Oral health problems linked to obstructive sleep apnea are not always recognized within dental care-As described by dental professionals.

OBJECTIVES: Obstructive sleep apnea (OSA) has an impact on an individual's quality of life and general health, and can also affect their oral health. The patient's experiences, together with intraoral signs and symptoms could indicate the presence of OSA. Knowledge that the patient has, or is at high risk for having OSA can help the dental healthcare provider maintain the oral health and general health for these patients. The purpose was to explore dentists and dental hygienists' experiences when encountering adult patients with potential, untreated and treated OSA. METHODS: A qualitative inductive approach was used. Experienced dentists and dental hygienists working within Swedish Public Dental Service were strategically selected. Semi-structured face-to-face interviews were performed followed by qualitative content analysis. RESULTS: Interviews from 13 participants, seven dental hygienist and six dentists, led to three areas describing varied experience: Importance of the patient encounter and identifying intraoral signs both of which describe experiences related to the importance of the initial unstructured conversation and focused clinical assessments, and strategies for nurturing care which point to interest about care, treatment, and collaborations with medical health care providers. CONCLUSIONS: Dental professionals are not able to consistently recognize patients who have, or are at high risk for OSA. During the patient encounter, is it important to determine if a patient is at risk for, or has oral signs of OSA.

Autism Spectrum Disorder and Sibling Relationships: Exploring Implications for Intervention Using a Family Systems Framework.

Purpose There is currently a very limited scope of research in the field of speech-language pathology on sibling involvement in the treatment of children with autism spectrum disorder (ASD). Principles of family systems theory (FST) recognize the interrelatedness and dynamic nature of the family unit, making it a relevant and useful guiding framework for future research and practice on sibling involvement in intervention. Method In this article, core principles of FST are reviewed, followed by the state of research related to sibling relationships in ASD, and roles of typically developing siblings and siblings with ASD in intervention programs. Implications for adopting an FST framework as well as considerations and future directions in this area of research and clinical practice are discussed. Results According to the principles of FST on the inclusion of siblings in treatment, there are several considerations to be made at the level of the child with ASD, the sibling(s), and the family unit. Factors such as developmental level, communication status, and areas of strength, challenge, and interest are key features of the children and family that will need to be addressed in order to promote positive sibling involvement and family functioning. Conclusions The development of family-centered sibling intervention programs for individuals with ASD is an area of research that warrants further exploration. With the guidance of the FST framework, researchers and clinicians can work to develop innovative interventions that consider the unique characteristics of each family to optimize outcomes at the levels of each individual, the sibling relationship, and the family as a unit.

Identification and drawing of early concepts in children with autism spectrum disorder and children without disability.

This comparative study is a replication and extension of previous work related to children's drawings of early concepts. In all, 15 children with autism spectrum disorder (ASD) and 19 children without disability took part in the study, and were video recorded as they drew 10 early emerging concepts such as "eat" and "more." In a second task, the participants were asked to label Picture Communication Symbols conventionally used in augmentative and alternative communication (AAC) systems. Descriptive, correlational, and inferential statistics were used to analyze the data. The results were consistent with previous research for both groups. Across the 10 features coded, participants in both groups drew entire scenes and were more likely to draw complete representations of people. Identification of PCS was less than 25% for both groups. After a brief time delay, the participants were able to remember the names of their drawings; however, performance on this recall task was positively related to their age. The language scores of the participants without disability were associated with their use of isolated parts in drawings. Trends in the data suggest potential avenues for follow up with larger studies examining use of self, others, and entire scenes in children with ASD. Implications for therapy and future directions pertaining to symbolic understanding in children with ASD are discussed.

To risk or not to risk: Anxiety and the calibration between risk perception and danger mitigation.

Anxiety prepares an organism for dealing with threats by recruiting cognitive resources to process information about the threat, and by engaging physiological systems to prepare a response. Heightened trait anxiety is associated with biases in both these processes: high trait-anxious individuals tend to report heightened risk perceptions, and inappropriate engagement in danger mitigation behavior. However, no research has addressed whether the calibration between risk perception and danger mitigation behavior is affected by anxiety, though it is well recognized that this calibration is crucial for adaptive functioning. The current study aimed to examine whether anxiety is characterized by better or worse calibration of danger mitigation behavior to variations in risk magnitude. Low and high trait-anxious participants were presented with information about the likelihood and severity of a danger (loud noise burst) on each trial. Participants could decide to mitigate this danger by investing a virtual coin, at the cost of losing danger mitigation ability on subsequent trials. Importantly, level of risk likelihood and severity were varied independently, and the multiplicative relationship between the 2 defined total danger. Multilevel modeling showed that the magnitude of total danger predicted the probability of coin investments, over and above the effects of risk likelihood and severity, suggesting that participants calibrated their danger mitigation behavior to integrated risk information. Crucially, this calibration was affected by trait anxiety, indicating better calibration in high trait-anxious individuals. These results are discussed in light of existing knowledge and models of the effect of anxiety on risk perception and decision-making. (PsycINFO Database Record

Survival rates of children with acute lymphoblastic leukemia presenting to a pediatric rheumatologist in the United States.

BACKGROUND: Approximately 30% of pediatric acute lymphoblastic leukemia patients present with musculoskeletal symptoms and are often referred first to a pediatric rheumatologist. We examined the survival and causes of death of these patients presenting to a pediatric rheumatologist and compared the rates with that reported in the hematology-oncology literature. PROCEDURE: We used the Pediatric Rheumatology Disease Registry, including 49,023 patients from 62 centers, newly diagnosed between 1992 and 2001. Identifiers were matched with the Social Security Death Index censored for March 2005. Deaths were confirmed by death certificates, referring physicians, and medical records. Causes of death were derived by chart review or from the death certificate. RESULTS: There were 7 deaths of 89 patients (7.9%, 95% confidence interval: 3.9%-15.4%) with acute lymphoblastic leukemia with a 5-year survival rate of 95.5% (88.3 to 98.3) and 10-year survival rate of 89.8% (79.0% to 95.2%). The causes of death were sepsis (bacterial and/or fungal) in 4 (57%) patients, the disease in 2 (29%) and post bone-marrow transplantation in 1 (14%). CONCLUSION: The overall survival of patients with acute lymphoblastic leukemia seen first by pediatric rheumatologists is higher than the range reported in the pediatric oncology literature for the same period of diagnosis.

Mortality outcomes in pediatric rheumatology in the US.

OBJECTIVE: To describe mortality rates, causes of death, and potential mortality risk factors in pediatric rheumatic diseases in the US. METHODS: We used the Indianapolis Pediatric Rheumatology Disease Registry, which includes 49,023 patients from 62 centers who were newly diagnosed between 1992 and 2001. Identifiers were matched with the Social Security Death Index censored for March 2005. Deaths were confirmed by death certificates, referring physicians, and medical records. Causes of death were derived by chart review or from the death certificate. Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were determined. RESULTS: After excluding patients with malignancy, 110 deaths among 48,885 patients (0.23%) were confirmed. Patients had been followed up for a mean +/- SD of 7.9 +/- 2.7 years. The SMR of the entire cohort was significantly decreased (0.65 [95% CI 0.53-0.78]), with differences in patients followed up for > or =9 years. The SMR was significantly greater for systemic lupus erythematosus (3.06 [95% CI 1.78-4.90]) and dermatomyositis (2.64 [95% CI 0.86-6.17]) but not for systemic juvenile rheumatoid arthritis (1.8 [95% CI 0.66-3.92]). The SMR was significantly decreased in pain syndromes (0.41 [95% CI 0.21-0.72]). Causes of death were related to the rheumatic diagnosis (including complications) in 39 patients (35%), treatment complications in 11 (10%), non-natural causes in 25 (23%), background disease in 23 (21%), and were unknown in 12 patients (11%). Rheumatic diagnoses, age at diagnosis, sex, and early use of systemic steroids and methotrexate were significantly associated with the risk of death. CONCLUSION: Our findings indicate that the overall mortality rate for pediatric rheumatic diseases was not increased. Even for the diseases and conditions associated with increased mortality, mortality rates were significantly lower than those reported in previous studies.