Bereavement and reactions of grief among children and adolescents: Present data and perspectives.

Losing a loved one is among the most common and stressful traumatic events that a child or and adolescent can experience and can be associated with mental health and somatic disorders, as well as a range of life issues and potentially negative outcomes that may impact longitudinal development. Complicated grief, a disorder that has been studied primarily among adults, has received increasing recognition among children and adolescents in recent years. The demonstration of the distinctive character of grief reactions in relation to major depressive disorder and posttraumatic stress disorder has resulted in the inclusion of "persistent complex bereavement disorder" in an annex section of DSM-5 and of "prolonged grief disorder" in ICD-11. The grieving process in children and adolescents is not linear and is often characterised by periods of regression. Developmental phases should be taken into account to understand and clinically describe grief reactions occurring during childhood and adolescence. There are currently numerous interventions for bereaved children and adolescents, but little evidence to support them. More research focusing on the understanding of the underlying mechanisms and the risk factors for complicated grief among children and adolescents, as well as the implementation of evidence-based interventions, is definitely warranted.

Perioperative analgesia in pulmonary surgery.

AIM: In pulmonary surgery many studies have shown how pain associated with residual doses of anaesthetic drugs can cause a decrease in pulmonary volumes and depression of the cough reflex. Both these phenomena are responsible for a rising incidence of postoperative mortality and morbidity. The most widely used postoperative analgesic techniques are continuous systemic analgesia and epidural analgesia. The aim of this study is to verify the advantages and the disadvantages of both analgesic techniques. METHODS: Fifty patients, undergoing pulmonary surgery, were recruited and divided, after randomization into 2 groups. Patients included in A group received an epidural administration of naropina 0.2%+fentanyl 4 microg/mL by elastomeric pump (rate 5 ml/h). Patients included in B group received an ev continuous infusion of tramadol 600 mg+ketorolac trometamina 120 mg+ranitidina 200 mg+ondansetron 16 mg by elastomeric pump (rate 5 ml/h for 48 hours). RESULTS: Both groups showed good analgesic effects. Pain rest relief was between 3 and 1.7 points in group B and between 2.5 and 0.4 points in group A. Incident pain was 4.8 at awakening time and it decreased to 4 after 48 hours in group B while in group A it was from 3.2 to 1.8 in the same period of B group. CONCLUSIONS: Our data show that both analgesic techniques are able to guarantee a good rest pain relief after thoracotomy. Epidural analgesia showed more efficacy as far as incident pain relief but it was more difficult to realise and it showed less acceptance by patients.

Computer-based assessment of habitual mastication.

A computer-based system to assess mandibular movements and EMG masseter and temporal muscle activity during habitual mastication was applied to 12 healthy subjects and the chewing performance was tested with a standardized bolus of crisp bread. A Siemens Sirognatograph instrument was used to record mandibular movements while EMG signals were recorded with surface silver-silver electrodes. Software provided data of single chewing cycles in space and versus time, of mean mandibular displacement during opening and closing, mean velocity, and EMG activity. Clockwise and counterclockwise cycles were computed separately. The data obtained allow the following conclusions: Habitual mastication is a rhythmic event with different envelopes of motion that alternate characteristically in each subject. Each chewing cycle accomplishes several tasks but, depending on its envelope, is probably more oriented to a specific performance. A mean chewing cycle can be constructed for each individual. Its pattern depends on the distribution of different envelopes of motion that alternate during the masticatory sequence. During closure, a prevalently isotonic and a prevalently isometric phase of muscle contraction can be distinguished. Mean movement and EMG data for the whole group are not distributed at random, but according to a typical pattern. The system seems to be finalized to a well-balanced function and distribution of loads.