Does Childhood Executive Function Predict Adolescent Functional Outcomes in Girls with ADHD?

We prospectively followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n = 140) and matched comparison girls (n = 88) over a period of 5 years, from middle childhood through early/mid-adolescence. Our aim was to examine the ability of measures of childhood executive function (EF) to predict functional outcomes in adolescence. Measures of neuropsychological functioning comprised the childhood predictors, with academic, social, and global functioning serving as adolescent criterion measures. Results indicated that childhood EF predicted (a) academic achievement and social functioning across our entire sample (independent of diagnostic group status) and (b) global functioning only in girls with ADHD (independent of IQ). These results highlight the non-specificity of EF deficits and suggest the importance of assessing and developing interventions that target EF impairments, particularly in those at high-risk for negative outcomes, in order to prevent long-term difficulties across a range of important functional domains

Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis

BACKGROUND: Among methods for preventing pneumonia and possibly also bacteremia in intensive care unit (ICU) patients, Selective Digestive Decontamination (SDD) appears most effective within randomized concurrent controlled trials (RCCT’s) although more recent trials have been cluster randomized. However, of the SDD components, whether protocolized parenteral antibiotic prophylaxis (PPAP) is required, and whether the topical antibiotic actually presents a contextual hazard, remain unresolved. The objective here is to compare the bacteremia rates and patterns of isolates in SDD-RCCT’s versus the broader evidence base. METHODS: Bacteremia incidence proportion data were extracted from component (control and intervention) groups decanted from studies investigating antibiotic (SDD) or non-antibiotic methods of VAP prevention and summarized using random effects meta-analysis of study and group level data. A reference category of groups derived from purely observational studies without any prevention method under study provided a benchmark incidence. RESULTS: Within SDD RCCTs, the mean bacteremia incidence among concurrent component groups not exposed to PPAP (27 control; 17.1%; 13.1-22.1% and 12 intervention groups; 16.2%; 9.1-27.3%) is double that of the benchmark bacteremia incidence derived from 39 benchmark groups (8.3; 6.8-10.2%) and also 20 control groups from studies of non-antibiotic methods (7.1%; 4.8 – 10.5). There is a selective increase in coagulase negative staphylococci (CNS) but not in Pseudomonas aeruginosa among bacteremia isolates within control groups of SDD-RCCT’s versus benchmark groups with data available. CONCLUSIONS: The topical antibiotic component of SDD presents a major contextual hazard toward bacteremia against which the PPAP component partially mitigates. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-014-0714-x) contains supplementary material, which is available to authorized users

Análise de erros ortográficos em diferentes problemas de aprendizagem Analyzing typical orthographic mistakes related to different learning problems

OBJETIVOS: descrever achados ortográficos em problemas de aprendizagem, verificar se os erros produzidos são aqueles encontrados na aprendizagem normal e analisar se predominam problemas de natureza ortográfica ou fonológica. MÉTODOS: examinou-se a escrita de 64 sujeitos avaliados pelo Laboratório de Distúrbios de Aprendizagem do Departamento de Neurologia da UNICAMP, diagnosticados com algum problema de aprendizagem: Transtorno do Déficit de Atenção/Hiperatividade (28); Dificuldades de Aprendizagem (13); Distúrbio de Aprendizagem (7); Dislexia (3); Distúrbios Associados (5) e Diagnóstico inconclusivo (9). As idades variaram entre 8;2 e 13;4 anos, média 10;6 anos. Foram incluídos sujeitos alfabetizados, sem rebaixamento intelectual. Os erros foram classificados em 11 categorias e quantificados para análise estatística. RESULTADOS: os erros correspondem àqueles observados em crianças sem queixa de aprendizagem. Os erros por Representações Múltiplas, Omissão de Letras e Oralidade, são respectivamente, os três tipos mais frequentes nos casos de Transtorno do Déficit de Atenção e Hiperatividade, Dificuldades Escolares, Distúrbios Associados e Diagnóstico Desconhecido. No Distúrbio de Aprendizagem a sequência é de Representações Múltiplas, Omissão, Outras Alterações e Surdas-sonoras. Na dislexia observa-se a sequência de Representações Múltiplas, Oralidade, Omissão e Outras Alterações. Existe uma tendência geral de predomínio das alterações ortográficas, embora sem diferença significante em relação aos erros de natureza fonológica. CONCLUSÃO: os erros de natureza ortográfica são os mais frequentes em relação aos de natureza fonológica. Com tendência contrária, os erros visuo-espaciais têm baixa ocorrência em geral, o que mostra que a dificuldade de todos os grupos é fundamentalmente de origem linguística e não perceptual.<br>PURPOSE: to describe the orthographic findings in several types of learning problems, check if the types of produced mistakes are those found in the learning that is considered normal and analyze if orthographic or phonological nature problems prevail in each disorder. METHODS: the writing of 64 subjects was evaluated by the Laboratory of Learning Disabilities of the Neurology Department of UNICAMP and diagnosed as showing some type of learning problem. Deficit of Attention / Hyperactivity disorder (28); School Difficulties (13); Learning Disabilities (7); Dyslexia (3); Associated Disorders (5) and Inconclusive Diagnosis (9). The ages varied between 8;2 and 13;4 years, with a 10;6 year-old average. Only subjects in alphabetical writing level without any type of intellectual deficit were included. The found mistakes were classified in eleven categories and quantified for ends of statistical analysis. RESULTS: the spelling mistakes found in each problem type correspond to those observed in children without learning complaint. The spelling mistakes through Multiple Representations, Omission of letters and Orality, are respectively, the three most frequent types in the cases Deficit of Attention and Hyperactivity disorder, School Difficulties, Associated Disorders and Unknown Diagnosis. In the Disturbance of Learning the sequence is of Multiple Representations, Omission, Other Mistakes and Voiced/Unvoiced mistakes. In the dyslexia we note the sequence of Multiple Representations, Orality, Omission and Other Mistakes. There is a trend, in each problem type, to the prevalence of orthographic nature mistakes, although with no statistically significant difference in relation to the phonological nature mistakes. CONCLUSION: the orthographic nature mistakes are the most frequent, although, there is no significant difference, in each group, in relation to the phonological nature mistakes. With contrary trend, the visual-spatial mistakes have low occurrence in general, which shows that the difficulty concerning all groups has fundamentally a linguistic origin and not a perceptual

Intensive Care Unit-Acquired Bacteremia in Mechanically Ventilated Patients: Clinical Features and Outcomes

Intensive care unit (ICU)-acquired bacteremia (IAB) is associated with high medical expenditure and mortality. Mechanically ventilated patients represent one third of all patients admitted to ICU, but the clinical features and outcomes in mechanically ventilated patients who develop IAB remain unknown. We conducted a 3-year retrospective observational cohort study, and 1,453 patients who received mechanical ventilation on ICU admission were enrolled. Among patients enrolled, 126 patients who had developed IAB ≧48 hours after ICU admission were identified. The study patients were divided into IAB and no IAB groups, and clinical characteristics of IAB based on specific bacterial species were further analyzed. The multivariate Cox regression analysis showed that ventilator support for chronic obstructive pulmonary disease and congestive heart failure, and patients admitted from nursing home were the independent risk factors for developing IAB. Patients with IAB were significantly associated with longer length of ICU stay, prolonged ventilator use, lower rate of successful weaning, and higher rate of ventilator dependence and ICU mortality as compared to those without IAB. IAB was the independent risk factor for ICU mortality (HR, 1.510, 95% CI 1.054–1.123; p = 0.010). The clinical characteristics of IAB related to specific bacterial species included IAB due to Pseudomonas aeruginosa being likely polymicrobial, lung source and prior antibiotic use; Escherichia coli developing earlier and from urinary tract source; methicillin-resistant Staphylococcus aureus related to central venous catheter and multiple sets of positive hemoculture; and Elizabethkingia meningoseptica significantly associated with delayed/inappropriate antibiotic treatment. In summary, IAB was significantly associated with poor patient outcomes in mechanically ventilated ICU patients. The clinical features related to IAB and clinical characteristics of IAB based on specific bacterial species identified in our study may be utilized to refine the management of IAB