Patient factors associated with delayed diagnosis of developmental dysplasia of the hip.

PURPOSE: Early detection and intervention for developmental dysplasia of the hip (DDH) is important for normal hip development. Previous studies have shown disparities in access to paediatric specialty care among different racial and socioeconomic backgrounds. This study aims to identify whether these factors are related to timely referral for infants with DDH. METHODS: A retrospective cohort study of patients seen and treated for DDH between July 2006 and June 2011 at a single institution were reviewed. The patients were divided into early-presenting (seen before six months of age) and late-presenting patients (seen at six months of age or later). RESULTS: A total of 457 patients met the eligibility criteria. There were 378 early and 79 late presentations. Late presentations were significantly more likely to be vertex at birth (85% vs 41%, p < 0.001). Bivariate analysis also demonstrated that late presentations were more likely to be non-white (65% vs 45%, p = 0.004), non-English speaking (20% vs 8%, p = 0.003), from lower income areas ($70 769 vs $61 591, p < 0.001) and hold public insurance (25%, p = 0.001). However, a logistic multiple regression analysis showed that only vertex birth presentation (p = 0.000), absent family history of DDH (p = 0.047) and affected right side (p = 0.001) were significantly associated with late presentation. CONCLUSION: Despite screening algorithms to facilitate early diagnosis of infants with DDH, better research is needed to understand how different demographic and socioeconomic factors play into the delayed access to paediatric orthopaedic care for DDH so that we may ultimately improve rates of early treatment.

Dimensional depression severity in women with major depression and post-traumatic stress disorder correlates with fronto-amygdalar hypoconnectivty.

Depressive symptoms are common in multiple psychiatric disorders and are frequent sequelae of trauma. A dimensional conceptualization of depression suggests that symptoms should be associated with a continuum of deficits in specific neural circuits. However, most prior investigations of abnormalities in functional connectivity have typically focused on a single diagnostic category using hypothesis-driven seed-based analyses. Here, using a sample of 105 adult female participants from three diagnostic groups (healthy controls, n=17; major depression, n=38; and post-traumatic stress disorder, n=50), we examine the dimensional relationship between resting-state functional dysconnectivity and severity of depressive symptoms across diagnostic categories using a data-driven analysis (multivariate distance-based matrix regression). This connectome-wide analysis identified foci of dysconnectivity associated with depression severity in the bilateral amygdala. Follow-up seed analyses using subject-specific amygdala segmentations revealed that depression severity was associated with amygdalo-frontal hypo-connectivity in a network of regions including bilateral dorsolateral prefrontal cortex, anterior cingulate and anterior insula. In contrast, anxiety was associated with elevated connectivity between the amygdala and the ventromedial prefrontal cortex. Taken together, these results emphasize the centrality of the amygdala in the pathophysiology of depressive symptoms, and suggest that dissociable patterns of amygdalo-frontal dysconnectivity are a critical neurobiological feature across clinical diagnostic categories.

Efficacy of a mydriatic spray in the pediatric population.

BACKGROUND: Children often resist instillation of mydriatic drops for dilated fundus evaluation. As cycloplegic sprays have proven useful, this study's aim was to demonstrate efficacy of a mydriatic spray. METHODS: Twenty-two healthy subjects, ages 2 to 8 years, participated in the study. All but two had dark brown irides. Subjects were given either one drop each of 1% tropicamide and 2.5% phenylephrine in each eye or one application of mydriatic spray (containing concentrations of 0.5% tropicamide and 2.5% phenylephrine) to each closed eyelid. Pupils were measured with a pupil gauge before drug delivery and every 10 min thereafter, for 40 min. RESULTS: Repeated measures analysis of variance for the five time intervals demonstrated no significant difference between the two application methods nor in the method/time interaction, but a statistically significant increase in pupil size over time (p < 0.0005) for each method. A t-test revealed no statistically significant difference in pupil size (p > 0.05) between the two methods of drug administration at 40 min after application. CONCLUSIONS: This study suggests that use of mydriatic sprays on closed eyelids is as efficacious as use of mydriatic drops in open eyes for children.