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PubMed1998

Psychosocial adjustment of children with spina bifida.

It was the aim of the present prospective study to investigate the influence of age, sex, intellectual function, and school type as well as of hydrocephalus, the level of lesion, and of the degree of handicap on the psychosocial adjustment of children with spina bifida. Seventy-five patients with spina bifida, aged 6 to 16 years were assessed concerning their psychosocial adjustment and their intellectual function by use of standardized instruments. The findings were compared with those of nondisabled controls, matched for age and sex. Children with spina bifida showed a tendency to be at an increased risk for psychosocial maladjustment. Influencing factors were age, sex, and the degree of handicap. Twelve- to 16-year-old boys and girls displayed significant adjustment problems in specific areas in comparison with their controls. There was a tendency for children with spina bifida to be attending inappropriate school types according to their intellectual abilities. Perhaps the most striking finding of our study was that children with spina bifida who attended a school for disabled children, even though it might be an IQ-appropriate setting, had a higher rate of psychosocial maladjustment than the disabled children in mainstream schools.

Adolescent↗
PubMed1995

Use of ECFMG certifying examinations for national comparisons: performance of graduates of Israeli medical schools in basic and clinical science examinations.

Examinations were used for comparison of Israeli medical school graduates. The two schools with traditional curricula had higher pass rates for first takers of Day 1 (68% and 61%, mean scores 76.6 and 76.4) than the community-based school (44%, mean score 74.5) and the technologically oriented school (40%, mean score 72.5). There were similar pass rates for traditional school first takers of Day 2 (97% and 91%, mean scores 82.4 and 80.4) as for community-based school first takers (94%, mean score 80.1). The traditional schools and the community-based school demonstrated higher pass rates and mean scores for first takers of Day 2 than the technologically oriented school. Analysis of the time lapse between the basic science curriculum and taking the basic science examination reveals no trend in scores or pass rates. While the likelihood of better performance on Day 1 seems enhanced by traditional curricula, there is an equivalent performance on Day 2 by graduates of schools with traditional curricula.

Certification↗
PubMed1994

The relationship of self-esteem to selected personal and environmental resources of adolescents.

This study examined the relationship of selected variables to self-esteem among 648 high school and college students. Multiple regression analyses, with self-esteem as the dependent variable, were computed separately for both males and females from small and large schools. Predictor variables were sex role orientation (masculinity/femininity); attitudes toward women's roles in society; high school activity participation; high school athletic participation; employment practices of students; and parents' education, occupational, and marital status. For all four groups, higher masculinity scores and greater levels of activity participation were significantly related to self-esteem. As predicted, however, there were differences in the regression equations as a function of school size. For males in small schools, but not in large schools, athletic participation was a significant predictor of self-esteem. For females in small schools, but not in large schools, more nontraditional or egalitarian attitudes toward women were related to higher self-esteem scores. Only masculinity and activity participation were significant predictors of self-esteem for both males and females in large schools. The implications of these results for the understanding of adolescent development are discussed.

Adolescent↗
PubMed1991

[Arterial pressure and race. A study in pauper children attending schools in an urban strip in Lisbon].

OBJECTIVE: To determine whether race is a factor of blood pressure levels in school-age children of similar social status, and to investigate other potential determinants of the levels of blood pressure. DESIGN: Inquiry in schools of the suburbs of Lisbon. SETTING: Three schools, four medical observers (general practitioners with school-health functions). SUBJECTS: Three hundred ninety seven children, aged 6-14 years, both sexes, 296 being white and 101 non-white. INTERVENTIONS: Inquiry to the following individual characteristics--sex, age, race, birthplace, type of housing, house availability of water, electricity and waste water, type of transportation to school, number of cohabitans, family income, school marks. Individual determination of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), weight and height. MEASUREMENTS AND MAIN RESULTS: Blood pressure values were cross-analyzed with all the determined variables, and the virtual correlations were checked. Main results as follows: Race does not influence either SBP or DBP. In this age group, sex does not influence blood pressure values. The used markers of socioeconomical status have equally no influence on blood pressure. Age has only a significant repercussion on SBP. No significant correlation was found between height and blood pressure. Body weight, however, influence either SBP or DBP. SBP was found to be lower in the second of two successive measurements, and the difference increases with age. CONCLUSIONS: In this school-aged biracial population, body weight seems to be the major factor of blood pressure levels, in the sense-bigger weight, higher SBP and DBP.

Adolescent↗
PubMed1983

Knowledge and attitudes of schoolteachers toward oral health programs and preventive dentistry.

Because teachers often take on major roles in school dental health programs, three surveys were completed between 1973 and 1981 to measure teachers' attitudes and knowledge about oral health and their own participation in school programs. The questionnaires were sent to teachers whose schools were included in major dental caries preventive programs and teachers whose schools were not included in such programs. Results showed that: Teachers were quite willing to teach oral health topics and were willing to take on a wide range of teaching, but not administrative, responsibilities. Teachers' acceptance of these responsibilities appeared to decrease during the surveys, possibly as a function of school budget difficulties, indicating a need for incentives and positive rein-forcement. However, their acceptance of responsibilities was not affected by their participation in preventive programs. Schoolteachers had basic misinformation about the purposes of personal oral hygiene, and about the relative effectiveness of measures such as oral hygiene and consumption of fluoridated water in preventing dental caries. The preventive knowledge of teachers was unaffected by either the passage of time or participation in school preventive programs. A series of recommendations is given for the inservice education of school-teachers.

Attitude to Health↗
PubMed1994

School-age outcomes in children with birth weights under 750 g.

BACKGROUND: Since the mid-1980s, increasing numbers of children with birth weights under 750 g have survived to school age. METHODS: We matched a regional cohort of 68 surviving children born from 1982 through 1986 with birth weights under 750 g (mean, 670 g; gestational age, 25.7 weeks) with 65 children weighting 750 to 1499 g at birth and 61 children born at term. Growth, neurosensory status, and functioning at school age in the three groups were compared. Associations of biologic and social risk factors with major developmental outcomes were examined by means of logistic-regression analyses. RESULTS: Children with birth weights under 750 g were inferior to both comparison groups in cognitive ability, psychomotor skills, and academic achievement. They had poorer social skills and adaptive behavior and more behavioral and attention problems. The mean (+/- SD) Mental Processing Composite score for the cohort was 87 +/- 15, as compared with 93 +/- 14 for children with birth weights of 750 to 1499 g and 100 +/- 13 for children born at term (P < 0.001). The rates of mental retardation (IQ < 70) in the three groups were 21, 8, and 2 percent, respectively; the rates of cerebral palsy were 9, 6, and 0 percent; and the rates of severe visual disability were 25, 5, and 2 percent. Major cerebral ultrasonographic abnormalities were associated with mental retardation (odds ratio, 5.4; 95 percent confidence interval, 1.8 to 15.8) and cerebral palsy (odds ratio, 15.2; 95 percent confidence interval, 3.0 to 77.4). Oxygen dependence at 36 weeks was associated with mental retardation (odds ratio, 4.5; 95 percent confidence interval, 1.2 to 10.7) and severe visual disability (odds ratio, 4.3; 95 percent confidence interval, 1.3 to 14.2). Social disadvantage, though associated with several neuropsychological outcomes, was not associated with major developmental impairment. CONCLUSIONS: Children with birth weights under 750 g who survive represent a subgroup of very-low-birth-weight children who are at high risk for neurobehavioral dysfunction and poor school performance.

Adaptation, Physiological↗
PubMed1984

New library building: Mercer University School of Medicine, Macon, Georgia.

The Mercer University School of Medicine (MUSM) enrolled its charter class in 1982. The curriculum is problem-based and adaptable to the learning needs of each student. MUSM is housed in a new building designed to support this unique educational program. Its library is an example of a comparatively small, but fully functional, medical school library. The planning process, design, and layout of the new library facility are described. Among its unique features are an integrated print and non-print collection, current periodical display space, and extensive use of task lighting.

Facility Design and Construction↗
PubMed1995

Rehabilitation of low back pain patients. A review.

Numerous methods have been developed for the rehabilitation of low back pain patients, including spinal flexion and extension exercises, lumbar spine locking in an intermediate position, enhancement of spinal and pelvic proprioceptive sensibility, swimming pool therapy, back schools, and functional restoration. Each seeks to achieve a goal assumed to be central to the prevention of a first or recurrent episode of low back pain. Goals include short-term pain relief, an improved ability to achieve self-sedation, abdominal and lumbar muscle strengthening, increased hip and lumbar spine mobility, improved lumbar and pelvic proprioceptive sensibility, intervertebral joint stabilization, lumbar posture modification and improved general fitness. Less than 30 studies meeting widely accepted validity and applicability criteria for therapeutic trials have addressed the clinical efficacy of rehabilitation in low back pain patients. Most studies of the back school approach have found no benefit. Spinal flexion and extension exercise programs have yielded short-lived improvements, with no differences across methods. There is evidence that functional restoration programs based on graded activity may provide long-term benefits including better social and occupational outcomes. We have evaluated the physical therapy methods most commonly taught to and used by physical therapists in France.

Back Pain↗
PubMedDate not supplied

Health of the Nation targets: where school nurses find constraints on achievement.

A qualitative research methodology was used to investigate 73 school nurses' perceptions of their contributions towards Health of the Nation targets (1). The inquiry aimed to identify areas in which the school nurses felt that educational assistance was required. The study demonstrated that school nurses function well and have an enormous potential to affect positively the health of the nation's children. Four main areas of constraint, however, were identified by the nurses. These areas, pinpointed as the major obstacles for target achievement, are education, joint planning, resources and perceived value. The author highlights recommendations for the future role of the school nurse.

Attitude of Health Personnel↗
PubMed1995

[Depression in children and adolescents].

The prevalence of major depression in preschool is less than 1 procent, in school-age children about 2 percent, and in adolescents about 4.7 percent. While as no significant sex differences have been reported among preadolescents, studies of adolescents have reported 2 to 3 times higher rates of depression. The most frequent course of depression is chronic and persistent, the mean length of depressive episode being 30 weeks. Depressed children and adolescents have impaired psychosocial functioning and school problems. Relapse occurs at a high frequency for depressed patients. The high recurrence of depression in children and adolescents calls for a long-term management in these age-groups.

Adolescent↗
PubMed1988

The relation between third graders' after-school care and social, academic, and emotional functioning.

Outcome differences associated with types of after-school care were explored among 150 white, predominantly middle-class third graders from a suburban school system. Children returned home to their mothers, attended day-care centers, stayed with sitters, or returned home alone or with siblings. No differences were found between latchkey and mother-care children in terms of their classroom sociometric nominations, academic grades, standardized test scores, conduct grades, self-reports of self-competence, or parent and teacher ratings of the children. Significant differences were found for children who attended day-care centers after school. These children received more negative peer nominations, made lower academic grades, and had lower standardized test scores than either mother-care or latchkey children. The children who stayed with sitters after school received more negative peer nominations than the latchkey and mother-care children but, in other areas, resembled these groups. These outcome differences were apparent in both divorced and intact families. Factors contributing to these differences are examined.

Achievement↗
PubMed1981

Neuropsychological differences between juvenile delinquents and functional adolescents: a preliminary study.

This study examines the neuropsychological differences between juvenile delinquents and functional high school adolescents by means of the Bender-Gestalt test and the Luria Neuropsychological Investigation. Forty-one subjects were examined, twenty-eight delinquent subjects (15 female, 13 male, mean age 15.5 years) and thirteen control subjects (8 female, 5 male, mean age 15 years). Of the nine subtests in the Luria Battery, eight were found statistically significant, with cutaneous and kinesthetic functions being the only subtest which did not prove significant (greater than .025). Overall t analysis between the groups displayed significance at the .01 level. As was expected the delinquent group performed significantly higher on those functions requiring complex problem-solving and language abilities. On the Bender-Gestalt test of visio-motor abilities group, significance was displayed at the .05 level.

Adolescent↗
PubMed1981

[Guidelines towards examination of the lung function in children (author's transl)].

Examination of the lung function in school children is complicated and necessitates a considerable amount of technical equipment. The general practitioner carrying out the examination should not forget that a detailed clinical examination and a good stethoscope can provide important information for the diagnosis, differential diagnosis and further therapy of the child. The range of so-called simple electronic spirometers with a print-out of data tempts practitioner to use them in the diagnostics of the functioning of the lung. There is, however, considerable danger that these instruments lead more often in wrong results. A simple bell spirograph with a recording unit together with a helium analysis instrument allows the doctor to make a complete spirogram which gives exact information. In addition, the doctor requires a special lung laboratory to which to transfer children for a period of supervision and larger. The doctor should be aware that an absence of clinical symptoms, proved in practice, does not necessarily mean that the lung is working normally. Indication of an extended examination of the lungs can be deduced from a blood gas analysis, which can, with some practice be determined in the office. A reduced pO2 or an increased pCO2 can indeed indicate a disorder even when the child appears on examination to be clinically healthy. Instruments new commonly in use for analyzing the blood gas with capillary blood can also be introduced into the office.

Body Height↗
PubMed1990

[The importance of nonverbal motor examination methods in screening for minimal brain dysfunction].

During screening of disorders of activities ascribed among others to the effect of minimal brain dysfunction (MBD) by means of indirect, questionnaire methods the influence of social conditioning, e.g. overprotection by parents or neglected education, cannot be ruled out. Because in screening of this type the testing part of the diagnostic process is lacking, it is desirable to assess not only disorders of acquired mental functions in school children but to check the course of learning. In order to eliminate verbal transfer and to restrict the influence of previously acquired cognitive strategies which are also socially conditioned, it is expedient to select for tests of learning new unequivocally defined motor patterns. The advantage of motor learning is the possibility to follow up readily observable movements in the course of learning. Contrary to gross cerebral lesions where there are usually disorders of various mental functions, depending on the affection of the right or left hemisphere, in subclinical compensated cerebral affections, e.g. in MBD, it is rather a problem of more difficult cooperation of the two cerebral hemispheres when the demands on attention and integrated activity are increased. In this connection we may also reflect on the relationship with the diffuse polymodal non-specific sensory system. In this respect the difference in performance of learned activities and in tests of motor learning in subjects with MBD is important. It may be assumed that after learning an activity the demands on attention are reduced and thus the differences between healthy children and children with MBD are masked.

Attention Deficit Disorder with Hyperactivity↗
PubMed1993

Pre- and postnatal low-level lead exposure and children's dysfunction in school.

The contributions of pre- and postnatal low-level lead exposures to the risk of learning problems were evaluated among 1923 children who were born in one Boston hospital in 1979-1980 and followed to age 8 years. In this relatively privileged group, more than 20% of the children had a mother with some formal postgraduate education. Prenatal lead exposure was estimated with a measurement of umbilical cord blood lead content, and postnatal lead exposure was approximated with measurement of lead in the dentin of an exfoliated deciduous tooth. Information about potential confounders and effect modifiers was obtained from maternal interview shortly after delivery and from a mailed questionnaire completed and returned when the child was approximately 6 years old. An assessment of each child's function in school was provided by the teacher, who completed a questionnaire near the end of the school year in which the child reached the age of 8 years. We considered a learning problem to be related to lead exposure if its adjusted prevalence increased with each loge increase in lead, and if the adjusted prevalence was elevated among children with high levels (i.e., approximating the highest decile) of umbilical cord blood lead (i.e., > or = 10 micrograms/dl) or dentin lead (i.e., > or = 5 micrograms/g). Girls with elevated umbilical cord blood lead levels were more likely than their peers to be dependent and inpersistent and to display an inflexible and inappropriate approach to tasks (defined as the "tasks" cluster). Boys with elevated umbilical cord blood lead levels were more likely than others to have difficulty with both simple directions and sequences of directions. Among girls, elevated deciduous tooth dentin lead content was associated with reading and spelling difficulties, the tasks cluster, and with "not functioning as well as peers." Elevated dentin lead levels were not overrepresented among boys with any of the assessed learning clusters. These findings are consistent with the inference that lead levels still prevalent among children (i.e., blood < 15 micrograms/dl) are associated with some learning problems in girls.

Child↗
PubMed1984

Epidemiological monitoring in the vicinity of a coal-fired power plant.

An epidemiological monitoring program has been designed and put into operation in response to a health monitoring requirement of a permit to build a coal-fired power plant. It will consist of four 350 megawatt units and is being built on the Mediterranean coast about halfway between Tel-Aviv and Haifa; the first unit became operational in 1981. The resident population within a 10 km. radius consists of about 69,000 persons. The permit to build this power plant required the installation of a comprehensive monitoring network including environmental, health and agricultural monitoring. Four types of studies are included in the epidemiological monitoring program: mortality analyses, monitoring of requests for health services, studies of pulmonary symptoms and lung function in school children, and panel studies of children and adults with chronic pulmonary conditions. Areas of maximal expected exposure risk and two other comparable areas of lesser risk were chosen, based on expected emissions, meterological and topographical considerations; baseline data were gathered for a year prior to the operation of the first unit of the power plant. Subsequent data are planned to be collected for another 10 years. The program permits detection of short-term effects based on increases in health service requests, medium-term effects by repeat examination of panelists, and long-term effects based on pulmonary conditions among school children. The initial survey, before plant operations showed, among other things, lower flow rates for children in the area expected to have medium levels of exposure.

Adult↗
PubMed1989

Impact of iron supplementation on cognitive functions in preschool and school-aged children: the Indian experience.

Four studies examined impacts of iron supplementation on school children of various ages and both sexes. The first study investigated impact of iron-folic acid supplements for 60 d on cognition in 94 boys and girls aged 5-8 y. Improvement in total scores of the anemics was significantly higher than the nonanemics in 7-8-y-old children only. The second study assessed impacts of supplementation on cognition in 14 pairs of 5-6-y-old anemic boys, with clear beneficial effects on cognitive function. The third study investigated effects of varying dosages of elemental iron on cognitive function in 48 boys aged 8-15 y, with different levels of improvement. The fourth study investigated impacts of iron supplementation on 163 anemic girls aged 8-15 y with treatment and evaluations at 4 and 8 mo, with significantly improved scores in cognitive function after the eighth month.

Adolescent↗
PubMed1995

The CARE Program: a nurse-managed collaborative outpatient program to improve function of frail older people. Collaborative Assessment and Rehabilitation for Elders.

BACKGROUND AND OBJECTIVES: Frail older adults are especially vulnerable in a health system that is fragmented and fails to focus on preservation or restoration of function. The School of Nursing at the University of Pennsylvania, together with the School of Medicine and the Hospital of the University of Pennsylvania, established the Collaborative Assessment and Rehabilitation for Elders (CARE) Program to meet the needs of this population. We used the British Day Hospital as a model because it provides a comprehensive approach to care and a bridge between acute, home-based, and institutional long-term care. We have designed our program to provide innovative, interdisciplinary care as well as to be reimbursable under current and future payment structures. This nurse-managed, collaborative practice seeks to maximize independent functioning, promote health, and enhance quality of life for chronically ill, frail older adults living in the community whose needs are left unmet by existing services. The program was certified as a Comprehensive Outpatient Rehabilitation Facility (CORF) in December 1993 to maximize reimbursement of services through Medicare and other third party payers. With a Gerontological Nurse Practitioner as care manager, clients receive an intensive, individualized, time-limited program of nursing, rehabilitation, mental health, social, and medical services in one setting several days each week. Additional geriatric services, such as primary care, are available in the same location when needed. SETTING: The program is housed in renovated space devoted to the care of older people. The academic and clinical offices of the University of Pennsylvania's nursing and medical gerontologic and geriatric faculty are in the same building. PARTICIPANTS: We have targeted those persons older than age 65 who have complex health problems and are living at home. Individuals must need multiple services, including at least one rehabilitation therapy, and they must be unsuitable-for inpatient rehabilitation. DESCRIPTION OF THE POPULATION: In its first 8 months of operation, the program received 97 referrals and admitted 53 clients. Clients were, on average, 78 years of age. Over three-fourths (77%) were women and 58% were black. The average stay in the program was 6 weeks. FIM scores, which improved a mean of 2.4 points, were found to lack sensitivity to the functional improvements achieved by clients. CONCLUSION: Under existing Medicare and third party reimbursement policies, it is feasible to establish a nurse-managed comprehensive outpatient rehabilitation program designed to meet the needs of frail older persons. Preliminary data support the beneficial effects of the program as well as the economic feasibility of this approach.

Academic Medical Centers↗