Introduction to the Special Issue on Pediatric Pain: Contextual Issues in Children's Pain Management

In this preliminary investigation we examined the relative contribution of various diabetes-related factors including age at disease onset, duration of disease, and metabolic control to the cognitive functioning in pediatric patients with insulin-dependent diabetes mellitus (IDDM). Although the overall intellectual functioning of the sample was well within the normal range, chronological age accounted for much of the variance, with older youth performing less well than their younger counterparts. There also was a significant association between children having the disease for a longer period of time and their decreased efficiency on a cognitive task related to attention and speed of processing. Within the limitations of this investigation, findings were interpreted to support the ongoing monitoring of the cognitive functioning of children and adolescents with IDDM, particularly those who are older and have sustained longer duration of the disease, and the implementation of intervention programs aimed at remediating learning problems in these youth.     

Classroom Parties in US Elementary Schools: The Potential for Policies to Reduce Student Exposure to Sugary Foods and Beverages

ObjectiveTo examine associations among school, district, and state policies regarding classroom birthday and holiday parties.DesignSchool-level policies assessed by survey during the 2009–2011 school years, with collection of corresponding district policies and state laws.SettingUnited States public elementary schools.ParticipantsSurveys from 1,204 schools (response rate, 60.9%).Variables MeasuredPrevalence of school-wide restrictions on sugary items served during parties. Predictor variables included district policy and state law.AnalysisMultivariate logistic regressions to examine associations between school-level restrictions (outcome) and district policies and state laws, controlling for demographics and school year.ResultsApproximately one half of schools discouraged or prohibited sugary items during parties, or did not allow parties. Schools with a district policy and state law were 2.5 times more likely to restrict sweet items at parties than were schools with no corresponding policy or law. School-level limits were more common where policy and law addressed specific nutritional aspects of foods and beverages served in classroom parties (odds ratios, > 2.0; P < .001).Conclusions and ImplicationsProhibitions on sugary party fare were uncommon at all levels. Even though most policies were framed as recommendations rather than requirements, policy and law were associated with increased school-level restrictions, which demonstrates the value of policy.     

Problem-Solving Intervention for Caregivers of Children With Mental Health Problems

Building Our Solutions and Connections (BOSC) focused on enhancing problem-solving skills (PSS) of primary caregivers of children with mental health problems. Aims were determining feasibility, acceptability, and effect size (ES) estimates for depression, burden, personal control, and PSS. Methods: Caregivers were randomized to BOSC (n = 30) or wait-list control (WLC) groups (n = 31). Data were collected at baseline, post-intervention, and 3 and 6 months post-intervention. Results: Three-months post-intervention, ES for burden and personal control were .07 and .08, respectively. ES for depressed caregivers for burden and personal control were 0.14 and 0.19, respectively. Conclusions: Evidence indicates that the intervention had desired effects.     

Excellent response rate of anismus to botulinum toxin if rectal prolapse misdiagnosed as anismus (‘pseudoanismus’) is excluded

Aim Anismus causes obstructed defecation as a result of inappropriate contraction of the puborectalis/external sphincter. Proctographic failure to empty after 30 s is used as a simple surrogate for simultaneous electromyography/proctography. Botulinum toxin is theoretically attractive but efficacy is variable. We aimed to evaluate the efficacy of botulinum toxin to treat obstructed defecation caused by anismus. Method Botulinum toxin was administered, under local anaesthetic, into the puborectalis/external sphincter of patients with proctographic anismus. Responders (resolution followed by recurrence of obstructed defecation over a 1‐ to 2‐month period) underwent repeat injection. Nonresponders underwent rectal examination under anaesthetic (EUA). EUA‐diagnosed rectal prolapse was graded using the Oxford Prolapse Grade 1–5. Results Fifty‐six patients were treated with botulinum toxin. Twenty‐two (39%) responded initially and 21/22 (95%) underwent repeat treatment. At a median follow up of 19.2 (range, 7.0–30.4) months, 20/21 (95%) had a sustained response and required no further treatment. Isolated obstructed defecation symptoms (OR = 7.8, P = 0.008), but not proctographic or physiological factors, predicted response on logistic regression analysis. In 33 (97%) of 34 nonresponders, significant abnormalities were demonstrated at EUA: 31 (94%) had a grade 3–5 rectal prolapse, one had internal anal sphincter myopathy and one had a fissure. Exclusion of these alternative diagnoses revised the initial response rate to 96%. Conclusion Simple proctographic criteria overdiagnose anismus and underdiagnose rectal prolapse. This explains the published variable response to botulinum toxin. Failure to respond should prompt EUA seeking undiagnosed rectal prolapse. A response to an initial dose of botulinum toxin might be considered a more reliable diagnosis of anismus than proctography.     

The variability of intramedullary alignment of the femoral component during total knee arthroplasty

Intramedullary instrumentation for femoral component alignment during total knee arthroplasty is readily used. Newer alignment techniques using computer navigation are now available. This study assesses the difference in the sagittal and coronal plane alignments using a cadaveric model with 3 different entry points for intramedullary alignment compared with a navigation system. Seven cadaveric limb's results show that the anterior starting point resulted in recurvatum (-2.2 degrees +/- 1.4 degrees ), the middle starting point resulted in 1.9 degrees +/- 2.2 degrees of flexion, and the posterior starting point in 3.8 degrees +/- 2.6 degrees of flexion compared with the calculated femoral axis by the computer navigation system. When comparing the valgus angle, no statistical difference between any methods resulted (average 5.2 degrees +/- 0.9 degrees valgus). The anterior and posterior starting points were significantly different in the sagittal plane. These data suggest that alignment can be significantly affected by the starting point chosen for intramedullary instrumentation.     

Importance of the periareolar approach in the augmentation of the ptotic breast

This is a retrospective review of 66 patients with grade II breast ptosis who underwent augmentation mammaplasty from January 1996 to January 2001. Of these 66 patients, 17 were augmented using a periareolar approach, and 49 were augmented using an inframammary approach. All patients had textured saline implants, and 64 of 66 patients had the implants placed in a submuscular position. Mean photographic follow-up was 4.8 months (range, 6 weeks-1 year). When compared with an inframammary approach in the presence of grade II ptosis, a periareolar approach results in improved fill of the lower pole of the breast, improved centralization of the nipple on the breast mound, and lessening or elimination of undesirable upper pole fullness.