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PubMed2004

Adult female outcomes of feminising surgery for ambiguous genitalia.

For the last half a century, feminising genital surgery has been routine practice for children with ambiguous genitalia assigned to a female sex of rearing. Due to various factors including the stigma and secrecy associated with intersex and the practical difficulties of paediatricians following-up adult patients, there has been little available outcome data on this policy. Recently however adult peer support groups have expressed dissatisfaction with the results of surgery. In addition there is increasing data to confirm a high rate of repeat vaginoplasty as well as a detrimental effect on adult sexual function. The lack of outcome data supporting this policy of genital surgery for all means it is time to radically evaluate our clinical practice. The option of psychological and peer support as an alternative to routine genital surgery must become a realistic proposition.

Adult↗
PubMed2004

Early intervention for adolescent substance abuse: pretreatment to posttreatment outcomes of a randomized clinical trial comparing multidimensional family therapy and peer group treatment.

This randomized clinical trial evaluated a family-based therapy and a peer group therapy with 80 urban, low-income, and ethnically diverse young adolescents (11 to 15 years) referred for substance abuse and behavioral problems. Both treatments were outpatient, relatively brief, manual-guided, equal in intervention dose, and delivered by community drug treatment therapists. Adolescents and their parents were assessed at intake to treatment, randomly assigned to either MDFT or group therapy, and reassessed at six weeks after intake and at discharge. Results indicated that the family-based treatment (MDFT, an intervention that targets teen and parent functioning within and across multiple systems on a variety of risk and protective factors) was significantly more effective than peer group therapy in reducing risk and promoting protective processes in the individual, family, peer, and school domains, as well as in reducing substance use over the course of treatment. These results, which add to the body of previous findings about the clinical and cost effectiveness of MDFT, support the clinical effectiveness and dissemination potential of this family-based, multisystem and developmentally-oriented intervention.

Adolescent↗
PubMedDate not supplied

The Polish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Polish language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Polish CHAQ CHQ were fully validated with 1 forward and 1 backward translation. A total of 30 subjects were enrolled: 17 patients with JIA (35% systemic onset, 18% polyarticular onset, 29% extended oligoarticular subtype, and 18% persistent oligoarticular subtype) and 13 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Polish versions of the CHAQ-CHQ are reliable, and valid tools for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMedDate not supplied

The Swedish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Swedish language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Swedish CHAQ CHQ were already published and therefore were revalidated in this study. A total of 129 subjects were enrolled: 69 patients with JIA (13% systemic onset, 39% polyarticular onset, 25% extended oligoarticular subtype, and 23% persistent oligoarticular subtype) and 60 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Swedish version of the CHAQ-CHQ are reliable, and valid tools for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMed1993

Overall function in rural childhood cancer survivors. The role of social competence and emotional health.

This study compared the functioning of 20 rural cancer survivors, aged 6 to 16 years, with that of 40 age- and gender-matched school peers. Social competence and emotional health were evaluated, along with academic performance and physical limitations. Eight measures were used: the teacher and parent Child Behavior Check Lists, the Health Resources Inventory, the Vineland Revised Scale of Social Maturity, the Piers-Harris Child's Self-Concept Scale, the Parcel and Meyers' Health Locus of Control, the Moos' Family Environment Scale, and the Functional Status II(r). Cancer survivors and controls had similar attitudes about self-esteem, family conflicts, physical functioning, social skills, independence, and sense of control over health. Both parents and teachers noted poorer social competence among the cancer survivors than among controls, but parents of survivors reported more behavior problems, whereas teachers stressed poorer school performance. Routine screening for emotional health, social competence, and academic performance should be part of the follow-up care of pediatric cancer survivors.

Activities of Daily Living↗
PubMed1988

Lessons drawn from observing young peers together.

Based on studies during the past 13 years of what transpires between young peers, lessons are drawn about the nature of human sociability and the development of social skill during the first three years of life. Peer encounters have proven especially helpful for discovering the forms of sociability and social skill the infant is capable of without the aid of a more skillful social partner. From early in infancy, children are quite sociable with peers (age-mates), both in novel play settings and in their own home or customary group care settings, both with an unfamiliar peer and with those quite familiar, both at the start of acquaintanceship with a particular peer and after many encounters with that peer. Their sociability is seen in their attraction to peers, their directing to peers of such distinctively social behaviors as vocalizations, smiles, and gestures, and the predominantly friendly nature of their behavior. Peer encounters in the absence of customary play materials refute claims that attraction to peers is a by-product of interest in toys and the inanimate spectacles peers create through their actions on toys. Distinctions should be drawn between sociability and social skills, especially interactive skills. Interactive skills are systematic ways the young child relates his/her own behavior to the details of a partner's behavior that function to facilitate such valued social outcomes as the generation of a cooperative game or a conversation or the resolution of a dispute. Observations of young peers highlight the distinctive nature of the infant's interactive skills. Social influence between peers is present from 6 months, but rarely takes the form customary for older children. Joining a peer and manipulating the same play material as the peer are rudimentary interactive skills that emerge by 12 months. Interactive skills enabling the generation of extended sequences of social interaction on a common cooperative theme progress rapidly during the third year of life. The distinctive form of the young child's interactive skills produces distinctive patterns of interaction among young peers. Their interactions are managed largely nonverbally well into the third year of life, and extended cooperative interactions most often take the form of games in which one or both children imitate each other's actions. Despite the predominance of imitation, their encounters are also marked by complementary role relationships. The distinctive features of peer encounters prompt speculations about the role peer encounters can play in early development.

Child, Preschool↗
PubMedDate not supplied

The German version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report the results of the cross-cultural adaptation and validation into the German language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The German CHAQ was fully validated with 3 forward and 3 backward translations, while the CHQ has already been published and therefore it was revalidated. A total of 197 subjects were enrolled: 142 patients with JIA (5% systemic onset, 13% polyarticular onset, 8% extended oligoarticular subtype, and 74% persistent oligoarticular subtype) and 55 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the German versions of the CHAQ-CHQ are reliable, and valid tools for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMedDate not supplied

Family context and gender role socialization in middle childhood: comparing girls to boys and sisters to brothers.

We studied the extent of sex-typing across different areas of child functioning (personality, interests, activities) in middle childhood as a function of the traditionality of parents' gender role attitudes and the sex composition of the sibling dyad. Participants included 200 firstborn children (mean = 10.4 years old), their secondborn siblings (mean = 7.7 years old) and their mothers and fathers. Family members were interviewed in their homes about their attitudes and personal characteristics and completed a series of seven evening telephone interviews about their daily activities. We measured children's attitudes, personality characteristics, and interests in sex-typed leisure activities (e.g., sports, handicrafts) as well as time spent in sex-typed leisure activities and household tasks (e.g., washing dishes, home repairs) and with same and opposite sex companions (i.e., parents, peers). Analyses revealed that sex-typing was most evident in children's interests and activities. Further, comparisons of girls versus boys and sisters versus brothers revealed that differences in children's sex-typing as a function of fathers' attitudes and sibling sex constellation were most apparent for children's activities. A notable exception was sex-typed peer involvement; time spent with same versus opposite sex peers was impervious to context effects. Analyses focused on children's sex-typing as a function of mothers' attitudes generally were nonsignificant.

Child↗
PubMed2004

Marital violence, co-parenting, and family-level processes in relation to children's adjustment.

A multimethod approach was used to examine relations between marital violence, coparenting, and family-level processes and children's adjustment in a community-based sample of marital violence. Two hypotheses were tested, one in which family-level and co-parenting processes mediate relations between marital violence and child functioning and one in which marital violence and family-level/co-parenting processes function relatively independently in influencing children's adjustment. Observations of family processes were made within a triadic parent-child interaction, and several dimensions of children's socioemotional adjustment (i.e., peer relations, behavior problems) were examined. Results indicated that hostile-withdrawn co-parenting mediated the relations between marital violence and children's anxiety and depression. Marital violence, co-parenting, and family-level processes also functioned independently in predicting child outcome. Findings are discussed in terms of the family dynamics present in maritally violent homes.

Adaptation, Psychological↗
PubMed1975

Exercise and asthma: overview and clinical impact.

The question of the relationship between exercise and asthma dates back to the second century A.D. and was not resolved until R.S. Jones and co-authors in 1962 reported that there were in reality two effects on the asthmatic patient from exercise depending on the duration of the exercise. Short-term exercise of less than four minutes resulted in bronchodilatation, whereas longer-term exercise resulted in bronchoconstriction. Exercise-induced bronchospasm occurs in all ages but is more common in children, developing in 85% of boys and 65% of girls with severe asthma. Pulmonary function tests are valuable in identifying these patients as well as their response to various drugs. With this information specific recommendations may be made for the prevention and control of exercise-induced bronchospasm, thus allowing asthmatic children to cope with their peers in exercise programs and competitive sports.

Asthma↗
PubMed2006

Executive functions and performance on high-stakes testing in children from urban schools.

High-stakes achievement testing is a centerpiece of education reform. Children from socially disadvantaged backgrounds typically perform more poorly than their more advantaged peers. The authors evaluated 91 fifth-grade children from low-income urban schools using clinical neuropsychological tests and behavioral questionnaires and obtained fourth-grade scores on state mandated standards-based testing. Goals were to determine whether executive functions are selectively diminished in children from poor urban environments and to evaluate to what extent integrity of executive functions is associated with test scores. Neuropsychological variables (particularly executive functions) accounted for 40% of the variance in English scores and 30% in mathematics. Efforts to improve children's academic achievement should consider developmental factors as well as curricular content.

Achievement↗
PubMedDate not supplied

The Italian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Italian language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Italian CHAQ was already published in the literature and was therefore revalidated while the Italian CHQ was fully cross culturally adapted with 3 forward and 3 backward translations, and than validated. A total of 1,192 subjects were enrolled: 404 patients with JIA (16% systemic onset, 31% polyarticular onset, 21% extended oligoarticular subtype, and 32% persistent oligoarticular subtype) and 788 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Italian version of the CHAQ-CHQ are reliable, and valid tools for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMed2002

Academic and school health issues among children exposed to maternal intimate partner abuse.

OBJECTIVE: To determine the association between children's exposure to maternal intimate partner violence (IPV) and academic problems and school health concerns. DESIGN: The study population consisted of 153 children aged 5 to 16 years who attended public school and whose mothers experienced police- or court-reported IPV. The comparison group consisted of public school peers of the exposed children. Generalized linear modeling using a binomial distribution and log-link function served as the primary method of analysis. SETTING: Urban public school district. MAIN OUTCOME MEASURES: The occurrence of academic problems and type-specific school nurse visits during the 1-year study period. RESULTS: Children whose mothers experienced IPV were more likely to be suspended from school (relative risk [RR], 1.8; 95% confidence interval [CI], 1.2-1.7) and to have had frequent non-suspension-related absences (RR, 1.6; 95% CI, 1.0-2.3) than comparison children after adjusting for relevant confounders. Intimate partner violence-exposed children were more likely to have a school nurse visit for social or emotional complaints (RR, 2.2; 95% CI, 1.3-3.9), a visit that resulted in being sent home from school (RR, 1.6; 95% CI, 1.1-2.3), or a visit that led to referral to the school speech pathologist (RR, 7.5; 95% CI, 1.9-29.6) relative to comparison schoolchildren after adjusting for relevant confounders. CONCLUSIONS: Children's exposure to maternal IPV is significantly associated with the occurrence of academic problems and school health concerns. Describing the increased risk of the academic and health problems exhibited by IPV-exposed children relative to nonexposed children offers the possibility of improving the likelihood that clinicians will identify the woman who experienced abuse and her children, and promote referral to appropriate resources.

Adolescent↗
PubMed1992

Attention, play, and social behavior in ADHD preschoolers.

We investigated attention, play and nonplay behavior in preschool children with attention deficit hyperactivity disorder (ADHD) and a matched control group of non-ADHD children. Forty 4- to 5-year-old children (20 ADHD and 20 matched control) participated. Across a 6-week-period, children's social and play interactions as well as nonplay behaviors were videotaped in the classroom. Videotape recordings were analyzed for the level of attention, cognitive play, and social participation. In addition, children's level of attention and cooperative behavior were observed during two group activities. Findings indicated that ADHD, relative to non-ADHD, children engaged in less overall play and greater functional or sensorimotor play. ADHD children also engaged in more transitional behavior, were less competent with peers, and were less attentive and cooperative during group activities.

Attention↗
PubMed2005

Comparing interventions in older unpartnered adults after myocardial infarction.

BACKGROUND: Older adults after myocardial infarction (MI) are a vulnerable group who may benefit from interventions to improve health outcomes. The use of a peer advisor or an advanced practice nurse (APN) to provide a self-efficacy intervention is a promising method of improving health outcomes after MI. AIMS: The purpose of this paper was to compare the effect of two self-efficacy interventions, a peer advisor and an APN, to a group who received standard care after MI. METHODS: The study was a three-group randomized clinical trial with a peer advisor intervention group, an APN intervention group, and a standard care group. Outcome data were collected in the hospital after MI and by telephone at 12 weeks after hospital discharge, after the interventions were completed. RESULTS: At 12 weeks after MI, there were no significant differences between the 3 groups in health outcomes. There were similar changes in self-efficacy for performing recovery behaviors, the actual performance of recovery behavior, physical and mental health across both intervention groups and the standard care group. CONCLUSIONS: Although the data did not validate the benefits of these self-efficacy interventions, future efforts at identifying changes in health outcomes may need to use more discrete measurements that are more sensitive to changes in the older unpartnered adult after an MI.

Activities of Daily Living↗
PubMed2004

Kinematic differentiation of prosodic categories in normal and disordered language development.

Prosody is complex and hierarchically organized but is realized as rhythmic movement sequences. Thus, observations of the development of rhythmic aspects of movement can provide insight into links between motor and language processes, specifically whether prosodic distinctions (e.g., feet and prosodic words) are instantiated in rhythmic movement output. This experiment examined 4-7-year-old children's (both normally developing and specifically language impaired) and adults' productions of prosodic sequences that were controlled for phonetic content but differed in morphosyntactic structure (i.e., content vs. function words). Primary analyses included kinematic measures of rhythmic structure (i.e., amplitude and duration of movements in weak vs. strong syllables) across content and function contexts. Findings showed that at the level of articulatory movement, adults produced distinct rhythmic categories across content and function word contexts, whereas children did not. Children with specific language impairment differed from normally developing peers only in their ability to produce well-organized and stable rhythmic movements, not in the differentiation of prosodic categories.

Adult↗
PubMed1990

The Secret Garden. A therapeutic metaphor.

This paper analyzes a work of children's literature, The Secret Garden by Frances Hodgson Burnett, to demonstrate a therapeutic process. Two children are able to resume normal development, and overcome pathological character traits, through the agency of new object relationships, peer group experiences, and favorable environmental influences. As a result, both attain the skills and ego functions of normal latency and prepuberty. Elements of this therapeutic process that resembles the psychoanalytic encounter and the therapeutic treatment milieu are highlighted and discussed. The central role of transference, with its similarities and differences in both settings, is emphasized. Finally, the metaphoric meanings of "secret gardens" are explored and connected with the enormous appeal of this book for its prepubertal girl readers.

Child↗
PubMed1995

Complications of fat grafting to the penis.

Fat grafting to the penis has recently become popular in some parts of the country. Surgery is commonly performed in the office, where peer review is lacking or nonexistent. A single case is reported documenting a poor cosmetic and functional result after irregular resorption of grafted fat. The external appearance of the penis remained stable for months, even though later biopsy revealed all the grafted fat to be dead. Analogy with pseudolipoma of Glisson's capsule is provided, showing that dead fat cells can survive for years or even a lifetime without absorption by the body. Several complications are examined in this article, and other potential risks are also discussed. The operation, although technically easy to perform, has many serious potential side effects that should be understood.

Adipose Tissue↗