Parent-reported health in extremely preterm and extremely low-birthweight children at age 8 years compared with comparison children born at term

Aim Extremely preterm and extremely low‐birthweight (EP/ELBW) children (<28 completed weeks’ gestation; birthweight <1000g) have a high risk of long‐term adverse outcomes. Clinical developmental surveillance is difficult to achieve for all of these children. Our aim was to study the ability of two parent‐completed questionnaires to differentiate health status of EP/ELBW children from that of a comparison group of children born at term, and to screen EP/ELBW children for disability compared with the ability of a multidisciplinary clinical assessment. Method A geographic cohort of 189 EP/ELBW children (100 males, 89 females) and a comparison group of 173 term children (92 males, 81 females) born in 1997 were assessed at the age of 8 years using parent questionnaires (the Child Health Questionnaire [CHQ] and the Health Utilities Index Mark 2 [HUI2]) and a multidisciplinary clinical assessment. The questionnaires and clinical assessment were compared with respect to their ability to differentiate between the health status of EP/ELBW children and children born at term and also to identify children with a disability. Results The HUI2 was better than the CHQ at differentiating the health status of EP/ELBW and comparison children. Moderate and severe disability status were identified by the HUI2 with sensitivity ranging from 86 to 97%, specificity from 60 to 64%, positive predictive values from 34 to 39%, and negative predictive values from 95 to 99%. Interpretation The HUI2 had suitable sensitivity and specificity to be used as a developmental screening tool for EP/ELBW children, but the CHQ did not. Given its low positive predictive values, however, the HUI2 should be viewed with caution as a final outcome measure for intervention trials, and would be better used to identify at‐risk children who need a definitive clinical assessment.     

Education of tobacco use prevention and cessation for dental professionals ‐ a paradigm shift

The use of tobacco continues to be a substantial risk factor in the development and progression of oral cancer, periodontitis, implant failure and poor wound healing. Dental and dental hygiene education providers have made great advances towards the incorporation of tobacco education into their curricula in recent years. Unfortunately, however, both medical and dental education research has consistently reported schools providing only basic knowledge‐based curricula that rarely incorporate more effective, behaviourally‐based components affecting long‐term change. The limited training of oral healthcare students, at least in part, is reflected in practising dental professionals continuing to report offering incomplete tobacco interventions. In order to prepare the next generation of oral healthcare providers, this paper proposes a paradigm shift in how tobacco use prevention and cessation (TUPAC) may be incorporated into existing curricula. It is suggested that schools should carefully consider: to what level of competency should TUPAC be trained in dental and dental hygiene schools; the importance of establishing rapport through good communication skills; the core knowledge level for TUPAC; suggested instructional and assessment strategies; the importance of continuing professional education for the enhancement of TUPAC.     

Somatic symptoms and the association between hepatitis C infection and depression in HIV-infected patients

Studies of depression and hepatitis C virus (HCV) infection in HIV-infected patients have been contradictory and often not addressed key differences between HCV-infected and uninfected individuals including substance use. This cross-sectional observational study from the University of Washington HIV cohort examined associations between HCV, symptoms, and depression in HIV-infected patients in routine clinical care. Patients completed instruments measuring depression, symptoms, and substance use. We generated depression severity scores and used linear regression to examine the relationship with HCV accounting for demographic and clinical characteristics. We conducted sensitivity analyses in which we removed depression somatic symptom items (e.g., fatigue) from depression scores, and sensitivity analyses in which we also adjusted for nondepression somatic symptom items to examine the role of somatic and nonsomatic symptoms in the association between depression and HCV. Of 764 HIV-infected patients, 160 (21%) were HCV-infected. In adjusted analysis, HCV-infected patients had worse depression severity (p =0.01) even after adjusting for differences in substance use. HCV remained associated with depression severity in secondary analyses that omitted the depression somatic patient health questionnaire-9 (PHQ-9) items (p=0.01). However, when nondepression somatic symptoms were included as covariates in multivariate analyses, HCV was no longer associated with depression (p=0.09).     

Guided tissue regeneration/deproteinized bovine bone mineral or papilla preservation flaps alone for treatment of intrabony defects. II: radiographic predictors and outcomes

OBJECTIVES: This study reports the secondary analysis of a randomized-controlled clinical trial designed to assess the efficacy of deproteinized bovine mineral and a collagen membrane in the treatment of intrabony defects. The specific aims of this report are (1) to analyse the radiographic bone changes 1 year after therapy and (2) to assess the association between radiographic defect angle and treatment outcomes. MATERIALS AND METHODS: Baseline and 12-month radiographs were collected from 120 patients with advanced chronic periodontitis from 10 centres in seven countries as part of a multi-centre clinical trial. All patients had at least one intrabony defect > or =3 mm in depth. The treatment consisted of simplified or modified papilla preservation flaps to access the defect. After debridement of the area, a deproteinized bovine mineral and a collagen membrane were applied in the test subjects, and omitted in the controls. Main outcome measures were radiographic bone fill and defect resolution 1 year after surgery. RESULTS: One hundred and twenty pairs of radiographs were obtained, of which 110 pairs were measurable (57 tests and 53 controls). One year after treatment, radiographic resolution of the intrabony component was significantly higher in the test group (3.2+/-1.7 mm) when compared with the controls (1.7+/-1.9 mm). Multivariate analysis indicated that the treatment and the baseline radiographic depth of the intrabony defect significantly influenced the radiographic bone fill of the intrabony defect 1 year following treatment. The percentage of resolution of the defect was influenced by the treatment provided and the baseline plaque score. The baseline radiographic defect angle did not show a significant impact on the clinical and radiographic outcomes. CONCLUSIONS: Regenerative periodontal surgery with a deproteinized bovine bone mineral and a collagen membrane offered additional benefits in terms of radiographic resolution of the intrabony defect and predictability of outcomes with respect to papilla preservation flaps alone.     

Early Emergence of Behavior and Social-Emotional Problems in Very Preterm Infants

ObjectiveChildren born very preterm are reported to have an increased frequency of social, emotional, and behavioral problems at school age compared with their peers born at term. The primary aim of this study was to compare social-emotional difficulties and competencies of very preterm and full-term children at 2 years' corrected age. In addition, the relation between perinatal variables and early behavior problems was also examined to help identify those very preterm children most at risk.MethodAt 2 years' corrected age, the parents of 188 very preterm (gestational age <30 weeks or birth weight <1,250 g) and 70 full-term (gestational age ≥37 weeks) children completed the Infant Toddler Social and Emotional Assessment to determine externalizing, internalizing, and dysregulation problems and social-emotional competencies. For the very preterm sample, extensive perinatal data were collected including sex, birth weight, gestational age, chronic lung disease, and postnatal steroids, as well as neonatal cerebral white matter abnormalities detected by magnetic resonance imaging.ResultsThe very preterm children at 2 years demonstrated significantly higher internalizing and dysregulation scores and lower competence scores than peers born at term. There was no significant difference in externalizing scores between groups. Female sex, lower birth weight z score, white matter abnormalities, and postnatal corticosteroids were significantly associated with lower competence scores in the very preterm group.ConclusionsVery preterm children exhibit higher rates of behavior problems early in development, in particular internalizing and dysregulation problems and poorer competence.     

The effects of high dose interferon-β1a on plasma microparticles: Correlation with MRI parameters

Background

Autoimmunity to brain may play a pathogenic role in autism. In autoimmune disorders, the formation of antigen-antibody complexes triggers an inflammatory response by inducing the infiltration of neutrophils. Local administration of recombinant progranulin, which is an anti-inflammatory neurotrophic factor, potently inhibit neutrophilic inflammation in vivo, demonstrating that progranulin represents a crucial inflammation-suppressing mediator. We are the first to measure plasma progranulin levels in autism.

Methods

Plasma levels of progranulin were measured, by ELISA, in 40 autistic patients, aged between 3 and 12 years, and 40 healthy-matched children.

Results

Autistic children had significantly lower plasma progranulin levels, P = 0.001. Reduced plasma progranulin levels were found in 65% (26/40) of autistic children. On the other hand, there was a non significant difference between plasma progranulin levels of children with mild to moderate autism and patients with severe autism, P = 0.11.

Conclusions

Plasma progranulin levels were reduced in a subgroup of patients with autism. Progranulin insufficiency in some patients with autism may result in many years of reduced neutrotrophic support together with cumulative damage in association with dysregulated inflammation that may have a role in autism. However, these data should be treated with caution until further investigations are performed, with a larger subject population, to determine whether the decrease of plasma progranulin levels is a mere consequence of autism or has a pathogenic role in the disease. The role of progranulin therapy should also be studied in autism.