Recognizing the Frequency of Exposure to Cyberbullying in Children: The Results of the National HBSC Study in Serbia

Nowadays, children are able to enrich their reality via the Internet. Unfortunately, this may increase their risk of becoming victims of cyberbullying. We analyzed the health characteristics and risk behavior of two cohorts of children in Serbia; those who reported being exposed to cyberbullying and those who did not. The statistical differences and logistic regression models were applied to the data on 3267 students collected from 64 schools participating in the 2017 Serbian Study on health behavior in school-age children (HBSC). Children exposed to cyberbullying reported having the following health problems on a daily basis: headache (18.5%), back pain (19.5%), depression (21.6%), irritability or bad mood (17.7%), nervousness (16.0%), sleep problems (16.1%), and dizziness (21.2%). As for the different types of risk behavior, cigarette smoking ranging from six to nine days ever was the most prevalent (26.9%). It was followed closely by getting drunk more than 10 times ever (24.1%). Compared to non-victims, victims were found to be at a higher risk of perceived back pain (OR = 2.27), depression (OR = 1.43), irritability or bad mood (OR = 2.07), nervousness (OR = 2.23), and dizziness (OR = 2.43) as well as being injured once or twice (OR = 1.98) or three or more times (OR = 4.09). Victims were associated with further risk factors: having smoked more than five cigarettes ever in life (OR = 1.73) and having gotten drunk two to three times (OR = 1.71) or four or more times (OR = 1.65). As the number of school-age children using social media continues to rise, we must prioritize educating them about self-help and community resources for addressing related health issues with greater speed and intensity. The findings from Serbia suggest that while children may be aware of their health issues, they may be unaware of their link to cyberbullying, which could hinder their ability to address these issues promptly. The respondents' attention to the health implications of cyberbullying could be increased by reformulating the survey questions used in the HBSC study.

A Review of Current Perspectives on Motoric Insufficiency Rehabilitation following Pediatric Stroke

Pediatric stroke (PS) is an injury caused by the occlusion or rupture of a blood vessel in the central nervous system (CNS) of children, before or after birth. Hemiparesis is the most common motoric deficit associated with PS in children. Therefore, it is important to emphasize that PS is a significant challenge for rehabilitation, especially since the consequences may also appear during the child's growth and development, reducing functional capacity. The plasticity of the child's CNS is an important predecessor of recovery, but disruption of the neural network, specific to an immature brain, can have harmful and potentially devastating consequences. In this review, we summarize the complexity of the consequences associated with PS and the possibilities and role of modern rehabilitation. An analysis of the current literature reveals that Constraint-Induced Movement Therapy, forced-use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation and robot-assisted therapy have demonstrated at least partial improvements in motor domains related to hemiparesis or hemiplegia caused by PS, but they are supported with different levels of evidence. Due to the lack of randomized controlled studies, the optimal rehabilitation treatment is still debatable, and therefore, most recommendations are primarily based on expert consensuses, opinions and an insufficient level of evidence.

The Genetic Basis of Strokes in Pediatric Populations and Insight into New Therapeutic Options

Strokes within pediatric populations are considered to be the 10th leading cause of death in the United States of America, with over half of such events occurring in children younger than one year of life. The multifactorial etiopathology that has an influence on stroke development and occurrence signify the importance of the timely recognition of both modifiable and non-modifiable factors for adequate diagnostic and treatment approaches. The early recognition of a stroke and stroke risk in children has the potential to advance the application of neuroprotective, thrombolytic, and antithrombotic interventions and rehabilitation strategies to the earliest possible timepoints after the onset of a stroke, improving the outcomes and quality of life for affected children and their families. The recent development of molecular genetic methods has greatly facilitated the analysis and diagnosis of single-gene disorders. In this review, the most significant single gene disorders associated with pediatric stroke are presented, along with specific therapeutic options whenever they exist. Besides monogenic disorders that may present with stroke as a first symptom, genetic polymorphisms may contribute to the risk of pediatric and perinatal stroke. The most frequently studied genetic risk factors are several common polymorphisms in genes associated with thrombophilia; these genes code for proteins that are part of the coagulation cascade, fibrolysis, homocystein metabolism, lipid metabolism, or platelets. Single polymorphism frequencies may not be sufficient to completely explain the stroke causality and an analysis of several genotype combinations is a more promising approach. The recent steps forward in our understanding of the disorders underlying strokes has given us a next generation of therapeutics and therapeutic targets by which to improve stroke survival, protect or rebuild neuronal connections in the brain, and enhance neural function. Advances in DNA sequencing and the development of new tools to correct human gene mutations have brought genetic analysis and gene therapy into the focus of investigations for new therapeutic options for stroke patients.

COMORBIDITY IMPACT ON SOCIAL FUNCTIONING AFTER HIP FRACTURE: THE ROLE OF REHABILITATION

Objective:

To analyze the impact of rehabilitation treatment on social functioning in elderly patients after hip fracture during a rehabilitation program.

Methods:

This study included 203 patients with hip fracture. Four groups were analyzed on rehabilitation: Group 1, at admission, Group 2, at discharge, Group 3, three months after discharge and Group 4, six months after discharge. The analyzed parameters included: musculoskeletal, neurological and cognitive impairments. Impairment severity was graded by cumulative index rating scale for geriatrics (CIRS-G). Evaluation of social functioning was completed by social functioning component (SFC) from quality of life (SF-36) questionnaire.

Results:

There was a significant improvement in SF-36 SFC values for observed impairments from admission to six months after discharge for each severity degree (p<0.01), except for CIRS-G severity degree 4 for cognitive impairment, where significance was p<0.05. For the group of patients with musculoskeletal impairment, there was a significant difference between the values of SF-36 SFC concerning different severity degrees of CIRS-G only at six months after discharge (p<0.05). Patients with neurological or cognitive impairments have shown significant differences between the values of SF-36 SFC in regard to severity degrees of CIRS-G in all observational groups.

Conclusion:

Different degrees of observed impairments influence the degree of social functioning recovery in the elderly after hip fracture.Level of Evidence II, Prognostic Studies .

Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome

OBJECTIVE

This study investigated the short-term efficacy of low-level laser therapy (LLLT) in patients with mild to moderate carpal tunnel syndrome (CTS), lasting for <1 year.

METHODS

Seventy-nine patients with CTS were included in this double-blind, placebo-controlled study, and randomly divided in two treatment groups: Experimental group (EG), active laser group (40 patients); and control group (CG), placebo (sham) laser group (39 patients). A GaAlAs diode laser [780 nm, 30 mW continuous wave (CW), 0.785 cm(2), 38.2 mW/cm(2)] was applied in contact with four points perpendicularly to the skin over the carpal tunnel area for 90 sec per point (2.7 J, 3.4 J/cm(2)/point). Both groups were treated five times per week, once a day over 2 weeks, followed by 10 treatments every other day for 3 weeks, that is, for a total of 20 treatments. Clinical assessment, including visual analogue scale (VAS) pain rating, Tinel's sign, and median nerve conduction studies (NCSs) were evaluated before, and 3 weeks after, the last LLLT treatment.

RESULTS

Significant reduction in pain, reduction in the percentage of patients with a positive Tinel's sign, and shortening of sensory and motor latency time in the NCS examination was observed in the experimental LLLT group (but not in the control group).

CONCLUSIONS

This study has observed and documented the statistically significant short-term effects of LLLT on CTS patients in comparison with a placebo group. The results support this conclusion, especially if the LLLT is applied in the earlier stages of CTS, and with mild to moderate cases.

Hip fractures in a geriatric population - rehabilitation based on patients needs

With an increased life expectancy in humans and thus an increase in the number of the elderly population, the frequency of hip fractures will rise as well. Aside from a higher incidence, hip fractures in a geriatric population is a significant problem due to the possible onset of severe and in some cases dramatic complications and consequences. The primary purpose of treatment and rehabilitation in the elderly after a hip fracture is to improve an individual's quality of life. It is important to underline that principles and methods of functional restoration after hip fracture should consider careful planning of a rehabilitation program individually for every patient and its implementation with respect to decisions made by the rehabilitation team.

Influence of selective comorbidity predictors on functional recovery after hip fracture in an older population

AIM

The purpose of the study was to evaluate the influence of four comorbidities from the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and their severity on functional status outcome after a rehabilitation program measured by the Berg Balance Scale (BBS) in patients with hip fracture.

METHODS

The study included 203 patients whose functional status was evaluated by the BBS at admission (Group 1), at discharge (Group 2) and 3 months after discharge (Group 3). Further comorbidity parameters from the CIRS-G were assessed: musculoskeletal impairment, neurological, vascular and cognitive impairment. For the evaluation of CIRS-G severity degree we used the range 0-4.

RESULTS

At admission there were non-significant differences in mean values of BBS between parameters for the same CIRS-G severity degree. Significant differences between BBS values were noticed in the period after discharge (Group 2((musculoskeletal)); P<0.05, Group 2((neurological and cognitive)); P<0.01) and after 3 months of follow-up (Group 3((musculoskeletal, neurological and cognitive)); P<0.01). Higher effects of CIRS-G severity degree on BBS values in Group 2 and Group 3 for neurological impairment (η(2)(Group2)=29.76 and η(2)(Group3)=28.35) and even higher for cognitive impairment (η(2)(Group2)=34.35 and η(2)(Group3)=40.63) were noticed.

CONCLUSION

Increase in CIRS-G severity degree of cognitive and neurological impairment in patients after hip fracture that were included in the rehabilitation program correlates closely with functional status after discharge and after 3 months of follow-up. Rehabilitation of patients after hip fracture should be mandatory for functional recovery regardless of the comorbidity and functional status.

Electrodiagnostic evaluation of patients with carpal tunnel syndrome regarding the presence of subjective and physical findings

The aim of our study was to evaluate the changes of median nerve conduction velocities by electrodiagnostic procedure in carpal tunnel syndrome (CTS) patients with and without present subjective and physical findings. We have evaluated 116 patients that were diagnosis with CTS. Subjective findings: weakness, numbness and night pain were analyzed. Further physical findings were evaluated: Tinels sign, muscles hypotrophy and weakness according to muscle manual test (MMT). Duration of complaints was evaluated as well. Electroneurographic findings included: estimation of median nerve motor terminal latency (mMTL), sensory velocity (mSV) and motor velocity (mMV). Significantly longer complaints were present in patients who experienced night pain (p=0.015) and those with muscles weakness on MMT (p=0.016). Statistically significant increase for mMTL values was noticed for patients with Tinels sign (p=0.045), present muscles hypotrophy (p=0.001) and weakness on MMT (p=0.001). There is significant decrease for mMV in group with present Tinels sign (p=0.048), muscle hypotrophy (p=0.003) and weakness on MMT (p=0.002), and for mSV in group with present muscle hypotrophy (p=0.008) and group with weakness on MMT (p=0.019). Multivariate logistic regressional analysis shown that only for hypotrophy, mMTL variable presents significant independent contributor (p=0.009). For the diagnosis confirmation and treatment planning along with elecroneurography it is necessary to evaluate patients with CTS clinically, since different clinical manifestations are correlating in different degree with electroneurographic findings.

Evaluation of functional recovery by motor functional independence measure test of elderly after hip fracture in Serbia

INTRODUCTION

The aim of the study was to evaluate motor functional status measured by motor Functional Independence Measure (mFIM) test in population above 65 years of age after the hip fracture.

MATERIAL AND METHODS

We evaluated 203 patients after hip fracture by mFIM test on 3 occasions: at admission (Period-1), at discharge (Period-2) and 3 months after discharge (Period-3); 3 age groups: Group(65-74), Group(75-84) and Group(85-up) and 2 groups concerning Severity Index (SI): group 0-1.99 (SI1) and group ≥ 2 (SI2).

RESULTS

In same SI group there is significant increase in mFIM values for Period-2 and Period-3 for both genders and in first two age groups, while for those above 85 years of age with higher SI we found non-significant change in mFIM values between discharge and 3 months post discharge period.

DISCUSSION

The most significant improvement is obtained for women in first and third age groups and with higher SI.

CONCLUSION

Gender is not significant predictor for motor functional recovery measured by mFIM test in patients with hip fracture, although the admittance mFIM is a good indicator for mFIM capacity recovery in women of certain age groups (first and third age groups).

Prediction functional independence measure in hip fracture patients

The importance of early inclusion in rehabilitation program and exercise of older people after the hip fracture could be explained by the fact that physical activity influences the muscle strength, balance and eventually degree of hip pain [11]. Such determinants are very important particularly for individuals quality of life and could prevent further risks of comorbidities and falls later in life. It has been often hypothesized that the success of recovery is extremely dependent on the timeliness and adequacy of the treatment. While it is desirable to provide the best possible care as soon as possible the actual limitations that may exist in health-care systems due to a limited number of medical staff as well as limited capacity in rehabilitation programs may create need for appropriate planning and/or scheduling.