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Η εφαρμογή κηδεμόνα αποτελεί την πιο αποτελεσματική, μη χειρουργική, μέθοδο αντιμετώπισης μετρίων παραμορφώσεων της σπονδυλικής στήλης στους εφήβους. Φαίνεται όμως να έχει σημαντικές επιπτώσεις στην καθημερινή δραστηριότητα των εφήβων. Με την παρούσα μελέτη διερευνήθηκε η αυτοεκτίμηση της κατάστασης της υγείας των εφήβων με τις δύο πιο κοινές παραμορφώσεις της σπονδυλικής στήλης, οι οποίες αντιμετωπίστηκαν με την χρήση κηδεμόνα. Σε εβδομήντα εννέα εφήβους με παραμόρφωση σπονδυλικής στήλης ( ιδιοπαθής σκολίωση, θωρακική κύφωση Scheuermann ) και εξήντα δύο εφήβους χωρίς παραμόρφωση της σπονδυλικής στήλης (ομάδα ελέγχου) τους ζητήθηκε και συμπλήρωσαν το ερωτηματολόγιο Quality Of Life Profile for Spine Deformities. Η παρούσα μελέτη έδειξε ότι οι έφηβοι με παραμόρφωση της σπονδυλικής στήλης είναι, στατιστικώς σημαντικά, λιγότερο πιθανόν να έχουν πόνο στην ράχη όταν αθλούνται σε σχέση με την ομάδα ελέγχου αλλά περισσότερο πιθανό να έχουν δυσκολίες τόσο όταν σκύβουν όσο και στις καθημερινές δραστηριότητές τους και ενώ φορούν τον κηδεμόνα. Οι έφηβοι αυτοί ( με την παραμόρφωση) παραπονούνται ότι ξυπνούν εξ’ αιτίας πόνου στην ράχη και εκνευρίζονται με την εξωτερική τους εμφάνιση. Οι ασθενείς αυτοί αντιμετωπίζουν, συχνά, προβλήματα στις σχέσεις με τους φίλους τους ενώ αναφέρουν δυσκολίες κατά την έγερσή τους από το κρεβάτι αλλά και στον ύπνο κατά τη διάρκεια της νύχτας, συγκριτικά με τους εφήβους χωρίς παραμόρφωση. Επιπλέον καθώς μεγαλώνουν ηλικιακά αισθάνονται μεγαλύτερη ντροπή για το σώμα τους και ανησυχούν για το μελλοντικό αποτέλεσμα της παραμόρφωσης. Όσο δε ο συνολικός χρόνος 56 εφαρμογής του κηδεμόνα αυξάνεται οι έφηβοι με παραμόρφωση έχουν περισσότερες πιθανότητες να εμφανίσουν μειωμένο πόνο στην οσφύ σε σχέση με τους εφήβους της ομάδας ελέγχου. Τα κορίτσια συγκρινόμενα με τα αγόρια, στις ομάδες με παραμόρφωση, έχουν περισσότερες πιθανότητες να εμφανίσουν πόνο στην οσφύ μετά από τις καθημερινές δραστηριότητες στο σπίτι ή μετά από την γυμναστική. Οι ασθενείς με τα μεγαλύτερα κυρτώματα δυσκολεύονται πιο πολύ στο να σκύψουν ενώ πονούν πιο συχνά στην ράχη. Οι ψυχολογικές επιπτώσεις από τη εφαρμογή του κηδεμόνα στους εφήβους με παραμόρφωση της σπονδυλικής τους στήλης σχετίζονται κυρίως με τις συναναστροφές των παιδιών στο χώρο του σχολείου και σε συνδυασμό με τον πόνο στην ράχη αποτελούν τις κυριότερες αιτίες χαμηλής συμμόρφωσης. Λεπτομερείς συστάσεις και ψυχολογική υποστήριξη απαιτείται για όλους τους ασθενείς που υποβάλλονται σε θεραπεία με κηδεμόνα ενώ κρίνεται απαραίτητη και η σωματική άσκηση, ιδιαίτερα για τα μεγαλύτερης ηλικίας κορίτσια και όλα αυτά με σκοπό να επιτευχθεί η καλύτερη δυνατή συμμόρφωση στην θεραπεία. / Bracing is the most effective non-operative treatment for mild progressive spinal deformities in adolescence but it has shown a considerable impact on several aspects of adolescents’ functioning. This cross-sectional study investigated the self-perceived health status of adolescents with the two most common deformities, treated with body orthosis. Seventy-nine adolescents with spinal deformities (idiopathic adolescent scoliosis, thoracic Scheuermann kyphosis) and 62 adolescents without spinal deformities were asked to complete the Quality of Life profile for Spine Deformities Instrument. This study showed that adolescents with deformities are significantly less likely to have back pain in training than controls, but more likely to have difficulty in forward bending, and in the most common daily activities while in brace. These individuals claim they wake up because of back pain and feel quite nervous with the external appearance of their body. These patients face often problems with their relations with friends, while they reported difficulties in getting up from bed and sleep at night more often than their counterparts without deformities. As they grow older, patients feel increasing ashamed of their body, as they are more concerned about the future effect of the deformity on their body. As the bracing time increases, patients have much more probability than controls to get low back pain. Girls with deformity have a higher probability than boys to get low back pain while working in the house and while training. Individuals 57 with larger spinal curvatures have more difficulties in bending and increased incidence of back pain than their counterparts with smaller curvatures. Psychological reasons associated mainly with relations at school and back pain are the main causes for low compliance in adolescents with spinal deformities treated with body orthosis. Careful instructions for all individuals who will undergo brace therapy, psychological support for all patients who develop psychological reactions and physical training particularly for older girls should be recommended to increase bracing compliance

BACKGROUND: Parents of children with juvenile idiopathic arthritis (JIA) are often forced to make trade-offs between the effectiveness, convenience, safety, and cost of drug treatments for their child. METHODS: A discrete choice experiment was administered to parents of children with JIA to determine their preferences for drug treatments. Multinomial logit regression was used to estimate part-worth utilities and willingness-to-pay. RESULTS: Participation in daily activities was the most important attribute, followed by child reported pain. Child age, gender, years with JIA, and household income had the greatest impact on preferences. Parents’ were willing to pay $2,080 to switch from a drug representing methotrexate to etanercept (95% CI $698, $4,065). CONCLUSIONS: Parents of children with JIA have the highest maximum willingness-to-pay for drug treatments that improve daily functioning and reduce pain. Cost is a significant factor in the decisions that parents make surrounding the best treatment for a child.

BACKGROUND: Parents of children with juvenile idiopathic arthritis (JIA) are often forced to make trade-offs between the effectiveness, convenience, safety, and cost of drug treatments for their child. METHODS: A discrete choice experiment was administered to parents of children with JIA to determine their preferences for drug treatments. Multinomial logit regression was used to estimate part-worth utilities and willingness-to-pay. RESULTS: Participation in daily activities was the most important attribute, followed by child reported pain. Child age, gender, years with JIA, and household income had the greatest impact on preferences. Parents’ were willing to pay $2,080 to switch from a drug representing methotrexate to etanercept (95% CI $698, $4,065). CONCLUSIONS: Parents of children with JIA have the highest maximum willingness-to-pay for drug treatments that improve daily functioning and reduce pain. Cost is a significant factor in the decisions that parents make surrounding the best treatment for a child.

The aim of the current study is to investigate novel therapeutic/treatment methods and outcome measurement for children with Idiopathic Toe Walking (ITW). Fifteen typically developing (TD) children and 15 children with ITW, aged between 4 to 10 years old, participated. The participants performed a gait exam including 30 barefoot walking trials over three 4-meter walkways before and after a whole-body vibration intervention. Vibration perception threshold tests were also conducted before and after the vibration intervention. In the gait exams, each of the walking surfaces represented a different tactile stimulus and the vibration intervention included standing on a whole body vibration platform for 60 seconds. Kinematics were collected at 100 Hz with a seven-camera 3-D motion analysis system. Walking surface and vibration intervention were the independent variables. Temporal-spatial gait parameters such as velocity, cadence, step length, and step width were measured. Heel rise occurrence (HR32) and vibration perception threshold (VPT) were also calculated as dependent variables. Walking surface significantly altered the gait parameter of both TD children and children with ITW. Vibration intervention altered the VPT scores of both TD children and children with ITW. Manipulated surface and excessive vibration may be important in the development of therapeutic/treatment methods for children with Idiopathic Toe Walking. HR32 is a novel calculation designed to distinguish on aspect of the toe-walking gait pattern. It significantly identified toe-walking patterns and quantified treatment results. Children with ITW appeared to have less toe-walking on the gravel surface. Walking on gravel surface is a potential novel method to reduce toe-walking immediately with no negative after-effects.

Die Allergische Rhinitis als Allergie vom Typ I (Soforttyp) ist nicht nur in Deutschland und Europa weit verbreitet, sondern eine weltweit auftretende Erkrankung. Als Verursacher werden neben bereits bekannten Aeroallergenen wie Hausstaubmilben, Gräser oder Pollen auch luftgetragene Algen diskutiert, die als möglichen Mechanismus über eine T-Zell-abhängige Stimulation Antigen-bindender B-Zellen zur IgE-Produktion führen. Diese Arbeit befasst sich mit der Untersuchung des allergenen Potentials der luftgetragenen Algenspezies S. bacillaris, T. aeria und X. montanum. Dafür wurden mittels direkter und indirekter Sandwich-ELISA-Verfahren Seren von Patienten mit der Diagnose Allergische Rhinitis oder Idiopathische Rhinitis auf enthaltene IgE-Antikörper getestet, die spezifisch an festphasengebundene Algenproteine binden. Des Weiteren wurden Kompetitionstestungen zur Untersuchung der Kreuzhemmbarkeit der drei Algen sowie SDS-Gelelektrophoresen und Western Blots zur Bestimmung der Molmasse der Algenproteine und zum Nachweis der Spezifität des algenbindenden IgEs durchgeführt. Die Ergebnisse belegen, dass die getesteten Algenproteine in der Lage sind, eine entsprechende Immunantwort mit IgE-Produktion auszulösen. Diese neue Gruppe von Allergenen konnte hinsichtlich der Entstehung einer Allergie vom Soforttyp und der damit verbundenen klinischen Bedeutung bewertet werden.

Idiopathic Parkinson’s disease (IPD) is the second most common neurodegenerative disease, yet effective disease modifying treatments are still lacking. Neurodegeneration involves multiple interacting pathological pathways. The extent to which neurovascular mechanisms are involved in IPD is not well defined. Indeed within the umbrella term of IPD great heterogeneity of motor (and non-motor) features exists, suggesting that different phenotypes may have differing underlying pathophysiologies. We aimed to determine whether novel magnetic resonance imaging (MRI) techniques can reveal changes in structural or physiological neurovascular measures, herein also referred to as ‘altered neurovascular status (NVS)’, in IPD.Based on preliminary data from our initial exploratory study in a small IPD cohort, phenotypic differences in structural and physiological MRI measures of NVS were investigated in a larger study. The 3 Tesla (3T) MRI protocol included T2-weighted fluid-attenuated inversion recovery (FLAIR) imaging to assess white matter lesion (WML) burden, arterial spin labelling (ASL) measurements of cerebral blood flow (CBF) and arterial arrival time (AAT) and dynamic contrast enhanced (DCE) measures of blood-brain barrier (BBB) integrity. Analysis was undertaken of IPD clinical phenotypes, by comparison with two control groups. In total, fifty-one patients with IPD (mean age 69.0 ± 7.7 years) (21 tremor dominant [TD], 24 postural instability and gait disorder [PIGD] and 6 intermediates) were compared with 2 control groups, the first comprising 18 control positive (CP) subjects with a history of clinical cerebrovascular disease (CVD) (mean age 70.1 ± 8.0 years) and the second comprising 34 control negative (CN) subjects without a history of clinical CVD (mean age 67.4 ± 7.6 years). IPD patients showed diffuse regions of significantly prolonged AAT and lower CBF by comparison with CN subjects, and a few regions of prolonged AAT by comparison with CP subjects, despite significantly fewer vascular risk factors. TD patients showed regions of significantly prolonged AAT and lower WML volume by comparison with PIGD patients. IPD patients also showed increased leakiness of the BBB in basal ganglia regions compared to the CN group, with a similar pattern in both IPD phenotypes. These data provide evidence of altered NVS in IPD, with IPD phenotype specific differences.

OBJECTIVE: The objective of this study is to determine the different biological, psychological, and social factors that affect patient adherence in bracing treatment for adolescent idiopathic scoliosis. By comparing adherent and non-adherent bracing patients, we hope to gain insight into how to improve patient adherence in bracing as a means of primary treatment and to avoid secondary and tertiary treatments such as surgery. METHODS: Of the 19 patients (15 adherent, 4 non-adherent) who were examined for this study, the majority of them completed all psychosocial surveys at one time point in their bracing treatment. Patients answered surveys for multidimensional anxiety, generalized anxiety, pain-related fear and avoidance, pain catastrophizing, and quality of life. Quantitative sensory testing was performed on only 5 of the 19 patients at the time of writing. Sensory testing was conducted to gather information on thermal sensitivities and thresholds. Statistical t-test significance was determined for all surveys distributed to adherent and non-adherent bracing groups, and scaled T-scores were calculated for each survey measure to determine clinical significance. RESULTS: There were no statistically significant differences in any measures examined between adherent and non-adherent bracing patients. The only statistically significant difference was the number of hours of brace wearing, with the adherent group wearing their brace over 11 hours more than the non-adherent group (p < 0.0004). CONCLUSIONS: Because of the underpowered nature of this study, measures for multidimensional anxiety, generalized anxiety, pain-related fear and avoidance, pain catastrophizing, and quality of life should be reexamined for potential differences between adherent and non-adherent bracing patients. Quantitative sensory testing should be included as a measure of possible sensory differences between the two groups. A future study with a larger sample size may provide greater understanding into the motivations for bracing adherence in an effort to help patients avoid more invasive means of intervention in treating adolescent idiopathic scoliosis.

Made available in DSpace on 2015-07-22T20:50:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-26. Added 1 bitstream(s) on 2015-08-11T03:26:19Z : No. of bitstreams: 1 Publico-140.pdf: 1558335 bytes, checksum: f630d19bbd2da038c706fccd9f88d5f9 (MD5) / Introdução: A escoliose idiopática do adolescente é uma das doenças infantis mais freqüentes, no entanto a sua etiologia permanece desconhecida. Estudos familiares são realizados na tentativa de mapear uma região cromossômica ligada a esta doença. Objetivos: Estudar os aspectos genéticos e pesquisar regiões cromossômicas relacionadas à escoliose idiopática do adolescente em uma família brasileira com múltiplos membros afetados Métodos: Avaliamos 56 membros, distribuídos em quatro gerações, de uma família brasileira com nove indivíduos portadores de escoliose idiopática do adolescente. A probanda apresentava curva escoliótica de 75 graus, mensurada pelo método Cobb. O critério para caracterização como afetado pela doença foi a presença de uma radiografia frontal, em ortostáse, demonstrando curva maior do que 15 graus. Após a assinatura do Termo de Consentimento Livre e Esclarecido, os indivíduos foram submetidos à coleta de sangue periférico para extração de DNA genômico e subsequente análise de ligação, utilizando marcadores microssatélites pertencentes à ABI PRISM® Linkage Mapping Set Version 2 (Applied Biosystems). Resultados: Não foi possível localizar uma região cromossômica ligada à escoliose idiopática do adolescente, na família estudada. Conclusão: Não foi possível, por meio do estudo de ligação genética, encontrar uma região cromossômica responsável pela escoliose idiopática do adolescente, ao analisar quatro gerações de uma família brasileira, com múltiplos membros afetados. / Introduction: The etiology of idiopathic scoliosis remains unknown and different factors have been suggested as causal. Hereditary factors can also determine the etiology of the disease; however, the pattern of inheritance remains unknown. Other studies have suggested possible chromosome regions related to the etiology of idiopathic scoliosis. Objetive: To study the genetic aspects and investigate chromosome regions for adolescent idiopathic scoliosis in a Brazilian family. Methods: Evaluation of 56 family members, distributed over 4 generations of a Brazilian family, with 9 carriers of adolescent idiopathic scoliosis. The proband presented a scoliotic curve of 75 degrees, as determined by the Cobb method. Genomic DNA from family members was genotyped. Results: Locating a chromosome region linked to adolescent idiopathic scoliosis was not possible in the family studied. Conclusion: While it was not possible to determine a chromosome region responsible for adolescent idiopathic scoliosis by investigation of genetic linkage using microsatellites markers during analysis of four generations of a Brazilian family with multiple affected members. / TEDE / BV UNIFESP: Teses e dissertações