Two Patients with Spastic Cerebral Palsy Complicating Cervical Spondylotic Myelopathy：Not Only Athetoid Type / The Japanese Journal of Rehabilitation Medicine

We report two cases of spastic cerebral palsy classified as diplegia-type complicated cervical spondylotic myelopathy. Under the Gross Motor Function Classification System (GMFCS), both were classified as Level IV, defined as standing with support, but with difficultly, after the diagnosis of cervical spondylotic myelopathy. Paralysis in both the upper and lower limbs deteriorated and became a form of quadriplegia. In one case, there was no appeal from the patient even after the manifestation of symptoms；diagnosis and surgery were both time consuming, with no improvements in post-operative symptoms including urinary incontinence. In the other case, early diagnosis was possible and operation was scheduled early. The post-operative response was positive, and the patient was able to recover to pre-cervical spondylotic myelopathy conditions. Complications of cervical spondylotic myelopathy is well-known in the athetosis type；however, reports on the spastic type are limited. Here, we report complications of cervical spondylotic myelopathy in spastic cerebral palsy and show that early detection and surgery are important factors in mitigating long-term recovery.

Two Patients with Spastic Cerebral Palsy Complicating Cervical Spondylotic Myelopathy：Not Only Athetoid Type / The Japanese Journal of Rehabilitation Medicine

We report two cases of spastic cerebral palsy classified as diplegia-type complicated cervical spondylotic myelopathy. Under the Gross Motor Function Classification System (GMFCS), both were classified as Level IV, defined as standing with support, but with difficultly, after the diagnosis of cervical spondylotic myelopathy. Paralysis in both the upper and lower limbs deteriorated and became a form of quadriplegia. In one case, there was no appeal from the patient even after the manifestation of symptoms；diagnosis and surgery were both time consuming, with no improvements in post-operative symptoms including urinary incontinence. In the other case, early diagnosis was possible and operation was scheduled early. The post-operative response was positive, and the patient was able to recover to pre-cervical spondylotic myelopathy conditions. Complications of cervical spondylotic myelopathy is well-known in the athetosis type；however, reports on the spastic type are limited. Here, we report complications of cervical spondylotic myelopathy in spastic cerebral palsy and show that early detection and surgery are important factors in mitigating long-term recovery.

Association between exposure to household smoking and dental caries in preschool children: a cross-sectional study

BACKGROUND@#We aimed to examine the association of exposure to environmental tobacco smoke with dental caries among preschool children. Exposure to environmental tobacco smoke was assessed in terms of urinary cotinine concentrations and pack-years of exposure to smoking by parents and other family members at home.@*METHODS@#This cross-sectional study included 405 preschool children aged 3-6 years from two preschools in Japan in 2006. Information on the smoking habits of family members living with the child was obtained from parent-administered questionnaires. Dental examination was conducted to assess dental caries, that is, decayed and/or filled teeth. Urinary cotinine levels were measured using first-void morning urine samples.@*RESULTS@#Overall, 31.1% of the children had dental caries, and 29.5% had decayed teeth. Exposure to current maternal and paternal smoking was positively associated with the presence of dental caries after controlling for covariates. More than three pack-years of exposure to maternal smoking and more than five pack-years of exposure to smoking by all family members were significantly associated with the presence of dental caries as compared with no exposure (odds ratio [OR] = 5.55, 95% confidence interval [CI] = 2.17-14.22, P for trend < 0.001 and OR = 2.00, 95% CI = 1.12-3.58, P for trend = 0.004, respectively). These exposure variables were similarly associated with the presence of decayed teeth (OR = 2.92, 95% CI = 1.23-6.96, P for trend = 0.01 and OR = 1.75, 95% CI = 0.96-3.20, P for trend = 0.03, respectively). As compared with lowest tertile of the urinary cotinine level, the highest tertile of the urinary cotinine level was significantly associated with the presence of dental caries as well as decayed teeth; the ORs for the highest vs. lowest tertile of urinary cotinine levels were 3.10 (95% CI = 1.71-5.63, P for trend = 0.012) and 2.02 (95% CI = 1.10-3.70, P for trend = 0.10), respectively.@*CONCLUSIONS@#These data suggest that exposure to tobacco smoke may have a dose-dependent influence on the development of caries.

Understanding the factors associated with initiation and adherence of osteoporosis medication in Japan: An analysis of patient perceptions

OBJECTIVES: This study aimed to identify factors associated with initiation and adherence of osteoporosis medication from a patient perspective. METHODS: A web-based survey was developed based on health behavior theories. Descriptive analyses were conducted for all survey items. Analyses in a structural equation modeling framework were conducted to identify factors associated with treatment initiation and adherence. RESULTS: Five hundred forty-five women completed the questionnaire. A majority were currently receiving medications for osteoporosis (n = 376, 69.0%) and 25.0% of these patients (n = 94) were considered adherent to their treatment. Knowledge was strongly associated with osteoporosis treatment initiation (standard error [SE], 0.58). Greater knowledge of disease was associated with increased likelihood of initiating medication. Medication complexity (SE, 0.49) and perceived susceptibility to fracture and loss of independence (SE, −0.37) were also associated with initiation. Perceived barriers (SE, −0.85) such as inconvenience, lack of efficacy and financial burden were observed to be the greatest obstacle to adherence. The greater the perceived barriers, the less likely patients were to adhere to medication. Patients' perception of self-efficacy (SE, 0.37) also affected adherence. The greater the patient perception of ability to independently manage their medication, the more likely they were to adhere to the medication. CONCLUSIONS: Different factors were found to be associated with initiation and adherence of osteoporosis medication. Patient knowledge of their disease and the perception of barriers were found to be the most influential. Empowering patients with the knowledge to better understand their disease and decreasing the perception of barriers through education initiatives may be effective in improving patient outcomes.