Pathways of emotional autonomy, self-care behaviors, and depressive symptoms on health adaptation in adolescents with type 1 diabetes.

BACKGROUND: Adolescents with type 1 diabetes mellitus (T1DM) need to adapt physically and psychologically to the impact of diabetes. PURPOSE: The purpose of this study was to examine the pathways of emotional autonomy, depressive symptoms, and self-care behaviors to glycosylated hemoglobin (HbA1c) levels and quality of life (QoL) in adolescents with T1DM. METHODS: Cross-sectional design was used in this study. Self-reported questionnaires and medical records were used to collect data from 265 adolescents with T1DM by convenience sampling in Taiwan. DISCUSSION: Structural equation modeling indicated that self-care behaviors directly positively influenced life satisfaction QoL but negatively influenced HbA1c levels. Depressive symptoms directly negatively influenced self-care behaviors and life satisfaction QoL. Emotional autonomy directly negatively influenced self-care behaviors and life-satisfaction QoL but directly positively influenced depressive symptoms. CONCLUSION: Emotional autonomy seems to be a risk factor contributing to poor health adaptation. Health care providers need to help adolescents with T1DM to balance the pursuit of emotional autonomy and health adaptation.

Living with illness and self-transcendence: the lived experience of patients with spinal muscular atrophy.

AIM: The aim of this study was to explore the lived experiences of patients afflicted with spinal muscular atrophy. BACKGROUND: Existing research studies on spinal muscular atrophy address the physical and psychological effects and complications of the disease; they also provide suggestions for how to improve the current management of this disease. However, information is limited on the disease process and the lived experience of spinal muscular atrophy patients. DESIGN: A phenomenological approach was conducted. METHODS: Through 18 in-depth interviews recorded by a pen voice recorder, this study collected data obtained from a purposive sample of nine patients from the, 'Taiwan spinal muscular atrophy Families,' between November 2010-August 2011. The audio recordings were transcribed verbatim and data were analysed using Colaizzi's steps. FINDINGS: Four themes and eight subthemes were identified: a loss of control (loss of muscular strength and independence), breaking limitations (assistive device use and mobility design), transcending limitations (independence/autonomy and social development) and living with hope (cherishing life and self-control). The results showed that the lived experiences of the spinal muscular atrophy patients involved living with illness, transcending the self and pursuing the meaning of life. Facing a life-threatening illness, these patients made self-adjustments in their lifestyles and exerted themselves to positively cope with hardships and maintain dignity and self-control. CONCLUSION: These findings could serve as evidence-based practice resources for healthcare professionals in helping individuals and their family members gain an in-depth understanding of spinal muscular atrophy's progression and life course and assist individuals in improving self-integrity to with hope.

Endoscopic transaxillary subfascial approach for persistent muscular torticollis in children.

BACKGROUND: The endoscopic approach is a technical innovation for release of the sternocleidomastoid (SCM) fibrosis in muscular torticollis, where operation scars can be hidden at less conspicuous areas, for example, at the axilla and hair-bearing scalp. As the SCM muscle is located beneath the investing layer of deep cervical fascia which is reported to continue to the fascia of the pectoralis major, the aim of the study was to describe and evaluate the preliminary result of transaxillary subfascial approach for persistent muscular torticollis in children. METHODS: A total of 4 children (2 boys and 2 girls) were included in this study from January to December 2009. Using a 2-port endoscopic technique, the division of the lower end of the fibrotic SCM muscle was performed through the subfascial working cavern. The subfascial dissection was performed under the fascia of the pectoralis major and above the muscular fibers from ipsilateral axilla with the aid of a homemade dissection balloon. RESULTS: The mean operating time was 67.5±11.9 minutes (range: 55 to 80 min). There was no serious operative morbidity and the mean follow-up period was 14.8±5.1 months (range: 9 to 20 mo). All patients had complete unrestricted movement of the head and no recurrence was observed during this period. CONCLUSIONS: The transaxillary endoscopic technique, a working cavern created under the fascia of the pectoralis major, offers a safe and straightforward way to surgically manage persistent muscular torticollis while preserving neurovascular structures, exempting extradissection of noninvolved tissues and avoiding the potential for poor cosmesis from any neck scar.

Laparoscopy in children with acute intestinal obstruction by aberrant congenital bands.

Aberrant congenital bands are a rare cause of acute intestinal obstruction and usually present a diagnostic challenge. In 2008, the authors encountered 2 children with acute terminal ileal herniation. In the first case, it was caused by a mesodiverticular band, and numerous freely hanging filmy membranes attached to the antimesenteric side of the small intestine were found concurrently; whereas, an anomalous band from the distal ileum to the cecum was the leading cause in the second case. The vascularity of both herniated intestines was not compromised, and laparoscopy was successfully carried out 84 and 93 hours after the onset of the symptoms, respectively. Instead of cohesive adhesions, both of the causes related to a single vascular band, and laparoscopy was an effective and safe tool in diagnosis and subsequent treatment. The case with a mesodiverticular band and filmy membranes is the first case report with incomplete regression of both the vitelline circulation and the ventral mesentery.