The purpose of this study was to compare the oral and demographic characteristics of children with attention‐deficit hyperactivity disorder (ADHD) to those of a control group of children. A sample of 25 dental records of children medicated for ADHD was compared to 127 records of healthy children not receiving any medication. The children with ADHD had a statistically higher prevalence of toothache, bruxism, bleeding gums, and oral trauma histories than the control group (chi square, p < 0.05). The differences in other recorded oral characteristics and habits, such as plaque accumulation, gingival inflammation, calculus, oral hygiene compliance, dental caries experience, and unmet dental needs, were not statistically significant. The demographic characteristics such as age, gender, residence, ethnicity, income, and payment method were also not significantly different between the two groups. There is a need to develop and implement specific strategies for the early prevention and treatment of oral diseases in children with ADHD.
\s=b\ Clinical and electrophysiologic features of an infant with stiff-baby syndrome were studied; his father, uncle, and paternal grandmother suffered from a similar disorder. They all had a similar facial appearance during infancy (an alert, frightened, tense look) and a tendency to vomit because of hiatal hernias. The condition is benign but causes anxiety and, later, embarrassment as affected adults suddenly fall when stumbling or startled. We suggest that the condition be called hereditary stiff-baby syndrome. The family history is suggestive of autosomal dominant inheritance. (Am J Dis Child 1981;135:909-911) In 1972, Klein and his colleagues1 described a familial congenital disorder, affecting ten individuals in three generations, that resembled but was distinct from the stiff-man syn¬ drome. Recently, we have observed a family with a similar disorder, and the purpose of this article is to document further this rare disorder. REPORT OF CASESCase 1.-The infant (propositus, Fig 1) was born at term after a normal pregnancy From the Department of Neurology (Drs Lingam and Wilson), Hospital for Sick Children, and the Department of Diseases of Children, The Middlesex Hospital (Dr Hart), London. Reprints not available. and weighed 4.02 kg. The intrauterine fetal movements were first noticed at 16 to 18 weeks and were normal. The labor lasted &k hours, but the second stage lasted only ten minutes. Immediately after birth, the infant stiffened in a "fetal position," with flexion of forearms and legs and fisting of both hands. It was noticed that the stiff¬ ness was less prominent during sleep and was most notable when he was active. He fed well but began to vomit after each feeding at 3 weeks of age and did not gain weight; at 4 weeks he smiled. At 3 months he was fixing and following visually, was responsive and alert, and his weight, height, and head circumference were in the third percentile. He had a pinched, "wor¬ ried" facial expression and easily became very tense and agitated. When excited, he was extremely hypertonic, but tendon reflexes were normal. Apart from a large umbilical hernia, there were no other clini¬ cal abnormalities. In view of the family history and normal findings in other affected relatives, the parents reasonably requested that a minimum of investiga¬ tions should be undertaken.Electromyography (EMG) showed that, although there were periods of relaxation, strong contraction was present most of the time, giving rise to a full interference pattern of 1 to 2 mV and, occasionally, single motor unit potentials of 1 mV. No gross abnormality of form was detected.Nerve conduction was normal.
Studies of the prevalence and contents of codes of conduct in the private sector show that their use to define an ethical environment or culture, and their effective implementation, must be as part of a learning process that requires inculcation, reinforcement and measurement. Consequently, the public sector must realise it cannot look solely to formal codes to revive and sustain public sector values. Alan Doig is Professor of Public Services Management, and John Wilson is Principal Lecturer and Head of the Centre for Public Services Management, at Liverpool Business School, Liverpool John Moores University.
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