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Parental smoking and lung function in children: an international study.

RATIONALE: Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children's population are less clear. OBJECTIVE: To study the relative impact of pre- and postnatal exposure on respiratory functions of primary school children in a wide range of geographic settings, we analyzed flow and volume data of more than 20,000 children (aged 6-12 yr) from nine countries in Europe and North America. METHODS: Exposure information had been obtained by comparable questionnaires, and spirometry followed a protocol of the American Thoracic Society/European Respiratory Society. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results and mean effects were estimated using meta-analytic tools. MAIN RESULTS: Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% maximal expiratory flow at 25% of vital capacity left (MEF25). A 4% lower maximal midexpiratory flow (MMEF) corresponded to a 40% increase in the risk of poor lung function (MMEF < 75% of expected). Associations with current passive smoking were weaker though still measurable, with effects ranging from -0.5% (FEV1) to -2% maximal expiratory flow (MEF50). CONCLUSIONS: Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue.

Child↗

Excessive sleepiness in adolescents and young adults: causes, consequences, and treatment strategies.

Adolescents and young adults are often excessively sleepy. This excessive sleepiness can have a profound negative effect on school performance, cognitive function, and mood and has been associated with other serious consequences such as increased incidence of automobile crashes. In this article we review available scientific knowledge about normal sleep changes in adolescents (13-22 years of age), the factors associated with chronic insufficient sleep, the effect of insufficient sleep on a variety of systems and functions, and the primary sleep disorders or organic dysfunctions that, if untreated, can cause excessive daytime sleepiness in this population.

Accidents, Traffic↗

The EARLY ALLIANCE prevention trial: an integrated set of interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure.

Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.

Adolescent↗

Influence of malnutrition on social maturity, visual motor coordination & memory in rural school children.

The social competence, visual motor coordination and memory functions of 1336 rural primary school children in the age group 6-8 yr were studied in relation to their nutritional status and socio-environmental factors. Children with grades, I, II and III malnutrition scored 4.4, 8.5 and 11.8 points lower respectively as compared to those in normal nutrition for the total social quotient. The effect was more marked in stunted wasted children. These rural children performed poorly on areas; communication, socialization and occupation, in grades II and III malnutrition their scores being below average (less than 90). Environmental factors like family size and type, economic sufficiency, and father's education also played a significant role in determining the social competence in girls. The scores for visual motor coordination (Bender Gestalt test) increased with severity of malnutrition (scores normal, 9.9 and grade III, 11.3) being statistically significant (P less than 0.01). Observations on memory test indicated that malnutrition had a significant but very weak relationship with immediate and delayed memory. The boys in grade II malnutrition had significantly lower immediate memory scores, as compared to normal boys for all the 3 modes of presentation (P less than 0.05, P less than 0.05; and P less than 0.001 respectively). In the girls, this was true only with respect to pictures. Further, for delayed memory, boys in grade II malnutrition scored poorly for pictures and words (P less than 0.05 for both).

Child↗

Mismatch negativity event-related potential elicited by speech stimuli.

The mismatch negativity (MMN) is a passively elicited event-related potential that is extremely sensitive to acoustic stimulus properties. The MMN was characterized in normal adults and school-age children in response to speech stimuli differing minimally in the onset frequency of the second and third formant transitions. The speech-evoked MMN consists of a negative waveform at about 230 msec that occurs in response to the deviant stimulus when it is presented in an oddball paradigm. It is absent in response to that same stimulus when presented alone. The MMN was clearly present in all adults and children tested. Using the procedures developed in this study, this event-related potential was found to be robust enough in individual subjects to be considered a potential clinical measure for assessing central auditory function in school-age children and adults.

Adolescent↗

Predicting school performance of preschool children from parent reports.

Parents of 391 preschool children ages 49 to 64 months completed a brief developmental inventory as part of a preschool screening program operated by an urban school district. The 28-item developmental inventory assessed adaptive behavior and language development. In addition, preschool children were administered the Minneapolis Preschool Screening Instrument. Teacher ratings of kindergarten performance the following year provided criterion data to validate the screening measures. Correlations with the overall teacher rating [the mean of nine ratings] were .40 for the adaptive behavior scale and .57 for the language scale. Validity figures for the developmental inventory were significantly higher for low SES than for high SES children, for older children [57 to 64 months] than for younger children [49 to 56 months], and for firstborn children than for younger siblings. No effects were found by sex. While a positive relationship between parent reports of developmental functioning and early school performance was clearly established, validity levels did not justify use of parent information as a sole source of preschool screening information.

Achievement↗

Implications of age of onset for delinquency risk.

A substantial body of research suggests that age of onset is a viable discriminator of risk for chronic versus transient delinquency. Also, a multivariate model of psychosocial variables (demographics, individual, school, and family functioning) appears likely to provide a comparatively accurate and useful discriminatory model for prediction. These two findings were applied to a normal sample of male adolescents (N = 199, ages 15-18) to study the relationship of age of onset to delinquent behavior (as opposed to use of legal status to denote delinquency) and legal status. Additionally, the efficiency and improvement over chance accuracy of a multivariate model developed as part of a larger research project was tested. Results indicated that age of onset is an important and accurate discriminator of extent of subsequent delinquency. Subjects with an early age of onset reported more delinquent behavior, were more likely to be adjudicated, and showed different patterns of delinquency. A combination of demographic, individual, school, and family variables predicted age of onset.

Achievement↗

Linking changes in whole family functioning and children's externalizing behavior across the elementary school years.

This study used observational assessments of 57 2-parent families working and playing together when their eldest child was in kindergarten and again in Grade 4 to identify distinct patterns of family functioning derived from structural family systems theory for (a) cohesive, (b) separate, and (c) triangulated families. Little consistency in family type from early to middle childhood was indicated. No significant mean differences were found in teacher reports of children's externalizing behavior in their Grade 1 classrooms for children in cohesive or triangulated families. Fourth graders in triangulated families were seen as more aggressive at school than were their peers in cohesive or separate families. Changes in observed family functioning across a 4-year period (kindergarten to Grade 4) were also systematically linked to changes in teachers' ratings of children's externalizing behavior from Grades 1 to 4.

Adult↗

The Virginia generalist initiative: lessons learned in a statewide consortium.

In response to Virginia's need for an increased supply of generalist physicians, the state's three medical schools--Eastern Virginia Medical School, Virginia Commonwealth University School of Medicine, and the University of Virginia School of Medicine--have formed a partnership with key governmental stakeholders in the Virginia Generalist Initiative funded by The Robert Wood Johnson Foundation's Generalist Physician Initiative. These state-supported medical schools historically have functioned independently, with little cooperative effort. This paper describes the consortium, its activities, its successes, and its unmet objectives, and uses a series of cases in point to illustrate relevant lessons learned. Some of these lessons are that (1) stakeholders must be involved from the beginning of planning to identify mutual goals and establish consortium protocols; (2) all partners must share a philosophical commitment to the consortium's mission, as well as the time and resources needed; (3) an atmosphere that enables risk-taking behavior must be created; (4) stakeholders must be willing to revise goals and sustain an environment conductive to change; and (5) trust is essential and must be vigilantly maintained. The paper concludes that the Virginia Generalist Initiative has dramatically altered the goals, objectives and programs of the three schools and has succeeded in aligning the schools' strategic objectives with the state's priorities.

Databases as Topic↗

Prader-Willi syndrome: new insights in the behavioural and psychiatric spectrum.

Prader-Willi syndrome (PWS) is a genetic disorder caused by the loss of the paternal contribution of the proximal part (15q11-q13) of the long arm of chromosome 15 (i.e. deletion, disomy and imprinting mutation). The syndrome is associated with distinct physical dysmorphism, as well as with specific behavioural and psychopathological characteristics. Psychiatric symptoms in adolescence and adulthood have been described, including acute cycloid psychosis, and obsessive compulsive, bipolar and pervasive developmental disorders. At the Centre for Human Genetics in Leuven, Belgium, 53 individuals (31 children and adolescents, and 22 adults) have been followed up for 15 years by a special multidisciplinary team. Attention was given to their medical, cognitive, behavioural and emotional development, and the evolution of psychiatric disorders in adolescence and adulthood. This study describes the psychiatric problems in four patients diagnosed with acute cycloid psychosis and traces their development from infancy to adolescence. Four other individuals needed psychiatric evaluation and treatment, and could be diagnosed as having unspecified bipolar disorder, also termed unstable mood disorder. Both groups were compared, and significant differences in early development and later evolution into adulthood were noted. The individuals with PWS who later developed psychotic episodes were described as active and extrovert toddlers, and showed autistic behaviour during their primary school education. Their intellectual functioning was in the moderate to severely retarded range. The individuals with PWS who later developed an unstable mood disorder were described as rather passive and introvert toddlers, and they presented less disturbed behaviour during their primary school education. The intellectual functioning of these subjects was in the normal to borderline range.

Adolescent↗

Minor neurological signs and perceptual-motor difficulties in prematurely born children.

AIM: To examine the spectrum of neurological dysfunction and perceptual-motor difficulties at school age in a cohort of prematurely born children, and the relation of these measures to neonatal brain lesions, intelligence quotient, and behavioural adjustment. METHOD: One hundred and eighty three children were tested at the age of 6 years using Touwen's Examination of the Child with Minor Neurological Dysfunction, the Movement Assessment Battery for Children (Movement ABC), the Developmental Test of Visual-Motor Integration (VMI), British Ability Scales, and Rutter Scales. RESULTS: Twenty six children had definite cerebral palsy and one was blind. Of the remaining 156, the proportions falling below the 15th centile point were 31% on Touwen's Examination, 44% on the Movement ABC, and 17% on the VMI. Forty two passed all three tests. No child with a normal ultrasound scan developed cerebral palsy, whereas nearly all those with major lesions did. Minor lesions, however, were not generally predictive of later outcome. Correlations between the tests were generally low. CONCLUSIONS: These findings stress the need to assess neurological and perceptual motor functioning separately at school age and to monitor relationships with other aspects of development.

Analysis of Variance↗

Rapid relapse of thyroid dysfunction and goiter in school-age children after discontinuation of salt iodization.

BACKGROUND: In programs to control iodine deficiency disorders (IDD), sustainability is a major concern. IDD has recently recurred in countries where salt iodization programs have lapsed. OBJECTIVE: The objective of the study was to describe the evolution of thyroid dysfunction after the discontinuation of salt iodization in a cohort of children in an area of severe endemic goiter. DESIGN: Moroccan children (aged 6-16 y, n = 159) with severe IDD received iodized salt (IS) for 1 y. Because of practical and financial constraints, including a lack of infrastructure and electricity at the production site, salt iodization abruptly ceased. The children were followed for another 14 mo, and concentrations of urinary iodine, thyrotropin, total thyroxine, and thyroglobulin and thyroid volume were measured. RESULTS: Before iodization, median urinary iodine was 18 microg/L, 88% of children had elevated serum thyroglobulin concentrations, and 72% were goitrous. One year after the introduction of IS, median urinary iodine and thyroglobulin concentrations had normalized, mean thyroid volume had decreased by 34%, and median thyrotropin and mean total thyroxine concentrations were improved. Five months after the discontinuation of salt iodization, median urinary iodine had fallen to 20 microg/L. Fourteen months after the discontinuation of salt iodization, the rate of goiter was again similar to the rate before salt iodization; median thyrotropin and thyroglobulin concentrations were sharply higher than before the introduction of IS (P < 0.001); and the prevalence of hypothyroidism was 10%, compared with 3% before the introduction of IS (P < 0.001). CONCLUSIONS: In IDD-affected areas, cessation of salt iodization is associated with a rapid deterioration of thyroid function in school-age children. These findings underline the importance of sustainability in IDD control and the vulnerability of children to even short-term lapses in IS programs.

Adolescent↗