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Biomedical subjects

B Lask

Publications and source records attributed to B Lask.

At least 19 recordsLinked to original sources
PubMed1999

Heart or heart-lung transplantation: psychosocial outcome.

The psychosocial outcome of 23 heart and 21 heart-lung transplant recipients, aged 5-17 yrs, was determined and compared with the psychosocial outcome of a group of 46 children and adolescents who underwent conventional cardiac surgery. Preoperatively, and 12 months post-operatively, the patients' physical health status, mental state (ICD-9) and level of psychosocial functioning (GAF scale, DSM-IIIR) were assessed. There was an improvement in physical health in all groups. Preoperatively, psychiatric disorder, including anxiety and phobic states, depression and adjustment reaction, was noted in 6/23 (26%) children assessed for heart transplantation, 6/21 (28.5%) children assessed for heart-lung transplantation, and 12/46 (26%) children undergoing conventional cardiac surgery. The prevalence of psychiatric disorder remained in the transplant group but decreased in the non-transplant comparison group (6.5%). Improvement in overall levels of psychosocial functioning were found in all groups, but over 40% of all the participants were still functioning below normal levels. In summary, children with end-stage cardio-respiratory disease benefit physically and psychologically from heart or heart-lung transplantation treatment but there is a need for systematic psychosocial support both before and after transplantation.

Adolescent↗
PubMed1998

Incomplete adherence after pediatric heart and heart-lung transplantation.

BACKGROUND: Poor adherence to treatment after organ transplantation is life threatening. Clinical experience indicates that failure to adhere to the medical regimen after pediatric heart or heart-lung transplantation is more common than might be anticipated. This is the first empirical study of adherence in this population. METHODS: The subjects were 53 children and adolescents (mean age 10.3 years) who underwent transplantation and were followed up for 12 months after transplantation. At each attendance blood levels of cyclosporine were measured and medical diaries checked. For children who had undergone heart-lung transplantation, serial measures of respiratory function were obtained, both at home and in the laboratory. Levels of adherence to the immunosuppressive therapy and completion of the medical diary were determined on the basis of prior operational definitions. RESULTS: Satisfactory adherence to medication and satisfactory completion of the diaries were found in 37 children (70%). Satisfactory adherence to medication but unsatisfactory completion of the diaries were found in 11 children (21%). There was poor adherence to medication in 5 other children (9%) regardless of whether the diary was satisfactorily completed. Independent variables associated with poor adherence to medication were heart-lung as opposed to heart transplantation, one-parent or blended families, and family adjustment. CONCLUSION: Nearly one third of the sample showed unsatisfactory adherence to the treatment regimen. This relatively high prevalence indicates the importance of close monitoring of adherence. The identification of family characteristics as risk factors indicates a need for more intensive psychoeducational family counseling in the 12 months after transplantation.

Adaptation, Psychological↗
PubMed1997

Childhood-onset anorexia nervosa: towards identifying a biological substrate.

OBJECTIVE: The etiology of anorexia nervosa is not fully understood, but is probably multifactorial, including a biological substrate. The purpose of this paper is to investigate the possible underlying biological substrate. METHOD: Fifteen children and adolescents aged 8-16 years underwent regional cerebral blood blow radioisotope scans. All fulfilled DSM-IV criteria for anorexia nervosa. Three of the girls had a follow-up scan when they had regained their lost weight. RESULTS: Thirteen of the 15 patients had unilateral temporal lobe hypoperfusion, 8 on the left side and 5 on the right. The abnormality persisted in the 3 girls who had a follow-up scan after weight restoration. DISCUSSION: This is the first report of reduced regional cerebral blood flow in childhood-onset anorexia nervosa, and suggests an underlying primary functional abnormality.

Adolescent↗
PubMed1997

Psychosocial morbidity in children, and their families, awaiting heart or heart-lung transplantation.

Awaiting heart or heart lung transplantation is a time of extreme stress for child and family, but there has been little evaluation of the psychosocial morbidity in this population. This preliminary study monitored changes in the mental health status of these children and their families. Fifty-one children considered suitable for transplantation and their families were assessed at the time of acceptance onto the waiting list and 6 months later. Twenty-five percent of the children had a psychiatric disorder, and 60% had a degree of impairment in psychosocial functioning. These high levels of morbidity indicate the need for a more comprehensive approach to treatment for this population.

Adolescent↗
PubMed1997

Sleep disorders.

Explore the source record for details and available documents.

Child↗
PubMed1997

Paediatrics at the cutting edge: do we need clinical ethics committees?

OBJECTIVES: To investigate the need for hospital clinical ethics committees by studying the frequency with which ethical dilemmas arose, the perceived adequacy of the process of their resolution, and the teaching and training of staff in medical ethics. DESIGN: Interviews with individuals and three multidisciplinary teams; questionnaire to randomly selected individuals. SETTING: Two major London children's hospitals. RESULTS: Ethical dilemmas arose frequently but were resolved in a relatively unstructured fashion. Ethical concerns included: the validity of consent for investigations and treatment; lack of children's involvement in consent; initiation of heroic or futile treatments; resource allocation. Staff expressed the need for a forum which would provide consultation on ethical issues, develop guidelines for good ethical practice, undertake teaching and training, and provide ethical reflection outside the acute clinical setting. CONCLUSION: Multidisciplinary, accountable and audited clinical ethics committees with predominantly advisory, practice development and educational roles could provide a valuable contribution to UK clinical practice and perhaps in other countries that have not developed hospital clinical ethics committees.

Child↗
PubMed1997

Eye movement abnormalities in a case of Tourette syndrome.

Tourette syndrome (TS) is a neuropsychiatric disorder that is characterised by the presence of multiple vocal, facial, and motor tics which change with time, and a number of other behavioural phenomena. Previous studies have not revealed any ocular-motor abnormalities. We report the eye movement studies of a patient with TS, using electrooculography and simultaneous video recording. Intrusive saccades occurred during smooth pursuit and optokinetic nystagmus. Reflexive and voluntary saccades were dysmetric and there was a complete failure of antisaccades. These abnormalities are characteristic of disease of the frontal lobes and basal ganglia. We review the literature with respect to the eye movement abnormalities associated with TS.

Adolescent↗
PubMed1994

Use of pelvic ultrasound to monitor ovarian and uterine maturity in childhood onset anorexia nervosa.

This study reports the use of pelvic ultrasound scanning in childhood onset anorexia nervosa. The aim was to determine the weight and weight for height ratio (wt/ht) that would correspond with ovarian and uterine maturity and therefore offer the optimal opportunity for the start or resumption of menstruation. On initial assessment, all children had mean weight, wt/ht, ovarian and uterine volumes significantly below expected. At follow up, half the children had started or resumed menstruation. When compared with those who had persisting amenorrhoea, the recovered children had a significantly higher mean weight (48.4 kg v 43.8 kg), mean wt/ht (96.5% v 87.5%), mean ovarian volume (6.2 ml v 4.9 ml), and mean uterine volume (14.6 ml v 10.8 ml). The study indicates that conventional target weight and wt/ht in anorexia nervosa may be too low to ensure ovarian and uterine maturity, and that pelvic ultrasound, which is well tolerated by this group of children, is a useful addition to their management.

Adolescent↗