Treatment of the Developmental Dysplasia of the Hip with an Abduction Brace in Children up to 6 Months Old

Introduction Le traitement de la dysplasie développementale de hanche (DDH) par le harnais de Pavlik est considéré comme efficace et sûr chez les enfants de 0-6 mois. Son utilisation pratique reste néanmoins compliquée pour les parents qui en subissent les contraintes quotidiennes. Par ailleurs, un défaut de réglage du harnais mène à des complications qui peuvent s'avérer sévères, en particulier la nécrose avasculaire de la hanche (AVN). Dans notre institution, depuis 2004, nous avons remplacé l'utilisation du harnais de Pavlik par une attelle d'abduction dont nous considérons l'utilisation et les réglages comme plus simples. Objectifs Evaluer les résultats du traitement de la DDH par notre attelle d'abduction chez les enfants de 0-6 mois de vie. Comparer nos résultats aux données présentes dans la littérature concernant l'usage du harnais de Pavlik. Méthode Etude rétrospective des patients âgés de 0 à 6 mois atteints de DDH entre 2004 et 2009 et suivi dans notre institution. Tous les patients ont été traités par une attelle d'abduction réalisée sur mesure par les ergothérapeutes. Les résultats se basent sur les taux de réduction des hanches ainsi que les taux d'apparition d'AVN. Le suivi était effectué à l'âge de 1 an et de 4 ans. Nous avons suivi 33 patients pour un total de 40 hanches dysplasiques. Les 33 patients ont eu un suivi à l'âge de 1 an et 28 patients à l'âge de 3-4 ans. Résultats L'attelle d'abduction a permis une réduction chez 28 des 33 patients (85%). Pour 5 cas la méthode s'est avérée insuffisante et une réduction fermée suivie de plâtres a été nécessaire. A l'âge de 4 ans, 4 enfants sur les 28 (15%) présentaient une dysplasie résiduelle. Concernant les complications, aucune nécrose avasculaire de hanche n'a été détectée et aucune autre complication n'a été décelée. Conclusion Nos résultats en terme de taux de réduction de hanche et de taux d'apparition d'AVN sont similaires aux données de la littérature évaluant le harnais de Pavlik. Par ailleurs, nous estimons notre attelle d'abduction comme un moyen de traitement confortable et d'utilisation quotidienne plus simple que le harnais

Treatment of the Developmental Dysplasia of the Hip with an Abduction Brace in Children up to 6 Months Old

Introduction. Use of Pavlik harness for the treatment of DDH can be complicated for parents. Any misuse or failure in the adjustments may lead to significant complications. An abduction brace was introduced in our institution, as it was thought to be easier to use. Aim. We assess the results for the treatment of DDH using our abduction brace in children of 0–6 months old and compare these results with data on treatments using the Pavlik harness. Method. Retrospective analysis of patients with DDH from 0 to 6 months old at diagnosis, performed from 2004 to 2009. Outcomes were rates of reduction of the hip and avascular necrosis of the femoral head (AVN). Follow-up was at one year and up to 4 years old. Results. Hip reduction was successful in 28 of 33 patients (85%), with no AVN. Conclusion. Our results in terms of hip reduction rate and AVN rate are similar to those found in literature assessing Pavlik harness use, with a simpler and comfortable treatment procedure

Persistence of elevated blood pressure during childhood and adolescence: a school-based multiple cohorts study.

OBJECTIVE Blood pressure (BP) screening is advocated in children. However, identification of children with sustained elevated BP is difficult because of high BP variability. We assessed the tracking of BP and the persistence of elevated BP across childhood and adolescence. METHODS Three cohorts of children from schools in the Seychelles were examined on two occasions at 3-4-year intervals. Obesity was defined as BMI at least 95th sex-specific, and age-specific percentile. On each visit, BP was based on the average of two readings and elevated BP was defined as BP at least 95th sex-specific, age-specific, and height-specific percentile. RESULTS Data was collected in 4519 children of mean ages of 5.5 and 9.2 years, 6065 of ages of 9.2 and 12.5 years, and 5967 of ages of 12.5 and 15.6 years, respectively. Prevalence of elevated BP was 10% at age 5.5 years, 10% at 9.2 years, 7% at 12.5 years, and 9% at 15.6 years, respectively. Among children with elevated BP at the initial visit, the proportions who had elevated BP at the subsequent visit 3-4 years later was 13% between ages of 5.5 and 9.2 years, 19% between 9.2 and 12.5 years, and 27% between 12.5 and 15.6 years. These proportions were higher among obese children with elevated BP, that is, 33, 35, and 39%, in each cohort, respectively. Tracking coefficients were slightly larger for SBP (range of tracking coefficients: 0.23-0.40) than for DBP (range: 0.19-0.35), and increased with age. By comparisons, tracking coefficients for BMI were much higher (range: 0.74-0.84). CONCLUSION During childhood and adolescence, having an elevated BP on one occasion is a weak predictor of elevated BP 3-4 years later. Tracking is, however, larger in older and obese children than in younger and nonobese children

Adolescents transgenres et non ­binaires : approche et prise en charge par les médecins de premier recours

Les adolescents transgenres, non binaires ou en questionnement sont de plus en plus visibles et font face à de nombreux obstacles pour accéder à des soins appropriés, tant pour leurs besoins de santé spécifiques que généraux. Les médecins de premier recours les rencontrent au cabinet et peuvent manquer d’éléments de communication et de connaissances spécifiques récentes pour mener la consultation et accompagner ces personnes et leurs proches dans leurs trajectoires individuelles. Cet article propose une synthèse des éléments et des ressources utiles pour le médecin de premier recours, dont le rôle est ­central pour la santé de tous les patients.Transgender, non-binary and questioning teenagers are increasingly visible. However, they face barriers in accessing appropriate care that meet their needs, both specific and regarding their general health. Primary care physicians increasingly see them in consultations but often lack elements of communication and recent knowledge that is needed to accompany them and their close ones in their -individual trajectories. This article aims to answer this need and provides a synthesis about recent evidence and suggested communication approaches for primary care physicians, who play a central role for the health of all patients

Simultaneous Reality Filtering and Encoding of Thoughts: The Substrate for Distinguishing between Memories of Real Events and Imaginations?

Any thought, whether it refers to the present moment or reflects an imagination, is again encoded as a new memory trace. Orbitofrontal reality filtering (ORFi) denotes an on-line mechanism which verifies whether upcoming thoughts relate to ongoing reality or not. Its failure induces reality confusion with confabulations and disorientation. If the result of this process were simultaneously encoded, it would easily explain later distinction between memories relating to a past reality and memories relating to imagination, a faculty called reality monitoring. How the brain makes this distinction is unknown but much research suggests that it depends on processes active when information is encoded. Here we explored the precise timing between ORFi and encoding as well as interactions between the involved brain structures. We used high-density evoked potentials and two runs of a continuous recognition task (CRT) combining the challenges of ORFi and encoding. ORFi was measured by the ability to realize that stimuli appearing in the second run had not appeared in this run yet. Encoding was measured with immediately repeated stimuli, which has been previously shown to induce a signal emanating from the medial temporal lobe (MTL), which has a protective effect on the memory trace. We found that encoding, as measured with this task, sets in at about 210 ms after stimulus presentation, 35 ms before ORFi. Both processes end at about 330 ms. Both were characterized by increased coherence in the theta band in the MTL during encoding and in the orbitofrontal cortex (OFC) during ORFi. The study suggests a complex interaction between OFC and MTL allowing for thoughts to be re-encoded while they undergo ORFi. The combined influence of these two processes at 200–300 ms may leave a memory trace that allows for later effortless reality monitoring in most everyday situations