Neurobehavioral and autonomic effects of hammock positioning in infants with very low birth weight.

PURPOSE: This study was designed to determine whether supine positioning of infants born preterm in a hammock instead of the prone position affects their neuromuscular maturity, growth, and autonomic stability. METHODS: Twenty healthy infants who were born premature with very low birth weight (VLBW) (<1500 g) were randomized into two groups. Subjects were pair-matched for weight (difference less than 100 g), gestational age (difference less than eight days), and postnatal age (difference less than eight days). Ten infants were placed supine in a hammock for three hours daily for ten consecutive days, and ten infants were maintained nested in the prone position. Neuromuscular maturity (based on three neurological parameters adopted from the Ballard examination), heart rate, respiratory rate, and weight gain (g/cal) were compared between the groups. RESULTS: Compared with nested prone positioning, supine positioning in a hammock was associated with a higher neuromuscular maturity score (p < 0.003) and a more relaxed condition, as expressed by lower heart rate and respiratory rate (p < 0.05 and p < 0.01, respectively). CONCLUSIONS: Maintaining infants who were born preterm with VLBW in the supine position in a hammock may positively affect their autonomic stability and neuromuscular maturity.

Musculoskeletal deformities in Behr syndrome.

SUMMARY: Seventeen children with Behr syndrome were investigated, focusing on the musculoskeletal deformities and long-term outcome. Behr syndrome is characterized by optic atrophy beginning in early childhood associated with ataxia, spasticity, mental retardation, and posterior column sensory loss. The ataxia, spasticity, and muscle contractures, mainly of the hip adductors, hamstrings, and soleus, are progressive and become more prominent in the second decade. In 70% of the patients, contractures developed in the lower limbs, requiring surgery mainly for the Achilles tendon, hamstrings, and adductor longus. At last follow-up at an average age of 21.7 years (range, 8-31 years), 13 of the patients are housebound walkers, 2 are nonfunctional walkers, and 2 are nonwalkers.

Social phobia treated as a problem in social functioning: a controlled comparison of two behavioural group approaches.

OBJECTIVE: Treatments for social phobia result typically in significant anxiety and avoidance reduction; the repercussions in terms of social functioning, however, are not clear. This controlled study compared two approaches designed to improve the social functioning of social phobics. METHOD: Sixty-eight socially phobic patients were randomly assigned to two treatments focused on improving interpersonal relationships either with or without social skills training or a waiting list; 60 completed treatment and 59 a 1-year follow-up. Treatment was administered in small groups, 14 sessions altogether. RESULTS: No clinically meaningful change was observed during the waiting period. A statistically significant and equivalent improvement obtained in both treatment conditions. CONCLUSION: Both treatments resulted in reduced anxiety, avoidance, general psychopathology and better social functioning that maintained over follow-up. Continuing improvement in remission rates was noted; fully 60% of the patients no longer fulfilled criteria for social phobia at the end of 1-year follow-up.

Early mobilization after sliding achilles tendon lengthening in children with spastic cerebral palsy.

Equinus deformity is a common finding in children with cerebral palsy and may be treated by Achilles tendon lengthening. To prevent recurrence, some authors recommend immobilizing the operated leg with an above-knee cast for six weeks, followed by use of a night splint or orthosis. Nevertheless, there are recurrence rates of up to 20.5%. The aim of this study was to evaluate the long-term result of postoperative immobilization for two weeks in a below-knee cast and early weight bearing, without the use of a splint or orthosis. Thirty-six children (52 feet) with spastic cerebral palsy underwent sliding Achilles tendon lengthening. Follow-up of five to ten years showed a comparable recurrence rate (19.2%) to that reported with the standard, more stringent management approach. Most of the recurrences were in children operated on before five years of age. We believe earlier motion helps to sustain the tendon length achieved at surgery and allows for earlier independent gait.

Social phobia viewed as a problem in social functioning: a pilot study of group behavioral treatment.

Available treatments of social phobia reduce anxiety and avoidance of social situations. Social functioning however, remains relatively unaffected. This study piloted a behavioral group treatment that aimed at improving patients' individual difficulties in social functioning. Five patients fulfilling DSM-IV criteria for social phobia were selected for treatment by a 16-session behavioral group treatment focusing on improving interpersonal functioning both in specific phobic situations as well as in different spheres of social life in general. Four out of 5 patients completed treatment and showed individual patterns of clinically significant improvement. Their individual test-score results and case-histories are presented. Three patients no longer fulfilled to the diagnostic criteria at the end of treatment; the fourth--at 6 month follow-up. This was maintained at a 2 year follow-up.

The treatment of sexually dysfunctional men without partners: a controlled study of three behavioural group approaches.

BACKGROUND: Models of sex therapy for sexual dysfunction in single men are available, but their value is not well established. This controlled study compared three approaches to the treatment of sexually dysfunctional single men. METHOD: Sixty-nine single men diagnosed as sexually dysfunctional were randomly assigned to treatments focusing on either their sexual dysfunction, their interpersonal problems, a combination of both or a waiting list; 51 completed treatment and 50 the one-year follow-up. Treatment was administered in small groups in 15 weekly sessions and four six-weekly sessions during the first six months of a year-long follow-up. RESULTS: No clinically meaningful change was observed during the waiting period. In contrast, a significant and equivalent improvement was observed in all treatment groups by the end of treatment. However, differences between them were in evidence at 6 and 12 months' follow-up. CONCLUSIONS: Both treatments paying attention to the patients' interpersonal difficulties resulted in significantly better outcomes overall than the approach that concentrated on problems in sexual functioning alone.

A retrospective study of separation in the development of adult avoidant personality disorder.

This retrospective study investigated experiences of separation and perceptions of early relations with parents and peers by patients diagnosed as having avoidant personality disorder. The main hypothesis of our study was that patients diagnosed as having avoidant personality disorder would report more actual separations and more pathogenic parenting than normal control subjects. This hypothesis was not supported. The main features differentiating patients from normals were: perceptions of a encouraging home climate, and less demonstrations of love and pride in the child on the part of the parents.