Evolutionary roots of the risk of hip fracture in humans.

The transition to bipedal locomotion was a fundamental milestone in human evolution. Consequently, the human skeleton underwent substantial morphological adaptations. These adaptations are responsible for many of today's common physical impairments, including hip fractures. This study aims to reveal the morphological changes in the proximal femur, which increase the risk of intracapsular hip fractures in present-day populations. Our sample includes chimpanzees, early hominins, early Homo Neanderthals, as well as prehistoric and recent humans. Using Geometric Morphometric methods, we demonstrate differences in the proximal femur shape between hominids and populations that practiced different lifestyles. We show that the proximal femur morphology is a risk factor for intracapsular hip fracture independent of osteoporosis. Changes in the proximal femur, such as the shortening of the femoral neck and an increased anterolateral expansion of the greater trochanter, are associated with an increased risk for intracapsular hip fractures. We conclude that intracapsular hip fractures are a trade-off for efficient bipedal walking in humans, and their risk is exacerbated by reduced physical activity.

Changes in human mandibular shape during the Terminal Pleistocene-Holocene Levant.

The transition to food production, exploitation of 'secondary' products (e.g., milk), and advances in cookware technology have affected all aspects of human life. The aim of the present study was to follow changes in mandibular form and shape throughout the terminal Pleistocene-Holocene Levant. The hemimandibles of four populations were included in this study: Natufian hunter-gatherers (n = 10), Pre-pottery Neolithic early farmers (n = 6), Chalcolithic farmers (n = 9), Roman-Byzantine (n = 16), and modern (n = 63) populations. A surface mesh of each mandible was reconstructed from CT or surface scans. Changes in mandibular form and shape were studied using the Procrustes-based geometric morphometrics method. Univariate and multivariate analyses were carried out to examine differences in size and shape between the studied populations. Our results reveal considerable temporal changes in mandibular shape throughout the Holocene Levant, mainly between the pre-agricultural population (the Natufian) and the succeeding ones, and between the post-industrial (the Modern) and the pre-industrial populations. A tendency for a reduction in mandibular size was identified between the pre-agricultural population and the farmers. Most regions of the mandible underwent shape changes. In conclusion, substantial changes in mandibular shape occurred throughout the Holocene Levant, especially following the agricultural revolution. These changes can be explained by the "masticatory-functional hypothesis".

Development of an International Odor Identification Test for Children: The Universal Sniff Test.

OBJECTIVE: To assess olfactory function in children and to create and validate an odor identification test to diagnose olfactory dysfunction in children, which we called the Universal Sniff (U-Sniff) test. STUDY DESIGN: This is a multicenter study involving 19 countries. The U-Sniff test was developed in 3 phases including 1760 children age 5-7 years. Phase 1: identification of potentially recognizable odors; phase 2: selection of odorants for the odor identification test; and phase 3: evaluation of the test and acquisition of normative data. Test-retest reliability was evaluated in a subgroup of children (n = 27), and the test was validated using children with congenital anosmia (n = 14). RESULTS: Twelve odors were familiar to children and, therefore, included in the U-Sniff test. Children scored a mean ± SD of 9.88 ± 1.80 points out of 12. Normative data was obtained and reported for each country. The U-Sniff test demonstrated a high test-retest reliability (r27 = 0.83, P < .001) and enabled discrimination between normosmia and children with congenital anosmia with a sensitivity of 100% and specificity of 86%. CONCLUSIONS: The U-Sniff is a valid and reliable method of testing olfaction in children and can be used internationally.

Maternal cognitions and depression in childhood behavioral insomnia and feeding disturbances.

OBJECTIVES: To investigate (1) maternal cognitions regarding infant's sleep and feeding and maternal depression among mothers of children with behavioral insomnia, feeding disturbances and healthy controls, and (2) the association between maternal cognitions about sleep and those about feeding. METHODS: Children 6-36 months of age with either behavioral insomnia or feeding disorders were recruited. Children 6-36 months of age who attended the well-baby clinics were recruited and served as controls. The participants' mothers completed three questionnaires on their cognitions/perceptions of their child's sleep and feeding habits and about their own feelings of depression. RESULTS: A total of 230 children (31 with behavioral insomnia, 29 with feeding disorders, 170 controls) were enrolled. Their mean age was 16.1 ± 7.6 months. Maternal cognitions/perceptions about sleep (maternal cognition infant sleep questionnaire, MCISQ) did not differ significantly between the behavioral insomnia group and the feeding disorders group. The MCISQ score was significantly higher in the behavioral insomnia group compared with controls (P < .02). Mothers of children with feeding disorders reported being significantly more frustrated or anxious when they fed their child (P < .0005), less confident about their child getting enough food (P < .0005), and less confident in their ability to manage their child's behavior at mealtime (P < .02) compared to the controls. Significant positive correlations were found between the MCISQ scores and the Beck Depression Inventory scores (r = 0.29, P < .0002), and between the MCISQ scores and the maternal cognitions of their child's feeding scores (r = 0.26, P < .0002). The latter remained significant after controlling for maternal depression (r = 0.25, P < .002). CONCLUSIONS: Mothers of children with either behavioral insomnia or feeding disorders differ significantly from mothers of controls regarding their cognitions about sleep and feeding. Maternal cognitions about infant sleep behavior correlated with their cognitions about infant feeding. Maternal cognitions are a modifiable factor that may serve as a target for intervention in both sleep and feeding disorders in children.

Coexistence of sleep and feeding disturbances in young children.

OBJECTIVE: Behavioral insomnia and feeding difficulties are 2 prevalent conditions in healthy young children. Despite similarities in nature, etiology, prevalence, and age distribution, the association between these 2 common disorders in young children has not been examined thus far. PATIENTS AND METHODS: Children aged 6 to 36 months with either behavioral insomnia or feeding disorders were recruited. Children aged 6 to 36 months who attended the well-care clinics were recruited and served as controls. Sleep and feeding were evaluated by using a parental questionnaire. RESULTS: Six hundred eighty-one children were recruited. Fifty-eight had behavioral insomnia, 76 had feeding disorders, and 547 were controls. The mean age was 17.0 ± 7.6 months. Parents of children with feeding disorders considered their child's sleep problematic significantly more frequently compared with controls (37% vs 16%, P = .0001 [effect size (ES): 0.66]). They reported shorter nocturnal sleep duration and delayed sleep time compared with controls (536 ± 87 vs 578 ± 88 minutes, P = .0001) and 9:13 ± 0.55 PM vs 8:26 ± 1.31 PM, P = .003). Parents of children with behavioral insomnia described their child's feeding as "a problem" more frequently compared with controls (26% vs 9%, P = .001 [ES: 0.69]). They reported being more concerned about their child's growth (2.85 ± 1.1 vs 2.5 ± 1.0, P = .03) and reported higher scores of food refusal compared with controls (3.38 ± 0.54 vs 3.23 ± 0.44, P = .04). CONCLUSIONS: Problematic sleep and feeding behaviors tend to coexist in early childhood. Increased awareness of clinicians to this coexistence may allow early intervention and improve outcome.

[Ingestion of an open safety pin--challenging treatment].

A 9 month old girl at the emergency room appeared with an acute onset of restlessness, drooling and suspected foreign body ingestion. An X-Ray revealed an open safety pin in the child's upper aero-digestive tract. The source of the safety pin was a "Hamsah" good luck charm that was attached to her bed. Open safety pins in the aero-digestive tract are difficult to manage and great care must be taken during removal to prevent further injury. Parents should be counseled regarding the presence of safety pins in the child's surroundings in order to prevent such hazards.