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Kamps J.L.,Childrens Hospital of New Orleans | Kamps J.L.,Louisiana State University Health Sciences Center | Varela R.E.,Tulane University
Diabetes Research and Clinical Practice | Year: 2010

Aims: To prospectively examine the effects of fear of hypoglycemia (FH), adherence to blood glucose testing, and anxiety on metabolic control in youth with Type 1 diabetes. To examine the relationships among these variables in the context of a hurricane. Methods: Participants included 158 children completing measures at two times, with 58 participants completing measures pre- and post-Hurricane Katrina. Hierarchical regressions were run predicting indices of metabolic control. Results: HbA1c was a unique predictor of subsequent HbA1c although a significant interaction between children's FH and hurricane group was found for HbA1c. Percent of low blood glucose (BG) was the only unique predictor of subsequent low BG. Percent of high BG and demographic variables were predictors of subsequent high BG. There was also a significant interaction between children's FH and hurricane group for high BG. Conclusions: Prior metabolic control is a strong predictor of subsequent metabolic control. Youth who exhibit FH are at risk for poor metabolic control, specifically demonstrating high BG levels and HbA1c if they have experienced a major stressor such as a natural disaster. © 2010 Elsevier Ireland Ltd. Source

Chiu E.S.,Tulane University | Alexander M.E.,Childrens Hospital of New Orleans | St. Hilaire H.,Plastic and Reconstructive Surgery | St. Hilaire H.,Louisiana State University Health Sciences Center | Moses M.,Cleft Lip and Palate Craniofacial Team
Cleft Palate-Craniofacial Journal | Year: 2011

Background: Reports after the 2005 Hurricane Katrina have documented an increase in stress reactions and environmental teratogens (arsenic, mold, alcohol). Objective: To assess the incidence of cleft pathology before and after the hurricane, and the distribution of cleft cases by gender and race. Methods: Retrospective chart review of cleft lip with or without cleft palate (CL/P) and cleft palate (CP) cases registered with the Cleft and Craniofacial Team at Children's Hospital of New Orleans, the surgical center that treated cleft cases in Greater New Orleans between 2004 and 2007. Live birth data were obtained from the Louisiana State Center for Health Statistics. Results: The incidence of cleft cases, beginning 9 months after the hurricane (i.e., June 1, 2006) was significantly higher compared with the period before the hurricane (0.80 versus 1.42; p = .008). Within racial group comparisons showed a higher incidence among African Americans versus whites (0.42 versus 1.22; p = .01). The distribution of CL/P and CP cases by gender was significant (p = .05). Conclusion: The increase in the incidence of cleft cases after the hurricane may be attributable to increased stress and teratogenic factors associated with the hurricane. The increase among African Americans may have been due to comparatively higher exposure to environmental risk factors. These findings warrant further investigation to replicate the results elsewhere in the Gulf to determine whether there is a causal relationship between environmental risk factors and increased cleft pathology. Source

Gracies J.-M.,CHU Henri Mondor | Burke K.,Texas Scottish Rite Hospital for Children | Clegg N.J.,Texas Scottish Rite Hospital for Children | Browne R.,Texas Scottish Rite Hospital for Children | And 5 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2010

Gracies J-M, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Objective: To measure the Tardieu Scale's reliability in children with cerebral palsy (CP) when used by raters with and without experience in using the scale, before and after training. Design: Single-center, intrarater and interrater reliability study. Setting: Institutional ambulatory care. Participants: Referred children with CP in the pretraining phase (n=5), during training (n=3), and in the posttraining phase (n=15). Interventions: The Tardieu Scale involves performing passive muscle stretch at 2 velocities, slow and fast. The rater derives 2 parameters; the Spasticity Angle X is the difference between the angles of arrest at slow speed and of catch-and-release or clonus at fast speed; the Spasticity Grade Y is an ordinal variable that grades the intensity (gain) of the muscle reaction to fast stretch. In phase 1, experienced raters without formalized training in the scale graded elbow, knee, and ankle plantar flexors bilaterally, without and with a goniometer. In phase 2, after training, the experienced and nonexperienced raters graded the same muscles unilaterally. Main Outcome Measures: Intrarater and interrater reliability of the Tardieu Scale. Results: After training, nonexperienced raters had mean ± SD intrarater and interrater agreement rates across all joints and parameters of 80%±14% and 74%±16%, respectively. For experienced raters, intrarater and interrater agreement rates before training were 77%±13% and 66%±15%, respectively, versus 90%±8% and 81%±13%, respectively, after training (P<.001 for both). Specific angle measurements at the knee were less reliable for the angles of catch measured at fast speed. Across all joints, agreement rates were similar using visual or goniometric measurements. Conclusions: Both parameters of the Tardieu Scale have excellent intrarater and interrater reliability when assessed at the elbow and ankle joints of children with CP, with no difference noted between visual and goniometric measurements. Angle measurements were less reliable at the knee joints. Training was associated with a highly significant improvement in reliability. © 2010 American Congress of Rehabilitation Medicine. Source

Mohammad S.,Northwestern University | Di Lorenzo C.,Nationwide Childrens Hospital | Youssef N.N.,Digestive Healthcare Center | Miranda A.,Medical College of Wisconsin | And 3 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2014

Objectives: Irritable bowel syndrome is a multisymptom construct, with abdominal pain (AP) acting as the driving symptom of patient-reported severity. The Food and Drug Administration considers a >30% decrease in AP as satisfactory improvement, but this has not been validated in children. We investigated the correspondence of 2 measures for AP assessment, ≥30% improvement in AP and global assessment of improvement. METHODS: Secondary analysis of data from 72 children who completed a randomized clinical trial for abdominal pain-associated functional gastrointestinal disorders. Children completed daily assessment of AP intensity, functional disability inventory (FDI), question regarding paine's interference with activities, and 2 global assessment questions. We measured the extent to which ≥30% improvement of AP and global assessment questions correlated with each other and with disability. RESULTS: The global questions correlated with each other (r=0.74; P<0.0001) and with a ≥30% improvement in AP (P<0.01). Global outcomes were satisfaction with treatment was inversely related to the childe's report of interference with activities (P<0.01) and symptom relief was positively associated with ≥30% improvement in FDI scores (P<0.009). A 30% change in FDI scores was associated with global questions of symptom relief (P=0.009) but not with satisfaction with treatment (P=0.07). The association of AP improvement with interference with activities (P=0.14) or change in FDI scores (P=0.27) did not reach significance. CONCLUSIONS: Currently used global assessments are significantly associated with decreased pain intensity, decreased interference with daily activities, and a ≥30% change in FDI scores, whereas recommended 30% improvement in pain intensity is not as comprehensive. © 2013 by European Society for Pediatric Gastroenterology,Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Source

Li Y.Q.,Guangzhou University | Xu H.W.,Guangzhou University | Li J.C.,Guangzhou University | Yu L.J.,Guangzhou University | And 3 more authors.
Journal of Pediatric Orthopaedics Part B | Year: 2015

This study evaluates improvement of the acetabular index (AI) in patients with developmental dysplasia of the hip at 4 years after closed reduction, and determines the association between the final AI and a set of factors. Sixtytwo patients (74 hips) treated with closed reduction were categorized into three groups according to age: group A (0-12 months, 18 hips), group B (13-18 months, 24 hips), and group C (>18 months, 32 hips). There was no difference in AI among the three groups before reduction (P=0.293). In groups A and C, the AI decreased significantly over time until 3 years after reduction and no differences were observed between the time points of 3 and 4 years. At 4 years after reduction, the AI of group C was significantly higher than that of groups A (P<0.001) and B (P=0.012). The overall AI improvement rate was 28.63%. The AI improvement rate of group A was significantly higher than that of group C (P=0.005). Pearson correlation analysis indicated no correlation between center-head distance discrepancy and the final AI (P=0.811). Linear regression suggested that age and initial AI correlated significantly with the final AI (R2=0.617, F=15.031, P<0.001). Other factors, such as sex, center-edge angle of Wiberg, bilaterally involved, and avascular necrosis of the femoral head, showed no correlations with the final AI (P>0.05). According to the coefficients, initial AI (ß1=0.432, P<0.001) had greater effect than age (ß2=0.197, P=0.023) on the final AI. In conclusion, the AI decreases in all patients after reduction and stabilizes at 3 years after reduction. The AI improvement rate is correlated negatively with age. Age and initial AI are early predictors of the progress of AI after closed reduction in developmental dysplasia of the hip patients. © 2014 Wolters Kluwer Health. Source

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