Promoting Time in Nature for Children: Investigating the Role of Provider Nature Relatedness

Research has shown that time spent in and exposure to natural environments has numerous benefits for children, both physical and mental. At the same time, children face many barriers to obtaining time in the outdoors and today\u27s youth spend less time outside than previous generations. Initiatives such as health care provider prescriptions for outdoor activity aim to encourage exposure to nature as a health intervention for children. In order to enhance the potential for success of programs such as these, factors influencing their implementation need to be assessed. This study aims to explore the impact that provider connectedness to nature, as measured by a validated connectedness to nature scale, has on the likelihood of utilizing a nature prescription program. This study is of descriptive correlational design utilizing a convenience sample of providers who participated in a park prescription program in the state of Vermont. Participants completed a survey that included a Nature Relatedness (NR) scale. These scores and responses were then analyzed in relationship to the number of nature prescriptions written during the program. Data analysis includes descriptive statistics, Pearson\u27s r and Spearman\u27s r and Multivariate MANOVA. Results from this study do not indicate a relationship between provider NR and utilization of a nature prescription program. Data from this study indicates that programs utilized by providers to promote time in nature, such as the park prescription program, may enhance provider awareness of the issue and likelihood to address the issue with their patients. This is an important finding for further initiatives aimed at increasing children\u27s time in nature through their primary care providers

Comparison of the canopy fauna of silver fir (Abies alba) and spruce trees (Picea abies)

Natürlicherweise war die Tanne (Abies alba) in den bayerischen Wäldern mit Anteilen von bis zu 20% vertreten (nach ROTHE & BORCHERT 2003). Seit 150 Jahren aber gehen die Tannenbestände in drastischem Ausmaß zurück, was nicht nur auf die wachsende Schadstoffbelastung der Luft, sondern auch auf hohe Wildbestände und die einseitige Waldbewirtschaftung zugunsten der Fichte (Picea abies) zurückzuführen ist. In jüngster Zeit wird seitens der Staatsforstverwaltung angestrebt, der Tanne ihren angestammten Platz in unseren Wäldern wieder einzuräumen (BAYERISCHES STAATSMINISTERIUM FÜR LANDWIRTSCHAFT UND FORSTEN 1993). Es stellt sich die Frage, welchen Beitrag die Tanne zur Biodiversität in Wäldern und speziell in Mischwäldern leistet. Frühere Untersuchungen beschrieben die Tannenfauna als artenarm im Vergleich mit anderen Baumarten (BÖHME 2001, BUCKING 1998), allerdings wurde die Kronenfauna dabei stets vernachlässigt. Da aber 90% eines Hochwaldes über der Reichhöhe eines Menschen liegt (BUßLER et al. 2004), sind Untersuchungen im Kronenraum höheren Straten für eine umfassende Aussage über die Fauna auf Bäumen von großer Bedeutung. Bis jetzt gibt es trotz des generell wachsenden Interesses an der Kronenfauna keine umfassenden Untersuchungen an Tanne (MÜLLER & GOSSNER 2004). Mit dem hier vorgestellten Projekt sollte begonnen werden, die Wissenslücke um die Insektenfauna in Tannenkronen zu schließen. Den xylobionten Käfern galt besondere Aufmerksamkeit, da sie als eine baumartengebundene Insektengruppe für vergleichendeUntersuchungen sehr gut geeignet und sowohl taxonomisch als auch ökologisch gut untersucht sind. Daneben wurden Heteroptera, Neuropterida und Hymenoptera bearbeitet .In the context of forest ecological support programs of silver fir as the “Tree of the year 2004”, the relative contribution of fir and spruce trees to forest insect diversity is compared in present investigation. Previous studies had postulated a species poor community on fir. Insects were sampled by flight-interception traps at 6 different sites in Bavaria in the year 2004. Traps were installed in the centre of the canopy of a total of 30 trees (>100 years) of each species and emptied monthly from April through October. Specimens of Coleoptera, Hymenoptera, Heteroptera and Neuropterida were enumerated. A total of 20.562 specimens was collected, with Coleoptera being the dominant order. The comparison between fir and spruce revealed significant differences in numbers of specimens of Hymenoptera, Heteroptera and Neuropterida. Regarding saproxylic beetle species, a significant difference between fir and spruce was found at one site (Feuchtwangen) only. The Sørensen index values showed a strong similarity between the mountainous sites (Inzell, Reit im Winkel, Nationalpark Bayerischer Wald). Several species in the samples are listed in the German Red Data Book of endangered and threatened species. Most of these were sampled on fir, e.g. Episernus striatellus (RL-D 0) and Euglenes pygmaeus (RL-D 1)

Clonazepam Treatment of Pathologic Childhood Aerophagia with Psychological Stresses

The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on the management of pathologic childhood aerophagia (PCA) with psychological stresses (PS), but not with mental retardation. Data from 22 consecutive PCA patients with PS (aged 2 to 10 yr), who had been followed up for over 1 yr, were reviewed. On the basis of videolaryngoscopic views, the authors observed that the pathologyof aerophagia was the result of reflex-induced swallowing with paroxysmal openings of the upper esophageal sphincter due to unknown factors and also observed that these reflex-induced openings were subsided after intravenous low dose benzodiazepine administration. Hence, clonazepam was administered to treat paroxysmal openings in these PCA patients with PS. Remission positivity was defined as symptom-free for a consecutive 1 month within 6 months of treatment. The results of treatment in 22 PCA patients with PS were analyzed. A remission positive state was documented in 14.3% of PCA patients managed by reassurance, and in 66.7% of PCA patients treated with clonazepam (p=0.032). Thus, clonazepam may produce positive results in PCA with PS. Future studies by randomized and placebo-controlled trials are needed to confirm the favorable effect of clonazepam in PCA

Problems related to levodopa-carbidopa intestinal gel treatment in advanced Parkinson's disease

Background: Continuous levodopa-carbidopa intestinal gel (LCIG) diminishes daily off time and dyskinesia in patients with advanced Parkinsons disease (PD). Complications are common with percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG-J). Aim of the Study: To report the clinical outcome of LCIG in patients with advanced PD in the years 2006-2014 at Helsinki University Hospital. Patients and Methods: Levodopa-carbidopa intestinal gel treatment started following PEG-J placement in patients with advanced PD after successful in-hospital LCIG trial with a nasojejunal tube. Demographics, PEG-J procedures, discontinuation of LCIG, complications and mortality were retrospectively analyzed. Results [mean (SD)]: Sixty patients with advanced PD [age 68(7) years; duration of PD: 11(4) years] had LCIG treatment for 26(23) months. The majority of patients with advanced PD were satisfied with the LCIG treatment. For 51 patients (85%), the pump was on for 16hr a day, and for nine patients (15%) it was on for 24hr a day. After 6months, the levodopa-equivalent daily dose (LEDD) had increased by 30% compared to pre-LCIG LEDD. Sixty patients underwent a total of 156 PEG-J procedures, and 48 patients (80%) had a total of 143 complications. Forty-six patients (77%) had 119 PEG-J or peristomal complications, and 22 patients (37%) had a total of 25 other complications. The most common complications were accidental removal of the J-tube in 23 patients (38%) and 5% weight loss in 18 patients (30%). Fifteen patients discontinued the LCIG after 21 (21) months. At the end of the follow-up period of 33(27) months, 38 patients were still on LCIG and nine (15%) had died. Conclusion: Most patients were satisfied with LCIG treatment. A few patients lost weight whereas the majority had complications with PEG-J. When LCIG treatment is carried out, neurological and endoscopic units must be prepared for multiple endoscopic procedures.Peer reviewe

Percutaneous endoscopic gastrostomy in children

PurposePercutaneous endoscopic gastrostomy (PEG) can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG.MethodsWe retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6) months.ResultsMean patient age was 9.4 (4.5) years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD). The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87%) had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment.ConclusionPEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children

Clinical Experiences of Fetal Ovarian Cyst: Diagnosis and Consequence

Ovarian cysts are the most frequent, prenatally diagnosed intra-abdominal cysts. Fetal ovarian cyst often presents complication such as torsion and seems to be an indication for surgical intervention. In this study, we reviewed pre- and post-natal medical records and ultrasonography of 17 fetuses that were diagnosed with ovarian cysts. In a total of 17 cases, postnatal surgery was performed in 7 infants. Of these cases, four cases of ovarian cyst torsion were confirmed. In the remaining 10 fetuses, one case regressed completely during pregnancy, and the other nine cases including two complex cysts resolve spontaneously after birth. Postnatal symptomatic cysts or cysts with a diameter greater than 5 cm that do not regress or enlarge should be treated, but uncomplicated asymptomatic cysts less than 5 cm in diameter should only be observed and reassessed by serial ultrasonography. If they regress spontaneously, no surgical intervention is necessary independent of their sonographic findings

Experimental foundation for natural orifice transluminal endoscopic surgery and hybrid natural orifice transluminal endoscopic surgery

Natural orifice transluminal endoscopic surgery (NOTES) is one of the most exciting concepts that has emerged recently in the surgical field. All accesses to the abdominal cavity in the porcine model using natural orifices, e.g. transgastric, transvesical, transcolonic and transvaginal, have been described and explored. The experimental feasibility of all procedures by NOTES was successfully demonstrated in the porcine model using different types of natural orifices. However, few translations to the human have been made. NOTES is in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. This paper is an update on the experimental foundation for NOTES and hybrid NOTES and examines the opportunities presented by this new surgical vision

Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report

BACKGROUND: Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy has become the most popular method for performing a gastrostomy for long-term enteral feeding. It has been associated, however, with a lot of minor and major complications. CASE PRESENTATION: A case of mediastinitis with concominant sepsis caused by a masked esophageal perforation after percutaneous endoscopic gastrostomy in a multi-traumatized, brain-injured patient is presented. Ten – fourteen days after the procedure, the patient became febrile and gradually septic with tenderness of the sternum and upper abdomen. Computerized tomography of the thorax revealed mediastinitis. An urgent left thoracotomy and laparotomy were performed for drainage of the mediastinum, removal of the gastrostomy and insertion of a jejunostomy tube. The patient improved soon after the surgery. He was successfully weaned off the ventilator and was discharged from the Intensive Care Unit. CONCLUSION: Perforating mediastinitis is a rare but potentially lethal complication of percutaneous endoscopic gastrostomy. When diagnosed and properly treated it may have a favourable outcome