Ice skating injuries: can they be reduced or prevented?

The opening of an ice rink resulted in 469 attendances at the local Accident and Emergency department over the first year. One hundred and eight had a significant injury. Thirty-seven patients were admitted. Thirty-three required an operation under general anaesthesia. Thirty had consumed alcohol at the rink's bar. Nine of these had a fracture. The number of skates attending the Accident and Emergency department per 1000 visits to the rink declined over the study period. Injuries could be reduced if protective clothing was worn. Alcohol should not be sold at the rink. First aid although effective could be improved.     

The experiences of primary caregivers raising school‐aged children with attention‐deficit hyperactivity disorder

Aims and objectives. To understand the experiences of primary caregivers who are bringing up school‐aged children with attention‐deficit hyperactivity disorder. The research findings will help address the problems related to caring for school‐aged children with attention‐deficit hyperactivity disorder. Background. In Taiwan, the rate of school‐aged children diagnosed with attention‐deficit hyperactivity disorder ranges from 7·9–11·7%. This study is the first, which tries to understand the experiences of primary caregivers who are bringing up school‐aged children with attention‐deficit hyperactivity disorder in Taiwan. Design. The study used a qualitative phenomenological approach to explore the experiences of caregivers raising school‐aged children with attention‐deficit hyperactivity disorder. Methods. Purposive sampling and in‐depth, face‐to‐face interviews were used to collect data. The unstructured interview guide allowed the major caregivers to express their experiences of raising school‐aged children with attention‐deficit hyperactivity disorder. When data saturation was reached, the sample size comprised 12 major caregivers. Narratives were analysed according to Colaizzi’s seven‐step method. Results. Three themes and seven sub‐themes emerged from this study: the burdens of caring (parenting burdens, emotional burdens and family conflicts), the lack of adequate support systems (lack of support from professionals, spouses and other family members) and the mechanisms of coping (cognitive coping strategies and social coping strategies). Furthermore, several other factors that affected the caregivers of children with attention‐deficit hyperactivity disorder are also revealed in the study. Conclusion. The findings of the study demonstrate the importance of understanding the experiences of primary caregivers, bringing up school‐aged children with attention‐deficit hyperactivity disorder. Improving professional services in family care should be a major concern for all healthcare professionals. Relevance to clinical practice. The recommendations that have been made based on the findings of this research can be used as a guide to improve the delivery of caring by people who have school‐aged children with attention‐deficit hyperactivity disorder and by the wider family.     

阻塞性睡眠呼吸暂停低通气综合征合并注意缺陷多动障碍患儿临床特征分析

目的:观察阻塞性睡眠呼吸暂停低通气综合征合并注意缺陷多动障碍患儿的临床表现情况,从而对临床特征进行分析.方法:随机选取2016年1 月至2019年1 月重庆市开州区人民医院收治的阻塞性睡眠呼吸暂停低通气综合征合并注意缺陷多动障碍患者60例作为研究对象,根据是否合并注意缺陷多动障碍分为观察组和对照组,每组30例,合并注意缺陷多动障碍为观察组,不合并为对照组,对2组患者的定量指标差异进行比较,包括:(睡眠障碍、身体情况、情绪障碍、多巴胺水平、去甲肾上腺素水平),对不同年龄的阻塞性睡眠呼吸暂停低通气综合征合并注意缺陷多动障碍患儿的睡眠监测指标进行比较,(AHI、SaO2).结果:观察组患者的睡眠障碍评分、身体情况评分、情绪障碍评分高于对照组,多巴胺水平高于对照组,去甲肾上腺素水平低于对照组,差异有统计学意义(P<0.05);随着年龄的增长,患者的AHI水平在逐渐提升,SaO2 则在逐渐降低.结论:阻塞性睡眠呼吸暂停低通气综合征合并注意缺陷多动障碍患儿的睡眠质量、身体健康以及心理情况均难以控制,多巴胺的水平升高,可以与并发症相关.     

Family Functioning as Perceived by Parents of Boys with Attention Deficit Disorder

The purpose of this study was to describe adaptability, cohesion, and family type in families of boys with attention deficit disorder. Comparisons were made across diagnostic groups for boys with and without hyperactivity and aggressive symptoms. Parents (N = 123) of 79 boys with attention deficit disorder (ADD), attention deficit hyperactivity disorder and attention deficit hyperactivity disorder plus aggressive symptoms participated in the study. The families were not significantly different in their functioning when compared to family nom established by Olson, Portner, and Lavee (1985). There were, however, sign cant differences in functioning across diagnostic categories. Parents of boys with ADD only, without the additional problem of hyperactivity or aggressive symptoms, reported the highest level of family functioning, and a larger percentage of parents whose child had hyperactivity or hyperactivity plus aggression reported extreme family functioning.     

An audit of dermatology in a paediatric accident and emergency department.

Two studies were undertaken of patients with dermatological disorders who attended the Accident and Emergency (A&E) Department of the Royal Belfast Hospital for Sick Children during 1990-1991. The aims were to review diagnostic accuracy and assess the benefits of an open-access consultant dermatology clinic. A retrospective survey of 14,340 new attendances at the A&E department over a 7-month period found that 540 of these (4%) had a primary dermatological disorder. In 26% no diagnosis had been made although only 10% were referred for a specialist opinion. A 2-month prospective study of patients who attended the department and were referred to a consultant dermatology open-access clinic revealed overall diagnostic accuracy of 66% (+/- 2 SEM). Individual rates of diagnostic concordance between junior doctor and consultant were 59% for skin infections and 77% for papulosquamous disorders. The open-access clinic allowed prompt referral for correct diagnosis and initiation of appropriate management.     

脑电生物反馈治疗注意缺陷多动障碍儿童的临床效果分析

目的 探讨脑电生物反馈治疗注意缺陷多动障碍儿童的临床效果。方法 采用VBFB3000脑电反馈系统，以抑制4～8Hz慢波活动，同时增加12～16Hz感觉运动节律波为训练目标，通过该装置采集患儿的脑电波并以各种图像的方式进行实时反馈。每次训练包括5级游戏，2次／周，每次训练45min左右。结果 注意力缺陷为主型训练40次后转为正常占84．6％；多动-冲动为主型训练40次后转为正常100G；混合型训练40次后转为正常占91．6％。结论 脑电生物反馈训练对不同亚型的注意缺陷多动障碍患儿均有明显疗效。     

Benign acute childhood myositis in an accident and emergency setting

Four children presented to the Accident and Emergency department of the Royal Hospital for Sick Children in Edinburgh during seven days in February 2003. They shared a strikingly similar clinical picture with debilitating muscle pain in their calves. This paper discusses their clinical course and presents a literature review of the problem.     

感觉统合训练治疗儿童注意缺陷多动障碍

目的探讨感觉统合训练治疗儿童注意缺陷多动障碍的临床疗效。方法将30名注意缺陷障碍儿童进行感觉统合训练40次;治疗前后分别采用CONNRS量表、注意力(划消测验、数字记忆能力)感觉统合评定量表评定疗效,并进行对比分析。结果治疗后学习问题、冲动多动有显著改善;注意错误率明显低于治疗前;治疗后大肌肉与平衡不良及本体感觉不佳因子分显著高于治疗前,差异有极显著性(P<0.01);触觉防御不当及学习能力发展不足因子分高于治疗前,差异有显著性(P<0.05)。结论感觉统合训练治疗儿童注意缺陷多动障碍有一定疗效。     

Increased prefrontal cortex activity on near-infrared spectroscopy after interpersonal counseling in individuals with attention deficit hyperactivity disorder

[Purpose] The number of patients with attention deficit hyperactivity disorder has been increasing. These patients show low activity in the prefrontal cortex, which can be improved by pharmacotherapy and neurofeedback training. This exploratory study aimed to examine whether the hemodynamic response in the prefrontal cortex during an inhibition response in patients with attention deficit hyperactivity disorder tendencies increased after interpersonal counseling. [Participants and Methods] Participants (n=5) received three interpersonal counseling sessions. Interpersonal counseling focuses on the patient’s current problems and devises specific coping strategies, and it can be performed by healthcare personnel such as physiotherapists. Prefrontal cortex activity during a suppression reaction task was measured by using near-infrared spectroscopy at baseline and post-interpersonal counseling. The outcome was a difference in the oxyhemoglobin level from baseline to post-interpersonal counseling. [Results] The oxyhemoglobin level in the prefrontal cortex significantly increased post-interpersonal counseling. [Conclusion] These results suggested that interpersonal counseling could improve the hemodynamic response in the prefrontal cortex under inhibition in individuals with attention deficit hyperactivity disorder tendencies, suggesting that interpersonal counseling may be effective for treating attention deficit hyperactivity disorder symptoms.     

Mechanisms and pattern of facial lacerations in the Accident Department

The purpose of this study was to determine patterns of facial laceration seen in the Accident and Emergency Department and identify how they are related to the mechanism of injury. A retrospective analysis of facial lacerations of an adult presenting to Accident and Emergency department was made over a 6-month period. There were 197 consecutive facial lacerations. The mean age of patients was 46 years. There were 137 male and 60 female patients. The aetiology of lacerations was falls (48%), assaults (11%), hit by an object by accident (21%) and hit stationary object by accident (15%). Mechanism of injury was found to be related to common patterns of laceration. Lacerations affecting the forehead mainly occurred in falls and those affecting the peri-orbital and peri-oral areas in assault. Lacerations were mainly linear, with a mean length of 2.4 cm, and about 75% were precipitated by blunt injury. Identification of common patterns of injury corresponding to a certain mechanism may allow assessment of the difficult or non-compliant patient. Understanding mechanisms of injury will allow safety planners to design safer domestic and workplace environments.     

Mothers' experiences of parenting a child with attention deficit hyperactivity disorder

Title. Mothers’ experiences of parenting a child with attention deficit hyperactivitydisorder. Aim. This paper is a report of a study to explore the perceptions and experiences of mothers parenting a child with attention deficit hyperactivity disorder. Background. Previous quantitative studies have focussed on parenting styles and treatments, and highlight that attention deficit hyperactivity disorder has a negative impact on family functioning. However, fewer researchers have explored maternal experiences of parenting a child with this disorder. A narrative‐based feminist approach can provide greater insights into complex issues related to mothering a child with this disorder. Method. Data were collected in 2007 with a volunteer sample of 11 mothers of children with attention deficit hyperactivity disorder via in‐depth interviews. Analysis was completed by listening for self‐evaluative statements, paying attention to meta‐statements and by identifying both consistencies and incongruities within participant’s narratives. Findings. Dominant issues identified were: It’s been 10 years of being on edge: The caring responsibility as overwhelming; If I had my time over again, I wouldn’t tell the truth: Stigmatized, scrutinized and criticized; What have I done? What did I do? How come I’ve got this child: Guilt and self‐blame and He doesn’t stand a chance: Mother as advocate. Conclusion. Mothering a child with attention deficit hyperactivity disorder is stressful and demanding, and mothers felt marginalized. Media portrayal of this disorder contributes to confusion related to causes, diagnosis and treatment choices. More education for healthcare professionals is needed to enable them to give appropriate guidance and support to enhance outcomes for children and their parents.     

“视、听、动”模式功能训练对儿童注意缺陷多动障碍的干预效果

目的 研究＂视、听、动＂模式功能训练对儿童注意缺陷多动障碍的干预效果.方法 采用随机对照研究的方法,把100例儿童注意缺陷多动障碍（ADHD）患儿随机分为研究组和对照组,每组各50例.研究组在服用安慰剂的同时,采用＂视、听、动＂模式功能训练法,对照组给予哌甲酯口服,并定期安排工娱活动.两组均干预6个月,并于入组的0,6个月各进行1次Conners儿童行为量表和肝肾功能及心电图检查,对结果进行比较.结果 6个月时研究组Conners儿童行为量表评分率及平均成绩变化与对照组比较,差异无统计学意义（P＞0.05）;研究组实验室检查异常率明显低于对照组,差异有统计学意义（P＜0.05）.结论 ＂视、听、动＂模式功能训练对儿童注意缺陷多动障碍有与药物治疗相似的治疗效果,但避免了服药带来的毒副作用,切实可行,值得临床推广应用.     

Clinical management of children with hyperactivity. A shift in diagnostic and therapeutic emphasis

Children who have attention deficit disorder with (or without) hyperactivity are handicapped by their inability to concentrate and control their impulsivity, especially while in school. Specific performance disabilities prevent them from demonstrating, especially through written schoolwork, what they have learned. Parents and teachers are likely to mistake these children's symptoms for willful misbehavior or lack of motivation, which leads to misunderstandings and even mistreatment. The critical issue in the management of a child with hyperactivity is to effectively treat the key problems of inattention and impulsivity rather than the hyperactivity per se. A nonintensive long-term approach combining stimulant therapy and a cooperative liaison among the physician, child, family, and teachers is recommended.     

注意缺陷多动障碍患儿家庭环境特征及自我意识的相关分析

目的探讨注意缺陷多动障碍(ADHD)患儿家庭环境特征及其与自我意识之间的相关性。方法采用家庭环境量表中文版(FES-CV)、Piers-Harris儿童自我意识量表(PHCSS)对79例ADHD儿童、71名正常儿童分别进行评估。结果 PHCSS中,AD-HD儿童行为、智力与学习情况、躯体外貌与属性、合群、幸福与满足及总分低于正常儿童(P<0.05);ADHD儿童在FES-CV中亲密度、独立性、知识性、娱乐性、道德宗教观、组织性得分低于正常儿童(P<0.05),矛盾性得分明显高于正常儿童(P<0.01)。回归分析显示,ADHD儿童FES-CV中的道德宗教观是影响PHCSS总分的主要危险因素(P<0.05)。结论 ADHD患儿的家庭存在家庭功能缺陷,并与患儿自我意识水平较低有关。     

Effects of therapeutic climbing activities wearing a weighted vest on a child with attention deficit hyperactivity disorder: a case study

[Purpose] The purpose of this study was to evaluate the effect of therapeutic climbing activities on the brain waves and attention of a child with attention deficit hyperactivity disorder. [Subject and Methods] The subject of this case study was a 7 year 6-month old child diagnosed with attention deficit hyperactivity disorder. This study was based on evidence gathered at 3 distinct stages: a pre-intervention period, 10 intervention periods (2 weeks), and one post-intervention period. The intervention involved therapeutic climbing activities wearing a weighted vest over the course of 4 weeks. The clinical outcome measures were electroencephalography and the Star Cancellation Test. [Results] The mean activation of alpha waves was improved by the therapeutic intervention. During the intervention, the mean activation of alpha waves was the highest at the F3 cortical locus and the lowest at the T4 cortical locus. The average Star Cancellation Test scores were 43 at pre-intervention, 50 during the therapeutic intervention, and 52 at post-intervention. The performance time of the Star Cancellation Test was 240.1 seconds at pre-intervention, 90.2 seconds during the therapeutic intervention, and 60.0 seconds at post-intervention. [Conclusion] The results of this study suggest that therapeutic climbing activities performed wearing a weighted vest had positive effects on the brain waves and the attention span of a child with attention deficit hyperactivity disorder.Key words: Attention, Brain wave, Sensory     

The use of a weighted vest to increase on-task behavior in children with attention difficulties.

OBJECTIVE: Children described as having attention deficit hyperactivity disorder often demonstrate inability to sustain visual attention during classroom fine motor activities. This study investigated the effect of wearing a weighted vest (deep-pressure sensory input) on children's on-task behavior in the classroom. METHOD: Four students with documented attention difficulties and hyperactivity were timed with a stopwatch to measure their on-task behavior during fine motor activities in the classroom. All 4 students were timed for six 15-min observations without wearing a weighted vest and for six 15-min observations while wearing a weighted vest. RESULTS: On-task behavior increased by 18% to 25% in all 4 students while wearing the weighted vest. Additionally, 3 of the 4 students frequently asked to wear the vest other than during the observation times. CONCLUSION: These preliminary findings support the hypothesis that wearing a weighted vest to apply deep pressure increases on-task behavior during fine motor activities.     

Management of minor head injuries according to NICE guidelines and changes in the number of patients requiring computerised tomography imaging in a district general hospital: a retrospective study

The objective of this study was to investigate how many patients with minor head injury would have required computerised tomography (CT) imaging if they were to be managed according to the National Institute of Clinical Excellence (NICE) guidelines (June 2003) and the difference in workload for patients presenting out of hours at Calderdale Royal Hospital, Halifax. The study was a retrospective cohort analysis of patient's notes presenting with head injury at Calderdale Royal Hospital, Halifax. The data set comprised case notes of 844 patients with head injuries, 400 adults and 444 children attending the Accident and Emergency department from January to June 2003. The case notes were evaluated according to the NICE guidelines for the indications for CT imaging for the time that they presented to the Accident and Emergency department, and how many of them actually underwent CT imaging. The number of patients who required CT imaging and how many of them presented out of hours (between 17:00 and 21:00 hours on weekdays and at any time on weekends). Ten patients underwent CT imaging for minor head injuries from January to June 2003. Eighty-eight patients required CT imaging if they were to be managed according to the NICE guidelines. Sixty-three per cent of these patients presented out of hours when a radiologist was not available in the hospital. Adhering to the NICE guidelines would significantly increase the number of patients requiring CT imaging. A significant proportion of these patients would present out of hours.     

哮喘儿童睡眠紊乱和注意缺陷多动障碍特征及相关性研究

目的 探讨哮喘患儿睡眠障碍与注意缺陷多动障碍的特点及关联性。方法 选择6~14岁哮喘慢性持续期患儿35例,通过肺功能及哮喘控制测试评分(ACT)分为哮喘基本控制组和未控制组。对患儿进行儿童睡眠紊乱量表评分和夜间睡眠监测,并完成视听整合持续操作测试( IVA CPT)和戴斯-纳格利尔里认知评估系统(D N:CAS)检测。结果 两组的儿童睡眠紊乱量表(SDSC)总粗分、入睡或维持睡眠障碍、睡眠-觉醒转换障碍、睡眠出汗过多指标比较差异有统计学意义(P＜0.01)。夜间睡眠监测参数多项指标两组比较差异有统计学意义(P＜0.05)。IVA CPT检测哮喘未控制组综合反应控制力商数(FSCQ)、综合注意力商数(FSAQ)较哮喘基本控制组明显减低(P＜0.01);D N:CAS参数指标中哮喘基本控制组和哮喘未控制组患儿的计划力(PLAN)、同时性加工能力(SIM)、注意力(ATT)、继时性加工能力(SUC)、认知水平得分(FS),比较均有统计学意义(P＜0.05)。 IVA CPT指标中FSCQ、FSAQ和D N: CAS中PLAN、SIM、ATT、SUC、FS 与睡眠参数中的SDSC总粗分 、入睡或维持障碍、睡眠-觉醒转换障碍、AHI呈负相关(均P＜0.05),与睡眠效率、最低血氧呈正相关 (均P＜0.05)。结论 哮喘患儿易出现睡眠结构紊乱和注意缺陷多动障碍,两者存在关联性影响。