Factors associated with depression and anxiety in children with intellectual disabilities.

BACKGROUND: Individuals with intellectual disabilities (ID) are at increased risk for depression and anxiety disorders; however, there is a paucity of research that pertains to associative factors for these mental health disorders in this population. The objective of this investigation was to determine factors associated with depression and anxiety problems in children with ID. METHODS: Children 6-17 years with ID (n = 423; 63% male) from the 2016 National Survey of Children's Health were included in this cross-sectional study. Outcome measures included depression and anxiety problems. Predictor variables included sociodemographics, ID severity, co-morbid conditions (autism spectrum disorders, epilepsy, cerebral palsy, Down syndrome and attention-deficit/hyperactivity disorder), physical factors (i.e. physical activity, sleep duration and pain) and social factors (e.g. participation in activities and bully victimisation). Multivariable logistic regression was performed to determine the association between all factors and depression and/or anxiety problems among children with ID. RESULTS: The prevalence of depression and/or anxiety problems was 35.4%. After adjusting for sociodemographics, Hispanic race was associated with lower odds [odds ratio (OR), 0.3; 95% confidence interval (CI), 0.1-0.8] of depression and/or anxiety problems. After adjusting for race, co-morbid conditions, and physical and social factors, autism spectrum disorders (OR, 4.4; 95% CI, 1.1-10.1), Down syndrome (OR, 0.2; 95% CI, 0.1-0.8), attention-deficit/hyperactivity disorder (OR, 5.9; 95% CI, 2.5-14.3), pain (OR, 7.0; 95% CI, 2.9-17.1) and bully victimisation (OR 2.3; 95% CI, 1.0-5.3) were each associated with depression and/or anxiety problems. CONCLUSIONS: The present study identified both treatable and modifiable, as well as unmodifiable, factors associated with depression and/or anxiety problems in children with ID.

Underdevelopment of trabecular bone microarchitecture in the distal femur of nonambulatory children with cerebral palsy becomes more pronounced with distance from the growth plate.

SUMMARY: We found that the underdeveloped trabecular bone microarchitecture in the distal femur of children with cerebral palsy (CP) who are unable to ambulate independently becomes more pronounced with increased distance from the growth plate. This suggests that the degree of underdevelopment in trabecular bone in children with CP is greater than previously understood. INTRODUCTION: Children with CP who are unable to ambulate independently have severely underdeveloped trabecular bone microarchitecture in the distal femur. The aim of the study was to determine if the level of underdevelopment in trabecular bone microarchitecture is consistent across the distal femur in children with CP. METHODS: Children with quadriplegic CP and typically developing children were studied (n=12/group, 5-14 years). Apparent bone volume to total volume (appBV/TV), trabecular number (appTb.N), trabecular thickness (appTb.Th), and trabecular separation (appTb.Sp) were estimated in each of 20 magnetic resonance images collected above the growth plate in the distal femur. RESULTS: For the total region, appBV/TV, appTb.N, and appTb.Th were lower (30, 21, and 12%, respectively) and appTb.Sp was higher (52%) (all p≤0.001) in children with CP than in controls. Distance from the growth plate was inversely related to appBV/TV and appTb.N and was positively related to appTb.Sp at the same distance in children with CP and controls (all p<0.01). However, the relationships were stronger (r2=0.87 to 0.92 versus 0.36 to 0.65) and the slopes were steeper in children with CP (all p<0.01). Furthermore, the steepness of the slopes in children with CP was positively related to appBV/TV, appTb.N, appTb.Th, and appTb.Sp for the total region (r2=0.37 to 0.75, p<0.05). CONCLUSIONS: The underdeveloped trabecular bone microarchitecture in the metaphysis of the distal femur in children with CP becomes more pronounced with greater distance from the growth plate. This pattern is most profound in children with the least developed trabecular bone microarchitecture.

Inadequate cerebral perfusion is an unlikely cause of perioperative stroke.

The purpose of this study was to determine the importance of hypoperfusion ischemia as a cause of stroke during carotid endarterectomy (CEA). A retrospective analysis of 128 consecutive CEA procedures were examined in patients at risk for hypoperfusion ischemia, namely, patients with occlusion of the contralateral carotid artery. All procedures were performed under general anesthesia without the use of a temporary indwelling shunt. Sixty-one percent of patients had cerebrovascular symptoms preoperatively and 39% were asymptomatic. The degree of stenosis of the carotid artery was 80%-99% in 67% (86/128) of patients, 60%-79% in 25% (32/128), 20%-59% in 7% (9/128), and 0-19% in 0.8% (1/128). The perioperative mortality was 0.8% (1/128), the incidence of permanent neurologic morbidity was 1.6% (2/128), and the incidence of transient neurologic morbidity was 3.9% (5/128). In conclusion, these data suggest that hypoperfusion ischemia is a rare cause of stroke during CEA even in patients with occlusion of the contralateral carotid artery and that CEA can be performed safely even in patients with contralateral occlusion without the use of a temporary indwelling shunt.

Carotid artery surgery without a temporary indwelling shunt. 1,917 consecutive procedures.

One thousand nine hundred seventeen consecutive carotid artery operations were performed in which the carotid artery was clamped for as long as necessary to accomplish a revascularization procedure. Those patients adversely affected by failure to use a shunt were identified. Results of a statistical analysis of stroke morbidity when compared with the literature show that the use of an intraoperative temporary shunt does not offer improved results in carotid artery surgery.