Yuko Ishizaki

Japanese clinical guidelines for juvenile orthostatic dysregulation version 1

This clinical practice guideline provides recommendations for the assessment, diagnosis and treatment of school‐aged children and juveniles with orthostatic dysregulation (OD), usually named orthostatic intolerance in USA and Europe. This guideline is intended for use by primary care clinicians working in primary care settings. The guideline contains the following recommendations for diagnosis of OD: (i) initial evaluation composed of including and excluding criteria, the assessment of no evidence of other disease including cardiac disease and so on; (ii) a new orthostatic test to determine four different subsets: instantaneous orthostatic hypotension, postural tachycardia syndrome, neurally mediated syncope and delayed orthostatic hypotension; (iii) evaluation of severity; and (iv) judgment of psychosocial background with the use of rating scales. The guideline also contains the following recommendations for treatment of OD on the basis of the result of an orthostatic test in addition to psychosocial assessment: (i) guidance and education for parents and children; (ii) non‐pharmacological treatments; (iii) contact with school personnel; (iv) use of adrenoceptor stimulants and other medications; (v) strategies of psychosocial intervention; and (vi) psychotherapy. This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OD. Rather, it is designed to assist primary care clinicians by providing a framework for decision making of diagnosis and treatments.

Evaluation of diagnostic criteria of acute renal failure in premature infants.

A prospective study was performed to investigate the validity of renal failure index (RFI) or fractional excretion of sodium (FENa) in preterm infants. The subjects were 128 newborn infants, 72 with oliguria and 56 without renal dysfunction (control). Oliguric infants were divided into two categories: acute renal failure (ARF) and prerenal failure (PRF), according to creatinine clearance (Ccr). Furthermore, all subjects were divided into four groups according to gestation, that is, 38 infants with gestational age of 25–28 weeks (group 1), 28 with 29–30 weeks (group 2), 38 with 31–36 weeks (group 3) and 24 of > 37 weeks (group 4). As a result, differentiation between ARF and PRF was valid when the RFI or FENa was used in infants of > 29 weeks gestation (groups 2, 3 and 4). Although infants of > 31 weeks gestation (groups 3 and 4) who present with an RFI > 3 or an FENa > 3% may be diagnosed as having ARF, infants in group 2 with an RFI of > 8 or an FENa of > 6% may be diagnosed as having ARF. For the infants in group 1, the application of RFI or FENa for diagnosis of ARF may be limited because of some overlap among the groups.

The transition of adult patients with childhood-onset chronic diseases from pediatric to adult healthcare systems: a survey of the perceptions of Japanese pediatricians and child health nurses

BackgroundAdvances in medical science have enabled many children with chronic diseases to survive to adulthood. The transition of adult patients with childhood-onset chronic diseases from pediatric to adult healthcare systems has received attention in Europe and the United States. We conducted a questionnaire survey among 41 pediatricians at pediatric hospitals and 24 nurses specializing in adolescent care to compare the perception of transition of care from pediatric to adult healthcare services for such patients.FindingsThree-fourths of the pediatricians and all of the nurses reported that transition programs were necessary. A higher proportion of the nurses realized the necessity of transition and had already developed such programs. Both pediatricians and nurses reported that a network covering the transition from pediatric to adult healthcare services has not been established to date.ConclusionsIt has been suggested that spreading the importance of a transition program among pediatricians and developing a pediatric-adult healthcare network would contribute to the biopsychosocial well-being of adult patients with childhood-onset chronic disease.

Japanese clinical guidelines for chronic pain in children and adolescents.

Chronic pain is a common problem in pediatric practice. The prevalence of chronic pain in children is >30%. Because pain indicates emotional expression as well as the physiological reaction toward infection, injury, and inflammation, both physiological and psychological assessments are essential to determine primary interventions for chronic pain. The Japanese Society of Psychosomatic Pediatrics Task Force of clinical practice guidelines for chronic pain in children and adolescents compiled clinical evidence and opinions of specialists associated with the primary care of pediatric chronic pain in the Japanese ‘clinical guidelines for chronic pain in children and adolescents’ in 2009, which are presented herein. The guidelines consist of three domains: general introduction to chronic pain; chronic abdominal pain; and chronic headache. Each section contains information on the physiological mechanism, psychological aspects, assessment methods, and primary interventions for pediatric chronic pain. These guidelines are expected to help disseminate knowledge on primary interventions for chronic pain in children and adolescents.

Chronic and persistent cough related to vulnerability to psychological stress: Tic or psychogenic?

After visiting several pediatric clinics a 10-year-old girl was referred to the Kansai Medical University Hospital, Osaka for further eva luation and treatment of disabling cough lasting for the last 5 weeks. Her cough was like a seal barking, which started 1 month after she suffered from an infl uenza. Chest X-ray, routine blood examinations including mycoplasm antibody, and allergen studies were all negative. None of the family members was a smoker. Under the tentative diagnosis of chronic bronchitis, she was placed on antibiotics, decongestants, antihistamines, inhaled bronchodilators, and inhaled corticosteroids without favorable outcome. Two weeks later the subject was asked by her schoolteacher not to attend the school as her cough was thought to be infectious. The subject became depressed and isolated from the classmates. Then a general pediatrician suspected that her cough was psychogenic and referred her to a developmental and behavioral pediatrician. At the fi rst psychological interview by the developmental and behavioral pediatrician it was noted that a stereotypic and peculiar movement was accompanied by barking cough: once she straightened her trunk and tilted it forward, this movement tended to be accompanied by dry and disruptive cough. Her mother said her cough was occasionally seen during sleep, but that the coughing did not disrupt the sleep. The subject had no previous developmental or behavioral problems. There was no family history suggestive of allergy or psychiatric illness, but her mother was extremely obsessive during the fi rst interview. The stereotypic movement of the patient and obsessive traits of the mother led us to speculate that her cough was not infectious in origin but rather a tic symptom. We explained to her mother that her cough was not due to infection but was considered to be a symptom of tic syndrome, which is related to both genetic and environmental factors such as psychological stress. It was thus considered to be particularly important to understand the etiology of cough and to reduce the psychological burden due to misunderstanding of tic symptoms. In addition we prescribed risperidone 0.3 mg daily, which was successful in abating her cough in 3 weeks. The medication was then withdrawn, and the patient remained free from cough thereafter for the last 24 months.

Effects of interview on mood status of pregnant women with high‐risk delivery

Background:  Expectant mothers at high risk for preterm labor admitted to the Mother and Child Health Centers (MCH) often have psychological problems and mood disturbances. The purpose of the present study was to evaluate the effects of an interview by health professionals on their mood status.

Surged leptin/ghrelin secretion associated with anorexia nervosa.

© 2008 by Lipp Received January 6, 20 Address correspondenc Department of Pediatrics nocho, Moriguchi, Osak kmu.ac.jp). Supported in part by th The authors report no Anorexia nervosa is the most common life-threatening condition of all psychiatric disorders. Although physical signs of extracellular volume depletion and plasma volume concentration are often studied in anorexia nervosa, few studies have focused on adipocytokines and glucose balance. Anorexia nervosa is associated with altered carbohydrate and lipid metabolism, multiple endocrine perturbations, and other dysfunctions (1). Although studies regarding insulin sensitivity in anorexia nervosa have had rather contradictory results, some have found increased insulin sensitivity (1,2), and others have postulated decreased or unchanged insulin sensitivity (3,4). Many experimental and clinical studies have shown that the adipose tissue–derived hormone leptin is a key player in the regulation of food intake and energy balance. In addition to leptin, several other adipose tissue–derived hormones with suggested roles in the regulation of energy metabolism and insulin sensitivity have been discovered recently. Although most studies have focused on changes in endocrine function of adipocytes in obesity, adipose tissue also plays an important role in patients with malnutrition and decreased body fat content: serum leptin levels are severely suppressed in patients with both protein-energy malnutrition and anorexia nervosa (2). We hypothesized that impaired ghrelin/leptin secretion in anorexia nervosa may be involved in the pathogenesis of this eating disorder. To examine this hypothesis and to further investigate the role of ghrelin in regulating energy homeostasis, we analyzed serial changes in circulating ghrelin and leptin in a patient with anorexia nervosa and examined a possible correlation of these hormones with nutritional status before and after weight gain.

Psychosocial Association of Japanese Mothers and Their Children When Living Temporarily Abroad

To evaluate the effects of overseas sojourns on the psychosocial conditions of children, we observed Japanese children and their mothers temporarily living in the United States. Using a questionnaire, we examined the psychosocial condition of 61 Japanese mother-and child pairs (male = 51 percent, aged 8 to 15) living in the United States. One-fourth of the mothers were regarded as having minor psychiatric illness according to the General Health Questionnaire. One-tenth of the children were assessed as depressive by the Children’s Depression Inventory, and 30 percent of the children were identified as having a high level of anxiety according to the Children’s Manifest Anxiety Scale. Multiple regression analysis revealed that the mother’s minor psychiatric illness was significantly associated with the levels of depression and anxiety in their children.

Research on promotion of management of children with psychosomatic and psychosocial disorders in Japan.

Abstract Background : The number of children with psychosomatic and psychosocial disorders has been increasing in Japan. There are, however, few trained pediatricians who have adequate knowledge of the treatment needed. The Research Group on the Promotion of Management of Children with Psychosomatic and Psychosocial Disorders carried out the present study to (i) disseminate knowledge about psychosomatic and psychosocial disorders of children; and (ii) establish a community‐based network model to ensure effective communication among relevant institutions.

Spatiotemporal characteristics of gaze of children with autism spectrum disorders while looking at classroom scenes

Children with autism spectrum disorders (ASD) who have neurodevelopmental impairments in social communication often refuse to go to school because of difficulties in learning in class. The exact cause of maladaptation to school in such children is unknown. We hypothesized that these children have difficulty in paying attention to objects at which teachers are pointing. We performed gaze behavior analysis of children with ASD to understand their difficulties in the classroom. The subjects were 26 children with ASD (19 boys and 7 girls; mean age, 8.6 years) and 27 age-matched children with typical development (TD) (14 boys and 13 girls; mean age, 8.2 years). We measured eye movements of the children while they performed free viewing of two movies depicting actual classes: a Japanese class in which a teacher pointed at cartoon characters and an arithmetic class in which the teacher pointed at geometric figures. In the analysis, we defined the regions of interest (ROIs) as the teacher’s face and finger, the cartoon characters and geometric figures at which the teacher pointed, and the classroom wall that contained no objects. We then compared total gaze time for each ROI between the children with ASD and TD by two-way ANOVA. Children with ASD spent less gaze time on the cartoon characters pointed at by the teacher; they spent more gaze time on the wall in both classroom scenes. We could differentiate children with ASD from those with TD almost perfectly by the proportion of total gaze time that children with ASD spent looking at the wall. These results suggest that children with ASD do not follow the teacher’s instructions in class and persist in gazing at inappropriate visual areas such as walls. Thus, they may have difficulties in understanding content in class, leading to maladaptation to school.