Institut Municipal d'Assistència Sanitària

Poor recovery of active glenohumeral external rotation (aGHER) after brachial plexus birth injury (BPBI) is common. Late spinal accessory nerve-to-infraspinatus motor branch (SAN-IS) transfer has been reported as effective. The authors investigated its efficacy in children older than 4 years with BPBI. This case series involved children with no aGHER undergoing SAN-IS transfer. Indications included absent aGHER in shoulder abduction and a positive external rotation drop test. Subscapularis release was done for passive GHER less than 30 degrees in patients without glenohumeral dysplasia, whereas external derotational humeral osteotomy was performed for those with dysplasia and passive GHER less than 0 degrees. Data collected included demographics, Narakas group classification, preoperative and postoperative hand-to-neck Mallet scores, postoperative aGHER, aGHER strength (British Medical Research Council scale), and parental satisfaction. Twenty-six patients, with a mean age of 9.9 years (range, 4 to 26 years) and mean follow-up of 27.9 months (range, 12 to 74 months), were included. Five patients (19%) had a concurrent upper subscapularis release, and 8 (31%) underwent derotational humeral osteotomy. Infraspinatus was macroscopically normal and contractile in all but 2 cases. Twenty-one patients (80%) achieved a mean aGHER of 71 degrees (range, 60 to 80 degress). Of these, 90% scored M4 on the British Medical Research Council scale, and 85% had a hand-to-neck Mallet score of 4. Shoulder forward flexion improved a mean of 35 degrees (range, 20 to 60 degrees) in 40% of patients. Parents were satisfied in 6 cases and extremely satisfied in 20 cases. Late SAN-IS transfer is both effective and safe for restoring aGHER in patients older than 4 years with BPBI.

veterinria so fundamentais para proteger a sade e bem-estar dos gatos.

Parenting is a key factor for the development of children with intellectual and developmental disabilities. Therefore, early intervention programs should target parenting behaviors to improve children’s developmental outcomes. The present study analyzed the effect of parental behaviors and other family factors on the cognitive and linguistic development of children with an intellectual disability (ID). Participants (n = 87, aged between 20 and 47 months) were recruited from several Spanish Early Intervention Centers. The children’s development was assessed with the Bayley Scales of Infant Development (BSID-III) on two occasions. Besides questionnaires including family factors, 10-min mother–child and father-child interactions during free play were auto-recorded at home. Intensive statistical modeling on the two measurement occasions was used to select relevant predictors as well as their interactions. Child cognitive development models, including predictors such as mother’s responsiveness and affection and father’s teaching, had a predictive capacity between 22 and 26%. The language development models, including the mother’s responsiveness and father’s teaching scores amongst other predictors, yielded adjusted-R2s between 26 and 28%. This study’s findings evidence that parental behaviors during adult–child interaction affect the development of children with intellectual disabilities. The study also provides data that can be used to guide early intervention.

The aims of this study were to analyze the interactions of mothers and fathers with their children with intellectual disabilities, focusing on certain parental behaviors previously identified as promoting child development, and to explore the relations between parenting and some sociodemographic variables. A sample of 87 pairs of mothers and fathers of the same children were recruited from Early Intervention Centers. The children (58 male and 29 female) were aged 20–47 months. Most of the families (92%) were from the province of Barcelona (Spain), and the remaining 8% were from the other provinces of Catalonia (Spain). Parenting behaviors, divided into four domains (Affection, Responsiveness, Encouragement, and Teaching) were assessed from self-recorded videotapes, in accordance with the validated Spanish version of the PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes). Parents were administered a sociodemographic questionnaire. The results revealed strong similarities between mothers’ and fathers’ parental behaviors. Mothers and fathers were more likely to engage in affectionate behavior than in teaching behavior. Only maternal teaching presented a significant positive relation to the child’s age. With respect to the child’s gender, no differences were observed in mothers’ parenting. Conversely, fathers scored significantly higher in Responsiveness, Encouragement and Teaching (and had higher total parenting scores) when interacting with boys. The severity of the child’s ID had a statistically significant effect only on fathers’ Teaching, which showed lower mean scores in the severe ID group than in the moderate and mild ID groups. Teaching also presented a significant positive relation to mother’s age, but father’s age was not related to any parenting domain. Mothers with a higher educational level scored significantly higher in Encouragement and Teaching, and the fathers’ educational level was not significantly related to any parenting domain. Mothers’ and fathers’ Teaching, and fathers’ Responsiveness, Encouragement and total parenting scores, presented a significant positive relation to family income. Finally, mothers spent more time in childcare activities than fathers, particularly on workdays. Our main conclusion is that mothers and fathers show very similar strengths and weaknesses when interacting with their children with intellectual disabilities during play.

ObjectiveTo describe and compare demographic and clinical profile of patients newly initiated on aclidinium (ACL) or tiotropium (TIO) and identify factors associated with newly initiated ACL in real-life clinical practice during 2013 in Catalonia.DesignWe performed a population-based, retrospective, observational study with data obtained from the Information System for Research Development in Primary Care, a population database that contains information of 5.8 million inhabitants (more than 80% of the Catalan population). Patients over 40 years old, with a recorded diagnosis of COPD and newly initiated treatment with either ACL or TIO during the study period (January to December 2013), were selected. A descriptive analysis of demographic and clinical characteristics was performed, and treatment adherence was also assessed for both cohorts.ResultsA total of 8,863 individuals were identified, 4,293 initiated with ACL and 4,570 with TIO. They had a mean age of 69.4 years (standard deviation: 11.3), a median COPD duration of 3 years (interquartile range: 0–8), and 71% were males. Patients treated with ACL were older, with more respiratory comorbidities, a longer time since COPD diagnosis, worse forced expiratory volume in 1 second (% predicted), and with a higher rate of exacerbations during the previous year compared with TIO. It was found that 41.3% of patients with ACL and 62.3% of patients with TIO had no previous COPD treatment. Inhaled corticosteroid and long-acting β2-agonist were the most frequent concomitant medications (32.9% and 32.6%, respectively). Approximately 75% of patients were persistent with ACL or TIO at 3 months from the beginning of treatment, and more than 50% of patients remained persistent at 9 months.ConclusionPatients initiated with ACL had more severe COPD and were taking more concomitant respiratory medications than patients initiated with TIO. ACL was more frequently initiated as part of triple therapy, while TIO was more frequently initiated as monotherapy.

Background Care coordination is the harmonious connection of the different services needed to provide care to a patient throughout the care continuum in order to achieve a common objective without producing conflicts. Continuity of care is related to how patients experience the coordination of services. The objective is to identify factors influencing care coordination and continuity across care levels …