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I feel pretty pleased with myself today. I took photos of absolutely everything I ate. Lately I've been letting nibbles here and there slide and it's not helping me stay honest with myself.
This morning I had a breakfast of a Starbucks Greek yogurt with honey parfait, mixed with canned pumpkin, pumpkin spice, a spoonful of drippy almond butter, and dried cranberries.
Oh I did take an unpictured double short ghetto mocha with me to class! One photo I did forget I guess. >.<
After my Intro to Research and Methods class, where my group pretty much learned that our tiny sample of data had no statistical significance and that we cannot throw out the null hypothesis, I ate my snack of dried cinnamon apple chips and raw almonds. My stomach was getting a bit growly.
I was still oh so ready for lunch by noon. Tuna salad on a bed of kale, tossed with a lime vinaigrette, and a few pineapple chunks for a pop. It was super delicious. I'm glad I eat fish now. Makes life a little easier.
I also knew I really needed a dessert today (Dessersday?) so I grabbed a carrot cake muffin that was to die for! So moist and delicious. Not overly sweet. Perfection really. =P Also ate my adult Go-Gurt. (Almost out of my free Chobani Champion Tubes :O What will I do then!?)
In my class after lunch, we watched a really great documentary called A Place At the Table. (click to watch trailer) It talks about hunger in America and was a really great watch. I may have cried in class. Give it a watch if you have time. It's available for free on Amazon Prime Instant and Netflix Instant.
After sticking around school to finish my case study on end stage renal disease, I headed home around 3pm. I had some snacks while there. Started with a bowl of cottage cheese and apple sauce with cinnamon and ended with two packets of crackers with brie cheese. I got munchy. =/
It was nice to be able to take some me time this afternoon though. I watched a movie and cross-stitched until I met up with my friend, Nick, at 5:30pm for a 65 minute bike. It was nice to catch up with him and get a good sweat on too.
By 7pm I had dinner ready. Two egg omelet filled with the leftover tofu and mushroom potsticker filling and topped with sautéed peppers and onions. On the side, cantaloupe and a toasted multigrain muesli bread. It was all really delicious. Expect to see a lot of eggs in the coming days. =P I had a coupon!
For dessert I really tried to fight my urge to graze. One really really excellent square of dark chocolate plus a mug of Joy tea did the trick! (Yes I am sticking my tongue out in the reflection of the cup..)
Enjoying my evening but probably won't stay up too late. Nick and I have a workout date at 8am! =D Night all!


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Seasonal fresh fruit can be a thoughtful expression of your sympathy. Always an appropriate gift from a friend or business associate. Approx. H 22" X W 16"
Delicious assortment of seasonal fruit and chocolates
Fresh mix of seasonal fruit with seasonal flowering plant
Assortment of cheese, chocolates, cracker, cookies and beautiful arrangement of fresh flowers

subset: commoncrawl


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When a person is unable to be confident in their abilities and themselves, they are noted to be someone who has a lack of self-confidence. No matter how much a person states they are confident, if they truly are not, it is easy for those who are around that person to determine otherwise. Mentally and physically, people can see just how unsure a person may be of themselves. With some assistance and perhaps mentoring, a person who lacks confidence can learn to be confident once more.
It is not too hard to know a person has lack of self-confidence. They may speak negative words about themselves and others. Physically, they may not dress as they really should. They may not put in any special effort in the workplace, and it will reflect on their job performance and evaluations. Not having confidence can also be seen physically as the person may neglect taking care of themselves. Sometimes help has to be sought to gain self-confidence.
A lot of the time a person has had low or no self-confidence for so long that he/she will have to seek help from professionals like ministers, therapists, and others to re-do their habits and thinking. Initially a person may not think it is possible to be like others and be confident so seeking help may not be so easy but usually, they will end up deciding to get some help with their problem. With professional help, the person will obtain the tools needs to become confident.
Other good ways to return your self-confidence is to read books on motivation and leadership, to take the active part in meetings, conferences, seminars, especially trying to speak more, to present your ideas. One more tip to grow your self-confidence is to attend some speaking clubs, discussion. You can even start it doing online through blog, forums, social networks. Then you will see that people agree with you or that you can to prove your opinions. So it will make you to be sure of yourself.
As soon as a person gains self-confidence, their attitudes change. They are more eager to participate in activities, more excited to speak in public, not afraid to take charge of tasks and assignments and on a daily basis keep trying to reinforce what they have learned while gaining their self-confidence back again. Social life, work life and personal life all improve.
As soon as a person who is not confident gets out of denial about the problem and seeks help, the sooner they can have some confidence and display it in their daily life. A person can be deceitful about having confidence, but many caught on to the act quickly. It is a myth that someone can not gain self-confidence once they lose it because, with the right support network and the support of family and friends, it can be done. Life is more blissful with happiness and self-confidence in place.
About the Author: Carol James is a writer and senior editor. She has MA degree in social sciences and writes articles, reviews on the different actual subjects. So, if you have any questions regarding the writing, feel free to ask her and visit her company's page EssayLab.
Thanks to Carol James
Dealing With Your Lack Of Self Confidence
April 26, 2018 by Leave a Comment


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Refresh Art Award
5th Base Gallery
Brick Lane
Closing date for submissions: 5th April 2019
We're a new art award trying to give value to all our entrants, and not just the lucky winners of the big prize. As well as a final show in London in 2019 for 24 artists, and several cash prizes of up to £3000, we're working hard to promote everyone who enters. So the earlier people enter, the more promotion they'll get! All entrants will also be allowed to show and sell their work through our online gallery throughout the duration of the show. We've also tried to keep entry financially viable, with a submission starting from only £10, and artists who win a place in the show do not need to have their work framed unless they want to. We're independent and started by artists, interested in work that people are currently making and hoping to break down some of the barriers that exclude many people from art shows.
The final exhibition will take place at 5th Base Gallery, Brick Lane, London.
For more information see www.refreshartaward.com


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Aim: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.
Methods: A prospective cohort study in 243 Neonatal Intensive Care Units (NICUs) from 18 European countries recorded frequency of pain assessments, use of mechanical ventilation, sedation, analgesia, or neuromuscular blockade for each neonate upto 28 days after NICU admission.
Results: Only 2113/6648 (31·8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46·0%), noninvasive ventilation (NiV, 35·0%), and no ventilation (NoV, 20·1%) groups (p<0·001). Daily assessments for continuous pain occurred in only 10·4% of all neonates (TrV: 14·0%, NiV: 10·7%, NoV: 7·6%; p<0·001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions, and surgical admissions prompted (all p<0·01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anesthetics (O-SH-GA) (all p<0·001), or surgery (p=0·028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1·60, p<0·001) and NiV groups (OR:1·40, p<0·001).
Conclusion: Assessments of continuous pain occurred in less than one-third of NICU admissions, and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns.
Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.
Aim: Early parental bonding with preterm babies is particularly important, and the aim of our study was to explore when parents experienced what they regarded as important events for the first time while their infant was in the neonatal intensive care unit (NICU).
Methods: The study was part of a longitudinal project on Kangaroo Mother Care at two Swedish university hospitals. The parents of 81 infants completed questionnaires during their infants' hospital stay.
Results: Most parents saw and touched their infants immediately after birth, but only a few could hold them skin to skin or swaddle them. Other important events identified by parents included the first time they performed care giving activities and did so independently, interaction and closeness with the infant, signs of the infant's recovery and integration into the family. The timing of the events depended on the physical design of the NICU, whether parents' could stay with their infant round-the-clock and when they were allowed to provide care under supervision and on their own.
Conclusion: The design and routines of the NICU dictated when parents first interacted with their infants. Clinical guidelines that facilitate early contact with preterm babies can help parents to make the transition to their parental role.
Aim: Poor social skills are a risk factor for becoming bullied, which could explain why this frequently occurs to children with autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD). Poor social skills tend to coexist with clumsiness. According to a pilot study, poor performance in physical education (PE) was correlated with bully victimization.
Methods: Sixty-nine healthy university students reported performance in PE and bully victimization in childhood. In addition, the participants responded to questionnaires for ADHD and ASDs to assess personality traits related to increased risk for bully victimization.
Results: Below average performance in PE was a risk factor of being bullied in school with an odds ratio of 3.6 [95% confidence interval: 1.23-10.5; p = 0.017]. Strong correlations between poor performance in PE and long duration of victimization (p = 0.007) and poor performance in PE and high frequency of victimization (p = 0.008) were found. Autistic traits were related to performance below average in PE.
Conclusion: Poor motor skills are a strong risk factor for becoming bullied. Prevention programmes that identify, protect and empower the clumsy children could be an important step to avoid bullying of the most vulnerable children.
AIM: We investigated the association between low Apgar score, other perinatal characteristics and low stress resilience in adolescence. A within-siblings analysis was used to tackle unmeasured shared familial confounding.
METHODS: We used a national cohort of 527,763 males born in Sweden between 1973 and 1992 who undertook military conscription assessments at mean age 18 years (17-20). Conscription examinations included a measure of stress resilience. Information on Apgar score and other perinatal characteristics was obtained through linkage with the Medical Birth Register. Analyses were conducted using ordinary least squares and fixed-effects linear regression models adjusted for potential confounding factors.
RESULTS: Infants with a prolonged low Apgar score at five minutes had an increased risk of low stress resilience in adolescence compared to those with highest scores at one minute, with an adjusted coefficient and 95% confidence interval of -0.26 (-0.39, -0.13). The associations were no longer statistically significant when using within-siblings models. However, the associations with stress resilience and birthweight remained statistically significant in all analyses.
CONCLUSION: The association with low Apgar score seems to be explained by confounding due to shared childhood circumstances among siblings from the same family, while low birthweight is independently associated with low stress resilience.
AIM: To investigate whether professional training and/or clinical experience affect the ability of caregiver to assess clinical signs of pre-emptive morphine analgesia. METHODS: In the Neurological Outcomes & Pre-emptive Analgesia In Neonates trial preterm infants undergoing mechanical ventilation were randomized to receive continuous infusion, either of morphine or placebo blinded. Staff from centres in Sweden (Stockholm and Orebro) completed an assessment form. RESULTS: A total of 360 assessment forms were collected from 52 neonates. In 59% of the cases, caregivers correctly identified patients group. Comparable proportion of answers were correct between physicians, nurses and assistant nurses (63, 60 and 54%, respectively, p = 0.60). Staff with Neonatal intensive care unit experience <1 year identified 63%, as compared to 65% for working 1-5 year, and 55% that has been working >5 years (p = 0.28). Staff's ability to correctly identify group assignment was reduced by amount of additional morphine (p < 0.01) and severity of illness (p = 0.01). CONCLUSIONS: Clinical medical staffs, including neonatologists, have great difficulties in assessing the presence and severity of pain. Further studies should focus on the methods for assessment of prolonged pain in preterm neonates, define the effects of adequate analgesia, and investigate the clinical factors that may alter neonatal responses to acute and prolonged pain.
Aim: Age-appropriate support for diabetes self-care is essential during school time, and we investigated the perceived quality of support children and adolescents received in 2015 and 2008.
Methods: This national study was based on questionnaires answered by children and adolescents aged 6-15 years of age with type 1 diabetes attending schools or preschools in 2008 (n = 317) and 2015 (n = 570) and separate parental questionnaires. The subjects were recruited by Swedish paediatric diabetes units, with 41/44 taking part in 2008 and 41/42 in 2015.
Results: Fewer participants said they were treated differently in school because of their diabetes in 2015 than 2008. The opportunity to perform insulin boluses and glucose monitoring in privacy increased (80% versus 88%; p < 0.05). Most (83%) adolescents aged 13-15 years were satisfied with the support they received, but levels were lower in girls (p < 0.05). More subjects had hypoglycaemia during school hours (84% versus 70%, p < 0.001), but hypoglycaemia support did not increase and was lower for adolescents than younger children (p < 0.001).
Conclusion: Children and adolescents received more support for type 1 diabetes in Swedish schools in 2015 than 2008, but more support is needed by girls and during hypoglycaemia.
Aim: The aim of this study was to investigate whether scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec could reduce the incidence of neonatal sepsis in a level-three neonatal intensive care unit.
Methods: We studied the incidence of neonatal sepsis caused by coagulase-negative staphylococci (CoNS) for 16.5 months before the initiative was launched on May 15, 2012 and then for a further 8.5 months after it was introduced. The hub routine was applied to all intravenous catheters.
Results: During the control period before the initiative was launched, there were nine cases of CoNS sepsis compared with no cases after it was introduced, resulting in a decrease in sepsis incidence from 1.5% to 0% with a risk reduction of 1.5% (0.53-2.58%) (p = 0.06). In the preterm infant population, the incidence of sepsis decreased from 3.6% to 0% (1.1-6.0%) (p = 0.11).
Conclusion: Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec seemed to be an efficient way of preventing sepsis caused by CoNS in newborn infants. However, the evidence for the benefits will remain weak until a large randomised trial has been completed.
Aim To describe initiation and extent of parents application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units.
Methods The duration of SSC was recorded in 104 infants medical charts during their hospital stay, and the parents answered a questionnaire.
Results Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 2478 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p < 0.001). The median daily duration of SSC was 403 min.
Conclusion Early initiation of SSC had positive impact on the extent of parents application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.
Aim: To investigate conversations between nurses and parents in Swedish child health services and to assess to what extent attention is directed towards dietary and physical activity behaviours in children.
Methods: Twenty-three nurses audio-recorded one session each. Recordings were assessed and topics were classified according to predetermined categories.
Results: The three most frequent topics of conversation concerned physical examinations of the child (30% of session time), talking to the child to establish or maintain contact and interest (15%), and development of language skills (12%). Dietary habits came on fourth place (10%), and physical activity ranked 14 (4%).
Conclusion: Attention to dietary and physical activity behaviours in children is infrequent in Swedish child health services. Concern is raised about the efficacy of prevention efforts against childhood obesity.
AIM: To study parenting stress in lesbian parents and to compare that stress with heterosexual parents following in vitro fertilization (IVF) or spontaneous pregnancies.
METHODS: This survey took place during 2005 to 2008 and was part of the Swedish multi-centre study on gamete donation. It comprised 131 lesbian parents, 83 heterosexual IVF parents, who used their own gametes, and 118 spontaneous pregnancy parents. The participants responded to the questionnaire when the child was between 12 and 36-months-old and parenting stress was measured by the Swedish Parenting Stress Questionnaire (SPSQ).
RESULTS: Lesbian parents experienced less parenting stress than heterosexual IVF parents when it came to the General Parenting Stress measure (p=0.001) and the sub areas of Incompetence (p<0.001), Social Isolation (p=0.033) and Role Restriction (p=0.004). They also experienced less parenting stress than heterosexual spontaneous pregnancy couples, according to the Social Isolation sub area (p=0.003). Birth mothers experienced higher stress than co-mothers and fathers, according to the Role Restriction measure (p=0.041).
CONCLUSION: These are reassuring findings, considering the known challenges that lesbian families face in establishing their parental roles and, in particular, the challenges related to the lack of recognition of the co-mother. This article is protected by copyright. All rights reserved.
AIM: This Swedish study determined which species of coagulase-negative staphylococci (CoNS) were found in neonatal blood cultures and whether they included Staphylococcus capitis clones with decreased susceptibility to vancomycin.
METHODS: CoNS isolates (n = 332) from neonatal blood cultures collected at Örebro University Hospital during 1987-2014 were identified to species level with matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). The antibiotic susceptibility pattern of S. capitis isolates was determined by the disc diffusion test and Etest, and the presence of heterogeneous glycopeptide-intermediate S. capitis (hGISC) was evaluated.
RESULTS: Staphylococcus epidermidis (67.4%), Staphylococcus haemolyticus (10.5%) and S. capitis (9.6%) were the most common CoNS species. Of the S. capitis isolates, 75% were methicillin-resistant and 44% were multidrug-resistant. No isolate showed decreased susceptibility to vancomycin, but at least 59% displayed the hGISC phenotype. Staphylococcus capitis isolates related to the strain CR01 displaying pulsotype NRCS-A were found.
CONCLUSION: Staphylococcus epidermidis, S. haemolyticus and S. capitis were the predominant species detected in neonatal blood cultures by MALDI-TOF MS. The number of episodes caused by S. capitis increased during the study period, but no isolates with decreased susceptibility to vancomycin were identified. However, S. capitis isolates related to the strain CR01 displaying pulsotype NRCS-A were found.
The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results:
Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.
AIM: The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).
METHODS: Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.
RESULTS: In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66-1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t=2.44, 95% CI 0.03-0.23, effect size d=0.26.
CONCLUSION: In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.
Equipment (Pea Pod) for assessing infant body density accurately and conveniently has recently become available. This density can be converted to body composition using the "Fomon" or the "Butte" model. These models differ regarding the water content in fat-free mass (hydration factor, HF). We assessed HF and its biological variability in newborns and compared results calculated using the two models at one and 12 weeks. Body volume and body weight were measured in 12 infants less than 10 days old using Pea Pod. Their total body water was assessed using isotope dilution. Their HF was found to be 80.9% with low biological variability (0.81% of average HF). Further, Pea Pod was used to assess body density of 108 infants at one and 12 weeks of age. Values for body fat (%) calculated using the "Butte" model were significantly lower than when using the "Fomon" model at one week (p<0.05) and 12 weeks (p<0.01). The difference between the two models was particularly large at one week, probably due to their different HF-values. Our HF-value is in agreement with that in the "Fomon" model and our results support the conclusion that this model is preferable when calculating body composition in infants.
Aim: To use Pea Pod, a device based on air displacement plethysmography, to study body composition of healthy, full-term infants born to well-nourished women with a western life-style. Methods: Body composition was assessed in 53 girls and 55 boys at 1 week (before 10 days of age) and at 12 weeks (between 77 and 91 days of age). Results: At 1 week girls contained 13.4 +/- 3.7% body fat and boys 12.5 +/- 4.0%. At 12 weeks, these figures were 26.3 +/- 4.2% (girls) and 26.4 +/- 5.1% (boys). Body fat (%) did not differ significantly between the genders. Body fat (%) at the two measurements was not correlated. At 1 week, the weight (r = 0.20, p = 0.044) and BMI (r = 0.26, p = 0.007) of the infants, but not their body fat (g, %) or fat free mass (g), correlated with BMI before pregnancy in their mothers. Conclusions: Pea Pod has potential for use in studies investigating the effect of external (i.e. nutritional status) and internal (i.e. age, gender, gestational age at birth) factors on infant body composition. This may be of value when studying relationships between the nutritional situation during early life and adult health.
AIM: The aim of this study was to investigate the degree to which Swedish neonatal units have adopted the national guidelines for prevention and treatment of pain in newborn infants. METHOD: A survey was sent to all units in Sweden that provide neonatal care. For a list of potentially painful procedures, compiled from the national neonatal pain guidelines, the units were asked if they would use pharmacological and/or behavioural interventions, and in each case to specify the treatment. RESULTS: The response rate was 80.4%. Eighty-eight percent of the units had written guidelines for pain management, and 59% of these had been updated within the last 2 years. For almost every presented case, all units reported that they used either pharmacological or behavioural treatment or both. The survey showed a wide variation in morphine and paracetamol dosing and the absence of a paracetamol loading dose in a fourth of the units. CONCLUSIONS: This study suggests that a majority of Swedish neonatal units have adopted pain management guidelines in concordance with the Swedish national guidelines, and kept them up-to-date. For most painful situations a variety of behavioural and pharmacological interventions are used, often in combination.
AIM: To assess the ability of galvanic skin response (GSR) to differentiate between tactile and painful stimulation in newborn infants, and to compare this with the ability of the premature infant pain profile (PIPP). METHODS: Thirty-two healthy full-term infants undergoing routine blood sampling were recruited. In a randomized order they were subjected to tactile and painful stimulation. The three GSR variables conductance baseline level, number of waves per second and mean amplitude of the waves were recorded together with the behavioural and physiological variables of PIPP. RESULTS: The GSR variables number of waves and amplitude of the waves increased more during painful stimulation than during tactile stimulation, as did also the PIPP score. Receiver operating characteristic curves analysis revealed no significant differences between the studied methods. CONCLUSION: GSR can differentiate painful from tactile stimulation, but more research is needed to achieve a clinically useful application.
AIM: The aim of the study was to assess the incidence, mortality and morbidity of dilated cardiomyopathy (DCM) and non-compaction of the left ventricle (LVNC) in Swedish children.
METHODS: We reviewed hospital records of all children with dilated cardiomyopathy (DCM) or left ventricular non-compaction cardiomyopathy (LVNC) up to the age of 18 in the healthcare region of western Sweden from 1991 to 2015.
RESULTS: In total, 69 cases (61% males) were identified. The combined incidence of DCM and LVNC was 0.77 (95% CI 0.59-0.96) per 100,000 person years. Children were divided into six groups and their outcomes were analysed depending on their aetiology. Idiopathic DCM was reported in 43% and familial dilated and left ventricular non-compaction aetiology was present in 32%. DCM due to various diseases occurred in 8%. DCM associated with neuromuscular diseases was present in 16%. The overall risk of death or receiving transplants in children with idiopathic and familial DCM was 30% over the study period and 21% died in the first year after diagnosis.
CONCLUSION: The combined incidence of DCM and LVNC was similar to previous reports. Most children with idiopathic DCM presented during infancy and mortality was highest during the first year after diagnosis.
Aim: To describe parental facilities for staying in neonatal units, visiting policies, and access to emotional support during hospitalization.
Methods: A cross‐sectional design was used in which a survey was presented to all neonatal units in Sweden; 34 out of 38 units participated (89%).
Results: The findings showed that in 50% of the units, parents could stay 24/7 for the infant's entire hospital stay. In 32% of the units, siblings could stay the night with their parents. Units had policies on restrictions for visits by siblings (80%), grandparents (59%), friends and relatives (71%). All units offered counselling to parents, and some units offered peer‐to‐peer groups (24%), diaries (35%), relaxation techniques (6%) or internet parental forums (6%). All units enabled parents to be at home with their infant and to visit the unit for check‐ups (35%) or to have staff visits at home (65%).
Conclusion: Facilities for parents to stay with their infant during hospitalization and to have significant others visit are good, but there is room for improvement. During the transitional phase to being at home, parents are facilitated in being at home before the infant is discharged and are supported by the unit, which must be considered beneficial for parents.
AIM: To explore the phenotype and response to growth hormone in patients with heterozygous-mutations in the insulin-like growth factor I receptor gene (IGF1R).
METHODS: Children with short-stature, microcephaly, born SGA combined with biochemical sign of IGF-I insensitivity were analyzed for IGF1R mutations or deletions using Sanger sequencing and Multiple ligation dependent probe amplification analysis.
RESULTS: In two families, a novel heterozygous non-synonymous missense IGF1R variant was identified. In family 1, c.3364G>T, p.(Gly1122Cys) was found in the proband and co-segregated perfectly with the phenotype in three generations. In family 2, a de novo variant c.3530G>A, p.(Arg1177His) was detected. Both variants were rare, not present in the GnomAD database. Three individuals carrying IGF1R mutations have received rhGH treatment. The average gain in height SDS during treatment was 0.42 (range: 0.26 - 0.60) and 0.64 (range: 0.32 - 0.86) after 1 and 2 years of treatment, respectively.
CONCLUSION: Our study presents two heterozygous IGF1R mutations causing pre- and postnatal growth failure and microcephaly and also indicates that individuals with heterozygous IGF1R mutations can respond to rhGH treatment. The findings highlight that sequencing of the IGF1R should be considered in children with microcephaly and short stature due to pre- and postnatal growth failure.
Background: It has been proposed that a systematic pain assessment increases the awareness of the need to treat and prevent pain, and most international and national neonatal pain guidelines state that pain assessment should be performed in a systematic way. National surveys show a wide variation in compliance to these guidelines.
Methods: A survey to all Swedish neonatal units was performed in 1993, 1998, 2003 and 2008, concerning the use of, and need for, pain assessment tools.
Results: The number of units that tried to assess pain increased from 64% in 1993 to 83% in 2008. Forty-four per cent of these used a structured method in 2003, compared to three per cent in 1998. The most common pain indicator was facial actions.
Conclusion: The proportion of neonatal units that reported the use of a structured pain assessment tool has increased significantly from 1993 to 2008. There is a need for better evidence for the relation between the implementation of pain guidelines and the actual performance of pain assessment.
AIM: This study examines socio-demographic determinants of initiation and duration of breastfeeding in a community-based cohort in northwest Russia.
METHODS: All infants born to women who were registered at the antenatal clinics in Severodvinsk in 1999 comprised the cohort (n=1399) and were followed up at 1 y. Data on maternal and infant characteristics as well as the duration of breastfeeding were obtained from medical records. Proportional hazard analysis was applied to quantify the effect of the selected factors on the risk of breastfeeding discontinuation adjusted for potential confounders.
RESULTS: Only 1.3% of infants were never breastfed. Breastfeeding rates were 75.0% and 47.2% at 3 and 6 mo, respectively. Maternal age and early initiation of prenatal care were positively associated with breastfeeding initiation rates. Increased risks of breastfeeding discontinuation were found in teenage mothers (OR=1.45, 95% CI: 1.06-1.99), in mothers with basic education (OR=1.68, 95% CI: 1.06-2.66) and in unmarried mothers (OR=1.19, 95% CI: 1.03-1.38). Women with no previous deliveries were more likely to breastfeed longer (OR=0.74, 95% CI: 0.62-0.90).
CONCLUSIONS: Compared with previous studies in Russia, almost universal initiation and considerably higher rates of breastfeeding at specific time points were found. Social variations in initiation and duration of breastfeeding should raise concern of inequalities in breastfeeding practices in transitional Russia.
The aim of this study was to evaluate some aspects of care given within the preventive Child Health Services (CHS) during the first 18 months of Life. A national random sample performed on child health records of 172 Swedish preschool children horn between 1982 and 1987 was analysed regarding services recorded as having been provided and used within and beyond the national programme of health surveillance. Most families had mode visits within the core programme of health surveillance to an optimal or at least sufficient extent. First-time parents visited the CHS more frequently than did more experienced parents. Procedures within the programme, such as growth monitoring, hip examination and immunizations, were documented to have been optimally performed on a majority of the children. Conversely, screening for hearing impairment and assessment of developmental milestones were performed less frequently, as were health information and postnatal parental education. To improve the quality of care, national recommendations ought to be more specific regarding both the performance and the documentation of the service.
Objectives: To explore whether physicians behave differently regarding ethics and respect for privacy depending on children's age. We explored whether physician behaviours contributed to child uneasiness.
Study design: Observational study of 21 children (0-12 years; 18 boys; mean age 3.2) undergoing evaluation for inguinal hernia. Specific physician-initiated verbal and nonverbal behaviours were coded from digital video discs of the consultations.
Results: Physician intrusiveness (i.e. approaching the child suddenly or in an uninvited way) during the physical examination was related to concurrent child uneasiness (r = 0.42, p < 0.06) and lasted through the postexamination phase of the consultation (r = 0.52, p < 0.01). Child mood during the examination strongly predicted postexamination mood (r = 0.69, p < 0.0001). Neither the total number of physician-initiated positive behaviours or privacy-related behaviours was associated with child age. Negative physician behaviours were strongly related to negative mood in the child (r = 0.72, p < 0.0001) at the close of the consultation.
Conclusion: Although physicians were more likely to provide information to older than younger children, their behaviours regarding privacy did not differ by child age. We found that intrusiveness was rather common and related to child uneasiness that has implications for the ethical practice and a child's willingness to be examined.
AIM: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care.
MATERIAL AND METHODS: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire.
RESULTS: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20% had woken at night due to asthma symptoms during the last week. About 15% had made unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings.
CONCLUSIONS: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better fulfilment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.
AIM: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand.
METHODS: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use.
RESULTS: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns.
CONCLUSION: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls.
AIM: To investigate if food frequencies are related to overweight/obesity in 5-year-old children.
METHODS: During 1997-1999, 21 700 infants were invited to participate in ABIS (All Babies in Southeast Sweden), a prospective, cohort study. Participants were followed from birth (n = 16 058) to 5 years (n = 7356). Food frequencies reported by parents at 2.5 and 5 years were studied in the relation to overweight/obesity at 5 years using multiple logistic regressions. A p-value < 0.01 was considered statistically significant.
RESULTS: At 2.5 years frequencies of intake of cheese were positively associated with overweight/obesity at 5 years while porridge, fried potatoes/french fries and cream/crème fraiche showed a negative association. When adjusting for known risk factors, porridge and fried potatoes/french fries remained negatively associated with overweight/obesity. At 5 years, chocolate and lemonade were positively associated with overweight/obesity whereas cream/crème fraiche, pastries and candy were negatively associated. Candy remained negatively associated to overweight/obesity after adjustment for potential confounders.
CONCLUSION: Food frequencies do not offer any simple explanation for overweight/obesity. Porridge at 2.5 years may protect against overweight/obesity at 5 years, while lemonade may contribute to overweight. Our finding that fried potatoes/french fries may protect against overweight/obesity is unexpected and must be interpreted with caution. These findings should be confirmed by prospective studies using objective recordings.
Aim: Our objective was to investigate whether overweight at a very young age predicts overweight at 5 years and to identify risk factors for overweight/obesity at 5 years, thereby making it easier for Child Health Services to focus their prevention strategies on risk groups.
Methods: We analysed data from the ABIS study (All Babies In Southeast Sweden), a prospective cohort study. Parents answered questionnaires between childbirth (n = 16,058) and 5 years (n = 7356).
Results: High body mass index (BMI; >95th percentile) at 1 year (adjusted odds ratio [AOR]= 6.57; 95% CI = 4.63–9.33; p < 0.001) and age-adjusted BMI > 25 at 2.5 years (AOR = 14.24; 95% CI = 10.52–19.29; p < 0.001) were associated with increased risk of obesity (age-adjusted BMI > 30) at 5 years. Heredity for type 2 diabetes (p = 0.022), high parental BMI and the child's own BMI at birth and at 1 year predicted higher BMI of the child at 5 years (p < 0.001). High parental education was inversely associated with child overweight (p = 0.054 respective p < 0.005).
Conclusion: Obesity at age 1 and at 2.5 years predicts obesity at 5 years. Obese parents, especially in families with heredity for type 2 diabetes and low education, should be targeted in early obesity prevention strategies by the Child Health Service.
Aim: Staphylococci are a major contribution for neonatal sepsis, which is the main risk factor for bronchopulmonary dysplasia. This study investigated the expression of pro-inflammatory mediators in endothelial and respiratory cells from newborns exposed to staphylococci.
Methods: Human vascular endothelial cells and small airway epithelial cells were incubated with neonatal blood isolates of Staphylococcus epidermidis (n = 14) and Staphylococcus aureus (n = 14). The extracellular release of IL-8, IL-10, sICAM-1, ICAM-1 mRNA and the expression of membrane bound ICAM-1 were assessed by ELISA, RT-PCR and immunofluorescence microscopy.
Results: Staphylococcus epidermidis induced higher levels of IL-8 (mean 38.5 ng/mL) and ICAM-1 mRNA (mean ratio 1.037) in the small airway epithelial cells than S. aureus (IL-8 mean 22.2 ng/mL, p < 0.01 and ICAM-1 mRNA mean ratio 0.715, p < 0.01). In the endothelial cells, ICAM-1 remained more integrated in the cell membranes after exposure to S. epidermidis compared with S. aureus, which induced disintegration and release of soluble ICAM-1 into the supernatants.
Conclusion: Staphylococcus epidermidis induced a higher chemoattractive response than S. aureus. A persistent transmigration of granulocytes into the lung tissue in neonatal S. epidermidis sepsis might contribute to the development of bronchopulmonary dysplasia.
New knowledge in perinatal medicine has resulted in increased survival of very-low-birthweight (VLBW) infants. After leaving hospital, the child is seen at regular medical check-ups, but there is often a persistent worry about the child which affects the family as a whole. This can lead to an increased utilization of healthcare. Our objective was therefore to describe the utilization of healthcare by VLBW infants during their first year of life and its relation to high-risk diagnoses in the neonatal period. The study group comprised 36 infants born at gestational ages of < or = 31 wk and with a birthweight of < or = 1500 g, and was compared with a control group of 36 full-term infants. Utilization of healthcare by the VLBW infants was higher than that by the control group in paediatric and ophthalmic outpatient clinics. The total number of contacts with healthcare was on average 38.7 versus 17.4. High-risk diagnoses in the neonatal period did not correlate with utilization of care, except for visits to the paediatric outpatient clinic, especially planned visits. Further studies focusing on how to support these families after leaving hospital are therefore needed.
AIM: To describe the parent's judgement of their own stress and the child's behaviour at 18 months after pre-term birth and if there are any correlations between these assessments, the morbidity in the neonatal period, the gestational age at birth and the occurrence of twin/triplet births. METHOD: Twenty-one mothers and 19 fathers of pre-term infants answered two questionnaires, The Swedish Parenthood Stress Questionnaire (SPSQ) and The Toddler Behaviour Questionnaire (TBQ). RESULTS: Mothers scored somewhat higher than fathers concerning parental stress. Parents with twins/triplets and of children born in gestational week 25-30 felt more stress, though the differences were not statistically significant. High-risk diagnoses did not correlate to any of the dimensions. The parents judged the behaviour of the children similar except that parents of children born in gestational week 25-30 scored significantly higher for intensity/activity (p = 0.002). The correlation between parental stress and judgement of their children's behaviour did not show any significant association except for the dimension regularity in TBQ (p = 0.016). CONCLUSIONS: The mothers' and fathers' assessments of their own stress and of the children's behaviour were similar. Parents of very pre-term children felt more stress and judged the children somewhat delayed in their social behaviours, probably due to their low gestational age.
AIM: To study the subjective opinions about what is important in care at neonatal units and child health centres (CHCs) for premature newborns, and to compare these opinions with the care actually given. SUBJECTS: 21 mothers, 20 fathers and 15 nurses at the neonatal unit, and 21 mothers, 14 fathers and 18 nurses at CHCs.
METHODS: A questionnaire on quality of Care from the Patient's Perspective was used. It contained three dimensions: identity-oriented approach, medical-technical competence and socio-cultural atmosphere. Each dimension was evaluated in terms of subjective importance and perceived reality of given care.
RESULTS: In general, subjective importance was rated higher than perceived reality both for neonatal care and care at CHCs for the dimensions identity-oriented approach and medical-technical competence. However, higher ratings were given to neonatal care compared to CHCs for medical-technical competence. High-risk diagnoses and very low gestational age in the newborn did not affect the answers. Mothers rated medical-technical competence higher than nurses for neonatal care. Mothers and nurses rated identity-oriented approach higher than fathers for CHCs.
CONCLUSION: Although both neonatal care and care at CHCs were highly rated, improvements can be made to fulfil the expectations of parents and nurses. Neonatal units seem to be more efficient in taking care of the special needs of these newborns compared to CHCs. The need for an optimal identity-oriented approach, medical-technical competence and socio-cultural atmosphere could strengthen the possibilities of parents to be confident in their parental role.
Aim: There have not been any continence-specific measurement tools in Swedish that have allowed clinicians to investigate the quality of life (QoL) in children with bladder dysfunction. This study evaluated the QoL in Swedish children with nocturnal enuresis and tested the reliability of a Swedish translation of the Paediatric Incontinence Questionnaire (PinQ).
Methods: This prospective study comprised 46 children aged 6-18 years with nocturnal enuresis, who completed the PinQ after it was translated into Swedish. It was completed twice by 33 patients and these responses were included in the test re-test evaluation.
Results: The self-reported mean sum score for the whole group was 26.3 ± 13.37 (range 5-58) and the most affected domains were social relations with peers and self-esteem. The highest individual scores were four, three or two for 71.7%, 17.4%, and 10.9% of the study population, respectively. Cronbach's alpha was 0.87 for the whole questionnaire, indicating good internal consistency. The test re-test stability was excellent, with an intra-class correlation coefficient of 0.76.
Conclusion: Children with nocturnal enuresis had impaired self-esteem and their impaired QoL affected their relationships with friends. The Swedish version of the PinQ proved to be a reliable tool that will be used in further studies.
Aim: To determine if the use of alcohol-based hand-disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism. Methods: Children aged 0–6 years attending DCC were studied in a cluster randomized controlled trial during 30 weeks. Thirty matched pairs of DCCs were included in the study, where one of the DCCs was randomized to intervention and the other to control within each pair. The intervention consisted in children and staff using alcohol-based oily disinfectant gel containing 70% ethanol after regular hand washing. The main outcome was the rate of episodes of absence from DCC due to infection. A regression model was fitted at the individual level and controlling several possible confounders for illness. Absences were reported by the parents. Results: Differences in missing absence reports between the two groups led to only evaluating those 29 DCCs (1431 children) that were able to provide complete reports. In the multivariate regression, the intervention significantly reduced the rate of absenteeism of a child by 12% compared to a child in a control DCC (IRR 95% CI: 0.799–0.965).
Aim: To investigate vascular function in children with a neonatal history of generalised inflammation indicated by premature prolonged rupture of membranes (PPROM) and bronchopulmonary dysplasia (BPD).
Methods: Children born at ≤ 30 weeks 1994–2000 were investigated at a present age of 6–12 years. Twenty-eight children participated and were divided into two groups with regard to BPD/no BPD (n = 15/13) and PPROM/no PPROM (n = 10/18). Vascular endothelial function was assessed by acetylcholine (ACh)-induced skin vasodilatation.
Results: Maximum ACh-induced skin perfusion was statistically significantly lower in the PPROM group compared with the non-PPROM group (p = 0.045) after adjustment for confounders. We found no association between BPD and maximum ACh-induced skin perfusion (p = 0.404), after adjustment for confounders.
Conclusion: A neonatal history of prolonged premature rupture of membranes was associated with later impairment of vascular endothelial function in childhood. This association was not observed with BPD. Some forms of perinatal inflammation may be associated with later cardiovascular function.
Aim: To investigate the prevalence of children who are in need of special support in the total population of children attending preschools (CA 1-6) in two Swedish counties, and the functional problems exhibited by the children in relation to demographical and environmental factors in the preschool context. Method: Survey distributed to (N = 1138) preschools in two Swedish counties. Results: The majority of children perceived by preschool teachers and in need of special support were undiagnosed children with functional difficulties related to speech, language and interaction with peers. Conclusion: Undiagnosed and diagnosed children share the same type of difficulties. Thus, in estimating the prevalence of children in need of special support in a preschool context, traditional disability categories capture only a small proportion of the children experiencing difficulties. Therefore, a functional approach in studies of children in need of special support is recommended.
Aim: To examine the prevalence of burnout symptoms in the context of parenting a chronically ill child. Methods: A total of 252 parents of children with Type 1 Diabetes Mellitus and 38 parents of children with Inflammatory Bowel Diseases participated in a population-based study. A control group consisted of 124 randomly selected parents of healthy children. We used self-report questionnaires to assess symptoms of burnout. Results: The main finding was that significantly more parents of children with chronic diseases (36%) scored for clinical burnout, compared with parents of healthy children (20%). Burnout symptoms were most prominent among mothers of children with diabetes, although fathers of children with diabetes and mothers and fathers of children with inflammatory bowel diseases also reported higher levels of various burnout symptoms. Conclusion: Burnout may be a useful model for understanding long-term parental responses and should be acknowledged among the different types of psychological consequences of the multi-faceted experience of parenting a child with chronic illness. Gender seems to influence the risk of burnout symptoms. Continued research about other background factors, and how the parents' situation changes over time are warranted. In the clinic, we need to draw attention to the group of parents who may suffer from burnout.
Aim: To examine associations between burnout and sociodemographic, psychosocial, personality and medical factors in parents of children with Type 1 Diabetes Mellitus (T1DM). Methods: A total of 252 parents of children with T1DM participated in a population-based study. We used self-report questionnaires to assess symptoms of burnout and background factors. Results: Psychosocial background factors were significantly associated with burnout in parents, whereas there were no associations between sociodemographic or medical factors and burnout. For both genders, parental burnout was associated with low social support, lack of leisure time, financial concerns and a perception that the child's disease affects everyday life. Low self-esteem and high need for control were risk factors for maternal burnout. Conclusion: In the screening of risk factors for long-term stress in parents of children with T1DM, we should recognize parents' attitudes as well as situational psychosocial issues. In clinics, we need to pay attention to the day-to-day life circumstances in the support of these parents. Certain factors were associated with the risk for burnout only for mothers, which warrant further investigation of gender aspects. Continued research about the causal relationship between the parental responsibility, psychosocial factors and burnout is warranted.
AIM: Adult studies indicate that gastrointestinal symptoms vary with sex and socioeconomic status. We examined socioeconomic factors, infant sex, smoking and gastrointestinal symptoms, especially constipation, in 2.5 year-old children. METHODS: This study was part of a prospective cohort study of children born 01.10.97-01.10.99 (the ABIS study; All Babies in Southeast Sweden). Socioeconomic factors, infant sex, smoking were analyzed vs. constipation, diarrhoea, anorexia, abdominal pain, meteorism and vomiting using logistic regression. All data were obtained through questionnaires distributed at infant birth, at 1 and 2.5 years of age. RESULTS: Out of 8341 children, 539 (6.5%) suffered from constipation. In a backward stepwise regression analysis (AOR; and 95% CI AOR = are given within brackets), constipation correlated with low maternal education (1.60; 1.08-2.35), female sex (1.52; 1.23-1.85), living in a large community with >3000 inhabitants (1.35; 1.09-1.64) and having no older siblings (1.28; 1.04-1.59). Smoking during pregnancy was linked to diarrhoea (multivariate analysis: 1.76; 1.02-3.02), anorexia (univariate analysis: 1.43; 1.09-1.87) and meteorism (univariate analysis: 1.58; 1.11-2.27). Adjusting for confounders, paracetamol use was linked to a five-fold increased risk of anorexia (5.12; 1.26-20.70). CONCLUSIONS: This study indicates that socioeconomic status, infant sex and parental smoking, are associated with gastrointestinal symptoms in children.
Aim: The coronavirus disease 2019 (COVID-19) pandemic has affected hundreds of thousands of people. Data on symptoms and prognosis in children are rare.
Methods: A systematic literature review was carried out to identify papers on COVID-19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), using the MEDLINE and Embase databases between January 1 and March 18, 2020.
Results: The search identified 45 relevant scientific papers and letters. The review showed that children have so far accounted for 1%-5% of diagnosed COVID-19 cases, they often have milder disease than adults and deaths have been extremely rare. Diagnostic findings have been similar to adults, with fever and respiratory symptoms being prevalent, but fewer children seem to have developed severe pneumonia. Elevated inflammatory markers were less common in children, and lymphocytopenia seemed rare. Newborn infants have developed symptomatic COVID-19, but evidence of vertical intrauterine transmission was scarce. Suggested treatment included providing oxygen, inhalations, nutritional support and maintaining fluids and electrolyte balances.
Conclusions: The coronavirus disease 2019 has occurred in children, but they seemed to have a milder disease course and better prognosis than adults. Deaths were extremely rare.
Aim: According to a number of small case series, orthodontic treatment may have anti-enuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children's nocturnal respiration and nasal airway dimensions.
Methods: Children with therapy-resistant enuresis underwent polysomnography, focusing on nocturnal respiration, and had their nasal airways examined. Rapid maxillary expansion was performed, widening the maxilla by approximately 0.5cm. The dental appliance was removed after 6months. Enuresis frequency was evaluated four times: at baseline, with the orthodontic apparatus in situ, after completed maxillary expansion and 1year post-treatment.
Results: Of the 34 children recruited, one dropped out due to oral discomfort. The numbers of wet nights per week on the four assessment occasions were 5.481.48, 5.12 +/- 1.73, 3.09 +/- 2.49 and 2.63 +/- 2.81; p<0.001. The proportions of responders, intermediate responders and non-responders during treatment were 21.2%, 27.3% and 51.5%, respectively. Responders were found to have a lower enuresis frequency at baseline (p=0.001) and to have larger nasal airway dimensions (p=0.01).
Conclusion: Orthodontic widening of the palate may be curative in a subgroup of children with therapy-resistant enuresis.
AimAlthough there is a known association between enuresis and snoring or sleep apnoeas, respiration during sleep has not been thoroughly studied in enuretic children. This study was performed with the aim of filling this gap in our knowledge. MethodsThirty-four children with therapy-resistant enuresis, but no history of heavy snoring or sleep apnoeas, underwent sleep registrations, including standard electroencephalography (EEG) and electrooculography (EOG) as well as registration of oxygen saturation, respiratory effort and nasal air flow. To assess nasal airway patency, rhinomanometry and acoustic rhinometry were performed before and after nasal decongestion. ResultsThe children were found to have a higher than expected apnoea hypopnoea index (AHI), due to a high frequency of hypopnoeas. They were also noted to have a tendency for respiratory arousals. Standard polysomnographic variables were normal. ConclusionWe provide baseline data of nocturnal respiration in enuretic children. The children were found to have subclinical signs of disordered respiration. This may be one of the explanations for their high arousal thresholds.
Aim: The study compared how four different growth references determined the prevalence of thinness and overweight, based on height and weight measurements from a nationally representative sample of Swedish children from seven to nine years of age.
Methods: The height and weight measurements of 4,518 Swedish schoolchildren aged seven to nine years were carried out in 2008 using a standardised protocol. The prevalence of different degrees of thinness and overweight were calculated using international growth references from the World Health Organization, the International Obesity Task Force and two Swedish growth references from Werner and Karlberg.
Results: Depending on which growth reference we used, the prevalence of different degrees of thinness varied from 7.5%-16.9% for the boys and 6.9%-13.7% for the girls, while for the prevalence of overweight, including obesity and severe obesity, varied from 16.5%-25.7% for the boys and 18.2-25.2% for the girls. There were also significant gender differences depending on the growth reference we used.
Conclusion: Using four different growth references, two international and two Swedish, produced wide variations in the prevalence of thinness and overweight, together with significant gender differences. In the absence of a global definition, we need both national and international growth references.
AIM: This study investigated whether substantial body mass index (BMI) reductions in Swedish schoolchildren aged 7-19 years, caused by disease, healthy or unhealthy behaviour, had any impact on their final height.
METHODS: We used height and weight data on 6,572 subjects from two nationally representative longitudinal samples of Swedish children born in 1973 and 1981. These provided information on their final height and any BMI reduction episodes.
RESULTS: Of the 6,572 subjects (50.9% boys), among individuals with information on final height, 1,118 had a BMI reduction of 5% and less than 10%, and 346 had at least one substantial BMI reduction of 10% of more. On a group level, there was no statistically significant difference in the final height of individuals with BMI reductions of 10% or more and those without. The findings were independent of age and the subject's BMI at the start of the reduction episode. However, there were a number of cases where a substantial BMI reduction probably had an impact on the subject's final height.
CONCLUSION: Our study found no evidence that a substantial BMI reduction had any impact on final height on a group level, but further analyses of specific case studies are necessary to determine whether substantial BMI reduction might have an impact on final height.


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In the heart of the old medieval village of Sault, Lavender Capital, and just next to one of the castle towers, this recently refurbished four levels house includes a dining room, living room and kitchen on the ground floor, a bedroom decorated with style and a bathroom on the first floor, another en-suite bedroom on the second floor with great views over the valley, and an open-plan kitchen living room on the top floor with a large window offering a fantastic view over the Mont Ventoux.
Ground Floor
Dining Room 22m2
Kitchen 7.4m2
Living room 19m2
Hall 8m2
Corridor 4.8m2
First Floor
Bedroom 1 10.7m2
Bathroom 5.5m2
Second Floor
Bedroom 2 11.1m2
Bathroom 5.2m2
Third Floor
Living Room with open plan kitchen 16m2
Sault is the capital of Lavender
Sault is situated at the altitude of 766 meters, known worldwide for the cultivation of lavender, Sault, once protect ted by fortifications, bears the traces of an intense human activity from prehistoric times on.
Sault is the ideal spot for hikes and excursions toward Mont Ventoux, the Nesque Canyon, the Toulourenc valley, the Montagne de Lure, the Luberon and other nearby sites in Drôme Provençale and Alpes-de-Haute-Provence
Besides the market, Wednesdays mornings since 1515, the summer period is marked by various animations, festivals, garage sales, with a culmination on august, 15th, with the inescapable lavender festival.
The village sports complex has a swimming pool (open in July and August), 3 tennis courts (access all year, a skate park, a soccer field and starting point for many hikes.
The top of Mont Ventoux is accessible from mid-april on, either by bike or by car. The "Giant of Provence" is only 26 kilometres off the village.
Carpentras 39km
Avignon TGV 72km
Marseilles Airport 104km
*These data are for information only and have no contractual value. Leggett Immobilier cannot be held responsible for any inaccuracies that may occur.*
**The currency conversion is for convenience of reference only.


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I literally mean it, GoPro cameras are giving us different perspectives of sports that we were used to watch from outside and from a distance, then they showed us what is it like to be inside it, up close and personal, but the different ways of mounting a GoPro can show us new and different angles that we never thought possible for shooting on "Home Video".
Our friends from Haugen Racing brought their LS powered Hyundai Genesis coupe to Willo Springs/Horse Thief Mile for Just Drift's toy drive drifting event. But they brought a new rotating camera rig that provides a whole different view of drifting.
Check out their new video right here and go follow them on Facebook for more cool drifting videos.
Also, we've been working on a music video for the 8-Bit Miata where we tried to emulate a 3rd person view similar to a video game, for which we created our own rig and so far it gave us a great shot for this video.
Here's a small teaser preview
So, what shot is the most original you have ever seen on any motorsport?? Of what would be your suggestions for an awesome shot?? We might do that on a new video!!
All camera mounts were designed and fabricated at 18Fab.


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Ashish A, BIW
We are immensely greatful of his presence when complex programming is placed before us to create certain types of applications, there is a great deal of logical programming involved with all applications and new technologies are the only way forward to apply the logic. Thank you Diptanshu for being an excellent team player and for being that team player in which any brand can totally rely on. It is a pleasure to have you here buddy!


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Lot 389: George S. Patton
Lot 389: Signed books from Patton's personal library: The Campaign of Santiago de Cuba, Two Volumes. Later printing. Chicago: A. C. McClurg & Co., 1914. Hardcover, 5.25 x 7.75, 274 and 236 pages. Signed on the front cover of both volumes, "G. S. Patton Jr.," as well as on the first free end page of Volume II in fountain pen, "G. S. Patton, Jr., 1924." Patton also writes the title on the spine and cover of each book. Autographic condition: fine, with signatures on the covers a shade or two light. Book conditions: VG-/None in VG+ custom-made quarter leather clamshell boxes. No other military leader wrote so frequently in his letters or diary what he was reading, and no leader's library was so well documented since Napoleon's. Patton's library, which was almost entirely inherited by his son, Major General George Patton III, was given to West Point, with just a small portion of books, including these volumes, inherited by other descendants or friends. Please email email@example.com for a complete description of the book's condition. RR Auction's Fine Autographs and Artifacts Auction 453 Sunday, 17th May 2015 Estimate: $1000-2000
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Official architecture photographer for new client 'Samoborka'
August 16, 2018
Samoborka is over a century old Croatian company and we made a collaboration this year to be their official photographer.
One of my assignments were to shoot architecture photographs for their online and printed portfolio on Island of Krk and in camp Straško on peninsula Pag.
Check out some of the images that got to the final selection!
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I started on the Beekeeper's Quilt in December 2011, so more than a year has passed since I made the very first hexipuff. More than 160 hexipuffs later, the quilt is almost halfway there. Unless, of course, I make it bigger than the original, which is very likely.
These most recent puffs have turned out really well, actually. I hadn't expected that when I saw the yarn. I just picked it up because I needed a change of colour to keep me interested in knitting more. So I ended up with puffs that remind me of snowfall (and we currently have the weather to match).


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Bulldog boys place third at BPS Invitational swim meet
The Hardin Bulldog swim team took to the pool in Billings Saturday for the BPS Invite. The boys' team defeated Billings Central and three double A schools, taking home a third place finish.
According to Coach Eric Hartl, 44 students are out for the swim team this year.
"That is fantastic," he said. "It's the most swimmers we've had out in a while."
In swimming, the top six competitors per event add scoring points.
In boys' action, Jayden Yarlott placed sixth in the 200-yard freestyle with a time of 2:29.44. In the 50-yard freestyle Caven Herrera placed sixth overall with a time of 25.70. Dominic Stevens took second place in two events. He swam the 100-yard butterfly in 58.29 and the 100-yard breaststroke in 1:06.66.
In the relay events, the boys' Herrera, Dalton Nedens, Stevens and Miguel Lopez placed fifth in the 200-yard medley relay with a time of 1:59.95.
In the 20-yard freestyle relay the combination of Herrera, Lopez, Stevens and Josh Whiteman took second place with a time of 1:44.39.
In the 400-yard freestyle relay, Yarlott, Nedens, Traylee Limy and Whiteman placed fifth, swimming the race in 4:38.50.
In team scoring, the girls placed sixth overall with Andrea Three Irons taking sixth place in the 200-yard medley relay. Three Irons also placed fifth in the 100-yard butterfly with a time of 1:23.75.
In the 100-yard freestyle, Mya Walks Over Ice placed fifth with a time of 1:08.29.
In the 200-yard freestyle relay, Hardin placed fifth with Angeleena Lind, Mia Ralston, Cora Wood and Three Irons swimming the event in 1:57.92.
The Ladies again took fifth place in the 400-yard freestyle behind the swimming of Kailee Roan, Maren Holds The Enemy, Celea Poitra and Macie Flamm. They swam the race in 4:53.27.
According to Hartl, the team has a lot of new and young talent and are improving every week.
Saturday, the swimmers will be at home hosting the Hardin Invite. Action starts at 11 a.m.
Billings Invitational (Saturday)
Boys team scores: Bozeman 127, Billings West 64, Hardin 32, Billings Central 31, Billings Skyview 28, Billings Senior 19
Girls team scores: Bozeman 114, Billings Senior 63, Billings Central 56, Billings West 40, Billings Skyview 22, Hardin 13
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5.5 Hour USCCA Concealed Carry and Home Defense
February 22 @ 8:00 am - 1:30 pm$125
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Students will need a firearm, 100 rounds of ammo, eye and ear protection. Firearms can be rented at Top Gun of Maine at our indoor location. This is not a beginner class and students must have firearms experience.
- Must be 18 years of age or older.
- Children 12 – 17 will need a parent to attend with the student.
Register at www.topgunofmaine.com to sign up!


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With Texas hunting seasons underway and others set to soon begin - including mule deer frameworks - it's advised to remember the requirements for chronic wasting disease (CWD) testing should you be successful on a hunt in some areas of the state.
The Texas Parks and Wildlife Department's CWD management plan includes protocols and requirements to prevent the spread of the disease, including mandatory check stations for mule deer killed inside a containment zone in far West Texas that includes portions of Hudspeth, Culberson and El Paso counties.
The plan was implemented after the disease was detected in tissue samples from two mule deer in far West Texas in 2012. Those were the first cases of the disease detected in Texas deer. After that nearly 300 tissue samples were collected from hunter-harvested mule deer from the Trans-Pecos during the 2012-13 season for testing. A Texas A&M veterinary lab and national veterinary lab confirmed CWD in four of those samples, with all positive deer harvested within the containment zone.
Hunters taking mule deer inside the containment zone during the general mule deer hunting season from Nov. 29 to Dec. 15 are required to submit their harvest, the unfrozen head of the animal, for sampling at mandatory check stations within 24 hours of harvest.
"We recommend hunters in the containment zone quarter deer in the field and leave all but the quarters, backstraps and head at the site of harvest if it is not possible to bury the inedible carcass parts at least 6 feet deep on the ranch or take them to a landfill," said Shawn Gray, mule deer program leader for TPWD, in a news release.
Hunters who harvest deer in the containment zone outside the general season under the authority of Managed Lands Deer Permits will need to call TPWD at 512-221-8491 the day the deer is harvested to make arrangements to have the deer sampled.
TPWD also has established check stations for voluntary CWD sampling for deer harvested in other parts of far West Texas. Biologists have collected mule deer harvest data in the region since 1980, and this year CWD sampling will be offered in addition to age and weight measurements.
Texas shut down the importation of deer from other states a decade ago and has conducted a rigorous CWD testing program. TPWD had received test results indicating no disease detection for roughly 30,000 samples collected from wild deer around the state since the 2002-03 hunting season, including more than 1,200 from the Rolling Plains, according to agency figures. Most were collected from hunter-harvested deer.
About 7,400 similar results were submitted from permitted deer breeders, and since 2001, 1,048 white-tailed deer and two mule deer have been confiscated from 45 captive facilities and tested for CWD and bovine tuberculosis. Those deer either were illegally imported or were of unknown origin and were possessed illegally.
In 'mad cow' family
CWD is a fatal transmissible neurological disease in the family of infectious diseases that include bovine spongiform encephalopathy, commonly known as "mad cow disease," scrapie in sheep, feline spongiform encephalopathy in cats in Europe, and Creutzfeldt-Jakob disease and a new variant in humans. CWD is believed to be caused by a misfolded protein that replicates and infects normal proteins, according to researchers. CWD is named for its symptoms, including appetite loss, weight loss, listlessness, excessive drooling, blank stares, decreased awareness and behavioral changes. The diagnosis of the disease can't be made by symptoms since other toxic and neurological afflictions can cause an animal to exhibit similar symptoms, according to researchers.
CWD was discovered in captive Colorado animals 35 years ago. However, during the past five years, the disease has been detected in free-ranging deer and elk in several surrounding states and Canada. In 2002, a year after Texas closed its borders to importation of deer due to disease risks, CWD was reported in free-ranging deer in South Dakota, Wisconsin, New Mexico, Illinois and Utah.
CWD, which has no known immunity or treatment, occurs via natural transmission in deer, elk and moose. However, research indicates that infection of livestock through natural pathways is unlikely. It should be noted that the disease has not shown the ability to jump the species barrier to humans, according to researchers.
CWD has been shown to affect the brain, spinal cord and other lymph areas of infected animals, but proper field dressing typically removes any of these sites and hunters are advised to also bone out their meat. If you take animals to be processed commercially, ask that the meat be handled separately from that of others, too. If you suspect an animal you harvest has some type of disease, wildlife officials urge you to keep the carcass refrigerated or on ice if you can't quickly submit it for testing, and contact biologists.
One troubling aspect of CWD is proof that it can spread, remain dormant for years and still affect natural resources, according to researchers. Case in point: A shipment of elk from an infected herd in Canada to South Korea in 1997 went undetected for nearly 10 years. Despite tracing back the imported animals, which were euthanized for testing in 2005, CWD persists in that country, TPWD officials said. The disease previously had been found only in Canada and the U.S.
Eradication of the disease increasingly is expected to become less attainable if it spreads through more populations, according to researchers. That makes a surveillance plan critical to the earliest detection followed with an adequate response plan.
Information: www.tpwd.state.tx.us/cwd; www.cwd-info.org.
WILL LESCHPER'S work has been recognized by the Outdoor Writers Association of America and the Texas Outdoor Writers Association. Visit TexanOutdoors.com for more hunting and fishing insight.


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Let's look at presidential nicknames shall we? Washington is the Father of our Country, Adams is the Colossus of Independance, Jefferson is the Man of the People, and Madison is the Father of the Constitution. Sounds like I made a super-hero team for Democracy. Well, every super hero team has its member that's a little bit…less. You know, like Ant-Man or Aquaman or Invisible Girl. Well, here we have James Monroe–The Last Cocked Hat.
Monroe was totally pushing is Founding Father cred at the time, insisting to dress in an out of style 18th century get-up long after the rest of the world had moved on. Was he a founding father? My answer is not completely. He was a soldier in the Revolutionary War, and yes he was involved in the Constitution ratification process, but he wasn't at the convention. In fact his greatest connection to founding fatherhood was that he was an aide for George Washington for a short time in the Revolutionary War, and studied law under Thomas Jefferson. However every president up to Monroe was directly involved in making this country, so Monroe emphasized his tenuous credibility as much as possible. Thus the out-of-fashion garb–and I do mean out of fashion–he dressed more like Washington than Washington himself.
That being said, Monroe is one of the few presidents who was much more popular at his time than his place in history would suggest. One reason outside of the Monroe Doctrine you usually get blank stares when is name is mentioned is very little happened when he was president. The country was doing well economically, there were no wars, outside of slavery (which we'll get to) there were no divisive social issues that ended up being historically relevant–he was the perfect status quo president–things were going well and he was not about to screw that up.
Also, his successes pale a little after the giants before him. Yes, his administration bought Florida, but after the bargain-basement success of the Louisiana Purchase, Florida is a little anti-climactic. The famous Monroe Doctrine, which set foreign policy for nearly a century dictated that America would remain neutral in European politics except for in the case of the western hemisphere where the United States would resist any further attempts to colonize or undermine any independent country. It's a wonderful set of policies that really clarified the United States's position in the world. No longer would we have to get in the middle of inter-European conflicts like between Britain and France. However, this policy was mostly constructed by John Quincy Adams.
Then we get to the Seminole War. At the time, Florida was mostly a backwater with a large Native American population and also was a place where many runaway slaves ended up. Spanish settlers were few, and the United States really wanted that land. Truth be told it was a dirty war with military operations done under the table, exaggerated accounts of the Spanish supplying arms for the Native Americans and runaway slaves. That's the other thing that makes this war a little skeezy–the Spanish (at this time) had a much more progressive view of race-relations than the United States, and there was even a fort completely managed by runaway slaves. Jackson had popular support to invade Florida to destroy this fort which he saw as being an intentional effort by the Spanish to destabilize America..whatever. After a series of burn and raid missions from both sides, the Spanish agreed to sell Florida just to get rid of a big giant headache for them.
Ok, now for slavery. We have the Missouri Compromise, which like all compromises, pleased nobody. Missouri wanted to be admitted to the Union as a slave state, however that would tip the balances for Congress by having one more slave state than free state. Also, many in government wanted to end slavery as an institution slowly–starting by not allowing new slave states at all. At the same time many others thought that states should be able to decide on their own whether they want to allow slavery or not–that's how the current states got there after all. Monroe (who was a slave owner) was in the second camp and seriously thought that Congress should not have the power to determine what is and is not legal in individual states. This sounds like he's waffling, but he was a very consistent anti-Federalist, so it does fit with is political worldview, however it might have been convenient for his situation. In the end Missouri was admitted as a slave state with the addition of Maine as a free state, and slavery would be only allowed in new territories below a certain longitudinal line. It doesn't matter, because when the next bunch of states came in a decade later, the whole issue would be revisited again. Monroe signed the law despite his misgivings because it was politically expedient and he wanted the issue behind him in an election year.
On a side-note, Monroe was a huge proponent for African Colonization by former American slaves. He saw this as the answer for slavery. In fact he was largely responsible for founding Liberia. On one hand, it shows that Monroe did want an alternative to the slavery issue, on the other hand it's not a very practical answer. Yes, they sent only willing people to Liberia, but for all the slaves in the country, it's not like they all wanted to go to Africa–in fact many had family lines that stretched as far back as the founding fathers. Also, compared to emancipation, this seems like a particularly expensive answer to a problem–I mean, he's proposing to send about a million people across the world with early 19th century resources. In any case the plan didn't ultimately work for that very reason.
So in the end President Monroe gets an A for the Monroe Doctrine, an F for the Seminole War. His views on slavery I don't even know what grade to give him because his plan is kind of crazy, and he mostly side-stepped the issue domestically. With the Monroe Doctrine though he did guide American international relations and makes me end up tipping him on the side of good rather than not.


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Hi Shazza, Here is my effort at July's artwork.
Kind regards, Dale
Hi Dale! Glad you joined in this month. Love the title you used and the pic, and I especially love that chunky brown flourish in the corner.... how gorgeous is that!!. Love the swirly brown pp you used. All criteria covered for the challenge :) Job well done! - Shazza


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Allan W. Kitchen, 61, of Roaring Branch, PA passed away unexpectedly on October 12, 2018 at Susquehanna Health Williamsport Hospital.
Born February 2, 1957 in Williamsport, PA, Allan Wayne was a son of the late James M and Sara J. (Sechrist) Kitchen. He attended Loyalsock High School with the class of 1975. Allan worked as a welder's helper with the Harrisburg Local 520 Plumbers & Steamfitters Union. He was a private person, an avid outdoorsman and hunter. Allan appreciated watching wildlife, especially the deer in his front yard. He was a lifetime member of the National Rifle Association.
Surviving are his siblings; Sharon Kitchen of Williamsport, Marie (Mike) Cole of Cogan Station, Kevin (Melody) Kitchen and Darren Kitchen (fiancée, Tara Updegraff) all of Roaring Branch. His nieces and nephews who were very special to Allan; Heather Eisenhour, Jessica Strailey, Echo, Amanda and Paul Cole, Brock, Adam and Lacey Kitchen, Sidney and Tyler Kitchen, several great nieces, great nephews, many good friends and special friends from the mountain, Terry and Randy Stahl. In addition to his parents, Allan was predeceased by a niece, Stephanie Strailey.
Calling hours are 11 – 12 p.m. Saturday, Oct. 20, at Pepper Funeral Home & Cremation Facility, 578 Springbrook Dr. Canton. Rev. Duane Taylor will officiate the funeral service at noon. Burial will follow in Beech Flats Cemetery. Those who wish may consider a memorial in Allan's name to a Charity of one's choice.
Share condolences and memories at www.pepperfuneralhomes.com
To send flowers to the family or plant a tree in memory of Allan W. Kitchen, please visit our floral store.


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Suzanne's Career
With its ragged black-and-white 16 mm photography and strong sense of 1960s Paris, Rohmer's second "Moral Tale" is a wonderfully evocative portrait of youthful naivete and the complicated bonds of friendship and romance.
Bertrand (Philippe Beuzen) bides his time in a casually hostile and envious friendship with college chum Guillaume (Christian Charriere). But when ladies' man Guillaume seems to be making a play for the spirited, independent Suzanne (Catherine See), Bertrand watches bitterly with disapproval and jealousy.