A comparison of clinical outcomes of acute testicular torsion between prepubertal and postpubertal males.

SHORT INTRODUCTION/BACKGROUND: Surgical intervention for acute testicular torsion can require either orchiopexy or orchiectomy. The decision of which surgery to perform is dependant on the amount of time that the testicle experienced ischemia and the viability of the testicle after reperfusion. OBJECTIVE: It is hypothesized that (1) there is a difference in orchiectomy and orchiopexy rates between prepubertal and postpubertal males with acute testicular torsion and (2) presenting symptoms may vary between the two age groups as prepubertal males may present with atypical symptoms, which could result in delayed presentation and diagnosis. STUDY DESIGN: A retrospective chart review was conducted on pediatric patients who were diagnosed with acute testicular torsion between June 2010 and August 2017. Demographic and clinical characteristics were extracted: age, ethnicity, referral pattern, primary insurance status, symptoms at presentation, prior history of ipsilateral testicular pain or intermittent torsion, recent trauma to genitalia, duration of symptoms (hours), gradual vs. acute onset of symptoms, time/weekday/season at presentation, and time interval from arrival at the study institution to surgical intervention (minutes). Patients were categorized into two groups: prepubertal group (age 1-12 years) and postpubertal group (age 13-18 years). Statistical analyses were performed using R, version 3.3.1. RESULTS: Ninety-one patients were included in the study. The overall orchiectomy rate was 30.8%. More prepubertal males underwent orchiectomy than postpubertal males (42.4% vs. 24.1%, respectively). Prepubertal males were more likely to present with abdominal pain than postpubertal males (27.3% vs. 10.3%, respectively). Those who underwent orchiectomy were more likely to present with longer duration of symptoms, testicular swelling, and abdominal pain than those who underwent orchiopexy. The risk of orchiectomy decreased by 14% per 1-year increase in age (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.94-1.00, p = .009). A steady decline in the proportion of patients undergoing orchiectomy was seen from 1 to 12 years of age. DISCUSSION: This study found that prepubertal males are at higher risk for orchiectomy than postpubertal males. The risk of orchiectomy decreases by 14-16% per 1-year increase in age. Prepubertal males are more likely to present with atypical symptoms and delayed presentation and diagnosis, leading to delayed surgical intervention. It is important for providers to perform a genital examination in prepubertal males who present with abdominal pain to rule out acute testicular torsion. Patients presenting with longer duration of symptoms, testicular swelling, and abdominal pain are at higher risk for orchiectomy. No correlation was found between orchiectomy rate and ethnicity, referral status, primary insurance status, and time/weekday/season at presentation. CONCLUSION: Among patients presenting to a tertiary pediatric hospital with acute testicular torsion, prepubertal males (younger than 12 years) are at higher risk for orchiectomy than postpubertal males. Prepubertal males are more likely to present with atypical symptoms which results in delayed presentation and diagnosis, leading to delayed in surgical intervention.

Development and validation of a childhood self-efficacy for functional constipation questionnaire.

BACKGROUND: Children with functional constipation fear painful bowel movements leading to stool withholding behavior. Self-efficacy is the belief that an individual can accomplish a given goal. If children with constipation avoid defecation because they think that they are unable defecate comfortably, this low self-efficacy may prevent treatment success. The aim of the current study was to develop and validate a constipation specific self-efficacy scale. METHODS: The self-efficacy for functional constipation questionnaire (SEFCQ) was developed by the authors and evaluated by 10 children and seven experts. Ninety-nine healthy children and 122 children with functional constipation completed the SEFCQ and three other questionnaires measuring related constructs. KEY RESULTS: Minor changes were made in wording based on feedback from experts and children. Factor analysis showed two scales, a 7 item Action scale (Cronbach's α = 0.88) and a 7 item Emotion scale (Cronbach α = 0.86). The SEFCQ total scale correlated positively with general self-efficacy (r = .32, P < .001) and quality of life (r = .20; P < .01) and negatively with anxiety (r = -.15; P < .05). Scores on the SEFCQ were higher in children without functional constipation compared to those with functional constipation (53.33 + 3.38 vs 39.34 + 7.19, P < .001). CONCLUSIONS & INFERENCES: We developed a constipation specific self-efficacy questionnaire with good initial internal reliability, excellent face validity and adequate content validity. A low self-efficacy for defecation, may make the child resist their physical urge to defecate and hence, the need for further studies to assess its effect on treatment outcomes.

Adolescent Health Risk and Behavior Survey: A School Based Survey in Central Nepal.

Background A comprehensive study of adolescent health risk specific to the Dhulikhel catchment area has not been performed. Objective This survey assesses trends in demographics, nutrition, hygiene and related infrastructure, causes of injury, violence, mental health, substance abuse, and menstrual hygiene. Method A 40 question survey was adapted from the Center for Disease Control (CDC) Youth Risk Behavior Surveillance System, translated into the Nepali language, and administered to 1200 students in eight different schools in central Nepal. Descriptive statistics were used to summarize the data. Result The data has identified nutrition, infrastructure, mental health, and menstrual hygiene as areas for improvement. The number of adolescents who reported going hungry some, most, or all of the time (30.5%, 25.8%, 13.9%) reveals a need for better food access. Approximately 44.5 % of students had no access to soap and water at school. Students who endorse dissatisfaction with themselves was 6.5% and those with suicidal ideation or attempt was 11.8% of the surveyed population. A significantly greater percentage of students who reported suicidal ideation also reported engaging in behaviors related to physical violence, substance abuse, being dissatisfaction with themselves, insomnia due to anxiety, and loneliness. Of the female students, 40.1% reported missing school at least once in the last three months due to their period. Conclusion This data shows a need for better food access, improved infrastructure in schools in central Nepal, and the need to address the prevalence of mental health issues through program interventions.

Dose reduction in thorax radiography in simulated neonates with additional filtration and digital luminescence radiography.

PURPOSE: To determine the minimum acceptable radiation dose for an adequate image quality in thorax a.p. radiographs of neonates using mobile X-ray equipment. MATERIAL AND METHODS: The influence of additional filtration (1.0 mm Al + 0.1 mm Cu) on image quality and radiation dose was determined for the speed class 400 screen-film system (SFS) and digital luminescence radiography (DLR) by making radiographs of a test phantom. Conventional and digital thorax a.p. radiographs of a rabbit were produced using various tube current-time products. The quality of the rabbit radiographs was judged by eight radiologists applying image quality criteria according to the German guidelines and the recommendations of the European Community. RESULTS: The added filter resulted in a dose reduction of 39% at 66 kV. DLR gave a further dose reduction of 25% in comparison to the speed class 400 SFS while maintaining adequate image quality, i.e. the radiographs were clinically acceptable with regard to quality criteria. CONCLUSION: The radiation dose resulting from thorax a.p. radiographs of neonates can be reduced by approximately 50% with the use of additional filtration and DLR.

The effect of head trauma on the visual system: the doctor of optometry as a member of the rehabilitation team.

Brain injury results from either head trauma or strokes and causes many visual and visually related disturbances. Rehabilitation is aimed at developing skills that allow the patient to optimally function as a viable and independent member of society. Often the resultant visual deficits remain undiagnosed and untreated, which hinder the patient's total rehabilitation. Optometric evaluation of brain injured patients should routinely be performed as part of the transdisciplinary team approach to rehabilitation. Optometrists are uniquely qualified to diagnose and treat visual and functional deficits of the visual system in the brain injured population. The purpose of this paper is to present a rationale for optometric participation in the rehabilitation of head trauma and stroke patients.

Family therapy outcome research: a trial for families, therapists, and researchers.

This article describes the process of an evolving research project. Initially conceived as a study investigating outcome measures and their sensitivity to change after a course of family therapy, the project soon changed its focus. As unexpected results were recorded, the clinical research team became destabilized and the individual team members responded by making their own "sense" of the data, reflecting their respective clinical and scientific positions. As clinicians and researchers began to challenge each other's belief systems, the project entered a new stage. The interactions within the team became of increasing interest and themselves objects of research. The recursive nature of re-search was demonstrated, and the act of writing this report completed the circle, as the various authors tried to achieve a balance between reporting the content and the process of this project.

Interaction in families with obese children.

In a controlled study using recently developed and validated methods for eliciting and describing family interactions, a characteristic dysfunctional pattern of interaction was found in families with an obese child. The pattern differed from patterns predicted by previous workers on the basis of indirect evidence or non-systematic study. The pattern was present in all the families studied, but was more marked in the sub-group recruited from a local school, than from subgroups recruited through medical sources. This sub-group had a more positive attitude to obesity and a slightly lower degree of obesity. No common or characteristic interactional pattern was found in the controls. The results were not explainable in terms of demographic criteria, family structure or composition variables, or family emotional health. The findings are discussed in relation to a model of obesity as a family syndrome and a manifestation of psychosocial identity.

Breathlessness and psychiatric morbidity in chronic bronchitis and emphysema: a study of psychotherapeutic management.

This paper describes a study of the outcome of psychotherapy with patients disabled by chronic obstructive airways disease giving rise to dyspnoea. Forty-three men and 22 women with severe COAD were randomly allocated for 8 weeks to one of three types of psychotherapy or to an untreated control group, and were followed up six months later. The group treated by a medical nurse without training in psychotherapy experienced sustained relief of dyspnoea but tended to undergo less psychodynamic change; psychiatric symptoms were reduced in those receiving supportive, but not analytical, psychotherapy. The psychosomatic mechanisms involved and the implications for medical and nursing practice and for liaison psychotherapy are discussed.