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Measuring functional outcome in paediatric patients with burns: methodological considerations.

Methodological criticisms of research undertaken in the area of paediatric burns are widespread. To date, quasi-experimental research designs have most frequently been used to examine the impact of impairments such as scarring and reduced range of motion on functional outcomes. Predominantly, these studies have utilised a narrow definition of functioning (e.g. school attendance) to determine a child's level of participation in activities post-burn injury. Until recently, there had been little attempt to develop and/or test a theoretical model of functional outcome with these children. Using a conceptual model of functional outcome based on the International Classification of Functioning, Disability and Health, this review paper outlines the current state of the research literature and presents explanatory case study methodology as an alternative research design to further advance the study of functional outcome post-burn injury.

Activities of Daily Living↗

Norms for the Wisconsin Card Sorting Test in 6- to 11-year-old children in Taiwan.

The main aims of this study were to develop norms for the Wisconsin Card Sorting Test in 6- to 11-year-old children in Taiwan; to explore the effect of sex, age, birth order, number of siblings, and parental education on WCST performance in 6- to 11-year-old children; and to make a comparison of WCST performance between children in Taiwan and the USA. The results of this comparison of developmental norms of school children in Taiwan and the United States may facilitate the WCST as a clinical or research instrument in combination with other test procedures to assess aspects of cognitive and neuropsychological functioning of school children.

Child↗

Functional assessment and treatment of aggressive and destructive behaviors in a child victim of physical abuse.

This case study describes the functional assessment and treatment of aggressive and destructive behaviors in a 14-year-old male child with a history of physical abuse. Evaluation was performed in a classroom within a residential school setting. Functional assessment in forms of indirect and descriptive methods was used to generate hypotheses regarding sources of behavioral control. A treatment plan that combined multi-level differential reinforcement of other behavior (DRO) and positive reinforcement for task completion was implemented based on the outcome of functional assessment. Treatment was associated with a gradual and steady reduction in challenging behaviors with near-zero rates achieved at follow-up. This case provides an example of clinical intervention for behavior disorders commonly observed in children who have been abused physically and a hypothesis-driven model of treatment formulation.

Adolescent↗

Airway responsiveness in early infancy predicts asthma, lung function, and respiratory symptoms by school age.

Asthma is the most common chronic childhood disease in developed nations. Little is known about the relationship between airway responsiveness in infancy and the development of asthma later in life. The relationship of airway responsiveness at 1 mo with asthma, atopy, lower respiratory symptoms, and lung function at 6 yr of age was investigated prospectively in 95 white children from a randomly ascertained birth cohort. Baseline spirometry, airway responsiveness to histamine, and skin reactivity to common allergens were assessed at the age of 1 mo and 6 yr. Total serum immunoglobulin E (IgE) was measured from cord blood and at 6 yr. Blood eosinophil counts were measured at 6 yr only. Family, symptom, and exposure histories at both time points were derived from questionnaire data. Independently of the other factors assessed, increased airway responsiveness at 1 mo was significantly associated with the following parameters measured at six yr: decreased FEV(1) (p < 0.001); decreased FVC (p < 0.001); physician-diagnosed asthma (p < 0.001); and lower respiratory tract symptoms (p < 0.05). None of the other physiologic factors measured in infancy showed such consistent associations with important clinical and physiologic outcomes at age 6. These data suggest that airway responsiveness in early life defines a functional state that is associated with abnormal airway function, lower respiratory symptoms, and the emergence of asthma by 6 yr of age.

Age Factors↗

[Preliminary survey of a school health program implementation in Guinea].

The Sectorial Adjustment Education Program implemented in Guinea by the Ministry of Pre-University Education in 1995 includes health-related measures. An important part is the fight against parasitosis and in particular against intestinal helminth infection which has been shown to impair cognitive function in school children. In order to obtain data for this purpose, a survey was carried out in 7 subprefectures across the country. A total of 1,649 children were examined to determine the prevalence in each school of macroscopic hematuria-related schistosomiasis and of various intestinal helminthiasis in stools. In 1468 of these children blood tests were also made to measure hemoglobin levels and detect malarial hematozoons. Overall prevalence rates were 60.0% for soil-transmitted nematodes, 9.1% for urinary schistosomiasis, 57.6% for blood plasmodium, and 57.0% for anemia. Hemoglobin levels were lower in children presenting plasmodium, multiple parasitic infection, and high ankylostoma burdens. Prevalence rates varied widely between regions indicating differences in therapeutic measures. In two villages more than 200 children not attending school who had been informed by school children were treated. This word-of-mouth effect shows that school health programs are also useful to reach children outside the school health system.

Child↗

The role of school context in the increase in young people's health complaints in Finland.

According to biological indicators trends in young people's health appear favourable, but the psychosocial aspects suggest a different pattern. We studied the differences across schools in common health complaints and in three groups of factors behind them: pupils' individual characteristics, family related factors and school-related factors. Multilevel linear regression models were used to analyse repeated cross-sectional data from Finnish 8th and 9th graders (14- and 15-year-olds, n=60347) in 109 schools that were surveyed in 1996, 1998 and 2000. Common health complaints increased steadily during the follow-up for all schools and they varied across schools. Both individual and school-level factors contributed significantly to the variation in common health complaints. The study suggests that young people's psychosocial health involves a range of influences deriving from individual susceptibility and from the social and educational functioning of schools. However, none of these factors can account for the rapid decrease in young people's psychosocial health.

Adolescent↗

Sleep schedules and daytime functioning in adolescents.

Sleep and waking behaviors change significantly during the adolescent years. The objective of this study was to describe the relation between adolescents' sleep/wake habits, characteristics of students (age, sex, school), and daytime functioning (mood, school performance, and behavior). A Sleep Habits Survey was administered in homeroom classes to 3,120 high school students at 4 public high schools from 3 Rhode Island school districts. Self-reported total sleep times (school and weekend nights) decreased by 40-50 min across ages 13-19, ps < .001. The sleep loss was due to increasingly later bedtimes, whereas rise times were more consistent across ages. Students who described themselves as struggling or failing school (C's, D's/F's) reported that on school nights they obtain about 25 min less sleep and go to bed an average of 40 min later than A and B students, ps < .001. In addition, students with worse grades reported greater weekend delays of sleep schedule than did those with better grades. Furthermore, this study examined a priori defined adequate sleep habit groups versus less than adequate sleep habit groups on their daytime functioning. Students in the short school-night total sleep group (< 6 hr 45 min) and/or large weekend bedtime delay group (> 120 min) reported increased daytime sleepiness, depressive mood, and sleep/wake behavior problems, ps < .05, versus those sleeping longer than 8 hr 15 min with less than 60 min weekend delay. Altogether, most of the adolescents surveyed do not get enough sleep, and their sleep loss interferes with daytime functioning.

Achievement↗

Functional impairment in children and adolescents with obsessive-compulsive disorder.

Although obsessive-compulsive disorder (OCD) is a chronic and oftentimes debilitating disorder, the specific impact of this illness on the psychosocial functioning of affected youngsters has not been systematically described. A total of 151 clinic-referred youngsters (mean age 11.8 years, 57% male, 83% Caucasian) with primary Diagnostic and Statistical Manual of Mental Disorders (fourth edition) OCD and a primary caretaker completed a checklist designed to assess the impact of OCD on school, social, and family functioning. The two most common OCD-related problems were concentrating on schoolwork and doing homework. Consistent with the heterogeneous nature of OCD, subjects exhibited a broad range of specific impairments. However, almost 90% of youngsters reported at least one significant OCD-related dysfunction, and close to half reported significant OCD-related problems at school, home, and socially. Parents were more likely to report significant impairments in home and school functioning than children. However, few systematic gender or age effects were noted. Impairment ratings were significantly correlated with clinician-generated measures of OCD severity. These results provide the most specific description to date of the adverse impact of OCD on child psychosocial functioning. Given the adverse developmental consequences of psychosocial dysfunction, treatment studies need to carefully track and address OCD-specific functional impairments in affected youngsters.

Adolescent↗

[The health status of pupils from different-profile schools].

The paper presents the results of prenosological examination of 1246 pupils from different-profile schools by computer-aided electrostructurography. The least children with morphofunctional changes in the viscera and systems were found at sports school. Gastrointestinal functional changes (intestinal dysfunction, biliary dyskinesia) and structural disorders (chronic gastritis, chronic colitis, posttoxic hepatic changes) hold the lead in the structure of total morbidity. In a great deal of the examinees, functional changes are frequently associated with morphological disorders within one or several systems.

Adolescent↗

Recurrent abdominal pain: a potential precursor of irritable bowel syndrome in adolescents and young adults.

OBJECTIVES: To assess symptoms of irritable bowel syndrome (IBS) in patients with recurrent abdominal pain (RAP) 5 years after their initial evaluation, to identify the relation of IBS symptoms to functional disability and health service use, and to determine the extent to which IBS symptoms are associated with life stress and poor psychosocial adjustment. METHODS: Patients with RAP (n = 76) and control subjects (n = 49) completed a telephone interview; measures included the Bowel Disease Questionnaire, the Functional Disability Inventory, the Life Events Questionnaire, the Family Inventory of Life Events, the Center for Epidemiological Studies Depression Scale, the Self-Perception Profile for Adolescents, and the Health Resources Inventory. RESULTS: Five years after the initial evaluation, patients with RAP reported significantly more episodes of abdominal pain than did control subjects, as well as significantly higher levels of functional disability, school absence, and clinic visits for abdominal distress. Female patients with RAP were more likely than female control subjects to meet the Manning criteria for IBS. Among patients with RAP, higher levels of IBS symptoms were associated with significantly greater functional disability, more clinic visits, more life stress, higher levels of depression, and lower academic and social competence. CONCLUSION: Female patients with a history of RAP may be at increased risk of IBS during adolescence and young adulthood. Among adolescents and young adults with a history of RAP, IBS symptoms are likely to be associated with high levels of disability and health service use.

Abdominal Pain↗

[Canonical correlation of body composition and pulmonary function in children aged eight to twelve].

Canonical correlation of body composition and pulmonary ventilation function in school boys and girls aged 8 to 12 and normally developed was analyzed. Skinfolds of triceps and subscapular angle were measured, and body composition was estimated as body fat percentage (BF%), body fat (BF) and lean body mass (LBM). Ventilation function was measured. Results indicated that correlation between body composition and ventilation function mainly attributed to a positive correlation between LBM and vital capacity (VC) and a negative correlation between BF% and a ratio of expiratory reserve volume (ERV) to VC. It suggests effects of body composition on ventilation function mainly attributed to LBM and BF%.

Body Composition↗

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↗

A public health response to a cluster of suicidal behaviors: clinical psychiatry, prevention, and community health.

OBJECTIVE: To develop and implement a community public health response to a suicidal behavior cluster, including collection of risk factor data in order to prevent further behaviors. METHODS: A three-phase response, including school-wide educational debriefings, individual screening for referrals, and on-site crisis management, was implemented. Incidence of suicidal behaviors and their association with hypothesized risk factors were measured. RESULTS: Thirty-three percent of students were screened. Depression and poor social functioning were associated with an increased risk of suicidal ideation. Poor social functioning and school adjustment were associated with an increased risk of suicide attempts. CONCLUSIONS: Development and implementation of a timely public health response, including elucidation of critical risk factors, might prevent further suicidal behaviors.

Journal Article↗

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↗

Clinical correlates of childhood and adolescent adjustment in adult patients with bipolar disorder.

Impaired psychosocial functioning has been well documented in bipolar disorder, although there is little information linking premorbid adjustment with adult functional outcome. Childhood and adolescent functioning in school, peer relations, and personal interests was evaluated by standardized interviews with 56 adult-onset DSM-IV bipolar I (N = 46), II (N = 7), or not otherwise specified (N = 3) patients, with collaboration by collateral historians, and assessed relative to current work functioning and overall illness features. Poor childhood or adolescent adjustment was associated with subsequent alcohol or drug abuse or dependence (p <.05), insidious onset of bipolar disorder (p <.02), and increased suicide attempts (p <.02). Poor adjustment in childhood was related to the lifetime development of rapid cycling. Poor premorbid adjustment may be linked with the potential to develop substance abuse comorbidity and an increased risk for suicide attempts and rapid cycling in bipolar patients. The prognostic significance of maladaptive childhood or adolescent behaviors may bear directly on clinical components of outcome in bipolar disorder.

Adolescent↗

Do relational risks and protective factors moderate the linkages between childhood aggression and early psychological and school adjustment?

This investigation addressed the question of how relational stressors and supports interface with a known behavioral risk (aggression) to influence early emerging adjustment trajectories. Children's risk for aggression, as well as multiple relational risk and protective factors (i.e., stressful and supportive features of peer and teacher relationships), were assessed in a sample of 396 children and used to predict changes in psychological functioning and school adjustment from the fall of their kindergarten year to the spring of their first-grade year. Results were largely consistent with additive risk-maladjustment models; with few exceptions, relational experiences predicted adjustment beyond children's aggressive risk status. For some adjustment criteria, however, there was evidence to suggest that relational stressors or supports exacerbated or compensated for dysfunctions that were linked with aggressive behavior. Moreover, compared with early onset, the chronicity of children's aggressive risk status and relational stressors and supports bore a stronger association with changes in maladjustment. Analyses conducted by ethnic groups suggested that African American children, who were typically a minority among their European American classmates, were more likely to experience particular stressors (e.g., chronic peer rejection), and were less likely to be afforded some form of support (e.g., stable teacher-child closeness). However, the nature of the predictive linkages found between the relational risk and protective factors and later maladjustment did not differ substantially by SES or ethnicity. The importance of investigating behavioral risks in conjunction with the relational features of children's interpersonal environments is discussed.

Adaptation, Psychological↗

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↗

[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↗