Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway

<p>Abstract</p> <p>Background</p> <p>Hip dislocation is a serious complication among children with cerebral palsy (CP). The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services.</p> <p>Methods</p> <p>This is a cross-sectional study in seven Norwegian counties providing regular care and one Swedish healthcare region where a hip surveillance programme was introduced in 1994. Data were provided by the Norwegian Cerebral Palsy Register and the CP Register in Southern Sweden. Children born 1996 - 2003 with moderate to severe CP, defined as Gross Motor Classification System (GMFCS) levels III - V, were included. In all, 119 Norwegian and 136 Swedish children fulfilled the criteria. In Norway, data on hip operations and radiographs of the hips were collected from medical records, while these data are collected routinely in the Swedish register. The hip migration percentage was measured on the recent radiographs. Hip dislocation was defined as a migration percent of 100%.</p> <p>Results</p> <p>The proportion of children at GMFCS levels III - V was 34% in the Norwegian and 38% in the Swedish population. In the Norwegian population, hip dislocation was diagnosed in 18 children (15.1%; CI: 9.8 - 22.6) compared with only one child (0.7%; 95% CI: 0.01 - 4.0) in Southern Sweden (p = < 0.001). Hip surgery was performed in 53 (44.5%) of the Norwegian children and in 43 (32%) of the Swedish children (p = 0.03). The total number of hip operations was 65 in Norway and 63 in Sweden. Norwegian children were first operated at a mean age of 7.6 years (SD: 2.9) compared with 5.7 years (SD: 2.3) in Sweden (p = 0.001).</p> <p>Conclusions</p> <p>The surveillance programme reduced the number of hip dislocations and the proportion of children undergoing hip surgery was lower. However, with the surveillance programme the first operation was performed at a younger age. Our results strongly support the effectiveness of a specifically designed follow-up programme for the prevention of hip dislocation in children with CP.</p

Learning To Be Affected: Social suffering and total pain at life’s borders.

The practice of Live Sociology in situations of pain and suffering is the author’s focus. An outline of the challenges of understanding pain is followed by a discussion of Bourdieu’s ‘social suffering’ (1999) and the palliative care philosophy of ‘total pain’. Using examples from qualitative research on disadvantaged dying migrants in the UK, attention is given to the methods that are improvised by dying people and care practitioners in attempts to bridge intersubjective divides, where the causes and routes of pain can be ontologically and temporally indeterminate and/or withdrawn. The paper contends that these latter phenomena are the incitement for the inventive bridging and performative work of care and Live Sociological methods, both of which are concerned with opposing suffering. Drawing from the ontology of total pain, I highlight the importance of (i) an engagement with a range of materials out of which attempts at intersubjective bridging can be produced, and which exceed the social, the material, and the temporally linear; and (ii) an empirical sensibility that is hospitable to the inaccessible and non-relational

Use of manual and powered wheelchair in children with cerebral palsy: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Mobility is important for the cognitive and psychosocial development of children. Almost one third of children with cerebral palsy (CP) are non-ambulant. Wheelchairs can provide independent mobility, allowing them to explore their environment. Independent mobility is vital for activity and participation and reduces the dependence on caregivers. The purpose of this study was to describe the use of manual and powered wheelchair indoors and outdoors in relation to the degree of independent wheelchair mobility or need for assistance in a total population of children with CP.</p> <p>Methods</p> <p>A cross-sectional study was performed including all children aged 3-18 years with CP living in southern Sweden during 2008. Data was extracted from a register and health care programme for children with CP (CPUP). There were a total of 562 children (326 boys, 236 girls) in the register. Information on the child's use of manual and powered wheelchair indoors and outdoors and the performance in self-propelling or need for assistance were analysed related to age, CP subtype and gross motor function.</p> <p>Results</p> <p>Wheelchairs for mobility indoors were used by 165 (29%) of the 562 children; 61 used wheelchair for independent mobility (32 using manual only, 12 powered only, 17 both) and 104 were pushed by an adult. For outdoor mobility wheelchairs were used by 228 children (41%); 66 used a wheelchair for independent mobility (18 using manual only, 36 powered only, 12 both) and 162 were pushed. The use of wheelchair increased with age and was most frequent in the spastic bilateral and dyskinetic subtypes. Most powered wheelchairs were operated by children at GMFCS level IV.</p> <p>Conclusion</p> <p>In this total population of children with CP, aged 3-18 years, 29% used a wheelchair indoors and 41% outdoors. A majority using manual wheelchairs needed adult assistance (86%) while powered wheelchairs provided independent mobility in most cases (86%). To achieve a high level of independent mobility, both manual and powered wheelchairs should be considered at an early age for children with impaired walking ability.</p

Sitting and standing performance in a total population of children with cerebral palsy: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Knowledge of sitting and standing performance in a total population of children with cerebral palsy (CP) is of interest for health care planning and for prediction of future ability in the individual child. In 1994, a register and a health care programme for children with CP in southern Sweden was initiated. In the programme information on how the child usually sits, stands, stands up and sits down, together with use of support or assistive devices, is recorded annually.</p> <p>Methods</p> <p>A cross-sectional study was performed, analysing the most recent report of all children with CP born 1990-2005 and living in southern Sweden during 2008. All 562 children (326 boys, 236 girls) aged 3-18 years were included in the study. The degree of independence, use of support or assistive devices to sit, stand, stand up and sit down was analysed in relation to the Gross Motor Function Classification System (GMFCS), CP subtype and age.</p> <p>Result</p> <p>A majority of the children used standard chairs (57%), could stand independently (62%) and could stand up (62%) and sit down (63%) without external support. Adaptive seating was used by 42%, external support to stand was used by 31%, to stand up by 19%, and to sit down by 18%. The use of adaptive seating and assistive devices increased with GMFCS levels (p < 0.001) and there was a difference between CP subtypes (p < 0.001). The use of support was more frequent in preschool children aged 3-6 (p < 0.001).</p> <p>Conclusion</p> <p>About 60% of children with CP, aged 3-18, use standard chairs, stand, stand up, and sit down without external support. Adding those using adaptive seating and external support, 99% of the children could sit, 96% could stand and 81% could stand up from a sitting position and 81% could sit down from a standing position. The GMFCS classification system is a good predictor of sitting and standing performance.</p

Robustness analysis of discrete predictor-based controllers for input-delay systems

In this article, robustness to model uncertainties are analysed in the context of discrete predictor-based state-feedback controllers for discrete-time input-delay systems with time-varying delay, in an LMI framework. The goal is comparing robustness of predictor-based strategies with respect to other (sub)optimal state feedback ones. A numerical example illustrates that improvements in tolerance to modelling errors can be achieved by using the predictor framework.The authors are grateful for grant nos. DPI2008-06737-C02-01, DPI2008-06731-C02-01, DPI2011-27845-C02-01 and PROMETEO/2008/088 from the Spanish and Valencian governments.González Sorribes, A.; Sala, A.; García Gil, PJ.; Albertos Pérez, P. (2013). Robustness analysis of discrete predictor-based controllers for input-delay systems. International Journal of Systems Science. 44(2):232-239. https://doi.org/10.1080/00207721.2011.600469S232239442Boukas, E.-K. (2006). Discrete-time systems with time-varying time delay: Stability and stabilizability. Mathematical Problems in Engineering, 2006, 1-10. doi:10.1155/mpe/2006/42489Du, D., Jiang, B., & Zhou, S. (2008). Delay-dependent robust stabilisation of uncertain discrete-time switched systems with time-varying state delay. International Journal of Systems Science, 39(3), 305-313. doi:10.1080/00207720701805982El Ghaoui, L., Oustry, F., & AitRami, M. (1997). A cone complementarity linearization algorithm for static output-feedback and related problems. IEEE Transactions on Automatic Control, 42(8), 1171-1176. doi:10.1109/9.618250Gao, H., & Chen, T. (2007). New Results on Stability of Discrete-Time Systems With Time-Varying State Delay. IEEE Transactions on Automatic Control, 52(2), 328-334. doi:10.1109/tac.2006.890320Gao, H., Wang, C., Lam, J., & Wang, Y. (2004). Delay-dependent output-feedback stabilisation of discrete-time systems with time-varying state delay. IEE Proceedings - Control Theory and Applications, 151(6), 691-698. doi:10.1049/ip-cta:20040822Gao, H., Chen, T., & Lam, J. (2008). A new delay system approach to network-based control. Automatica, 44(1), 39-52. doi:10.1016/j.automatica.2007.04.020Garcia , P , Castillo , P , Lozano , R and Albertos , P . 2006 . Robustness with Respect to Delay Uncertainties of a Predictor Observer Based Discrete-time Controller . Proceeding of the 45th IEEE Conference on Decision and Control . 2006 . pp. 199 – 204 .Guo , Y and Li , S . 2009 . New Stability Criterion for Discrete-time Systems with Interval Time-varying State Delay . Joint 48th IEEE Conference on Decision and Control and 28th Chinese Control Conference . 2009 . pp. 1342 – 1347 .Hägglund, T. (1996). An industrial dead-time compensating PI controller. Control Engineering Practice, 4(6), 749-756. doi:10.1016/0967-0661(96)00065-2V.J.S. Leite, and Miranda, M.F. (2008), ‘Robust Stabilization of Discrete-time Systems with Time-varying Delay: An LMI Approach’,Mathematical Problems in Engineering, 2008, 15 pages (doi:10.1155/2008/875609)Liu, X. G., Tang, M. L., Martin, R. R., & Wu, M. (2006). Delay-dependent robust stabilisation of discrete-time systems with time-varying delay. IEE Proceedings - Control Theory and Applications, 153(6), 689-702. doi:10.1049/ip-cta:20050223Lozano, R., Castillo, P., Garcia, P., & Dzul, A. (2004). Robust prediction-based control for unstable delay systems: Application to the yaw control of a mini-helicopter. Automatica, 40(4), 603-612. doi:10.1016/j.automatica.2003.10.007Manitius, A., & Olbrot, A. (1979). Finite spectrum assignment problem for systems with delays. IEEE Transactions on Automatic Control, 24(4), 541-552. doi:10.1109/tac.1979.1102124Michiels, W., & Niculescu, S.-I. (2003). On the delay sensitivity of Smith Predictors. International Journal of Systems Science, 34(8-9), 543-551. doi:10.1080/00207720310001609057Palmor, Z.J. (1996), ‘Time-delay Compensation – Smith Predictor and Its Modifications’, inThe Control Handbook, ed. W.S. Levine, Boca Raton: CRC Press, pp. 224–237Pan, Y.-J., Marquez, H. J., & Chen, T. (2006). Stabilization of remote control systems with unknown time varying delays by LMI techniques. International Journal of Control, 79(7), 752-763. doi:10.1080/00207170600654554Richard, J.-P. (2003). Time-delay systems: an overview of some recent advances and open problems. Automatica, 39(10), 1667-1694. doi:10.1016/s0005-1098(03)00167-5Wang, Q.-G., Lee, T. H., & Tan, K. K. (1999). Finite-Spectrum Assignment for Time-Delay Systems. Lecture Notes in Control and Information Sciences. doi:10.1007/978-1-84628-531-8He, Y., Wu, M., Han, Q.-L., & She, J.-H. (2008). Delay-dependentH∞control of linear discrete-time systems with an interval-like time-varying delay. International Journal of Systems Science, 39(4), 427-436. doi:10.1080/00207720701832531Yue, D., & Han, Q.-L. (2005). Delayed feedback control of uncertain systems with time-varying input delay. Automatica, 41(2), 233-240. doi:10.1016/j.automatica.2004.09.006Zhang, B., Xu, S., & Zou, Y. (2008). Improved stability criterion and its applications in delayed controller design for discrete-time systems. Automatica, 44(11), 2963-2967. doi:10.1016/j.automatica.2008.04.01

Imaging the Dopamine Uptake Site with Ex Vivo [ 18 F]GBR 13119 Binding Autoradiography in Rat Brain

We studied the binding of [ 18 F]GBR 13119 {1-[[(4-[ 18 F]fluorophenyl) (phenyl)methoxy]ethyl]-4-(3-phenylpropyl)piperazine} to rat brain with autoradiography after intravenous injection. The rank order of binding was dorsal striatum > nucleus accumbens = olfactory tubercle > sub-stantia nigra = ventral tegmental area > other areas. Binding was blocked by prior injection of dopamine uptake blockers but not by injection of dopamine receptor antagonists or drugs that bind to the dialkylpiperazine site. Unilateral 6-hydroxy dopamine lesions of dopamine neurons caused a marked decrease in striatal and nigral binding on the side of the lesion. We conclude that intravenous injection of [ 18 F]GBR 13119 provides a useful marker of presynaptic dopamine uptake sites.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66209/1/j.1471-4159.1990.tb04178.x.pd

Health service utilization patterns of primary care patients with osteoarthritis

Contains fulltext : 53455.pdf ( ) (Open Access)BACKGROUND: To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). METHODS: Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. RESULTS: 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the "symptom" scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. CONCLUSION: Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully

Cerebral palsy in a total population of 4–11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to investigate the prevalence of cerebral palsy (CP) as well as to characterize the CP population, its participation in a secondary prevention programme (CPUP) and to validate the CPUP database.</p> <p>Methods</p> <p>The study population was born 1990–1997 and resident in Skåne/Blekinge on Jan 1^st2002. Multiple sources were used. Irrespective of earlier diagnoses, neuropaediatrician and other professional medical records were evaluated for all children at the child habilitation units. The CPUP database and diagnosis registers at hospital departments were searched for children with CP or psychomotor retardation, whose records were then evaluated. To enhance early prevention, CP/probable CP was searched for also in children below four years of age born 1998–2001.</p> <p>Results</p> <p>The prevalence of CP was 2.4/1,000 (95% CI 2.1–2.6) in children 4–11 years of age born in Sweden, excluding post-neonatally acquired CP. Children born abroad had a higher prevalence of CP with more severe functional limitations. In the total population, the prevalence of CP was 2.7/1,000 (95% CI 2.4–3.0) and 48% were GMFCS-level I (the mildest limitation of gross motor function).</p> <p>One third of the children with CP, who were born or had moved into the area after a previous study in 1998, were not in the CPUP database. The subtype classification in the CPUP database was adjusted in the case of every fifth child aged 4–7 years not previously reviewed.</p> <p>Conclusion</p> <p>The prevalence of CP and the subtype distribution did not differ from that reported in other studies, although the proportion of mild CP tended to be higher.</p> <p>The availability of a second opinion about the classification of CP/CP subtypes is necessary in order to keep a CP register valid, as well as an active search for undiagnosed CP among children with other impairments.</p

The relationship between spasticity in young children (18 months of age) with cerebral palsy and their gross motor function development

<p>Abstract</p> <p>Background</p> <p>It is thought that spasticity has an influence on the development of functional motor abilities among children with cerebral palsy (CP). The extent to which spasticity is associated with the change in motor abilities in young children with CP has not been established. The objective of this study is to evaluate the relationship of initial spasticity in young children with CP and their gross motor function development over one year.</p> <p>Methods</p> <p>Fifty children with CP aged 18 months, GMFCS-levels I-V participated in a longitudinal observational study. Change in gross motor functioning (GMFM-66) was measured over one year. The level of spasticity measured at the first assessment was determined with the Modified Tardieu Scale in three muscle groups of the lower extremity (adductor muscles, the hamstrings and the m. gastrocnemius). The Spasticity Total Score per child was calculated with a maximum score of 12 points.</p> <p>Results</p> <p>Spearman's Rho Correlation (-0.28) revealed a statistically significant relationship (p < 0.05) of small strength between the Spasticity Total Score and the change score of the GMFM-66.</p> <p>Conclusion</p> <p>Our findings indicate that when measured over one year, spasticity is marginally related to gross motor function development in infants with CP. The initial level of spasticity is only one of the many child, environmental and family factors that determines gross motor development of a young child with CP.</p

An Improved Protocol for N-Glycosylation Analysis of Gel-Separated Sialylated Glycoproteins by MALDI-TOF/TOF

Different glycoforms of some proteins have been identified as differential spots for certain diseases in 2-DE, indicating disease-related glycosylation changes. It is routine to determine the site-specific glycosylation of nonsialylated N-glycoproteins from a single gel spot, but some obstacles still exist in analyzing sialylated glycoproteins due to the lability and higher detection limit of acid glycans in MALDI-TOF/TOF analysis. Thus, we present an improved protocol here. Tryptic glycopeptides were separated and subjected to MALDI-TOF/TOF analysis, resulting in the identification of site-specific glycosylation of high-intensity glycopeptides. Sequential deglycosylation and desialylation were used to improve the identification of glycosylation sites and desialylated glycans. The site-specific glycosylation of large glycopeptides and low-intensity glycopeptides was deduced based on the masses of glycopeptides, deglycosylated peptides and desialylated glycans. By applying it to 2-DE separated human serum, the difference of N-glycosylation was successfully determined for α1-antitrypsin between different gel spots