Hematogenous calcaneal osteomyelitis in children

This study reviewed 21 cases of hematogenous osteomyelitis of the calcaneus in skeletally immature patients. The average patient age was 2.9 years. Local tenderness, swelling, and erythema were the most common findings. The erythrocyte sedimentation rate was elevated in 20 (95%) of 21 patients, whereas the C-reactive protein was abnormal in only seven (47%) of 15 patients tested. Nine patients had positive cultures, with Staphylococcus aureus being the most common organism. Plain films showed a lytic lesion in 15 (71%) of 21 cases, whereas scintography was positive in all 16 cases scanned. Ten patients were treated with antibiotics alone, whereas 11 patients underwent surgical irrigation and debridement in association with antibiotic therapy. Seventeen patients returned for follow-up, and although only one was symptomatic, three of 10 follow-up radiographs revealed residual abnormalities of the calcaneus.     

Antibodies against copper-oxidised and malondialdehyde-modified low density lipoproteins in pre-eclamptic pregnancies

Objective To measure auto-antibodies against oxidatively modified low density lipoprotein (LDL) in pre-eclamptic pregnancies using two different techniques.
Design Clinical study comparing pre-eclamptic and normal pregnancies.
Setting Tampere University Hospital, Finland.
Population Twenty-one primigravidae with pre-eclampsia and 13 healthy, normotensive primigravidae as controls.
Methods The serum titers of antibodies against both malondialdehyde-modified and copper-oxidised LDL (MDA-LDL and copper-ox LDL) were analysed and related to parameters reflecting the severity of pre-eclampsia.
Results There was a positive correlation (   r = 0.58  ) between antibodies against MDA-LDL and copper-ox LDL in women with pre-eclampsia but not in healthy pregnant controls. The antibody levels against copper-ox LDL, but not against MDA-LDL, were higher in women with pre-eclampsia than in women with a normal pregnancy (   P < 0.01  ). While the antibody titers against copper-ox LDL did not correlate with any parameter reflecting the severity of pre-eclampsia, those against MDA-LDL showed a positive correlation with the level of diastolic blood pressure (   r = 0.54  ) and a negative correlation with platelet count (   r = 461  ) in women with pre-eclampsia.
Conclusions There are increased titers of serum autoantibodies against copper-oxidised LDL in pre-eclampsia, which may reflect enhanced lipid peroxidation involving circulating lipoproteins.     

The Contextuality of Children's Communication Difficulties in Specialist Practice: A Sociological Account

This paper reports findings from fieldwork in situations that brought young children and child welfare practitioners together with the aim of diagnosing and treating children's communication difficulties. The findings suggest that communication difficulties tend to be treated as a property of the individual child rather than as an emergent, contextual property of interaction. The attention will be steered from clinical definitions of “impairment” and “disability” to dynamics of social interaction, where understandings of “good” and “normal” communication play a central role. The findings have implications for current recommendations for good practice, which derive from needs-led, rights-led and skills-led approaches.     

Dental fear affects adolescent perception of interaction with dental staff

The main purpose of this study was to explore whether subjective perception of interaction with dental staff is associated with dental fear in a population‐based sample of 18‐yr‐old adolescents (n = 773). The interaction was measured using the Patient Dental Staff Interaction Questionnaire (PDSIQ), validated with exploratory and confirmatory factor analyses, which yielded the factors of ‘kind atmosphere and mutual communication’, ‘roughness’, ‘insecurity’, ‘trust and safety’, and ‘shame and guilt’. Dental fear was measured using the Modified Dental Anxiety Scale (MDAS). Gender and sense of coherence (SOC) were included as potential confounding variables. Adolescents with high dental fear more often perceived their interaction with dental staff negatively and more often felt insecure than others. This difference persisted after adjustment for gender and SOC. In conclusion, adolescents with high dental fear may perceive their interaction with dental staff more positively if the staff succeed in creating a positive, trusting, approving, and supportive atmosphere with kindness, calmness, and patience. The communication and interaction skills of dental staff may play a particularly important role when encountering highly fearful dental patients.     

Benefits of repeated individual dietary counselling in long‐term weight control in women after delivery

As pregnancy may trigger overweight in women, new means for its prevention are being sought. The aim here was to investigate the effect of individual dietary counselling during and after pregnancy on post‐partum weight and waist circumference up to 4 years post‐partum. A cohort of women (n = 256) were randomized to receive repeated individual dietary counselling by a nutritionist during and after pregnancy, or as controls not receiving dietary counselling, from the first trimester of pregnancy until 6 months after delivery. Counselling aimed to bring dietary intake into line with recommendations, with particular focus on the increase in the intake of unsaturated fatty acids instead of saturated. Pre‐pregnancy weight was taken from welfare clinic records. Weight and waist circumference were measured at 4 years after delivery. The proportion of overweight women increased from 26% prior to pregnancy to 30% at 4 years after delivery among women receiving dietary counselling, as against considerably more, from 32% to 57%, among controls. The prevalence of central adiposity was 31% in women receiving dietary counselling, 64% in controls. Likewise, both the risk of overweight (odds ratio: 0.23, 0.08–0.63, P = 0.005) and central adiposity (odds ratio: 0.18, 0.06–0.52, P = 0.002) were lower in women receiving dietary counselling compared with controls. Repeated dietary counselling initiated in early pregnancy can be beneficial in long‐term weight control after delivery.     

Use of hospitals at age 90. A population-based study

People live longer than ever before, and the rapidly growing population of the oldest-old are increasingly frequent users of health care services. To determine the extent and causes of hospital care in the population aged 90, we examined the hospital discharge registers for the annual cohorts of Tampere residents born in 1907-1910 at age 90. The basic population consisted of 1077 people, 20.6% of who were men and 79.4% women. Close on one-fifth or 18.7% of this group died during the year under review. During this year, 43.2% of men and 50.3% of women had been admitted to hospital. Men spent significantly fewer days in hospital than women: the mean length of stay for men was 19 days, for women 46 days. Of the 90-year olds, 6.7% were permanently staying in hospitals. The most common diagnoses at discharge were cardiovascular diseases, infections, psychiatric diseases including dementia, and trauma. Of those who had been admitted to hospital once or more within the year, 31.7% died during the follow-up time, while the figure for those not admitted was only 6.2%. People aged 90 are an important group of hospital users. In the future, hospitals need to be prepared to provide adequate care for the most common diseases affecting the growing population of the oldest-old.     

Spirometric lung function. Distribution and determinants of test failure in a young adult population.

Spirometric test failure has been defined as failure by a subject to meet the acceptability and/or reproducibility criteria laid down by the American Thoracic Society for measurements derived from forced expiratory maneuvers. The prevalence and determinants of spirometric test failure were examined in 416 men and women aged 20 to 45 yr working in an office environment. In this study population, 11.5% (28 men and 20 women) exhibited test failure for forced expiratory volume in one second (FEV1). The main determinant of test failure in men was bronchial hyperresponsiveness to methacholine challenge (odds ratio 6.7; confidence interval 1.7, 27.1) and in women being a current smoker (odds ratio 4.02; confidence interval 1.13, 14.33). There was also a relationship to eczema in both men and women, but not at a statistically significant level. When FEV1 variability was defined as the difference (in milliliters) between the two best FEV1 values and the results of men and women combined for analysis, significant predictors were a history of eczema, recurrent chest illness in the past 3 yr, and level of bronchial responsiveness to inhaled methacholine. These findings contribute to the gathering evidence that test failure may be of itself an indicator of impaired respiratory health, and its association with bronchial hyperresponsiveness to methacholine in men suggests that in them test failure is related to airway lability, but in women the relationship to smoking suggests an irritative mechanism.     

Students’ Perceptions of Motivational Climate and Enjoyment in Finnish Physical Education: A Latent Profile Analysis

The purpose of this study was to identify student clusters with homogenous profiles in perceptions of task- and ego-involving, autonomy, and social relatedness supporting motivational climate in school physical education. Additionally, we investigated whether different motivational climate groups differed in their enjoyment in PE. Participants of the study were 2 594 girls and 1 803 boys, aged 14-15 years. Students responded to questionnaires assessing their perception of motivational climate and enjoyment in physical education. Latent profile analyses produced a five-cluster solution labeled 1) ‘low autonomy, relatedness, task, and moderate ego climate’ group’, 2) ‘low autonomy, relatedness, and high task and ego climate, 3) ‘moderate autonomy, relatedness, task and ego climate’ group 4) ‘high autonomy, relatedness, task, and moderate ego climate’ group, and 5) ‘high relatedness and task but moderate autonomy and ego climate’ group. Analyses of variance showed that students in clusters 4 and 5 perceived the highest level of enjoyment whereas students in cluster 1 experienced the lowest level of enjoyment. The results showed that the students’ perceptions of various motivational climates created differential levels of enjoyment in PE classes.

Key points

• Latent profile analyses produced a five-cluster solution labeled 1) ‘low autonomy, relatedness, task, and moderate ego climate’ group’, 2) ‘low autonomy, relatedness, and high task and ego climate, 3) ‘moderate autonomy, relatedness, task and ego climate’ group 4) ‘high autonomy, relatedness, task, and moderate ego climate’ group, and 5) ‘high relatedness and task but moderate autonomy and ego climate’ group.
• Analyses of variance showed that clusters 4 and 5 perceived the highest level of enjoyment whereas cluster 1 experienced the lowest level of enjoyment. The results showed that the students’ perceptions of motivational climate create differential levels of enjoyment in PE classes.

Key words: Motivational climate, enjoyment, physical education, clusters