Childhood Autism—A Review of the Clinical and Experimental Literature

This review of the literature on childhood autism discusses the clinical characteristics, differential diagnosis, prognosis and treatment of the autistic behavioral syndrome from a developmental perspective. It includes a discussion of the influence of prenatal and perinatal antecedents, genetic and socio-familial factors, and epidemiologic considerations. Neurologic, electro-encephalographic and experimental neurophysiologic, metabolic, biochemical and hematologic investigations are reviewed. Special emphasis has been given to the changing clinical manifestations which accompany maturation and to the problems of recognition of childhood autism in the very young child.     

Drug Withdrawal Syndromes: A Literature Review

Drug withdrawal syndromes reportedly have been caused by numerous pharmacological agents, but only a few drugs have been adequately studied in this regard. Criteria for evaluating drug withdrawal syndromes have been proposed. Sedative-hypnotic agents, opiates, corticosteroids, clonidine, tricyclic antidepressant medications and beta-adrenergic blocking agents meet the criteria for such syndromes. Gradual tapering of the dose of these drugs is recommended when therapy must be discontinued. Whether or not other drugs cause rebound reactions is questionable, but caution should be used when discontinuing drugs for which numerous reports of withdrawal syndromes exist.     

LCA for Site Remediation: A Literature Review

Remediation of contaminated sites provides a cleaner local environment, but may also have negative environmental impacts on the local, regional, and global scales. Methods based on Life Cycle Assessment (LCA) are designed to take the negative effects into consideration when deciding how to treat a site, and to improve the environmental efficiency of remediation techniques. This paper reviews nine case studies that use LCA tools to evaluate alternative remediation techniques to summarize the findings of methodologies and results. The methodologies were found to differ in the limitation of the LCA for space, time and secondary processes. This strongly influenced the results. Bioremediation was the worst when the secondary process of producing electron acceptors was included; otherwise it was the best. The choice of impact categories heavily affected the results. Inclusion of land use was especially important in site remediation studies. In general, the negative impact of site remediation was due to energy consumption. For excavation combined with ex-situ treatment, the transport of contaminated soil to the treatment facility or landfill required the most energy. For in-situ treatment of soil and groundwater, pumping consumed the most energy. It is proposed that different methods be applied to the same site.     

Subclinical Hyperthyroidism: A Review of the Clinical Literature

Subclinical hyperthyroidism (SCHyper) is a biochemical diagnosis characterized by a decreased serum thyroid-stimulating hormone (TSH) and normal serum thyroxine (T4) and triiodothyronine (T3) concentrations. Because SCHyper can be resolved, it is recommended to repeat serum TSH, T3, and T4 concentrations in 3 to 6 months before confirming a diagnosis of SCHyper to consider treatment. Proposed grading systems distinguish between mild (TSH, 0.1-0.4 mIU/L) and severe SCHyper (TSH, <0.1 mIU/L) and are used alongside patients’ age and the presence of risk factors and symptoms to guide treatment. Appropriate evaluation includes an investigation of the underlying cause and assessment of an individual’s risk factors to determine the necessity and type of treatment that may be recommended. SCHyper may be associated with increased risks of cardiovascular-related adverse outcomes, bone loss, and in some studies, cognitive decline. Treatment may include observation without therapy, initiation of antithyroid medications, or pursuit of radioiodine therapy or thyroid surgery. Considerations for treatment include the SCHyper etiology, anticipated long-term natural history of the condition, potential benefits of correcting the thyroid dysfunction, and risks and benefits of each treatment option. The purpose of this overview is to provide a guide for clinicians in evaluating and managing SCHyper in the routine clinical practice.     

Weight Cycling: A Review of the Animal Literature

This review critically evaluates the animal literature concerning the effects of weight cycling on factors related to development of obesity, diabetes, hypertension, and hyperlipidemia. Although human studies have been used to retrospectively examine the relationship between fluctuations in body weight and a variety of disease markers, direct causal links between weight cycling and negative health effects have been inferred from a series of scientific publications using animals as subjects. We use data from 24 such publications to evaluate evidence for and against a series of hypotheses that have been suggested regarding weight cycling and health. Although there are some intriguing results, there is currently little evidence to support any of these hypotheses. However, methodological limitations were identified in many of these studies, and caution should be used in making definitive decisions about weight cycling. Weight cycling studies could be improved by including more appropriate controls, comparing controls to weight cycling animals at more appropriate time points, and giving more attention to potential effects of diet composition. While more careful research is needed, at this time we conclude that the published animal literature does not justify any warnings about the hazards of weight cycling.     

Explanations of Native American Drinking: A Literature Review

Abstract

In behavioral science literature, the drinking patterns of some Native Americans have received considerable attention. Because the modal Indian drinking style has been viewed and characterized as different from the patterns of most other groups in the United States, numerous works have attempted to explain this divergence. In this paper the most common explanations of Indian drinking behavior are described and reviewed: biological, psychoanalytic, anomie and normative. In addition, three common approaches to the study of Indian drinking are described: the ethnography, the social problem approach and the integrative study. Some suggestions for further research are presented in the conclusion.     

Childhood Learning Disabilities and Atypical Dementia: A Retrospective Chart Review

Objective

To further our understanding of the association between self-reported childhood learning disabilities (LDs) and atypical dementia phenotypes (Atypical Dementia), including logopenic primary progressive aphasia (L-PPA), Posterior Cortical Atrophy (PCA), and Dysexecutive-type Alzheimer’s Disease (AD).

Methods

This retrospective case series analysis of 678 comprehensive neuropsychological assessments compared rates of self-reported LD between dementia patients diagnosed with Typical AD and those diagnosed with Atypical Dementia. 105 cases with neuroimaging or CSF data available and at least one neurology follow-up were identified as having been diagnosed by the neuropsychologist with any form of neurodegenerative dementia. These cases were subject to a consensus diagnostic process among three dementia experts using validated clinical criteria for AD and PPA. LD was considered Probable if two or more statements consistent with prior LD were documented within the Social & Developmental History of the initial neuropsychological evaluation.

Results

85 subjects (Typical AD n=68, Atypical AD n=17) were included in the final analysis. In logistic regression models adjusted for age, gender, handedness, education and symptom duration, patients with Probable LD, compared to patients without Probable LD, were significantly more likely to be diagnosed with Atypical Dementia vs. Typical AD (OR 13.1, 95% CI 1.3-128.4). All three of the L-PPA cases reporting a childhood LD endorsed childhood difficulty with language. By contrast, both PCA cases reporting Probable childhood LD endorsed difficulty with attention and/or math.

Conclusions

In people who develop dementia, childhood LD may predispose to atypical phenotypes. Future studies are required to confirm whether atypical neurodevelopment predisposes to regional-specific neuropathology in AD and other dementias.     

植物竞争研究进展

竞争系指两个以上有机体或物种间阻碍或制约的相互关系。它是塑造植物形态、生活史的主要动力之一;并对植物群落的结构和动态具有深刻的影响。因其在生态学的中心地位,生态学家已从不同的侧面研究了这一复杂的生态学现象;生态学也因此而得到了发展。然而,人们对竞争的理解不尽一致,因而导致了概念上的混乱,平行研究相对缺乏、不同研究间的比较困难,从而阻碍了学科的发展。本文试就植物竞争的概念、竞争理论、竞争研究的实验方法、影响竞争能力的主要因素、种内和种间竞争对种群和群落的影响,如竞争与物种共存等进行综述;我们在总结研究成就的同时,亦指出了现有研究的局限性。     

Evaluating Ecological Restoration Success: A Review of the Literature

Assessing the success of ecological restoration projects is critical to justify the use of restoration in natural resource management and to improve best practice. Although there are extensive discussions surrounding the characteristics that define and measure successful restoration, monitoring or evaluation of projects in practice is widely thought to have lagged behind. We conducted a literature review to determine trends in evaluations of restoration projects and identify key knowledge gaps that need to be addressed. We searched the Web of Knowledge plus two additional restoration journals not found in the database for empirical papers that assessed restoration projects post‐implementation. We quantified the extent that key attributes of success, including ecological (vegetation structure, species diversity and abundance, and ecosystem functioning) and socioeconomic, were addressed by these papers along with trends in publication and restoration characteristics. Encouragingly, we found the number of empirical evaluations has grown substantially in recent years. The increased age of restoration projects and number of papers that assessed ecological functions since previous reviews of the literature is also a positive development. Research is still heavily skewed toward United States and Australia, however, and identifying an appropriate reference site needs further investigation. Of particular concern is the dearth of papers identified in the literature search that included any measure of socioeconomic attributes. Focusing future empirical research on quantifying ecosystem services and other socioeconomic outcomes is essential for understanding the full benefits and costs of ecological restoration and to support its use in natural resource management .     

Vitamin D Supplementation for Childhood Asthma: A Systematic Review and Meta-Analysis

Importance

There is growing evidence that vitamin D plays a role in the pathogenesis of asthma but it is unclear whether supplementation during childhood may improve asthma outcomes.

Objectives

The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of vitamin D supplementation as a treatment or adjunct treatment for asthma.

Data Sources

We searched MEDLINE, Embase, CENTRAL, and CINAHL through July 2014.

Study Selection

We included RCTs that evaluated vitamin D supplementation in children versus active control or placebo for asthma.

Data Extraction and Synthesis

One reviewer extracted data and one reviewer verified data accuracy. We qualitatively summarized the main results of efficacy and safety and meta-analyzed data on comparable outcomes across studies. We used GRADE for strength of evidence.

Main Outcome Measures

Main planned outcomes measures were ED visits and hospitalizations. As secondary outcomes, we examined measures of asthma control, including frequency of asthma exacerbations, asthma symptom scores, measures of lung function, β₂-agonist use and daily steroid use, adverse events and 25-hydroxyvitamin D levels.

Results

Eight RCTs (one parallel, one crossover design) comprising 573 children aged 3 to 18 years were included. One study (moderate-quality, n = 100) reported significantly less ED visits for children treated with vitamin D. No other studies examined the primary outcome (ED visits and hospitalizations). There was a reduced risk of asthma exacerbations in children receiving vitamin D (low-quality; RR 0.41, 95% CI 0.27 to 0.63, 3 studies, n = 378). There was no significant effect for asthma symptom scores and lung function. The serum 25(OH)D level was higher in the vitamin D group at the end of the intervention (low-quality; MD 19.66 nmol/L, 95% CI 5.96 nmol/L to 33.37 nmol/L, 5 studies, n = 167).

Limitations

We identified a high degree of clinical diversity (interventions and outcomes) and methodological heterogeneity (sample size and risk of bias) in included trials.

Conclusions and Relevance

Randomized controlled trials provide some low-quality evidence to support vitamin D supplementation for the reduction of asthma exacerbations. Evidence on the benefits of vitamin D supplementation for other asthma-related outcomes in children is either limited or inconclusive. We recommend that future trials focus on patient-relevant outcomes that are comparable across studies, including standardized definitions of asthma exacerbations.     

Childhood Tuberculosis in Northern Viet Nam: A Review of 103 Cases

Background

Childhood tuberculosis causes significant morbidity and mortality in Southeast Asia, yet little is known about the epidemiology and clinical characteristics of this disease in Viet Nam.

Objectives

To determine the demographics, clinical presentations, radiographic and microbiologic findings, treatment regimens, and outcomes of children admitted with tuberculosis (TB) to a national referral hospital in Viet Nam.

Methods

We conducted a retrospective case series study of children ≤ 15 years old with bacteriologically confirmed or clinically diagnosed TB admitted to a national referral hospital in Ha Noi, Viet Nam from January through December 2007.

Results

One hundred three children were identified: median age 5 years (IQR 2-10), 44% female, 99% Kinh ethnicity, 27% residing in Ha Noi, 88% with BCG vaccination, 27% with known TB contact, and 38% malnourished. Intrathoracic TB was present in 62%, extrathoracic in 52%, both intra and extrathoracic in 19%, and undetermined site in 5%. The most common extrathoracic manifestation was peripheral lymphadenitis, and children under 5 were more likely to have miliary TB or both intra and extrathoracic TB. Fever and failure to thrive were common presenting symptoms among all participants (65% and 56%, respectively), 66% of those with intrathoracic TB presented with cough, and 92% of those with TB meningitis presented with severe neurologic impairment. Acid-fast bacilli smears and mycobacterial cultures were positive in 18% and 21% of children tested, and histopathology was positive in 88% of those biopsied. There were no adverse drug reactions necessitating change in therapy, and no inpatient mortality.

Conclusions

Extrathoracic TB was common, treatment well tolerated and clinical outcomes excellent. Culture confirmation rates were low and emphasize the need for improved diagnostics.     

Preterm Birth and Childhood Wheezing Disorders: A Systematic Review and Meta-Analysis

Background

Accumulating evidence implicates early life factors in the aetiology of non-communicable diseases, including asthma/wheezing disorders. We undertook a systematic review investigating risks of asthma/wheezing disorders in children born preterm, including the increasing numbers who, as a result of advances in neonatal care, now survive very preterm birth.

Methods and Findings

Two reviewers independently searched seven online databases for contemporaneous (1 January 1995–23 September 2013) epidemiological studies investigating the association between preterm birth and asthma/wheezing disorders. Additional studies were identified through reference and citation searches, and contacting international experts. Quality appraisal was undertaken using the Effective Public Health Practice Project instrument. We pooled unadjusted and adjusted effect estimates using random-effects meta-analysis, investigated “dose–response” associations, and undertook subgroup, sensitivity, and meta-regression analyses to assess the robustness of associations. We identified 42 eligible studies from six continents. Twelve were excluded for population overlap, leaving 30 unique studies involving 1,543,639 children. Preterm birth was associated with an increased risk of wheezing disorders in unadjusted (13.7% versus 8.3%; odds ratio [OR] 1.71, 95% CI 1.57–1.87; 26 studies including 1,500,916 children) and adjusted analyses (OR 1.46, 95% CI 1.29–1.65; 17 studies including 874,710 children). The risk was particularly high among children born very preterm (<32 wk gestation; unadjusted: OR 3.00, 95% CI 2.61–3.44; adjusted: OR 2.81, 95% CI 2.55–3.12). Findings were most pronounced for studies with low risk of bias and were consistent across sensitivity analyses. The estimated population-attributable risk of preterm birth for childhood wheezing disorders was ≥3.1%.Key limitations related to the paucity of data from low- and middle-income countries, and risk of residual confounding.

Conclusions

There is compelling evidence that preterm birth—particularly very preterm birth—increases the risk of asthma. Given the projected global increases in children surviving preterm births, research now needs to focus on understanding underlying mechanisms, and then to translate these insights into the development of preventive interventions.

Review Registration

PROSPERO CRD42013004965 Please see later in the article for the Editors'' Summary     

Headache Treatment with Pulsing Electromagnetic Fields: A Literature Review

Pulsing electromagnetic field (PEMF) therapy may be a viable form of complementary and alternative medicine. Clinical applications include the treatment of fractures, wounds, and heart disease. More recent applications involve treatment of recurrent headache disorders. This paper reviews available studies investigating PEMF for headache management. Possible mechanisms for effects (neurochemical, electrophysical, and cardiovascular) are discussed. The available data suggest that PEMF treatment for headache merits further study. Suggestions for future research are provided.