Application of the clinical version of the narrow path walking test to identify elderly fallers.

INTRODUCTION: Falling during walking is a common problem among the older population. Hence, the challenge facing clinicians is identifying who is at risk of falling during walking, for providing an effective intervention to reduce that risk. We aimed to assess whether the clinical version of the narrow path walking test (NPWT) could identify older adults who are reported falls. MATERIALS AND METHODS: A total of 160 older adults were recruited and asked to recall fall events during the past year. Subjects were instructed to walk in the laboratory at a comfortable pace within a 6 meter long narrow path, 3 trials under single task (ST) and 3 trials dual task (DT) conditions without stepping outside the path (i.e., step errors). The average trial time, number of steps, trial velocity, number of step errors, and number of cognitive task errors were calculated for ST and DT. Fear of falling, performance oriented mobility assessment (POMA) and mini-metal state examination (MMSE) were measured as well. RESULTS: Sixty-one subjects reported that they had fallen during the past year and 99 did not. Fallers performed more steps, and were slower than non-fallers. There were no significant differences, however, in the number of steps errors, the cognitive task errors in ST and DT in POMA and MMSE. CONCLUSION: Our data demonstrates slower gait speed and more steps during the NPWT in ST and DT in fallers. There is no added value of DT over the ST for identification of faller's older adults.

On the track to adulthood: the missions of the young human being, dodging the risks and gaining the tools.

Medical staff are expected to cooperate with other professions and agencies in helping the young human in achieving the goal of becoming a healthy, well- functioning adult that expresses her/his maximal potential. Achieving this goal should be cost-effective. Cost includes not just the economic burden but also psychosocial determinants such as emotional disruption, stress, living at risk, malfunctioning, and dependency. Acknowledging the risks and the expected achievements at each age are useful in analyzing the failure of community health programs and in planning preventive modalities and needed remedies.

Should we consider alternatives to universal well-child behavioral-developmental screening?

The prevalence of developmental disabilities in the young age is of the order of 15%. When behavioral and social-emotional disorders, physical impairments, and sensory disorders are included, the need for special intervention increases to one out of four children. As the sensitivity and specificity of the best screening tests are in the range of 70-80%, their predictive value is controversial. The cost of conducting definitive tests and repeat screening for those who fail the screening tests is high. Children with severe disorders can be identified clinically without a screening test. The poor predictability, difficulty in implementation, and the high costs of developmental testing suggest that children, particularly those in high-risk communities, might be better served by implementing intervention programs for all, instead of trying to identify the outliers through screening.

Night-time cough in children with acute wheezing and with upper respiratory tract infection.

AIMS: To evaluate night-time cough patterns in children with either acute wheezing or an URTI, and to correlate them to the clinical diagnosis. METHODS: Night-time cough variables of 49 children diagnosed with acute wheezing and with URTI were compared using a portable cough monitoring instrument placed in the child's room. RESULTS: Children with acute wheezing had significantly more coughs per night, a longer duration of cough sounds, a higher number of coughing bouts per night, and a higher number of coughs per second within a bout, than children with an URTI. Children with acute wheezing coughed significantly more between 23.00 and 01.00, whereas between 01.00 and 06.00 there was no significant difference in the number of coughs between the two groups. CONCLUSIONS: Significant differences were found in night-time cough variables between children with an acute episode of wheezing and children with an URTI. This could be useful in clinical practice.

Who accompanies a child to the office of the physician?

The arrival of a minor, unaccompanied by a parent, for a clinic visit, is challenging to the physician with legal, ethical, and practical implications. This prospective study, conducted in three community pediatric clinics, examined the relationship of accompanying persons to the minors visiting the clinics. About 90% of the 1,104 visits were with an accompanying parent, mostly a mother. Over 9% of minors, especially adolescents, arrived at the clinic unaccompanied by a parent. A regression analysis demonstrated that for each increase of one month in age there was a 2% increased chance for a visit without a parent (p < .0001). Adolescents were more likely to be among the 6% of minors, who visited the clinic alone, with a rate 0.066 per 1,000 visits in the more affluent community, compared to 0.019 and 0.016 in the middle and low income communities (p < .001). Physicians as well as parents should be made aware of the regulations regarding accompaniment of minors on a visit to the clinic. Policies regarding unaccompanied visits should take into account the risk posed by the absence of a parent versus the right of adolescents for independence and privacy.

Respiratory distress secondary to esophageal foreign body: a case report.

The ingestion or aspiration of a foreign body is a common, but preventable occurrence in childhood. Primary healthcare personnel should alert parents to the risk of swallowing a foreign object, the signs and the need for immediate medical attention. It should be emphasized that protecting children from access to objects that can be swallowed or aspirated is the best preventive measure. A case of an eight year old child, who had swallowed a marble ball is presented and the symptoms and intervention discussed. Medical staff should be aware of the symptomatic variation in ingested foreign body presentation and the importance of rapid diagnosis and management.

The effect of voluntary dehydration on cognitive functions of elementary school children.

AIMS: (1) To describe the occurrence of voluntary dehydration in two classes of elementary school students as expressed by their morning and noon-time urine osmolality; and (2) to determine the relationship between the children's scores on cognitive tests and their state of hydration. METHODS: Group comparison among fifty-eight sixth-grade students (age range 10.1-12.4 y old) during mid-June at two schools in a desert town. Morning and noon-time urine samples were collected in school, and five cognitive tests were scored in the morning and at noon-time. MAIN OUTCOME MEASURES: (1) morning and noon-time urine osmolality; (2) scores of five cognitive tests (hidden figures, auditory number span, making groups, verbal analogies, and number addition) that were applied in the morning and at noon-time. RESULTS: Thirty-two students were dehydrated (urine osmolality above 800 mosm/kg H(2)O) in the morning. An individual's noon-time urine osmolality was highly related to morning osmolality (r=0.67, p=0.000). The morning cognitive scores were similar in the hydrated and dehydrated students (p=0.443). The adjusted mean scores of the noon-time tests, with the morning test scores as covariates, demonstrated an overall positive trend in four of the five tests in favor of the hydrated group (p=0.025). The effect was mainly due to the auditory number span test (p=0.024). CONCLUSION: Voluntary dehydration is a common phenomenon in school-aged children that adversely affects cognitive functions.

Adolescents, accidents and the need to extend our scope of research.

Accidents in adolescence result in mortality and disability that in many cases could have been prevented. The issue is a multi-factorial complex phenomenon, where new research ideas are needed to improve outcome. This short communication presents several research ideas that could provide new relevant answers.

[Primary care approach to children with special needs].

Children with special needs have medical, educational, social and emotional needs which are significantly greater than the average needs of their healthy peers. They and their families have to struggle with the physical, economical and emotional burden imposed on them by their special needs. The role of primary physicians is to lead a team that is capable of diagnosing, treating and coordinating treatment and support for the child and the family. Case management and anticipatory guidance are the cornerstone of the art of dealing with children who have special needs. Primary community physicians are expected to conduct a survey in order to identify the children with special needs in the community and to prepare an intervention plan for each of them. Early detection and proper management of the problems are expected to help these children to maximize their potential and integration in society.