Kidney transplantation in childhood: mental health and quality of life of children and caregivers

Our objective was to assess the mental health and health-related quality of life (HRQOL) in children and their parents after renal transplantation (TX) compared to healthy controls and children with acute lymphoblastic leukemia (ALL) and to identify possible health status variables associated with impaired mental health and HRQOL. Thirty-eight TX children with a median age of 13 (range 3–19) years were investigated. Mental health was assessed by the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and the Strength and Difficulties Questionnaire (SDQ-20). Each mother’s own mental health and QOL were assessed by the General Health Questionnaire (GHQ-30) and the Quality of Life Scale (QOLS). Forty children with ALL [median age 11 (8.5–15.4) years] and 42 healthy children [median age 11 (8.9– 15) years] served as controls. Treadmill exercise results from 22 of the 38 patients were included in the analysis. TX children showed significantly higher levels of mental health problems and lower HRQOL at 2 to 16 years after transplantation compared to both control groups. Body mass index and maximal oxygen uptake (n = 22/38) were significant predictors of child mental health (SDQ) and child QOL (PedsQL), respectively. Based on these results, we suggest that rehabilitation after TX should include a focus on physical activity and QOL to reduce interconnected physical and psychological morbidity in kidney TX children

Alport syndrome: significance of gingival biopsy in the initial diagnosis and periodontal evaluation after renal transplantation

Alport Syndrome (AS) is an important hereditary disorder affecting the glomerular basement membrane. Diagnosis of AS is based on the presence of hematuric nephropathy, renal failure, hearing loss, ocular abnormalities and changes in the glomerular basement membrane of the lamina densa. The aims of this case report were to show the changes in the gingival tissues in a patient with AS under therapy with cyclosporin-A after renal transplantation and to discuss the possible role of type IV collagen in gingival basal lamina as an alternative approach for the diagnosis of AS. A 20-year-old male patient with AS underwent periodontal therapy including a series of gingivectomy surgeries. Gingival samples obtained during the second surgery were examined histopathologically and by transmission electron microscopy for further pathological examination. Gingivectomy procedures have been performed every 6 months over the last 4 years. The excessive and fibrous gingival enlargements resulted in migration of the anterior teeth, but no alveolar bone loss occurred. This is the first report to demonstrate the possible changes in the gingival tissues caused by AS. It is suggested that gingival biopsy can be an initial diagnostic tool instead of renal or skin biopsies. Proper dental and periodontal care and regular visits to the dentist could provide limited gingival hyperplasia to patients with AS

Understanding the Cyber-Victimisation of People with Long Term Conditions and the Need for Collaborative Forensics-Enabled Disease Management Programmes

Research shows that people with long term conditions and disabilities are frequently labelled as vulnerable, and commonly victimised online. They require instrumental support to understand their conditions and empower them to manage their own treatment in everyday life. However, additional short and long term consequences related to cyber-victimisation could intensify existing psychological and health complications. For instance, ‘distress’ as a commonly reported impact of cyber-victimisation could theoretically lead to neurohormonal changes in the blood, increasing cortisol, catecholamine and insulin secretion resulting in increased blood glucose, heartbeat, blood pressure, urination and other changes. Therefore, in this study we demonstrate the need and explain the means towards extending support and risk assessment systems and procedures to cover the collection and preservation of incidents reported by individuals. This can be used to support third-party interventions such as taking a legal action in cases where the impact of cyber-victimisation is seen to escalate and worsen. As such, we first define vulnerable groups with long term conditions and provide a review of the impact of various types of cyber-victimisation on their health management. Then, we discuss how Disease Management Programmes (DMP) developed over time to include web-based applications as an example of existing cost-effective approaches to improve the quality of healthcare provided to people with long term conditions. We then demonstrate the added value of incorporating forensics readiness to enable Police intervention, support the victim’s eligibility for extended instrumental support from national health services. Finally, this level of documentation offers an opportunity to implement more accurate methods to assess risk associated with victimisation