Eleanor Katherine Louise Mitchell

Nephron Endowment and Filtration Surface Area in the Kidney after Growth Restriction of Fetal Sheep

Low birth weight is associated with adult-onset diseases including hypertension and renal disease; altered renal development after intrauterine growth restriction (IUGR) may underlie such prenatal programming. Our aim was to investigate nephron endowment and renal filtration surface area in fetal sheep in which IUGR resulted from late gestational umbilico-placental embolization (UPE) or natural twinning. UPE was performed between 120 and 140 d of gestation (term ∼147 d). At autopsy (140 d), body weights of UPE and twin fetuses were, respectively, 34% and 28% lower than controls. Kidneys were sampled using a smooth fractionator approach and glomerular number was estimated using a physical disector/fractionator technique. Glomerular capillary length and filtration surface area were estimated using unbiased stereological techniques. Although relative kidney weights (grams per kilogram body weight) were not different between groups, nephron endowment was 40% lower in twin fetuses compared with controls (34.3 ± 10.6 × 104 and 55.9 ± 19.8 × 104, respectively; p < 0.05); UPE did not alter nephron number (50.7 ± 13.2 × 104). There was no difference in the glomerular capillary length or surface area between the UPE and control fetuses. IUGR due to twinning leads to reduced nephron endowment whereas late gestational IUGR does not, suggesting that reduced nephron endowment is dependent on the timing of the growth restriction. Our findings demonstrate that reduced birth weight per se does not necessarily imply reduced nephron endowment.

Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature

OBJECTIVE The purpose of this study was to review the literature for cases of adverse events in infants and children treated by chiropractors or other manual therapists, identifying treatment type and if a preexisting pathology was present. METHOD English language, peer-reviewed journals and non-peer-reviewed case reports discussing adverse events (ranging from minor to serious) were systematically searched from inception of the relevant searchable bibliographic databases through March 2014. Articles not referring to infants or children were excluded. RESULTS Thirty-one articles met the selection criteria. A total of 12 articles reporting 15 serious adverse events were found. Three deaths occurred under the care of various providers (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist) and 12 serious injuries were reported (7 chiropractors/doctors of chiropractic, 1 medical practitioner, 1 osteopath, 2 physical therapists, and 1 unknown practitioner). High-velocity, extension, and rotational spinal manipulation was reported in most cases, with 1 case involving forcibly applied craniosacral dural tension and another involving use of an adjusting instrument. Underlying preexisting pathology was identified in a majority of the cases. CONCLUSION Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare. The 3 deaths that have been reported were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date. Because underlying preexisting pathology was associated in a majority of reported cases, performing a thorough history and examination to exclude anatomical or neurologic anomalies before applying any manual therapy may further reduce adverse events across all manual therapy professions.

Health knowledge and iodine intake in pregnancy

Pregnant women have much higher iodine requirements as compared to all other population groups. The National Health and Medical Research Council (NHMRC) recommends pregnant women take a daily iodine supplement of 150 μg to meet their high iodine requirements.

Feeling supported and abandoned: mixed messages from attendance at a rural community cardiac rehabilitation program in Australia.

PURPOSE: In 2010, the Healthy Heart (HH) community-based cardiac rehabilitation program was offered at Latrobe Community Health Service in rural Victoria, Australia. The 8-week program, based on National Heart Foundation guidelines, consisted of exercise sessions; health education on diet, stress, and smoking cessation; and behavioral change strategies. Participants were also informed about local community exercise opportunities. A program evaluation was conducted in 2011 to assess whether the content of the program was meeting the needs of participants and to identify what suggestions they had for improvement. METHODS: Eighteen patients had completed the HH program in 2010. Eight of these participants, 7 men and 1 woman, volunteered to take part in a focus group. Conventional content analysis was used to identify and group the common themes that emerged from the focus group discussions. RESULTS: Three themes were identified that reflected the participant experiences of attending the HH program. The first, “recovering confidence,” described participant responses to the content of the sessions. The second, “putting it into practice,” referred to their comments about taking responsibility for making lifestyle changes. The third, “feeling abandoned,” emerged from the reported difficulty participants expressed about maintaining motivation for change after program completion. CONCLUSION: Participants rated the HH program as very successful by objective measures. However, they reported struggling to maintain self-management strategies postprogram. There is clearly a need to develop strategies that support cardiac rehabilitation participants over the longer-term.

Forces of Commonly Used Chiropractic Techniques for Children: A Review of the Literature.

OBJECTIVE The purpose of this study is to review the available literature that describes forces of the most commonly used chiropractic techniques for children. METHODS Review of the English-language literature using search terms Chiropract* and technique, protocol, or approach in databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, and Index to Chiropractic Literature and direct contact with authors of articles and book chapters. RESULTS Eleven articles that discussed the 7 most commonly used pediatric chiropractic techniques and the forces applied were identified. Chiropractic techniques reviewed described forces that were modified based on the age of the patient. Force data for mechanically assisted devices were varied, with the minimum force settings for some devices outside the age-specific safe range recommended in the literature when not modified in some way. CONCLUSION This review found that technique selection and application by chiropractors treating infants and young children are typically modified in force and speed to suit the age and development of the child.