Feasibility of Family-Centered Workshops for Children Aged 18-36 Months with Language Developmental Delay.

BACKGROUND: Family-centered workshops' effects on children with language developmental delay remain unknown. This study assessed the feasibility of workshops for children with language developmental delay. METHODS: A total of 122 children aged 18-36 months with language developmental delays and their parents participated in six sessions of 2-h family-centered multidisciplinary workshops for 6 weeks. The Mandarin-Chinese Communicative Development Inventory, Peabody Developmental Motor Scale, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Child Health Questionnaire, Pediatric Quality of Life Inventory, Caregiver Strain Index, Impact on Family Scale, PedsQL Family Impact Module, and World Health Organization Quality of Life (QOL) were administered to the children and their parents before and after the workshop. RESULTS: We found improvement of emotion (P = 0.037), upper extremity and physical function (P = 0.038), and transfer and basic mobility (P = 0.019) in children and parental QOL related to children's conditions (P = 0.049), with no effect on communication ability and QOL in children and family strain and function. We also noted more significant improvement in children with pure developmental language delay than in children with nonpure developmental language delay concerning the success rates (from delayed to normal development) for expressive vocabulary (P < 0.001) and word combination (P = 0.002). Satisfaction levels toward the workshop were high. CONCLUSIONS: Family-centered workshops improved children's emotions, functional performance, and parental QOL. Although the samples were too small to test different conditions of the developmental delay, the workshops for children with language developmental delays are acceptable and feasible.

Short-term multidisciplinary family-centered workshop for preschool children with global developmental delays.

BACKGROUND: Children with developmental delays have a great impact on their families. Educating families on how to interact with their children is an important task. Therefore, we assessed the short-term effectiveness of the workshop for children with global developmental delays. METHODS: In total, 101 children aged 18-36 months with global developmental delays, all with language delay along with other developmental delays, and their parents participated in six 2-h family-centered workshop sessions for six weeks. Measures were taken before and after the workshop, including the Mandarin-Chinese Communicative Developmental Inventory, Peabody Developmental Motor Scales, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Pediatric Evaluation of Disability Inventory, Pediatric Daily Occupation Scale, Pediatric Quality of Life Inventory (PedsQL), Caregiver Strain Index, and PedsQL-Family Impact Module. RESULTS: Significant improvements with a small or intermediate effect size in emotions, upper extremity and physical functioning and global functioning, daily occupation performance in sensorimotor, communication, cognitive autonomy, and psychosocial domains, and parental quality of life and family impact were noted with high workshop satisfaction. CONCLUSION: Short-term family-centered workshop is effective for children with global developmental delays. However, due to the lack of follow-up after the intervention, it should be careful in inferring the developmental gain effect. IMPACT: The effectiveness of short-term family-centered workshops on children with global developmental delays remains uncertain. Short-term family-centered workshops improved the children's emotions, physical functional performance, and occupational performance in daily life. The short-term family-centered workshop is practical and effective for children with global developmental delays. Further long-term, large-scale, prospective, randomized trials are warranted to confirm these results. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05418933.

Combined effects of nucleotide-binding domain-like receptor protein 3 polymorphisms and environmental metals exposure on chronic kidney disease.

Chronic inflammation is the cause of chronic kidney disease (CKD). The nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome plays a vital role in the inflammation process and is associated with the regulatory effects of NLRP3 gene polymorphisms. This study evaluated the association between NLRP3 gene polymorphisms and CKD, and further explored whether the association of environmental metals with CKD varied by the NLRP3 genotypes. A total of 218 CKD patients and 427 age- and sex-matched healthy controls were recruited in this clinic-based case-control study. Patients were identified as having CKD if their estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and stage 3-5 for at least 3 months. We examined the genotypes of fifteen common ssingle-nucleotide polymorphisms in NLRP3 genes. Concentrations of total urinary arsenic were examined by summing of urinary inorganic arsenic species. Concentrations of selenium, cadmium, and lead were measured from blood samples. Associations between NLRP3 polymorphisms, environmental metals exposure, and CKD were evaluated using multivariable logistic regression while controlling for confounders. We observed that the odds of carrying NLRP3 rs4925650 GA/AA genotypes, NLRP3 rs1539019 CA/AA genotypes, and NLRP3 rs10157379 CT/TT genotypes were significantly higher among CKD cases compared to controls, with the adjusted odds ratio (95% confidence interval) were 1.54 (1.01-2.36), 1.56 (1.04-2.33), and 1.59 (1.05-2.38), respectively. The significant multiplicative interactions were identified between high levels of blood lead and NLRP3 rs4925650 GA/AA genotypes; high levels of blood cadmium or low levels of plasma selenium and the NLRP3 haplotype (rs4925648, rs4925650, rs12048215, and rs10754555) C-A-A-C multiplicatively interacted to increase the risk of CKD. Our results imply that NLRP3 polymorphisms may play an important role in the development of environmental metals exposure related CKD.

Effects of Intra-articular Coinjections of Hyaluronic Acid and Hypertonic Dextrose on Knee Osteoarthritis: A Prospective, Randomized, Double-Blind Trial.

OBJECTIVE: To determine whether intra-articular coinjection with hypertonic dextrose improves the outcome of hyaluronic acid (HA) prolotherapy for knee osteoarthritis (OA). DESIGN: Prospective, randomized, double-blind trial. SETTING: Medical center in Taiwan. PARTICIPANTS: In total, 104 participants who fulfilled the American College of Rheumatology clinical and radiographic criteria for knee OA with a Kellgren-Lawrence score of 2 or 3 were recruited (N=104). INTERVENTIONS: The participants were blocked randomized to the treatment (HA and hypertonic dextrose) or control (HA and normal saline) group. Ultrasound-guided knee intra-articular injections were administered once a week for 3 weeks. MAIN OUTCOME MEASURES: The primary outcomes were performance-based physical function measures (regular and fastest walking speed, stair climbing time, and chair rising time), and the secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). The outcome measures were assessed before the injections and at 1 week and 1, 3, and 6 months after the injections. The data were analyzed through repeated-measures analysis of covariance. RESULTS: Significant intergroup difference-in-differences favoring the treatment group were observed for improvements in stair climbing time (-1.6; 95% confidence interval, -8.56 to 4.16; P=.38) and WOMAC physical function (-21.2; 95% confidence interval, -126.05 to 103.83; P = .045) at 6 months. The group×time interaction effects favored the treatment group for regular (P=.001) and fastest walking speed (P=.001) and chair rising time (P=.038); WOMAC stiffness (P < .001) and physical function (P = .003); and KOOS for pain (P = .035), other symptoms (P=.022), and quality of life (P=.012). CONCLUSIONS: Compared with HA plus normal saline coinjections, HA plus dextrose coinjections resulted in more significant improvements in stair climbing time and physical function at 6 months, effectively decreased pain, and improved physical function and physical functional performance from 1 week to 6 months. HA plus dextrose coinjections could be a suitable adjuvant therapy for patients with knee OA.

Associations between Plasma Folate and Vitamin B12, Blood Lead, and Bone Mineral Density among Adults and Elderly Who Received a Health Examination.

This study hypothesized that plasma folate and vitamin B12 levels modified the association between blood lead and cadmium and total urinary arsenic levels and bone loss. A total of 447 study subjects who received a physical examination at the Wanfang Hospital Medical Center were recruited. Bone loss was defined as a calcaneus bone mineral density T-score less than -1. Blood cadmium and lead concentrations were measured by ICP-MS. Urinary arsenic species were determined using HPLC-HG-AAS. A SimulTRAC-SNB radioassay was used to measure plasma folate, vitamin B12, and homocysteine levels. Total urinary arsenic and blood lead concentration were positively correlated with the odds ratio (OR) for bone loss in a dose-response manner. The OR and 95% confidence interval (CI) for bone loss in participants with blood lead concentrations > 56.14 versus ≤33.82 µg/dL were 1.82 and 1.10-3.01. No correlation between plasma folate and vitamin B12 levels alone and bone loss was observed. However, this study is the first observational study to find that blood lead concentrations tend to increase the OR of bone loss in a low plasma folate and plasma vitamin B12 group with multivariate ORs (95% CI) of 2.44 (0.85-6.96).

The combined effects of nucleotide-binding domain-like receptor protein 3 polymorphisms and levels of blood lead on developmental delays in preschool children.

Nucleotide-binding domain-like receptors protein 3 (NLRP3) inflammasomes are associated with neuroinflammation and multiple NLRP3 genes regulate NLRP3 expression. Our study aimed to investigate the association of NLRP3 polymorphisms with developmental delay in preschool children. We also explored whether NLRP3 polymorphisms modified the effects of total urinary arsenic and blood cadmium and lead to developmental delays. A total of 178 children with developmental delays and 88 healthy children were analyzed for urinary arsenic concentrations and red blood cell lead and cadmium concentrations. We examined the genotypes of fifteen common single-nucleotide polymorphisms in NLRP3. We observed that levels of total urinary arsenic and blood lead were significantly associated with developmental delay. The NLRP3rs10754555 CG versus CC/GG, NLRP3rs12048215 AG versus AA/GG, and NLRP3rs12137901 TC/TT versus CC genotype showed a lower odds of developmental delay, with the odds ratio (OR) and 95% confidence interval (CI) = 0.38 (0.19-0.75), 0.52 (0.27-0.99), and 0.33 (0.12-0.90), respectively. Children with the NLRP3rs10754555 CC/GG genotype and high blood lead levels had a significant multiplicative interaction with developmental delay [OR (95% CI) = 9.74 (3.59-26.45)]. This study found evidence that suggested the joint effects of NLRP3rs10754555 CC/GG genotype and high blood lead levels on developmental delays.

Effects of Repeated Co-Injections of Corticosteroids and Hyaluronic Acid on Knee Osteoarthritis: A Prospective, Double-Blind Randomized Controlled Trial.

BACKGROUND: We compared the effects of repeated co-injections of corticosteroids plus hyaluronic acid (HA) with the effects of HA injections alone in patients with knee osteoarthritis. METHODS: A double-blind randomized controlled trial was conducted between October 2016 and July 2017 at a medical center. Patients (n = 57) who fulfilled the clinical and radiographic criteria for knee osteoarthritis established by the American College of Rheumatology with a Kellgren-Lawrence score of 2 or 3 were included. They were assigned to either the HA group (n = 29) or corticosteroids plus HA group (n = 28), and injections were administered under ultrasound guidance once a week for 3 consecutive weeks. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were the primary outcomes. Physical functional performance (10-m fast walking and chair-rising time) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were secondary outcomes. The assessment was performed prior to injections, 1 week, and 1, 3, and 6 months after injections. Data were analyzed through repeated-measures analysis of covariance. RESULTS: Both groups experienced decreased pain and improved physical function and physical functional performance over time. We found significant group × time interaction effects favoring the corticosteroids plus HA group in WOMAC-pain (P = .005) and physical function (P = .005), chair-rising time (P = .032), and KOOS-pain (P = .001). CONCLUSIONS: Repeated co-injections of corticosteroids plus HA more effectively decreased pain and improved physical function and physical functional performance than injections of HA alone from 1 week through 6 months posttreatment.

Alcohol Consumption Moderated the Association Between Levels of High Blood Lead or Total Urinary Arsenic and Bone Loss.

Metal exposure and lifestyle are important risk factors for osteoporosis. Our study aimed to investigate the association between red blood cell lead and cadmium, total urinary arsenic, and plasma selenium levels and bone mineral density (BMD). In addition, we explored whether alcohol and coffee consumption modified the association between BMD and metals and metalloids. In total, 437 participants who underwent adult or senile physical examinations were recruited. Bone loss was defined as a calcaneus BMD T-score of <-1. Blood cadmium and lead and plasma selenium levels were measured using inductively coupled plasma mass spectrometry. Levels of urinary arsenic species were determined using high-performance liquid chromatography-hydride generator-atomic absorption spectrometry. The total urinary arsenic level was defined as the sum of the levels of urinary arsenic species. The BMD T-scores decreased significantly with increasing blood lead levels. The BMD T-scores also showed a downward trend with increasing total urinary arsenic levels. The odds ratio (OR) and 95% confidence interval (CI) for bone loss in patients with blood lead levels >57.58 versus 35.74 µg/dL were 1.98 and 1.17-3.34. In addition, the greater the lead or arsenic exposure and alcohol intake was the higher the OR for bone loss with multivariate ORs of 2.57 (95% CI 1.45-4.56) and 2.96 (95% CI 1.67-5.22), respectively. To the best of our knowledge, this study is the first to demonstrate that high total urinary arsenic or blood lead levels and frequent or occasional alcohol consumption had a significant multiplicative interaction for increasing the OR for bone loss.

Combined effect of polymorphisms of MTHFR and MTR and arsenic methylation capacity on developmental delay in preschool children in Taiwan.

Polymorphisms of methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) are related to cognitive dysfunction and mental disability. These genes, along with folate and vitamin B12 levels, are regulators of one-carbon metabolism, which synthesizes S-adenosylmethionine (SAM) as a methyl donor for arsenic methylation. The aim of this study was to explore whether polymorphisms of MTHFR and MTR influence arsenic methylation capacity and plasma folate and vitamin B12 levels and if these influences cause developmental delay in preschool children. A total of 178 children with developmental delay and 88 without developmental delay were recruited from August 2010 to March 2014. A high-performance liquid chromatography-hydride generator and atomic absorption spectrometer were used to determine urinary arsenic species. Plasma folate and vitamin B12 concentrations were measured by SimulTRAC-SNB radioassay. Polymorphisms of MTHFR C677T, MTHFR A1298C, and MTR A2756G were examined by polymerase chain reaction and restriction fragment length variation. The results show that MTHFR C677T C/T and T/T genotypes had a lower risk of developmental delay than the C/C genotype (odds ratio [OR] = 0.47; 95% confidence interval, 0.26-0.85). Subjects with the MTHFR C677T C/C genotype had significantly lower plasma folate and vitamin B12 levels than those with the MTHFR C677T C/T and T/T genotype. The MTHFR C677T C/C genotype combined with high total urinary arsenic and poor arsenic methylation capacity indices significantly increased the OR of developmental delay in a dose-response manner. This is the first study to show the combined effect of MTHFR C677T genotype and poor arsenic methylation capacity on developmental delay.

Active video games for knee osteoarthritis improve mobility but not WOMAC score: A randomized controlled trial.

BACKGROUND: Active video games (AVGs) have become popular and have been investigated for their therapeutic purposes. However, the effect of AVGs on patients with knee osteoarthritis (OA) remains uncertain. OBJECTIVE: We aimed to compare the effects of AVGs with those of traditional therapeutic exercise on patients with knee OA. METHOD: This was a prospective single-blind, randomized controlled trial. Participants (n=80) with knee OA were allocated to the AVGs group (n=40) or therapeutic exercise group (n=40). Both groups received treatment 3 times a week for 4 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and secondary outcome measures were the World Health Organization Quality of Life-Brief Vision, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, physical functional performance (including time for 10-m walking and for ascending and descending stairs), Biodex Stability System, Chronic Pain Grade Questionnaire, and Work Ability Index. The patients were evaluated at baseline, 2 and 4 weeks after treatment, and 1 and 3 months after treatment completion. RESULTS: Both groups showed significant time effect in the pain subcategory of the WOMAC (P=0.047). However, we found no significant group×time interaction effect between the groups at any follow-up assessments for pain (P=0.066), stiffness (P=0.284), or physical function (P=0.179) for the WOMAC. Among the secondary outcomes, we found significant group×time effects favoring the AVG group in dynamic balance (P=0.020), and physical functional performance including 10-m walking time (P=0.002) and stair ascent time (P=0.005), and the physical domain of health (P=0.032). CONCLUSIONS: Therapeutic exercises and playing AVGs similarly improved the pain of patients with knee OA; however, playing AVGs improved dynamic balance, physical functional performance, and physical health more than therapeutic exercises did.

Association of plasma folate, vitamin B12 levels, and arsenic methylation capacity with developmental delay in preschool children in Taiwan.

Developmental delay has been associated with inefficient arsenic methylation capacity in preschool children. Folate and vitamin B12 are important nutrients that produce s-adenosylmethionine during single-carbon metabolism and provide methyl groups for arsenic methylation. The aim of the present study was to explore whether plasma folate and vitamin B12 levels influence arsenic methylation capacity and in turn are related to developmental delay in preschool children. A case-control study was conducted in 178 children with developmental delay and 88 normal children, who were recruited from Shin Kong Wu Ho-Su Memorial Teaching Hospital from August 2010 to March 2014. Arsenite (AsIII), arsenate (AsV), monomethylarsonic acid (MMAV), and dimethylarsinic acid (DMAV) in the urine was determined by high-performance liquid chromatography-linked hydride generator and atomic absorption spectrometry. Plasma folate and vitamin B12 levels were measured using a SimulTRAC-SNB radioassay. The results show that the combination of high plasma folate and high vitamin B12 levels were correlated with efficient arsenic methylation capacity (low MMAV %, low InAs %, and high DMAV %). High MMAV % significantly increased and high DMAV % and secondary methylation index decreased the odds ratio (OR) of developmental delay in a dose-dependent manner in both low plasma folate and low vitamin B12 (low/low) groups; the multivariate OR and 95% confidence interval were 5.01 (0.83-30.06), 0.21 (0.04-1.23), and 0.20 (0.03-1.20), respectively. This is the first study to show that the combination of high plasma folate and high vitamin B12 levels increases arsenic methylation capacity and indirectly decreases the OR of developmental delay in preschool children.

Plasma selenium influences arsenic methylation capacity and developmental delays in preschool children in Taiwan.

Inefficient arsenic methylation capacity has been associated with developmental delay in preschool children. Selenium has antioxidant and anti-inflammatory properties that protect experimental animals from chemically induced neurotoxicity. The present study was designed to explore whether plasma selenium levels affects arsenic methylation capacity related to developmental delay in preschool children. A case-control study was conducted from August 2010 to March 2014. All participants were recruited from the Shin Kong Wu Ho-Su Memorial Teaching Hospital. In total, 178 children with a developmental delay and 88 children without a delay were recruited. High-performance liquid chromatography-linked hydride generator and atomic absorption spectrometry were used to determine urinary arsenic species, including arsenite (AsIII), arsenate (AsV), monomethylarsonic acid (MMAV), and dimethylarsinic acid (DMAV). Plasma selenium levels were measured by inductively coupled plasma mass spectrometry. As results, plasma selenium concentration was significantly inversely associated with the odds ratio (OR) of developmental delay. Plasma selenium concentration was positively associated with arsenic methylation capacity [percentage of inorganic arsenic and percentage of MMAV (MMAV%) decreased, and percentage of DMAV (DMAV%) increased]. High plasma selenium concentration and high DMA% significantly and additively interacted to decrease the OR of developmental delay; the OR and 95% confidence interval were 0.40 (0.18-0.90). This is the first study to show a combined dose-response effect of plasma selenium concentration and that efficient arsenic methylation capacity decreased the OR of developmental delay in preschool children.

Effects of a family-centered workshop for children with developmental delays.

This study investigated the effects of a short-term family-centered workshop for children with developmental delays.This study was conducted in a rehabilitation outpatient clinic of a teaching hospital. We recruited 30 children with developmental delays and their parents as the study group and 57 age- and sex-matched children with typical development and their parents as the control group. The workshop was conducted for the children with developmental delays and their parents in the form of one 2-hour session per week for 6 weeks by health and education professionals by using a family-centered multidisciplinary approach. The Mandarin-Chinese Communicative Developmental Inventory and Peabody Developmental Motor Scales-Second Edition were used to assess the communication and motor skills of the children with developmental delays. The parent form of the Pediatric Outcomes Data Collection Instrument, Child Health Questionnaire, Pediatric Quality of Life (PedsQL) Inventory, and PedsQL Family Impact Module were administered to the parents of both groups.On study commencement, no significant differences were noted in functional performance and family impact between the children with developmental delays and those without delays. The children with developmental delays had lower health and health-related quality of life (HRQOL) scores than the children with typical development. Following the workshop, the study group exhibited significant improvements in physical health (94.2 vs 80.2, effect size: 1.00, P = .026), global function (94.8 vs 78.7, effect size: 0.88, P = .006), impact of the child's health on parental HRQOL (85.0 vs 70.4, effect size: 0.81, P = .043), and parental HRQOL (81.3 vs 65.0, effect size: 0.81, P = .015). No significant differences were recorded in function, health, HRQOL, or family impact between the children with developmental delays and those with typical development after 6 weeks.The multidisciplinary short-term family-centered workshop for children with developmental delays improved the children's physical health and global functional skills, and it reduced the impact of the child's health on parental HRQOL while also improving parental HRQOL.

Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial.

BACKGROUND: Limited evidence is available regarding the effects of insoles on pediatric flexible flatfoot because of the heterogeneity and low methodological quality of previous studies. The purpose of this prospective trial is to examine the short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children by using the International Classification of Functioning, randomized controlled Disability, and Health (ICF) framework. METHODS: This study was conducted in a rehabilitation outpatient clinic of a teaching hospital. Fifty-two children with symptomatic flexible flatfoot were included. The children in the treatment group wore customized arch support insoles for 12 weeks, whereas those in the control group did not wear the insoles. Both clinical and radiographic measurements, including the navicular drop, foot posture index, Beighton hypermobility score, talonavicular coverage angle, calcaneal inclination angle, and calcaneal-first metatarsal angle, were used for diagnosing flexible flatfoot. Physical activity (10-m normal and fast walking, stair ascent, stair descent, and chair rising), physical function, and psychometric properties (Pediatric Outcome Data Collection Instrument and Pediatric Quality of Life Inventory) were evaluated at the baseline and 12 weeks after the intervention. RESULTS: Compared with the control group, the treatment group exhibited significant improvement in pain/comfort (P = .048), physical health (P = .035), stair ascent time (P = .015), upper extremity and physical function (P = .016), and transfer and basic mobility (P = .042) during the intervention period. CONCLUSION: Children with flexible flatfoot who wore customized arch support insoles for 12 weeks exhibited significantly improved pain/comfort, physical health, stair ascent time, upper extremity and physical function, and transfer and basic mobility. These variables belong to the domains of body functions and structures and activity and participation in the ICF framework. However, because the groups were not comparable, additional studies with larger sample sizes should be conducted.

Corrigendum to "Local and Systemic Cardiovascular Effects from Monochromatic Infrared Therapy in Patients with Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Study".

[This corrects the article DOI: 10.1155/2012/583016.].

Association of blood heavy metals with developmental delays and health status in children.

The aim of this study was to evaluate the association of blood lead, mercury, and cadmium concentrations with developmental delays and to explore the association of these concentrations with the health status of children. This study recruited 89 children with developmental delays and 89 age- and sex-matched children with typical development. Their health status was evaluated using the Pediatric Quality of Life (PedsQL) Inventory for health-related quality of life (HRQOL) and the Pediatric Outcomes Data Collection Instrument for function. Family function was also evaluated. Blood lead, mercury, and cadmium concentrations were measured using inductively coupled mass spectrometry. The children with developmental delays had a considerably poorer HRQOL, lower functional performance and family function, and a higher blood lead concentration than those with typical development. The blood lead concentration had a significantly positive association with developmental delays [odds ratio (OR) = 1.54, p < 0.01] in a dose-response manner, and it negatively correlated with PedsQL scores (regression coefficient: -0. 47 to -0.53, p < 0.05) in all the children studied. The higher blood cadmium concentration showed a significantly positive association with developmental delays (OR = 2.24, for >1.0 µg/L vs. <0.6 µg/L, p < 0.05). The blood mercury concentration was not associated with developmental delays and health status.