RESUMEN
PURPOSE: Smooth muscle dysfunction syndrome (SMDS) due to heterozygous ACTA2 arginine 179 alterations is characterized by patent ductus arteriosus, vasculopathy (aneurysm and occlusive lesions), pulmonary arterial hypertension, and other complications in smooth muscle-dependent organs. We sought to define the clinical history of SMDS to develop recommendations for evaluation and management. METHODS: Medical records of 33 patients with SMDS (median age 12 years) were abstracted and analyzed. RESULTS: All patients had congenital mydriasis and related pupillary abnormalities at birth and presented in infancy with a patent ductus arteriosus or aortopulmonary window. Patients had cerebrovascular disease characterized by small vessel disease (hyperintense periventricular white matter lesions; 95%), intracranial artery stenosis (77%), ischemic strokes (27%), and seizures (18%). Twelve (36%) patients had thoracic aortic aneurysm repair or dissection at median age of 14 years and aortic disease was fully penetrant by the age of 25 years. Three (9%) patients had axillary artery aneurysms complicated by thromboembolic episodes. Nine patients died between the ages of 0.5 and 32 years due to aortic, pulmonary, or stroke complications, or unknown causes. CONCLUSION: Based on these data, recommendations are provided for the surveillance and management of SMDS to help prevent early-onset life-threatening complications.
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Actinas/genética , Aneurisma de la Aorta Torácica/genética , Conducto Arterioso Permeable/genética , Enfermedades Hereditarias del Ojo/genética , Midriasis/genética , Adolescente , Adulto , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/fisiopatología , Arginina/genética , Niño , Preescolar , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/fisiopatología , Enfermedades Hereditarias del Ojo/diagnóstico , Enfermedades Hereditarias del Ojo/diagnóstico por imagen , Enfermedades Hereditarias del Ojo/fisiopatología , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Humanos , Lactante , Registros Médicos , Músculo Liso/diagnóstico por imagen , Músculo Liso/fisiopatología , Midriasis/diagnóstico , Midriasis/diagnóstico por imagen , Midriasis/fisiopatología , Adulto JovenRESUMEN
A paper was published in 2003 discussing the ethics of nurses participating in executions by inserting the intravenous line for lethal injections and providing care until death. This paper was circulated on an international email list of senior nurses and academics to engender discussion. From that discussion, several people agreed to contribute to a paper expressing their own thoughts and feelings about the ethics of nurses participating in executions in countries where capital punishment is legal. While a range of opinions were presented, these opinions fell into two main themes. The first of these included reflections on the philosophical obligations of nurses as caregivers who support those in times of great need, including condemned prisoners at the end of life. The second theme encompassed the notion that no nurse ever should participate in the active taking of life, in line with the codes of ethics of various nursing organisations. This range of opinions suggests the complexity of this issue and the need for further public discussion.
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Pena de Muerte/legislación & jurisprudencia , Códigos de Ética , Ética en Enfermería , Enfermería de Cuidados Paliativos al Final de la Vida/ética , Australia , Humanos , Reino Unido , Estados UnidosRESUMEN
Transcervical sterilization is a non-surgical method of permanent female sterilization that is widely used and critically discussed. A review of the historiography of the method reveals that instances of its coercive use are not included in the historical account. This study offers a reexamination of the work of Carl Clauberg and Hans-Joachim Lindemann, to more deeply contextualize within the framework of current usage the coercive use of transcervical sterilization during the Third Reich and in postwar Germany. This inquiry is based on postwar criminal trial records on Clauberg, and on archival documents detailing Lindemann's activities in 1979. A comparative analysis examines arguments by medical historian Karl-Heinz Roth, and identifies shared characteristics and differences between Clauberg and Lindemann, their methods and scientific connections. The results demonstrate that the technique of transcervical sterilization has an abusive potential that may be explained as a function of the person of the physician, of the scientific method itself, and of societal and political influences. The analysis supports the argument that insights from the cases of Clauberg and Lindemann are transferrable geographically and over time, and have the potential to inform current medical practice, such as transcervical sterilization with the Essure device, whose historiographic exploration remains a desideratum.
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Experimentación Humana , Histeroscopía/efectos adversos , Esterilización Reproductiva/historia , Esterilización Tubaria/historia , Crímenes de Guerra/historia , Femenino , Alemania , Historia del Siglo XX , Humanos , Masculino , Embarazo , Esterilización Reproductiva/efectos adversosRESUMEN
BACKGROUND AND PURPOSE: In adult stroke, the advent of thrombolytic therapy led to the development of primary stroke centers capable to diagnose and treat patients with acute stroke rapidly. We describe the development of primary pediatric stroke centers through preparation of participating centers in the Thrombolysis in Pediatric Stroke (TIPS) trial. METHODS: We collected data from the 17 enrolling TIPS centers regarding the process of becoming an acute pediatric stroke center with capability to diagnose, evaluate, and treat pediatric stroke rapidly, including use of thrombolytic therapy. RESULTS: Before 2004, <25% of TIPS sites had continuous 24-hour availability of acute stroke teams, MRI capability, or stroke order sets, despite significant pediatric stroke expertise. After TIPS preparation, >80% of sites now have these systems in place, and all sites reported increased readiness to treat a child with acute stroke. Use of a 1- to 10-Likert scale on which 10 represented complete readiness, median center readiness increased from 6.2 before site preparation to 8.7 at the time of site activation (P≤0.001). CONCLUSIONS: Before preparing for TIPS, centers interested in pediatric stroke had not developed systematic strategies to diagnose and treat acute pediatric stroke. TIPS trial preparation has resulted in establishment of pediatric acute stroke centers with clinical and system preparedness for evaluation and care of children with acute stroke, including use of a standardized protocol for evaluation and treatment of acute arterial stroke in children that includes use of intravenous tissue-type plasminogen activator. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01591096.
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Ensayos Clínicos como Asunto/normas , Fibrinolíticos/administración & dosificación , Hospitales Pediátricos/normas , Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/terapia , Centros de Atención Terciaria/normas , Terapia Trombolítica/normas , Activador de Tejido Plasminógeno/administración & dosificación , Adolescente , Niño , Preescolar , Femenino , Fibrinolíticos/efectos adversos , Hospitales Pediátricos/organización & administración , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Masculino , Estudios Multicéntricos como Asunto , Calidad de la Atención de Salud/estadística & datos numéricos , Accidente Cerebrovascular/tratamiento farmacológico , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/estadística & datos numéricos , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/efectos adversosRESUMEN
BACKGROUND: Modern contraceptive use persists to be low in most African countries where fertility, population growth, and unmet need for family planning are high. Though there is an evidence of increased overall contraceptive prevalence, a substantial effort remains behind in Ethiopia. This study aimed to identify factors associated with modern contraceptive use and to examine its geographical variations among 15-49 married women in Ethiopia. METHODS: We conducted secondary analysis of 10,204 reproductive age women included in the 2011 Ethiopia Demographic and Health Survey (DHS). The survey sample was designed to provide national, urban/rural, and regional representative estimates for key health and demographic indicators. The sample was selected using a two-stage stratified sampling process. Bivariate and multivariate logistic regressions were applied to determine the prevalence of modern contraceptive use and associated factors in Ethiopia. RESULTS: Being wealthy, more educated, being employed, higher number of living children, being in a monogamous relationship, attending community conversation, being visited by health worker at home strongly predicted use of modern contraception. While living in rural areas, older age, being in polygamous relationship, and witnessing one's own child's death were found negatively influence modern contraceptive use. The spatial analysis of contraceptive use revealed that the central and southwestern parts of the country had higher prevalence of modern contraceptive use than that of the eastern and western parts. CONCLUSION: The findings indicate significant socio-economic, urban-rural and regional variation in modern contraceptive use among reproductive age women in Ethiopia. Strengthening community conversation programs and female education should be given top priority.
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Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/estadística & datos numéricos , Adolescente , Adulto , Niño , Mortalidad del Niño , Países en Desarrollo , Etiopía/epidemiología , Servicios de Planificación Familiar , Femenino , Encuestas Epidemiológicas , Humanos , Matrimonio , Mortalidad Materna , Población Rural , Factores Socioeconómicos , Servicios de Salud para Mujeres/estadística & datos numéricosRESUMEN
OBJECTIVE: To describe presumptive risk factors (RFs) for childhood arterial ischemic stroke (AIS) and explore their relationship with presentation, age, geography, and infarct characteristics. METHODS: Children (29 days-18 years) were prospectively enrolled in the International Pediatric Stroke Study. Risk factors, defined conditions thought to be associated with childhood AIS, were divided into 10 categories. Chi-square tests were used to compare RFs prevalence across regions and age; logistic regression was used to determine whether RFs were associated with particular features at presentation or infarct characteristics. RESULTS: A total of 676 children were included. No identifiable RFs was present in 54 (9%). RFs in others included arteriopathies (53%), cardiac disorders (CDs) (31%), infection (24%), acute head and neck disorders (AHNDs) (23%), acute systemic conditions (ASCs) (22%), chronic systemic conditions (CSCs) (19%), prothrombotic states (PTSs) (13%), chronic head and neck disorders (CHNDs) (10%), atherosclerosis-related RFs (2%), and other (22%). Fifty-two percent had multiple RFs. There was lower prevalence of arteriopathy in Asia, lower prevalence of CSCs in Europe and Australia, higher prevalence of PTSs in Europe, and higher prevalence of ASCs in Asia and South America. Prevalence of CDs and ASCs was highest in preschoolers, arteriopathies in children 5 to 9 years old, and CHNDs were highest in children aged 10 to 14 years. Arteriopathies were associated with focal signs and ASCs, CHNDs, and AHNDs with diffuse signs. Arteriopathies, CSCs, and ASCs were associated with multiple infarcts and CDs with hemorrhagic conversion. INTERPRETATION: RFs, especially arteriopathy, are common in childhood AIS. Variations in RFs by age or geography may inform prioritization of investigations and targeted preventative strategies.
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Accidente Cerebrovascular/epidemiología , Adolescente , Distribución por Edad , Asia/epidemiología , Australia/epidemiología , Encéfalo/patología , Isquemia Encefálica/epidemiología , Infarto Cerebral/epidemiología , Infarto Cerebral/patología , Niño , Preescolar , Europa (Continente)/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Prevalencia , Factores de Riesgo , América del Sur/epidemiología , Accidente Cerebrovascular/diagnósticoRESUMEN
BACKGROUND AND PURPOSE: Stroke is an important cause of death and disability among children. Clinical trials for childhood stroke require a valid and reliable acute clinical stroke scale. We evaluated interrater reliability (IRR) of a pediatric adaptation of the National Institutes of Health Stroke Scale. METHODS: The pediatric adaptation of the National Institutes of Health Stroke Scale was developed by pediatric and adult stroke experts by modifying each item of the adult National Institutes of Health Stroke Scale for children, retaining all examination items and scoring ranges of the National Institutes of Health Stroke Scale. Children 2 to 18 years of age with acute arterial ischemic stroke were enrolled in a prospective cohort study from 15 North American sites from January 2007 to October 2009. Examiners were child neurologists certified in the adult National Institutes of Health Stroke Scale. Each subject was examined daily for 7 days or until discharge. A subset of patients at 3 sites was scored simultaneously and independently by 2 study neurologists. RESULTS: IRR testing was performed in 25 of 113 a median of 3 days (interquartile range, 2 to 4 days) after symptom onset. Patient demographics, total initial pediatric adaptation of the National Institutes of Health Stroke Scale scores, risk factors, and infarct characteristics in the IRR subset were similar to the non-IRR subset. The 2 raters' total scores were identical in 60% and within 1 point in 84%. IRR was excellent as measured by concordance correlation coefficient of 0.97 (95% CI, 0.94 to 0.99); intraclass correlation coefficient of 0.99 (95% CI, 0.97 to 0.99); precision measured by Pearson ρ of 0.97; and accuracy measured by the bias correction factor of 1.0. CONCLUSIONS: There was excellent IRR of the pediatric adaptation of the National Institutes of Health Stroke Scale in a multicenter prospective cohort performed by trained child neurologists.
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National Institutes of Health (U.S.)/normas , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Proyectos Piloto , Estudios Prospectivos , Reproducibilidad de los Resultados , Estados Unidos/epidemiologíaRESUMEN
HIV thrives in an atmosphere of silence and secrecy. The stigma, real or feared, of HIV/AIDS is often a barrier to support and care that adolescent orphans need. The purpose of this article is to describe the burden of silence borne by adolescents orphaned by HIV and AIDS. A phenomenological study using photography and photo-elicitation was done among orphaned adolescents. Fifteen adolescents orphaned by HIV and AIDS, living in an urban area of South Africa, participated in the study. Participants photographed objects, such as graveyards, hearses, and a room where a parent committed suicide. These photographed objects were grouped as symbols of death. Nature and people also were photographed. Photo-elicitation revealed the psychosocial impact that results from the secrecy about parental cause of death. Implications for mental health practitioners are also discussed.
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Síndrome de Inmunodeficiencia Adquirida/enfermería , Síndrome de Inmunodeficiencia Adquirida/psicología , Niños Huérfanos/psicología , Confidencialidad , Costo de Enfermedad , Países en Desarrollo , Infecciones por VIH/enfermería , Infecciones por VIH/psicología , Estigma Social , Apoyo Social , Adolescente , Actitud Frente a la Muerte , Femenino , Humanos , Masculino , Fotograbar , Sudáfrica , Suicidio/psicología , Simbolismo , Población UrbanaRESUMEN
BACKGROUND: The safety and efficacy of thrombolysis after acute stroke in children have not been established. Our aim was to describe current practices and results of the use of alteplase for acute arterial ischaemic stroke in children enrolled in an international pediatric stroke registry and to compare current practices with those published in case reports and with guidelines for the use of alteplase for adult stroke. METHODS: In this multicentre observational cohort study, we analysed the clinical features, the dosing and timing of treatment, and the short-term outcome in children treated with alteplase for acute arterial ischaemic stroke who were enrolled in the International Pediatric Stroke Study (IPSS) between January, 2003, and July, 2007. The findings from the IPSS were compared with published case reports for clinical features, adherence to adult guidelines for alteplase, and outcomes. FINDINGS: Of 687 children with acute arterial ischaemic stroke enrolled in the IPSS, 15 (2%) received alteplase: nine received intravenous alteplase and six received intra-arterial alteplase. The median time to treatment from stroke onset was 3.3 h (range 2.0-52.0 h) for intravenous alteplase and 4.5 h (3.8-24.0 h) for intra-arterial alteplase. Two patients died (one owing to massive infarction and brain herniation, and one owing to brainstem infarction). At discharge from hospital, one patient was healthy and 12 patients had neurological deficits. Intracranial haemorrhage after alteplase occurred in four of 15 patients, although none of the bleeding events was judged to be acutely symptomatic. When compared with ten patients reported in published articles who were given intravenous alteplase, the nine patients in the IPSS cohort were mostly younger, waited longer for treatment, and had worse outcomes, which suggests there is a publication bias towards short treatment intervals from symptom onset and favourable outcomes. INTERPRETATION: Children with acute stroke received alteplase infrequently and at time intervals that often deviated from adult guidelines. Although no alteplase-related deaths or symptomatic intracranial haemorrhage was reported, poor neurological outcome was common. Clinical trials to evaluate the dose and the safety and efficacy of alteplase are needed in childhood stroke.
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Fibrinolíticos/uso terapéutico , Pediatría , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Adolescente , Isquemia Encefálica/complicaciones , Niño , Preescolar , Estudios de Cohortes , Femenino , Fibrinolíticos/efectos adversos , Humanos , Lactante , Cooperación Internacional , Hemorragias Intracraneales/inducido químicamente , Masculino , Observación/métodos , Estudios Retrospectivos , Accidente Cerebrovascular/etiología , Factores de Tiempo , Activador de Tejido Plasminógeno/efectos adversos , Resultado del TratamientoRESUMEN
Children with disabilities were killed during the Nazi era, often by nurses. Some nurses killed children, saying that they were under orders. Propaganda about the need for "racial purity" was all pervasive and influenced much of the population, including nurses. The German people accepted the "mercy" killing of children with disabilities. We describe the children's "euthanasia" program, explore the influence of propaganda, ask why it was acceptable to kill children, and provide historical context demonstrating "slippery slopes" which can lead to abrogation of ethical principles. Discussion of such history is essential as the ethical principles which were breached are still the cornerstone of nursing practice today. Only by openly discussing past wrongs can we attempt to ensure that they do not happen again. Archival documents from Germany and Israel, including trial depositions and transcripts, provided material, supplemented by secondary classic sources.
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Niños con Discapacidad/historia , Eutanasia/historia , Nacionalsocialismo/historia , Personal de Enfermería/historia , Niño , Eugenesia/historia , Alemania , Historia del Siglo XX , Humanos , Ética Basada en Principios/historia , Propaganda , Argumento Refutable , Segunda Guerra MundialRESUMEN
In 1939, Hitler authorized a programme of 'euthanasia' of children and adults with physical and psychiatric disorders. Initially, gas chambers were established at six psychiatric institutions in Germany and Austria. This programme was discontinued in August 1941 but the killings continued on an individual basis. Physicians selected patients who were unable to work or who required extensive care, and ordered the nurses to administer lethal doses of sedatives. Meseritz-Obrawalde was a site for 10,000 of these killings. Using documents from the trial of one of Obrawalde's physicians, Hilde Wernicke, the era of 'wild euthanasia' is described and her rationale for participating in the killings is explored.
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Eutanasia/historia , Hospitales Psiquiátricos/historia , Nacionalsocialismo/historia , Alemania , Historia del Siglo XX , HumanosRESUMEN
Eugenics underpinned the Nazi race theories which saw the murder of over 10 million people from "undesirable" groups, including Sinti (referred to in Nazi times as "Gypsies"), during the Holocaust. Eva Justin, from Dresden, completed a doctoral dissertation which examined a group of Sinti children of St Josef's Home in Mulfingen, Germany. She aimed to prove the racial inferiority of these children; her work was done with no informed consent, and the children were sent to Auschwitz after her experiments. The study was supported by senior Nazis, supervised by Nazi "scientists" and examined by committed Nazis. We argue that her work was biased, poorly designed, and ultimately unethical, but was in keeping with methods of the emerging disciplines of anthropology and racial hygiene, in Germany and other countries, at the time. It is not possible to say that her work caused the children to meet their deaths (of the 39 children she included, only four survived); however, she did reinforce the Nazi racial theories. It is unfortunate that one of the first nurses in the world to receive a PhD did so through research attempting to prove that a group of children were "racially inferior" in support of National Socialism.
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Eugenesia/historia , Historia de la Enfermería , Holocausto/historia , Nacionalsocialismo/historia , Romaní/historia , Niño , Alemania , Historia del Siglo XX , Humanos , Enfermeras y EnfermerosRESUMEN
Recombinant tissue plasminogen activator, although the standard of care for the management of acute ischemic stroke in adults, is used infrequently in children. The authors describe the use of intra-arterial recombinant tissue plasminogen activator in a young child with embolic stroke. Thrombolysis restored flow to the affected middle cerebral artery and appeared to limit the extent of the infarction and the severity of the subsequent neurologic deficits.
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Fibrinolíticos/uso terapéutico , Activadores Plasminogénicos/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Preescolar , Femenino , Humanos , Infarto de la Arteria Cerebral Media , Inyecciones Intraarteriales/métodosRESUMEN
OBJECTIVE: This study identifies social determinants of HIV infection, hotspot areas and subpopulation groups in Ethiopia. DESIGN: The study used data from the 2011 Ethiopian Demographic and Health Survey (EDHS). Sample blood tests from the finger pricks collected on filter paper cards were labelled with a barcode unique to each respondent. Spatial scan statistics and geographic information system tools were used to map hotspot areas of HIV prevalence. Bivariate and multivariable logistic regression models were used to identify social determinants of HIV infection. POPULATION: A total of 30,625 adults (16,515 women and 14,110 men) were included from 11 administrative states of Ethiopia. MAIN OUTCOME MEASURES: Laboratory-confirmed HIV serostatus is the main outcome variable. RESULTS: HIV prevalence reached 10-21% in the central, eastern and western geographic clusters of Ethiopia. Multivariable analysis showed that individuals who were in the middle, richer and richest wealth quintiles had increased odds of having HIV over those in the poorest quintile. Adults who had primary, secondary and higher educational levels had higher odds of being HIV positive than non-educated individuals. The odds of having HIV were higher among adults who had multiple lifetime sexual partners than those with a single partner. An increasing odds of HIV infection were observed among adults in the age groups of 25-29, 30-34, 35-39 and 40-45â years compared with adults in the age group of 45-49â years. Merchants had higher odds of being HIV positive than those who were not employed. The odds of having HIV were higher among urban residents and females than among rural residents and males, respectively. CONCLUSIONS: This study found statistically significant HIV concentrations in administrative zones of central, eastern and western Ethiopia. Geospatial monitoring and targeting of prevention strategies for specific population groups is recommended.
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Infecciones por VIH/epidemiología , Adolescente , Adulto , Escolaridad , Etiopía/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
Iron deficiency anemia is a rare cause of cerebral sinovenous thrombosis in children. We report three cases of cerebral sinovenous thrombosis and iron deficiency anemia treated at Primary Children's Medical Center in Salt Lake City, Utah, between 1998 and 2001. The children were 9, 19, and 27 months old at the time of admission. Hemoglobin levels ranged from 6.6 to 7.0 g/dL, mean corpuscular volume levels from 45 to 56 fL, and platelet counts from 248,000 to 586,000/microL. Magnetic resonance imaging and magnetic resonance venography revealed thrombosis of the straight sinus and internal cerebral veins in all three children, with the addition of the vein of Galen, left transverse and sigmoid sinuses, and upper left internal jugular vein in one child. Recovery ranged from excellent to poor in 3 months to 3 years of follow-up. Four additional cases, ages 6 to 22 months, were found in the English-language literature. Evaluation for prothrombotic disorders was negative in all children, including the current cases. Treatments have included thrombectomy, corticosteroids, mannitol, heparin, low-molecular-weight heparin, warfarin, aspirin, blood transfusion, and iron supplementation, but there is no consensus regarding therapy, other than to correct the anemia and treat iron deficiency. Iron deficiency anemia, a preventable cause of cerebral sinovenous thrombosis, deserves consideration when cerebral sinovenous thrombosis is detected in young children.
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Anemia Ferropénica/complicaciones , Trombosis Intracraneal/etiología , Anemia Ferropénica/tratamiento farmacológico , Preescolar , Senos Craneales , Femenino , Humanos , Lactante , Trombosis Intracraneal/patología , Imagen por Resonancia Magnética , Masculino , PronósticoRESUMEN
Poland was invaded by Nazi Germany on 1 September 1939 and World War II began on 3 September. Polish nurses have their place in this difficult history. In the first months of occupation, nurses focused on caring for wounded soldiers. In order to protect them from prisoner-of-war camps and execution, nurses sought safe havens for the wounded in private homes and transported them there. After their regular jobs, the nurses visited them, changed their dressings and provided them with civilian clothes so that soldiers could eventually escape. This paper describes the work of two of these nurses, Wanda Ossowska and Stanislawa Leszczynska. The first three authors (BD, SH, AJS) were nurses in Poland at that time and they present some of the information in this paper as primary source data.
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Historia de la Enfermería , Nacionalsocialismo/historia , Segunda Guerra Mundial , Alemania , Historia del Siglo XX , Historia del Siglo XXI , Humanos , PoloniaRESUMEN
INTRODUCTION: Over the past three decades, significant advances in treatment have improved the mortality of children with cardiac disease. The effect of these advances on the prevalence of arterial ischemic stroke (AIS) is unknown. We describe AIS in children with cardiac disease in the modern era. DESIGN: The prospectively enrolled Intermountain Pediatric Stroke Database (including Utah, Wyoming, Idaho, and Nevada) was queried for all patients less than 18 years old with new-onset AIS between January 1, 2003 and August 31, 2009. Medical records of patients with AIS and cardiac disease were reviewed for cardiac diagnosis, age at AIS, anticoagulant therapy, diuretics, hematocrit, bolus fluids, and ongoing morbidity. Data were analyzed using chi-square test and a mixed-effects Poisson regression growth curve model. RESULTS: AIS incidence in our catchment area was 0.01% (10.7/100,000; N = 97). The incidence of AIS in patients with cardiac disease was higher compared with AIS in the total population (incidence 0.13% [132/100,000], odds ratio [OR] 16.1, 95% confidence interval [CI; 9.7--25.9], P < 0.001). Of the 97 patients with AIS, 24 had cardiac disease (25%). The most common cardiac diagnosis was single ventricle (SV; 8/24, 33%). The incidence of AIS in patients with SV cardiac disease was higher compared with those with other cardiac diagnoses (incidence 1.38% [1380/100,000], OR 15.3, 95% CI [5.7--38.2], P < 0.001). Modeling the prevalence estimates reported since 1978, the prevalence of cardiac disease in AIS patients has remained unchanged across time (prevalence increase per each additional year, 0.5%, 95% CI [--2.1%, 3.1%], P = 0.71). CONCLUSION: Children with cardiac disease (particularly those with SV) have increased risk for AIS. The prevalence is unchanged from reports over previous decades. AIS occurred in SV patients despite compliance with current anticoagulation recommendations. Future efforts should focus on best practices to prevent AIS in cardiac patients.