acute limp implies an underlying pathology that causes disruption of the standard gait pattern. DIAGNOSIS AND HISTORY OF DISEASE: The differential diagnosis of a limp includes trauma, infection neoplasia, inflammatory, congenital, neuromuscular or developmental disorders. History of disease and clinical examination present first steps in adequate evaluation. A useful approach is to consider the causes of limping from head to foot to avoid overlooking common underlying conditions. The age of patient can further narrow the differential diagnosis, because certain disease entities are age-specific. LABORATORY ANALYSIS: Laboratory analysis should always include complete blood count, erythrocyte sedimetation rate, C-reactive protein, rheumatic factor, PPD 3. In some cases we have to perform tests of enzyme values such as alkaline phosphatase, lactate dehydrogenase, and other subspecial analyses in order to exclude some systemic and autoimmune diseases. RADIOLOGIC DIAGNOSIS: Radiologic diagnosis should include: ultrasonography (doppler ultrasonography and in some cases, arteriography); Plain films (always anteroposterior (AP) and profile or some special angle); computed tomography, magnetic resonance imaging. CONCLUSION: In this paper we suggested an algorithm for examination of a limping child: 1. Analysis of foot morphology and the gait without socks and shoes. 2. Strength test including walking on toes and heels and running. 3. Evaluation of arthritis, stiffness, pain, skin changes. 4. Points of a maximum pain with ROM testing. 5. Traces of trauma with echimosis. 6. Evaluation of leg length discrepancy. 7. Muscle tonus. 8. Abdominal examination 9. Examination of the spine and back.
Acute Disease↗
First admissions for psychiatric disorders. A comparison between the Faroe Islands and Denmark.
Historical accounts emphasize a high rate of mental morbidity in the Faroe Islands compared with Denmark. As prerequisites for a comparative investigation are now present, we have compared a 10-year period of first admission rates in both areas. We found a lower rate for the Faroes generally, in particular for women, for the age group 30-64, and also for the majority of diagnostic groups. The group manic-depressive psychosis come closest to Danish conditions, followed by reactive psychosis and alcohol and drug abuse. The greatest difference was found for the groups personal disorders, neuroses, and schizophrenia.
Adolescent↗
Predictive features for persistence of atopic dermatitis in children.
Allergen exposure plays an important role in atopic dermatitis (AD). Because immunological mechanisms underlying asthma and AD have great similarities, we evaluated whether features such as allergen sensitization, immune response, disease severity and duration or allergen exposure could be considered predictive for AD persistence. Seventy-one AD children (age range 14-158 months) were enrolled and followed for 3 consecutive years for AD severity using the SCORAD index (SI). At enrollment, reactivity to inhalant and food allergens using the skin prick test (SPT) and house dust mite (HDM) atopy patch test (APT), and HDM allergens in house dust were evaluated. After 3 years, 38 children outgrew their AD (AD- group), while in 33 AD persisted (AD+ group). At enrollment, AD+ children had a higher SI, higher rate of positivity to SPT and APT for mites (p = 0.001), and higher environmental exposure to HDM allergens (p = 0.035). The AD+ children developed more respiratory symptoms in comparison to AD- children (p < 0.001). None of the AD- children presented APT positivity. In our study population, positivity of SPT and APT for HDM, environmental allergen exposure levels and severity of the disease at enrollment presented a significant predictive power towards AD persistence. Subjects with positive skin reactivity to HDM should be considered at risk of AD persistence and of possible development of allergic respiratory disorders.
Adolescent↗
Anaesthetic management of a patient with erythropoietic protoporphyria for ventricular septal defect closure.
Erythropoietic protoporphyria (EPP) is due to a deficiency in ferrochelatase required for haem synthesis. We describe the anaesthetic management of a seven-year-old with EPP undergoing closure of a haemodynamically significant ventricular septal defect. Photosensitivity in EPP patients is triggered at wavelengths near 400 nm and light-excited porphyrins generate free radicals and singlet oxygen that lead to erythrocyte deformity and haemolysis. Stimuli that could trigger a porphyric crisis during anaesthesia and surgery were reduced by avoiding exposure to the sensitive 400 nm spectrum and using light sources covered with yellow acrylate filters in the operating room. Anaesthetic agents not previously associated with porphyric crisis were chosen. Whole blood priming of the extracorporeal circuit was performed to ensure adequate haemoglobin concentrations during the perioperative period.
Anesthesia, General↗
The effect of genetic and environmental factors on the prevalence of allergic disorders at the age of two years.
The effect of genetic and environmental factors on the prevalence of allergic disorders in early childhood was determined in a prospective follow-up study. Information was available on 1174 children at the age of 2 years. Two-hundred and seventy-five were considered to have an allergic disorder. The prevalence varied from 3.2% for rhinitis to 10.9% for asthma. At 2 years 60 children reacted positively on skin-prick test (SPT). Multivariate logistic regression analysis was used to obtain adjusted odds ratios (95% confidence interval) for each factor. For asthma, positive family history, male sex, low birth-weight, maternal smoking and season of birth were significant risk factors. For eczema, positive family history was the only significant risk factor. For rhinitis, lower socio-economic group and autumn birth were significant. Male sex and low birth-weight were significant for skin test positivity. Positive family history and low birth-weight were significant risk factors for any allergy. Low birth-weight was also a significant risk for skin test reactivity to house dust mite. Genetic and environmental factors have a profound effect on the development of allergic disorders in the first two years of life.
Child, Preschool↗
[Trachoma and inclusion conjunctivitis: similarities and differences].
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Adolescent↗
[Vascular reactivity in the area of both carotids in children and adolescents with headaches of a migraine character].
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Adolescent↗
Development of conduct problems and peer rejection in preschool children: a social systems analysis.
The development of impulsive-aggressive problem behavior and peer rejection was examined in sixty 4- to 5-year-old boys from low-income family backgrounds. Children's sociometric status and behavioral adjustment were assessed longitudinally at the beginning and end of the preschool year, and related to measures of peer interaction at three different points in time. Boys identified as socially rejected and aggressive in the beginning of the year were highly likely to be identified as such at the end of the year. Early in the preschool year, these children contributed to their own rejection by initiating socially aversive exchanges with peers. Although peers clearly perceived these problems, they did not reciprocate with counteraggression at first. However, as time passed, peers began to actively victimize these children, and most of the aggression on the part of victims became reactive in nature. Thus, the current findings strongly support a transactional model of the development of early peer rejection and conduct problems.
Aggression↗
Mood and hormone responses to psychological challenge in adolescent males with conduct problems.
BACKGROUND: Relations between stress hormones and antisocial behavior are understudied. METHODS: A subsample (n = 335) of at-risk males recruited in first grade for a longitudinal study were recruited at approximately 16 years of age for a laboratory study, including two psychological challenges: describing their worst experience on videotape, and a task in which a loud tone could be avoided. Measures of affect, urine, and saliva were collected multiple times before and after challenges. RESULTS: Negative affect increased following the worst-event challenge and decreased following the avoidance challenge. Mean conduct problems (CP) across ages 7-17 years were positively related to negative affect and inversely related to positive affect. CP were inversely related to post-challenge urinary epinephrine (E) levels when baseline E and potential confounds were controlled. Cortisol concentrations in saliva collected soon after the first challenge were positively related to CP in a post hoc subset of youths with extreme CP. CONCLUSIONS: Key findings A) associated persistent CP with more negative affectivity and less positive affectivity, B) replicated and extended prior findings of an inverse association of CP and urinary E, and C) suggested provocative hypotheses for future study relating CP, trauma history, trauma recall, and cortisol reactivity.
Acoustic Stimulation↗
Cognitive dysfunction and the inherited predisposition to alcoholism.
A battery of neuropsychological tests was administered to 22 nonalcoholic sons of male alcoholics (SOMAs) from families with extensive histories of male alcoholism and to 22 nonalcoholic controls with no history of familial alcoholism. In each group 11 subjects were tested while sober and 11 were tested while alcohol-intoxicated. Analyses of the results of this battery suggested (1) that SOMAs may be characterized by comparative decrements in those cognitive functions associated with the organization of novel information, dependent in theory upon the prefrontal cortex; and (2) that alcohol detrimentally affects delayed memory, associated with the temporal cortex, equally across groups. Of these SOMAs 20 had previously participated in one of two studies that demonstrated their cardiovascular hyper-reactivity to threat/stress and their increased sensitivity to the reactivity-dampening effects of alcohol intoxication. Correlational analyses of the results of the present and previous studies demonstrated the existence of a highly significant relationship between cognitive impairment, cardiovascular hyper-reactivity and susceptibility to the reactivity-dampening effects of alcohol.
Adult↗
[Importance and determinants of early mother-child relations].
In a prospective longitudinal study on child development from birth to age eight 362 first-born infants and their families were investigated. The subjects were distributed across the nine cells of a two-factorial design, factor 1 representing the degree of organic, factor 2 the degree of psychosocial risk. At age 3 months mother-child interaction was videotaped and evaluated with microanalytic technique. The quality of MCI could be demonstrated to be as predictive for later cognitive development as early developmental tests. Social-emotional problems of the toddler and preschool child was predicted better by parameters of early MCI than by temperament. Disturbed interactions were associated with later cognitive retardation and enhanced behavior problems. MCI is significantly determined by neglect and rejection, which showed typical behavioral patterns. The early separation of mother and high risk newborn itself did not lead to alterations in maternal attachment. Compared with mother daughter dyads early interaction of mother and son was characterized by more reactivity and positive emotion.
Affect↗
Langerhans cell histiocytosis involving epiphysis of a long bone.
Eosinophilic granulomas of long tubular bones, a form of Langerhans cell histiocytosis, occurs in metaphyses and diaphyses with equal frequency. Epiphyseal location is unusual, with only 13 cases previously reported in the literature. The present case involves the epiphysis of the upper end of the left femur in a 12-year-old boy with pain and limp in the affected area. Radiographic findings were an oval, radiolucent rarefaction with nonsclerotic border, measuring approximately 3.5 x 3.0 cm. Microscopic examination identified aggregates of histiocytes, multinucleated giant cells, scattered eosinophils, and few plasma cells and lymphocytes. Ultrastructural studies demonstrated Birbeck granules within cytoplasm of histiocytes diagnostic of Langerhans cell histiocytosis. Whether Langerhans cell histiocytosis is a neoplastic disorder or a reactive process remains controversial. The true nature of the Langerhans cell, the proliferating cells and hallmark of this disease, is likewise under scrutiny.
Child↗
Psychophysiologic reactivity to trauma-related imagery in PTSD. Diagnostic and theoretical implications of recent findings.
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Child↗
Emotional disorder in XYY children: four case reports.
Four boys, from a group of fourteen with an XYY chromosome constitution identified by cytogenetic screening at birth, were referred for psychiatric treatment, age seven to nine years. Presenting symptoms included severe temper tantrums, stealing and enuresis, and they were diagnosed as having mild to severe emotional disorders. There were multiple factors of increased risk for psychiatric disturbance in their backgrounds nd there was evidence of reactive depression in all four boys. Treatment with individual and family psychotherapy, combined with antidepressant medication in two of the four children and special educational provisions in one, resulted in good short-term outcome comparable to that achieved in chromosomally normal boys.
Affective Symptoms↗