Summary
This study assessed distal femur and lumbar spine bone mineral density (BMD) Z-scores in children with cerebral palsy. BMD z-score was lower in non-ambulatory than in ambulatory children. ...Somewhat surprisingly, among ambulatory children, those with better walking abilities had higher BMD z-score than those with more impaired walking ability.
Introduction
Children with cerebral palsy (CP) have increased risk for low bone mineral density (BMD). The aim was to explore the difference in BMD at the distal femur and lumbar spine between ambulatory and non-ambulatory children with CP and the relationship between vitamin D status and BMD.
Methods
Fifty-one children (age range 8–18 years; 20 girls) with CP participated. Their BMD Z-scores were measured in the lumbar spine and the distal femur using dual X-ray absorptiometry, and 25-hydroxy-vitamin D (25-OHD) concentrations were measured in serum. Children with GMFCS level I–III were defined as ‘walkers’ while children with level IV–V were defined as ‘non-walkers.
Results
Non-walkers had lower mean BMD Z-scores (range −1.7 to −5.4) than walkers at all sites (range −0.8 to −1.5). Among walkers, BMD Z-scores at the distal femur were lower in those with GMFCS level II than with level I (
p
values < 0.004). A similar difference was found between the affected and unaffected limb in children with hemiplegia. Mean 25-OHD concentration was 45 nmol/L (SD = 18); lower in walkers (mean = 41 nmol/L; SD = 18) than in non-walkers (mean = 53 nmol/L; SD = 19;
p
= 0.041). There were no correlations between 25-OHD and BMD z-scores.
Conclusions
The main predictor of low BMD Z-scores in the distal femur was the inability to walk, but the results suggest that the degree of the neuromotor impairment may also be a significant predictor. Vitamin D status did not correlate with BMD z-scores.
Objective
To study the risk of cerebral palsy (CP) associated with placental weight, and also with placental weight/birthweight ratio and placental weight/birth length ratio.
Design
Population‐based ...cohort study.
Setting
Perinatal data in the Medical Birth Registry of Norway were linked with clinical data in the CP Register of Norway.
Population
A total of 533 743 singleton liveborn children in Norway during 1999–2008. Of these, 779 children were diagnosed with CP.
Methods
Placental weight, placental weight/birthweight ratio, and placental weight/birth length ratio were grouped into gestational age‐specific quartiles. Odds ratios (OR) with 95% confidence intervals (95% CI) for CP were calculated for children with exposure variables in the lowest or in the highest quartile, using the second to third quartile as the reference.
Main outcome measures
CP and CP subtypes.
Results
Overall, children with low placental weight had increased risk for CP (OR 1.5, 95% CI 1.2–1.7). Low placental weight/birthweight ratio (OR 1.2, 95% CI 1.0–1.4) and low placental weight/birth length ratio (OR 1.5, 95% CI 1.2–1.8) were also associated with increased risk for CP. In children born at term, low placental weight was associated with a twofold increase in risk for spastic bilateral CP (including both quadriplegia and diplegia) (OR 2.1, 95% CI 1.5–2.9). In children born preterm, high placental ratios were associated with increased risk for spastic quadriplegia.
Conclusions
Our results suggest that placental dysfunction may be involved in causal pathways leading to the more severe subtypes of CP.
Tweetable
Low placental weight increases the risk for cerebral palsy, especially for the spastic bilateral subtype.
Tweetable
Low placental weight increases the risk for cerebral palsy, especially for the spastic bilateral subtype.
Background: The prevalence of VTE is increasing in tertiary pediatric hospitals. Identification of high‐risk populations using uniform criteria is required to develop evidence‐based VTE prevention ...guidelines.
Objective: To develop a VTE risk prediction rule, the Peds‐Clot clinical Decision Rule (PCDR), to identify high‐risk children who were at increased risk of developing VTE.
Methods: This retrospective case‐control study developed the PCDR using a derivation cohort (173 cases, 346 controls) and validated it on a separate validation cohort (100 cases, 100 controls). A uniform data collection strategy was applied to derive both the samples. Conditional logistic regression analyses were used to develop a risk‐prediction model. Each significant predictor was assigned a score based on its beta coefficient and the PCDR was developed. ROC curves were derived to test the performance of the PCDR.
Results: Characteristics of derivation and validation cohorts were comparable. Six risk factors (positive blood stream infection, central venous catheter, direct admission to ICU/NICU, hospitalization for ≥ 7 days, immobilization for > 72 h, and use of birth control pills) formed the final risk prediction model (risk score range, 0.5–9.5). A risk score of 3 or more identified high‐risk children at a sensitivity of 70% and specificity of 80% and AUC of 0.852 (95% confidence interval, 0.814–0.890). The application of a risk score to the validation sample showed sensitivity 57% and specificity 88% and an AUC of 0.875 (95% confidence interval, 0.82–0.924).
Conclusion: Incorporation of the PCDR in routine clinical care can be an attractive strategy to identify high‐risk hospitalized children with a predisposition for VTE. The clinical utility of the PCDR needs validation in prospective studies.
Background
Survival of childhood cancer in high-income countries is approximately 80%, whereas in low-income countries, it is less than 10%. Limited access to health insurance in low-income settings ...may contribute to poor survival rates. This study evaluates the influence of health insurance status on childhood cancer treatment in a Kenyan academic hospital.
Methods
This was a retrospective study. All children diagnosed with a malignancy from 2010 until 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were abstracted from patient charts.
Results
Of 280 patients, 34% abandoned treatment, 19% died, and 18% had progressive or relapsed disease resulting in 29% event-free survival. The majority of patients (65%) did not have health insurance at diagnosis. Treatment results differed significantly between patients with different health insurance status at diagnosis; 37% of uninsured versus 28% of insured patients abandoned treatment, and 24% of uninsured versus 37% of insured patients had event-free survival. The event-free survival estimate was significantly higher for patients with health insurance at diagnosis compared with those without (
P
= 0.004). Of patients without health insurance at diagnosis, 77% enrolled during treatment. Among those patients who later enrolled in health insurance, frequency of progressive or relapsed disease and deaths was significantly lower (
P
= 0.013,
P
< 0.001, respectively), while the event-free survival estimate was significantly higher (
P
< 0.001) compared with those who never enrolled.
Conclusion
Childhood cancer event-free survival was 29% at a Kenyan hospital. Children without health insurance had significant lower chance of event-free survival. Childhood cancer treatment outcomes could be ameliorated by strategies that prevent treatment abandonment and improve access to health insurance.
The Energy Performance Certificate (EPC) allows building users to be informed and aware of the quality of the buildings in terms of energy needs. Additionally, the EPC includes a future for existing ...buildings, which is the incorporation of a Recommendation list of Measures (RLMs) to improve their energy performance in a cost-effective way. Which have risen the question if this tool can provide trustful Cost-effective recommendations due despite the uses of standardized inputs. This study focuses on estimating the impact of using measure ventilation rate, heating set point and airtightness on the profitability of the recommendations. The study is based on common dwelling in Norway, comparing results obtained with a Building Performance Simulation Software, following the Norwegian standard for energy certification and with the uses of measured ventilation rate, airtightness and real heating set points. The results show that the performance gap can be reduced significantly just by adopting these inputs, increasing the confidence on the RLMs and reducing the uncertainty of the investment.
Objective: To evaluate the prevalence of psychiatric symptoms and disorders associated with low birth weight. Design/study groups: A population based follow up study of 56 very low birthweight (VLBW: ...birth weight ⩽ 1500 g), 60 term small for gestational age (SGA: birth weight < 10th centile), and 83 term control (birth weight ⩾ 10th centile) children at 14 years of age. Outcome measures: Schedule for affective disorders and schizophrenia for school aged children, attention deficit/hyperactivity disorder (ADHD) rating scale IV, autism spectrum screening questionnaire, and children’s global assessment scale. Results: VLBW adolescents had a higher prevalence of psychiatric symptoms (46%) than controls (13%) (odds ratio (OR) 5.7, 95% confidence interval (CI) 2.5 to 13.0) and more psychiatric disorders (25%) than controls (7%) (OR 4.3, 95%CI 1.5 to 12.0), especially anxiety disorders. Although 25% of the VLBW adolescents had attention problems, ADHD was diagnosed in only 7%. Four VLBW adolescents had symptoms of Asperger’s disorder, and the VLBW group had a higher sum score than controls on the autism spectrum screening questionnaire. Although more SGA adolescents had psychiatric symptoms than controls (23% v 13%), the difference was not statistically significant. Results remained essentially the same when adolescents with low estimated intelligence quotient were excluded, and persisted after possible psychosocial confounders had been controlled for. Conclusion: VLBW, but not SGA adolescents, have a high risk of developing psychiatric symptoms and disorders by the age of 14, especially attention deficit, anxiety symptoms, and relational problems.
Infants with low birth weight are at increased risk of perinatal brain injury. Disruption of normal cortical development may have consequences for later motor, behavioural and cognitive development. ...The aim of this study was to measure cerebral cortical thickness, area and volume with an automated MRI technique in 15-year-old adolescents who had low birth weight. Cerebral MRI for morphometric analysis was performed on 50 very low birth weight (VLBW, birth weight ≤1500 g), 49 term small for gestational age births (SGA, birth weight <10th percentile at term) and 58 control adolescents. A novel method of cortical surface models yielded measurements of cortical thickness and area for each subject's entire brain and computed cross-subject statistics based on cortical anatomy. The cortical surface models demonstrated regional thinning of the parietal, temporal and occipital lobes in the VLBW group, whereas regional thickening was demonstrated in the frontal and occipital lobes. The areas of change were greatest in those with the shortest gestational age at birth and lowest birth weight. Cortical surface area and cortical volume were lower in the VLBW than in the Control group. Within the VLBW group, there was an association between surface area and estimation of the intelligence quotient IQ (IQest) and between cortical volume and IQest. Furthermore, cortical grey matter as a proportion of brain volume was significantly lower in the VLBW, but not in the SGA group compared with Controls. This observed reorganization of the developing brain offers a unique opportunity to investigate any relationship between changes in cortical anatomy and cognitive and social impairments, and the increase in psychiatric disorders that have been found in VLBW children and adolescents.
Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment. Study ...participants were parents of childhood cancer patients diagnosed between August 2013 and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9-1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days; P < .001). Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media.
Drugs can affect the cardiovascular (CV) system either as an intended treatment or as an unwanted side effect. In both cases, drug-induced cardiotoxicities such as arrhythmia and unfavourable ...hemodynamic effects can occur, and be described using mathematical models; such a model informed approach can provide valuable information during drug development and can aid decision-making. However, in order to develop informative models, it is vital to understand CV physiology. The aims of this tutorial are to present (1) key background biological and medical aspects of the CV system, (2) CV electrophysiology, (3) CV safety concepts, (4) practical aspects of development of CV models and (5) regulatory expectations with a focus on using model informed and quantitative approaches to support nonclinical and clinical drug development. In addition, we share several case studies to provide practical information on project strategy (planning, key questions, assumptions setting, and experimental design) and mathematical models development that support decision-making during drug discovery and development.
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