257uptake of speech therapy throughout Britain suggests that families of lower social class are making worse use of the speech therapy provisions available in their vicinity.Detailed analysis was made of a high-risk group of children, comprising 1-6% of all the 7-year-olds, who were considered to have a marked speech defect in the absence of any auditory difficulty after evaluation of a large amount of data available on speech and hearing from doctor, teacher, and health visitor and assessment of test results. Even though this was clearly a very handicapped group not more than a third were reported as having been referred by 7 years for speech therapy. It would have been interesting to have considered these children under aetiological headings, but the absence of specialized tests to assist differential diagnosis inevitably led to the bracketing of many different conditions under the heading of marked speech defect. These included true language disorders and dysarthrias of every type, as well as late-resolving developmental phonetic substitutions which would normally have disappeared spontaneously by the age of 7 years. Nevertheless, when considered as a group these children did manifest a number of important sociobiological characteristics. These children, more often males, came from a poorer social background and were of later birth order than controls. Apart from aetiological considerations such findings help to define the type of child worthy of further investigations of their speech problems. The children more often showed other disabilities, such as visual defect or squint, emphasizing the need for searching for other handicaps. They were more often rated as being clumsy by their teachers, perhaps indicating that a proportion might be associated with neurodevelopmental dysfunction. Perinatal factors were sought, but apart from the tendency for these children to be born before term abnormalities of pregnancy or labour were not found to be significantly more common than in controls.Over On the evidence available from these results there can be no question that children with speech defects at 7 years need and should be urgently provided with expert treatment and followup by speech therapists, not working in isolation but in conjunction with paediatricians, psychologists, psychiatrists, teachers, and parents.We should like to thank the local authority medical officers and teachers without whose help this investigation would not have been possible. We should also like to thank the National Children's Bureau, who mounted the National Child Development Study, and also Mr.

No abstract

Hätten Sie bei einem 38-Jährigen an eine Osteoporose gedacht? 2014 suchte ein 38-jähriger Patient die hausärztliche Sprechstunde auf. Er gab an, seit fünf Tagen unter Schmerzen im Bereich der rechten Hüfte zu leiden. Den Schmerzcharakter beschrieb er als ziehend und in den rechten Oberschenkel ausstrahlend. Dr. med. Henrik Lamers Niedergelassener Hausarzt in einer Gemeinschaftspraxis in Heidelberg FORTBILDUNG KASUISTIK Abb. 1 In der MRT mit Kontrastmittel zeigte sich ein deutliches Knochenmark ödem im rechten Hüftkopf und Schenkelhals. Plötzlich Schmerzen in der Hüfte, die sich beim Laufen noch verstärken: Was steckt wohl dahinter? © Jan-Otto / iStock © Radiologische Praxis Prof. Dr. med. Rieden, Heidelberg 54 MMW Fortschritte der Medizin 2015 . 19 / 157

No abstract