School and cognitive functioning problems in adolescent bariatric surgery candidates

BackgroundPrior studies have reported that students with overweight and obesity have impairments in performance IQ and executive function and worse school functioning in comparison with peers of normal weight. The present study assessed school and cognitive functioning in a sample of adolescents with severe obesity being evaluated for laparoscopic adjustable gastric banding.MethodsEligible candidates for bariatric surgery were referred for psychiatric evaluation, which included a semistructured clinical interview measuring school functioning and the vocabulary and matrix reasoning subtests of the Wechsler Abbreviated Scale of Intelligence (WASI).ResultsSelf-reported school problems were common, with 55.5% of adolescents failing a grade or subject, 38.7% attending summer school, and 17.8% failing a citywide examination. A significant relationship was observed between body mass index, estimated WASI IQ (r = ?.250; P = .005), and the vocabulary subtest (r = ?.241; P = .006), but not matrix reasoning (r = ?.126; P = NS).ConclusionEven among a sample of adolescents with severe obesity, increased body mass index was associated with lower WASI IQ and vocabulary subtest scores. Increasing awareness of potential cognitive and school problems in bariatric candidates among teachers, school counselors, and other mental health providers is an important first step to improving academic support and educational systems deficiencies for students with overweight and obesity.     

钽棒植入联合带血管蒂髂骨瓣转移治疗中青年早期股骨头坏死

目的探讨钽棒植入联合带血管蒂髂骨瓣转移治疗中青年早期股骨头坏死的临床疗效。方法回顾性分析2007年10月至2012年1月中山大学附属江门医院采用钽棒植入联合带血管蒂髂骨瓣转移治疗的11例（15髋）中青年早期股骨头坏死患者的临床资料,记录手术时间、术中出血量,观察内置钽棒松动、断裂及症状改善情况,末次随访时进行髋关节Harris评分和影像学检查。结果11例患者随访12~60个月（平均24个月）。手术时间60～100min（平均70min）、术中出血量200~400mL（平均280mL）。随访期间内置钽棒未见松动、断裂,未出现钽棒排斥反应。患髋疼痛感减轻或消失,末次随访时Harris评分为（85士4）分,较术前的（62士3）分明显提高（f=6．505,P=O．000）。影像学检查未见股骨头塌陷,植骨区域未出现骨坏死趋势。结论钽棒植入联合带血管蒂髂骨瓣转移手术可改善血供,提供足够的力学支持,有效防止股骨头进一步塌陷,临床功能改善效果较理想,是治疗中青年早期股骨头坏死的有效方法。     

Airport metal detector activation is rare after posterior spinal fusion in children with scoliosis

Purpose

Since the September 11, 2001 terrorist attacks on the World Trade Center in New York City, travel security has become an ever-increasing priority in the United States. Frequent parent and patient inquiry and recent literature reports have generated interest in the impact of heightened security measures on patients with orthopaedic implants, and have indicated increasing rates of metal detector triggering. There are no reports to date, however, evaluating children and adolescents who have undergone posterior spinal fusion for scoliosis, so responses to patient and parent inquiries are not data-driven. The purpose of this study is to determine the frequency of airport metal detector triggering by patients who have had posterior-only spinal fusion and to characterise any potential predictors of metal detector activation.

Methods

A cross-sectional study was performed by interviewing 90 patients who underwent posterior-only spinal fusion for a diagnosis of juvenile or adolescent idiopathic scoliosis and have travelled by air in the past year. Demographic, clinical and surgical instrumentation data were collected and evaluated, along with patients’ reports of airport metal detector triggering and subsequent screening procedures.

Results

Five patients with stainless steel instrumentation (5.6 % of the cohort) triggered an airport walkthrough metal detector, and an additional five patients who did not trigger an airport detector triggered a handheld detector at a different venue. All patients who triggered an airport metal detector had stainless steel instrumentation implanted prior to 2008, and no patient with titanium instrumentation triggered any detector in any venue. All trigger events required subsequent screening procedures, even when an implant card was presented.

Conclusions

In this cohort of children and adolescents with posterior spinal instrumentation, airport walkthrough metal detector triggering was a rare event. Therefore, we advise patients and families with planned posterior scoliosis fusions using titanium instrumentation that airport detection risk is essentially non-existent, and only rare for those with planned stainless steel instrumentation. We no longer issue implant cards postoperatively, as these did not prevent further screening procedures in this cohort.

Level of evidence

Prognostic level 2. Study design: cross-sectional.     

Reliability of assessing the coronal curvature of children with scoliosis by using ultrasound images

Purpose

To investigate the intra- and inter-observer reliability of the coronal curvature asymmetry of children with adolescent idiopathic scoliosis (AIS) using the center of lamina (COL) method on ultrasound (US) images.

Methods

A cadaver spinal column phantom which was manipulated to present 30 scoliotic curves of varying severity of scoliotic deformities was scanned using both the US and laser scanner (LS) systems. Three observers of varying experience and skill measured the coronal curvature using the Cobb method on the LS images and the COL method on the US images. All of the measurements were performed twice, with a 1-week interval to reduce memory bias. The intra-class correlation coefficient (ICC), the mean absolute differences (MAD), and the error index (EI) were calculated to determine the agreement on selecting the end vertebrae. In addition, five AIS subjects were scanned using the US system. One observer measured the coronal curvature on the US images twice, and the measurements were compared with the Cobb angle reported in the clinical records.

Results

In the phantom study, the COL method showed high intra- and inter-observer reliabilities, with all ICC values >0.88. The maximum MAD of the COL measurements between different sessions among all observers was <4.1°. The EI values of the US method had similar end-vertebra selections as the LS method. The results of the pilot study showed a high intra-reliability for the US measurements. The measured difference between the Cobb and COL methods was 0.7° ± 0.5°.

Conclusions

The COL method using US images appears to be a very reliable method for measuring the coronal curvature in AIS without the need to expose the patient to radiation.     

Anterior surgery for adolescent idiopathic scoliosis

Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50–60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pull-out, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of >70° have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS (>90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3.     

Addressing career barriers for high risk adolescent girls: The PATHS curriculum intervention

The study evaluated a gender-specific comprehensive career development curriculum designed to target career barriers faced by high risk adolescent girls – those with disabilities and at risk for school failure. The goal of the curriculum was to promote social cognitive career and self determination outcomes associated with adaptive career development and adjustment. A pre-post control group design was used to evaluate the curriculum. Findings suggest that participation in the curriculum resulted in significant and large gains in autonomy and in disability and gender-related knowledge. Meaningful gains were noted in perceptions of social support and relevance of school. Participants in a high fidelity sample made significant and large gains in vocational skills self-efficacy and disability and gender-related knowledge. Meaningful improvements were noted in self-advocacy, autonomy, and vocational outcome expectations. The findings suggest that the curriculum can improve important indicators of positive career development and adjustment in high risk adolescent girls.     

Adolescent lumbar disc herniation: Experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing,China

Purpose

This article discusses the aetiology, medical history, physical examination, imaging characteristics and treatment modalities relevant to this entity aiming to increase awareness among paediatricians regarding LDH (lumbar disc herniation) in young children.

Methods

We retrospectively reviewed the medical records of 120 adolescent patients (aged 13–20 years old) with LDH at the orthopaedics department of a teaching hospital in Chongqing, China, between 2001 and 2011.

Results

The present retrospective analysis was performed on 121 adolescent patients (2.6%, 121/4695 cases with LDH operations) with LDH. One hundred and thirteen patients (93.4%) presented with low back pain with or without radiculopathy, and 12 patients (9.9%) presented with leg pain as the first symptom. Only 60 patients (49.6%) were diagnosed with LDH as their first outpatient diagnosis. Thirty-eight patients (31.4%) had a history of trauma before the onset of their symptoms. The most common segments were L4/5 (61, 50.4%), L5/S1 (42, 34.7%) and L4/5 + L5/S1 (13, 10.7%). Disc herniation was centrolateral in 77.7% (n = 94) and central in 35.5% (n = 43). Eighty patients were treated by MED (microendoscopy discectomy), 25 by PELD (percutaneous endoscopic lumbar discectomy) and 16 by OLD (open lumbar discectomy). The rate of operative complications was 3.8%, 4.0% and 6.3% in MED, PELD and OLD, respectively. Through the ordinal regression analysis, we found that the patients with central disc herniation had much better outcomes than the patients with centrolateral disc herniation (P = 0.046).

Conclusions

Diagnosis of LDH in young children is usually delayed, but there were no risk factors for the delayed outpatient diagnosis of LDH. Awareness of LDH will help the paediatrician extract a relevant medical history, perform a directed physical examination and order appropriate imaging studies.     

Factor structure and individual patterns of DSM-IV conduct disorder criteria in adolescent psychiatric inpatients

We investigated the factor structure of the DSM-IV conduct disorder (CD) diagnostic criteria and typical individual patterns of CD subscales in an adolescent inpatient population using detailed hospital records of a Norwegian nationwide sample of 1087 adolescent psychiatric inpatients scored for the 15 DSM-IV CD criteria. Varimax rotated principal components and full-information factor analyses of 12 CD criteria were carried out separately for boys and girls employing two methods. Standardized values on three subscales of CD criteria were subjected to Ward's method of hierarchical cluster analyses followed by k-means relocation employing a double cross-replication design. Similar factor structures emerged regardless of factoring method and gender. With the exception of Criteria 8 (“Fire setting”) and 14 (“Run away from home”) the factor loadings for both genders were in accordance with Loeber's tripartite model, with Aggression, Delinquency, and Rule Breaking factors largely corresponding to Loeber's overt, covert and authority conflict pathways. A five-cluster solution proved highly replicable and interpretable. One cluster gathered adolescents without CD, and the remaining four described groups with different conceptually meaningful constellations of CD criteria, which were not equally prevalent in each gender. Delinquency appeared in all symptomatic clusters. The cluster analytic results highlighted typical forms of expressions of conduct problems, and the fact that these forms may not be equally prevalent in girls and boys even while the underlying structure of conduct problems may be similar across genders. Future research should address the prediction of specific outcomes from CD criteria subscales or constellations.     

En SkizofrenLTeori Psykologisk og neurologisk belyst

Abstract

Background: Previous research has shown that loneliness is strongly associated with both physical and psychological ill health, particularly among adolescents. Factor analytic research has also shown that loneliness is a multi-dimensional construct, characterized by e.g. feelings of isolation, and relational and collective connectedness. While factor analytic representations of the phenomenon effectively illustrate the structure and form of the loneliness construct, they may not adequately capture its expression in the population within, among and across individuals. Method: The current study modelled the expression of loneliness among a population sample of Northern Irish adolescents using latent class analysis. Data from the Young Life and Times Survey (2011) was used to identify the fewest groups of adolescents in the population characterized by discrete and shared loneliness profiles based on their responses to the UCLA Loneliness Scale (UCLA-LS). Individual “at risk” status for psychiatric morbidity was then assessed on the basis of LCA-group membership. Results: Four groups of adolescents were identified: 1) high loneliness, characterized predominantly by feelings of isolation, 2) intermediate loneliness (two groups), and a baseline group with low levels of loneliness. While all groups were more likely to screen positive for psychiatric morbidity compared with the baseline group, notable risk, however, was attributable to specific isolation experiences or disconnectedness, that characterized both the profiles of the high loneliness group and the similar, but less severe, intermediate loneliness group. Conclusions: Loneliness is distributed throughout the adolescent population; however, among a significant minority, loneliness is predominantly characterized by feelings of isolation and is strongly indicative of psychological ill health.