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PubMed1994

Interagency coordination: the key to mainstreaming children with special needs into day care.

While the need for mainstreamed day-care services continues to increase, many barriers remain that prevent or delay providers from enrolling children with special needs. The suggestions in this article to coordinate local resources will help programs begin to provide initial necessary services to children with special needs. The use of volunteers will help supplement the staffing needs of a day-care center and allow for more individualized care of the children. Unfortunately, the absence of public funds for child day care continues to be a major barrier to creating appropriate programs for children with special needs. State and federal policies need to be expanded to support day care in general and children with special needs specifically. Part H of PL 99-457 (now Part H of IDEA PL102-119) is a national impetus to promote interagency collaboration at state and local levels. This is a beginning, but more state and federal funding is needed. In addition, regulations need to be developed that will make it easier rather than more difficult for local agencies to participate. Day-care providers and professionals in every community must work together to provide appropriate services to children with special needs. The most effective services use interdisciplinary teams to work together to plan and implement the care. Let us pick up the challenge of this mandate and develop programs that will help future generations recognize and accept the differences between individuals as well as see the similarities.

Child↗
PubMedDate not supplied

Insurance coverage of special foods needed in the treatment of phenylketonuria.

Optimal medical management of phenylketonuria (PKU) requires the use of special low-phenylalanine foods for many years. For women with PKU, elevated maternal blood levels of phenylalanine even at conception can lead to fetal damage. Despite this need, private health insurance, Medicaid, and other public health programs often exclude the cost of these foods from their benefits. The New York State Department of Health conducted a survey of metabolic disorders treatment centers to elucidate the problems PKU patients have obtaining and paying for the special foods essential to their care. Payment for special foods was denied to nearly half of those with private health insurance policies and was covered for only 10 percent of Medicaid-eligibles. A public program for children with special health care needs covered these food costs in upstate New York but not in New York City. There is no program of assistance for adults who are not eligible for Medicaid and who do not have private insurance coverage of special foods. At present, many private health insurance policies and public programs do not cover the costs of low-phenylalanine foods other than infant formula. Payment for this essential part of the management of PKU should be mandated for all public programs for persons with chronic illnesses, public medical assistance (Medicaid) programs, and private health insurance. There is a need for a public program to assist adults with PKU who are not eligible for Medicaid and who do not have health insurance that covers these costs.

Adolescent↗
PubMed1995

Specializing in nursing: nephrology certification and recertification: benefits and barriers.

The diversity and complexity of nephrology is increasing and specialized knowledge and skills are required to practise this subspeciality. As a result, specialization and certification by the Canadian Nurses' Association (CNA) in nephrology nursing has become a reality. Specialization benefits patients, nurses and employers by ensuring high professional standards, providing an increased sense of professional achievement and innovative ways of providing quality care. Maintaining these high standards requires continuing education and recertification. A number of educational opportunities meet these needs. Recognition of speciality services would motivate more nurses to commit to nephrology certification. Specialization demands a greater commitment from the health care system, but provides significant dividends to both the health care system and the patient.

Canada↗
PubMedDate not supplied

Structure, function, and evolution of the oviducts of squamate reptiles, with special reference to viviparity and placentation.

In lizards and snakes, the oviducts function in fertilization, sperm storage, egg transport, eggshell deposition, maintenance of the early embryo, and expulsion of the egg or fetus. In viviparous forms they also contribute to placentae responsible for gas exchange and nutrient provision to the fetus. Dissections of species of 30 genera coupled with data from the literature indicate that squamate oviducts vary interspecifically in seven macroscopic features, including the extent and nature of regional differentiation, vascular supply, topographic asymmetry, number of oviducts, vaginal pouches, and relationship to the cloaca. The uterus, infundibulum, and vagina differ histologically in their epithelia, glands, and myometrial layers. Season cyclicity occurs in all three oviductal regions, most prominently in the uterus, and is under endocrinological control. Regional and cytological specializations reflect the diverse functions performed by the oviduct. Definitive evidence for oviductal albumen production and egg resorption is lacking. In viviparous squamates, three uterine specializations may facilitate maternal-fetal gas exchange: an attenuated epithelium, reduced uterine glands (and a reduced shell membrane), and increased vascularization. Contrary to previous reports, pregnant uteri show no epithelial erosion or capillary exposure. Specializations for nutrient provision to the fetus include mucosal hypertrophy, enlarged glandular epithelia, and multicellular glands whose secretions are absorbed by the chorioallantois. Comparisons with other amniotes indicate that squamates inherited the oviduct as an organ with capabilities for egg uptake and transport, fertilization, eggshell deposition, and oviposition. Other features have evolved convergently among squamates: infundibular sperm receptacles, unilateral oviduct loss, uterine gestation, placentation, and specializations for placentotrophy. Cladistic analysis indicates that oviductal features associated with deposition of tertiary egg investments in reptiles reflect evolutionary convergence as well as secondary simplification, rather than a unidirectional trend towards increased specialization.

Animals↗
PubMed1998

Environmental stressors and emotional status of adolescents who have been in special education classes.

OBJECTIVE: To identify environmental and psychosocial factors associated with receiving special education services. DESIGN: The 1992 Minnesota Student Survey, an anonymous, self-report survey. SETTING: Minnesota public schools. PARTICIPANTS: A total of 121848 adolescents in the 6th, 9th, and 12th grades. MAIN OUTCOME MEASURES: Emotional status and potential environmental risk factors including family structure, family substance use problems, family violence, and sexual abuse were compared between adolescents reporting a history of having been in classes for learning problems and a grade- and race-matched comparison group of adolescents who had never been in classes for learning problems. Comparisons were conducted separately for male and female respondents. RESULTS: Compared with adolescents who had never been in classes for learning problems, a significantly greater proportion of male and female students who had been in special education classes lived in single-parent and nontraditional households, indicated that a family member had an alcohol or other drug problem, had witnessed or experienced physical abuse, and reported a history of sexual abuse and poor emotional health. Most of these associations remained significant when simultaneously controlling for the other factors in logistic regression. Significant factors showed modest odds ratios in the multivariate analyses (<1.6), except for the emotional status variable. Students with a history of receiving special education services had from 6 to 14 times the odds of reporting poor emotional health. This association was strongest among the youngest adolescents. CONCLUSION: Several environmental stressors and psychosocial factors, most notably poor emotional health, are associated with a history of special class placement for learning problems.

Adolescent↗
PubMed2004

Influence of volume and specialization on survival following surgery for colorectal cancer.

BACKGROUND: Previous studies have shown that significant surgeon-related differences in survival exist following surgery for colorectal cancer. It is not clear whether these differences were due to differences in caseload or degree of specialization. METHODS: Outcome in 3200 patients who underwent resection for colorectal cancer between 1991 and 1994 was analysed on the basis of caseload and degree of specialization of individual surgeons. Five-year survival rates, and the corresponding hazard ratios adjusted for case mix, were calculated. RESULTS: Cancer-specific survival rate at 5 years following curative resection varied among surgeons from 53.4 to 84.6 per cent; the adjusted hazard ratios varied from 0.48 to 1.55. Cancer-specific survival rate at 5 years following curative resection was 70.2, 62.0 and 65.9 per cent for surgeons with a high, medium and low case volume respectively. There were no consistent differences in the adjusted hazard ratios by volume. Cancer-specific survival rate at 5 years following curative resection was 72.7 per cent for those treated by specialists and 63.8 per cent for those treated by non-specialists; the adjusted hazard ratio for non-specialists was 1.35 (95 per cent confidence interval 1.13 to 1.62; P = 0.001). CONCLUSION: The differences in outcome following apparently curative resection for colorectal cancer among surgeons appear to reflect the degree of specialization rather than case volume. It is likely that increased specialization will lead to further improvements in survival.

Adult↗
PubMed1999

Psychiatric disorders, performance level at school and special education at early elementary school age.

We assessed the relationship between psychological deviance and performance level at school among 8-year-old children. The use of special education among children with psychiatric disorders was also studied. In Stage 1, 5813 children were studied using the Rutter Parent Questionnaire (RA2), the Rutter Teacher Questionnaire (RB2) and the Children's Depression Inventory (CDI). In Stage 2, a subsample (n = 424) of these children were interviewed, using the Isle of Wight Interview. In Stage 1, more children defined as low achievers (LAs) came from low SES families than did average (NAs) and high achievers (HAs). They also had more psychiatric symptoms, and they scored above the cutoff (13 points on the RA2, nine points on the RB2 and 17 points on the CDI) more commonly than other children. In Stage 2, two thirds of children who received special education had some psychiatric disorder. The probability of a child with psychiatric disorder obtaining some extra tutoring or special education was 3.1-fold when compared with children without psychiatric disorders. Depressive children and children with attention deficit disorders most commonly had extra tutoring (4.8-fold) when compared with children without psychiatric disorders. The probability of getting special education was highest for attention deficit disorders (6.2-fold), thereafter for anxiety (3.1-fold), and for oppositional/conduct disorders (2.8-fold).

Achievement↗
PubMed2006

[Putting the new model of the statute for specialized medical training into practice: implications for European law].

Specialized medical training serves to deepen the abilities and talents acquired during medical training. It usually takes place during professional activity under the guidance of experienced physicians authorized for specialized training and ends after a successfully completed examination with the acquisition of a specialized training title. The structural requirements, which are to be taught in the context of the specialized medical training, are specified in a statute (Weiterbildungsordnung), which was adopted by the chamber of physicians. The model Weiterbildungsordnung, decided upon by the German medical assembly (Deutscher Arztetag), serves as a recommendation in the individual States in Germany to achieve statutes as uniform as possible. The regional law bases and the implementation of the Weiterbildungsordnung in the Heilberufe-Kammergesetz are described by the example of the State of Baden-Württemberg. The extensive effects of the European law are illustrated by the example of the general practitioner (Arzt für Allgemeinmedizin).

Curriculum↗
PubMed2006

Environmental mercury release, special education rates, and autism disorder: an ecological study of Texas.

The association between environmentally released mercury, special education and autism rates in Texas was investigated using data from the Texas Education Department and the United States Environmental Protection Agency. A Poisson regression analysis adjusted for school district population size, economic and demographic factors was used. There was a significant increase in the rates of special education students and autism rates associated with increases in environmentally released mercury. On average, for each 1,000 lb of environmentally released mercury, there was a 43% increase in the rate of special education services and a 61% increase in the rate of autism. The association between environmentally released mercury and special education rates were fully mediated by increased autism rates. This ecological study suggests the need for further research regarding the association between environmentally released mercury and developmental disorders such as autism. These results have implications for policy planning and cost analysis.

Autistic Disorder↗
PubMed2001

Demand for a new main speciality in image-guided therapy.

As image-guided and minimally invasive therapy advances in complexity and volume, it becomes more obvious that none of the existing main specialities in medicine offer the ideal clinical or technological training for the responsible physicians at this time. The radiologists lack a clinical basis, and do not have adequate opportunities for proper pre- and post-procedural follow-up of their patients. The clinical doctors, i.e. cardiologists or vascular surgeons, do not have the proper technological background, or the training in 2D/3D imaging diagnostics or radiation hygiene. Radiology 'possesses' the technology, while the clinical specialities 'possess' the patients. Integrated use of various imaging modalities (fluoroscopy, computed tomography, ultrasound, magnetic resonance imaging, endoscopy or video-assisted techniques) may also be exploited more effectively for guidance and control of surgical or minimally invasive intervention. To pursue the progress and secure the quality and efficiency of future medical developments in the field, a fusion of clinical medicine and radiology into a new speciality is proposed. A basic training of 2 years in surgery or internal medicine, and 2 years of radiology can be followed by organ-wise (gastrointestinal, vascular, cardiology, etc.) subspecialisation. In this way, devastating turf battles and conflicts of interests in the hospital system may be neutralised and the traditional specialities join forces to the best of patients. Proposed terms for this new kind of specialist could be 'Clinical Surgical Radiologist', 'Clinical Cardiological Radiologist', etc., or simply 'Image-guided Therapist'.

Clinical Medicine↗
PubMed1999

[Visually handicapped children and young adults in specialized schools in the French North department in 1995].

BACKGROUND: In 1988, the prevalence of blindness in France was 0.17/1000 and that of amblyopia 0.48/1000. Medical advances in the last 30 years have modified the population of children with visual impairment. PATIENTS AND METHODS: The populations in two specialized schools of the north (340 children and adolescents, 3-20-year-olds) were studied and compared with the literature. RESULTS: Cataracts (13%) and congenital nystagmus (11%) were the two most frequent causes. The children taken in charge had less severe diseases than in the past but needed all the same specialized education. However these schools provided more specialized help for children educated near home, in ordinary schools. The children who were educated in the two specialized schools had more severe diseases or more social problems in their families. CONCLUSION: The education and educative treatment of these children are discussed.

Adolescent↗
PubMed2002

Education rights and the special needs child.

A child with a disability has a federally protected right to special education and related services when he or she needs them to benefit from education. The term "disability" is not limited to physical disability but rather includes mental disability, including mental retardation, serious emotional disturbance, autism, traumatic brain injury, specific learning disabilities, and other health impairments. A parent may request that a child be evaluated by the school district for special education and related services. The law sets forth specific guidelines for the evaluation, assessment, and eligibility determination. Unique to each child, the IEP is the written plan that documents the child's special education and related services. The initial IEP is developed at a meeting among parents, various school personnel, and others whom the parents may wish to invite. Parents are an integral part of the team and are involved in all decisions by the team. The IEP must be reviewed annually, with attention given to whether educational objectives have been met. For a child with mental health issues, the IEP likely contains "related services," such as counseling, and measurable goals to improve behaviors in the school setting. When a child's condition is such that he or she cannot benefit from education in the regular school setting, other placements are considered. The school district maintains the ultimate responsibility of the cost of all such education placements, including residential care. A child with behaviors that result in frequent suspensions should have a functional analysis assessment by the school psychologist. The results of the assessment can be used to create a behavioral intervention plan. (If the school refuses to perform an assessment or develop a plan, the usual remedy of a due process hearing is available to the parents.) This plan should address problem behaviors and include strategies for redirecting the child's behavior. Even if a special education child is "expelled" from school, the district maintains the responsibility of providing FAPE. For this reason, districts--even in their own interests--should be proactive in dealing with these children, which often has not been the case. The Supreme Court has said that a child with services under IDEA (a child with an IEP) must receive some benefit from his or her education [31]. The issue of "how much benefit is enough benefit" is still troubling to parents and schools alike. The court also has ruled that related services, even costly ones such as a one-to-one nursing aide, must be provided if a qualifying child needs such services to access education [29]. Children with disabilities were long excluded from the public education system in this country. Obvious exclusion rarely occurs in the current education system, although exclusion through isolation does. Children with disabilities, especially mental disabilities, need and deserve the same educational benefit offered to children without those differences.

Adolescent↗
PubMed2003

Epilepsy in mainstream and special educational primary school settings.

This population based study compared the prevalence, nature and management of epilepsy between primary school children in mainstream education and those attending a special educational placement (children with special needs). The overall prevalence of epilepsy was 4.3/1000, but was 30 times higher in children with special needs, many of whom also had severe physical disabilities. Seizure types and the proportion of subjects with multiple seizures were similar in mainstream children and those with special needs. Epilepsy syndromes were identified in 74% of children. Although seizures were better controlled in children at mainstream school, 44% of these children did not have well controlled seizures. Children with epilepsy are an educationally vulnerable group and both education and health staff need to be aware of the additional support that many of these children require in all types of primary educational settings.

Child↗
PubMed1999

Differences in problems of motivation in different special groups.

In general, children with a range of special needs have below-average motivation and perceived control. We have investigated whether differences exist between the types of problem in different special groups. Theory distinguishes between two types: low motivation and perceived control can be based either on a low perceived contingency, or on a low perceived competence. These two types of problem require different intervention strategies. The development of these types is related to several factors that might vary systematically in different special groups: specific histories of experience of success and failure, the possibilities of perceiving contingencies, and the kind of feedback and attributions from important others. We asked teachers to rate their pupils and found, in accord with our expectations, that children with social, emotional and behavioural problems, children with moderate learning difficulties and children with specific learning difficulties have more problems in perceived competence than children with physical or visual impairments. There was a non-significant tendency in the expected direction for children with physical impairments to have lower perceived contingency scores than the other groups. We conclude that caution is required in generalizing research findings from one special group to another, and in the application of intervention techniques that have been developed for one particular group.

Child↗
PubMed2001

Sleep problems in primary school children: comparison between mainstream and special school children.

This paper reports on a study of the prevalence and social correlates of dyssomnias, features associated with obstructive sleep apnoea, and parasomnias in primary school children aged 4-12. Head teachers of schools selected randomly from lists of local primary and special schools were contacted by telephone and asked to distribute a questionnaire package to the parents of all pupils aged 4-12 years. In all, 890 parents of children from mainstream schools and 300 from special schools were approached. The response rates were 64.7% and 60%, respectively. The results showed that significantly higher proportions of children in special schools than in mainstream schools presented four of the five dyssomnias investigated and all of the features associated with obstructive sleep apnoea. In contrast, only two of the seven parasomnias were presented by higher proportions of the children in special schools. Age and gender differences for the two groups of children are presented. Finally, multiple correlations were computed between a range of child, family, and environmental characteristics and the three problems most frequently reported: frequency of settling problems; sleeping in the parents' bed; and night waking. The findings are discussed with reference to other studies of children's sleep problems, and the implications for treatment are considered.

Child↗
PubMed2005

[Patient safety in view of specialization, minimum quantity and regionalization].

BACKGROUND: The introduction of a set of volume standards in Germany 2003 has lead to a discussion whether statutory volume thresholds as well as the enhancement of further regionalization would do more harm than good. The objective of this study is to evaluate the influence of specialization, volume standards and regionalization on patient safety. METHODOLOGY: According to study objectives patient safety was defined as "hospital mortality", "hospital morbidity", "long-term outcome" and "readmission rate". A MEDLINE analysis was performed using the following terms: "hospital", "volume", "outcome", "specialization", "regionalization", "readmission", "patient safety" and "review". In order to lower the high number of studies only journals published between 1999 and 2004 with high impact factors were used for evaluation. RESULTS: A vast majority of studies have been published in recent years finding significant higher probabilities for good outcome in high volume hospitals compared with low volume hospitals. However, the magnitude of the volume - outcome relation varies greatly among procedures and conditions, showing a strong and persistent relation for severe ill patients and high-risk procedures. Patient safety can also be influenced by surgeon volume and specialization. CONCLUSIONS: Specialization, volume standards and regionalization have shown to be effective in improving patient safety. Further studies are needed to estimate the potential benefits of this strategy to foster patient safety in German hospitals.

Bed Occupancy↗
PubMed1981

Educational attainments of spina bifida children attending ordinary or special schools.

Children with spina bifida who attend special schools are usually found to be retarded in their school attainment compared with those who attend ordinary schools. This finding has, however, often been confounded by the fact that the special school children tend to have lower IQs. In this study two groups of children were identified from those in the Greater London Council (GLC) Spina Bifida Survey, one attending ordinary and the other special schools. There were 11 pairs of boys and 11 of girls, each pair being closely matched for IQ. Examination of their scores on attainment tests showed that while results of reading tests did not differ significantly between the two types of schools, children of both sexes at special schools were behind their ordinary school counterparts in number work. These results were supported by similar findings, using analysis of co-variance, on the larger group of children in the GLC survey. The effect of other factors such as physical handicap, presence of a valve, and time spent in hospital, were explored, and possible explanations for the findings are discussed.

Achievement↗
PubMed2002

Development of transferable skills during short special study modules: students' self-appraisal.

Special study modules (SSMs) were introduced into the Leeds undergraduate medical curriculum following recommendations by the General Medical Council (GMC). The main rationale behind such project work is to enable students to develop the skills and attitudes necessary for future self-directed learning along with the knowledge required to practise as competent doctors. At the University of Leeds, the students complete SSM monitoring forms for each SSM in the fourth year, aimed at allowing students to self-evaluate the SSMs. In addition, it provides useful feedback from the students on the themes of the projects as well as on the transferable skills developed by the students during their individual SSMs. The aim of the study was to identify the themes pursued in each project, look at the transferable skills developed and evaluate the differences or similarities between the type of project pursued and the themes and skills identified in the different specialities. A total of 181 monitoring forms of fourth-year students were analysed for the themes and the transferable skills identified. There were 55 students each in Obstetrics and Gynaecology and Paediatrics and 50 students each in Psychiatry and General Practice/Public Health. The results from the four specialities were compared for themes and skills identified. Overall, health and prevention was the commonest theme identified followed by communication skills (64.4% and 62.7% respectively). All transferable skills were well represented in the different specialities with information gathering and learning/organizational skills identified by most students as the major component. The feedback from the students is positive in terms of a wide range of transferable skills developed and most of the themes identified by the GMC are being pursued.

Clinical Competence↗