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PubMed2004

Current concepts and therapeutic strategies for allergic rhinitis in school-age children.

BACKGROUND: Allergic rhinitis (AR) is a common debilitating disorder that can adversely affect the quality of life and the academic performance of school-age children. Symptoms during the day can hamper concentration and lead to learning problems. Nocturnal symptoms can cause sleep loss and secondary daytime fatigue, further undermining a child's ability to function well during the school day Oral antihistamines are the foundation of pharmacologic therapy, but there are important differences between the agents. OBJECTIVE: The purpose of this review is to provide an overview of the diagnostic and treatment challenges posed by AR in school-age children. The paper discusses and compares the available treatment modalities for this age group, with a focus on their beneficial and adverse effects. METHODS: Pertinent articles were identified in the literature through a MEDLINE search (1990-2003). Keywords used were antihistamines cetirizine fexofenadine loratadine desloratadine intranasal corticosteroids and CNS effects. Results of numerous clinical trials of first-generation early second-generation and the newer antihistamines were identified. RESULTS: This review established that the socioeconomic costs of AR are considerable. In children aged > or =12 years, direct US expenditures (eg, physician visits, medications) in 1996 amounted to $2.3 billion. Indirect costs measured by variables such as missed school days and poor performance also have an impact Major concerns include underdiagnosis and inadequate treatment, increasing the risk of serious comorbid conditions such as asthma. Advantages and drawbacks of antihistamines show that first-generation agents (eg, hydroxyzine) are effective and readily available over the counter, but are associated with sedation and the potential for suboptimal dosing. Newer agents, such as cetirizine, loratadine, desloratadine, and fexofenadine are effective and safer than the older drugs tie, no cardiotoxicity and less sedation). Of these, fexofenadine has been shown to be beneficial and nonsedating, even at higher-than-recommended doses. Other therapies reviewed include intranasal corticosteroids and leukotriene modifiers. CONCLUSIONS: AR has a considerable negative impact on children in terms of their physical, social, and psychological well-being and academic performance. An appropriate treatment must be effective and tolerable. Of particular importance for enhancing treatment adherence in the school-age population are pleasant taste and ease of use of medication. A drug that has minimal or no sedative or anticholinergic effects is optimal.

Adolescent↗
PubMed1991

Association between Rh and plasma iron binding (transferrin).

In order to establish the mechanism involved in the maintenance of the Rh polymorphism and fetomaternal compatibility relationships, we examined a sample of children from the North Area of Santiago (Chile), with respect to their growth and development patterns since 1973. This sample had shown large sib-sib segregation distortions for the Rh system. Metric variables, such as plasma protein fractions and iron, academic performance at the end of the last secondary grade and adult stature, were studied in relation to genetic markers, viz., sex, ABO, Xg, MN, Rh, haptoglobins, phosphoglucomutase, and esterase D, by means of unbalanced one way analyses of variance. Highly significant results were found for Rh phenotypes and total iron binding capacity (TIBC, transferrin). However, plasma iron did not differ significantly among Ph phenotypes. Children with the C (Rh) specificity had higher values of TIBC than non-C or c individuals (P less than 0.00001). Evolutionary considerations regarding iron transport and erythroblastosis, relationships between Rh and the transferrin receptor at the plasma membrane, and the location of the Blym-I oncogene (that shares common sequences with transferrins) close to Rh in chromosome 1 are discussed. Less significant results were found between phosphoglucomutase and stature, gamma globulin level and sex, and academic performance (history) and sex.

Analysis of Variance↗
PubMed2000

Rational dosages of nutrients have a prolonged effect on learning disabilities.

CONTEXT: Reports that administration of nutrients has increased the academic performance of learning-disabled children exist in the literature. OBJECTIVE: To document the effects of nutrients on learning-disabled children in a controlled study. DESIGN: A randomized, double-blind, placebo-controlled crossover trial, which followed 1 year of open-label nutrients. Children who improved in the open-label trial were eligible to enter the controlled phase of the study. SETTING: Subjects were enrolled from the general community through advertisements. PATIENTS OR OTHER PARTICIPANTS: Twenty children met the criteria for being learning disabled. INTERVENTION: Each child was tried out on some (but not necessarily all) of the B vitamins and minerals used in this study. These were administered semi-blinded for the first year; double-blinded in crossover rotations during the second year; and open-label in the ensuing years. MAIN OUTCOME MEASURES: At various time points, school-certified psychologists administered psychoeducational tests. School report cards were evaluated at baseline and for all subsequent periods. RESULTS: Twenty learning-disabled children entered the study, but 1 dropped out because of nausea. The remaining 19 children showed significant academic and behavioral improvements within a few weeks or months of open-label treatment with nutrient supplements. Some children gained 3 to 5 years in reading comprehension within the first year of treatment; and all children in special education classes became mainstreamed, and their grades rose significantly. Twelve of the children completed the 1-year double-blind phase, after which approximately half of the children chose to remain on the nutrients for at least 2 additional years. For those who discontinued, it took at least 1 year to begin to see the first indications of decline in academic performance, and another year for their grades to drop significantly. In contrast, for children who remained on nutrients, the gains continued the upward trend; at the end of year 4, the difference in scores between the 2 groups had reached statistical significance (P < .01). CONCLUSION: The overall results of this study tentatively support the concept that learning disabilities may in some cases be a nutrient-responsive disorder.

Adolescent↗
PubMed1992

Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study.

The implications of low-level lead exposure for children's intellectual and academic performance at school age are uncertain. This issue was investigated in a prospective study of middle-class and upper-middle-class children with low lifetime exposures to lead. A battery of neuropsychological tests was administered at age 10 years to 148 children whose lead exposure and cognitive function had been previously assessed at ages 6, 12, 18, 24, and 57 months. Primary endpoints were Wechsler Intelligence Scale for Children-Revised (WISC-R) and the Kaufman Test of Educational Achievement (K-TEA). Higher levels of blood lead at age 24 months, but not at other ages, were significantly associated with lower global scores on both the WISC-R and the K-TEA after adjustment for potential confounders. Over the range of approximately 0 to 25 micrograms/dL, a 0.48-mumol/L (10 micrograms/dL) increase in blood lead at 24 months was associated with a 5.8-point decline in WISC-R Full-Scale IQ (95% confidence interval: 1.7 to 9.9, P = .007) and an 8.9-point decline in K-TEA Battery Composite score (95% confidence interval: 4.2 to 13.6, P = .0003). Mean blood lead level at age 24 months was 0.31 mumol/L (6.5 micrograms/dL; SD: 4.9, 90% percentile: 12.5). Slightly elevated blood lead levels around the age of 24 months are associated with intellectual and academic performance deficits at age 10 years.

Child↗
PubMed2003

Two decades of student career choice at the University of Florida: increasingly a lifestyle decision.

Recently, there has been a decrease in the number of graduating U.S. medical students entering surgical residency. Therefore the purpose of this study was to examine student career choice over the last two decades (1982-2002) at the University of Florida. Residency match and academic performance data for the University of Florida medical school graduates from 1982 through 2002 were obtained from the College of Medicine's Offices of Student Affairs and Education. The percentage of medical students pursuing a career in surgery rose slightly in the 1980s to peak at 22 per cent of the graduating class in 1991 and then steadily declined in the 1990s to 15 per cent in the graduating class of 2002. The percentage of women entering surgical residency has remained relatively constant (20-year mean = 6.41 +/- 0.77) despite a significant increase percentage of women in the graduating class (Class of 1983, 24%; Class of 2002, 55%). The percentage of graduating students entering a primary care residency has remained relatively constant (54.4 +/- 1.24), whereas the number of students pursuing a "lifestyle-friendly" specialty has increased substantially over the last two decades (Class of 1983, 9%; Class of 2002, 22%). In addition the mean overall grade point average of female students entering 'lifestyle-friendly' specialty residencies is significantly higher than the mean overall grade point average of all students entering a surgical residency (3.61 +/- 0.38 versus 3.48 +/- 0.35; P < 0.05). Similar to national trends the percentage of senior medical students entering surgical residency at the University of Florida is gradually declining. Although the percentage of graduating medical students entering primary care has remained relatively constant the number of students following a lifestyle-friendly specialty has steadily increased. A disproportionately low number of graduating female medical students are entering surgical residency. By one measure of academic performance the quality of female graduates entering lifestyle-friendly specialty residencies is superior to that of students entering surgical residency. Lifestyle issues are increasingly important in student career choice decisions.

Career Choice↗
PubMed2001

Social dimensions of adolescent substance use.

OBJECTIVES: The aim of this study was to explore in detail the relationship between various social aspects of young people's lives and substance use and differences in the degree of influence exerted by the different social factors as a function of age. Design, setting, participants. The study was a survey of pupils aged 11-16 in a stratified sample of five English schools. Data from 4516 participants were obtained in relation to their cigarette, alcohol and illicit drug use and their contact with the police, perceived academic achievements and future expectations, religious beliefs, family structure, the importance of family versus peer opinions and suspension from school. MEASURES: Cumulative, age-specific preferences of substance misuse were compared. Logistic regression was used to rank the various risk factors. RESULTS: Substantial differences were found between substance users and non-users and the various risk factors being examined. For example, of those who had only been in trouble with the police, 18.8% used illegal drugs compared with 1.6% of those who had not had a police contact and who had no other risk factors. Many of these relationships were age-sensitive. For instance, the negative relationship between belief in God and illicit drug use became stronger as age increased (non-believers: y = 8.1886x - 9.16 R(2) = 0.9484; believers: y = 5.1514x - 8.08 R(2) = 0.9247). These results suggest that, within this sample of English adolescents, there was a strong relationship between substance use and the social factors examined. Although there were differences depending upon whether cigarette, alcohol or illicit drug use was being modelled, logistic regression indicated that the social factors could be ranked in the following order of importance: concurrent use of the second and third substances, having been in trouble with the police, perceived poor academic performance and low future academic expectations, a lack of religious belief, coming from a non-intact family, favouring peer over family opinion and having been suspended from school. Many of these relationships were age-sensitive with substance use peaking at age 15. CONCLUSION: The models and relationships presented in this paper show that a constellation of behaviours are related to adolescent substance use. Also demonstrated is that behaviours cannot be considered in isolation, but need to be examined from an holistic or biopsychosocial standpoint. These relationships are complex and future research should consider not only causality of adolescent substance use, but also of the aetiology of the satellite behaviours.

Adolescent↗
PubMed1984

The music therapy clinical intern: performance skills, academic knowledge, personal qualities, and interpersonal skills necessary for a student seeking clinical training.

The music therapy curriculum consists of two distinct parts: the academic phase and the internship. The music therapy student must apply for a clinical internship during the last year of the academic phase, and the student is expected to evolve from student to professional music therapist during the internship phase. The present study sought to determine the skills, knowledge, and qualities clinical training directors considered most important for a prospective intern to possess. The sample population of the survey consisted of 25 clinical training directors from the Great Lakes Region. Results of the survey indicated that piano skills, knowledge of psychology, emotional maturity, and the ability to express needs and feelings were considered most important for the prospective intern to possess.

Great Lakes Region↗
PubMed1975

Conspiracy of silence: psychiatric counseling with students at high risk for academic failure.

The authors examined the academic records and counseling histories of 132 freshman students at a state university who sought psychiatric counseling. They found that most students with poor previous academic performance were not helped academically by brief (crisis intervention) psychiatric counseling. They also found that many couselors resisted confronting such students with their academic inadequacies.

Achievement↗
PubMed1987

Simulated grading decisions of allied health educators: a survey of Texas faculty.

Using simulated student data, this study investigated the grading decisions and future performance expectations of faculty members from allied health programs in Texas. These randomly selected faculty members evaluated linear and nonlinear grade profiles and formed expectations of students' future performances based on these grade profiles. Results indicated that student grade-performance patterns were differentially related to assigned grades and future expectations. Factors related to overall grade assignment included mean performance level, slope of academic performance (ascending, descending), and time of performance change (early, late). Two potential grading biases were suggested (age, sex of faculty), particularly for ascending performance patterns. Other faculty characteristics were unrelated to grading decisions and expectations.

Achievement↗
PubMed1985

Cognitive performance and academic achievement of Japanese, Chinese, and American children.

Chinese, Japanese, and American children at grades 1 and 5 were given a battery of 10 cognitive tasks and tests of achievement in reading and mathematics. Samples consisted of 240 children in each grade in each culture. 2 major purposes of the study were to determine possible differences in cognitive abilities of Japanese, Chinese, and American children and to investigate the possible differential relation of scores on cognitive tasks to reading by children of the 3 cultures. Similarity was found among children of the 3 cultures in level, variability, and structure of cognitive abilities. Chinese children surpassed Japanese and American children in reading scores; both Chinese and Japanese children obtained higher scores in mathematics than the American children. Prediction of achievement scores from the cognitive tasks showed few differential effects among children of the 3 cultures. The results suggest that the high achievement of Chinese and Japanese children cannot be attributed to higher intellectual abilities, but must be related to their experiences at home and at school.

Achievement↗
PubMed1975

A behavioral-educational alternative to drug control of hyperactive children.

A behavioral procedure for controlling hyperactivity without inhibiting academic performance is described. Using a time-sample observational method, the hyperactivity displayed by three school children was recorded during math and reading classes. Concurrently, math and reading performances were measured. The study consisted of two baselines, one while the children were on medication and the second while they were off medication. A multiple-baseline design across the two academic subject matters was used to assess the behavioral intervention, which consisted of token reinforcement for correct academic responses in math and subsequently math and reading. Discontinuation of medication resulted in a gross increase in hyperactivity from 20% to about 80%, and a slight increase in math and reading performance. Introduction of a behavioral program for academic performance, during no medication, controlled the children's hyperactivity at a level comparable to that when they were on drugs (about 20%). At the same time, math and reading performance for the group jumped from about 12% during baseline to a level of over 85% correct. Each child performed behaviorally and academically in an optimal manner without medication. Contingency management techniques provided a feasible alternative to medication for controlling hyperactivity in the classroom while enabling the children to grow academically.

Achievement↗