scholarly journals Cardiometabolic outcomes in children and adolescents with West syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Inbar Gilboa ◽  
Galit Israeli ◽  
Avivit Brener ◽  
Michal Yackobovitch-Gavan ◽  
Uri Kramer ◽  
...  
Keyword(s):  
Early Childhood ◽  
Medical Center ◽  
Density Lipoprotein ◽  
West Syndrome ◽  
Group Differences ◽  
Significant Group ◽  
Diastolic Hypertension ◽  
Z Scores ◽  
Obesity Hypertension

Abstract Background West syndrome is a convulsive disorder of infancy with unique seizures and a characteristic background electroencephalograph pattern. Adrenocorticotropic hormone (ACTH) is effective in spasm cessation, yet metabolic consequences of this therapeutic agent in childhood have not been published. Methods In this observational study we explored the cardiometabolic outcomes of 117 children with West syndrome (78 ACTH-treated and 39 non-ACTH-treated) monitored at a single medical center from 1995 to 2019 (median follow-up 7.2 years). Outcomes included the prevalence of cardiometabolic derangements (obesity, hypertension, and dyslipidemia) during infancy (< 2 years), early childhood (2–6 years), and childhood/adolescence (6–18 years). Results The rates of metabolic derangements during infancy in the West syndrome cohort were high compared to childhood/adolescence (obesity 27.3 % vs. 3.3 %, [p = 0.010], diastolic hypertension 48.8 % vs. 5.1 % [p < 0.001], hypertriglyceridemia 71 % vs. 40 % [p = 0.008], low high-density lipoprotein cholesterol [HDL-c] 54.2 % vs. 12.9 % [p = 0.001], and elevated triglycerides/HDL-c ratios 62.5 % vs. 12.9 % [p < 0.001]). The proportion of systolic and/or diastolic blood pressure levels categorized as hypertensive was 58.5 % during infancy, 48.1 % during early childhood, and 26.3 % during childhood/adolescence. ACTH-treated patients had higher weight and weight-to-length z-scores and higher triglyceride levels during infancy compared to non-ACTH-treated patients (p = 0.008, p = 0.001, and p = 0.037, respectively), and higher triglyceride levels during early childhood (p = 0.050), with no significant group differences during childhood/adolescence. Conclusions Children with West syndrome apparently have an increased prevalence of cardiometabolic derangements more pronounced in infants and in ACTH-treated patients. These findings highlight the need to monitor these children for cardiometabolic derangements, even though these cardiometabolic abnormalities are transitory and tend to decrease with time. The health implications of cardiometabolic derangements during critical windows of growth and development warrant further investigation.

scholarly journals OP0159 EFFICACY OF COMPREHENSIVE TECHNOLOGY-ASSISTED HOME-BASED EXERCISE IN ANKYLOSING SPONDYLITIS: A RANDOMIZED, CONTROLLED TRIAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
Y. Wang ◽  
X. Liu ◽  
Y. Shi ◽  
X. Ji ◽  
W. Wang ◽  
...  
Keyword(s):  
Exercise Intervention ◽  
Medical Center ◽  
Controlled Trial ◽  
Intervention Group ◽  
Exercise Program ◽  
Group Differences ◽  
Control Group ◽  
Home Based ◽  
The Mean

Background:Clinical practice guidelines recommend that exercise is an essential component in the self-management of Ankylosing Spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be burdensome and patients may decline participation, whereas, effective home-based exercise interventions that do not need regular medical center visits are likely to be more accessible and acceptable for patients with AS. Recently, increasing evidences have been accumulated that the wearable devices could facilitate patients with inflammatory arthritis by giving exercise instructions and improving self-efficacy. Therefore, patients with AS may benefit from an effective technology-assisted home-based exercise intervention.Objectives:To investigate the efficacy of a comprehensive technology-assisted home-based exercise intervention on disease activity in patients with AS.Methods:This study was a 16-week assessor-blinded, randomized, waiting-list controlled trial (ChiCTR1900024244). Patients with AS were randomly allocated to the home-based exercise intervention group and the waiting-list control group. A 16-week comprehensive exercise program consisting of a moderate intensity (64%-76% HRmax) aerobic training for 30min on 5 days/week and a functional training for 60min on 3 days/week was given to patients in the intervention group immediately after randomization, with 1.5h training sessions for two consecutive days by a study physical therapist at baseline and Week 8. The aerobic exercise intensity was controlled by a Mio FUSE Wristband with a smartphone application. The functional training consisted of the posture training, range of motion exercises, strength training, stability training and stretching exercises. Patients in control group received standard care during the 16-week follow-up and started to receive the exercise program at Week 16. The primary outcome was ASDAS at Week 16. The secondary outcomes were BASDAI, BASFI, BASMI, ASAS HI, peak oxygen uptake, body composition and muscle endurance tests. The mean difference between groups in change from baseline was analyzed with the analysis of covariance.Results:A total of 54 patients with AS were enrolled (26 in intervention group and 28 in control group) and 46 (85.2%) patients completed the 16-week follow-up. The mean difference of ASDAS between groups in change from baseline to 16-week follow-up was −0.2 (95% CI, −0.4 to 0.003, P = 0.032), and the mean change from baseline was -0.4 (95% CI, -0.5 to -0.2) in the intervention group vs -0.1 (95% CI, -0.3 to 0.01) in the control group, respectively. Significant between-group differences were found between groups for BASDAI (−0.5 [95% CI, −0.9 to −0.2], P = 0.004), BASMI (−0.7 [95% CI, −1.1 to −0.4], P <0.001), BASFI (−0.3 [95% CI, −0.6 to 0.01], P=0.035), peak oxygen uptake (2.7 [95% CI, 0.02 to 5.3] ml/kg/min, P=0.048) and extensor endurance test (17.8 [95% CI, 0.5 to 35.2]s, P=0.044) at Week 16. Between-group differences were detected in ASAS HI (−0.9 [95% CI, −1.7 to −0.1], P=0.030), body fat percentage (−1.0 [95% CI, −2.0 to −0.01] %, P=0.048) and visceral adipose tissue (−4.9 [95% CI, −8.5 to −1.4] cm2, P=0.008) at Week 8, but not at Week 16. No significant between-group differences were detected in the total lean mass, time up and go test and the flexor endurance test during the follow-up.Conclusion:Comprehensive technology-assisted home-based exercise has been shown to have beneficial effects on disease activity, physical function, spinal mobility, aerobic capacity, and body composition as well as in improving fatigue and morning stiffness of patients with AS.References:[1]van der Heijde D, Ramiro S, Landewé R, et al. Ann Rheum Dis 2017;76:978–991.Disclosure of Interests:None declared

scholarly journals A Pilot Feasibility Study of Interpersonal Psychotherapy for the Prevention of Excess Weight Gain Among Adolescent Military-dependent Girls

2020 ◽  
Author(s):  
Abigail E Pine ◽  
Natasha A Schvey ◽  
Lisa M Shank ◽  
Natasha L Burke ◽  
M K Higgins Neyland ◽  
...  
Keyword(s):  
Weight Gain ◽  
Treatment Acceptability ◽  
Outcome Data ◽  
Excess Weight ◽  
Group Differences ◽  
Military Dependents ◽  
Significant Group ◽  
Excess Weight Gain ◽  
Military Dependent

ABSTRACT Introduction Adolescent military-dependents face unique psychosocial stressors due to their parents’ careers, suggesting they may be particularly vulnerable to excess weight gain and symptoms of depression and anxiety. Despite these risk factors, there is a lack of tested preventative interventions for these youths. Given the transient nature of military family deployments, research may be hindered due to difficulty in collecting long-term prospective outcome data, particularly measured height and weight. The primary aim of this study was to examine the feasibility and acceptability of collecting body mass index (BMI, kg/m2) outcome data up to 2 years following a randomized controlled pilot trial of an adapted interpersonal psychotherapy (IPT) program aimed at preventing excess weight gain and improving psychological functioning for adolescent military-dependents. In exploratory analyses, patterns in body composition over time were examined. Materials and Methods Twenty-seven adolescent military-dependent girls (baseline: Mage: 14.4 ± 1.6 years; MBMI: 30.7 ± 4.9 kg/m2; MBMI-z: 1.9 ± 0.4) participated in this study. After a baseline assessment, utilizing a computerized program to create a randomization string, girls were assigned to either an IPT or a health education (HE) program. Participants completed three follow-up visits (posttreatment, 1-year follow-up, and 2-year follow-up). Girls completed a Treatment Acceptability Questionnaire at posttreatment; at all time points, height and fasting weight were collected. For the primary aim, Fisher’s exact tests examined the rate of obtained follow-up data and lost to follow-up status between the two groups, Mann-Whitney U tests examined the session attendance between groups, and treatment acceptability ratings were compared between the two groups at posttreatment using an independent samples t-test. For the exploratory aim, one-way analyses of covariance (ANCOVAs) examined the group differences in BMI at each time point, adjusting for baseline values, and paired samples t-tests examined the within-group differences at each time point relative to baseline. Using imputed data in the full intent-to-treat sample, mixed model ANCOVAs were conducted to examine the group differences over time. Results Across both groups, girls attended an average of 72.0% of sessions. At least partial data were collected at posttreatment, 1-year follow-up, and 2-year follow-up for 96.3%, 85.2%, and 74.1% of the participants, respectively. There were no significant group differences in follow-up data collection rates, follow-up status, number of sessions attended, or treatment acceptability. BMI-z stabilized across groups, and there were no group differences in BMI-z. In adjusted ANCOVA models with imputed data, no significant group-by-time effects emerged. Conclusions For this randomized controlled prevention trial, long-term outcome data collection of measured BMI was possible in adolescent military-dependents and IPT was an acceptable and feasible intervention. An adequately powered trial is required to assess the efficacy of this intervention among military-dependents for obesity prevention and improvements in BMI.

scholarly journals A real-world evaluation of a tertiary care childhood obesity intervention to reduce metabolic risk in a hard-to-reach urban population

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nagla S. Bayoumi ◽  
Elizabeth Helzner ◽  
Aimee Afable ◽  
Michael A. Joseph ◽  
Sarita Dhuper
Keyword(s):  
Blood Pressure ◽  
Lifestyle Intervention ◽  
Severe Obesity ◽  
Low Density Lipoprotein ◽  
Tertiary Care ◽  
Density Lipoprotein ◽  
Z Score ◽  
Lipid Levels ◽  
Diastolic Hypertension

Abstract Background Research on outcomes associated with lifestyle interventions serving pediatric populations in urban settings, where a majority have severe obesity, is scarce. This study assessed whether participation in a lifestyle intervention improved body mass index (BMI) percentile, BMI z-score, blood pressure, and lipid levels for children and adolescents. Methods The Live Light Live Right program is a lifestyle intervention that uses medical assessment, nutritional education, access to physical fitness classes, and behavioral modification to improve health outcomes. Data was analyzed for 144 subjects aged 2–19 who participated for a minimum of 12 consecutive months between 2002 and 2016. McNemar tests were used to determine differences in the proportion of participants who moved from abnormal values at baseline to normal at follow-up for a given clinical measure. Paired sample t-tests assessed differences in blood pressure and lipid levels. Multiple linear regression assessed the change in blood pressure or lipid levels associated with improvement in BMI%95 and BMI z-score. Results The majority were female (62.5%), mean age was 9.6, and 71% were Black. At baseline, 70.1% had severe obesity, systolic hypertension was present in 44, and 13.9% had diastolic hypertension. One-third had abnormally low high-density lipoprotein (HDL) at baseline, 35% had elevated low-density lipoprotein (LDL), and 47% had abnormal total cholesterol (TC). The average difference in percentage points of BMI%95 at follow-up compared was − 3.0 (95% CI: − 5.0, − 1.1; p < 0.003). The mean difference in BMI z-score units at follow-up was − 0.15 (95% CI: − 0.2, − 0.1; p < 0.0001). Participants with systolic or diastolic hypertension had an average improvement in blood pressure of − 15.3 mmHg (p < 0.0001) and − 9.6 mmHg (p < 0.0001), respectively. There was a mean improvement of 4.4 mg/dL for participants with abnormal HDL (p < 0.001) and − 7.8 mg/dL for those with abnormal LDL at baseline (p = 0.036). For those with abnormal baseline TC, a one-unit improvement in BMI%95 was associated with a 0.61 mg/dL improvement in TC while holding constant age, contact hours, and months since enrollment (p = 0.043). Conclusions Participation in the program resulted in significant improvements in BMI percentile, BMI z-score, blood pressure, and lipid levels.

scholarly journals Home Environment as a Predictor of Long-Term Executive Functioning following Early Childhood Traumatic Brain Injury

2017 ◽  
Vol 24 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Christianne Laliberté Durish ◽  
Keith Owen Yeates ◽  
Terry Stancin ◽  
H. Gerry Taylor ◽  
Nicolay C. Walz ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Early Childhood ◽  
Brain Injury ◽  
Executive Functioning ◽  
Home Environment ◽  
Group Differences ◽  
Severe Tbi

AbstractObjectives:This study examined the relationship of the home environment to long-term executive functioning (EF) following early childhood traumatic brain injury (TBI).Methods:Participants (N=134) were drawn from a larger parent study of 3- to 6-year-old children hospitalized for severe TBI (n=16), complicated mild/moderate TBI (n=44), or orthopedic injury (OI;n=74), recruited prospectively at four tertiary care hospitals in the United States and followed for an average of 6.8 years post-injury. Quality of the home environment, caregiver psychological distress, and general family functioning were assessed shortly after injury (i.e., early home) and again at follow-up (i.e., late home). Participants completed several performance-based measures of EF at follow-up. Hierarchical regression analyses examined the early and late home environment measures as predictors of EF, both as main effects and as moderators of group differences.Results:The early and late home environment were inconsistent predictors of long-term EF across groups. Group differences in EF were significant for only the TEA-Ch Walk/Don’t Walk subtest, with poorer performance in the severe TBI group. However, several significant interactions suggested that the home environment moderated group differences in EF, particularly after complicated mild/moderate TBI.Conclusions:The home environment is not a consistent predictor of long-term EF in children with early TBI and OI, but may moderate the effects of TBI on EF. The findings suggest that interventions designed to improve the quality of stimulation in children’s home environments might reduce the long-term effects of early childhood TBI on EF. (JINS, 2018,24, 11–21)

Effects of Interactive Book Reading for Increasing Children’s Knowledge of Instructional Verbs

2018 ◽  
Vol 39 (4) ◽  
pp. 477-489 ◽  
Author(s):  
Joneen Lowman ◽  
Laura T. Stone ◽  
Jing Guo
Keyword(s):  
Intervention Group ◽  
Teacher Talk ◽  
Book Reading ◽  
Group Differences ◽  
Control Group ◽  
Reading Group ◽  
Significant Group ◽  
Academic Content ◽  
Interactive Book

Interactive book reading (IBR) has proven effective for increasing children’s lexicons with most of the results based on students’ learning of nouns. Little is known about the application of IBR to instructional verbs (i.e., words used during the instruction of academic content). To address this gap, 122 prekindergarten children were recruited from seven elementary schools. Each school was randomly assigned to the intervention group or the control group. Children in the intervention group were taught 12 instructional verbs across a 3-week period using interactive book-reading strategies. Children assigned to the control group only received implicit exposure to instructional verbs during teacher talk. Children in the book-reading group knew significantly more words on a receptive picture identification task than children in the control group both at posttesting and at follow-up testing in the fall. No significant group differences were noted at spring testing.

Abstract 19227: Results of an Implantable Cardioverter Defibrillator Screening Program Based on Transthoracic Echocardiography at a Tertiary Academic Medical Center

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
William F Dresen ◽  
Augustus E Mealor ◽  
Will Camnitz ◽  
Samuel Love ◽  
Neha Choubey ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Risk Score ◽  
Screening Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lv Function ◽  
Significant Group ◽  
Academic Medical ◽  
Improvement Programs

Introduction: There has been interest in quality improvement programs based on screening of LV function in order to increase rates of adherence to guideline-based recommendations for implantable cardioverter defibrillators (ICDs) for primary prevention (PP) of sudden cardiac death. Methods: We queried the echocardiography database at a tertiary academic medical center for patients with LVEF ≤ 35% on a transthoracic echocardiogram (TTE) and analyzed clinical data from the electronic medical record. We then determined the proportion receiving ICDs, reasons ICDs were not implanted, mortality rates, and our risk score for death (JACC 2012; 60:1647-55). Results: Of the 406 patients reviewed with LVEF 35% or less, 22.9% had an ICD at the time of the TTE and 10.8% had an ICD implanted during a median follow-up of 4.0 years (ICD-DURING-FU). With respect to patients without ICDs, 6.2% (of total group) did not survive the index hospitalization, 16.4% did not meet primary prevention criteria due to life expectancy less than 1 year or other guideline-based criteria, and 23.4% had spontaneous LVEF improvement to above 35% (LVEF-SPONT-IMPROVED), while the remaining 20.0% met guideline-based criteria for a primary prevention ICD (NO-ICD-DESPITE-CRITERIA) (Table). The NO-ICD-DESPITE-CRITERIA group had a greater mortality (35.8%) than the LVEF-SPONT-IMPROVED group (21.1%; p=0.03) and the ICD-DURING-FU group (20.5%; trend with p=0.07). In a multivariable logistic model, LVEF-SPONT-IMPROVED (v. ICD-DURING-FU) patients had OR=0.50 for death (p=0.049) after adjustment for the risk score. Conclusions: In a large cross section of patients with TTEs and extended follow-up, 1 in 5 patients did not have ICDs implanted despite meeting standard PP criteria. Another significant group did not have ICDs implanted because they had improvement in LV function during follow-up, and these patients had a similar survival probability to patients who did have ICDs implanted during follow-up.

Daily Hassles and Profiles of Well-Being among Older Residents of Small Rural Towns

1986 ◽  
Vol 58 (2) ◽  
pp. 587-590 ◽  
Author(s):  
Rick J. Scheidt
Keyword(s):  
General Pattern ◽  
Well Being ◽  
Daily Hassles ◽  
Group Differences ◽  
Subjective Well Being ◽  
Significant Group ◽  
Social Reactions ◽  
Interview Format ◽  
Post Hoc

As part of a larger study of adaptation to environmental stress, 101 older (65 yr. +) small-town residents displaying four distinct profiles of subjective well-being (frail, disengaged, partially-, and fully-engaged) were administered a 67-item version of the Daily Hassles Scale in interview format. A 1-way multivariate analysis was conducted on frequency of hassles and intensity scores across eight hassle-content categories (Health, Friends and Relatives, Finances, Social Reactions, Physical Environment, Declines in Capacity, Time, and Job). Follow-up univariate F tests and post hoc analyses indicated significant group differences on the number of hassles for five categories (except Social Reactions, Time, and Job). Reliable group differences on intensity of hassles were found for Health, Friends and Relatives, and Declines in Capacity. The general pattern of data showed both frail and fully engaged elderly experiencing more hassles and with greater intensity than the partially engaged and disengaged. Interpretations are offered.

scholarly journals Is Laparoendoscopic Single-Site Adrenalectomy a Feasible Alternative in Treating Aldosterone-Producing Adenoma?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Che-Hsiung Wu ◽  
Leay-Kiaw Er ◽  
Ya-Hui Hu ◽  
Chia Da Lin ◽  
Shih-Chieh Chueh ◽  
...  
Keyword(s):  
Single Site ◽  
Group Differences ◽  
Significant Group ◽  
Open Conversion ◽  
Laparoendoscopic Single Site ◽  
Serum Aldosterone ◽  
Feasible Alternative ◽  
Aldosterone Producing Adenoma ◽  
One Year

Objective. To compare laparoendoscopic single-site (LESS) and conventional multiport adrenalectomy in patients with aldosterone-producing adenoma (APA).Material and Methods. We retrospectively reviewed patients who had been clinically confirmed with unilateral APA and who underwent LESS or multiport adrenalectomy between 2009 and 2014. Perioperative data were obtained for all patients. Blood pressure and the levels of serum aldosterone, renin, and potassium were checked periodically.Results. We identified 45 APA patients in the LESS group and 71 in the multiport group. The baseline characteristics were matched between two groups. All adrenalectomies were completed successfully, except one with laparoscopic conversion in the single-port group and one open conversion in the multiport group. After a mean follow-up around one year, there were no significant group differences in the improvement of hypertension, number of types of medication taken, and cure of hypokalemia after operation.Conclusions. Our study confirm that LESS adrenalectomy achieved similar clinical and functional outcomes as conventional multiport adrenalectomy for management of unilateral APA.

Further Evidence for Two Varieties of Nonconformity

1967 ◽  
Vol 20 (3) ◽  
pp. 885-886
Author(s):  
Robert J. Smith
Keyword(s):  
Response Style ◽  
Group Differences ◽  
Previous Theory ◽  
Significant Group ◽  
College Sample ◽  
Follow Up Study ◽  
Male College

In a brief follow-up study the attitudes expressed by three empirically defined groups, conformers, independents, and anticonformers, related very closely to those found with a previous male college sample (Smith, 1967). The earlier significant correlation between a scale of attitudes and one of response style also held. A scale to measure psychological anomie reflected significant group differences in this study as was expected from previous theory and research.

Maximum Performance Tests in Children With Developmental Spastic Dysarthria

1993 ◽  
Vol 36 (3) ◽  
pp. 452-459 ◽  
Author(s):  
J. Wit ◽  
B. Maassen ◽  
F. J. M. Gabreëls ◽  
G. Thoonen
Keyword(s):  
Fundamental Frequency ◽  
Group Differences ◽  
Performance Tests ◽  
Frequency Range ◽  
Significant Group ◽  
Maximum Performance ◽  
Performance Tasks ◽  
Syllable Duration ◽  
Z Scores ◽  
Normal Speech

Three noninvasive Maximum Performance Tasks (MPT)—Maximum Sound Prolongation (MSP), Fundamental Frequency Range (FFR), and Maximum Repetition Rate (MRR)—were administered to 11 children with spastic dysarthria due to cerebral palsy and to 11 control children with normal speech in order to determine the value of the tasks for differentiating between these groups of children. From the acoustic measurements, nine parameters were calculated, and in seven of them highly significant group differences were found. By adding the unweighted z-scores of four parameters (maximum sound prolongation, syllable duration, fundamental frequency range, inter-utterance variability of syllable duration), a composite z-score was constructed with nonoverlapping distributions for both groups. The authors conclude that maximum performance tasks, despite the large intrasubject and intersubject variability in both normal and pathological speakers, are powerful tools for detecting spastic dysarthria.

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