Performance of parental history for the targeted screening of hypertension in children.

OBJECTIVES: Several guidelines recommend universal screening for hypertension in childhood and adolescence. Targeted screening to children with parental history of hypertension could be a more efficient strategy than universal screening. Therefore, we assessed the association between parental history of hypertension and hypertension in children, and estimated the sensitivity, specificity, negative, and positive predictive values of parental history of hypertension for hypertension in children. METHODS: The present study was a school-based cross-sectional study including 5207 children aged 10-14 years from all public 6th grade classes in the Canton of Vaud, Switzerland. Children had hypertension if they had sustained elevated blood pressure over three separate visits. RESULTS: In children, the prevalence of hypertension was 2.2%. Some 8.5% of mothers and 12.9% of fathers reported to be hypertensive. Maternal history of hypertension (odds ratio 2.0, 95% confidence interval 1.2-3.3) and paternal history of hypertension (odds ratio 2.2, 95% confidence interval 1.4-3.6) were independent risk factors for hypertension in children. Nevertheless, the sensitivity of parental history of hypertension for the identification of hypertension in children was low (from 4% for both parents' positive history up to 41% for at least one parent's positive history). Positive predictive values were also low (between 4 and 5%). CONCLUSION: Children with hypertensive parents were at higher risk of hypertension. Nevertheless, parental history of hypertension helped only marginally to identify hypertension in offspring. Targeting screening only toward children with a parental history of hypertension may not be a substantially better strategy to identify hypertension in children compared with universal screening.

Cognitive Predictors and Risk Factors of PTSD Following Stillbirth: A Short-Term Longitudinal Study.

This short-term longitudinal study investigated cognitive predictors and risk factors of posttraumatic stress disorder (PTSD) in mothers following stillbirth. After a stillbirth at ≥ 24 weeks gestational age, 65 women completed structured clinical interviews and questionnaires assessing PTSD symptoms, cognitive predictors (appraisals, dysfunctional strategies), and risk factors (perceived social support, trauma history, obstetric history) at 3 and 6 months. PTSD symptoms decreased between 3 and 6 months (Cohen's d ranged .34-.52). Regression analyses also revealed a specific positive relationship between Rumination and concurrent frequency of PTSD symptoms (β = .45). Negative Self-View and Negative World-View related positively and Self-Blame related negatively to concurrent number of PTSD symptoms (β = .48, .44, -.45, respectively). Suppression and Distraction predicted a decrease and Numbing predicted an increase in time-lagged number of PTSD symptoms (β = -.33, -.28, .30, respectively). Risk factors for PTSD symptoms were younger age (β = -.25), lower income (β = -.29), fewer previous pregnancies (β = -.31), and poorer perceived social support (β = -.26). Interventions addressing negative appraisals, dysfunctional strategies, and social support are recommended for mothers with PTSD following stillbirth. Knowledge of cognitive predictors and risk factors of PTSD may inform the development of a screening instrument.

La figura del fisioterapeuta en obstetrícia: estudi aleatoritzat de l’impacte del massatge perineal durant la primera etapa del part per prevenir-ne el trauma.

La pregunta clínica d’investigació que s’ha plantejat en un inici ha estat: Resulta eficaç el massatge perineal (MP) per reduir-ne el trauma post-part? Després d’haver realitzat una cerca bibliogràfica per revisar la literatura sobre el tema, s’ha vist que ja existeixen publicacions anteriors. Per aquest motiu s’ha definit millor la pregunta en base a la informació aportada per altres estudis, realitzant variacions en quant a l’etapa del part en la qual aplicar la intervenció. La pregunta clínica d’investigació definitiva ha estat: Resulta eficaç el MP aplicat durant la primera etapa del part per reduir-ne el trauma post-part? Es tracta, doncs, d’una pregunta rellevant, nova i factible que naix d’un problema assistencial justificat a continuació. Pregunta estructurada en format P.I.C.O: P (pacient): gestants primípares. I (Intervenció): MP durant la primera etapa del part. C (Comparació): MP durant la primera etapa del part vs. atenció al part de rutina sense MP. O (Resultats): el MP durant la primera fase del part disminueix el risc de trauma perineal (TP) post-part i les conseqüències que aquest comporta. Objectiu: L’objectiu general d’aquest projecte d’investigació és comprovar l’efectivitat del MP durant la primera fase del part per reduir el TP post-part en dones primípares. Metodologia: Projecte d’assaig clínic experimental, probabilístic, aleatori simple amb control concurrent. Consta de dos grups, un grup experimental i un grup control.

Delayed presentation of deep penetrating trauma to the subaxial cervical spine.

PURPOSE: To present a rare case of deep penetrating neck trauma in which a retained foreign body in the cervical spine (a broken knife blade) resulted in delayed radicular injury. We describe the surgical management using a retrojugular approach. CASE REPORT: Our patient sustained a stab wound to the supraclavicular triangle from a small pocketknife. He was initially managed in a local hospital by simple primary wound closure without any radiological examinations, and was discharged home. The patient re-consulted in a delayed fashion with mild local persistent neck pain. Subsequent radiological investigations revealed a foreign body (the broken blade of a pocket knife) embedded in the left neural foramen between the C6 and C7 vertebrae penetrating the disc space. The blade was lying between the left C7 nerve root and the ipsilateral vertebral artery (VA) at the transition of V1 and V2 segments. Initial neurological evaluation was normal. Some days later, the patient developed a delayed left C7 radicular deficit. We undertook urgent exploration along the wound corridor through a retrojugular, transforaminal approach with successful removal of the blade. DISCUSSION: To our knowledge, this is a unique case where a retained foreign body penetrated the soft tissues of the neck, embedding deep in the vertebral column without vascular, aerodigestive or significant primary neurological injury, while causing delayed neck pain and delayed onset radicular injury. We describe our surgical management for removal of the retained blade. The retrojugular approach gives excellent access to all of the important anatomical structures of the neck from an anterolateral approach.

Genetic origin of the relationship between parental negativity and behavior problems from early childhood to adolescence: A longitudinal genetically sensitive study.

Little is known about how genetic and environmental factors contribute to the association between parental negativity and behavior problems from early childhood to adolescence. The current study fitted a cross-lagged model in a sample consisting of 4,075 twin pairs to explore (a) the role of genetic and environmental factors in the relationship between parental negativity and behavior problems from age 4 to age 12, (b) whether parent-driven and child-driven processes independently explain the association, and (c) whether there are sex differences in this relationship. Both phenotypes showed substantial genetic influence at both ages. The concurrent overlap between them was mainly accounted for by genetic factors. Causal pathways representing stability of the phenotypes and parent-driven and child-driven effects significantly and independently account for the association. Significant but slight differences were found between males and females for parent-driven effects. These results were highly similar when general cognitive ability was added as a covariate. In summary, the longitudinal association between parental negativity and behavior problems seems to be bidirectional and mainly accounted for by genetic factors. Furthermore, child-driven effects were mainly genetically mediated, and parent-driven effects were a function of both genetic and shared-environmental factors.

Comprometimento ósseo do joelho pós-trauma: avaliação pela ressonância magnética

Neste trabalho são apresentados 50 casos de trauma do joelho submetidos a ressonância magnética, no período de janeiro de 1996 a dezembro de 1997. Foram avaliados o aspecto e a incidência das principais alterações ósseas, correlacionando-as com os mecanismos de agressão e com os dados clínicos, e demonstrando as principais lesões associadas. As contusões ósseas foram os achados mais comuns, sendo encontradas em 38 indivíduos (76%). As fraturas osteocondrais ocorreram em cinco pacientes (10%). As fraturas ósseas foram detectadas em cinco casos (10%), sendo três deles associados a contusão de outros compartimentos ósseos adjacentes. A condromalácia da patela mostrou-se presente em apenas dois indivíduos (4%). Concluímos que a ressonância magnética é o método de escolha no estudo por imagem para o diagnóstico das lesões ósseas no trauma do joelho.

Developing a theoretical framework using a nursing perspective to investigate perceived health in the "Sandwich Generation" group

Coexisting workloads from professional, household and family, and caregiving activities for frail parents expose middle-aged individuals, the so-called "Sandwich Generation", to potential health risks. Current trends suggest that this situation will continue or increase. Thus SG health promotion has become a nursing concern. Most existing research considers coexisting workloads a priori pathogenic. Most studies have examined the association of one, versus two, of these three activities with health. Few studies have used a nursing perspective. This article presents the development of a framework based on a nursing model. We integrated Siegrist's Effort-Reward Imbalance middle-range theory into "Neuman Systems Model". The latter was chosen for its salutogenic orientation, its attention to preventive nursing interventions and the opportunity it provides to simultaneously consider positive and negative perceptions of SG health and SG coexisting workloads. Finally, it facilitated a theoretical identification of health protective factors.

Values-driven management as perceived by personnel

Organizational values can be used as a tool for improving organization performance. The role of the leaders in building support and developing behaviours consistent with values-driven management is studied through value perceptions by the personnel in the object organization.