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5021. Relationship of patient and medical characteristics to health status in children and adolescents after the Fontan procedure. Full Text available with Trip Pro

summary scores were significantly lower than the US population sample for Physical Functioning (mean Z score, -0.47+/-1.19; P<0.001) and Psychosocial Functioning (-0.28+/-1.08; P<0.001). Parent-reported medical conditions and long-term and current medical problems explained the greatest amount of variation in the Physical Functioning scores. Parent-reported patient conditions, including behavior, learning, anxiety, and attention problems and depression, explained the greatest amount of variation (...) related in multivariable analysis to patient and medical characteristics obtained from medical record review. For 537 patients (mean age at study, 11.9 years; 60% male) with a median age at Fontan of 2.8 years (range, 0.7 to 14.6 years), parent-reported patient morbidities included deficits in vision in 33%, speech in 27%, and hearing in 7%, as well as problems with attention in 46%, learning in 43%, development in 24%, behavior in 23%, anxiety in 17%, and depression in 8%. Child Health Questionnaire

2006 Circulation

5022. Association between visual attention and mobility in older adults. (Abstract)

of a prospective study on mobility: a test of visual attention/processing speed; a performance mobility assessment; and self-reported measures of falls, falls efficacy, mobility/balance, and physical activity.Lower scores on visual attention/processing speed were significantly related to poorer scores on the performance mobility assessment, even after adjustment for age, sex, race, education, number of chronic medical conditions, cognitive status, depressive symptoms, visual acuity, and contrast sensitivity (P (...) =.04). Scores on the visual attention/processing speed test were unrelated to the self-reported measures of mobility.Results imply that visual attention impairment/slowed visual processing speed in older adults is independently associated with mobility problems. Interventions to reverse or minimize the progression of mobility dysfunction in older adults should take this common aging-related deficit in visual processing into account.

2004 Journal of the American Geriatrics Society

5023. Emotional, developmental, and behavioral health of American children and their families: a report from the 2003 National Survey of Children's Health. (Abstract)

of the World Health Organization.Answers to questions of interest from the 2003 National Survey of Children's Health were reported using estimates and SEs of rates. Statistical comparisons of rates with chi2 tests at the 0.05 level were made when relevant.The most commonly diagnosed problems among children 6-17 years of age were learning disabilities (11.5%), attention-deficit/hyperactivity disorder (8.8%), and behavioral problems (6.3%); among preschoolers, speech problems (5.8%) and developmental delay (...) (3.2%) were most common. One in 200 children was diagnosed with autism. In contrast, rates of parental concerns about emotional, developmental, or behavioral problems were much higher; for example, 41% of parents had concerns about learning difficulties and 36% about depression or anxiety. Children with developmental problems had lower self-esteem, more depression and anxiety, more problems with learning, missed more school, and were less involved in sports and other community activities

2006 Pediatrics

5024. Understanding co-morbidities affecting children with epilepsy. (Abstract)

Understanding co-morbidities affecting children with epilepsy. Co-morbid conditions frequently occur in childhood epilepsy and may significantly affect epilepsy and its treatment. Similarly, epilepsy and antiepileptic drugs (AEDs) may affect these associated conditions. Co-morbidities that have a significant association with childhood epilepsy include attention-deficit/hyperactivity disorder, autism, developmental disabilities, accidental injury, migraine, and depression/anxiety. Understanding (...) the interrelationships among co-morbidities, epilepsy, and their treatments is essential to optimal management of pediatric patients. Treatment should be individualized with consideration for specific co-morbidities and concomitant medications. Key treatment goals are to achieve seizure control and optimal physical and cognitive function using the simplest possible AED regimen. The clinician should consider whether an antiepileptic treatment can be chosen that also ameliorates the co-morbid condition. Newer AEDs

2004 Neurology

5025. Spectroscopic axonal damage of the right locus coeruleus relates to selective attention impairment in early stage relapsing-remitting multiple sclerosis. Full Text available with Trip Pro

attentional deficits. A consonant-vowel DL test was measured with and without attentional instructions. For the attentional condition, the test was digitally manipulated to cue automatically to the ear to be attended, thus allowing the obtention of both a linguistic lateralization index (LI) and an index of integrity of attentional shifts (ASI). Attentional impairment was demonstrated in 47.3% of the patients. Pontine NAA/Cr levels accounted for 39% of the ASI variability (beta = 0.65, P < 0.002) but did (...) Spectroscopic axonal damage of the right locus coeruleus relates to selective attention impairment in early stage relapsing-remitting multiple sclerosis. Lower levels of N-acetylaspartate (NAA), a marker of axonal damage, have been found in the normal-appearing white matter (NAWM) of relapsing-remitting multiple sclerosis (RRMS) patients with low physical disability. However, its relation to the clinical status of these patients remains unclear. We explored the association between NAA levels

2004 Brain

5026. Understanding disability in Tourette syndrome. (Abstract)

Understanding disability in Tourette syndrome. The aim of this study was to understand how children with Tourette syndrome (TS), with or without attention-deficit-hyperactivity disorder (ADHD) and/or obsessive-compulsive disorder (OCD), experience disability. Children seen at two TS centres were eligible for participation. Clinicians compiled baseline information and symptom severity rating scales. Parents completed the Child Health Questionnaire, a measure of physical and psychosocial health (...) . Seventy-one children (56 males, 15 females); mean age 11y 2mo [SD 3y 1mo], range 7-17y) were analyzed in the subgroups: TS only (n=20), TS+ADHD (n=22), TS+ADHD+OCD (n=18), and TS+OCD (n=11). Almost all psychosocial domain scores were significantly lower than national norms for the TS+ADHD and TS+ADHD+OCD subgroups (p<0.001). For the TS only subgroup, only the family activities domain was significantly affected. Psychosocial summary scores were 53.2 for norms, 54.4 for the TS only subgroup (ns), 41.4

2008 Developmental Medicine and Child Neurology

5027. Care of girls and women with Turner syndrome: A guideline of the Turner Syndrome Study Group. Full Text available with Trip Pro

to pregnancy and certain types of exercise. We recommend that puberty should not be delayed to promote statural growth. We suggest a comprehensive educational evaluation in early childhood to identify potential attention-deficit or nonverbal learning disorders. We suggest that caregivers address the prospect of premature ovarian failure in an open and sensitive manner and emphasize the critical importance of estrogen treatment for feminization and for bone health during the adult years. All individuals

2007 Journal of Clinical Endocrinology and Metabolism

5028. Retropharyngeal Abscess

cefuroxime). [ ] Complications . Mediastinitis. . . Epidural abscess. . . Erosion of the second and third cervical vertebrae. Cranial nerve IX and/or XII deficits. Septic thrombosis of the jugular vein or haemorrhage secondary to erosion into the carotid artery, Prognosis [ ] Prognosis is generally good if the condition is diagnosed early, is managed promptly and effectively and if no complications occur. Mortality rate may be as high as 40-50% if any serious complications do occur. Did you find (...) with high fever, agitation, neck pain, malaise, fever, dysphagia, drooling, cough, respiratory distress, and stridor. [ ] There is a stiff neck with the head tilted to one side. There is a smooth bulge on one side of the midline of the posterior pharyngeal wall. Associated signs include tonsillitis, peritonsillitis, pharyngitis and otitis media. Symptoms in adults: sore throat, fever, dysphagia, neck pain, and dyspneoa. Physical signs in adults: posterior pharyngeal oedema, neck stiffness, cervical

2008 Mentor

5029. Puberty - Normal and Abnormal

and European Guidelines. You may find one of our more useful. In this article In This Article Normal and Abnormal Puberty In this article See also separate and articles. Puberty is the process by which a child's body develops into an adult body and becomes capable of reproduction. It involves physical growth and sexual and psychosocial maturation. Growth accelerates in the first half of puberty and stops at the completion of puberty. Puberty usually begins between 8 and 14 years of age in girls and 9 (...) , on average, spermarche occurs at about the same time as menarche with attainment of reproductive capability being achieved at about the same age. Normal puberty [ ] The onset of puberty is signalled by the secretion of increasing frequency and amplitude of pulses of gonadotrophin-releasing hormone (GnRH). Activation of the hypothalamic-pituitary-gonadal system leads to the changes of puberty, via production of GnRH, luteinising hormone (LH) and follicular-stimulating hormone (FSH), and subsequently

2008 Mentor

5030. Shoulder Pain

) and affects people aged 30-60. It is a self-limiting condition as the calcium will eventually resorb but may take many years. Glenohumeral disorders most often presents between the ages of 40 to 65 years, whereas is most common in those aged 60 years or older. Adhesive capsulitis (frozen shoulder) and arthritis often present with a history of non-adhesive capsulitis symptoms, cause deep joint pain and restrict activities such as putting on a jacket - because of impaired external rotation. Adhesive (...) or avoid overhead activities; attention to any contributing factors; medication for pain relief, including corticosteroid injection. If symptoms don't settle quickly or are severe initially, physiotherapy focused on the specific cause is indicated. [ ] Rotator cuff disorders: Advise modification of activities, including reducing precipitating movements (eg, reaching overhead). Offer analgesia; paracetamol with or without codeine, or an oral . Refer to physiotherapy with the goal of optimising shoulder

2008 Mentor

5031. Screening for Fragile X Syndrome

behaviours, emotional lability and aggressive or self-aggressive behaviours. Affected girls and women are more likely to have problems with shyness or social withdrawal. In some cases, those affected may also have a diagnosis of attention deficit hyperactivity disorder (ADHD) or an autism spectrum disorder. Around 30% of affected males have autism and as many again may have an autism spectrum disorder. [ , ] Other symptoms may include hand-flapping, repetitive actions, clumsiness, avoidance of gaze (...) and European Guidelines. You may find one of our more useful. In this article In This Article Fragile X Syndrome In this article Fragile X syndrome (FXS) is an inherited condition which presents with typical behavioural, developmental and physical problems. Genetics [ , ] FXS is the most common cause of sex-linked, general learning disability. It is one of a number of repeat expansion disorders. In DNA coding it is common to see repeated sequences of the nucleotides that make up the genetic strand. In FXS

2008 Mentor

5032. Recurrent Abdominal Pain in Children

factors for recurrent abdominal pain Parental anxiety in the first year of life is associated with early RAP. Children with a parent with gastrointestinal problems are more likely to have RAP. There is an association with a history of illness in siblings [ ] . Attention deficit hyperactivity disorder (ADHD) is associated with a two-fold increase in RAP [ ] . Being bullied is associated with an increase in all health complaints in children, including RAP [ , ] . Child abuse, including sexual abuse (...) 2014 Mar 13. ; Pain, disability, and symptoms among siblings of children with functional abdominal pain. J Dev Behav Pediatr. 2007 Feb28(1):2-8. ; The association of bullying and health complaints in children with attention-deficit/hyperactivity disorder. Postgrad Med. 2010 Sep122(5):62-8. doi: 10.3810/pgm.2010.09.2202. ; Bully victims: psychological and somatic aftermaths. Psychiatry (Edgmont). 2008 Jun5(6):62-4. ; Unexplained gastrointestinal symptoms after abuse in a prospective study

2008 Mentor

5033. Poverty and Mental Health

. [ ] Child poverty Because of the social decline associated with mental illness, research has looked at mental health of young people who are still dependent upon their parents for their economic position: Most surveys suggest an increased rate of mental health problems in children in families with low incomes compared to those in better-off households (1 in 6, compared to 1 in 20). [ ] This difference is most exaggerated in boys, with double the risk. Attention deficit hyperactivity disorder (ADHD (...) a heavy social stigma. Surveys have shown a widespread reluctance amongst employers to take on employees with a disability at any level and that applies especially to those with a mental disability. Of people actively seeking employment, the rate of unemployment is much lower amongst those without any medical problems than it is amongst those with physical disability. Those with mental disability face even greater difficulty. It is more difficult to hold down a job - a person with mental illness may

2008 Mentor

5034. Premature Babies and their Problems

and numerous and so a range of tests was used. The preterm children had a higher incidence of motor impairment and this affected how well they did at school even when their intelligence was normal. Over 30% had developmental co-ordination disorder (DCD) compared with 6% of classmates. The preterm children were significantly more likely to be overactive, easily distractible, impulsive, disorganised and lacking in persistence. They also tended to overestimate their ability. Attention deficit hyperactivity (...) disorder (ADHD) was found in 8.9% of the preterm children and 2% of controls. The children who had been the most premature were not necessarily those with the lowest scores. Although major disabilities have been reduced, the levels of disability tested in this study did not seem lower than those found in children born 10 or 20 years earlier, despite improvements in care of the newborn. Brain development IUGR may be very important in terms of early growth of the brain, leading to poor IQ

2008 Mentor

5035. Lead Poisoning

is a relative rarity but the condition should be on the list in patients presenting with diffuse abdominal pain. Other conditions which may need to be considered include: . Acute memory loss. . Encephalopathies. . . . General learning disability (includes learning disorder, developmental delay, language disorder). or pervasive developmental disorder. Organic solvent poisoning. Other . Radial mononeuropathy and other peripheral neuropathies. . , acute and chronic. . . Investigations [ , ] Laboratory tests (...) . Epidemiology Incidence Lead poisoning is a lot less common than it used to be with less use in petrol, paints or cosmetics and generally improved housing.The effect of long-term elevated lead levels on children is of particular concern and can lead to a reduction of IQ and to disruptive behaviour. A survey by Public Health England's Health Protection Agency of lead levels in children was concluded in 2012 but the results have yet to be published. In the interim, a study of the incidence of high lead levels

2008 Mentor

5036. Kernicterus

, hypertonia of extensor muscles with arched back and hyperextended neck, bulging fontanelle and seizures. Later neurological features include sensory hearing loss, intellectual disability, muscle rigidity, speech difficulties, seizures and movement disorder. Chronic bilirubin encephalopathy This develops over the first few years of life. The first phase occurs in the first year of life with hypotonia, hyperreflexia and delayed physical milestones. The tonic neck reflex can also be present. In children (...) irreversible athetoid cerebral palsy, and speech, visual, auditory and other sensori-processing disabilities. [ ] Prevention Prevention of kernicterus is based on the identification and adequate treatment of hyperbilirubinaemia in neonates. Attention needs to be paid to any baby with hyperbilirubinaemia, but particularly to those who are premature, to those who are known to have a family history of G6PD deficiency or other disorders that may produce neonatal haemolysis, and to any baby seeming to develop

2008 Mentor

5037. Intrauterine Growth Restriction

dysfunction. Behavioural problems: hyperactive behaviour, attention deficit hyperactivity disorder. Poor perceptual performance, poor visuo-motor perception. They are also more susceptible to develop adult-onset diseases in their infancy and adolescence - eg, diabetes, hypertension, obesity, metabolic syndrome, coronary heart disease. See separate article for further information. Prognosis [ ] IUGR neonates are prone to complications after birth, including perinatal asphyxia, meconium aspiration (...) BMI less than 20, weight less than 45 kg or more than 75 kg. Assisted reproductive technologies. Pregnancy: moderate to heavy physical work, severe maternal starvation, poor weight gain, high-altitude and maternal hypoxia, poor medical care. Maternal medical disorders - eg, asthma, cyanotic congenital heart disease, hypertensive disorders, pre-eclampsia, diabetes associated with vasculopathy, chronic kidney disease, systemic lupus erythematosus, antiphospholipid syndrome, sickle cell disease

2008 Mentor

5038. Insomnia Full Text available with Trip Pro

other . In this article In This Article Insomnia In this article Normal sleep requirements vary widely, and there is no standard definition of what is normal. [ ] The amount of sleep required tends to decrease with age. Insomnia is a condition of unsatisfactory sleep, either in terms of sleep onset, sleep maintenance or early waking. Because it is a disorder that subsequently impairs daytime well-being and subjective abilities and functioning, it has been termed a "24-hour disorder (...) ". [ ] It is a subjective condition. Insomnia may be associated with fatigue, mood disturbances, problems with interpersonal relationships, occupational difficulties and a reduced quality of life. It has a negative impact on both physical and mental health. [ , ] Epidemiology [ ] Estimates of prevalence of insomnia vary according to the definition used. It is thought to affect about a third of the general population in the UK. [ , ] Prevalence is between 1.5 and 2 times higher in women than in men. Insomnia is a long

2008 Mentor

5039. Infantile Hypercalcaemia (Williams' Syndrome)

therapies is also beneficial. Infants often benefit from feeding therapy. Psychological and psychiatric evaluation should guide therapy for the individual. Referral to a nephrologist is necessary for management of nephrocalcinosis and persistent hypercalcaemia and/or hypercalciuria. Pharmacological Behavioural counselling and psychotropic medication are often used to manage behavioural problems, especially attention deficit hyperactivity disorder and anxiety. Treatment of hypercalcaemia may include diet (...) profile: Strength - verbal short-term memory and language. Very poor visuospatial construction. Unique personality: Overly friendly and empathetic with excessive sociability. [ ] Generalised anxiety, specific phobias and attention deficit. Growth abnormalities: Prenatal growth deficiency with failure to thrive in infancy. Rate of linear growth is less than normal with resulting short stature. Endocrine abnormalities: Idiopathic hypercalcaemia and hypercalciuria. Hypothyroidism and early puberty

2008 Mentor

5040. Neck Pain (Cervicalgia) and Torticollis

of neurological symptoms and signs in the upper limbs. Spinal cord compression in the neck may lead to lower limb problems and abnormal gait, as well as bladder and bowel disturbance. Nonspecific neck pain Symptoms of nonspecific neck pain vary with different physical activities and over time. It is aggravated by particular movements, posture and activities, and relieved by others. Pain is often, but not always, aggravated by exercise and relieved by rest. It radiates in a non-segmental distribution (...) , refer the patient urgently for investigations and further assessment. Manage any comorbidities, such as other chronic pain conditions, chronic physical conditions, anxiety and mood disorders. A single cervical manipulation has been shown to be capable of producing immediate and short-term benefits for mechanical neck pain [ ] . However, not all manipulative techniques have the same effect. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain

2008 Mentor

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