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1.
Brain Inj ; 28(1): 114-21, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24328806

RESUMEN

OBJECTIVE: Little is known about the impact of acquired brain injury (ABI) on the long-term quality-of-life (QoL) in children and youth. The objectives of this study were to illustrate the long-term QoL trajectories at 5 years post-ABI. METHODS: The QoL of children between 5-18 years (n = 94) admitted to McMaster Children's Hospital with ABI were assessed longitudinally for a minimum of 5 years post-injury using the Child Health Questionnaire. Independent t-tests were used to examine differences in QoL between the study cohort and a normative sample at different time points. Mixed-effects models were used to identify predictors for QoL. RESULTS: The QoL of children with ABI was significantly poorer (p < 0.05) than the normative data on all domains and at all-time points except at baseline. The CHQ physical summary score (PHSS) showed a significant decline immediately after injury and a significant recovery at 8 months post-injury; while the CHQ psychosocial summary score (PSSS) showed a significant immediate decline, which remained over the course of the study. Pre-morbid school record, time post-injury and mechanism of injury significantly predicted the CHQ PSSS. CONCLUSIONS: QoL is impacted by ABI regardless of severity. This impact is further affected by time post-injury.


Asunto(s)
Actividades Cotidianas , Adaptación Psicológica , Lesiones Encefálicas/psicología , Trastornos de la Conducta Infantil/etiología , Trastornos del Conocimiento/etiología , Calidad de Vida , Adolescente , Lesiones Encefálicas/fisiopatología , Niño , Trastornos de la Conducta Infantil/psicología , Preescolar , Trastornos del Conocimiento/psicología , Evaluación de la Discapacidad , Femenino , Escala de Coma de Glasgow , Humanos , Masculino , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Perfil de Impacto de Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo
2.
J Am Acad Child Adolesc Psychiatry ; 41(5): 572-9, 2002 May.
Artículo en Inglés | MEDLINE | ID: mdl-12014790

RESUMEN

OBJECTIVE: To understand better the relationship between pregnancy and birth complications and genetic factors in autism. METHOD: The sample included 78 children with an autism spectrum disorder and 88 unaffected siblings. A standardized interview was used to ask mothers about the pregnancy and birth of each child, and an overall index reflecting freedom from complications (termed "optimality") was determined. The presence of autism-like traits (termed the "broader autism phenotype") in second- and third-degree relatives was ascertained by reports from multiple informants. The pro-. portion of relatives with the broader autism phenotype, corrected for degree of relation, was used as an index of family loading. RESULTS: Children with autism spectrum disorders have lower optimality (higher rates of complications) than unaffected siblings. High family loading for the broader autism phenotype is associated with higher rates of complications in unaffected siblings. Family loading was not significantly associated with complications in affected siblings in this sample. Overall, these findings argue against complications being a direct cause of autism, as one would expect to find the most complications in sporadic cases (i.e., in children without a positive family history). CONCLUSION: Increased rates of birth and pregnancy complications are likely secondary to familial factors associated with autism.


Asunto(s)
Trastorno Autístico/genética , Complicaciones del Trabajo de Parto/diagnóstico , Fenotipo , Complicaciones del Embarazo/diagnóstico , Trastorno Autístico/diagnóstico , Trastorno Autístico/psicología , Niño , Femenino , Predisposición Genética a la Enfermedad/genética , Genética de Población , Humanos , Masculino , Complicaciones del Trabajo de Parto/psicología , Embarazo , Complicaciones del Embarazo/psicología , Factores de Riesgo
3.
J Am Acad Child Adolesc Psychiatry ; 43(2): 172-80, 2004 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-14726723

RESUMEN

OBJECTIVE: To describe the clinical characteristics of children given a diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) by expert clinicians and to compare these to the clinical characteristics of children given a diagnosis of autism and Asperger syndrome (AS). METHOD: Two hundred sixteen children with autism, 33 with AS, and 21 with PDD-NOS were compared on measures of level of functioning (communication, daily living and social skills, IQ, and age of acquisition of language) and on various symptoms of autism (impaired communication and reciprocal social interaction and a preference for repetitive and stereotyped activities). RESULTS: In terms of level of functioning measures, the PDD-NOS children had scores that were between those of the children with autism and those of the children with AS. In contrast, the PDD-NOS group had fewer autistic symptoms, especially repetitive stereotyped behaviors, than both the autism and AS groups (chi2 = 11.06, p =.004). Children with PDD-NOS could be placed into one of three subgroups: a high-functioning group (24%) who resembled AS but had transient language delay or mild cognitive impairment; a subgroup resembling autism (24%) but who had late age of onset or too severe cognitive delays or were too young to potentially meet the full diagnostic criteria for autism; and a group (52%) not fulfilling the criteria for autism because of fewer stereotyped and repetitive behaviors. CONCLUSIONS: With some revision to current diagnostic criteria, a more homogenous atypical group with significant impairments in social-communication but fewer repetitive behaviors can be differentiated from the more nonspecific PDD-NOS group. This differentiation may lead to better reliability in diagnosis and to further progress in studies of etiology.


Asunto(s)
Síndrome de Asperger/diagnóstico , Trastorno Autístico/diagnóstico , Trastornos Generalizados del Desarrollo Infantil/diagnóstico , Encuestas y Cuestionarios , Niño , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad
4.
Pediatrics ; 125(2): 327-34, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20083526

RESUMEN

OBJECTIVE: The term "concussion" is frequently used in clinical records to describe a traumatic head injury; however, there are no standard definitions of this term, particularly in how it is used with children. The goals of this study were to examine the clinical correlates of the concussion diagnosis and to identify the factors that lead to the use of this term in a regional pediatric center. METHODS: Medical data were prospectively collected from 434 children with traumatic brain injury who were admitted to a Canadian children's hospital. A proportional hazards regression was used to examine the association of the concussion diagnosis and the times until discharge and school return. A classification-tree analysis modeled the clinical correlates of patients who received a concussion diagnosis. RESULTS: The concussion label was significantly more likely to be applied to children with mild Glasgow Coma Scale scores of 13 to 15 (P = .03). The concussion label was strongly predictive of earlier hospital discharge (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-1.9; P = .003) and earlier return to school (OR: 2.4 [95% CI: 1.6-3.7]; P < .001). A diagnosis of a concussion was significantly more likely when the computed-tomography results were normal and the child had lost consciousness. CONCLUSIONS: Children with mild traumatic brain injuries have an increased frequency of receiving the concussion label, although the label may also be applied to children with more-severe injuries. The concussion diagnosis is associated with important clinical outcomes. Its typical use in hospital settings likely refers to an impact-related mild brain injury, in the absence of indicators other than a loss of consciousness. Clinicians may use the concussion label because it is less alarming to parents than the term mild brain injury, with the intent of implying that the injury is transient with no significant long-term health consequences.


Asunto(s)
Conmoción Encefálica/clasificación , Lesiones Encefálicas/clasificación , Terminología como Asunto , Adolescente , Conmoción Encefálica/diagnóstico , Lesiones Encefálicas/diagnóstico , Niño , Preescolar , Femenino , Escala de Coma de Glasgow , Humanos , Lactante , Alta del Paciente
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