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[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↗

Tobacco cessation within the dental curriculum in the United States and internationally.

Tobacco use is a worldwide public health issue with enormous costs in morbidity and mortality. Dentists are in a unique position as health care providers to offer tobacco cessation counseling to their patients. In order to do so, clinicians must be properly trained in tobacco cessation skills. The onus falls upon professional schools to include information about tobacco use, its clinical effects, and ways to help patients quit into the dental curriculum. In the past 15 years, there has been an increase in the number of dental schools that have adopted anti-tobacco policies and included tobacco in their clinical courses both here in the United States and in Europe. Dental schools with functional tobacco cessation programs in place must follow up on the activities conducted in their clinics to ensure that dental students are appropriately employing the correct techniques and, thus, learning to provide optimal care to their patients.

Curriculum↗

Early childhood diarrhea predicts impaired school performance.

OBJECTIVE: Diarrhea is a leading cause of mortality worldwide; however, its long-term morbidity is poorly understood. Recently, early childhood diarrhea (ECD) has been associated with impaired physical fitness, growth and cognitive function 6 to 9 years later. We studied the effects of ECD on school functioning in a shantytown in northeastern Brazil. DESIGN: We administered 77 educational surveys. Complete diarrhea surveillance (ie, >90%) in the first 2 years of life and demographic and anthropometric information were available for 73 children. Age at starting school was calculated for 62 children, whereas age appropriateness for the current grade (AFG) was calculated for all 73 children who were >6 years old. Stepwise regression was used to examine the independent effect of ECD on school functioning after controlling for socioeconomic factors, maternal education, breast feeding, growth and cognitive functioning. RESULTS: ECD correlated with age at starting school (r = 0.55, P = 0.0005) and remained a significant predictor even after controlling for family demographics, days of breast feeding, early growth and TONI-3 test of nonverbal intelligence. This was true despite significant correlations of ECD with growth shortfalls and impaired cognitive functioning. ECD also correlated with AFG (r = 0.38, P = 0.001). Only TONI-3 test scores explained this association, suggesting that ECD may hinder school performance, but only in part school readiness, by impairing cognitive function as measured by performance on the TONI-3 nonverbal intelligence test. CONCLUSIONS: These findings document effects of early childhood diarrhea on later school readiness and performance and hence potential long-term human and economic costs of ECD, which warrant further attention and far greater investment for the control of ECD and its consequences.

Age Factors↗

[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↗

Fitting back in: adolescents returning to school after severe acquired brain injury.

PURPOSE: To explore the experiences of Australian adolescents with severe acquired brain injury (ABI) and their families as the adolescent returned to school. In particular, to understand the influence of services and support on the school return. METHOD: In-depth interviews conducted over a two-year period with families who had an adolescent with a recent severe ABI (mean age 15 years, 11 months) analysed using a grounded theory approach. RESULTS: Two critical phases for adolescents returning to school post ABI were identified: organizing the school return and being back at school. Experience in these phases was influenced by length of school absence, extent of noticeable and hidden problems and school response to the students' return post injury. The central concept characterizing experience was the challenge of fitting back in. Some adolescents fitted back in adequately and continued school participation. Those that did not fit in tried again by revisiting the organizing phase, re-evaluated their school experience and either continued or left school. CONCLUSIONS: Adolescents with ABI faced the challenge of fitting back in when they returned to school. This was either facilitated or hindered by the extent and quality of organization, communication and support from parents, schoolteachers and the rehabilitation team.

Activities of Daily Living↗

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↗

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↗

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↗

Homocysteine, folic acid and vitamin B12 in relation to pre- and postnatal health aspects.

Studies linking hyperhomocysteinemia (HHCY) and B-vitamin deficiency to some health aspects in children have been accumulating. Low B-vitamin status inearly life, even as early as the time of conception, may endanger the potential for new life and may negatively influence the health of the offspring. Early abortion, pregnancy complications and poor pregnancy outcomes have been linked to elevated concentrations of total plasma homocysteine (tHcy) and low folate or vitamin B12. Maternal vitamin status predicts that of fetuses and neonates. Lactating women are likely to experience low micronutrient status, which might affect breast-milk composition and hence the nutritional status of their breast-fed infants. Elevated concentrations of methylmalonic acid (MMA) is common in infants (age <6 months), which may indicate a transient inadequate vitamin B12 status. Deficiency of B-vitamins might confer deleterious effects on the physical and mental health of the child, such as impaired growth, gross motor function, poor school performance and other adaptive skills. The importance of maintaining adequate B-vitamin status during periods of progressive growth and development should be emphasized because symptoms related to folate and vitamin B12 deficiency are difficult to detect. Serum levels of tHcy and MMA should be estimated in several target groups of children, pregnant and lactating women and those planning for pregnancy. Concentrations of tHcy and MMA are useful indicators of B-vitamin status in the pediatric laboratory. Using these functional markers may facilitate detecting sub-optimal B-vitamin status in children.

Congenital Abnormalities↗

Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birth weight children at school age.

OBJECTIVE: The Bayley Scales of Infant Development, Second Edition (BSID II) are commonly used to assess outcomes of extremely low birth weight (ELBW) infants. We sought to assess the predictive validity of the BSID II Mental Developmental Index (MDI) for cognitive function at school age. DESIGN/METHODS: Of 330 ELBW infants admitted in 1992-1995, 238 (72%) survived to the age of 8 years, of whom 200 (84%) were tested at both 20 months' corrected age (CA) and 8 years. Mean birth weight was 811 g, mean gestational age was 26.4 weeks, 41% were boys, and 60% were black. Measures included the BSID II at 20 months' CA and the Kaufman Assessment Battery for Children (KABC) Mental Processing Composite (MPC) at 8 years' postnatal age. BSID II MDI and MPC scores were compared and the predictive validity calculated for all 200 ELBW children and for the 154 ELBW neurosensory-intact subgroup. Predictors of stability or change in cognitive scores were examined via logistic regression adjusting for gender and sociodemographic status. RESULTS: For all ELBW children, the mean MDI was 75.6 +/- 16 versus a mean KABC of 87.8 +/- 19. For the neurosensory-intact subgroup, the mean MDI was 79.3 +/- 16 and the mean KABC was 92.3 +/- 15. Rates of cognitive impairment, defined as an MDI or KABC of <70, dropped from 39% at 20 months' CA to 16% at 8 years for the total ELBW population and from 29% to 7% for the neurosensory-intact subgroup. The positive predictive value of having an MPC of <70 given an MDI of <70 was 0.37 (95% confidence interval [CI]: 0.27, 0.49) for all ELBW infants, 0.20 (95% CI: 0.10, 0.35) for the neurosensory-intact subgroup, and 0.61 (95% CI: 0.42, 0.77) for the neurosensory-impaired subgroup. The negative predictive values were 0.98, 0.99, and 0.85 for the 3 groups, respectively. Neurosensory impairment at 20 months' CA predicted lack of improvement of cognitive function (odds ratio: 6.9; 95% CI: 2.4, 20.2). Children whose cognitive scores improved between 20 months and 8 years had significantly better school performance than those whose scores stayed at <70, but they did less well than those whose scores were persistently >70. CONCLUSIONS: The predictive validity of a subnormal MDI for cognitive function at school age is poor but better for ELBW children who have neurosensory impairments. We are concerned that decisions to provide intensive care for ELBW infants in the delivery room might be biased by reported high rates of cognitive impairments based on the use and presumptive validity of the BSID II MDI.

Blindness↗

School staff's satisfaction with school health services.

The School Nurse Impact Committee of the Columbus Public Schools in Columbus, Ohio, initiated a survey to determine staff satisfaction with the delivery of health services. School nurses need the cooperation and support of the staff to successfully deliver school health services, therefore, the staff's satisfaction with school health services is crucial to the school nurses' ability to fulfill their role. The objectives of the survey were to (a) determine staff satisfaction with school nurse interventions, (b) determine staff satisfaction with the effectiveness of interventions, (c) identify areas of health service delivery which may need improvement, and (d) determine areas of school health services where school nurses may need to more effectively communicate their involvement. Critical elements of school nurse practice included staff health, safety and environment, classroom education, medication, school system collaboration, and program management. Several key issues were identified through the survey. School system collaboration issues need more school nurse involvement. School nurses also need to improve their visibility regarding school system collaboration, and in classroom and individual pupil education. Traditional school nurse functions were adequately covered. Results indicate that staff would be more satisfied if they had more nursing support in the classroom and more nurse time in their building.

Drug Therapy↗

High school rugby players' understanding of concussion and return to play guidelines.

OBJECTIVE: To document high school players' understanding and attitudes towards concussion return to play guidelines. METHODS: A questionnaire based survey was performed of national high school rugby players as to their knowledge of existing concussion return to play guidelines. RESULTS: A total of 600 male players were surveyed, and 477 responded (response rate 80%). Half (237/477) were aware of concussion guidelines, and 60% (288/477) identified the mandated stand down period that is part of the regulations governing rugby football. Players obtained their information primarily from: teachers/coaches (239 responses), medical personnel (200), and other players (116). Of those players who suspected that they had been concussed (296/477, 62%), only 66 returned to play after medical clearance. CONCLUSIONS AND IMPLICATIONS: This sample of high school players showed a limited knowledge of the concussion guidelines covering their sport, and even when concussed did not follow recommended protocols. This indicates the need for an increased focus on player education.

Adolescent↗

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↗

[The history of the Psychiatric Nursing in Rio Grande do Sul, Brazil: Part II].

The purpose of this article is contributing to the historiography and history of Psychiatric Nursing in Rio Grande do Sul, Brazil by reconstructing the process that culminated in the closing of the Nursing Professional School, which functioned from 1939 to 1952, at Hospital São Pedro, Porto Alegre, Brazil. Documentary research and oral history were the primary sources of information. The reports of various witnesses of this process helped to detect the diverse political-partidary, corporative and inter-institutional factors that led to the extinction of that establishment.

Brazil↗

Admission to university engineering programs in Sweden: a multipurpose approach.

This brief article provides a description of some new ideas about admission of university engineering students in Sweden. The current system of admission is based on upper-secondary school grades and the Swedish Scholastic Assessment Test. These measures are used for admission to all higher education. For many reasons, ideas for a new admission model have been proposed. This model includes a sector-oriented admission test, which the universities are supposed to use for different purposes, such as selection, eligibility, diagnostics, and recruitment.

Adolescent↗

Long-term behavioral sequelae of prematurity.

OBJECTIVE: Longitudinal evaluation of the competence and the prevalence of behavior problems in preterm children with serious neonatal complications. METHOD: Prospective follow-up of nonhandicapped preterm children who had been hospitalized in a neonatal intensive care unit (n = 177). The follow-up extended from early school age to early adolescence and was conducted with the help of the Child Behavior Checklist (CBCL) (parent form). RESULTS: The preterm children had lower scores on the Social and School Competence scales than did controls (n = 276). They also were more likely to attend special schools than were children in the general population. With regard to behavior problems, the preterm children had more social problems. The very preterm children and the children who were small for gestational age (SGA) were the ones who contributed to the significant findings. The children who were appropriate for gestational age did not differ from controls. No differential changes in CBCL ratings were found between the preterm and control children. The stability with regard to internalizing problems, attention problems, and social problems was high among the very preterm children and SGA children. CONCLUSION: Very preterm and preterm SGA children are at increased risk of problems in social functioning and functioning at school. These problems persist with age.

Achievement↗

Epidemiology and pathophysiology of minor traumatic brain injury.

This review article presents evidence from the current literature on the epidemiology and pathophysiology of concussion. The recent epidemiologic data for a variety of sports are presented relevant to the general population, and professional, college, and high school athletics. The evidence for the pathophysiology of head injury is presented using a mixture of current animal and human studies. A brief discussion on the benefits and limitations of the evidence is offered for the both the epidemiology and pathophysiology of concussion, and how it relates to current treatment options.

Animals↗

Interaction of spatial perception, vestibular function, and exercise in young school age boys with learning disabilities.

Form rotation, figure directionality, and figure-ground discrimination were evaluated before and after 10 days of vestibular or aerobic exercises for 30 boys (7 to 12 yr.) who showed problems in learning, reading, and inattention. Eight subjects had normal vestibulo-ocular reflex (VOR) responses as determined by caloric and rotational testing. They were assigned to a vestibular program (Control Group I). The 22 subjects with abnormal VOR test responses were randomly assigned to either aerobic exercises (Experimental Group II) or a vestibular program (Experimental Group III). Spatial perceptual test scores varied widely, with the majority performing below age-expected norms but no significant differences on vestibular status appeared. Postexercise, only subjects completing the vestibular program made significant gains: Experimental Group III (abnormal VOR) made significant gains in accuracy and normal test responses compared to the other groups, and Control Group I made significantly greater gains in speed of spatial perceptual processing. For boys with problems in learning, reading, inattention, and vestibular function, a vestibular exercise program complementing a traditional or special educational program may enhance the spatial perceptual skills needed for reading.

Attention↗