[Heart rate variability alteration in patients on chronic hemodialysis]. / Altération de la variabilité sinusale chez les malades en hémodialyse chronique.

BACKGROUND AND AIM: Decrease in heart rate variability (HRV) is a known risk factor for cardiovascular morbidity and mortality. The aim of our study is to evaluate HRV in chronic hemodialysis patients and to determine factors that might decrease or increase it. METHODS: This is a retrospective study including 51 patients, 23 males and 28 females, with a mean of age of 64.5 years (23-84 years) on chronic hemodialysis for end stage renal disease due to various causes. Twenty-four-hour heart rate monitoring was recorded in all patients to evaluate HRV. HRV of hemodialysis patients was compared to normal patients (control). We also looked for correlation between HRV and a number of clinical and biological factors. RESULTS: All HRV parameters were decreased in chronic hemodialysis patients compared to normal controls with a significant difference (p<0.0005). HRV decreases with age (p=0.012), and is lower in diabetic patients (p=0.026). Interestingly, we found that chronic hemodialysis patients on beta-blockers had higher HRV with p=0.011. CONCLUSION: HRV is reduced in chronic hemodialysis patients mainly in old and diabetic patients, but this decrease is less important in those receiving beta-blockers.

[Heart rate variability and vasovagal syncope]. / Intérêt de la variabilité sinusale dans la syncope vasovagale.

OBJECTIVE: Tilt Table testing is widely used for the diagnosis and evaluation of vasovagal syncope. By evaluating the fluctuations of the autonomic nervous system that play an important role in syncope genesis, heart rate variability (HRV) can be considered as a tool of added value. METHODS: We evaluated prospectively 123 patients admitted for recurrent syncope with a positive tilt Table testing. A time domain analysis of a 24 hours ambulatory electrocardiography was used in all patients to asses the particularities of their autonomic function. We compared their results with those obtained from a group of 82 healthy volunteers. RESULTS: Statistical analysis of the results showed a significant increase of all HRV parameters in the group of vasovagal syncope compared to the healthy volunteers. SDNNidx (58 vs 42; p < 0.001), rMSSD (40 vs 27; p < 0.001), SDNN (102 vs 83; p < 0.001), SDANN (79 vs 67; p< 0.001), pNN50 (11 vs 4.9; p <0.001). CONCLUSION: Time domain analysis of heart rate variability reveals increased values in patients with vasovagal syncope. It seems to be an interesting, easy and complementary test in the evaluation of syncope of unknown etiology.

Language impairment in Swedish bilingual children: a comparison between bilingual and monolingual children in Malmö.

UNLABELLED: In this study two groups of children were compared, 192 bilingual and 246 monolingual, referred over a 12-mo period to University Hospital in Malmö for suspected language impairment. Compared with monolingual children, bilingual children ran a significantly lower risk (RR = 0.76, p < 0.0001) of being referred by a child health centre, and a significantly higher risk (RR= 1.54, p < 0.0103) of being referred after 5 y of age. In the bilingual group there was also a significantly higher risk of parental refusal of assessment (RR = 2.35, p < 0.0016) and of the children being diagnosed with a severe language impairment (RR = 1.87, p < 0.0009). The risk for bilingual children with severe language impairment being discharged owing to non-attendance was high (RR = 6.20, p < 0.0002) compared to monolingual children. The risk increased with severity of language impairment. CONCLUSION: Bilingual children displayed a higher risk of a diagnosis of severe language impairment and of being discharged for non-attendance. The problem of low compliance among bilingual parents, despite strong indications of parental distress, must be addressed.

Risk factors for language impairment in Swedish bilingual and monolingual children relative to severity.

AIM: To explore potential risk factors for language impairment (LI) relative to degree of severity in bilingual and monolingual children. METHODS: Two groups of clinically assessed children were compared, 252 bilinguals whose parents were both non-Swedish and 446 monolinguals, who were referred over a period of 24 mo to the University Hospital in Malmö for suspected LI. RESULTS: A multivariate linear regression for both groups showed that two risk factors were the same: parental distress (p < 0.0001 in both groups) and short attention span (p < 0.0001 in both groups). Male gender (p < 0.0001) was an additional predictor for LI relative to degree of severity in the monolingual group. Specific risk factors for LI relative to degree of severity in the bilingual children were maternal arrival within 1 y in relation to birth (p < 0.002) and parental need for an interpreter after > 5 y in Sweden (p < 0.040). CONCLUSION: Most risk factors for LI relative to degree of severity in this study seemed to apply to both groups, although they sometimes appeared in another form in the bilingual group. Gender and possibly also hereditary factors seemed to need to interact with environmental factors to appear as risk factors for the bilingual children in this study.

The acquisition of Swedish as second language in a group of Arabic-speaking pre-school children: word order patterns and phrasal morphology.

Children with Swedish as a second language (L2) and Swedish children with specific language impairment (SLI) have displayed interesting similarities in their linguistic development. A group of 18 normally developed Arabic-speaking children, five and six years old, were tested with respect to their development of word order patterns and phrasal morphology in the noun phrase. The results were in accordance with Pienemann's processability theory, that predicts the order of acquisition of both morphological and syntactical structures. The results on word order patterns showed similarities between L2 and SLI children. Processability theory could be a powerful tool in analyzing the grammar in children with SLI.