ARFID—Strategies for Dietary Management in Children

Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new disease entity in DSM-5 and ICD-11. This disorder continues to pose a diagnostic and therapeutic challenge for many professionals. This disorder can affect people of all ages. The most characteristic pattern is considered to be a lack of interest in eating or avoidance of food intake, which may result in nutritional deficiencies, weight loss or lack of expected weight gain, dependence on enteral feeding or dietary supplements, and impaired psychosocial functioning. This disorder cannot be explained by a current medical condition or co-occurring other psychiatric disorders, but if ARFID co-occurs with another disorder or illness, it necessarily requires extended diagnosis. Its treatment depends on the severity of the nutritional problem and may include hospitalization with multispecialty care (pediatrician, nutritionist, psychologist, psychiatrist, neurologist). The nutritional management strategy may include, inter alia, the use of Food Chaining, and should in the initial stage of therapy be based on products considered “safe” in the patient’s assessment. The role of the dietitian in the management of a patient with ARFID is to monitor weight and height and nutritional status and analyze the foods that should be introduced into the food chain first.     

小儿重度感染性脑损伤与心肌酶谱相关性分析

目的 探讨小儿感染引起重度脑损伤后心肌酶谱改变与格拉斯哥昏迷( GCS)评分及预后的关系,指导临床治疗和护理. 方法 对30例符合重度脑损伤诊断标准的患儿,于入院当天抽血化验心肌酶谱,包括天冬氨酸转氨酶( aspartate aminotransferase,AST)、乳酸脱氢酶(lactate dehydrogenase,LDH)、α-羟丁酸脱氢酶(α-hydroxybutyrate dehydrogenase,α-HBDH)、肌酸磷酸激酶( creatine phosphokinase,CPK)、心肌型肌酸激酶同功酶(MB isoenzyme of creatine kinase,CKMB).结果 患儿GCS评分3～5分组的19例患者的心肌酶浓度明显高于11例GCS评分6～8分患者(P＜0.05).治愈组11例,留有后遗症组14例,死亡组5例,三组间心肌酶浓度差异显著,死亡组的浓度最高,治愈组的浓度最低(P＜0.05). 结论 小儿重度感染性脑损伤GCS评分越低,心肌酶谱值越高,预后越差.     

Effects of Welfare Reform on Children of Adolescent Mothers: Moderation by Maternal Depression,Father Involvement,and Grandmother Involvement

SUMMARY

There are few data available on how effects of welfare reform on children may differ for different kinds of families. This study examined the constructs of maternal depression, father involvement, and grandmother involvement as moderators of the effects of a welfare reform program on children. The sample included 1,602 children between the ages of 3 and 6 ½ whose mothers had participated in New Chance, a multi-site welfare-to-work program with an emphasis on human capital development (i.e., education, job training). Father and grandmother co-residence were investigated, in addition to perceived support from these family members, in predicting cognitive and behavioral child outcomes. The mediating roles of parenting stress and emotional support in parenting were also explored. Although main effects were found for the intervention and for maternal depression, no main effects were found for the family ecology variables. However, interactions suggested complex relationships among New Chance and the family characteristics for both the full sample and for Latina families. Results are discussed in terms of policy implications and possible future research.     

Clinical Session Evaluation:

The purpose of the study was to establish whether clinical supervisors tend to agree or disagree in their evaluations of an individual clinical session, depending on whether or not they are familiar with the supemisee. Twelve supervisors with similar training and experience, all holding certificationby the American Speech-Language-Hearing Association, were divided equally among three training institutions in three states. The supervisors independently evaluated the same videotaped therapy session with two evaluation forms. The supervisors in the three settines differed in their ratines of the session. with those who were familiar with the supervisee giving significantly more favorable evaluations. Implications for speech-language phathol- ogy supervision and research are discussed.     

Standing on the shoulders of giants: Understanding calcium and vitamin D requirements

The quote by Sir Isaac Newton, ‘If I have seen further it is by standing on ye sholders of Giants’ was the theme of the British Nutrition Foundation (BNF) Annual Lecture 2012. Illustrations of the seminal contributions of six ‘giants’ of nutrition science, chosen because of their links to the BNF and to vitamin and mineral research in Cambridge, were used to give a historical context to recent studies and controversies on calcium and vitamin D requirements, particularly focusing on rickets and maternal and child nutrition.     

Hepatitis B virus infection in children

For two decades, hepatitis B vaccine has been integrated into national routine childhood vaccination programs in almost all countries. The prevalence of HBsAg has decreased in children worldwide. However, there are children who miss the benefit of hepatitis B vaccine in some regions and countries. Long-term follow-up studies have revealed the clinical outcomes of chronic hepatitis B virus infection in children. A small percentage of chronically infected children develop liver cirrhosis and hepatocellular carcinoma. However, it is controversial who should be treated and when antiviral treatment should be initiated in children. Compared with adult studies, the data are insufficient to evaluate the pathogenesis of hepatitis B infection and the efficacy of antiviral treatment in childhood. New antiviral drugs have been approved for children and adults. Also, oral antiviral drugs are administered to pregnant women to reduce the hepatitis B virus mother-to-child transmission rate.