The Assessment of Psychomotor Development in Full-Term Children at 12 Months of Age with Munich Functional Development Diagnostics Depending on the Feeding Method: A Cross-Sectional Study.

BACKGROUND: Psychomotor development is the most important outcome determining the proper growth and development of children. Optimizing childcare and modifying risk factors can provide the child with the best conditions to realize their developmental potential. The study aimed to assess the impact of the feeding method on the psychomotor development of full-term children at 12 months of age with Munich Functional Developmental Diagnostics (MFDD). METHODS: The study included 242 full-term children who were examined at 12 months of age by a child neurologist using MFDD. The children were divided into two groups depending on the feeding method: breastfed (146) vs. formula-fed (93). We analysed selected obstetric and neonatal risk factors as well as MFDD scores within the groups. RESULTS: The only axis on the MFDD scale on which we observed a difference between the groups was social skills. No differences were noted between the groups in the analysis of the gross and fine motor skills, with regard to perception or active and passive speech. CONCLUSIONS: The full-term, exclusively breastfed infants over their first 6 months of age or longer have greater social skills in comparison with the formula-fed infants when measured on the MFDD axis.

Carisoprodol Single and Multiple Dose PK-PD. Part II: Pharmacodynamics Evaluation Method for Central Muscle Relaxants. Double-Blind Placebo-Controlled Clinical Trial in Healthy Volunteers.

Centrally acting skeletal muscle relaxants (CMR) such as carisoprodol are used to treat acute, painful musculoskeletal conditions, though its precise mode of action has not been characterized. A double-blinded, placebo-controlled, randomized clinical trial was designed to evaluate the pharmacokinetics-pharmacodynamics (PKPD) of CMR after single (350 mg), double (700 mg), and multiple doses (up to 350 mg/8 h, 14 days) of carisoprodol. Muscular (Electromyogram-EMG, muscular strength dynamometry), central (sedation), and tolerability (psychomotor activity test, adverse events) parameters, as well as withdrawal symptoms, were evaluated. Thirteen healthy volunteers were enrolled. No evidence of direct muscle relaxation was evidenced, but some differences on sedation were evidenced throughout the study, suggesting that CMRs act, at least partly, through sedation. Most significant differences were detected at 1.5 h after dosing. The effect on psychomotor impairment was variable, most prominently after 1.5 h, too, suggesting that it is produced by carisoprodol rather than by meprobamate. No withdrawal symptoms were detected, so the risk of dependence following maximum doses and duration of treatment recommended, and under medical supervision, should be low.

Principal Component Analysis of Munich Functional Developmental Diagnosis.

OBJECTIVES: Munich Functional Developmental Diagnosis (MFDD) is a scale for assessing the psychomotor development of children in the first months or years of life. The tool is based on standardized tables of physical development and is used to detect developmental deficits. It consists of eight axes on which the following skills are assessed: crawling, sitting, walking, grasping, perception, speaking, speech understanding, social skills. METHODS: The study included 110 children in the first year of life examined with the MFDD by the same physician. The score obtained on a given axis was coded as a negative value (defined in months) below the child's age-specific developmental level. Next, we examined the dimensionality of the scale and the intercorrelation of its axes using polychoric correlation and principal component analysis. RESULTS: Correlation matrix analysis showed high correlation of MFDD axes 1-4, and MFDD 6-8. The PCA identified three principal components consisting of children's development in the areas of large and small motor skills (axis 1-4), perception (axis 5), active speech, passive speech and social skills (axis 6-8). The three dimensions obtained together account for 80.27% of the total variance. CONCLUSIONS: MFDD is a three-dimensional scale that includes motor development, perception, and social skills and speech. There is potential space for reduction in the number of variables in the scale.

"Light cannabis" consumption in a sample of young adults: Preliminary pharmacokinetic data and psychomotor impairment evaluation.

INTRODUCTION: In 2019, the Italian Supreme Court established that hemp cannot be commercialized for human use, when the "psychotropic effect" of the product or its "offensiveness" can be demonstrated. The aim of the present study is to assess Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) blood concentrations after smoking cannabis with a low percentage of Δ9-THC, also referred as "light cannabis", and its effects on young adults' vigilance, cognitive and motor skills. MATERIALS AND METHODS: Eighteen young adults consumed three light cannabis cigarettes containing 400 mg of inflorescences each, with a percentage of 0.41% of Δ9-THC and of 12.41% of CBD. Blood samples were collected before the experiment (t0), after each light cannabis cigarette (t1→t3), 60 (t4) and 120 (t5) minutes after the beginning of the experiment. Five performance tasks and a subjective scale were employed for measuring cognitive and psychomotor performances the day before the experiment (TT0) and after the third cigarette (TT1). RESULTS: Mean (SD) concentrations (ng/ml) were 1.0 (0.8) in t1, 1.2 (0.9) in t2, 1.0 (0.8) in t3, 0.6 (0.4) in t4 and 0.3 (0.3) in t5 for Δ9-THC; 10.5 (10.3) in t1, 10.3 (13.2) in t2, 15.1 (14.8) in t3, 9.9 (9.2) in t4 and 5.7 (5.7) in t5 for CBD. No significant differences were observed between TT0 and TT1 for all performed psychomotor performance task. None of the subjects declared to feel "high" after the experiment. DISCUSSION: All study participants reported that a higher number of cigarettes, corresponding in this study to 1200 mg of herbal product, could hardly be consumed by smoking in a recreational setting. Δ9-THC and CBD concentrations showed a high inter-subject variability, and the average concentrations were lower than those previously reported. Toxicological results showed a decrease of Δ9-THC and CBD after the third light cannabis cigarette, and a Δ9-THC /CBD ratio always<1 was observed. The lack of impairment observed in our participants can be interpreted as a consequence of the very low concentrations detectable in the blood.

Combined machine learning and functional magnetic resonance imaging allows individualized prediction of high-altitude induced psychomotor impairment: The role of neural functionality in putamen and pallidum.

Hypoxia exposure during high-altitude expedition cause psychomotor impairment. Neuroimaging studies indicated that the impairment may be significantly associated with neuron loss and decreased regional homogeneity (ReHo) in several brain regions, suggesting the neural functionality in these regions may be utilized to predict psychomotor impairment under exposure. In this study, 69 subjects come from Shaanxi-Tibet immigrant cohort. Reaction time (RT) tasks were performed to measure the subject's psychomotor function before and after 2-year high-altitude exposure. For each individual, the RT differences between pre-exposure and post-exposure were calculated, which were referred to as "targets" in model establishment. Rs-fMRI data were acquired at the same time with RT tasks. For each individual, the map of ReHo alteration was generated, from which the patterns would be recognized. A pattern recognition procedure was utilized to train and test the predictive models. Two different cross-validation strategies were utilized to evaluate the model performance: leave-one-out cross-validation and four-fold cross-validation. For the models displaying significant R2 and MSE, weight maps were built. As a result, the predictive models were able to decode the changes of simple and recognition reaction time from the alterations of brain activation under the exposure. The regions with highest contributions to the predictions were bilateral putamen and bilateral pallidum, suggesting that predictions were mainly based on the patterns concentrated in these regions. This study was a proof of concept study designed to examine whether individual-level psychomotor impairment under high-altitude exposure could be predicted by a combination of pattern recognition approach and neuroimaging data.

Genetic and behavioral characterization of a Kmt2d mouse mutant, a new model for Kabuki Syndrome.

The recessive mutant mice bate palmas (bapa) - claps in Portuguese arose from N-ethyl-N-nitrosourea mutagenesis. A single nucleotide, T > C, change in exon 13, leading to a Thr1289 Ala substitution, was identified in the lysine (K)-specific methyltransferase 2D gene (Kmt2d) located on chromosome 15. Mutations with a loss-of-function in the KMT2D gene on chromosome 12 in humans are responsible for Kabuki syndrome (KS). Phenotypic characterization of the bapa mutant was performed using a behavioral test battery to evaluate the parameters related to general activity, the sensory nervous system, the psychomotor system, and the autonomous nervous system, as well as to measure motor function and spatial memory. Relative to BALB/cJ mice, the bapa mutant showed sensory and psychomotor impairments, such as hypotonia denoted by a surface righting reflex impairment and hindquarter fall, and a reduction in the auricular reflex, suggesting hearing impairment. Additionally, the enhanced general activity showed by the increased rearing and grooming frequency, distance traveled and average speed possibly presupposes the presence of hyperactivity of bapa mice compared with the control group. A slight motor coordination dysfunction was showed in bapa mice, which had a longer crossing time on the balance beam compared with BALB/cJ controls. Male bapa mice also showed spatial gait pattern changes, such as a shorter stride length and shorter step length. In conclusion, the bapa mouse may be a valuable animal model to study the mechanisms involved in psychomotor and behavior impairments, such as hypotonia, fine motor coordination and hyperactivity linked to the Kmt2d mutation.

HIV-associated cognitive performance and psychomotor impairment in a Thai cohort on long-term cART.

OBJECTIVES: To assess cognitive performance and psychomotor impairment in an HIV-positive cohort, well-suppressed on combination antiretroviral therapy (cART), in an Asian resource-limited setting. METHODS: Cross-sectional sociodemographic and cognitive data were collected in 329 HIV-positive and 510 HIV-negative participants. Cognitive performance was assessed using the International HIV Dementia Scale (IHDS), Montreal Cognitive Assessment (MoCA), WAIS-III Digit Symbol, Trail Making A, and Grooved Pegboard (both hands). Psychomotor test scores in the HIV-positive participants were converted to Z-scores using scores of the HIV-negative participants as normative data. Psychomotor impairment was defined as performance on two tests more than 1 standard deviation (SD) from controls or more than 2 SD on one test. Multivariate linear and logistic regression analyses were used to investigate associations between HIV and non-HIV-related covariates and poorer cognitive performance and psychomotor impairment. RESULTS: HIV-positive participants, mean age 45 (SD 7.69) years received cART for a median of 12.1 years (interquartile range [IQR] 9.1-14.4). Median CD4 cell count was 563 cells/mm3 (IQR 435-725), and 92.77% had plasma HIV RNA <40 copies/mL. The adjusted mean differences between HIV-positive versus HIV-negative cohorts indicated significantly inferior cognitive performance (tests all P<0.001) with increasing age and lower income, independently associated. Psychomotor impairment was found (P<0.02) in all tests except the Grooved Pegboard non-dominant hand (P=0.48). Psychomotor impairment prevalence was 43% in the HIV-positive cohort, associated with male gender and lower income. CONCLUSIONS: In this study, in individuals with viral suppression rates >90% on long-term cART, we found that inferior cognitive performance and psychomotor impairment were primarily associated with non-HIV-related factors.

Dental Care for an adolescent with chromosome pentasomy: rare case report with a two year follow-up / Atenção Odontológica a jovem com pentassomia cromossômica: relato de caso raro com acompanhamento de 2 anos

Pentasomy of the x chromosome is a rare syndrome of unknown incidence and there are few reports in the scientific literature, especially in terms of dental care for patients with this syndrome. The aim of this study was to report the dental care given to an adolescent with pentasomy of the X chromosome. The patient presented a cleft palate, impacted teeth, malocclusion, high caries activity, gingivitis and multiple tooth loss due to caries. Despite the difficulties of carrying out the dental work due to involuntary movements and the initial lack of collaboration from the patient the overall dental care was completed on an outpatient basis. The therapeutic success of the treatment was strongly supported by the significant cooperation and relationship that grew up along the period of the treatment, as well as the desire to have the treatment done by both the patient and her parents.

A pentassomia do cromossomo x é uma síndrome rara, de incidência desconhecida e com poucos relatos na literatura científica, especialmente no que diz respeito à atenção odontológica para pacientes portadores da mesma. O objetivo deste estudo foi relatar um caso de atenção odontológica a uma jovem com pentassomia do cromossomo x, que apresentava fenda palatina, dentes inclusos, má-oclusão, alta atividade de cárie, gengivite e múltiplas perdas dentárias devido à cárie. Apesar das dificuldades de se realizar o tratamento dentário devido aos movimentos involuntários e a não colaboração inicial da paciente, houve total viabilidade da atenção odontológica em âmbito ambulatorial, observando-se significativa cooperação, formação de vínculo e adesão ao tratamento pela mesma e seus responsáveis, o que gerou sucesso terapêutico.

Effectiveness of equine therapy in children with psychomotor impairment.

INTRODUCTION: Equine therapy, an intervention method that has been practiced for decades around the world, is used to treat patients susceptible to psychomotor delays. OBJECTIVES: We examine development of gross motor function compared to other psychomotor skills in patients undergoing this therapy, and analyse how this improvement affects general health status and quality of life. MATERIAL AND METHODS: The study includes 11 children with delayed psychomotor development (aged 8.82 ± 3.89; 6 boys, 5 girls). The main study variables were gross motor function (GMFM-88) and perceived quality of life (Pediatric Quality of Life Inventory, PedsQL). Three measurements were performed: before and after a period of inactivity, and once again 2 months after the second measurement, following completion of a sustained period of therapy. RESULTS: We observed significant differences in overall results on the GMFM-88 between the initial and final tests and between the intermediate and final tests. Regarding the PedsQL quality of life scale, no statistically significant results were recorded. CONCLUSIONS: Noticeable changes in motor control were recorded throughout the course of the intervention, which suggests that equine therapy may be appropriate treatment in cases of delayed psychomotor development.

The relationship between observed signs of impairment and THC concentration in oral fluid.

BACKGROUND: Studies have shown that cannabis intake increases the risk of traffic accidents. Controlled experiments support these findings and have shown a positive dose-effect relationship. METHODS: In this retrospective cross-sectional study of data from a roadside survey, we investigated whether a police officer's judgment regarding signs of impairment is related to the concentration of delta-9-tetrahydrocannabinol (THC) in the oral fluid (OF). We investigated 2,632 cases from a representative sample of 3,302 Spanish drivers: 253 drivers positive for THC only, 32 positive for THC and ethanol, 201 with only ethanol detected in their breath, and 2,146 drivers who tested negative for ethanol in breath and drugs in OF. Recorded data comprised breath alcohol concentrations, THC concentrations in the OF, and the 31 observed signs of impairment. Subject groups were compared using the chi-square test, and logistic regression was used to examine the risk of being categorized as exhibiting signs of impairment. RESULTS: A relationship was found between the OF THC concentration and some observed signs of impairment. Eye signs were noticeable from a THC concentration >3.0 ng/ml in OF, and >25 ng/ml was related to behavior, facial expression, and speech signs. Alcohol and THC contribute to impairment independently and, when taken simultaneously, the effects are comparable to the sum of the effects when consumed separately. CONCLUSIONS: The observation of signs of impairment due to cannabis occurs in an OF concentration-related manner but, as a clinical test, OF has low sensitivity and specificity in a random roadside survey.

Monitoreo de los indicadores del Programa "Chile Crece Contigo" 2008-2011 / Monitoring indicators of the program "Chile Grows with you" 2008-2011

Objective: To monitor coverage and outcomes associated with the activities of the integrated protection system for early childhood Chile Grows with You (CHCC), which includes the comprehensive psychosocial development of children between 18 months and 3 years old, in each of the 29 Health Services of the country, as well as the changes observed after 4 years. Material and Method: Database analysis of all local public networks in the country between 2008 and 2011 was performed. The application of the test regarding psychomotor development, prevalence of development delay and risk, participation of mothers in educational workshops, home visits and recovery rate of deficient children by age were studied. Median and observed changes of each indicator were analyzed developing a ranking based on the results observed. Results: Approximately 75% of children were evaluated, with a prevalence of delay or risk of about 5% and a rate of recovery close to 50%. The participation of mothers in educational workshops increased from 7.6 to 11.0% (p <0.001) and home visits to developmentally delayed children increased 6 times between 2009 and 2011 (p <0.001). Most changes were positive, although the prevalence of developmentally delayed children under 2 years slightly increased (0.6%), and the recovery of 3 year olds decreased (-14.4%). A great variability was observed among the Health Services. Conclusions: There are some positive results in relation to psychomotor development, with significant regional differences. A lower than expected deficit rate regarding psychomotor development was observed, which implies the need to further analyze the instrument used or the conditions of application.

Objetivo: Monitorear la cobertura y resultados de las principales actividades planificadas en el subsistema de protección social Chile Crece Contigo (CHCC) en relación al desarrollo psicosocial integral en niños de 18 meses y 3 años, en cada una de los 29 Servicios de Salud del país y los cambios observados en 4 años. Material y Método: Análisis de bases de datos de todos los establecimientos de la Red Pública del país, 2008 y 2011. Se estudió: aplicación del test de desarrollo psicomotor, prevalencia de retraso y riesgo del desarrollo, participación de madres en talleres educativos, visitas domiciliarias integrales y tasa de recuperación de niños con déficit según edad. Se analizó mediana y cambio observado de cada indicador por servicios de salud y se elaboró un ranking en función de los resultados observados. Resultados: Aproximadamente el 75% de los niños fueron evaluados, con una prevalencia de retraso o riesgo del orden de 5% y tasa de recuperación cercana al 50%. La participación de madres en talleres educativos aumentó de 7,6 a 11,0% (p < 0,001) y las visitas domiciliarias en niños con rezago 6 veces entre el 2009 y 2011 (p < 0,001). La mayor parte de los cambios fueron positivos, aunque aumentó levemente la prevalencia de rezago en menores de 2 años (0,6%) y disminuyó la recuperación de niños de 3 años (-14,4%). Destaca amplia variabilidad entre servicios de salud. Conclusiones: Existen algunos resultados positivos en relación al desarrollo psicomotor, con importantes diferencias regionales. Destaca una tasa de déficit del desarrollo psicomotor menor a lo esperado, lo que implica la necesidad de revisar el instrumento utilizado o las condiciones de aplicación.

Establishing legal limits for driving under the influence of marijuana.

Marijuana has become the most commonly detected non-alcohol substance among drivers in the United States and Europe. Use of marijuana has been shown to impair driving performance and increase crash risk. Due to the lack of standardization in assessing marijuana-induced impairment and limitations of zero tolerance legislation, more jurisdictions are adopting per se laws by specifying a legal limit of Δ9-tetrahydrocannabinol (THC) at or above which drivers are prosecuted for driving under the influence of marijuana. This review examines major considerations when developing these threshold THC concentrations and specifics of legal THC limits for drivers adopted by different jurisdictions in the United States and other countries.

The development and psychometric assessment of a questionnaire to assess sleep and daily troubles in parents of children and young adults with severe psychomotor impairment.

BACKGROUND: Children with severe psychomotor impairment (SPMI) often experience sleep disturbances that severely distress both the child and his or her parents. Validated questionnaires for the assessment of parents' distress related to their child's sleep disturbances are lacking. METHODS: We developed and validated a new questionnaire, the HOST (holistic assessment of sleep and daily troubles in parents of children with SPMI) to assess the effect of the sleep disturbances in children with SPMI on their parents. The questionnaire was developed based on published data and expert opinion, and it was refined via direct consultation with affected parents. Its psychometric characteristics were assessed in a sample of parents of 214 children with SPMI. It was retested using a random subsample of the participants. RESULTS: Explorative factor analysis revealed that the HOST was composed of four scales. Fit indices, item analysis, and convergent validity (coherence with preexisting instruments of sleep disturbances and health status) were adequate. Retest analysis (n=62) revealed high stability of the HOST questionnaire and adequate replication validity. CONCLUSION: Sleep-related difficulties significantly impact the sociomedical characteristics of the parents of children with complex neurologic diseases. Typically, parents are severely affected in various aspects of daily life (i.e., medical health, social life, professional life). The HOST proved to be a valid, reliable and economical assessment tool of sleep-related difficulties in parents and relatives of children with SPMI. The HOST is capable of identifying individuals and specific areas requiring intervention.