[Evaluation of care load for children and teenagers with severe and multiple handicaps. A quantitative empirical study]. / Pflege- und Betreuungsaufwand für schwerst mehrfachbehinderte Kinder und Jugendliche. Eine quantitative empirische Studie.

INTRODUCTION: The aim of the study was to gain differentiated and plausible data on care load for severely and multiply disabled children and teenagers. Those data are required for public health as well as for forensic reasons. METHODS: In 33 children and teenagers between 3 and 18 years (20 in nursing home care, 13 in family care) all measures of care were exactly documented (in minute grades) over 7 days. All individuals were severely disabled and immobile. Due to insufficient plausibility the data of 6 individuals were excluded, so that the final analysis is based on 27 records over a whole week each. RESULTS: The average amount of time for all measures of care was 41 hours and 12 minutes per week, family care exceeding nursing home care by 82 %. Regarding basic care solely, the average amount of time was 26 hours and 7 minutes, family care exceeding nursing home care only by 22 %. On the other hand, the deal of time for stimulation, therapy and leisure activities in families was more than fourfold in comparison with nursing home. In both areas, care load of feeding was found most time consuming and emotionally distressing. DISCUSSION: The documented times for basic care show relatively small differences between family and nursing home care and are in good correspondence with findings in other western countries. Therefore it can be assumed that an average time amount of about 26 hours per week or about 3S hours per day respectively may reflect the real need for basic care in immobile and severely handicapped children and teenagers. The great deal of time documented in family care for general stimulation and leisure activities can be interpreted as an expression of special attention and emotional attachment, so acting as an important factor of quality of life.

Properties of fujicalin, a new modified anhydrous dibasic calcium phosphate for direct compression: comparison with dicalcium phosphate dihydrate.

The novel, commercially available, free-flowing spherically granulated dicalcium phosphate anhydrous (SGDCPA) Fujicalin for direct tableting was compared with directly compressible dicalcium phosphate dihYdrate (DCPD), the properties of which are well known. The two excipients were investigated and compared with regard to their physical and powder properties, compressibility, and compactibility. As a consequence of the spherical shape of its particles, SGDCPA shows the same good flowability and even better compactibility. In contrast to DCPD, SGDCPA shows significant uptake of moisture when exposed to relative humidities (RHs) exceeding 70%. For both excipients, the main deformation mechanism is fragmentation, with SGDCPA yielding significantly stronger tablets.

Randomized clinical trial of melatonin after night-shift work: efficacy and neuropsychologic effects.

OBJECTIVE: Melatonin has received considerable publicity for its sleep-promoting properties; however, there is little scientific evidence of its efficacy. The objective of this study is to determine whether there are measurable beneficial effects from exogenous melatonin in emergency physicians after intermittent night-shift duty. METHODS: This randomized, placebo-controlled, double-blind, crossover trial was conducted in the emergency department of an urban tertiary care hospital. Fifteen emergency physicians were given melatonin 5 mg or placebo for 3 consecutive nights after night-shift duty with crossover to the opposite agent after a subsequent block of night shifts. The primary outcome measure was the global assessment of recovery measured by a visual analog scale. Secondary outcome measures included sleep quality, duration, and tiredness. In addition, the Profile of Mood States questionnaire and neuropsychologic testing were performed. RESULTS: There was no difference between melatonin and placebo in the global assessment of recovery (60.4+/-16.9 and 58.9+/-14.5, respectively; P=.29). There were no differences in sleep quality, duration or tiredness scores, sleep latency, hours of sleep obtained per night, and night or early awakening at any measurement point. Profile of Mood States and neuropsychologic test performances were similar. CONCLUSION: We found no beneficial effect of melatonin on sleep quality, tiredness, or cognitive function in emergency physicians after night-shift duty. Our results suggest that exogenous melatonin is of limited value in recovery from night-shift work in emergency physicians.

Image-guided MR spectroscopy volume of interest localization for longitudinal studies.

Longitudinal magnetic resonance spectroscopy (MRS) studies require accurate repositioning of the volume of interest (VOI) over which measurements are made. In this work we present and evaluate a method for the image-guided repositioning of brain volumes of interest. The point-based registration technique we developed allows the repositioning to be performed on-line (i.e. while the patient is in the scanner). MR image volumes were acquired from six subjects, three scans each over the course of a month. During the first scan, two spectroscopy VOIs are visually selected: one in the frontal white matter, the other in the superior cerebellar vermis. The coordinates of 13 internal brain landmarks are also identified. During both subsequent scans, the same 13 landmarks are identified, and the transformation that registers the first set of landmarks to the subsequent set is computed. This result is used to automatically map the position of the spectroscopy VOIs from the first volume to the current volume. For the six subjects evaluated to date, we show an average repositioning error of the spectroscopy VOIs in the order of 1 mm. This accuracy allows us to conclude that any variations in the MR spectra are unlikely to be due to repositioning error.

[Specific developmental disorders and the family--pathogenetic factors in children with behavioral disorders]. / Teilleistungsstörungen und Familie--pathogenetische Faktoren bei verhaltensauffälligen Kindern.

121 children aged 5;6 to 8;6 years referred to our center as out-patients because of various types of behavioral problems and showing distinct symptoms of minor neurological dysfunction were investigated with regard to family-related variables, specific developmental disorders, and the extent of the behavioral problems. A comparison of the groups with few and numerous behavioral problems showed a significant difference in the number of familial risk factors, but not in the degree of neurological and cognitive dysfunction. These results indicate the importance of child-independent familial factors, e.g. marital problems and psychosocial stress, in the pathogenesis of behavioral disturbances in children with minor neurological dysfunction. The resulting need for a family-oriented perspective in assessment and therapy is discussed.

[Promoting the development of handicapped children--possibilities and limits and responsibilities of the pediatrician]. / Entwicklungs-förderung behinderter Kinder--ihre Möglichkeiten und Grenzen und die Aufgaben des Kinderarztes.

The assessment of strategies to improve the development of handicapped children is difficult. Results of empirical investigations show marked differences with regard to the underlying handicap or developmental risk. The major impact of social conditions is beyond doubt, and within these conditions the coping process of the parents plays an important role. A survey of the literature is given. From this the pediatrician's tasks are derived: Early diagnosis of severe developmental disturbances; early and sympathetic information of the parents including a realistic estimate of given possibilities of help with special regard to social conditions, and an optimal support for the parents' coping process.

[Encephalocraniocutaneous lipomatosis and linear naevus sebaceus]. / Encephalocraniocutane Lipomatose und linearer Naevus sebaceus.

Encephalocraniocutaneous lipomatosis is a rare neurocutaneous dysgenetic syndrome, which is characterized by unilateral lipomas in the subcutis of the face, skalp and skull, porencephalic cyst of the ipsilateral hemisphere, epilepsy, and severely delayed development. Furthermore a variety of skin lesions (choristomas) has been described. In the present case the skin lesions had the form of a linear nevus sebaceus. This condition is frequently combined with epilepsy and neurological disorders (Schimmelpenning-Feuerstein-Mims-syndrome). The latter seems not to be a very rare syndrome. The coincidence of characteristics of both syndromes in the same child supports the suggestion of a pathogenetical relationship.

[The concept of social pediatric assistance in the development of handicapped children. Possibilities, problems and future measures]. / Das sozialpädiatrische Konzept der Entwicklungsförderung behinderter Kinder. Möglichheiten, Probleme und lünftige Antgaben.

Principles and possibilities of the social pediatric concept (Hellbrügge) in treatment and aids for handicapped children are demonstrated. Beside positive experiences there are still some unsolved problems: control of therapeutic efficiency, increasing amount of psychic and social handicaps, lack of psychotherapeutic possibilities, problems of the organization and the public rôle of social pediatric work.

[Neurophysiological activation and behavior during mental achievement. Comparative studies in healthy, minimally brain damage and mongoloid children]. / Neurophysiologische Aktivation und Verhalten bei geistiger Leistung. Vergleichende Untersuchungen bei gesunden, leicht hirngeschädigten und mongoloiden Kindern.

A comparison of normal, mildly brain-injuried and mongoloid children. For psychophysiological investigations in young or mentally disturbed children a new methodical approach was developped. In children with minor nervous dysfunction (aged 6--8;3 years) and mongoloid children (5;6--11 years) as well as in younger and older normal children (3;9--5;5 resp. 5;6--7;6 years) the changes of EEG basic rhythm, heart rate and behaviour during defined mental work were observed. Each group consisted of 18 children. The physiological data were analyzed by computer. The main results are summarized in the following points: 1) The request of mental activity with increasing task difficulty causes increasing neurophysiological and behavioural activation up to an optimal value at the highest degree of individual efficiency. 2) Overstrain leads to a deterioration of activation and consecutively to a loss of motivation, especially in the handicapped children. 3) Alpha waves of the EEG can be unterstood as an index of selective stimulus inhibition or "concentration". In the normal children the amount of alpha waves during mental work was very significantly higher than in both the groups of the handicapped children. 4) Further differences in EEG, heart rate and behaviour between the 4 groups support the understanding of the psychic features in Down's syndrome and in the syndrome of minor nervous dysfunction at a physiological level.

Neurophysiological and behavioural changes during mental work in children with Down's syndrome.

Telemetered EEG and ECG were recorded from 18 Down's syndrome children (5;6--11 years) during rest, a visuomotor and a cognitive test, exploration and play. Simultaneously the behaviour was observed and recorded. In comparison with normal children (3;9--5;5 y. resp. 5;6--7;6 y.) the Down's syndrome children showed a low degree of motor activity, reduced attention and exploration and little variation of heart rate in relation to test difficulty. The main findings in the EEG (parieto-occipital recording) were a low amount and a small variability of alpha waves and a high amount of beta waves. This EEG phenomenon which is obviously not due to high activation is discussed with regard to possible connections with defective neurophysiological mechanisms of attention.

[Anophthalmia and accompanying malformations (author's transl)]. / Anophthalmie und begleitende Fehlbildungen

Six children with bilateral or unilateral anophthalmia were described. Malformations of the face and the extremities, stunted growth, hydrocephalus, muscle hypotony and mental retardation in varying degrees and combinations were also found. The genesis is not clear. With two siblings who exibited a combination which has not been described previously of anophtalmia on one side and microphthalmia on the other together with a cutaneous hexadactyly, the fact that the combination occurs in both children and that the mother exibits a "incomplete form" (?) of the ophthalmologic symptom tends to indicate that the cause is genetic.

[Quantification of visual EEG evaluation by using the concept of optimality (author's transl)]. / Quantifizierung der visuellen Auswertung des kundlichen Wach-EEG

For the visual evaluation of the EEG in children (awake) 17 items are formulated and defined. They are to be examined and determined as beeing either optimal or non-optimal, as it is easier to define what is optimal, than what is normal. The non-optimal items are summed up for a total score. It could be shown that this score discriminates between sample groups of 50 children each, one with "minimal brain dysfunction" and another with normal controls of the same age and sex. There are also several distinct differences within the particular items. The objectivity of the items was proved by fourfold examination of the same sample group. The concept of optimality therefore offers a valid and objective method of quantifying the visual EEG evaluation, thus improving the interpretation of minor abnormalities in the EEG.