Quality of life in children suffering from headaches: a systematic literature review.

BACKGROUND: Headaches are the most common complaints among pediatric populations. Determining the cause and appropriate treatment for headaches may be challenging and costly, and the impact of headaches on the lives of patients and their families is not well understood. OBJECTIVE: A systematic literature review was conducted to examine what PROMs are currently used, and to identify quality of life (QoL) concepts important to children suffering from headaches and any known determinants of QoL. METHODS: Embase, Medline, Web of Science, CINAHL, EBSCOhost, PsychINFO, Cochrane CENTRAL and Google Scholar were searched from their inception through to June 2021. Studies investigating QoL, using a validated outcome measure in pediatric patients with headaches, were included. Relevant studies were identified through title and abstract screening and full text review by two independent reviewers. A citation review of included studies was performed. QoL concepts were extracted from the outcome measures that were used in each study to develop a preliminary conceptual model of QoL in children suffering from headaches. Determinants of QoL were also identified and categorized. RESULTS: A total of 5421 studies were identified in the search. Title and abstract screening resulted in the exclusion of 5006 studies. Among the 415 studies included for full text review, 56 were eligible for final analysis. A citation review resulted in the addition of five studies. Most studies were conducted in high-income countries and included a patient-sample accordingly (n = 45 studies). Sixteen different PROMs were identified in the included studies, of which the PedsQL was used the most often (n = 38 studies). The most common health concepts reported were physical functioning (n = 113 items), social and psychological wellbeing (N = 117, n = 91 resp.). Twenty-five unique determinants of QoL were extracted from the included studies. CONCLUSION: There is a need for a condition-specific PROM to facilitate the measurement of QoL outcomes in the pediatric headache population. A conceptual model was developed based on the findings from the health concepts. Findings from this review could be used for future qualitative interviews with pediatric patients with headaches to elicit and refine important QoL concepts.

The importance of microsurgery in childhood meningioma: a case report.

INTRODUCTION: Although meningiomas are frequently diagnosed in adults, it is a rare (intracranial) tumor in the pediatric population, with an incidence of 0.06/100,000. The pathology and treatment of meningiomas in adulthood has been a topic of increasing investigation. So far, the treatment of pediatric meningiomas has been extrapolated from these results. The question remains, however, whether translation of adult meningioma data into the childhood population is legitimate. METHODS: We present the case of a 3-year-old girl diagnosed with an intraventricular malignant meningioma and type 2 neurofibromatosis. She was operated on multiple times to achieve complete resection and received adjuvant chemotherapy. Since, she has been stable with no neurological sequelae and/or recurrence of the meningioma. CONCLUSION: Pediatric meningiomas are rare tumors and differ from their adult counterparts in various aspects. We believe that gross total resection of meningioma in the pediatric population, when possible, is the treatment of choice. In the event of a subtotal resection, repeat resection is recommended. Any adjuvant treatment with chemotherapy or radiation therapy should be carefully considered during multidisciplinary meetings.

Atypical presentation of a newborn with Apert syndrome.

INTRODUCTION: Apert syndrome is a rare syndrome characterized by a consistent phenotype including bilateral coronal suture synostosis with an enlarged anterior fontanel, midface hypoplasia, and complex symmetric syndactyly of hands and feet. CASE REPORT: We present a boy with Apert syndrome caused by the pathogenic c.755C > G p.Ser252Trp mutation in the FGFR2 gene with atypical characteristics, including premature fusion of the metopic suture with a small anterior fontanel, hypotelorism, and a massive posterior fontanel. Directly after birth, he showed papilledema, epilepsy, and central apneas. CONCLUSION: We present a newborn with Apert syndrome with atypical craniofacial presentation.

Sphenoid dysplasia in patients with neurofibromatosis type 1: Clinical features and imaging findings including cerebrospinal fluid alterations.

INTRODUCTION: Neurofibromatosis Type 1 (NF-1) is a genetic disorder that occurs in 1:2500-3000 live births and may involve multiple organs. An uncommon but well-known phenomena is sphenoid dysplasia, which appears in 3-11% of the patients, and may result in significant lowering of the orbit. Understanding the cause and development of this process might predict its course and its treatment. METHODS: The records of 29 patients with PNF in the head and neck region were searched for location of the PNF and type of surgery. Photographs were studied for facial disturbances, including vertical dystopia, hypertelorism, ptosis, exophthalmos and enophthalmos. MR and CT scans were studied for the presence of PNF, aspect of the sphenoid bone, alteration in the CSF circulation, and other tumour involvement. RESULTS: Fourteen of 29 patients with PNF in the head and neck presented with sphenoid dysplasia. All 14 patients had their PNF located in the periorbital region. Increased locoregional CSF collections were seen in almost all of these patients. Besides glioma of the optical nerve or hamartomas in the cerebrum and cerebellum, there were no other tumours found. Surgical treatment varies from simple excision to excessive debulking of the PNF, reconstruction of the orbit and even enucleation. CONCLUSION: Although sphenoid dysplasia is uncommon in NF-1 patients, early recognition is important to prevent facial disfigurement and vision loss. Clinicians should be aware that abnormalities in the periorbital region and especially vertical dystopia might be the first sign of sphenoid dysplasia. Performing a CT or black-bone MR scan would be the next step to confirm or exclude sphenoid dysplasia and abnormal CSF dynamics.

Clustering and Annotation of T Cell Receptor Repertoires.

Immunological protection against a wide variety of pathogens is largely mediated by the diverse and dynamic T cell receptor (TCR) repertoire, a crucial component of the adaptive immune system. An encounter with infectious agents stimulates specific T cells to initiate a direct immune response to combat intruders. Hence, the TCR repertoire may conceal crucial information regarding current and past infections and might assist in the development and monitoring of vaccines. To unlock its knowledge, we describe a computational workflow involving both supervised and unsupervised machine learning techniques to analyze and annotate full TCR repertoire data. The method is explained using data from a published yellow fever virus (YFV) vaccination study in healthy individuals. The TCR repertoire of one individual is studied before and 2 weeks after vaccination, using an efficient clustering method and identification of YFV-specific TCRs.

Real-time polymerase chain reaction quantification of the transgenes for roundup ready corn and roundup ready soybean in soil samples.

A method for quantification of recombinant DNA for Roundup Ready (RR) corn and RR soybean in soil samples is described. Soil DNA from experimental field samples was extracted using a soil DNA extraction kit with a modified protocol. For the detection and quantification of recombinant DNA of RR corn and RR soybean, a molecular beacon and two pairs of specific primers were designed to differentially target recombinant DNA in these two genetically modified crops. Soil DNA extracts were spiked with RR corn or RR soybean DNA, and recombinant DNA was quantified using real-time PCR with a molecular beacon. As few as one copy of RR corn genome or one copy of RR soybean genome was detected in the soil DNA extract.

Determinants of physical activity among female adolescents.

INTRODUCTION: Women, and particularly African-American women, may be less physically active than what is ideal. Knowledge of factors that influence physical activity is valuable information to those planning and administering exercise promoting interventions. METHODS: The associations of 25 variables with current global physical activity were assessed via regression analysis. Eight hundred and fifty-two young women, 14-18 years of age, were sampled. Each completed a 7-day recall of physical activity and an 83-item survey. The sample was further subdivided by ethnic group, and then ethnic group and age to ascertain whether determinants of physical activity differ across these groups. RESULTS: Ethnic group (Caucasians more active) and age (younger more active) were significant influences on physical activity. Overall, nurture from biological fathers and participation in organized sports associated with physical activity. Viewing two or more hours of television per night negatively influenced physical activity. Among African-American girls (n = 626), participation in organized sports, friend support, and nurture from biological fathers significantly associated with physical activity. However, following sports through the media negatively influenced physical activity. Among Caucasians (n = 226), attitudes were the sole significant correlate of physical activity. CONCLUSIONS: Those planning interventions targeting female adolescents should consider employing distinct strategies for specific ethnic group and age subgroups. Opportunities for physicians to have an impact on the physical activity of female adolescents includes using their community standing to influence school policies and to counsel female patients individually during office visits.

Analysis of hearing loss after shunt placement in patients with normal-pressure hydrocephalus.

OBJECT: Following shunt placement for treatment of normal-pressure hydrocephalus (NPH), several patients suffered hearing loss. The authors undertook a study to analyze this outcome. METHODS: Sixteen patients in whom NPH was diagnosed were treated by placement of a ventriculoperitoneal shunt. Their hearing was assessed pre- and postoperatively by using pure tone audiometry. Two thirds of the ears tested showed a postoperative hearing loss of more than 10 dB. Recovery of the hearing loss occurred 6 to 12 weeks after shunt placement in 75% of the ears examined. CONCLUSIONS: Although shunt insertion for treatment of NPH results in a decrease in hearing, most of the loss can be recovered.

Correlates of aggressive and violent behaviors among public high school adolescents.

PURPOSE: This study analyzed the types and predictors of violent behaviors reported by 4,137 South Carolina adolescents, grades nine through twelve. METHODS: The 70 item self-report Youth Risk Behavior Survey developed and piloted by the Centers for Disease Control and Prevention was utilized in 57 of the state's public high schools. A series of logistic regression analyses were performed for each race/gender group to explore the relation of the demographic and potential risk variables to fighting and carrying weapons. RESULTS: Results indicate that 38 percent of males and 11 percent of females reported carrying a weapon. Eleven percent of males and five percent of females reported fights resulting in an injury. The strongest predictors of fighting were binge drinking and sexual activity for males, any alcohol use and illegal drug use for white females, and sexual activity for black females. For carrying a weapon, the strongest predictors included alcohol use and sexual activity in all but white females, and illegal drug use among whites, but not blacks. CONCLUSION: Prevention of adolescent violence calls for creative approaches in school and community settings and will require long-term intervention strategies, focused on adolescent behavior change and environmental modifications.

Adolescent risk behaviors and the potential for violence: a look at what's coming to campus.

This study analyzed the types and predictors of violent behaviors reported by students in Grades 11 and 12 in South Carolina. Results are based upon responses of 2,299 students from 57 schools, approximately 3% of the total state enrollment in those grades. The 70-item self-report Youth Risk Behavior Survey developed and piloted by the Federal Centers for Disease Control was used to collect data. The authors performed a series of logistic regression analyses to explore the relation of the demographic and potential risk variables to fighting and carrying weapons. Results from the simple logistic analyses, adjusting for race and gender, indicated that alcohol use, binge drinking, sexual activity, and use of any drugs were significantly associated (p < .05) with reported fighting. These variables and poor academic self-image were significantly associated with carrying weapons. Comprehensive multivariable models indicated that, when considered simultaneously, being black, male, sexually active, and engaging in binge drinking and drug use were significant predictors of fighting. Gender, but not race, alcohol use, drug use, or sexual activity, remained a significant predictor of carrying a weapon. Findings suggest that college risk-reduction and health-promotion programs should direct efforts at environmental modification, policy development and enforcement, as well as at personal change, including effective conflict resolution, stress management, and communication skills.

Contraceptive patterns of college students who experienced early coitus.

PIP: This study investigates sex behavior, contraceptive use, and attitudes of college students who experienced initial coitus early in adolescence, as contrasted to those who experienced it later in adolescence. Data were gathered from a survey of 530 college students in South Carolina; the survey employed a questionnaire containing 57 multiple-choice items. Data in this report were derived from a subsample of the total survey. The subsample included 20-year-old males and females who were either early coital initiators (ECI), those who had coitus for the first time at age 16 or younger, or late coital initiators, (LCI), those who had first coitus between 17-20. 51% of respondents had initial coitus at 16 or younger, and 49% between 17-20. 26% of ECIs reported having coitus only once with the 1st partner, as opposed to 11% of LCIs. In general, lack of commitment appears to be more characteristic of ECI, since half of them had relations with a casual acquaintance, as opposed to 73% of LCIs who had initial coitus with a steady friend. Over 75% of ECIs experienced coitus with more than 1 partner. During the year before the survey, 51% of LCIs had coitus with only 1 partner, as opposed to only 20% of ECIs. In terms of contraception information the respondents knew little; 43% of the LCIs reported mass media to be the primary source of information, as compared to 13% of ECIs, who relied more on friends' advice. 68% of ECIs and 51% of LCIs did not discuss contraception with their 1st partner. As to the most recent coital experience 57% of LCIs stated to use contraception, as opposed to 45% of ECIs. Knowledge levels about fertility and contraception were extremely low for both groups. It seems obvious that older teens tend to be more effective contraceptive users than younger teens at 1st coitus; the advantage of maturity seems more evident in people who experience 1st coitus at a later moment in life.^ieng

Correlates of condom use and number of sexual partners among high school adolescents.

Factors associated with condom use and number of sexual partners were examined in a statewide sample of public high school students in grades 9-12 (N = 3,893). Data were collected in spring 1990 using the 70-item, self-report Youth Risk Behavior Survey, developed and piloted by the Centers for Disease Control. Composite scores were constructed to measure aggression, physical recklessness, alcohol use, illegal drug use, cigarette use, lack of exercise, and academic self-image. Since simple polychotomous logistic regression models revealed a significant race by gender interaction, multivariate models were run separately for each race-gender group. Odds ratios and 95% confidence intervals were calculated from polychotomous logistic regression of lifetime sexual activity and condom use with their potential correlates. Risky sexual behavior appears to be correlated with a complex of other behaviors that place students at risk. A pattern of declining condom use with increasing number of partners was evident, especially for White students.

PIP: The heterosexual transmission of HIV is increasing. A proclivity for engaging in risk-related sex, young age at first intercourse, nonuse of contraceptives or ineffective contraceptive practices, multiple sex partners, high rates of sexually transmitted diseases, and an apparent lack of AIDS knowledge place adolescents at a particularly high risk of contracting and transmitting HIV. A national study of the Centers for Disease Control found that almost 66% of male students and more than 50% of female students became sexually active before reaching age 17; of the sexually active, only 25% of males and 47% of females reported using condoms as a primary contraceptive method. 25-33% of sexually active adolescents never use any form of contraceptive. The authors explore factors associated with condom use and the number of sex partners in a statewide sample of 3893 public high school students in grades 9-12. Participants were sampled in April and May, 1990, with the self-report Youth Risk Behavior Survey in 57 schools across 37 districts in South Carolina. The survey included measures to assess respondent aggression, physical recklessness, alcohol use, illegal drug use, cigarette use, lack of exercise, and academic self-image. 74% of the participants were 15-17 years old, with 12% younger and 14% older. 63% were White and 37% were Black. 34% reported never having intercourse, 19% reported intercourse with 1 partner, 21% with 2-3 partners, and 26% with 4 or more partners. Among those reporting the highest level of sexual activity, 63% were male and 51% were Black. 52% of the sexually active students reported not using condoms at last intercourse. A strong correlation was observed between the failure to use condoms, higher numbers of lifetime sex partners, and reckless or aggressive behavior. A significant correlation was also found between alcohol use and risky sex behavior, consisting of multiple partners and no condom use, for all race-gender groups except Black males. A weaker correlation exists between the use of illicit drugs and risky sex behavior for White adolescents. Especially for White students, a clear pattern was revealed of declining condom use with increasing number of partners. Among the females, academic self-image strongly correlated with lifetime sexual activity and the failure to use condoms; the females also reported less frequent condom use than males. School-age youths desperately need more objective information about the routes of HIV infection and how to prevent infection. Education and prevention programs should not dwell upon the need for abstinence, but should be incorporated into the larger context of comprehensive school health education curricula. Specific interventions should focus upon improving the decision-making skills, communication skills, stress management skills, and goal-setting skills of adolescents.

Correlates and consequences of early initiation of sexual intercourse.

This cross-sectional analysis of the 1991 CDC Youth Risk Behavior Survey explored factors associated with an early age at first sexual intercourse. Almost 18% of White males, 49% of Black males, 5% of White females and 12% of Black females were sexually active before age 13. Carrying a weapon to school, fighting, and early (< age 13) experimentation with cigarettes and alcohol were associated with early initiation of sexual activity for all four race and gender groupings. Those initiating sexual activity early had greater numbers of partners but were 50% less likely to use condoms regularly and were two-seven times more likely to have been pregnant or caused a pregnancy. Females who initiated sexual activity early were more likely to have had a sexually transmitted disease (STD). Interventions to postpone sexual activity need to be tailored to the ethnic and gender differences observed in these analyses. Interventions must begin before age 13 and should be comprehensive school-based efforts.

PIP: The 1991 CDC Youth Risk Behavior Survey is a statewide survey of 1509 White male, 1234 Black male, 1479 White female, and 1256 Black female public school students in grades 9-12 conducted February-May 1991 in South Carolina. Survey data were used in the study of factors associated with experiencing first sexual intercourse at younger than age 13. Students younger than 14 years old were excluded from the analysis. 17.8% of White males, 49.2% of Black males, 5.1% of White females, and 11.9% of Black females had had sexual intercourse before age 13. 38% of White males, 12% of Black males, 47% of White females, and 27% of Black females were virgins at the time of the interview. Controlling for race, males were 6.8 times more likely than females to have had first sexual intercourse when younger than 13. Fighting, experimenting with cigarettes and alcohol younger than age 13, and carrying a weapon to school were associated for all race and gender groupings with the early initiation of sexual intercourse. 54.8% of White males, however, compared to 39.3% of Black males brought weapons to school, 51.1% of White males compared to 47.0% of Black males got into a fight at school, 11.6% of White males compared to 5.3% of Black males smoked before age 13, and 39.0% of White males compared to 30.6% of Black males drank alcohol before age 13. Respondents who initiated sexual intercourse before age 13 had greater numbers of partners, but were 50% less likely to use condoms regularly and were two-seven times more likely to have been pregnant or caused a pregnancy. Females who initiated sexual activity early were more likely to have had a sexually transmitted disease. The authors recommend that the ethnic and gender differences observed in this study be considered when designing interventions to postpone sexual activity. Interventions must begin before age 13 and should be both comprehensive and school-based.

Support for school-based sexuality education among South Carolina voters.

A random-digit dialed telephone survey was conducted in a traditionally conservative southern state to determine the level of support for sexuality education in the public schools including support for specific sexuality education topics, the earliest grade level at which each topic should be taught, and the amount of instruction time required for sexuality education in the high schools. Survey data were obtained from 534 South Carolina registered voters in late January/early February 1997. Results demonstrated that most South Carolina registered voters: 1) supported sexuality education in the public schools; 2) supported instruction on a variety of sexuality education topics; 3) supported instruction at all grade levels, especially beginning in middle school; and 4) believed instruction time for sexuality education in the high schools should either remain the same or be increased. In addition, a significant increase in support for sexuality education occurred from the beginning of the survey to the end, suggesting that the instrument itself may have served as an educational tool for respondents. The characteristics of registered voters who supported sexuality education at the beginning of the survey and at the end were examined and compared. These results may assist in the development of educational and marketing strategies designed to build support for school-based sexuality education programs in South Carolina and elsewhere.

Development of multidimensional scales to measure key leaders' perceptions of community capacity and organizational capacity for teen pregnancy prevention.

This study discusses the development of scales to measure key leaders' self-reported involvement in community capacity building, perceptions of organizational capacity for teen pregnancy prevention, and the relationship between capacity and teen pregnancy rates. Data were collected from 1,516 key leaders across a rural southern state. Findings indicate that key leaders' perceptions of organizational capacity are related to their involvement in community capacity building efforts and community capacity is associated with teen pregnancy rates. This research represents progress toward measuring community and organizational capacity and may be used to inform future work focusing on developing quantitative measures of community capacity.

Reducing adolescent pregnancy through school and community-based education.

The resident population of the western portion of a South Carolina county has undergone a public health information and education intervention since October 1982. The purpose of the intervention has been to reduce the occurrence of unintended pregnancies among unmarried adolescents. Intervention messages are targeted at parents, teachers, ministers and representatives of churches, community leaders, and children enrolled in the public school system. The messages emphasize development of decision-making and communication skills, self-esteem enhancement, and understanding human reproductive anatomy, physiology, and contraception. The estimated rate of pregnancy ([live births plus fetal deaths plus induced abortions] per 1000 female population) for females aged 14 to 17 years in the county's western portion has declined remarkably since the intervention began, and the changes are statistically significant when compared with three sociodemographically similar counties and also with the eastern portion of the county.

Needed: more private physician involvement to help reduce unwanted teenage conceptions.

PIP: The data that are presented could be used to support the need for more private physician care for sexually active youth in the U.S. Data in this report were generated from a convenience sample survey of 530 students in 8 South Carolina colleges and universities during the spring of 1978. The respondents were students enrolled in personal health courses taught at each of the institutions. The data are presented from a subsample of the total survey respondents. This subsample includes all never married sexually active females--161. 14% of the sample had intercourse only once, and 21% had intercourse only 2-5 times. 7% had received contraceptive information from a medical doctor or nurse. High school instruction was the source of information for 18% and parents were the source for 11%. The remaining sources were media (26%) and friends (15%). 18% of the sample indicated an ignorance of contraception. Males in the total study were even more unaware (20%) with 37% receiving information regarding contraception from their friends. No sexually experienced males in the total survey sample reported that they had received information from a physician or clinic. Only 10% of the women reported using oral contraception (OC) with 1st sexual intercourse. Condoms (33%), withdrawal (23%), or no method (33%) were the dominant responses. No subjects reported the use of an IUD or diaphragm. There was increased reliance upon medical methods with 49% using OC and 4% using the IUD in their most recent sexual encounter. Recommendations are made regarding public health type clinics versus private physician care, office practice modifications, and community activities.^ieng

Folic acid uptake characteristics of a human colon carcinoma cell line, Caco-2. A newly-described cellular model for small intestinal epithelium.

To investigate a newly described model for differentiated small intestinal function, folic acid uptake characteristics were examined in the human colon carcinoma cell line, Caco-2. Monolayers of this cell line spontaneously exhibit structural and functional differentiation patterns characteristic of mature enterocytes, with the appearance of brush border microvilli and high activity levels of the enzymes associated with the brush border. Our results concur with other models of folic acid uptake that emphasize the importance of intraluminal factors on micronutrient absorption. Folate uptake declined rapidly between pH 5.8 and 7.5, and was dependent on the initial folate concentration in the media. A dual uptake process is suggested, with a high rate of uptake at folate concentrations below 20 nmol/ml and linear uptake characteristics at higher concentrations.

Attitude and knowledge change in response to sexuality education training.

PIP: Teachers of human sexuality classes are one of the most important factors in the success of school based programs; until recently, professionals involved in sex education acquired their expertise randomly and informally. The purpose of this paper is to report the effect of a 16 week sexuality education training program on attitudes and knowledge about human sexuality among teachers in a public school district. 39 participants (teachers, school nurses, and psychologists) were enrolled in a University of South Carolina course which consisted of lectures, group discussions, role playing, and films. The evaluation instrument used was the Sex Knowledge and Attitude Test (SKAT), and was administered to each participant before and after the course was given. Results show that there are significant changes in knowledge, acceptance and rejection of sexual myths, and attitudes concerning abortion and autoeroticism. The training course resulted in a shift deemed positive and conducive for teacher effectiveness in teaching sex education. There was a significant shift in a more liberal direction in all of the attitudinal scales except heterosexual relations. This positive change in attitudinal scores is essential for teachers who will be instructing students from a variety of family backgrounds.^ieng