Association between habitual snoring,middle ear disease,and speech problems in young children with non-syndromic cleft palate anomalies

The purpose of this study was to investigate the association between habitual snoring (HS), middle ear disease (MED), and speech problems in children with cleft palate. This cross-sectional study included children aged 2.0–7.9 years with non-syndromic cleft palate anomalies. Parents completed the Pediatric Sleep Questionnaire and a questionnaire about MED. Audiograms and speech assessment were also conducted. Ninety-five children were enrolled; 15.2% of families reported HS, 97.6% MED, and 17.1% speech problems. HS (37.5% vs 10.3%, P = 0.007) and early episodes of MED (92.3% vs 58.2%, P = 0.021) were more likely to be reported for children with isolated cleft palate when compared to those with cleft lip and palate. Children with cleft lip and palate had a higher frequency of MED with effusion compared to those with Robin sequence (86.4% vs 57.1%, P = 0.049). The odds ratio for HS in children with ≥1 episode of MED in the last year was 7.37 (95% confidence interval 1.55–35.15, P = 0.012). There was a trend for children with speech problems reported by parents to have HS (30.8% vs 11.5%, P= 0.076). Anatomical factors play a role in the frequency of upper airway symptoms in children with cleft palate. A recent history of at least one episode of MED was associated with an increased frequency of HS.     

Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood: Data from mandatory school entry examinations in Germany

BackgroundFrom birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family’s socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration.MethodWe used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children’s school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high).ResultsFamily SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation.ConclusionFamily SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course.     

ITERATIVE DYNAMIC PROGRAMMING FOR MINIMUM ENERGY CONTROL PROBLEMS WITH TIME DELAY

This paper presents the use of iterative dynamic programming employing exact penalty functions for minimum energy control problems. We show that exact continuously non-differentiable penalty functions are superior to continuously differentiable penalty functions in terms of satisfying final state constraints. We also demonstrate that the choice of an appropriate penalty function factor depends on the relative size of the time delay with respect to the final time and on the expected value of the energy consumption. A quadratic approximation (QA) of the delayed variables is much better than a linear approximation (LA) of the same for relatively large time delays. The QA improves the rate of convergence and avoids the formation of ‘kinks‘. A more general way of selecting appropriate penalty function factors is given and the results obtained using four illustrative examples of varying complexity corroborate the efficacy of the method.     

Pleiotropy in Coffin-Lowry syndrome: Sensorineural hearing deficit and premature tooth loss as early manifestations

We report on 7 patients (6 M, 1 F) with Coffin-Lowry syndrome who have a sensorineural hearing deficit in addition to developmental delay and characteristic facial changes. One of the patients also had a history of premature exfoliation of primary teeth. These are previously unappreciated clinical signs that may aid in the early diagnosis of Coffin-Lowry syndrome. Early diagnosis and recognition of a hearing deficit in the patient can lead to the use of hearing aids to help the patient achieve his or her full potential. These “;new”; clinical manifestations expand the phenotype of Coffin-Lowry syndrome and constitute an additional indication of pleiotropy. © 1993 Wiley-Liss, Inc.     

非控制性出血休克大鼠早期低压液体复苏的理想复苏压力研究

目的利用大鼠非控制性出血休克模型,探讨早期低压复苏的理想复苏压力。方法W istar大鼠64只,基础平均动脉血压(MAP)为(129.9±14.3)mmHg,断脾法复制非控制性出血休克模型,将血压(MAP)降至40或50mmHg,分为3个处理时段,第1时段模拟院前救治时段,用2∶1乳酸林格氏液和6%的右旋糖酐输注分别将MAP维持在40、50、60、70、80、100mmHg,维持1小时;第2时段模拟医院确定性处理情况,结扎脾动脉止血,输血输液将MAP恢复至100mmHg,维持2小时;第3时段,观察第1时段不同压力复苏对大鼠休克复苏效果的影响。观察指标包括动物存活情况、血压、液体输注量、血细胞比容及动脉血气等。结果院前急救采用高压复苏(80、100mmHg),动物存活时间短,在第1时段末就有50%的动物死亡,需要的液体输注量大,血液稀释严重,代谢性酸中毒明显,血气指标差;而以<70mmHg(50、60、70mmHg)的血压复苏,动物存活时间延长,液体输注量小,血液稀释轻,血气指标正常或接近正常;以50、60mmHg血压输注效果最好,但太低的输注压力(40mmHg)也不利于休克复苏,在第三时段末动物死亡率为75%。结论对非控制性出血休克及活动性出血,止血前采用高压复苏会增加血液丢失及血液稀释,明显影响休克复苏效果,适当低压复苏有利于动物的后期恢复,输注压力以50、60mmHg最好,但太低的输注压力(40mmHg)也不利于休克复苏。     

Parenting children with and without developmental delay: the role of self-mastery

Background While parenting behaviours have direct effects on children’s behavioural outcomes, other, more distal factors also may be shaping the way a mother handles parenting responsibilities. Dispositional factors are likely to be a major influence in determining how one parents. Although researchers have studied the relationships among maternal dispositional factors, parenting, and child behaviours, few studies have examined these relationships when the child is at developmental risk. Children with developmental delays evidence elevated clinical level behaviour problems, so this group is of primary interest in the search for precursors to psychopathology. The present study examined how the maternal dispositional trait of self‐mastery, as well as supportive and non‐supportive parenting, relate to behaviour problems in young children with and without developmental delay. Method Participants were 225 families, drawn from Central Pennsylvania and Southern California. The children, all aged 4 years, were classified as delayed (n = 97) or non‐delayed (n = 128). The Self‐Mastery Scale measured perceived level of control over life events. The Coping with Children’s Negative Emotions Scale measured different ways parents perceive themselves as reacting to their children’s distress and negative affect. The Child Behavior Checklist assessed children’s behaviour problems. Results Delayed condition mothers reported significantly more child behaviour problems than non‐delayed condition mothers; the two conditions did not differ in self‐mastery, supportive parenting, or non‐supportive parenting. Self‐mastery, non‐ supportive parenting reactions, and child behaviour problems all related significantly to one another. For the sample as a whole and within the delayed condition, the association between self‐mastery and child behaviour problems was partially mediated by non‐supportive parenting reactions, although self‐mastery was still significantly associated with problem behaviour. In the non‐delayed condition, although significant relationships also were found among the variables of interest, non‐supportive parenting did not have a significant main or mediation effect. Delay status moderated the relationship between negative parenting reactions and child behaviour problems, assessed by the Child Behavior Checklist Total and Internalizing scores. When mothers displayed low levels of non‐supportive reactions, children in the delayed and non‐delayed groups had similar levels of total problem behaviour. However, when mothers were medium or high in non‐supportive reactions, children in the delayed group had much higher levels of problem behaviours than those in the non‐delayed group. Conclusions The present study extended research on parental dispositional factors and parenting by measuring self‐mastery as a global personality trait rather than measuring self‐efficacy related specifically to childrearing. Moreover, relationships were examined for both developmentally delayed and non‐delayed samples, allowing for a clearer understanding of the influences on problem behaviours in children with developmental delays. The findings support the view that parenting behaviours have a greater impact on children at developmental risk.     

The potential of an anaesthesiologist–manned ambulance service in a rural/urban district

The use of anaesthesiologists in prehospital emergency care is controversial. We wanted to assess the impact of an anaesthesiologist and a short time interval from acceptance of a mission to take–off at survival rates in a rural/urban emergency medical service. Prospectively registered data for 991 consecutive patients through a 12–month period were retrospectively evaluated by an independent foreign expert. Of all primary missions, 3.3% were considered probably lifesaving from site of injury to receiving hospital. Of these, the lifesaving result in 50% were dependent on both the qualifications of the anaesthesiologist and a short response time. Survival from hospital admission to discharge was 44%. All patients were discharged to their own homes, able to live a fully functional life. The consistent use of anaesthesiologists compared to less qualified personnel and the maintaining of response times below presently required minima doubles the potential for lives saved in services comparable to the one studied.