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Severe Disability (severe + disability)
Selected AbstractsCerebral palsy in southern Sweden I. Prevalence and clinical featuresACTA PAEDIATRICA, Issue 11 2001E Nordmark The prevalence, clinical features and gross motor function of children with cerebral palsy in southern Sweden were investigated. The study covered the birth year period 1990,1993, during which 65514 livebirths were recorded in the area. On the census date (1 January 1998), 68 366 children born in 1990-1993 lived in the area. The study comprised 167 children, 145 of them born in Sweden and 22 born abroad. The livebirth prevalence was 2.2 per 1000, and the prevalence including children born abroad was 2.4 per 1000. The distribution according to gestational age, birthweight and subdiagnoses was similar to that in earlier Swedish studies, except for a higher rate of dyskinetic syndromes in this study. Conclusion: The point prevalence of cerebral palsy was 2.4 and the livebirth prevalence was 2.2. Children born abroad had a higher prevalence and were more often severely disabled. Severe disability was often combined with associated impairments such as mental retardation, epilepsy and visual impairment. [source] Factors affecting vocabulary acquisition at age 2 in children born between 23 and 28 weeks' gestationDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2007Louise Marston MSc Language development is often slower in preterm children compared with their term peers. We investigated factors associated with vocabulary acquisition at 2 years in a cohort of children born at 28 weeks' gestation or less. For children entered into the United Kingdom Oscillation Study, language development was evaluated by using the MacArthur-Bates Communicative Development Inventories score, completed by parents as part of a developmental questionnaire. The effect of demographic, neonatal, socioeconomic factors, growth, and disability were investigated using multifactorial random effects modelling. Questionnaires were returned by 288 participants (148 males, 140 females). The mean number of words vocalized was 42 (SD 29). Multifactorial analysis showed only four factors were significantly associated with vocabulary acquisition. These were: (1) level of disability (mean words: no disability, 45; other disability, 38; severe disability, 30 [severe disability is defined as at least one extreme response in one of the following clinical domains: neuromotor, vision, hearing, communication, or other physical disabilities]; 95% confidence interval [CI] for the difference between no and severe disability 7- 23); (2) sex (39 males, 44 females; 95% CI 0.4-11); (3) length of hospital stay (lower quartile, 47; upper quartile, 38; 95% CI -12 to -4); and (4) weight SD score at 12 months (lower quartile, 39; upper quartile, 44; 95% CI 1,9). There was no significant association between gestational age and vocabulary after multifactorial analysis. There was no significant effect of any socioeconomic factor on vocabulary acquisition. We conclude that clinical factors, particularly indicators of severe morbidity, dominate the correlates of vocabulary acquisition at age 2 in children born very preterm. [source] Types and Patterns of Later-life MigrationGEOGRAFISKA ANNALER SERIES B: HUMAN GEOGRAPHY, Issue 3 2000William H. Walters This paper refines previous typologies of later-life mobility by explicitly evaluating the spatial migration patterns and household characteristics of retired American migrants. Migrants' lifecourse attributes (economic status, disability, presence of spouse), large-scale migration patterns (internal migration) and household characteristics (living arrangements, economic independence, residential independence) are used to identify three types of post-retirement mobility. The first type, amenity migration, has a distinctive spatial pattern that suggests a search for attractive climate and leisure amenities. The second type of mobility, assistance migration, can be traced to low income and the absence of a spouse in the household. It often results in residential and economic dependence , specifically, in co-residence with adult children or other labor force members. The third type of mobility, migration in response to severe disability and spouse absence, tends to result in nursing home residence. While amenity migration has long been associated with good health and favorable economic status, this analysis reveals that many disabled and lower-income retirees share the inmigration pattern typical of amenity migrants. In fact, amenity migration is the predominant type of mobility among those migrants with fewer than two unfavorable lifecourse attributes (low income, severe disability and spouse absence). Unlike previous lifecourse typologies, this study shows no clear relationship between moderate disability and co-residence with adult children. The results suggest that co-residence is primarily a strategy for reducing living costs rather than a means of coping with moderate disability. [source] Diabetes hyperglycemia and recovery from strokeGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1-2 2001Christopher S Gray Strokeis a major cause of death and severe disability in older people. Despite the burden of disease, there is still no safe, simple and proven medical therapy for the treatment of acute stroke. Advances in acute stroke treatment have been either consistently disappointing (neuroprotective therapy) or fraught with controversy regarding risk/benefit (thrombolysis), and attention is once again being directed towards physiological variables that may influence outcome. Both insulin-dependent and non-insulin-dependent diabetes mellitus are major risk factors for stroke. Diabetes mellitus has also been shown to be associated with increased mortality and reduced functional outcome after stroke. Hyperglycemia is a frequent finding following stroke and may reflect the metabolic stress of the acute event, so-called stress hyperglycemia, and/or underlying impaired glucose metabolism. Several large clinical studies have now demonstrated a positive association between a raised blood glucose and poor outcome from stroke; greater mortality and reduced functional recovery. What is not clear is to what extent hyperglycemia is a ,normal' physiological response to stroke or whether hyperglycemia per se increases cerebral damage in the acute phase. There are many potential mechanisms by which hyperglycemia can exert a harmful effect upon cerebral tissue and it is probable that an important relationship exists, not only between glucose and stroke outcome, but also between insulin and neuroprotection. It remains to be determined whether lowering and maintaining ,normal' glucose levels in the immediate aftermath of stroke, combined with the administration of insulin as an acute treatment, can modify this outcome. [source] A Pivotal Moment in 50 Years of Headache History: The First American Migraine StudyHEADACHE, Issue 5 2008Stewart J. Tepper MD Objective., To describe the magnitude and distribution of the public health problem posed by migraine in the United States by examining migraine prevalence, attack frequency, and attack-related disability by gender, age, race, household income, geographic region, and urban vs rural residence. Design., In 1989, a self-administered questionnaire was sent to a sample of 15,000 households. A designated member of each household initially responded to the questionnaire. Each household member with severe headache was asked to respond to detailed questions about symptoms, frequency, and severity of headaches. Setting., A sample of households selected from a panel to be representative of the US population in terms of age, gender, household size, and geographic area. Participants., After a single mailing, 20,468 subjects (63.4% response rate) between 12 and 80 Years of age responded to the survey. Respondents and nonrespondents did not differ by gender, household income, region of the country, or urban vs rural status. Whites and the elderly were more likely to respond. Migraine headache cases were identified on the basis of reported symptoms using established diagnostic criteria. Results., In total, 17.6% of females and 5.7% of males were found to have 1 or more migraine headaches per year. The prevalence of migraine varied considerably by age and was highest in both men and women between the ages of 35 to 45 years. Migraine prevalence was strongly associated with household income; prevalence in the lowest-income group (less than $10,000) was more than 60% higher than in the 2 highest-income groups (greater than or equal to $30,000). The proportion of migraine sufferers who experienced moderate to severe disability was not related to gender, age, income, urban vs rural residence, or region of the country. In contrast, the frequency of headaches was lower in higher-income groups. Attack frequency was inversely related to disability. Conclusions., A projection to the US population suggests that 8.7 million females and 2.6 million males suffer from migraine headache with moderate to severe disability. Of these, 3.4 million females and 1.1 million males experience 1 or more attacks per month. Females between ages 30 and 49 years from lower-income households are at especially high risk of having migraines and are more likely than other groups to use emergency care services for their acute condition. [source] Peripheral Neurostimulation for the Treatment of Chronic, Disabling Transformed MigraineHEADACHE, Issue 4 2003Charles A. Popeney DO Background.,Up to 5% of the general population suffers from transformed migraine. This study analyzes clinical responses of transformed migraine to cervical peripheral nerve stimulation. Methods.,Headache frequency, severity, and disability (Migraine Disability Assessment [MIDAS] scores) were independently measured in an uncontrolled consecutive case series of 25 patients with transformed migraine implanted with C1 through C3 peripheral nerve stimulation. All patients met International Headache Society (IHS) criteria for episodic migraine, as well as suggested criteria for transformed migraine, and had been refractory to conventional treatment for at least 6 months. Responses to C1 through C3 peripheral nerve stimulation were recorded. Results.,Prior to stimulation, all patients experienced severe disability (grade IV on the MIDAS) with 75.56 headache days (average severity, 9.32; average MIDAS score, 121) over a 3-month period. Following stimulation, 15 patients reported little or no disability (grade I), 1 reported mild disability (grade II), 4 reported moderate disability (grade III), and 5 continued with severe disability (grade IV), with 37.45 headache days (average severity, 5.72; average MIDAS score, 15). The average improvement in the MIDAS score was 88.7%, with all patients reporting their headaches well controlled after stimulation. Conclusions.,These results raise the possibility that C1 through C3 peripheral nerve stimulation can help improve transformed migraine symptoms and disability. A controlled study is required to confirm these results. [source] Idiopathic Hyperphosphatasia and TNFRSF11B Mutations: Relationships Between Phenotype and Genotype,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2003Belinda Chong Abstract Homozygous mutations in TNFRSF11B, the gene encoding osteoprotegerin, were found in affected members from six of nine families with idiopathic hyperphosphatasia. The severity of the phenotype was related to the predicted effects of the mutations on osteoprotegerin function. Introduction: Idiopathic hyperphosphatasia (IH) is a rare high bone turnover congenital bone disease in which affected children are normal at birth but develop progressive long bone deformities, fractures, vertebral collapse, skull enlargement, and deafness. There is, however, considerable phenotypic variation from presentation in infancy with severe progressive deformity through to presentation in late childhood with minimal deformity. Two recent reports have linked idiopathic hyperphosphatasia with deletion of, or mutation in, the TNFRSF11B gene that encodes osteoprotegerin (OPG), an important paracrine modulator of RANKL-mediated bone resorption. Materials and Methods: We studied subjects with a clinical diagnosis of IH and unaffected family members from nine unrelated families. Clinical, biochemical, and radiographic data were collected, and genomic DNA examined for mutations in TNFRSF11B. The relationship between the mutations, their predicted effects on OPG function, and the phenotype were then examined. Results: Of the nine families studied, affected subjects from six were homozygous for novel mutations in TNFRSF11B. Their parents were heterozygous, consistent with autosomal recessive inheritance. Four of the six mutations occurred in the cysteine-rich ligand-binding domain and are predicted to disrupt binding of OPG to RANKL. Missense mutations in the cysteine residues, predicted to cause major disruption to the ligand-binding region, were associated with a severe phenotype (deformity developing before 18 months age and severe disability), as was a large deletion mutation. Non-cysteine missense mutations in the ligand-binding domain were associated with an intermediate phenotype (deformity recognized around the age of 5 years and an increased rate of long bone fracture). An insertion/deletion mutation at the C-terminal end of the protein was associated with the mildest phenotype. Conclusion: Mutations in TNFRSF11B account for the majority of, but not all, cases of IH, and there are distinct genotype-phenotype relationships. [source] Assessing the skeleton in children and adolescents with disabilities: Avoiding pitfalls, maximising outcomes.JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2009A guide for the general paediatrician Abstract: Assessment of bone health of a young person with a severe disability is complex. Age of onset of disability, degree of physical limitation, nutritional status, calcium and vitamin D intake and pubertal progress all contribute to adult outcomes. Concomitant medical conditions may further adversely affect bone accrual. Bone quality, until growth is complete, must be interpreted in light of growth, height and puberty. For those children and adolescents who have disabilities where weight bearing is limited, satisfactory and reproducible measurements of bone density may be impossible to obtain. Fracture risk is dependent on the degree of immobilisation and on bone quality at any age. Meeting the goal of reducing extent and complications of adult osteoporosis is dependent upon an understanding of the nature and contribution of individual components of bone accrual, so that interventions can be appropriately targeted to optimise outcomes. [source] Quality of life and disability assessment in neuropathy: a multicentre studyJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2005Luca Padua Abstract Neuropathy can severely affect patients' quality of life (QoL), causing disability and decreased motor efficiency while modifying their perception of the external environment. We performed a large, multiperspective, and multimeasurement assessment using validated clinical measurements of disability and QoL. With regard to general disability, more than 10% of patients needed assistance to walk. With regard to arm disability, about 10% of patients had severe disability defined as impairment in carrying out simple tasks. General disability was similar both in polyneuropathic and multineuropathic groups, but arm disability appeared more severe in multineuropathic patients. QoL profiles were highly deteriorated in our sample with respect to the Italian normative sample. All age brackets were highly impaired except for older patients for whom the QoL picture was only mildly impaired with respect to Italian norms. We believe that our study provides reliable data on QoL in patients with neuropathies and that it may represent a quantitative step forward in understanding the disability of patients with neuropathy. [source] The elderly and undue influence inter vivosLEGAL STUDIES, Issue 2 2003Fiona R Burns An important demographic and social trend is becoming indisputably evident in the UK. The population is ageing, and a clearly discernible group of elderly persons is growing. As this trend continues, it will be necessary to reconsider the effectiveness and application of the law from the perspective of the elderly claimant. While it has been recognised that there must be a legal scheme to oversee the care and protection of persons, including elders, who are unable to care for their interests due to severe disability, it is becoming evident that even elders who are apparently healthy and able may be vulnerable. Undue influence inter vivos is a significant legal doctrine upon which elderly people have relied in recent times to set aside gifs, contracts and guarantees which they (or their representatives) have considered in hindsight were not in their best interests. This paper seeks to provide an analysis of and contribute to an understanding of the doctrine of undue influence from the perspective of the elderly claimant in the UK. The paper considers actual and presumed undue influence and the impact of the House of Lords decision in Royal Bank of Scotland plc v Etridge (No2). It will be argued that the law of undue influence inter vivos is in transition from a nineteenth-century doctrine which did not confer a special legal status on the elderly to one which is applied in the context of an increasing recognition that the events leading up to the transaction and the circumstances of the case may indicate that elders need the relief which the doctrine affords. Nevertheless, the transition to a modem system of undue influence for the elderly is incomplete. There remain outstanding issues which need consideration before it can be said that there is a comprehensive or logically coherent approach to elders and undue influence. [source] Sensory ataxic neuropathy dysarthria and ophthalmoparesis (SANDO) in a sibling pair with a homozygous p.A467T POLG mutationMUSCLE AND NERVE, Issue 2 2010John C. McHugh MRCPI Abstract Two siblings who developed fifth-decade-onset, concurrent progressive sensory ataxia, dysarthria, and ophthalmoparesis were found to be homozygous for the p.A467T mutation of the polymerase gamma (POLG) gene. The clinical course in both subjects was progression to severe disability. The enlarging spectrum of sensory ataxic neuropathies associated with mitochondrial DNA (mtDNA) instability and POLG mutations should be recognized and considered in the differential diagnosis of this unusual presentation. Muscle Nerve, 2010 [source] Neurological rehabilitation: a science struggling to come of agePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2002Valerie Pomeroy Abstract Over the last few decades, there have been considerable improvements in the outcome of stroke patients both as regards mortality and disability. At least some of these improvements can be attributed to better organization of services and improved rehabilitation. Many patients, however, remain severely disabled and we will need to develop new strategies in which the focus will be on reversing impairments rather than simply helping patients to adapt to unaltered impairments. For this to happen, neurological rehabilitation research will have to develop therapies that have a clearly defined rationale and are rooted in neurosciences, are clinically described, are addressed to a well-characterized target population and are evaluated using appropriate outcome measures. Few studies at present meet all these criteria. The recent revolution in our understanding of the nervous system as being soft-wired, of the potential for recovery through reorganization and of the central role of afferent information associated with normal activity is ground for optimism and indicates the direction in which future therapies should be sought. The paper considers some approaches to providing appropriate afferent information, including inputs such as that from electrotherapy, novel approaches to assisted activity and constraint-induced therapy. We are on the verge of a revolution in neurological rehabilitation. If we exploit the new understanding of the nervous system arising from basic neurosciences in developing and evaluating therapies we should be able to build on the achievements of the last few decades so that fewer of our patients have to carry the burden of severe disability. Copyright © 2002 Whurr Publishers Ltd. [source] Balance assessment in patients with peripheral arthritis: applicability and reliability of some clinical assessmentsPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2001Anne Marie Norén MSc PT Abstract Background and Purpose Many individuals with peripheral arthritis blame decreased balance as a reason for limiting their physical activity. It is therefore important to assess and improve their balance. The purpose of the present study was to evaluate the applicability and the reliability of some clinical balance assessment methods for people with arthritis and various degrees of disability. Method To examine the applicability and reliability of balance tests, 65, 19 and 22 patients, respectively, with peripheral arthritis participated in sub-studies investigating the applicability, inter-rater reliability and test,retest stability of the following methods: walking on a soft surface, walking backwards, walking in a figure-of-eight, the balance sub-scale of the Index of Muscle Function (IMF), the Timed Up and Go (TUG) test and the Berg balance scale. Results For patients with moderate disability walking in a figure-of-eight was found to be the most discriminative test, whereas ceiling effects were found for the Berg balance scale. Patients with severe disability were generally able to perform the TUG test and the Berg Balance Scale without ceiling effects. Inter-rater reliability was moderate to high and test,retest stability was satisfactory for all methods assessed. Conclusions Applicable and reliable assessment methods of clinical balance were identified for individuals with moderate and severe disability, whereas more discriminative tests need to be developed for those with limited disability. Copyright © 2001 Whurr Publishers Ltd. [source] NONIDENTITY, WRONGFUL CONCEPTION AND HARMLESS WRONGSRATIO, Issue 3 2005P. J. Markie Joel Feinberg and Dan Brock have independently developed a solution to the Problem of Nonidentity as it occurs in cases where a mother's negligent act of conception causes her child to be born with a severe disability. I display three problems in the Feinberg-Brock proposal and develop an alternative view that explains both cases of wrongful conception and additional instances of the Problem of Nonidentity presented by Derek Parfit and others. [source] Trends in the prevalence of disability and chronic conditions among the older population: implications for survey design and measurement of disabilityAUSTRALASIAN JOURNAL ON AGEING, Issue 1 2004Xingyan Wen A number of issues that are crucial for measuring disability and monitoring trends in disability prevalence include: (i) Why has a decline in the reported disability prevalence been accompanied by an increase in the reported prevalence of chronic diseases in some developed countries? (ii) Why have different trends (increases and decreases) in disability prevalence been reported among the Organisation for Economic Co-Operation and Development (OECD) countries? (iii) While the cross-nation comparison of level of disability prevalence is limited by the differences in survey design and methods, can trends in disability within each country be compared internationally on the basis of the existing survey data? The present paper discusses recent trends in reported prevalence of disability and chronic conditions among the older population and explores implications for population survey methods and measurement of disability. A comparison of examples from the USA and Australia indicates that the reported disability prevalence may be affected by whether the presence of any chronic conditions restricting everyday activity are included as part of the survey definition of disability. Focusing on long-term and severe disability may increase the comparability of disability estimates from different countries, including estimates from time series data. [source] Small for gestational age preterm infants and relationship of abnormal umbilical artery Doppler blood flow to perinatal mortality and neurodevelopmental outcomesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009Antonia W. SHAND Aim: To determine the outcomes of preterm small for gestational age (SGA) infants with abnormal umbilical artery (UA) Doppler studies. Methods: A retrospective cohort study of SGA singleton infants delivered between 24 and 32 weeks gestation at King Edward Memorial Hospital, Perth, who had UA Doppler studies performed within seven days of birth. Main outcomes assessed were perinatal mortality and morbidity, and neurodevelopmental outcomes at , 1 year of age. Outcomes were compared by normality of UA blood flow. Results: There were 119 infants in the study: 49 (41%) had normal UA Doppler studies, 31 (26%) had an increased systolic,diastolic ratio , 95th centile, 19 (16%) had absent end diastolic blood flow (AEDF) and 20 (17%) had reversed end-diastolic flow (REDF). Infants in the AEDF and REDF groups were delivered significantly more preterm (P = 0.006) and had lower birthweights (P < 0.001). Ninety four per cent (110 of 117) of live born infants survived. Neurodevelopmental follow-up at 12 months of age or more (median 24 months) was available on 87 of 108 (81%) of live children. Twenty-eight per cent (11 of 39) of fetuses who had had AEDF or REDF died or were classified with moderate or severe disability. There was no significant association between abnormality of UA blood flow, perinatal morbidity, perinatal mortality and neurodevelopmental disability after correction for gestational age. Conclusion: Fetuses that are SGA with abnormal UA Doppler studies remain at significant risk of perinatal death, perinatal morbidity and long-term neurodevelopmental disability, associated with their increased risk of preterm birth. [source] Predictive value of clinical and radiological findings in inflicted traumatic brain injuryACTA PAEDIATRICA, Issue 9 2010Pilvi Ilves Abstract Aims:, The aim of this study is to evaluate the value of early radiological investigations in predicting the long-term neurodevelopmental outcome of infants with inflicted traumatic brain injury (ITBI). Methods:, Clinical and radiological investigations of 24 infants with ITBI were performed during the acute phase of injury (1,3 days), and during the early (4 days up to 3 months) and late (>9 months) postinjury phases. The clinical outcome in survivors (n = 22) was based on the Rankin Disability Scale and the Glasgow Outcome Score. Results:, Five out of 24 infants (21%) had a poor neurodevelopmental outcome (death and severe disability), 17 infants (71%) had different developmental problems and 2 infants were normal at the mean age of 62 (54,70) (95% CI) months. A low initial Glasgow Coma Scale score of 8 or below [p < 0.05, OR 13.0 (1.3,133.3)], the development of brain oedema [p < 0.005, OR 13.0 (1.6,773)], focal changes in the basal ganglia during the acute phase [p < 0.01, OR 45 (2.1,937.3)], the development of new intracerebral focal changes early postinjury [p < 0.05, OR 24.1(1.0,559.1)], a decrease in white matter [p < 0.01, OR 33 (1.37,793.4)] and the development of severe atrophy before 3 months postinjury [p < 0.05, OR 24 (11.0,559.1)] were significantly correlated with a poor neurodevelopmental outcome. Conclusions:, Early clinical and radiological findings in ITBI are of prognostic value for neurodevelopmental outcome. [source] Growth, neurological and cognitive development in infants with a birthweight <501 g at age 5 yearsACTA PAEDIATRICA, Issue 9 2010E Rieger-Fackeldey Abstract Aim:, To determine growth, neurological and cognitive development at 5 years of preterm infants with birthweights <501 g born in three German tertiary perinatal centres between 1998 and 2001. Methods:, Structured neurological examination, the Gross Motor Function Classification Scale and the Kaufman-Assessment-Battery Test for Children. Results:, Of 107 infants, 48 received immediate life support (gestational age 25.2 weeks [21,30.7]; birth weight 435 g [290,500]) median [range]), 27 (56%) survived until follow-up [95% CI 39,69%], 19 (70%) could be tested. In few infants had catch-up growth taken place. Neurological test results were normal in five infants (26%) and mildly abnormal/severely abnormal in 11 (58%)/3 (16%) infants. Visual impairment was present in eight (42%), and hearing disability in three (16%). The mean mental processing composite (IQ) was 82 [50,104] (median [range]). Conclusion:, Of all resuscitated infants with a birthweight <501 g, 56% survived to school age. Of these, composite outcome score showed normal development or mild disability in one-half, and moderate or severe disability in the other half of them. Investigators should include such infants in studies and their reports should give specific information about them. [source] Cool heads: ethical issues associated with therapeutic hypothermia for newbornsACTA PAEDIATRICA, Issue 2 20092Article first published online: 1 DEC 200, Dominic J Wilkinson Abstract Hypothermia is the first treatment for newborns with hypoxic-ischaemic encephalopathy (HIE) with consistent evidence of a reduction in the risk of death or severe disability. This paper addresses a number of ethical and practical issues faced by clinicians as cooling moves from an experimental treatment into practice. These issues are not unique to therapeutic hypothermia. They include the extrapolation of evidence from trials to clinical care, as well as the impact of hypothermia on prognosis and withdrawal of life-sustaining treatment. Conclusion: Hypothermia is a promising new therapy, but further research will be necessary to help resolve some of the ethical concerns associated with its use in newborns with HIE . [source] Micronutrient status in children with cerebral palsyACTA PAEDIATRICA, Issue 8 2007Elisabet Hillesund Abstract Aim: To investigate micronutrient status in a group of children with cerebral palsy (CP). Methods: Thirty-six children with CP, aged 1.5,17 years, completed a 4-day food diary, underwent anthropometric measurements and delivered blood for analysis of micronutrient concentrations. Results: Low intake of iron, folate, niacin, calcium, vitamin E and vitamin D was common, even among those who were receiving nutritional supplements. Laboratory tests revealed low serum concentration of folate in eight children, ,-tocopherol in six children, ferritin in five children and pyridoxal-5-phosphate in three children. Two participants were low in zinc and one was low in selenium. Severely disabled children received nutrition supplements more frequently than those with less severe disability (71% vs.16%, p = 0.01). Tube feeding and use of nutrition supplements was reflected in higher concentrations of micronutrients in blood and serum. Conclusion: Low intake of micronutrients as well as low micronutrient concentrations was common in this heterogenic group of children with CP. Children with neurological disabilities should have their nutritional status evaluated in order to ascertain sufficient intake of micronutrients. [source] Antithrombotic management of ischaemic stroke and transient ischaemic attack in China: A consecutive cross-sectional surveyCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 8 2010Yi-Long Wang Summary 1.,Little is known about the prevention of secondary stroke in China. In the present study, we assessed the status of antithrombotic management of stroke patients in clinics across China. 2.,A cross-sectional survey was conducted in 19 urban neurological clinics. All subjects diagnosed with ischaemic stroke (IS) or transient ischaemic attack (TIA) were enrolled consecutively in the study. Face-to-face interviews were conducted by research assistants using questionnaires on the day of enrolment. The data recorded included demographic and clinical characteristics, medication and reasons for not using medication. Independent predictors for the prescription of antiplatelet drugs were determined using multivariate logistic regression models. 3.,Of the 2283 patients with IS or TIA enrolled in the study (34.7% women; mean ( ± SD) age 65.8 ± 11.6 years), 1719 (75.3%) had a prescription for antiplatelet therapy. Of the 108 patients with atrial fibrillation, only 14 (13.0%) were receiving warfarin therapy. The main independent factors significantly associated with being on antiplatelet therapy were having basic health insurance (odds ratio (OR) 1.47; 95% confidence interval (CI) 1.09,1.99), government insurance and labour insurance (OR 1.63; 95% CI 1.03,2.59) and a monthly income of > 500 yuan (US$66.70; OR 2.14; 95% CI 1.51,3.03). Being older (OR 0.70; 95% CI 0.50,0.99) and having a severe disability (OR 0.68; 95% CI 0.49,0.97) were associated with lower odds of receiving antiplatelet therapy. 4.,Based on the survey results, adherence to guidelines for antithrombotic management in neurological clinics in China is poor. The main reasons contributing to the less than optimal management of stroke patients include negative attitudes among neurologists, a lack of medical insurance, a lower income and being elderly and/or severely disabled. [source] | ||||||||||||||||||||||||||||