Autism and attachment security

Autisme en veilige gehechtheid Men heeft lang gedacht dat kinderen met autisme, door hun problemen in sociale interacties en communicatie, niet in staat zijn om een emotionele band te ontwikkelen met hun ouders, met andere woorden zich te hechten aan hun ouders. Empirisch onderzoek heeft echter laten zien dat kinderen met autisme wel degelijk gehechtheidsgedrag laten zien (Buitelaar, 1995). Uit onze meta-analyse bleek dat kinderen met autisme wel minder vaak veilig gehecht zijn dan kinderen zonder autisme. Dat geldt echter alleen voor kinderen met strikt gedefinieerd autisme en kinderen met autisme en een verstandelijke beperking. Het observeren van gehechtheid in een natuurlijke situatie heeft verschillende voordelen. De Attachment Q-sort (AQS; Vaughn & Waters, 1990; Waters, 1995) is ontwikkeld voor thuisobservatie van gehechtheid bij 'normale' kinderen, maar gebruik ervan bij kinderen met autisme blijkt gerechtvaardigd op grond van een studie onder 59 experts. Uit de literatuur komt naar voren dat de opvoeding van kinderen met autisme een groot beroep doet op de ouders. In onze studie bleek echter dat ouders van kinderen met autisme goed lijken om te kunnen gaan met de uitdagingen die gepaard gaan met het opvoeden van hun kind met autisme.UBL - phd migration 201

Can patients with Parkinson's disease use dry powder inhalers during off periods?

Because of its rapid onset of action, pulmonary administration of levodopa is an interesting alternative to oral administration for the rescue treatment of Parkinson's disease patients in an off period. We studied the ability of Parkinson's disease patients to operate a dry powder inhaler (DPI) correctly during an off period. We used an instrumented test inhaler with three different resistances to air flow to record flow curves and computed various inhalation parameters. We observed that all (13) patients were able to generate pressure drops > 2 kPa over the highest resistance and 10 out of 13 patients achieved at least 4 kPa. Inhaled volumes (all resistances) varied from 1.2 L to 3.5 L. Total inhalation time and the time to peak inspiratory flow rate both decreased with decreasing inhaler resistance. Twelve out of thirteen patients could hold their breath for at least five seconds after inhalation and nine could extend this time to ten seconds. The data from this study indicate that patients with Parkinson's disease will indeed be able to use a dry powder inhaler during an off period and they provide an adequate starting point for the development of a levodopa powder inhaler to treat this particular patient group

Subchondral Bone Trabecular Integrity Predicts and Changes Concurrently with Radiographic and MRI Determined Knee Osteoarthritis Progression

OBJECTIVE: To evaluate subchondral bone trabecular integrity (BTI) on radiographs as a predictor of knee osteoarthritis (OA) progression. METHODS: Longitudinal (baseline, 12-month, and 24-month) knee radiographs were available for 60 female subjects with knee OA. OA progression was defined by 12- and 24-month changes in radiographic medial compartment minimal joint space width (JSW) and medial joint space area (JSA), and by medial tibial and femoral cartilage volume on magnetic resonance imaging. BTI of the medial tibial plateau was analyzed by fractal signature analysis using commercially available software. Receiver operating characteristic (ROC) curves for BTI were used to predict a 5% change in OA progression parameters. RESULTS: Individual terms (linear and quadratic) of baseline BTI of vertical trabeculae predicted knee OA progression based on 12- and 24-month changes in JSA (P < 0.01 for 24 months), 24-month change in tibial (P < 0.05), but not femoral, cartilage volume, and 24-month change in JSW (P = 0.05). ROC curves using both terms of baseline BTI predicted a 5% change in the following OA progression parameters over 24 months with high accuracy, as reflected by the area under the curve measures: JSW 81%, JSA 85%, tibial cartilage volume 75%, and femoral cartilage volume 85%. Change in BTI was also significantly associated (P < 0.05) with concurrent change in JSA over 12 and 24 months and with change in tibial cartilage volume over 24 months. CONCLUSION: BTI predicts structural OA progression as determined by radiographic and MRI outcomes. BTI may therefore be worthy of study as an outcome measure for OA studies and clinical trials. Copyright 2013 by the American College of Rheumatology

Autism and attachment: A meta-analytic review

Opvoeding, diagnostiek en behandeling van kinderen en jeugdigen met (ernstige) ontwikkelings-, opvoedings-, en onderwijsprobleme

The ability of Parkinson's disease patients to use dry powder inhalers during off periods

Objective: The aim of our study was to assess the applicability of Parkinson's patients to use a dry powder inhaler correctly during their off periods, when motor function impairments like tremor, bradykinesia and rigidity are present. Background: Because of its expected rapid onset of effect, pulmonary administration of levodopa is an interesting alternative to orally administered levodopa for the rescue treatment of Parkinson's disease patients in an off period. The inspiratory flow manoeuvre performed by a patient is crucial for the performance and the suitability of a dry powder inhaler and is therefore assessed. Methods: After obtaining written informed consent, 15 patients were asked to postpone there scheduled levodopa dose in order to become off. Before the inhalation procedure started, the extent of the off state was scored by a neurologist, by using the (old) UPDRS motor section 3. Patients were asked to simulate an inhalation manoeuvre through a test inhaler (without drug), with three different resistances to air flow, in order to obtain information about their ability to inhale correctly through an inhaler during off periods. The study was approved by the ethics commitee. Results: Two patients did not become off and were therefore not included for analysis. Measurements with the other 13 Parkinson's patients during off periods showed that patients were able to perform an inhalation manoeuvre correctly, hold their breath for an acceptable time to facilitate deep lung deposition and create the pressure drop necessary to achieve a proper dispersion of a dry powder formulation, like levodopa. Conclusions: The inhalation data gathered in this study set the limits within which levodopa dry powder inhalation products for the rescue treatment of Parkinson's disease patients in an off period should effectively disperse and emit the required dose. They are, therefore, essential in any development activities towards such a product. The demonstrated ability of Parkinson's disease patients in an off period to perform an inhalation manoeuvre is expected to be sufficient for the successful development of levodopa dry powder inhalation products for the rescue treatment during an off period of this particular patient group

Axillary Lymph Node Dissection vs Axillary Radiotherapy: A Detailed Analysis of Morbidity

Surgical oncolog