An Unusual Triad in Pediatric Neurology:A Case Report on Cerebral Palsy, Epilepsy, and Duchenne Muscular Dystrophy

We present a case of an unusual triad in pediatric neurology: a currently 12-year-old boy with cerebral palsy and epilepsy who was later also diagnosed with Duchenne muscular dystrophy. We describe the clinical path that resulted in this exceptional diagnosis. This case report illustrates how different neurological disorders may overshadow each other. In addition, it demonstrates that every child with cerebral palsy and either an atypical clinical course or with inexplicable laboratory values-as well as every infant boy born to a theoretical Duchenne muscular dystrophy carrier-should be subjected to additional investigations.</p

Increase in incidence of anorexia nervosa among 10- to 14-year-old girls:A nationwide study in the Netherlands over four decades

Objective: This primary care study examined time trends in the incidence of anorexia nervosa (AN) and bulimia nervosa (BN) in the Netherlands across four decades. Methods: A nationwide network of general practitioners, serving approximately 1% of the total Dutch population, recorded newly diagnosed patients with AN and BN in their practices from 1985 to 2019 (2,890,978 person-years). DSM-IV diagnostic criteria were consistently used and the same psychiatrist was responsible for the final diagnostic decision. Incidence rates (IRs) were calculated for: the total population (all ages), females overall, and females per 5-year age category. Time trends in IRs were analyzed using JoinPoint regression analyses. Results: In four decades, the incidence of AN among 10- to 14-year-old females increased significantly from 8.6 to 38.6 per 100,000 person-years (average period percentage change [APPC] = 56.7; 95% confidence interval [CI] = 6.5–130.6. The overall incidence of AN was stable, with IRs ranging from 6.0 (95% CI = 4.3–8.1) to 8.4 (95% CI = 6.4–10.8). The IR of BN decreased significantly from 8.7 (95% CI = 6.7–11.0) to 3.2 (95% CI = 2.0–4.9) in the 2000s, before leveling off in the 2010s (IR 3.2; 95% CI = 2.0–4.8). Discussion: The incidence of AN among 10- to 14-year-old girls increased significantly over four decades. Both biological and sociocultural factors, for example, early pubertal timing and the impact of social media, might explain this. In other age groups and overall, the incidence of AN remained stable. The significant decrease of the incidence of BN in the previous decades halted in the last decade. Public Significance: An important finding of the present study is that for 10- to 14-year-old girls, the risk for developing anorexia nervosa has increased significantly over 40 years. More healthcare facilities for younger people are needed, and prevention programs could include social media use. For bulimia nervosa, the general decrease in the occurrence of new cases has halted in the 2010s.</p

Increase in incidence of anorexia nervosa among 10- to 14-year-old girls:A nationwide study in the Netherlands over four decades

Objective: This primary care study examined time trends in the incidence of anorexia nervosa (AN) and bulimia nervosa (BN) in the Netherlands across four decades. Methods: A nationwide network of general practitioners, serving approximately 1% of the total Dutch population, recorded newly diagnosed patients with AN and BN in their practices from 1985 to 2019 (2,890,978 person-years). DSM-IV diagnostic criteria were consistently used and the same psychiatrist was responsible for the final diagnostic decision. Incidence rates (IRs) were calculated for: the total population (all ages), females overall, and females per 5-year age category. Time trends in IRs were analyzed using JoinPoint regression analyses. Results: In four decades, the incidence of AN among 10- to 14-year-old females increased significantly from 8.6 to 38.6 per 100,000 person-years (average period percentage change [APPC] = 56.7; 95% confidence interval [CI] = 6.5–130.6. The overall incidence of AN was stable, with IRs ranging from 6.0 (95% CI = 4.3–8.1) to 8.4 (95% CI = 6.4–10.8). The IR of BN decreased significantly from 8.7 (95% CI = 6.7–11.0) to 3.2 (95% CI = 2.0–4.9) in the 2000s, before leveling off in the 2010s (IR 3.2; 95% CI = 2.0–4.8). Discussion: The incidence of AN among 10- to 14-year-old girls increased significantly over four decades. Both biological and sociocultural factors, for example, early pubertal timing and the impact of social media, might explain this. In other age groups and overall, the incidence of AN remained stable. The significant decrease of the incidence of BN in the previous decades halted in the last decade. Public Significance: An important finding of the present study is that for 10- to 14-year-old girls, the risk for developing anorexia nervosa has increased significantly over 40 years. More healthcare facilities for younger people are needed, and prevention programs could include social media use. For bulimia nervosa, the general decrease in the occurrence of new cases has halted in the 2010s.</p

Direct and inverse spectral transform for the relativistic Toda lattice and the connection with Laurent orthogonal polynomials

We introduce a spectral transform for the finite relativistic Toda lattice (RTL) in generalized form. In the nonrelativistic case, Moser constructed a spectral transform from the spectral theory of symmetric Jacobi matrices. Here we use a non-symmetric generalized eigenvalue problem for a pair of bidiagonal matrices (L,M) to define the spectral transform for the RTL. The inverse spectral transform is described in terms of a terminating T-fraction. The generalized eigenvalues are constants of motion and the auxiliary spectral data have explicit time evolution. Using the connection with the theory of Laurent orthogonal polynomials, we study the long-time behaviour of the RTL. As in the case of the Toda lattice the matrix entries have asymptotic limits. We show that L tends to an upper Hessenberg matrix with the generalized eigenvalues sorted on the diagonal, while M tends to the identity matrix.Comment: 24 pages, 9 figure

Economic evaluation of a weight control program with e-mail and telephone counseling among overweight employees: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Distance lifestyle counseling for weight control is a promising public health intervention in the work setting. Information about the cost-effectiveness of such interventions is lacking, but necessary to make informed implementation decisions. The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aimed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective.</p> <p>Methods</p> <p>A randomized controlled trial comparing a program with two modes of intervention delivery against self-help. 1386 Employees from seven companies participated (67% male, mean age 43 (SD 8.6) years, mean BMI 29.6 (SD 3.5) kg/m²). All groups received self-directed lifestyle brochures. The two intervention groups additionally received a workbook-based program with phone counseling (phone; n=462) or a web-based program with e-mail counseling (internet; n=464). Body weight was measured at baseline and 24 months after baseline. Quality of life (EuroQol-5D) was assessed at baseline, 6, 12, 18 and 24 months after baseline. Resource use was measured with six-monthly diaries and valued with Dutch standard costs. Missing data were multiply imputed. Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves.</p> <p>Results</p> <p>At two years the incremental cost-effectiveness ratio was €1009/kg weight loss in the phone group and €16/kg weight loss in the internet group. The cost-utility analysis resulted in €245,243/quality adjusted life year (QALY) and €1337/QALY, respectively. The results from a complete-case analysis were slightly more favorable. However, there was considerable uncertainty around all outcomes.</p> <p>Conclusions</p> <p>Neither intervention mode was proven to be cost-effective compared to self-help.</p> <p>Trial registration</p> <p>ISRCTN04265725</p

The legacy of cover crops on the soil habitat and ecosystem services in a heavy clay, minimum tillage rotation

Abstract Cover crops are grown as potential ways to improve soil fertility, soil structure, and biodiversity, while reducing weed/pest burdens. Yet, increased costs (in both time and fuel), farmer knowledge requirements, and yield uncertainty (green bridge effect and variable crop establishment) have led to hesitation among farmers. This study was conducted at the field scale (covering an area of nearly 20 hectares) to determine whether different cover crop mixtures affected soil properties and ecosystem services on a heavy clay soil. Measurements of soil chemistry, physics, biology, weed abundance, and subsequent crop performance were taken within a minimum tillage management system, across three cover crop mixtures (commonly sold to UK farmers). The cover crop mixtures included oats (Avena sativa), radish (Raphanus sativus), phacelia (Phacelia tanacetifolia), vetch (Vicia sativa), legumes, buckwheat (Fagopyrum esculentum) and a bare stubble control followed by a spring oat crop. Soil physics (penetrometer and bulk density) and chemistry (N, P, K, Mg, Ca, and organic matter) varied little across treatments, although there was significantly lower Mg in the cover crop including legumes and an increase in NO3 within this treatment. Soil biology and botanical composition were also assessed, monitoring earthworm and mesofauna abundance; and sown and unsown (weed) biomass. Epigeic earthworms were found to have significantly larger abundance in cover crop mixtures with radish present, although other meso- and macrofauna did not differ. Significant weed suppression was found during both the cover crop growing period and as a legacy in the subsequent crop, leading to significant yield increases and economic benefits in some treatments. Our study confirms that cover crops are providing benefits, even on heavy clay soils, including improvements in nutrient leaching risk reduction, weed suppression, and crop yield, coupled with wider ecosystem benefits. We therefore consider cover crops to have a role in sustainable management of arable rotations

Coping strategies used by older adults to deal with contact isolation in the hospital during the COVID-19 pandemic

Due to the COVID-19 pandemic, many older adults have experienced contact isolation in a hospital setting which leads to separation from relatives, loss of freedom, and uncertainty regarding disease status. The objective of this study was to explore how older adults (55+) cope with contact isolation in a hospital setting during the COVID-19 pandemic in order to improve their physical and psychological wellbeing. The realist evaluation approach was used to formulate initial program theories on coping strategies used by (older) adults in an isolation setting. Twenty-one semi-structured interviews with older patients (n = 21) were analysed. This study revealed that both emotion-focused coping strategies as well as problem-focused coping strategies were used by older adults during contact isolation. The study also uncovered some new specific coping strategies. The results have useful implications for hospital staff seeking to improve the wellbeing of older adults in contact isolation in hospitals. Problem-focused coping strategies could be stimulated through staff performing care in a person-centred way. Trust in staff, as part of emotion-focused coping strategies, could be stimulated by improving the relationship between patients and staff

Dystrophin Distribution and Expression in Human and Experimental Temporal Lobe Epilepsy

Objective: Dystrophin is part of a protein complex that connects the cytoskeleton to the extracellular matrix. In addition to its role in muscle tissue, it functions as an anchoring protein within the central nervous system such as in hippocampus and cerebellum. Its presence in the latter regions is illustrated by the cognitive problems seen in Duchenne Muscular Dystrophy (DMD). Since epilepsy is also supposed to constitute a comorbidity of DMD, it is hypothesized that dystrophin plays a role in neuronal excitability. Here, we aimed to study brain dystrophin distribution and expression in both, human and experimental temporal lobe epilepsy (TLE). Method: Regional and cellular dystrophin distribution was evaluated in both human and rat hippocampi and in rat cerebellar tissue by immunofluorescent colocalization with neuronal (NeuN and calbindin) and glial (GFAP) markers. In addition, hippocampal dystrophin levels were estimated by Western blot analysis in biopsies from TLE patients, post-mortem controls, amygdala kindled (AK)-, and control rats. Results: Dystrophin was expressed in all hippocampal pyramidal subfields and in the molecular-, Purkinje-, and granular cell layer of the cerebellum. In these regions it colocalized with GFAP, suggesting expression in astrocytes such as Bergmann glia (BG) and velate protoplasmic astrocytes. In rat hippocampus and cerebellum there were neither differences in dystrophin positive cell types, nor in the regional dystrophin distribution between AK and control animals. Quantitatively, hippocampal full-length dystrophin (Dp427) levels were about 60% higher in human TLE patients than in post-mortem controls (p < 0.05), whereas the level of the shorter Dp71 isoform did not differ. In contrast, AK animals showed similar dystrophin levels as controls. Conclusion: Dystrophin is ubiquitously expressed by astrocytes in the human and rat hippocampus and in the rat cerebellum. Hippocampal full-length dystrophin (Dp427) levels are upregulated in human TLE, but not in AK rats, possibly indicating a compensatory mechanism in the chronic epileptic human brain