What is the incidence of late detection of developmental dysplasia of the hip in England?: a 26-year national study of children diagnosed after the age of one.

AIMS: The aim of this study was to establish the incidence of developmental dysplasia of the hip (DDH) diagnosed after one-year of age in England, stratified by age, gender, year, and region of diagnosis. PATIENTS AND METHODS: A descriptive observational study was performed by linking primary and secondary care information from two independent national databases of routinely collected data: the United Kingdom Clinical Practice Research Datalink and Hospital Episode Statistics. The study examined all children from 1 January 1990 to 1 January 2016 who had a new first diagnostic code for DDH aged between one and eight years old. RESULTS: The incidence of late-diagnosed DDH was 1.28 per 1000 live births. Within the study population, 754 children were identified with a diagnosis of DDH after one-year of age. Of all late diagnoses, 536 (71.1%) were detected between one to two years of age. There were 608 female patients (80.6%) and 146 male patients (19.4%), giving a female-to-male ratio of 4.2:1. Distribution was evenly spread throughout England. CONCLUSION: The incidence of late-diagnosed DDH has not been reduced from that reported 35 years ago, prior to the introduction of the national selective screening programme for DDH. Cite this article: Bone Joint J 2019;101-B:281-287.

Chronic progressive multiple sclerosis. Relationship between cerebral ventricular size and neuropsychological impairment.

Forty-seven patients with chronic progressive multiple sclerosis were examined to assess the possible relationship between cerebral atrophy (by computed tomography [CT] ) and performance on neuropsychological tests of memory and verbal intelligence. Nineteen patients were found to have mildly dilated ventricles and another nine patients had moderate to severe ventricular enlargement. Performance on memory and intelligence testing was related to the degree of ventriculomegaly. Three linear CT measurements were also recorded. Using this method, the width of the third ventricle proved to be the best indicator of intellectual and memory dysfunction. Measures of cognition and ventricular size did not correlate with length of illness or overall disability as rated by the Kurtzke Disability Status Score.

Alcohol induced discoordination is not reversed by naloxone.

It has previously been reported that prior administration of naloxone may prevent the decrement in performance produced by alcohol. To be clinical value, however, naloxone must be shown to reverse rather than prevent this decrement. This study examined the effect of naloxone given after consumption of alcohol. A double blind balanced crossover protocol was used to examine the effect of either 1.2 mg or 10 mg naloxone on the sensory-motor impairment produced by blood alcohol concentrations maintained between 75 and 85 mg/100 ml. This alcohol concentration significantly impaired two measures of sensory-motor performance, but there was no evidence that either dose of naloxone could reverse this decrement. We tested our subjects for a chlorpropamide alcohol flush but none gave a positive response. These results indicate that naloxone (1.2 mg or 10 mg) does not reverse the sensory-motor impairment produced by alcohol intoxication in subjects who do not exhibit a chlorpropamide alcohol flush. Nearly all the subjects exhibited somnolence after receiving alcohol and naloxone (1.2 mg or 10 mg) but not after receiving alcohol and saline.

Systemic and local effects of the application of a tourniquet.

The effect of the application of a tourniquet to a limb and the release of the accumulated metabolites have been investigated with reference to the acid-base level in the blood from the limb and in the right atrium. Investigations have been carried out experimentally in rhesus monkeys and observations have been made on patients undergoing reconstructive operations on the knee. The acidotic blood from the ischaemic limb produces little systemic effect. The limb recovers in approximately 40 minutes after a tourniquet has been in place for four hours. Three hours is recommended as a reasonable upper limit for the safe application of a pneumatic tourniquet.

Options and issues for pregnant adolescents.

PIP: Because of the increased rate of adolescent pregnancies, maternal-child nurses need to be aware of some of the special legal issues associated with pregnant adolescents. A pregnant adolescent has 4 options, each has legal implications. Abortion is a constitutionally protected right to privacy. However, state statutes vary in their treatment of adolescents seeking abortion. Parental notification may be required before an abortion can be performed. It is a nurse's obligation to be familiar with the state laws that apply to the adolescents they will encounter. It must be clearly understood that if the state has no parental involvement laws, it is a breach of patient confidentiality to notify parents. Retaining custody simply involves the mother keeping the child and raising it even though it is illegitimate. However, illegitimate children are today extended the rights and privileges of legitimate children e.g., inheritance, insurance benefits, and standing to sue in civil actions. Paternity can be either admitted to or demonstrated. Adoption laws vary tremendously by state, but they all function similarly in that the mother must sign away her right to custody. Some states allow for this to be revoked if the mother has somehow been forced or deceived into signing. Marriage is another option, however in most states the mother and father must be 18. In some states the age is 16 or 17 with parents' permission. In other states the couple can petition a judge for permission.^ieng

Defining minors' abortion rights.

PIP: The right to abortion is confirmed in the Roe versus Wade case, by the US Supreme Court. It is a fundamental right of privacy but not an absolute right, and must consider state interests. During the first trimester of pregnancy abortion is a decision of the woman and her doctor. During the second trimester of pregnancy the state may control the abortion practice to protect the mothers health, and in the last trimester, it may prohibit abortion, except in cases where the mother's life or health are in danger. The states enacted laws, including one that required parents to give written consent for a unmarried minor's abortion. This law was struck down by the US Court, but laws on notification were upheld as long as there was alternative procedures where the minor's interests are upheld. Many of these law have been challenged successfully, where the minor was judged mature and where it served her best interests. The state must enact laws on parental notification that take into consideration basic rights of the minor woman. Health professionals and workers should be aware of these laws and should encourage the minor to let parents in on the decision making process where possible.^ieng

Webster versus reproductive health services.

PIP: The US Supreme Court's agreement to decide the Webster v Reproductive Health Service (MIssouri) case represents a direct challenge to the basic premise of the 1973 Roe v Wade decision. While the 1973 decision determined that woman's right to choose abortion during the 1st trimester of pregnancy is protected by the Constitutional right to privacy, the Webster case seeks to restrict access to legal abortion through 20 provisions, 5 of which were addressed by the Supreme Court. The 1st 2 provisions concerned the preamble of the MIssouri statute that contains statements to the effect that life begins at conception and unborn children have inalienable rights. The Supreme Court declined to the rule on the constitutionality of this preamble, maintaining that the preamble did no regulate abortions or medical practice. The 3rd provision involved restrictions on the use of public facilities and employees for the performance of nontherapeutic abortions. The Court upheld this restriction on the grounds that the Constitution does not mandate federal aid to abortion and the withholding of public facilities and funds does not deny women the right to abortion. The 4th provision, which the Court stated was not a moot controversy, made it illegal for public funds, employees, or facilities to be used for abortion counseling. Finally, the 5th provision of the MIssouri statute considered by the Supreme Court requires physicians to determine whether a fetus is viable before an abortion is performed on a woman 20 or more weeks pregnant. The Court found this provision to be constitutional since it furthers the state's interest in protecting viable fetuses and did not stipulate the means to be used to ascertain viability. Although Roe v Wade remains in force, the Supreme Court's actions on this case set the groundwork for other states to enact similarly restrictive statutes.^ieng

Issue update: parental notification.

PIP: In 2 recent federal cases, parental notification provisions of state statutes regulating abortions have reached conflicting conclusions. Many state laws establish waiting periods or requirements that parents of a minor be notified when their daughter is seeking an abortion. Physicians and providers who are challenging the laws either seek an injunction of implementation of the law, or file a lawsuit seeking an unconstitutionality ruling. A case in point is Planned Parenthood Association of the Atlanta Area vs. Miller. The Georgia legislature passed a parental notification act that required a parent to accompany a minor patient to the clinic. A physician sued, and the district court enjoined the implementation of the act. In response, the state legislature eliminated the requirement, but it added a provision that required notification before the abortion could be performed. The Federal Court of Appeals upheld the law following a 1990 Supreme Court decision that upheld a 24-hour waiting period after parental notification before an abortion can be performed ion unmarried, unemancipated women under the age of 18. In contrast, the Illinois Parental Notice of Abortion Act that requires a waiting period and documentation of parental permission has been enjoined from implementation since 1983 when several physicians and minors seeking abortions successfully sued. Recently, the State of Illinois made a bid to have the injunction over the 24-hour period removed in view of the above court decisions, but the court concluded that these provisions were overly burdensome and maintained the injunction. Conflicting decisions are common in the complex and controversial laws on abortion. Nurses in maternal and child health areas are duty-bound to keep abreast of the current laws in their respective localities and states.^ieng