Posted by James
DISCUSSION
This report documents a case in which, if not for the persistence of the care-seekers, appropriate medical care might not have been obtained for this person, possibly because of preconceptions held by certain physicians about people with mental retardation. The patient in question was in extreme pain, but she had to “doctor shop” to receive a standard treatment that probably would have been offered enthusiastically to a developmentally normal person.
Read the rest of this entry »
Posted by James
The patient, a Medicare fee-for-service enrollee, has profound mental retardation due to Down syndrome. She was born following a full-term pregnancy with no complications. The diagnosis of Down syndrome was evident at the time of birth, and she was placed in an institution shortly thereafter. She has lived at the same center for the past 37 years. Although nonverbal, she can express her feelings and needs through gestures and facial expressions and using signs that she has learned through a speech-language program at the developmental center. The patient’s medical history is significant for Tourette’s disorder, hypothyroidism, degenerative cervical disc disease, mild spastic paraplegia, hearing impairment, allergic rhinitis and inactive hepati-tis-B surface antigen (HBsAg) carrier state. Other than the persistence of HBsAg, she has never demonstrated any increased rate of infection.
Read the rest of this entry »
Posted by James
INTRODUCTION
In 2002, the then-surgeon general of the United States, David Satcher, issued a report entitled Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation. In preparation for this report, hundreds of physicians, therapists and spokespeople for individuals with mental retardation testified as to their experiences in securing treatment for these patients, and a course of action to facilitate access was drafted. In the introduction to this report, Tommy Thompson, secretary of Health and Human Services stated that:
Read the rest of this entry »
Posted by James
This study, which consisted predominantly of African-American children, demonstrated that inner-city children are more likely to be overweight com pared with other children. Fifty-three percent of children in this study were that caloric intake is similar in children with or without asthma but that children with asthma are more likely to have exercise-induced bronchospasm. The latter is related to the amount of subcutaneous fat in the bodies of asthmatic children. Exercise-induced bronchospasm may lead to an aversion to exercise, with subsequent risk of overweight and obesity. This is despite the fact that resting energy expenditure, which makes up the largest contribution to total energy expenditure, is greater in children with asthma when compared with children without asthma. These data indicate that increases in overweight and obesity in children with asthma may be related to decreases in physical activity.
Read the rest of this entry »
Posted by James
One-hundred-nine children were included in the study. Eleven children were excluded because of unacceptable pulmonary function tests. The demographics and other characteristics are shown in Table 2. Overall, 58 children (53%) were overweight (BMI >85th percentile). Girls were more likely to be overweight (35/61, 57%) compared with boys (24/48, 50%); however, this difference was not statistically significant (p=0.46). Eighteen (17%) children were diagnosed with asthma by a physician, but spirometry parameters were consistent with a diagnosis of asthma in only two of these 18 children. There was not a statistically significant difference between the overweight (8/58, 14%) and lean children (9/51, 18%) with regard to a physician diagnosis of asthma(p=0.412), nor was there a statistically significant association between asthma symptoms and the diagnosis of asthma based on spirometry.
Read the rest of this entry »
Posted by James
Spirometry (pre- and postbronchodilator) was assessed using a flow-sensitive spirometer (Renaissance II; Puritann-Bennett, Carlsbad, CA). A respiratory therapist who was experienced in performing spirometry in children conducted all tests, and all tests conformed to the criteria of the American Thoracic Society. All tests were performed between 10 a.m. and 2 p.m. The following parameters were measured: forced vital capacity (FVC), forced expiratory volume in 1 second (FEVi) and forced expiratory flow at midlung volume (FEF25-75). The ratio of FEVi to FVC (FEVi/FVC) was calculated. All values were adjusted for body temperature and barometric pressure. Percent predicted values for FVC,
Table 1. Questionnaires used to elicit symptoms of asthma
1. Wheezing at any time
2. Wheezing with exercise
3. Wheezing while sleeping
4. Cough at night
5. A severe attack of wheezing requiring emergency department visit
Read the rest of this entry »
Posted by James
This study gathered information on weight, height, BMI and the spirometry findings of children enrolled in public seventh-to-12th grades in one secondary school in Flint, MI, from March 1, 2004, to May 31, 2004. The school is located 2 miles from a highway and had 483 students enrolled for the above academic year. Children with recent upper or lower respiratory diseases, chest or skeletal deformities, and immunodeficiency were excluded from the study. Informed consent was obtained from parents. An assent was obtained when appropriate. The institutional review board of Hurley Medical Center approved the study.
Read the rest of this entry »
