Natural sequence of recovery from child post-traumatic amnesia: A retrospective cohort study

The aim of this study was to determine the sequence of skills recovery during post-traumatic amnesia (PTA) in children with moderate to severe traumatic brain injuries (TBIs). Setting: Fifty children aged 8 to 15 years consecutively admitted to a children’s hospital with TBI and PTA>24 were tested in a retrospective cohort study where the main measure was the Westmead PTA Scale (WPTAS). The group analyses show that orientation to time took longer to recover than orientation to person and place, but not memory, while the individual analyses revealed that when orientation to time was grouped with memory, 94% of children recovered orientation to person and place before orientation to time and memory (examiner and pictures). Correlation coefficients between age and the number of days taken to recover skills were not found to be significant. It was established that, in terms of the natural sequence of skills recovery in children aged 8 to 15 years following moderate to severe TBI, recovery of orientation to time is more closely aligned to memory than to orientation to person and place. It was also established that WPTAS items are developmentally appropriate for children aged 8 to 15 years who have sustained TBI. These findings are clinically important because monitoring recovery from PTA both impacts the rehabilitation offered to individuals during acute care and aids discharge planning.     

Psychiatric Comorbidity and Functional Status in Adult Patients with Asthma

The goals of this study were to characterize the frequency of psychiatric disorders among patients with asthma, and to compare differences in functional status among asthma patients with and without comorbid depression and anxiety disorders. Fifty patients with confirmed asthma were administered the Diagnostic Interview Schedule for DSM-III-R and completed the Medical Outcomes Study Short Form-36 Health Survey. Patients with asthma had a higher lifetime prevalence of major depression, panic disorder, and agoraphobia, but a lower prevalence of social phobia, compared to lifetime prevalence rates for psychiatric disorders in a national probability sample. Participants with comorbid asthma and major depression had poorer physical and mental health functioning and health perception than did asthma patients without major depression. The results suggest that certain psychiatric disorders are common among patients with asthma and that depression is associated with significantly increased functional morbidity. These findings underscore the need for the appropriate detection and treatment of these comorbid conditions.     

一氧化氮在支气管哮喘中的作用

一氧化氮是一种具有广泛并且复杂生物活性的小分子化合物,参与多种病理生理过程。众多研究表明,其在支气管哮喘的发病机制中有着多种复杂的双相调节作用。本文通过对一氧化氮在支气管哮喘发病机制中的调节作用研究的历史回顾和现状的阐述,探讨辩证法与系统论在科学研究中的应用。     

儿童支气管哮喘诊断的几点思考

支气管哮喘（以下简称哮喘）是小儿常见的慢性气道疾病。5岁及以下儿童哮喘的诊断极为困难,是富有挑战性的;因为诊断只能依靠临床判断、症状评价和体征分析。病毒感染所至的喘息在婴幼儿期很常见,与哮喘鉴别较困难。目前还没有诊断婴幼儿期哮喘的特异检测手段和方法,因此诊断需要综合考虑,包括反复喘息的类型、特异体质病史、哮喘危险因素、长期随访、广泛鉴别诊断和观察对支气管舒张剂及抗炎治疗的反应。     

做好哮喘控制工作利国又利民

本文结合我院哮喘教育管理工作的成绩和经验,系统地阐述了做好哮喘控制工作的重要意义,包括减少哮喘发作减轻患者痛苦;提高哮喘患者生命质量;降低医疗费用;减轻社会和家庭负担;减少误工误学,保护社会生产力;有助于解决"看病贵"问题和构建和谐的医患关系等。     

搞好哮喘控制是一项长期而艰巨的任务

哮喘在全世界是一个严重的公共卫生问题。当哮喘未控制时,哮喘可以影响患者的日常生活质量,甚至可以致命。搞好哮喘控制工作是一项长期而艰巨的任务,在实际工作中应推广以“哮喘临床控制”为核心的哮喘治疗循环模式,即评估患者的哮喘控制水平、治疗并达到哮喘控制、监测并维持哮喘控制。     

过敏性鼻炎和支气管哮喘治疗的统一性与整体观

过敏性鼻炎和支气管哮喘是常见的上下气道联合炎性疾病。尽管其治疗手段多样,效果良好,但由于目前对过敏性鼻炎的认识及重视程度不够,治疗现状并不乐观。从哲学上辩证统一的认识过敏性鼻炎和支气管哮喘的治疗,并以现代整体医学的观点分析两者的同一性,为临床实践中针对两者进行整体治疗提供理论依据。     

Performance-based and parent ratings of attention in children treated for a brain tumor: The significance of radiation therapy and tumor location on outcome

Children are at increased risk for cognitive difficulties following the diagnosis and treatment of a brain tumor. Radiation therapy (RT) and tumor location are commonly-cited predictors of neurocognitive functioning. Disruptions to foundational neurocognitive processes such as attention, working memory, and processing speed underlie declines on measures of general intellectual functioning. While several studies have examined visual sustained attention in pediatric brain tumor patients, auditory sustained attention has yet to be examined. This study employs a longitudinal design to examine performance-based and parent ratings of attention in children undergoing surgical resection of a brain tumor (n = 29) and treated with (n = 11) or without (n = 18) RT at 6.79 months post-surgery (baseline) and then again at 30.56 months post-surgery (follow-up). The measures include an auditory continuous performance test (CPT) and parent ratings of attention and hyperactivity on a behavior rating scale. Ultimately, children treated with and without RT performed similarly on performance-based and parent ratings of attention. However, the performance on the auditory CPT differed according to tumor location, with children with infratentorial tumors committing more inattention and inhibitory control errors compared to children with supratentorial tumors. Parent ratings did not differ according to tumor location, and parent ratings and auditory sustained attention performance are not significantly correlated. The findings are interpreted in the context of neurocognitive and brain development.     

Wisconsin Card Sorting Test embedded validity indicators developed for adults can be extended to children

Past studies have examined the ability of the Wisconsin Card Sorting Test (WCST) to discriminate valid from invalid performance in adults using both individual embedded validity indicators (EVIs) and multivariate approaches. This study is designed to investigate whether the two most stable of these indicators—failures to maintain set (FMS) and the logistical regression equation S-B_LRE—can be extended to pediatric populations.

The classification accuracy for FMS and S-B_LRE was examined in a mixed clinical sample of 226 children aged 7 to 17 years (64.6% male, MAge = 13.6 years) against a combination of established performance validity tests (PVTs).

The results show that at adult cutoffs, FMS and S-B_LRE produce an unacceptably high failure rate (33.2% and 45.6%) and low specificity (.55–.72), but an upward adjustment in cutoffs significantly improves classification accuracy. Defining Pass as <2 and Fail as ≥4 on FMS results in consistently good specificity (.89–.92) but low and variable sensitivity (.00–.33). Similarly, cutting the S-B_LRE distribution at 3.68 produces good specificity (.90–.92) but variable sensitivity (.06–.38). Passing or failing FMS or S-B_LRE is unrelated to age, gender and IQ.

The data from this study suggest that in a pediatric sample, adjusted cutoffs on the FMS and S-B_LRE ensure good specificity, but with low or variable sensitivity. Thus, they should not be used in isolation to determine the credibility of a response set. At the same time, they can make valuable contributions to pediatric neuropsychology by providing empirically-supported, expedient and cost-effective indicators to enhance performance validity assessment.     

Quality of Life and Adjustment in Youths with Asthma: The Contributions of Family Rituals and the Family Environment

This cross‐sectional study explored the relationships among family ritual meaning, cohesion, conflict, and health‐related quality of life (both specific to chronic health conditions and in general), and the emotional and behavioral problems reported by youths with asthma. Participants included 149 Portuguese children and adolescents between the ages of 8 and 18 who had been diagnosed with asthma and attended outpatient services at three public hospitals. The results showed that stronger family ritual meaning predicted a more positive family environment (i.e., higher cohesion levels and lower conflict levels), better health‐related quality of life, and fewer emotional and behavior problems in youths. Furthermore, family cohesion and conflict mediated the links between family ritual meaning and health‐related quality of life, and emotional and behavioral problems. These results did not change after controlling for participant age, gender, and asthma severity. The findings of this study suggest that family ritual meaning contributes to the adaptation of youths with asthma via its positive association with the family environment. The implications for multicontextual interventions with families are briefly discussed with regard to the positive role of family rituals and of their potential as a modifiable factor in families with increased health challenges.