Active engagement in a web-based tutorial to prevent obesity grounded in Fuzzy-Trace Theory predicts higher knowledge and gist comprehension.

We used Sharable Knowledge Objects (SKOs) to create an Intelligent Tutoring System (ITS) grounded in Fuzzy-Trace Theory to teach women about obesity prevention: GistFit, getting the gist of healthy eating and exercise. The theory predicts that reliance on gist mental representations (as opposed to verbatim) is more effective in reducing health risks and improving decision making. Technical information was translated into decision-relevant gist representations and gist principles (i.e., healthy values). The SKO was hypothesized to facilitate extracting these gist representations and principles by engaging women in dialogue, "understanding" their responses, and replying appropriately to prompt additional engagement. Participants were randomly assigned to either the obesity prevention tutorial (GistFit) or a control tutorial containing different content using the same technology. Participants were administered assessments of knowledge about nutrition and exercise, gist comprehension, gist principles, behavioral intentions and self-reported behavior. An analysis of engagement in tutorial dialogues and responses to multiple-choice questions to check understanding throughout the tutorial revealed significant correlations between these conversations and scores on subsequent knowledge tests and gist comprehension. Knowledge and comprehension measures correlated with healthier behavior and greater intentions to perform healthy behavior. Differences between GistFit and control tutorials were greater for participants who engaged more fully. Thus, results are consistent with the hypothesis that active engagement with a new gist-based ITS, rather than a passive memorization of verbatim details, was associated with an array of known psychosocial mediators of preventive health decisions, such as knowledge acquisition, and gist comprehension.

Evidence that small molecule enhancement of ß-hexosaminidase activity corrects the behavioral phenotype in Dutch APP(E693Q) mice through reduction of ganglioside-bound Aß.

Certain mutant Alzheimer's amyloid-ß (Aß) peptides (that is, Dutch mutant APP(E693Q)) form complexes with gangliosides (GAß). These mutant Aß peptides may also undergo accelerated aggregation and accumulation upon exposure to GM2 and GM3. We hypothesized that increasing ß-hexosaminidase (ß-hex) activity would lead to a reduction in GM2 levels, which in turn, would cause a reduction in Aß aggregation and accumulation. The small molecule OT1001 is a ß-hex-targeted pharmacological chaperone with good bioavailability, blood-brain barrier penetration, high selectivity for ß-hex and low cytotoxicity. Dutch APP(E693Q) transgenic mice accumulate oligomeric Aß as they age, as well as Aß oligomer-dose-dependent anxiety and impaired novel object recognition (NOR). Treatment of Dutch APP(E693Q) mice with OT1001 caused a dose-dependent increase in brain ß-hex levels up to threefold over those observed at baseline. OT1001 treatment was associated with reduced anxiety, improved learning behavior in the NOR task and dramatically reduced GAß accumulation in the subiculum and perirhinal cortex, both of which are brain regions required for normal NOR. Pharmacological chaperones that increase ß-hex activity may be useful in reducing accumulation of certain mutant species of Aß and in preventing the associated behavioral pathology.

Impact of non-routine vaccination on the incidence of invasive Haemophilus influenzae type b (Hib) disease: experience in the autonomous region of Valencia, Spain.

OBJECTIVE: This study assessed the impact of non-routine vaccination against invasive Haemophilus influenzae (Hib)disease before the introduction of universal childhood Hib vaccination. METHODS: Data were obtained from a prospective surveillance program for invasive bacterial diseases in children <15 years of age that was begun in the Autonomous Region of Valencia on 1 December 1995. RESULTS: An incidence of 15.5 cases of invasive Hib disease per 100,000 children <5 years of age was reported in the first year of the surveillance program (from 1 December 1995 to 30 November 1996), when Hib vaccination coverage was estimated to be 32.5%. An increase in vaccination coverage to 44% in the second year (1 December 1996 to 30 November 1997) was associated with a reduction in disease incidence to 3.3 cases per 100,000. After the initiation of universal vaccination in December 1998, only two cases were reported. The effectiveness of non-routine vaccination was 71% in 1997. CONCLUSIONS: These results show that before the introduction of routine childhood Hib vaccination, widespread use of the vaccine can dramatically reduce the occurrence of invasive Hib disease.

Epidemiology of invasive streptococcus pneumoniae infections in children in Spain, 1996-1998.

BACKGROUND: Streptococcus pneumoniae is a significant cause of meningitis and septicemia in early infancy, being associated to a high case-fatality rates and serious sequelae. OBJECTIVE: To investigate the burden of invasive disease caused by S. pneumoniae in Valencia, Spain, during a three-year period (1996-1998). METHODS: Hospital-based prospective active surveillance program for invasive bacterial diseases in children < or = 15 years of age in Valencia, from December 1, 1995 to January 1999. RESULTS: A total of 94 cases of invasive pneumococcal disease were detected in patients < or = 15 years of age. The overall annual incidence of invasive pneumococcal disease was 4.6/100,000 persons, < or = 15 years of age. The incidence of invasive disease and meningitis was higher among children younger than 2 years of age (16.8 and 3.8, respectively). Serotypes 19, 14 and 6 accounted for 83% of the isolates. CONCLUSIONS: The age distribution of invasive pneumococcal disease and meningitis shows a peak in the first two years of life and a decline thereafter. Serotypes 19, 14 and 6 are those primarily responsible for invasive pneumococcal disease in children of this region of Spain.

Experimental evaluation and clinical use in the head and neck of a 3M/Precise microvascular anastomotic device.

Microvascular reconstructions in the head and neck are usually long operating time procedures. Mechanical anastomotic devices help to reduce operating time and can reduce anastomotic failures avoiding foreign bodies in the lumen of the vessel. One of these systems is the 3M/Precise microvascular anastomotic device, it is a non-absorbable device, however, criticisms of this system have been directed to the fact that pulsation of the vessel wall against a rigid structure could lead to thinning of the vessel wall and aneurysm formation. No aneurysms have been found previously in other experimental models. Our experimental study on the aorta and vena cava of the rat comprises 25 arterial and 25 venous anastomoses. In the arteries, four proximal aneurysms were found, two of these were failures. In the venous anastomoses, no failures were found nor aneurysm formation. The system is very useful for performing clinical end to end venous anastomosis helping to reduce anastomotic failures. Aneurysms have been found in arteries although four different ring sizes were available. The device is less easy to use in them than in veins and sometimes can be difficult to apply, making manual suturing a better choice for clinical arterial anastomosis.

Midface soft tissue reconstruction with the facio-cervico-pectoral flap.

The reconstruction of large soft tissue defects in the orbital and maxillomalar region is a difficult task. A good functional and aesthetic result has to be achieved. The cervicopectoral rotation flap has many advantages; it is easy, rapid and safe to harvest, compatible with cervical dissection and radiotherapy. It is an anatomical unit, with skin properties similar to the rest of the facial skin. This is our pedicle flap of choice for large soft tissue defects in the midface, specially in elderly patients. We use it in association with the temporalis myofascial flap in cases of orbital exenteration. In large defects, the alternatives to these flaps are microsurgical free flaps or other pedicled flaps. These flaps require more complex techniques, are time consuming surgically, have greater morbidity and equal or worse functional and aesthetic results. In this paper we present our experience. Twenty-two patients with large soft tissue defects in the maxillomalar and orbital regions have had reconstructions with these flaps (facio-cervico-pectoral rotation flap and temporalis myofascial flap) in the last 8 years.

Aesthetic and functional reconstruction with the trapezius osseomyocutaneous flap and dental implants in oral cavity cancer patients.

The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.

Epidemiologic aspects of pediatric multiple trauma in a Spanish urban population.

BACKGROUND/PURPOSE: Trauma is still the most frequent cause of mortality and disability in childhood and adolescence. An epidemiologic prospective study on children under 16 years of age with multiple trauma (MT) was conducted in a large Spanish urban university hospital over a 6-year period. METHODS: Of 1,937 children admitted at the pediatric trauma unit for musculoskeletal injuries from March 1988 until March 1994, 56 patients including 37 boys and 19 girls had MT. MT was considered when at least 2 long bones were fractured or there was a fracture of 1 long bone combined with an injury of 4 other major anatomic regions (face and neck, thorax, abdomen, or neural system). The severity of injuries was evaluated according to the modified injury severity score (MISS). RESULTS: Injury to pedestrians was the most frequent cause of MT (54%). The overall mortality rate of the series, including those children dying during transport to the hospital was 11.5%. The average MISS for the whole group was 15 (range, 5 to 59). Head trauma was the most frequent associated injury (52%), two thirds of which were considered minor injuries (Glasgow Coma Scale >15). Seventy-seven fractures were registered, 10% of which were open fractures. External fixation was the most common surgical technique among operated fractures. The average hospitalization period was 16 (median, 13; range, 1 to 150) days. Children with a MISS above 18 points showed a significant longer hospitalization period (mean, 31 +/- 45 days) as compared with those with MISS below 18 points (mean, 10 +/- 7 days; P < .05). There was a strong correlation between the MISS and both the period of hospitalization at the pediatric intensive care unit and the total length of hospital stay. CONCLUSIONS: Pedestrian accidents caused by motor vehicles in children playing at the street contributed most significantly to MT in the urban pediatric population. Special care for prevention must be taken in the age group of 6 to 10 years. Head injury was the main cause of death in children with multiple trauma. MISS was found to be a good predictor of survival and duration of hospital stay in pediatric MT.

Auditory neuropathy in children.

Auditory neuropathy is a sensorineural disorder characterized by absent or abnormal auditory brainstem evoked potentials and normal cochlear outer hair cell function. A variety of processes is thought to be involved in its pathophysiology and their influence on hearing may be different. We present here the diagnostic sequence and management of two new cases of auditory neuropathy in breastfeeding children.

Distortion product otoacoustic emissions in healthy newborns: normative data.

Distortion product otoacoustic emissions (DPOAE) offer an alternative to transiently evoked otoacoustic emissions (TEOAE) as an audiological test. The former can be used as a screening technique, and may also provide frequency-specific information about the functional state of the cochlea. We recorded DPOAE in a group of healthy newborns to establish the characteristics of a DPOAE "audiogram" (DP-gram) in this population. The DP-gram can be obtained with characteristics quite similar to those observed in adults, with two sharp peaks of maximum amplitude at F2 frequencies of 2 kHz and 5-6 kHz, and a decline in DPOAE amplitude in midfrequencies. The results confirm the limitations of DPOAE recording for testing parts of the basilar membrane where lower frequencies are coded.

[Haemophilus influenza type b invasive disease in the Community of Valencia. Study Group on Invasive Diseases]. / Enfermedad invasora por Haemophilus influenzae tipo b en la Comunidad Valenciana. Group de Estudio de Enfermedades Invasoras.

The objective of this study was to estimate the incidence of systemic Haemophilus influenzae type b (Hib) disease in the Valencian Community, Spain, and to study the microbiological characteristics of the strains. Prospective, active surveillance of children in the Valencian Community. Data were obtained from microbiology laboratories and paediatricians. A case was considered when a child younger than 15 years of age had clinical invasive disease and a Haemophilus influenzae (Hi) was isolated from a normally sterile site, or when a positive capsular antigen was identified with a compatible Gram strain. In the first year of surveillance, starting on December 1, 24 cases were identified. Of the 20 strains studied in our laboratory, 19 were serotype b and one non typable. 75% of the strains were beta-lactamase positive. Meningitis was the most frequent clinical presentation. All children were less than five, and 51.2% were less than one year of age. The mortality was 8.3%. For unvaccinated children less than 5 years the estimated incidence of invasive disease was 18.2/100,000 and of meningitis 14.0/100,000. The incidence of Hib invasive disease in unvaccinated children justifies the universal Hib vaccine programme in the Valencian Community.

[Psychogenic paroxysmal disorders in children]. / Trastornos paroxísticos psicógenos en los niños.

INTRODUCTION: Paroxystic psychic disorders which imitate organic disorders of the nervous system may have peripheral effects, present as changes in level of consciousness or appear as paroxystic behaviour changes. DEVELOPMENT AND CONCLUSIONS: The types of crises of psychological origin are: tantrums, panic attacks, crises of psychopathic rage, onanism or masturbation, epileptic pseudocrises or pseudoconvulsions and Munchausen's syndrome. In general psychic crises are not frequent in infancy: tantrums are commoner in small children and the other conditions usually occur after puberty or during adolescence. The anamnesis is the most important factor in the correct diagnosis of psychogenic paroxystic disorders. Complementary studies are done in doubtful cases, to rule out different pathological processes which might be causing the paroxystic disorder. Amongst these investigations, we emphasize the importance of the video-EEG for differential diagnosis of paroxystic disorders in children.

[Children at risk for learning disorders]. / Niños con riesgo de padecer dificultades en el aprendizaje.

INTRODUCTION: To find what is meant by normal learning, it is essential to understand learning difficulties not only from the anatomical but also from the functional point of view. DEVELOPMENT: We review the literature concerning risk factors for learning difficulties in order to treat them early on and attain satisfactory long-term development. CONCLUSIONS: Learning difficulties are the largest groups of disorders in everyday neuropaediatric practice. It should be remembered that in most children with learning difficulties there are undiagnosed preexisting neurological disorders, which come to light on reaching an age at which improved academic achievement is obligatory.

[The pharmacological approach to the autistic spectrum]. / Abordaje farmacológico en el espectro autista.

OBJECTIVE: To describe our experience of the drug treatment of children within the autistic spectrum. DEVELOPMENT: We analyze some neuroleptic drugs, the serotonin uptake inhibitors and antiepileptic drugs, emphasizing the most suitable drugs for each symptom we wish to treat and how to do so. CONCLUSIONS: The treatment of children within the autistic spectrum should be specific, meticulous and well controlled by the neuropaediatrician. It should be changed according to the symptoms and never expected to be the same during the patient s entire life. More studies are needed in this field.

[Pharmacological treatment with risperidone in children with behavior disorders]. / Tratamiento farmacológico con risperidona en niños con trastornos en el comportamiento.

INTRODUCTION: Behavior disorders are frequently seen in children attending a neuropaediatric clinic. The classical neuroleptic drugs are usually used for treatment. However response tends to be irregular with adverse effects at a cognitive level and extrapyramidal symptoms. PATIENTS AND METHODS: We started to use risperidone in children with serious behavior problems who had not responded to other drugs, and evaluated the clinical course and side effects. RESULTS: A total of 16 patients aged between 7 and 14 years were treated for diagnoses of: hyperactivity attention deficit disorder, mental retardation with non specific behavior disorder, Gilles de la Tourette disorder with hyperactivity attention deficit disorder and generalized disorder of development. The doses of risperidone varied between 0.01 and 0.05 mg/kg/day. In two cases the evolution could not be assessed, was good in 10 and no change was seen in 4. The group of patients with most improvement were those with mental retardation. The commonest adverse effect was weight gain. No patient had extrapyramidal symptoms. CONCLUSION: We consider risperidone to be a safe drug for the pharmacological treatment of children with behavior problems.

[Risk factors in learning difficulties]. / Factores de riesgo de las difficultades en el aprendizaje.

OBJECTIVE: To review the literature of the risk factors in learning difficulties (LD) and to assess these factors in children diagnosed as having LD in the Neuropaediatric Department of the Hospital Universitario Infantil La Fe in Valencia, in 1996 and 1997. MATERIAL AND METHODS: A retrospective study was done of children diagnosed in the Hospital Infantil Universitario La Fe in Valencia as having learning difficulties. The different factors related to LD were assessed. RESULTS: Between 1 January 1996 and 31 December 1997 a total of 32 children were diagnosed as having learning difficulties. There were 62.5% boys and 37.5% girls of an average age of 10 years and 10 months. The average intelligence quotient was 82.1. The commonest LD was difficulty with reading and writing. CONCLUSION: Learning difficulties form a large proportion of the routine pathology seen in the Neuropaediatric Department. It must be remembered that in most children with learning difficulties there is undiagnosed underlying neurological pathology which becomes noticeable on reaching an age at which schooling becomes more demanding.

[The effects of psychostimulants on the cognitive results and behaviour of children with the combined subtype of attention deficit with hyperactivity]. / Efectos de los psicoestimulantes en el desempeño cognitivo y conductual de los niños con un déficit de atención con hiperactividad subtipo combinado.

INTRODUCTION: Many studies have shown the efficacy of methylphenidate in treating children with attention deficit and hyperactivity to reduce the main symptoms of the disorder and problems of behaviour: behaviour which is disruptive, antisocial, negative and aggressive. OBJECTIVES: 1. Analyze the therapeutic effects of methylphenidate on the cognitive function of children with TDAH, combined subtype, evaluated by means of neuropsychological tests of attention and inhibitory control. 2. Determine the efficacy of methylphenidate in improving the basic symptoms of TDAH C according to the DSM 1V for parents and teachers, and their behaviour, evaluated by their teachers, in the combined subtype. PATIENTS AND METHODS: The sample was made up of 48 children with TDAH C. 24 of these had been referred by paediatricians and received drug treatment with methylphenidate, 0.5 mg/kg once in the morning and once after lunch (TDAH C/CTF). The other group of 24 children with TDAH C were referred from their teachers to a school psychologist so that they followed the usual guidelines for orientation but not a systematically developed treatment (TDAH C/C or control group). RESULTS. In relation to the first objective the results were good for the TDAH C/CTF compared with the TDAH C/C group regarding the proportion of children who improved their results on neuropsychological testing of planning inhibitory control and attention. The differences between the two groups were statistically significant in the latent period of the reflexive impulsive test (MFF), arithmetic, cancellation of rhomboids and cancellation of numbers. Regarding the second objective, the improvement in the TDAH C/CTF group according to the teachers opinions were statistically significant with respect to attention, hyperactivity and impulsiveness, as compared with the control group. However, according to the parents assessment, although improvement was greater in both dimensions, the differences between the two groups did not reach statistical significance. Finally, the teachers observed greater improvement in the medicated group as compared to the control group regarding three variables: learning problems, antisocial conduct and failure to adapt to school. CONCLUSIONS: Overall, our results coincide with those of other excellent reviews, which have shown the effectiveness of methylphenidate in the treatment of cognitive and behaviour disorders in this group.

[Disseminated acute encephalomyelitis in children. A retrospective study of seven patients]. / Encefalomielitis aguda diseminada en la infancia. Estudio retrospectivo de siete pacientes.

INTRODUCTION AND OBJECTIVE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. This study is based on clinical symptoms and diagnostic tests employed. PATIENTS AND METHODS: We describe a seven children series indicating the initial neurologic abnormalities, diagnostic tests, treatments used and clinical-neuroradiological evolution. RESULTS: The mean presentation age was 4.1 years. Initial neurologic symptoms were mainly spastic hemi/paraparesis, cerebellous and pyramidal syndrome, consciousness changes, meningeal signs, seizures and cranial nerve palsies. The cerebrospinal fluid was abnormal in four patients with positive serologic tests in two of them (Coxsackie B). Electrophysiological studies were affected in 50%. MRI findings consisted of multifocal supratentorial white matter lesions. Clinical evolution revealed a progressive improvement with resolution after two months. Follow-up was made between six months and five years. The treatment was based on aciclovir and corticosteroids. CONCLUSIONS: ADEM runs a monophasic course of progressive neurologic abnormalities. Diagnosis is based on suggestive clinical and neuroimaging findings. Generally speaking, MRI showed resolution of multifocal lesions in conjunction with clinical improvement.

[Epidemiology of Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae in children in the Valencia Community, Spain. Acute diseases study group]. / Epidemiología de la meningitis producida por Haemophilus influenzae tipo b, Neisseria meningitidis y Streptococcus pneumoniae en niños de la Comunidad Valenciana, España. Grupo de Estudio de Enfermedades Invasoras.

OBJECTIVE: To asses the incidence of Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae meningitis in children of de Valencian Community (VC), Spain, and to describe the microbiologic characteristics. MATERIAL AND METHODS: Prospective surveillance system with paediatrician and microbiologist participation of all public hospitals of the VC. Cases are children less than 15 with clinical meningitis and with isolation of Hib, N. meningitidis or S. pneumoniae from CSF of blood. RESULTS: From 1st December 1995 to 30th November 1996, 51 cases were declared, 33.3% were Hib, 49.0% N. meningitidis and 17.7% S. pneumoniae. The annual incidence of meningitis was 7.6 cases/100,000 < 15 years, 20.5/100,000 < 5 years and 56.2/100,000 < 1 year. 84.3% of the cases occurred in children younger than 5. S. pneumoniae had the highest mortality. CONCLUSIONS: Hib is a frequent cause of meningitis in spite of that one third of children are vaccinated. 43% of the N. meningitidis isolated in meningitis are serogroup C. S. pneumoniae meningitis are more frequent in children less than one, and has a high mortality rate.

[Tectal tumours in paediatrics. A review of eight patients]. / Tumores tectales en pediatría. Revisión de ocho pacientes.

INTRODUCTION: Tumours of the tectal region form, within the group of gliomas of the brain stem, a sub group with better prognosis which require a different therapeutic strategy. OBJECTIVES: A retrospective review of tectal tumours in children to find the most suitable therapeutic approach and the prognosis to be expected. PATIENTS AND METHODS: We reviewed 8 paediatric patients who, during the past 11 years, had developed tectal tumours diagnosed by means of neuro imaging techniques. We evaluated their clinical features and especially their clinico radiological progress. RESULTS: The average age at the time of diagnosis was 10 years. All cases presented with the clinical features of raised intracranial pressure secondary to obstruction of the aqueduct of Sylvius. MR was the key to visualization of the tectal lesion in all cases but one, which had already been shown on CT. The initial and only treatment given was a ventricular shunt. The average clinico radiological follow up in our series was 4 years, with good progress in all cases so that no other therapeutic measures were required. MR follow up showed that the tumours were stable in all cases but one, which had increased slightly in size but without parallel clinical signs. CONCLUSION: In most cases tectal tumours in children follow a benign course. A ventricular shunt is usually the only treatment necessary. However, close clinical and radiological follow up should be carried out to rule out growth of the tumour which make other treatment also necessary. MR is the method of choice for initial evaluation and follow up of these tumours.