Sleep in pediatric neuromuscular disorders.

Sleep disordered breathing (SDB) is prevalent among children with neuromuscular disorders (NMD). The combination of respiratory muscle weakness, altered drive, and chest wall distortion due to scoliosis make sleep a stressful state in this population. Symptomatology can range from absent to snoring, nocturnal awakenings, morning headaches, and excessive daytime sleepiness. Sequelae of untreated SDB includes cardiovascular effects, metabolic derangements, and neurocognitive concerns which can be compounded by those innate to the NMD. The clinician should have a low threshold for obtaining polysomnography and recognize the nuances of individual disorders due to disproportionately impacted muscle groups such as hypoventilation in ambulating patients from diaphragm weakness. Non-invasive or invasive ventilation are the mainstay of treatment. In this review we explore the diagnosis and treatment of SDB in children with various NMD.

Screening for Children's Chronic Health Conditions and Their Strengths and Difficulties in Primary Care.

OBJECTIVE: This study explores parents' perceptions of their child's health status and their strengths and difficulties using 2 validated instruments in primary care settings. METHODS: This cross-sectional study was conducted between February 2018 and October 2019. Parents of children aged 2 to 18 years completed the Children with Special Health Care Needs (CSHCN) screener and the Strengths and Difficulties Questionnaire (SDQ) as well as demographics. The CSHCN uses 5 questions to identify children with chronic health conditions. Three subgroups were created: children with no chronic health condition (NCHC), chronic health condition with no functional limitations (NFLs), and chronic health condition with functional limitations (FLs). Higher SDQ scores indicate higher degrees of a factor. Associations between CSHCN subgroups and SDQ scores, controlling for demographics, were analyzed with multiple linear regressions. RESULTS: In total, 970 parents' surveys (87.9% completed surveys) were included in this analysis: 76.4% of respondents were married, 56.4% had an annual household income ≥$50,000%, and 61.7% were employed full time; 53.0% of the index children were males, 72.1% were White, and 61.4% had private insurance. Mean (SD) total SDQ scores across the 3 CSHCN subgroups were significantly different (NCHC, 7.7 [4.8]; NFL, 12.6 [6.6]; FL, 16.0 [6.7], p < 0.001). The mean SDQ prosocial scores were higher in the NCHC subgroup (p < 0.001), as hypothesized. The SDQ means for the 3 subgroups remained significantly different after controlling for demographics. CONCLUSION: Children with FLs had significantly higher total SDQ scores than children in the other 2 subgroups, which may aid clinicians in the early identification of children who would benefit from behavioral health resources.

In-Service Delaminations in FRP Structures under Operational Loading Conditions: Are Current Fracture Testing and Analysis on Coupons Sufficient for Capturing the Essential Effects for Reliable Predictions?

Quasi-static or cyclic loading of an artificial starter crack in unidirectionally fibre-reinforced composite test coupons yields fracture mechanics data-the toughness or strain-energy release rate (labelled G)-for characterising delamination initiation and propagation. Thus far, the reproducibility of these tests is typically between 10 and 20%. However, differences in the size and possibly the shape, but also in the fibre lay-up, between test coupons and components or structures raise additional questions: Is G from a coupon test a suitable parameter for describing the behaviour of delaminations in composite structures? Can planar, two-dimensional, delamination propagation in composite plates or shells be properly predicted from essentially one-dimensional propagation in coupons? How does fibre bridging in unidirectionally reinforced test coupons relate to delamination propagation in multidirectional lay-ups of components and structures? How can multiple, localised delaminations-often created by impact in composite structures-and their interaction under service loads with constant or variable amplitudes be accounted for? Does planar delamination propagation depend on laminate thickness, thickness variation or the overall shape of the structure? How does exposure to different, variable service environments affect delamination initiation and propagation? Is the microscopic and mesoscopic morphology of FRP composite structures sufficiently understood for accurate predictive modelling and simulation of delamination behaviour? This contribution will examine selected issues and discuss the consequences for test development and analysis. The discussion indicates that current coupon testing and analysis are unlikely to provide the data for reliable long-term predictions of delamination behaviour in FRP composite structures. The attempts to make the building block design methodology for composite structures more efficient via combinations of experiments and related modelling look promising, but models require input data with low scatter and, even more importantly, insight into the physics of the microscopic damage processes yielding delamination initiation and propagation.

Update on the management of overactive bladder.

Overactive bladder (OAB) syndrome is a common condition characterised by urinary urgency, with or without urgency incontinence, frequency and nocturia, in the absence of any other pathology. Clinical diagnosis is based upon patient self-reported symptomology. Currently there is a plethora of treatments available for the management of OAB. Clinical guidelines suggest treatment via a multidisciplinary pathway including behavioural therapy and pharmacotherapy, which can be commenced in primary care, with referral to specialist services in those patients refractory to these treatments. Intradetrusor botulinum A and sacral neuromodulation provide safe and efficacious management of refractory OAB. Percutaneous tibial nerve stimulation and augmentation cystoplasty remain available and efficacious in a select group of patients. Unfortunately, there remains a high rate of patient dissatisfaction and discontinuation in all treatments and thus there remains a need for emerging therapies in the management of OAB.

Modern advancements in minimally invasive surgical treatments for benign prostatic obstruction.

A wide variety of minimally invasive surgical techniques are now being offered for treating voiding lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). These options offer an alternative to both medical therapy and traditional surgical options. Minimally invasive surgical treatments in LUTS/BPO boast both day case and local anaesthetic options, with a potentially reduced side effect profile compared to traditional surgical interventions matching the needs for a range of patients. We provide a narrative review of minimally invasive surgical treatments available for BPO in terms of the technology, efficacy, safety, institutional recommendations, cost and potential future developments.

Partnership between parents/caregivers and pediatricians when children are hospitalized: Parents' perspective.

The relationship between children's caregivers and pediatricians is both complex and critical to the well-being of patients. A strong partnership has been shown to improve children's health outcomes 1. Patient and family engagement has been defined as patients, families/guardians, and health care professionals working together in an active partnership to improve patients' health outcomes 1. The caregiver and pediatric clinician partnership has been examined for children in outpatient settings 2. However, the partnership between children's caregivers and pediatric hospitalists, has not been carefully examined 2. The partnership between children's caregiver and pediatrician is especially challenging in the inpatient setting as the initial therapeutic relationship is often established during a time of acute stress for the family. Further investigation and analysis of this partnership will offer key insights into the therapeutic relationships, patient care and safety, and the overall patient/family experience in the inpatient environment.

Validation of pediatric sleep questionnaire in children with Chiari malformation and/or spina bifida with or without myelomeningocele.

Sleep-disordered breathing (SDB) is common in Chiari Malformation (CM) and Spina Bifida (SB) and can lead to adverse consequences if untreated. Therefore, screening is very important but the Pediatric Sleep Questionnaire (PSQ) has not been validated in this population. Further, there is limited data on the validity of this tool in children with central nervous system malformations. Retrospective chart review of CM and SB patients evaluated in our sleep center between 2008 and 2018. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PSQ and several of its components were calculated to predict obstructive sleep apnea (OSA). A total of 149 patients met criteria for analysis. The majority were referred to a sleep specialist due to concern for SDB. OSA was found in 36% (53/149) of all patients. The sensitivity and specificity of the PSQ to predict OSA was 73.58% and 20.83%, respectively. The PPV was 33.91%, and the NPV was 58.82%. Specificity values were higher for PSQ as negative predictors of moderate or severe OSA. In this population, the sensitivity of PSQ for OSA is reasonable but lower than values described in other populations. The specificity and NPV are low. Even with a high prevalence of OSA, symptoms of SDB may overlap with those of other comorbidities leading to a low specificity. A PSQ could be used to prioritize which patients need a PSG more urgently than others. Further studies are needed to define an optimal cut-off value of the PSQ in this population.

Child Sleep and Parent Depressive Symptoms.

OBJECTIVES: Parent distress and child sleep problems have been associated in earlier research. The present study expands on past research on parent depressive symptoms and their child's sleep. This study examines the relation between parents who screen positive for depressive symptoms and their perception of their child's sleep. METHODS: Three hundred sixty-nine English-speaking parents of children ages 3 to 5 years (n = 134) or 6 to 11 years (n = 235) met this study's inclusion criteria within the Southwestern Ohio Ambulatory Research Network (response rate 90%). The validated scales used were the RAND Depression Screener (DS), the Wisconsin Abbreviated Children's Sleep Habits Questionnaire (WCSHQ), and the Jenkins Sleep Questionnaire. Multiple logistic regression was used to determine adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for associations with the WCSHQ. RESULTS: In total, 74.3% of the study children were White, 82.4% of respondents were the child's mother, 75.1% had at least some college education, and 54.4% reported an annual income of <$50,000. In total, 54.4% of children were male and 53.8% had public health insurance. Approximately one-fourth of parents had a positive DS and nearly one-third reported sleep problems. Adjusting for child's age and other factors, we found that parents with a positive (vs negative) DS had AOR 2.42 (95% CI 1.38-4.24) for higher WCSHQ scores. Children ages 3 to 5 years (vs 6-11 years) had AOR 2.48 (95% CI 1.56-3.95) for higher WCSHQ scores. CONCLUSIONS: Parents with a positive DS were more likely to report sleep problems in their children after adjusting for the child's age. These findings from a diverse sample of US Midwestern families at primary care venues corroborate previous research.