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PubMed2004

Clinicopathologic findings in patients with infantile hemiparesis and epilepsy.

Infantile hemiparesis may be associated with significant morbidity and may have a profound impact on a child's physical and social development. There are little published data evaluating the clinicopathologic features of patients with infantile hemiparesis. The present study retrospectively examines these clinicopathologic features in a surgical series of 21 patients with infantile hemiparesis. The study group was comprised of 21 patients, 13 females and 8 males, ranging in age from 5 to 41 years (mean, 20 years) at the time of surgery. Hemiparesis involved the right side in 16 patients and the left side in 5 patients. Imaging studies identified porencephaly in 8 patients (38%), encephalomalacia in 5 patients (24%), focal cerebral atrophy in 9 patients (43%), ventricular dilatation in 6 patients (29%), and white matter hyperintensities in 4 patients (19%). Concomitant neurologic diseases included medically intractable epilepsy in all 21 patients and visual field defects in 11 patients (52%). Significant perinatal history included prematurity in 7 patients (33%) and cesarean section, forceps delivery, placental abruption, fetal distress, and prolonged rupture of membranes each in 1 patient (5%). The remainder of the patients had an uncomplicated perinatal course (43%). Twelve patients underwent functional hemispherectomy (57%), 8 patients underwent lobectomy (38%) and 1 patient underwent "cyst" resection (5%). Histological evaluation demonstrated lesional (corresponding to radiographic findings) tissue in 15 of the 21 cases (71%). Infarction, malformations due to abnormalities of cortical development (cortical dysplasia) and gliosis with microcalcifications were each found in 6 patients (29%). Infarction and a geographically distinct area of cortical dysplasia were found to coexist in 1 case. Histopathologic findings in the 6 cases in which excised tissue was considered nonlesional included gliosis in all 6 of the cases, hippocampal sclerosis in 2 cases (10%), and neuronal heterotopia in 2 cases (10%). An osteoma was identified in 1 patient. The most common pathological findings observed in our series were infarction and cortical dysplasia, although radiographically, infarct-related changes were the most evident. Hippocampal sclerosis was encountered in 2 patients, suggesting that a subset of cortical dysplasias and hippocampal sclerosis may be caused by an in utero ischemic event.

Adolescent↗
PubMed2005

The Health Promoting Prison (HPP) and its imperative for nursing.

The World Health Organisation's (WHO) Ottawa Charter for Health Promotion in 1986 provided the catalyst from which the Health Promoting Prison (HPP) movement emerged. Here, an extensive review of the available prison-related health literature provides the basis for critical discussion and recommendations for nursing services and prison-related health care. The findings suggest that current prison-based nursing services are seriously neglected and woefully lacking in structure and resources. This article recommends strategies for reform that includes nurses who practice in all settings, and not just prison-based nurses. If nurses wish to be at the forefront of future HPP strategies, they must first embrace the radical health promotion reforms that are emerging from the current literature. Building sustainable group capacity into prison-based health care, through developing social interaction, cohesion, participation and political action can only benefit the community at large and further emphasise the health promotion role of nursing.

Clinical Competence↗
PubMed2006

Parental awareness of hearing impairment in their school-going children and healthcare seeking behaviour in Kisumu district, Kenya.

BACKGROUND: Hearing-impaired children who are identified early and appropriately managed have improved outcomes in speech, language, cognitive and social development. Enhanced parental awareness of their child's hearing disability, behavioral, developmental and psychosocial limitations is essential to sustaining timely detection and appropriate intervention. Additionally, availability of services for diagnosis, treatment and habilitation would improve the demand for pedaudiological care in this community. OBJECTIVE: To describe level of parental awareness of childhood HI and the pattern of access to and utilization of ambulatory care services. SUBJECTS: Thirty-three parents of lower primary school-going children who failed audiometric screening from sampled schools in Kisumu district, western Kenya. MAIN OUTCOME MEASURES: First person to detect HI, age of child at first suspicion of HI, source of ambulatory health care and use of the health care facilities. RESULTS: The prevalence of HI was 2.48%. Most parents/guardians (69.7%) were aware of their child's hearing impairment. Of these, 63.6% were first to detect HI in the pupils, while 30.3% were detected by screen. Most children (57.2%) were first recognized with (HI) after age 2 years. The mean age at identification was 5.5 years. The median travel distance to the preferred health care facility was 2 km (IQR 1-2.5). Parents seldom sought or lacked help for their hearing-impaired children. Of 27.3% who asked for hearing assessment, 9.1% received some counsel on HI and 12.1% received medication, one (3%) was referred for audiological assessment and none used a hearing aid. Use of health facilities for maternal care was (65.7%) and immunization (62.9%). CONCLUSIONS: Despite adequate parental awareness of chronic childhood disability, health facilities were underutilized. This indicates the need to further stimulate and maintain a desirable level of uptake of services for diagnosis, treatment and habilitation of childhood HI, while sustaining delivery of effective and acceptable high quality paediatric care.

Adolescent↗
PubMed2004

Adolescent mothers: support needs, resources, and support-education interventions.

Adolescent mothers are prone to live in poor conditions, lack adequate financial resources, suffer high stress, encounter family instability, and have limited educational opportunities. These factors contribute to inadequate parent-child interactions and diminished infant development. Social support can promote successful adaptation for adolescent mothers and their children. This review article describes the support needs and challenges faced by adolescent parents and their children, the support resources available to and accessed by adolescent parents, and existing support-education intervention studies, to provide directions for future research. Relevant research published between January 1982 and February 2003 was obtained from online database indices and retrieved article bibliographies. Frequently encountered problems included small sample sizes and attrition, lack of suitable comparison groups, and measurement inconsistencies. When planning support-education interventions, content, duration, intensity, mode, level, intervention agents, and targets should be considered. Future research can address these challenges.

Adolescent↗
PubMed2005

Intradermal botulinum A toxin injection for axillary hyperhydrosis.

Axillary hyperhydrosis in children and teenagers may be severe enough to affect social development. Current treatments range from aluminum chloride compounds to surgical removal of sweat glands and sympathectomy. Intradermal injection of botulinum A toxin has recently been found to be a safe and effective alternative in the adult population. Use in children has so far not been documented. We hereby report a case illustrating the use of botulinum A toxin in a 14-year-old girl with disabling axillary hyperhydrosis.

Adolescent↗
PubMed2005

The associations of emotion regulation and dysregulation with the metabolic syndrome factor.

OBJECTIVE: Emotion regulation has been associated with good, and dysregulation with poor subjective health; but it is unclear if emotion regulation is related to metabolic syndrome. METHODS: Associations between the metabolic syndrome factor (systolic and diastolic blood pressure, waist circumference, high-density lipoprotein, triglycerides, and glucose), emotion regulation (the strategies of repair and maintenance, self-perceived emotion regulation) and dysregulation (emotional ambivalence); and subjective health (self-rated health and psychosomatic symptoms) were studied using a structural equation modelling (SEM) approach. The participants (96 women, 85 men) were drawn from the Jyväskylä Longitudinal Study of Personality and Social Development (JYLS). RESULTS: High repair was associated directly to the low metabolic syndrome factor, while high maintenance, high self-perceived emotion regulation, and low emotional ambivalence were related indirectly to the low metabolic syndrome factor through good subjective health. CONCLUSIONS: Successful emotion regulation may have an association not only with the subjective experience of health, but also with physiological regulation systems, leading to a reduced risk for metabolic syndrome.

Adult↗
PubMed2004

Factors affecting children's participation and amount of labor on family farms.

METHOD: A two-stage decision-making model is estimated to explain children's participation and labor supply on family farms using unitary and cooperative bargaining frameworks. RESULTS: Results indicate that parents have different preferences about whether their children work and how much they work. The models incorporate non-economic factors and allow for different stochastic processes in the participation and labor supply decisions. CONCLUSIONS: Concerns about children's social development appear to be crucial in deciding children's labor participation, while the child's economic contribution significantly influences both whether they work and how much they work. Some variables affect the two decisions differently. For instance, the higher the parents' education level, the higher the probability children will work but the fewer hours they will work.

Adult↗
PubMed2004

Risk and protective factors for sexual risk taking among adolescents involved in Prime Time.

This article describes a preliminary qualitative evaluation of risk and protective factors associated with consistent contraceptive use and healthy sexual decision-making among ten of the first participants in the Prime Time intervention study. Prime Time is an 18-month intervention including one-on-one case management and peer educator training targeting sexually active 13-17-year-old girls who are recruited from health care clinics. Using an approach grounded in findings from previous research, social cognitive theory, and the social development model, Prime Time aims to improve participants' contraceptive use consistency, reduce number of sexual partners, and reduce unwanted sexual activity. Findings from this preliminary evaluation alert health care providers to the complex and dynamic nature of adolescent girls' sexual behaviors and to a broad range of risk and protective factors within individuals and their environments that may influence adolescent girls' sexual behaviors and contraceptive use. Findings suggest that an ongoing, supportive relationship with a case manager who is able to pace and tailor an intervention to the individual young person can have positive effects on adolescent girls' sexual behaviors and contraceptive use.

Adolescent↗
PubMed2005

Conceptions and uses of public health ideas by New Zealand government policymakers: report on a five-agency survey.

OBJECTIVES: This article describes New Zealand government policymakers' awareness of, attitudes toward and self-reported use of ideas about the determinants of health. Some comparison with an earlier Canadian study is provided. METHODS: Employees with policymaking and advisory responsibilities in government departments of health, social development, housing, education and finance were surveyed. RESULTS: More than half of the respondents (58%) were familiar with ideas about health determinants. Eighty percent felt that health determinants should be considered in all government policy, but that more practical information on effective policy interventions is needed. Commitment to the idea that the economy should take precedence over reducing health inequalities was low. CONCLUSIONS: There is a demand for literature on health determinants that is sector specific and which provides practical and proven information about effective interventions that influence health.

Canada↗
PubMed2004

New concepts in organ transplantation.

Over the past several decades, many factors have led to higher rates of patient and graft survival in organ transplantation. These factors include enhanced immunosuppressants available in recent years such as Neoral, Prograf, sirolimus, mycophenolate mofetil and anti-interleukin-2 receptor monoclonal antibodies. In addition, other new drugs, such as FTY 720, FK 778, anti-CD20, anti-CD40, and anti-CH52 monoclonal antibodies, are now being tested in clinical studies. Furthermore, there have been advances in surgical techniques, such as the piggyback method without venovenous bypass, side-to-side anastomosis of the hepatic veins, use of vascular staplers, biliary duct-to-duct anastomosis with or without tube drainage, microsurgical hepatic artery anastomosis and laparoscopic donor nephrectomy. Finally, better patient and donor selection criteria with regard to HBV- and HCV-seropositive donors, diabetic donors, donors with malignancies, older donors, ABO-incompatible donors, and non-heart-beating donors have been combined with optimal timing of transplantation, better options for treating early surgical and late medical complications, and improved management in intensive-care units. Other noteworthy scientific and social development are on the horizon namely genetic advances in xenografting and cell transplantation, and induction of immunologic tolerance. This article reviews the current developments that have significantly improved graft and patient survival among solid-organ transplants.

Humans↗
PubMedDate not supplied

The complexities of nursing research with men.

There has been a proliferation of nursing and other research on women's health over the last thirty years but a similar interest in men's health has not materialised. Within this paper we seek to explore the issues that need to be taken into consideration when conducting research with (or on) men. It outlines the current thinking on men and masculinity and the social development of stereotypes of men. The position of men with regard to the development of feminist thinking is also explored. The paper develops the argument by an examination of the different stages of the research process in nursing. The effect of gender on the setting of the research question; the choice of methodology; obtaining the data; analysis; discussion and dissemination of the findings of research conducted upon men are considered. We suggest that there is a requirement to consider the gender of both researched and researcher during the research process.

Data Collection↗
PubMed1983

Fecal incontinence: a simple pneumatic device for home biofeedback training.

A simple pneumatic biofeedback device has been designed for patients who have failed to develop social fecal continence following sacroabdominoperineal pull-through operations for anorectal anomalies. The components that make up the device are easily and cheaply available. This device was designed to be used by the patient at home and needs only the assistance of an adult.

Biofeedback, Psychology↗
PubMed1997

Continent appendicostomy in the bowel management of fecally incontinent children.

BACKGROUND: Fecal incontinence is common in children who have anorectal malformations, Hirschsprung's Disease, and spina bifida and can negatively impact their emotional and social development. Enemas have been used as an artificial way to keep children clean and to improve their quality of life. This method is unpleasant for many children, particularly when they reach adolescence. Malone in 1990 described an alternative method in which the appendix is used as a conduit to administer an antegrade enema. METHODS: The authors describe their experience with this new procedure, modified by them, and used in 20 patients. In the original procedure, the base of the appendix is divided, inverted, and reimplanted into the cecum with an antireflux technique. The authors simplify this by plicating the cecum around the appendix to create a one-way valve mechanism but leaving the appendix in its original position. The authors also mobilize the cecum and exteriorize the appendix at the umbilicus to create an inconspicuous stoma. If the native appendix is absent a neoappendix was created from a flap of cecum. RESULTS: Nineteen of 20 patients (95%) are now completely clean 24 hours a day. Stricture of the stoma occurred in two patients and required revision. Leakage at the appendicostomy site occurred in three patients, and two required a tighter plication. CONCLUSIONS: The technique is used to change the route of enema administration, and is only used in patients for whom bowel management with rectal enemas has been proven successful. The appendix must be preserved whenever possible in patients at risk for fecal incontinence.

Adolescent↗
PubMed1999

Long-term results of 45 thoracoscopic sympathicotomies for primary hyperhidrosis in children.

BACKGROUND/PURPOSE: Thoracoscopic sympathicotomy (TS) is successful in treatment of excessive hyperhidrosis of the upper limb after limited follow-up observation. The aim of the study was to assess for the first time long-term results of TS in children. METHODS: A total of 26 children (9 boys, 17 girls) aged 11 to 17 years with severe palmar or axillar hyperhidrosis underwent TS, and 19 patients were treated bilaterally. A total of 19 patients were observed after a median follow-up period of 16 years by questionnaire or clinical examination. RESULTS: Permanent relief from palmar hyperhidrosis was given in all examined patients. Twelve patients had compensatory and 12 patients gustatory sweating. Postoperatively, 1 subcutaneous emphysema and 1 temporary miosis and ptosis were noted. Eleven patients were fully satisfied with the result. Seven patients were only partially satisfied because of compensatory or gustatory sweating but would again undergo operation. One patient was not satisfied because of excessive compensatory sweating. CONCLUSIONS: TS is a safe and efficient procedure even after long-term follow-up. Severe palmar hyperhidrosis often starts in childhood; thus, early surgical treatment can improve social development. Compensatory and gustatory sweating are the most frequent and enduring side effects and should be mentioned in preoperative patient and parent information.

Adolescent↗
PubMed1991

Congenital heart disease, parental stress, and infant-mother relationships.

The effect of congenital heart disease on early social relationships was assessed by observing 42 infants with the disease and 46 healthy infants in a standardized laboratory setting with their mothers. Significantly fewer infants with congenital heart disease, in comparison with healthy peers, were considered to have secure relationships with their mothers. The quality of the infant-mother relationship in the group with congenital heart disease was not related to parents' reports of their own stress or psychologic well-being. Severity of illness did not have a direct effect on the quality of the infant-mother relationship, but securely attached infants showed more subsequent improvement in health than insecurely attached peers showed. Attention to the infant-mother relationship in clinical care may improve the social development of babies with congenital heart disease and may have positive effects on physical health as well.

Adult↗
PubMed1984

Neonatal ethanol withdrawal: characteristics in clinically normal, nondysmorphic neonates.

Although neonatal withdrawal syndrome is often noted in infants of narcotics addicts, ethanol withdrawal has been reported only among neonates with fetal alcohol syndrome. To examine the possibility that ethanol withdrawal occurs more widely and to identify its characteristics, the behavior of eight neonates born to women who drank a mean of 21 ounces of absolute alcohol per week during gestation was compared with that of two contrast groups: 15 infants whose mothers drank an equivalent amount but stopped in the second trimester, and 29 infants whose mothers never drank. None of the 52 infants had fetal alcohol syndrome, and all were in good health. Neurobehavioral evaluation 3 days postnatally compared the groups for the occurrence of characteristic signs of withdrawal from central nervous system depressants. Whereas there was no difference in the frequency of withdrawal symptoms among infants of mothers who never drank (mean 1.4) or of mothers who stopped drinking (mean 1.8), infants of mothers who continued to drink (mean 4.7) had significantly more tremors, hypertonia, restlessness, excessive mouthing movements, unconsolable crying, and reflex abnormalities. By interfering with state control and interactive behaviors, withdrawal could affect mother-infant bonding as well as the conditions that foster cognitive and social development.

Alcohol Drinking↗
PubMed1990

Fundamental issues in the care of homosexual youth.

The development of a homosexual identity spans the entire life cycle, but adolescence is a critical period in the lives of gay and lesbian persons. Various pre- and postnatal biologic and environmental factors are thought to determine sexual orientation early in life. An emerging homosexual identity may be reflected in youths' sexual attractions, fantasies, and cultural affiliations, as well as their behaviors. The adolescent experiences of homosexual persons profoundly affect health outcomes. The goals of care are to promote normal adolescent development, social and emotional well-being, and physical health. Comprehensive and coordinated educational, mental health, social, and medical services are recommended.

Adolescent↗
PubMed2003

Attention-deficit/hyperactivity disorder evaluation and diagnosis: a practical approach in office practice.

Attention-deficit/hyperactivity disorder is the most common neurobehavioral disorder of childhood, with most children maintaining symptoms of ADHD as adolescents and as adults. It is among the most common chronic conditions that primary care pediatricians see. Progress in brain imaging, genetics, neuropsychology, and molecular biology of ADHD reveals complex interactions between neurologic mechanisms, genetics, and environmental influences. Core behaviors seen in children with ADHD include hyperactivity, impulsivity, and inattention. The DSM-IV standard for diagnosis emphasized the importance of documenting that these behaviors occur at school and in the home, the chronicity of symptoms, and the connection between the behaviors and impairments in educational achievement or social development. The complex nature of this disorder is indicated by the observation that children and adolescents with ADHD have associated conditions, such as learning disorders, anxiety, oppositional behaviors, and depression. The AAP practice guideline on the evaluation and diagnosis of school-aged children with ADHD provides primary care pediatricians with a scientific foundation for assessing children with behavior and learning problems. Attention to accurate documentation of behaviors, coexisting learning disorders and mental health conditions, and the development of office practices that support the diagnostic process will ensure that children receive an appropriate and comprehensive assessment.

Adolescent↗