Co-development of the CMAP Book: a tool to enhance children's participation in pediatric rehabilitation.

PURPOSE: The purpose of the co-development project was to create a tool that enhances children's active participation and agency in rehabilitation and in everyday life. MATERIALS AND METHODS: Action research was the methodological approach. Participants in the different phases of the process (2015-2017) were children with disabilities, parents and rehabilitation professionals. The co-development process included: (1) designing the tool's first version, (2) piloting the tool, (3) evaluating the tool by collecting feedback and reflection, (4) generating the tool's final version. RESULTS: Through the co-development process, an accommodating and digital tool called the CMAP Book-a description of the child's meaningful activities and participation-was developed. The CMAP Book is used with an electronic app enabling the identification and description of what is meaningful in daily life from the child's perspective with videos, photos, pictures, recording and writing. The tool enables the child, family and professionals to prepare and build collaboration in rehabilitation with flexibility according to child and family needs. CONCLUSIONS: Use of the CMAP Book promotes the active involvement of the child and parents in designing the rehabilitation process in daily life in partnership with professionals. The stakeholder involvement in the co-development facilitated meaningful results and a concrete tool for rehabilitation.IMPLICATIONS FOR REHABILITATIONThe CMAP book is a new tool that enhances the child's active participation and agency in the rehabilitation process based on meaningful activities in everyday life expressed by the child.Identifying and utilising meaningful issues in the child's daily life through collaboration increases the child's commitment and motivation, and thus may enhance the benefits and effects of rehabilitation. Through co-development, the child and his/her family can be active and equal partners not only in development projects but also in the rehabilitation process.In the future, child-specific practices and policies should be developed to promote participatory co-research between families and clinicians linked to the daily lives of families with children.

The use of Atlantic hagfish (Myxine glutinosa) as a bioindicator species for studies on effects of dumped chemical warfare agents in the Skagerrak. 1: Liver histopathology.

Within the framework of the international project DAIMON (Decision Aid for Marine Munitions), the impact of dumped chemical munitions on fish health was investigated. The Skagerrak Straight (North Sea, at 600 m depth) contains munitions with chemical warfare agents (CWA), scuttled after the end of World War II. Studies of liver histopathology in Atlantic hagfish (Myxine glutinosa) were carried out at three sampling sites: at a wreck with CWA in the Skagerrak (n = 82), a Skagerrak reference site considered to be free of CWA (n = 14) and at a reference site in the northern North Sea outside the Skagerrak (n = 17). Liver lesions were diagnosed and categorized according to standardized ICES and BEQUALM protocols and OSPAR guidelines. Non-specific liver lesions were found in 87.6% of 113 hagfish examined. The prevalence of pre-neoplastic lesions was 7.1% and of neoplastic lesions 6.2%. There was no statistically significant difference in prevalence between hagfish samples from the wreck site and from the reference site near the wrecks. However, at the reference site in the northern North Sea, the prevalence of non-specific lesions was low and neither pre-neoplastic nor neoplastic lesions were observed.

The use of Atlantic hagfish (Myxine glutinosa) as a bioindicator species for studies on effects of dumped chemical warfare agents in the Skagerrak. 2. Biochemical biomarkers.

The sea bottom of the Skagerrak Strait (North Sea) contains munitions loaded with chemical warfare agents (CWA), mostly stored in shipwrecks scuttled intentionally after the end of the World War II. The munition shells inside the wrecks are in different states of deterioration and corrosion and their environmental risk potential is unknown. The Atlantic hagfish (Myxine glutinosa), a sediment-dwelling chordate, was used as a model organism to study the potential impact of dumped CWA on the local ecosystem by using biochemical biomarkers. The hagfish were collected in 2017 and 2018 at three sampling sites: in the immediate vicinity of a wreck with CWA in the Skagerrak, a few kilometres from the wreck, and a reference site 21 km from the wreck, considered to be free of CWA. Significant differences were observed between the wreck site and the reference sites in the activities of glutathione reductase, superoxide dismutase and glutathione S-transferase, while the activity levels of catalase and acetylcholinesterase were identical at all sites. The recorded differences demonstrated negative biological effects in the hagfish sampled close to the dumped chemical munitions. Due to the limited knowledge of hagfish biology and of the extent of CWA contamination in Skagerrak, the results presented here warrant more research to further elucidate the potential environmental risks of the scuttled wrecks. The usefulness of the species as a bioindicator organism is further discussed.

Immunological responses in the mussel Mytilus trossulus transplanted at the coastline of the northern Baltic Sea.

The applicability of immune responses in transplanted Baltic blue mussels (Mytilus trossulus) as biomarkers of immunotoxic effects was studied at differently contaminated locations in the Gulf of Bothnia (northern Baltic Sea). Here, we present a detailed report on the immune responses measured as complementary part of transplantation study by Turja et al. (2014).Various immunological endpoints such as total and differential cell count, morphological alterations,phagocytic activity, and caspase 3/7 activity of mussel haemocytes as well as haemolytic activity of the haemolymph were used. Mussels collected at a reference site at a Finnish coastal site (Hanko, H) were transplanted at the Swedish coast near industrial and urban regions of the cities Sundsvall (S1, S2) and Gävle (G1, G2), respectively. Based on the measured immunological responses, multivariate statistical analysis (PCA biplot) showed a clear separation of the most polluted site S1, indicating immunotoxic impacts of the mixture of contaminants present at this location. Based on these observations and results from Turja et al. (2014), we suggest the implementation of immunotoxic biomarkers for the evaluation of ecosystem health. However, these should be accompanied by complementary endpoints of biological effects encompassing i.e., physiological, antioxidant and bioenergetic markers.

Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events: a nationwide prospective study.

OBJECTIVES: The long-term prognosis of individuals fulfilling the laboratory criteria, but not clinical criteria, of antiphospholipid syndrome (APS) has not been widely investigated. The primary aim of this study was to evaluate the incidence of first thrombotic event (deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), stroke or transient ischaemic attack (TIA) in a nationwide antiphospholipid antibody (aPL) carrier cohort. DESIGN: We conducted a prospective nationwide cohort study. SETTING: The aPL profile of participants was recorded from the laboratory database. Information was collected about thrombotic and pregnancy complications, subsequent medical history, other risk factors for thrombosis, use of prophylactic antithrombotic medication and general health. PARTICIPANTS: Participants included adult asymptomatic aPL carriers recognized in Finland during 1971-2009. MAIN OUTCOME MEASURE: The main outcome measure was incidence of first thrombotic event. RESULTS: A total of 119 (89% female) aPL carriers were followed for mean (SD) of 9.1 (7.5) years (range 3-41 years). Sixty-one per cent of the study participants had autoimmune disease, most often systemic lupus erythematosus (SLE). Thirty-six of 119 (30%) were either double or triple positive, 56% single lupus anticoagulant (LA) positive, and 8% and 5% single anticardiolipin antibodies (aCL) and anti-ß2glycoprotein I antibodies (aß2GPI) positive, respectively. Nine (7.6%) study patients experienced a first thrombotic event (five DVT, one PE, two MI, one TIA) mean (SD) 7.2 (8.3) years (range 1-26 years) after aPL detection (annual incidence rate 0.8%). All individuals who developed thrombotic complications had autoimmune disease. Annual rate of first thrombotic event in carriers of single positivity (0.65%) was equal to the known risk of thrombosis in the healthy Caucasian population, whereas the rate was two times higher in carriers of double or triple positivity (1.27%). Sixteen of 79 (20%) women experienced pregnancy complications. CONCLUSIONS: Double or triple positivity for aPL is a risk factor for future thrombotic events, especially in individuals with an underlying autoimmune disease, whereas single positivity does not seem to carry an elevated risk of thrombosis.

A multibiomarker approach to the assessment of pollution impacts in two Baltic Sea coastal areas in Sweden using caged mussels (Mytilus trossulus).

Blue mussels (Mytilus trossulus) were transplanted in cages for three months in two Swedish coastal areas in the Bothnian Sea (northern Baltic Sea) to investigate the interactions between analysed environmental chemicals and biological responses. A wide array of biological parameters (biomarkers) including antioxidant and biotransformation activity, geno-, cyto- and neurotoxic effects, phagocytosis, bioenergetic status and heart rate were measured to detect the possible effects of contaminants. Integrated Biomarker Response index and Principal Component Analysis performed on the individual biological response data were able to discriminate between the two study areas as well as the contaminated sites from their respective local reference sites. The two contaminated sites outside the cities of Sundsvall (station S1) and Gävle (station G1) were characterised by different biomarker response patterns. Mussels at station S1 showed a low condition index, increased heart rate recovery time and phagocytosis activity coinciding with the highest tissue concentrations of some trace metals, polycyclic aromatic hydrocarbons and organotins. At station G1 the highest organochlorine pesticide concentration was recorded as well as elevations in glutathione S-transferase activity, thiamine content and low lysosomal membrane stability. Significant variability in the geno- and cytotoxic responses and bioenergetic status was also observed at the different caging stations. The results obtained suggest that different chemical mixtures present in the study areas cause variable biological response patterns in organisms.

Exposure of Carcinus maenas to waterborne fluoranthene: accumulation and multibiomarker responses.

Fluoranthene (FLU) is a priority polycyclic aromatic hydrocarbon (PAH) commonly detected in estuarine sediments, water and biota. Despite this, information on FLU detection, accumulation and effects on marine crustaceans is scarce. This work investigated the accumulation of FLU in Carcinus maenas and the responses of several early-warning biomarkers after a 7-day laboratory exposure to five FLU concentrations (2.56 to 100 µg L(-1)). After exposure to FLU, sub-samples of the crabs' digestive gland and muscle were collected for biomarker determinations. The remaining digestive gland and muscle, together with the rest of the whole-body soft tissues, were analysed for FLU residues by gas chromatography-mass spectrometry (GC-MS). The biomarkers assessed were: i) the quantification of FLU-type compounds by fixed wavelength fluorescence (FF); ii) the activities of glutathione S-transferases (GST) and glutathione reductase (GR), and the levels of total glutathione (GT) and lipid peroxidation (LPO) for oxidative stress; iii) the activity of acetylcholinesterase (AChE) for neurotoxicity; iv) the activities of isocitrate dehydrogenase (IDH) and lactate dehydrogenase (LDH) enzymes, and total protein, glycogen and lipids as indicators of changes in energy metabolism and storage; and v) the lysosomal membrane stability (LMS) as a measure of cell damage. The results showed strong (R(2)>0.95) concentration-dependent accumulation of FLU residues (as measured by GC-MS) in the remaining whole-body soft tissues and of FLU-type compounds (as measured by FF) in the digestive gland and muscle. A strong positive linear relationship (R(2)=0.91) between FLU residues and FLU-type compounds was also found. Comparing to controls, activities of GST and GR were significantly higher in crabs exposed to ≥16 and ≥40 µg L(-1) FLU, respectively. TG levels and IDH activity showed a significant trend to increase with FLU concentrations whereas AChE activity exhibited the opposite trend. FF measurements in the digestive gland and muscle proved to be an expeditious cost-effective method to assess the uptake and availability of FLU and its metabolites in C. maenas. The results suggest that under continuous environmental exposure, FLU may enhance detoxification and anti-oxidant defences, and cause alterations in the aerobic energy pathway, as well as neuromuscular toxic effects that may increase C. maenas risk of predation.

Lower extremity isometric strength in children with juvenile idiopathic arthritis.

OBJECTIVE: The aim of this study was to measure lower extremity isometric strength in patients with juvenile idiopathic arthritis (JIA) and to evaluate the usefulness of an adjustable dynamometer chair in the clinical work. METHODS: Twenty-five children with JIA and 25 healthy, age-matched controls, aged 7-12 (mean age 10.1) were studied. The isometric maximal strength of knee and ankle muscles was measured on both sides using the dynamometer chair. Before and after the measurements the Children's Effort Rating Table (CERT) was used to assess physical effort and feelings of exertion during the measurements. RESULTS: In all the tested muscle groups, there was a trend towards lower muscle strength values in the patients with JIA but significant differences were found only in knee extension (at 80 degrees knee angle) on both sides and in ankle plantarflexion if both ankles had had arthritis. No difference was observed in perceived exertion between patients and controls, but both groups significantly sensed the exertion after the muscle strength measurement (mean exertion before, JIA/control 2.2/2.0, and after 5.9/5.8). CONCLUSION: Isometric muscle strength in children with JIA can be close to normal when the disease is not active. However, especially in knee extensors and ankle plantarflexors, muscle weakness may occur. From technical standpoint, an adjustable dynamometer chair can be used for assessment of isometric maximal strength in children with JIA.

Comparison of a Multidose Powder Inhaler Containing Beclomethasone Dipropionate (BDP) with a BDP Metered Dose Inhaler with Spacer in the Treatment of Asthmatic Patients.

OBJECTIVE: The clinical efficacy, tolerability and acceptability of a new multidose powder inhaler (MDPI) [Easyhaler((R)), Orion Pharma, Finland] containing a high dose (500 microg/dose) of beclomethasone dipropionate (BDP) were compared with those of BDP metered dose inhaler administered with a large volume spacer (MDI-spacer). PATIENTS AND STUDY DESIGN: Recruited patients were adult asthmatics currently receiving 800 to 1000 microg/day of inhaled corticosteroid. The dose of BDP during the study was 1000 mg/day. The study was an open, randomised, parallel-group multicentre study and included a 2-week run-in period followed by a 12-week treatment period. RESULTS: 74 patients were randomised to both groups. During the run-in period the mean morning peak expiratory flow (PEF) was 489 and 478 L/min in the MDPI and MDI-spacer groups, respectively. During the last 2 weeks of the study the morning PEF was 485 L/min in the MDPI group and 477 L/min in the MDI-spacer group. Asthma symptom scores and use of rescue medication were low in both groups. The median dose of histamine required to decrease forced expiratory volume in 1 second (FEV(1)) by 15% was 1.05mg in the MDPI group and 0.64mg in the MDI-spacer group. The most frequent adverse events were hoarseness and sore throat. Mean serum cortisol levels were not affected in either treatment group. Patients' personal opinion regarding acceptability of the devices clearly favoured the MDPI. CONCLUSION: In conclusion, the novel powder inhaler was well tolerated and at least equally effective compared with the conventional MDI-spacer combination in the treatment of asthma with BDP. However, in everyday use the patients clearly favoured the powder inhaler.

Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma.

BACKGROUND: In a previous study, we found that two years of treatment with an inhaled corticosteroid, budesonide, was more effective than treatment with an inhaled beta 2-agonist, terbutaline, in patients with newly diagnosed, generally mild asthma. We continued this study for a third year to investigate whether the steroid dose could be reduced or discontinued and what effect crossover of patients from beta 2-agonist therapy to corticosteroid therapy would have. METHODS: A total of 37 patients treated for two years with inhaled budesonide at a dose of 1200 micrograms per day were randomly assigned to treatment with 400 micrograms of budesonide per day (19 patients) or placebo (18 patients) in a double-blind manner. Another 37 patients, who had received terbutaline during the first two years, were crossed over in an open-label manner to treatment with 1200 micrograms of budesonide per day during the third year. RESULTS: Treatment with the reduced dose of budesonide was sufficiently effective in 74 percent of the patients to maintain bronchial responsiveness at a level similar to that achieved with the higher dose. In contrast, improvement was maintained in only 33 percent of the patients receiving placebo, and the differences in pulmonary function between the steroid and placebo groups were significant (for forced expiratory volume in one second, P = 0.007; for bronchial responsiveness to histamine, P = 0.025; and for peak expiratory flow in the morning, P = 0.040). The condition of patients who were crossed over from terbutaline therapy to treatment with 1200 micrograms of budesonide per day improved. However, the degree of improvement in these patients appeared to be less than in those who were treated with budesonide at the beginning of the three-year study. CONCLUSIONS: Early treatment with inhaled budesonide results in long-lasting control of mild asthma. Maintenance therapy can usually be given at a reduced dose, but discontinuation of treatment is often accompanied by exacerbation of the disease.

Projective drawings as an aid to music therapy.

Music therapy is becoming an increasingly prevalent method for assisting in the mental health needs of a variety of different conditions. However, other tangential aids can greatly facilitate the music therapy process. The use of Projectives techniques to assist in the process of music therapy and to assess the growth and development of clients is described.

Comparison of a beta 2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma.

BACKGROUND: The presence of airway inflammation even in mild asthma points to the potential value of antiinflammatory therapy. We compared the effect of an inhaled corticosteroid, budesonide, with that of an inhaled beta 2-agonist, terbutaline, in the long-term treatment of newly detected asthma. METHODS: We studied 103 patients (29 male and 74 female patients 15 to 64 years old) in whom asthma had appeared within the previous year. The patients were randomly assigned in blinded fashion to two treatment groups: one to receive 600 micrograms of inhaled budesonide twice a day, and the other to receive 375 micrograms of inhaled terbutaline twice a day. The study period was two years. RESULTS: After six weeks of treatment, the patients treated with budesonide tolerated inhaled histamine better than the patients treated with terbutaline (a difference of one doubling dose step, P less than 0.001), and the difference was sustained. Patients' diaries kept during the first three months of the study and during the last month of the first and second years showed budesonide to be more effective than terbutaline in improving peak expiratory flow in the morning (average increase from the pretreatment value, 32.8 liters per minute for budesonide vs. 4.8 liters per minute for terbutaline; P less than 0.001) and in the evening (P less than 0.01). Budesonide was also more effective in reducing the symptoms of asthma (P less than 0.01) and the use of supplemental beta 2-agonist medication (P less than 0.01). Ten patients were withdrawn from the terbutaline group because treatment was insufficiently effective, whereas only one dropped out of the budesonide group. The adverse reactions to both treatments were few and mild. CONCLUSIONS: Antiinflammatory therapy with inhaled budesonide is an effective first-line treatment for patients with newly detected, mild asthma, and it is superior to the use of terbutaline in such patients.

Practical principles of the prevention of occupational eye injuries.

The prevention of eye accidents is one part in the whole field of occupational safety which can be carried out in the most clear-cut manner. Solution patterns are easily mapped out and applied to use. Eye accidents occur mostly in the metal industry but are spreading through the whole field of industry from year to year. The principles of the prevention of eye accidents can be applied as an example for many other branches of occupational safety and thus models of functions created by the enterprise for sight protection can be projected to other prevention points.