Auditory sensory impairment in children with oral clefts as indexed by auditory event-related potentials

Children with nonsyndromic oral clefts and with the CATCH 22 syndrome (acronym for cardiac defects, abnormal faces, thymus hypoplasia, clefts, and hypocalcemia) display a range of language and learning disabilities, the neurofunctional bases of which are not yet understood. This review summarizes recent event-related brain potential (ERP) studies on central auditory processing in infants and children with different cleft types and presents an effort to integrate these ERP and earlier behavioral findings into a workable hypothesis on the mechanisms of cognitive impairment in the oral cleft population. The encoding of the acoustic sound features and the functioning of auditory sensory memory (ASM) were studied by recording cortical auditory ERPs. Tapped were two ASM functions: tone pitch discrimination and the duration of sensory memory for tone pitch. In infants with cleft palate, tone pitch discrimination was impaired at birth and at 6 months of age. In infants with cleft lip and palate, no ASM impairment was detected at either age. In school-aged children with clefts and CATCH 22 syndrome, the discrimination of tone pitch was intact under optimal stimulation conditions. However, in these children, shortened duration of ASM was observed, with the magnitude of its shortening covarying with cleft type and being most pronounced in children with CATCH 22 syndrome. The different types of ASM dysfunction found in children with different cleft types could not be accounted for by the peripheral hearing deficits. The relation between ASM dysfunction and known behavioral cognitive disability profiles in children with different cleft types suggests that ASM is implicated in language disabilities of children with oral clefts. Furthermore, it appears that the ASM impairment and oral clefting are linked in a comorbid fashion.     

Labor market position after a rejection of a disability pension application: a register-based cohort study

Abstract

Purpose: To study labor market positions of rejected disability pension applicants and to examine which characteristics predict ending up in these positions after the rejection.

Methods: Nationwide Finnish register data was used to describe employment, unemployment and disability pension trajectories of rejected applicants (n?=?5740) from four years before to four years after the rejection. Demographic, occupational and health-related determinants of labor market position after the rejection were examined among those employed and not employed at the time of the rejection.

Results: The proportion of the employed steeply decreased and that of unemployed increased before the rejection of a disability pension application. Four years after the rejection, 30% of the rejected applicants were employed, 24% were unemployed and 30% received disability pension. Employment at the time of the rejection, younger age, shorter unemployment history, public sector employment and milder work disability increased future employment. Manual work, public sector employment and previous long-term unemployment predicted future unemployment. Apart from higher age, associations with receiving disability pension were relatively weak.

Conclusions: For many rejected disability pension applicants return to work is challenging. Special efforts should be targeted to support the remaining work ability and to promote employment opportunities of the rejected applicants.

• Implications for Rehabilitation

• Employment, unemployment and receiving disability pension were equally common labor market positions four years after the rejection.

• Rejected DP applicants with unemployment history need special efforts to increase their employability.

• As a disability pension application, even if rejected, clearly indicates some degree of work ability problems, rehabilitation should be targeted at this time point to support employment.

     

Midlife cardiovascular risk factors and late cognitive impairment

Cardiovascular risk factors increase the risk of dementia in later life. The aims of the current study were to assess the effect of multiple midlife cardiovascular risk factors on the risk of cognitive impairment in later life, and to assess the validity of the previously suggested CAIDE Study risk score predicting dementia risk 20 years later. A total of 2,165 Finnish twins were followed and at the end of the follow-up their cognitive status was assessed with a validated telephone interview. The assessment of the risk factors at baseline was based on a self-report questionnaire. Relative risk ratios (RR) were calculated and receiver operating characteristic analyses performed. Midlife obesity (RR 2.42, 95 % CI 1.47–3.98), hypertension (RR 1.38, 95 % CI 1.01–1.88) and low leisure time physical activity (RR 2.52, 95 % CI 1.10–5.76) increased the risk of cognitive impairment after a mean follow-up of 22.6 ± 2.3 years. Hypercholesterolemia did not significantly increase the risk (RR 1.52, 95 % CI 0.92–2.51). Overweight individuals who gained more than 10 % weight between 1981 and 1990 had an increased risk of cognitive impairment (RR 4.27, 95 % CI 1.62–11.2). The CAIDE Study risk score combining various individual risk factors had an area-under-curve of 0.74 (95 % CI 0.69–0.79, n = 591), and there was a strong association between an increasing risk score and the risk of cognitive impairment. The results indicate that multiple midlife cardiovascular risk factors increase the risk of cognitive impairment in later life. Also, a risk score including easily measurable midlife factors predicts an individual’s cognitive impairment risk well.     

Serum total and unbound testosterone and sex hormone binding globulin (SHBG) in female acne patients treated with two different oral contraceptives

Serum total an unbound testosterone (T) and sex hormone binding globulin (SHBG) levels were studied in fifty-four female acne patients before treatment and during the treatment by two different oral contraceptives, the other containing 0.150 mg desogestrel plus 0.03 mg EE and the other 0.150 mg levonorgestrel plus 0.03 mg EE. Pretreatment values were abnormal in 57% of the patients. A borderline significant correlation between the severity of acne and SHBG was found. Ater six months' treatment a 250% increase in SHBG was seen in desogestrel/EE group and no significant change in SHBG in levonorgestrel/EE group. However, at the same time serum free testosterone fell 60% in both treatment groups. SHBG cannot be the only regulator of serum free testosterone. Acne improved significantly in both treatment groups. It is likely that the improvement was in connection with the free testosterone decrease and the improvement was better in the desogestrel/EE group where also SHBG elevation was seen.     

Impaired gallbladder function in patients after total gastrectomy

Background and aims: The incidence of gallstones and gallbladder sludge is higher in patients after total gastrectomy than in general population. Formation of gallstones after gastrectomy is multifactorial. Here, we investigate the changes in gallbladder and biliary tract functions by cholescintygraphy and monitored changes in cholecystokinin (CCK) release in long-term survivors after total gastrectomy for gastric carcinoma.

Material and methods: Patients had undergone total gastrectomy for gastric carcinoma at least five years ago. The final study population consisted of 25 patients.

Results: Eight patients had undergone cholecystectomy before or at the time of gastrectomy. Gallstone formation was observed in seven of the remaining 17 patients during follow-up (41%). Maximum uptake of radioactivity and gallbladder maximum uptake was significantly delayed in the gastrectomy group than in the control group. There was no significant difference in CCK levels after the overnight fasting and at 60?minutes after stimulation among patients with or without stones in situ compared with healthy volunteers, but 30?minutes after the energy-rich drink patients had higher CCK levels than the control group.

Conclusions: In gastrectomy patients, technetium isotope visualisation of the gallbladder and time for maximum activity was significantly delayed. This may indicate impaired gallbladder function. On the contrary, CCK release was not impaired.     

Effects of desogestrel and levonorgestrel in low-dose oestrogen oral contraceptives on serum lipoproteins

Serum HDL-cholesterol and total cholesterol levels were analyzed in 54 women before and after 3, 6 and 12 months of treatment with oral contraceptives containing 0.030 mg ethinyloestradiol (EE) plus 0.150 mg desogestrel or levonorgestrel. The combination of 0.150 mg desogestrel + 0.030 mg EE induced a small increase in HDL-cholesterol and in the ratio HDL-cholesterol/total cholesterol, whereas 0.150 mg levonorgestrel + 0.030 mg EE induced a small decrease; the differences between the effects of the two combination on these parameters were statistically significant after 6 and 12 months of treatment and can be best explained by the higher androgenicity of levonorgestrel.     

Gynecological follow-up of parkinsonian patients on long-term bromocriptine treatment

Bromocriptine given for prolonged times at high doses has been found to induce tumors in the uterus in aged rats. To elucidate the possible tumorigenic effect of long-term treatment with bromocriptine in humans, 35 women treated with this drug for chronic parkinsonism were studied. For each patient a gynecological anamnesis and examination were performed; one or several cervicovaginal smears and endometrial samples were also taken, by jetwash. No evidence of malignant changes was seen. Thus, in this respect bromocriptine would appear to be a safe drug, even for long-term use.     

Progestagen-dependent effect on some plasma proteins during oral contraception

Seventeen healthy women received a combination of 0.030 mg of ethinyl estradiol and 0.150 mg of levonorgestrel or a combination of 0.030 mg of ethinyl estradiol and 0.150 mg of desogestrel for 2 years as oral contraception. Serum levels of sex hormone binding globulin, transcortin, ceruloplasmin, and pregnancy-associated protein were measured before contraception, during 3, 6, 12, 18, and 24 months of treatment, and 2 months after stopping the pill. Oral contraception with both preparations induced a similar, significant rise in both ceruloplasmin and pregnancy-associated protein. Sex hormone binding globulin levels rose significantly with the ethinyl estradiol-desogestrel, but not with the ethinyl estradiol-levonorgestrel combination. Transcortin increased with both preparations, more with the ethinyl estradiol-desogestrel combination.     

Outcome of periacetabular osteotomy: joint contact pressure calculation using standing AP radiographs, 12 patients followed for average 2 years

BACKGROUND: Due to wide variations in acetabular structure of individuals with hip dysplasia, the measurement of the acetabular orientation may not be sufficient to predict the joint loading and pressure distribution across the joint. Addition of mechanical analysis to preoperative planning, therefore, has the potential to improve the clinical outcome. We analyzed the effect of periacetabular osteotomy on hip dysplasia using computer-aided simulation of joint contact pressure on regular AP radiographs. The results were compared with the results of surgery based on realignment of acetabular angles to the normal hip. PATIENTS AND METHODS: We studied 12 consecutive periacetabular osteotomies with no femoral head deformity. The median age of patients, all females, was 35 (20-50) years. The median follow-up was 2 years (1.3-2.2). Patient outcome was measured with the total score of a self-administered questionnaire (q-score) and with the Harris hip score. The pre- and postoperative orientation of the acetabulum was defined using reconstructed 3D CT-slices to measure angles in the three anatomical planes. Peak contact pressure, weight-bearing area, and the centroid of the contact pressure distribution (CP-ratio) were calculated. RESULTS: While 9 of 12 cases showed decreased peak pressure after surgery, the mean changes in weight-bearing area and peak contact pressure were not statistically significant. However, CP-ratio changed (p < 0.001, paired t-test) with surgery. For the optimal range of CP-ratio (within its mid-range 40-60%), the mechanical outcome improved significantly. INTERPRETATION: Verifying the correlation between the optimal CP-ratio and the outcome of the surgery requires additional studies on more patients. Moreover, the anatomically measured angles were not correlated with the ranges of CP-ratio, suggesting that they do not always associate with objective mechanical goals of realignment osteotomy. Mechanical analysis, therefore, can be a valuable tool in assessing two-dimensional radiographs in hip dysplasia.