BackgroundThyroid hormone plays a crucial role in the growth and function of the central nervous system. The purpose of the study was to examine the relationships between the status of subclinical thyroid conditions and cognition among adolescents in the United States.MethodsStudy sample included 1,327 adolescents 13 to 16 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Serum thyroxine (T4) and thyroid stimulating hormone (TSH) were measured and subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroid groups were defined. Cognitive performance was assessed using the subscales of the Wide Range Achievement Test-Revised (WRAT-R) and the Wechsler Intelligence Scale for Children-Revised (WISC-R). The age-corrected scaled scores for arithmetic, reading, block design, and digit span were derived from the cognitive assessments.ResultsSubclinical hypothyroidism was found in 1.7% and subclinical hyperthyroidism was found in 2.3% of the adolescents. Cognitive assessment scores on average tended to be lower in adolescents with subclinical hyperthyroidism and higher in those with subclinical hypothyroidism than the score for the euthyroid group. Adolescents with subclinical hypothyroidism had significantly better scores in block design and reading than the euthyroid subjects even after adjustment for a number of variables including sex, age, and family income level.ConclusionSubclinical hypothyroidism was associated with better performance in some areas of cognitive functions while subclinical hyperthyroidism could be a potential risk factor.
The authors analyzed data from a national sample to examine the relationships between blood concentrations of selected volatile organic compounds (VOCs) and the assessment scores of neurobehavioral evaluation tests. They calculated summary statistics to describe blood concentrations of 30 VOCs. For instance, the 95th percentiles were as follows: 1,1,1-trichloroethane, 0.799 microg/l; 1,4-dichlorobenzene, 11.081 microg/l; benzene, 0.476 microg/l; and toluene, 0.281 microg/l. For 1,4-dichlorobenzene, benzene, dibromochloromethane, and trichloroethene, a blood level higher than the 95th percentile was associated with a poorer neurobehavioral assessment score than was a blood level up to the 95th percentile. The authors found a linear relationship between blood toluene concentration and the Serial Digit Learning Test score. The findings suggest that exposure to certain VOCs may result in poor neurobehavioral performance. The study was exploratory and precludes a conclusive statement, so further investigation is warranted.
No data is routinely collected by emergency departments (ED) in the UK to identify people who attend and who have a learning disability. This group have numerous additional needs in their healthcare management and a lack of support could be detrimental to their care. F800 codes from the International Classification of Diseases (ICD-10) that identify disorders of psychological development are often used to categorise specific disorders once admitted to hospital. Consequently, the F800 codes of patients who were admitted to hospital from Birmingham Heartlands Hospital ED for 1 year have been analysed to obtain some of this data. This study argues that, although only a small proportion of the admissions from this ED were by people with an F800 code, the exact numbers of attendances in many EDs remain unknown and the impact of their disabilities on their immediate care and the workload of the ED medical staff may be significant.
Objectives & BackgroundFacial injuries are a common presentation to the ED with data suggesting that this may be as high as 4%. There is little data on the epidemiology of paediatric facial injuries and how these are managed by the ED team. The exposure of structures such as the eyes, brain and thyroid to ionising radiation may be potentially harmful and at present there are no nationally agreed guidelines on which patients require imaging in the ED. The aim of this study was to look at the patterns of imaging in a cohort of paediatric facial injuries presenting to an ED in the West Midlands. A comparison of the imaging requests for the paediatric and adult facial injuriesCT HeadCT FacePA MandibleOPGTMJOMOrbitChild8117404864Adult100241714022669411MethodsA retrospective note review of all facial injuries presenting to any one of the three sites that make up the Heart of England NHS Foundation Trust in 2012 was conducted. Electronic records were examined to look for the mechanism of injury, disposal as well if any imaging had been performed during the initial presentation. Where imaging was performed the actual imaging as well as formal radiology reports were accessed to ascertain for the presence or absence of a facial fracture.ResultsPaediatric facial injuries made up 1131/3416 (33%) of the overall number of facial emergencies presenting to the ED in 2012. The mean age for the children was 6.9±4.3 years. 32% of the children were female as opposed to 68% who were male. 164/1131(14.5%) children were imaged and of these only 17/164 (10.4%) were confirmed to have a fracture. In contrast 47% of the adults were imaged and 26% of these were confirmed to have a facial fracture. Chi-squared tests demonstrated that the proportion of patients who had imaging requested was significantly lower in the paediatric cohort when compared to adults (P<0.005). Also the difference in the numbers of confirmed facial fractures in those who were imaged was significantly lower in children when compared to the adults (P<0.005). Occipitomental (OM) and orthopantomograms (OPG) were the commonest facial views requested for both the paediatric and adult facial injuries.ConclusionThe study highlights that paediatric facial injuries are less common than adult facial injuries and that facial fractures make up only 1.5% of all paediatric facial injuries. Clinicians should consider this when requesting facial X-rays given the potential harm of ionising radiation to the head and neck region. Further studies are in progress to develop evidence based guidelines for imaging children with facial injuries within the ED.The table refers to the total number of different imaging requests and not the number of patients imaged. Some patients had more than one type of imaging requested.
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