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PubMedDate not supplied

Issues in the development of cross-cultural assessments of speech and language for children.

BACKGROUND: There is an increasing demand for the assessment of speech and language in clinical and research situations in countries where there are few assessment resources. Due to the nature of cultural variation and the potential for cultural bias, new assessment tools need to be developed or existing tools require adaptation. However, there are few guidelines on how to develop 'culturally appropriate' assessment tools. AIMS: To review the literature on cross-cultural assessment in order to identify the major issues in the development and adaptation of speech and language assessments for children and to illustrate these issues with practical examples from our own research programme in Kenya. METHODS & PROCEDURES: Five broad categories pertaining to cross-cultural assessment development were identified: the influence of culture on performance, familiarity with the testing situation, the effect of formal education, language issues and picture recognition. It was outlined how some of these issues were addressed in our research. The results of the review were integrated to produce a list of ten guidelines highlighting the importance of collaboration with mother tongue speakers; piloting; familiar assessment materials; assessment location; and practice items and prompts. CONCLUSIONS: There are few clinicians and assessors, whether in the UK or abroad, who do not assess or treat children from a culture different to their own. Awareness of cultural variation and bias and cooperative efforts to develop and administer culturally appropriate assessment tools are the foundation of effective, valid treatment programmes.

Behavior↗
PubMed2005

Factors associated with academic achievement in children with recent-onset seizures.

Children with chronic epilepsy are more at risk for achievement problems than either children without seizures or children with other chronic disorders. Factors that lead to such problems in children with epilepsy, however, are not well understood. Exploring these factors is important because academic underachievement can lead to poor social outcomes and contribute to underemployment or unemployment in adulthood. This descriptive, cross-sectional study investigated a group of children who had been diagnosed with seizures approximately 12 months previously, providing the opportunity to describe relationships among family and child characteristics; parent, child, and teacher responses; and child academic achievement at the same point in time across the sample. Seventy-two children had standardized test total battery scores, 101 had a teacher's rating of performance, and 67 had scores for both. Data were analyzed using multivariable regression. Child adaptive competency and seizure severity were associated with higher teacher ratings of academic performance (beta=0.73, p<0.0001 and beta=2.38, p=0.0182, respectively). Child adaptive competency was associated with higher total battery scores (beta=0.73, p<0.0001). Contrary to findings in studies of children with chronic epilepsy, mean academic achievement in this sample of children with recent-onset seizures was in the average range; however, 25% of the children were at or below one standard deviation below the mean on the teacher's rating of performance and 10% on the total battery. It is therefore important for health professionals and educators to regularly assess the child's academic functioning and school performance to identify those at risk for problems. Health professionals and educators need to collaborate on assessment and interventions to help maximize child academic success.

Achievement↗
PubMed1989

Type A behavior pattern in Japanese employees: cross-cultural comparison of major factors in Jenkins Activity Survey (JAS) responses.

The responses to the Japanese edition of the Jenkins Activity Survey (JAS) (Form C) were analyzed in 1682 male employees of a Japanese enterprise to investigate the characteristics of the Type A behavior pattern (TABP) in Japan. When the occupational level was controlled, the mean values of the Type A score were found to be quite similar to those of the Western Collaborative Group Study (WCGS), although those of factor H scores were considerably lower than those of the WCGS. Additionally, the results of a factor analysis conducted on the responses to JAS questions showed that the factor structure of the responses was basically equal to that found in the WCGS. In contrast to factor J of the WCGS, however, Japanese factor J did not comprise the items which signaled rises in positions or incomes in recent years. The results of this study indicate that the JAS is able to measure the TABP in Japan, at least concerning its three component factors. Furthermore, they suggest that the TAPB is not necessarily reinforced in Japanese occupational environments.

Coronary Disease↗
PubMedDate not supplied

Local partnerships for community assessment and planning.

PURPOSE: Community assessment is a core function of public health. National and state policies encourage local health departments (LHDs) to engage local partners in conducting community assessments. This study examined the prevalence, characteristics, and effectiveness of community assessment partnerships between LHDs and other organizations. METHODS: LHDs in Wisconsin completed a 2-stage, cross-sectional survey. A subset analysis of community assessment partnerships was conducted using descriptive, bivariate, and multivariate statistical methods. RESULTS: Ninety percent of LHDs reported a partnership focused on community assessment (n = 69). Sixty-six percent of community assessment partnerships had existed for three or more years, and all of these had implemented plans (n = 43). Community assessment partnerships were more likely than partnerships focused on other issues to have formed because of a mandate, to include many partners, and to receive some forms of financial support from the LHD. Partnerships focused on community assessment were no more likely to be effective than other types of partnerships. CONCLUSIONS: LHDs and community partners realize mutual benefits from collaborating on community assessment. Successful community assessment partnerships can be supported by building competencies in the public health workforce and sustaining partnerships for substantial periods of time.

Community Health Planning↗
PubMed2002

Injury prevention for children with disabilities.

Little injury data exists for children who have disabilities. There is an urgent need to address injury prevention and to improve safety standards for this group. Understanding the epidemiology of injuries will allow clinicians to accurately advise patients and their families on individual risks and counsel them in steps to take to reduce those risks. Safety information must be tailored to consider each child's functional impairments. All children who have disabilities are at risk for maltreatment. Open discussion of this problem is warranted given the immensity of the problem. Identifying parental concerns and supporting parents in the use of respite resources are appropriate. For children who have problems in mobility, falls are the number one concern. Collaboration with reliable vendors and therapists that adhere to standards for safe seating is essential for reducing the risk of wheelchair tips and falls. In addition, therapists should be directed to provide mobility training for activities from safe transfers to street crossing in a community setting. Parents should be counseled to approach their child's injury risk based on the child's cognitive and behavioral level rather than their chronological level. Knowledge of the child's developmental quotient or intelligence quotient will also allow the clinician to accurately formulate an injury prevention plan. Many children will always need supervision for tasks that put them in situations of injury risk (i.e., swimming, street crossing, bathing). Sensorineural deficits such as blindness or deafness create significant alterations in negotiating the environment and an increased risk of injury. Awareness of the special needs for fire risk reduction and street safety are critical in this population. The collection of injury data is critical to define the scope of the problem and to influence changes in policy and the development of technical standards. Educational efforts focused on safety should include pediatricians, rehabilitative therapists, social workers, teachers, parents, and--most importantly--the empowerment of children as they age injury-free into adults. SUGGESTED STRATEGIES: A national injury surveillance system for children who have disabilities should be developed to identify injury risk factors for children with disabilities. Children with disabilities should be monitored as a separate risk group in data collection regarding injuries. Parents should be aware of the cognitive level of their child and its influence on their injury risk. Crash testing on passenger restraints should include crash dummies whose physical characteristics resemble those of children who have disabilities. Families should have an emergency evacuation plan with specific consideration of their disabled child in the event of an emergency. Risk of burns to insensate skin and risks of thermal and friction trauma should be discussed when appropriate. The fire department and the police department should be notified of the presence of a child who has a disability in the home. Parents must be aware of the risk of falls to children who are mobile but cognitively impaired and to those in wheelchairs regardless of cognitive ability. Hospitals must have Child Protective Services teams with specific training in abuse to children with disabilities. Discussion of maltreatment risk should be addressed during routine office visits and appropriate resources should be made available to provide support to families. Educational programs should be developed to alert providers to the risks of abuse of children who have disabilities.

Accident Prevention↗
PubMed1993

Using yeast genetics to generate a research environment.

Many of the same features of the yeast Saccharomyces cerevisiae that have made it so useful as a genetics and molecular biology research organism make it equally useful as a teaching organism. Furthermore, the fact that it is a modern research organism makes it all the more exciting to students and teachers. The unique characteristic of yeast as a unicellular, eukaryotic organism with a complete sexual life cycle is ideal for teaching. A simple monohybrid cross to explore dominance and recessiveness, a dihybrid cross to demonstrate independent assortment, pigmented adenine auxotrophs for investigating the fundamentals of gene action, and easily measured responses to ultraviolet radiation provide an array of appropriate laboratory tools that put real science in the hands of students and teachers. Direct collaborations between scientists and science teachers bring together complementing knowledge and experience, providing an effective and efficient way to adapt and simplify techniques and procedures to accommodate time and money constraints. Collaborations quickly identify technical and theoretical problems that must be solved for implementation in classrooms. They also provide a continuing stimulus to teachers and students to participate in the research process.

Evaluation Studies as Topic↗
PubMed2006

Health promotion teams' effectiveness: a structural perspective from Israel.

This study addressed the question of how to structure coalitions in order to increase their engagement in multiple strategies for health promotion and consequently to improve their effectiveness. Three structural variables were chosen: (i) coalition's heterogeneity, captured by the professional diversity of its members; (ii) coalition's configuration, defined as the way members were involved in the coalition: full- or part-cycle membership, full- or part-time assignment, and core or peripheral membership; and (iii) coalition's contractual collaborations with external professionals. A large non-profit network of community centers served as the setting for this study. The sample consisted of 37 coordinators of local coalitions for health promotion in Israel. The study's design was a cross-sectional survey. Data were collected by a multimethod (semistructured interviews, self reported questionnaires and administrative data) approach. Effectiveness was assessed by a self-report questionnaire administrated to coalition coordinators. Engagements in multistrategies as well as structural variables were measured by semistructured interviews with coalition coordinators. Results demonstrated that while a homogeneous, bounded structure seemed to promote the implementation of health education programs, a more flexible coalition configuration with frequent use of professionals contributed more to working by multiple strategies and improved coalition's effectiveness. In addition, the use of external professionals promoted action for a healthier environment, but did not add to empowering the community. The results contribute to shifting the conception of a coalition as a tightly bounded, well-defined, stable entity to that of a more fluid and permeable structure interacting with an external environment. These findings highlight the importance of incorporating structural considerations into the management of coalitions and are discussed in light of the potential costs and benefits of alternative modes of structuring such coalitions.

Community Health Services↗
PubMed2004

Quasi-monoenergetic neutron reference fields in the energy range from thermal to 200 MeV.

Well-characterised neutron fields are a prerequisite for the investigation of neutron detectors. Partly in collaboration with external partners, the PTB neutron metrology group makes available for other users neutron reference fields covering the full energy range from thermal to 200 MeV. The specification of the neutron fluence in these beams is traceable to primary standard cross sections.

Algorithms↗
PubMed2006

Developing an institution-based assessment of resident communication and interpersonal skills.

PURPOSE: The authors describe the development and validation of an institution-wide, cross-specialty assessment of residents' communication and interpersonal skills, including related components of patient care and professionalism. METHOD: Residency program faculty, the department of medical education, and the Clinical Performance Center at the University of Illinois at Chicago College of Medicine collaborated to develop six standardized patient-based clinical simulations. The standardized patients rated the residents' performance. The assessment was piloted in 2003 for internal medicine and family medicine and was subsequently adapted for other specialties, including surgery, pediatrics, obstetrics-gynecology, and neurology. We present validity evidence based on the content, internal structure, relationship to other variables, feasibility, acceptability, and impact of the 2003 assessment. RESULTS: Seventy-nine internal medicine and family medicine residents participated in the initial administration of the assessment. A factor analysis of the 18 communication scale items resulted in two factors interpretable as "communication" and "interpersonal skills." Median internal consistency of the scale (coefficient alpha) was 0.91. Generalizability of the assessment ranged from 0.57 to 0.82 across specialties. Case-specific items provided information about group-level deficiencies. Cost of the assessment was about $250 per resident. Once the initial cases had been developed and piloted, they could be adapted for other specialties with minimal additional effort, at a cost saving of about $1,000 per program. CONCLUSION: Centrally developed, institution-wide competency assessment uses resources efficiently to relieve individual programs of the need to "reinvent the wheel" and provides program directors and residents with useful information for individual and programmatic review.

Clinical Competence↗
PubMedDate not supplied

The development of argument skills.

This work sought to obtain experimental evidence to corroborate cross-sectional patterns of development in argument skills and to evaluate the effectiveness of an intervention designed to foster development of these skills in academically at-risk 13- to 14-year-olds. Students participated in 16 sessions of a collaborative, goal-based activity providing dense exercise of argumentive thinking. One condition included peer dialogues; another did not. The former was the more effective, although both groups progressed. Participants showed increased frequency of usage of powerful argumentive discourse strategies, such as counterargument, and decreased frequency of less effective strategies. Quality of individual arguments (for or against a claim) also improved, supporting the existence of a close relation between these two kinds of argument skills.

Adolescent↗
PubMedDate not supplied

Models for community health partnerships.

More so than ever, the collaborative efforts of community partnerships are considered a powerful means of improving community health. These partnerships--voluntary collaborations of diverse community organizations--can enhance organizational and personal relationships in the community and thus promote the health of residents. But when major institutions and community leaders join forces, they frequently face problems in organizing their efforts. Some leading cross-sectoral partnerships have made major strides in overcoming these problems and in demonstrating tangible results.

Community Health Planning↗
PubMed2002

Cross-linking surface Ig delays CD40 ligand- and IL-4-induced B cell Ig class switching and reveals evidence for independent regulation of B cell proliferation and differentiation.

T cells stimulate B cells to divide and differentiate by providing activating signals in the form of inducible membrane-bound molecules and secreted cytokines. Provision of these signals in vitro reproduces many of the consequences of T-B collaboration in the absence of any form of Ag stimulation. Although clearly not obligatory, Ag signals appear to play an important regulatory role in numerous aspects of the B cell response. To examine directly the effect of an Ag signal, naive B cells were stimulated in the presence of rCD40 ligand, with or without IL-4 in the presence or absence of different anti-Ig mAbs. Anti-Ig mAbs exerted variable effects on the B cell division rate, from enhancement to no effect to inhibition. In contrast, all anti-Ig mAbs tested inhibited division-linked isotype switching to IgG1 and IgE. Thus, B cell Ag receptor ligands could modify the rates of B cell expansion and class switching independently. The ability of anti-Ig reagents to modify class switching suggests the B cell Ag receptor may play an important role in the selection of Ig isotypes during T cell-dependent humoral immune responses to Ags of different physical structure.

Adjuvants, Immunologic↗
PubMed2003

Benchmark dose risk assessment for formaldehyde using airflow modeling and a single-compartment, DNA-protein cross-link dosimetry model to estimate human equivalent doses.

Formaldehyde induced squamous-cell carcinomas in the nasal passages of F344 rats in two inhalation bioassays at exposure levels of 6 ppm and above. Increases in rates of cell proliferation were measured by T. M. Monticello and colleagues at exposure levels of 0.7 ppm and above in the same tissues from which tumors arose. A risk assessment for formaldehyde was conducted at the CIIT Centers for Health Research, in collaboration with investigators from Toxicological Excellence in Risk Assessment (TERA) and the U.S. Environmental Protection Agency (U.S. EPA) in 1999. Two methods for dose-response assessment were used: a full biologically based modeling approach and a statistically oriented analysis by benchmark dose (BMD) method. This article presents the later approach, the purpose of which is to combine BMD and pharmacokinetic modeling to estimate human cancer risks from formaldehyde exposure. BMD analysis was used to identify points of departure (exposure levels) for low-dose extrapolation in rats for both tumor and the cell proliferation endpoints. The benchmark concentrations for induced cell proliferation were lower than for tumors. These concentrations were extrapolated to humans using two mechanistic models. One model used computational fluid dynamics (CFD) alone to determine rates of delivery of inhaled formaldehyde to the nasal lining. The second model combined the CFD method with a pharmacokinetic model to predict tissue dose with formaldehyde-induced DNA-protein cross-links (DPX) as a dose metric. Both extrapolation methods gave similar results, and the predicted cancer risk in humans at low exposure levels was found to be similar to that from a risk assessment conducted by the U.S. EPA in 1991. Use of the mechanistically based extrapolation models lends greater certainty to these risk estimates than previous approaches and also identifies the uncertainty in the measured dose-response relationship for cell proliferation at low exposure levels, the dose-response relationship for DPX in monkeys, and the choice between linear and nonlinear methods of extrapolation as key remaining sources of uncertainty.

Administration, Inhalation↗
PubMed2001

The adequacy of diabetic care for children in a developing country.

UNLABELLED: A cross-sectional study was conducted over 4 months evaluating the quality of care provided to diabetic children in public children's hospitals in Alexandria, Egypt. RESULTS: Adult diabetologists were the main healthcare providers (HCP) (60.4%) in the School Health Insurance Hospital followed by paediatric diabetologists in the University Hospital. Insured children had a significantly higher frequency of physical examination, investigations and diabetes education compared to uninsured children. One-quarter of insured and 22% of uninsured children were performing self monitoring of blood glucose, while 45.2% of insured children were checking glucosuria at home compared to 34.0% of uninsured children. Premixed suspensions of biosynthetic human insulin, administered mainly via a syringe, was the most commonly prescribed insulin type with little possibility for personal initiative. Acute diabetic complications were also higher in uninsured compared to insured children. The frequency of these life threatening acute diabetic complications in the school health insurance system is estimated to be approximately 12.7 severe hypoglycaemic and 57.2 hyperglycaemic/ketoacidotic episodes per 1000 diabetic children per year. Recurrence of diabetic emergencies was significantly higher among children of parents with lower educational levels and children living in semiurban and rural residence. Children with recurrent diabetic emergencies had lower educational achievement, and more grade repeating and school absence during the year. CONCLUSION: The results of this study appear to reflect marked deficiencies in the provision of information to children with diabetes and their parents in a developing country. A need for public-education strategies, consensus about treatment recommendations, use of more flexible insulin regimens, and devices for home monitoring is identified.

Adolescent↗
PubMed2004

Educational epidemiology: applying population-based design and analytic approaches to study medical education.

Conducting educational research in medical schools is challenging partly because interventional controlled research designs are difficult to apply. In addition, strict accreditation requirements and student/faculty concerns about educational inequality reduce the flexibility needed to plan and execute educational experiments. Consequently, there is a paucity of rigorous and generalizable educational research to provide an evidence-guided foundation to support educational effectiveness. "Educational epidemiology," ie, the application across the physician education continuum of observational designs (eg, cross-sectional, longitudinal, cohort, and case-control studies) and randomized experimental designs (eg, randomized controlled trials, randomized crossover designs), could revolutionize the conduct of research in medical education. Furthermore, the creation of a comprehensive national network of educational epidemiologists could enhance collaboration and the development of a strong educational research foundation.

Education, Medical↗
PubMed2006

Identification and referral of patients with progressive CKD: a national study.

BACKGROUND: It is unclear whether primary care physicians (PCPs) and nephrologists differ in their recognition of progressive chronic kidney disease (CKD), agree on diagnostic and referral strategies, and identify similar barriers to caring for patients. METHODS: We conducted a national study of PCPs and nephrologists in the United States through a questionnaire describing a PCP caring for a patient with progressing CKD and questions to assess recognition of kidney dysfunction and approaches to diagnostic evaluation and referral. We identified participant and patient characteristics independently associated with CKD recognition and referral. RESULTS: We randomly identified a national sample of 304 physicians (126 nephrologists [39% response rate], 89 family physicians [28% response rate], and 89 general internists [28% response rate]). PCPs recognized CKD less (adjusted percentage, 59%; 95% confidence interval [CI], 47 to 69, family physicians; adjusted percentage, 78%; 95% CI, 67 to 86, general internists; adjusted percentage, 97%; 95% CI, 93 to 99, nephrologists; P < 0.01), differed from nephrologists in their recommendations for diagnostic testing, and recommended referral less (adjusted percentage, 76%; 95% CI, 65 to 84, family physicians; adjusted percentage, 81%; 95% CI, 70 to 89, general internists; adjusted percentage, 99%; 95% CI, 95 to 100, nephrologists; P < 0.01). PCPs differed from nephrologists in their expected intensity of specialists' involvement in care (16%, family physicians; 20%, general internists; 6%, nephrologists recommending nephrologist input monthly to every 6 months; P = 0.01). Lack of awareness of clinical practice guidelines and lack of clinical and administrative resources were identified as important barriers to care. CONCLUSION: PCPs recognize and recommend specialist care for progressive CKD less than nephrologists and differ in their clinical evaluations and expectations for referral. Improved dissemination of existing guidelines and targeted education in conjunction with efforts to build consensus among PCPs and nephrologists regarding their roles in the care of patients with CKD, including the collaborative development of clinical practice guidelines, could enhance patient care.

Chronic Disease↗
PubMed2000

Nosocomial ringworm in a neonatal intensive care unit: a nurse and her cat.

An outbreak of nosocomial ringworm involved five infants in a neonatal intensive care unit. The index case was a nurse infected with Microsporum canis by her cat. After standard infection control measures were initiated, the outbreak was resolved successfully by an interdisciplinary professional collaboration of physician and veterinary dermatologists and infection control personnel.

Adult↗
PubMed2005

Preferences of cardiologists and clinical geneticists for the future organization of genetic care in hypertrophic cardiomyopathy: a survey.

In view of the increasing demands for genetic counselling and DNA diagnostics in cardiogenetics, the roles of cardiologists and clinical geneticists in the delivery of care need to be redefined. We investigated the preferences of both groups of professionals with regard to the future allocation of six cardiogenetic responsibilities in counselling and testing, using hypertrophic cardiomyopathy (HCM) as a prevalent model disease. In this cross-sectional survey, the participants were Dutch cardiologists (n = 643) and clinical geneticists (n = 60), all members of professional societies. Response rates were 33 and 82%, respectively. In both groups, the majority preferred to perform most of the tasks described above in collaboration. Informing HCM patients about the genetics of HCM and requesting DNA testing in symptomatic patients was viewed by 43 and 35% of cardiologists, respectively, as their sole responsibility, however, and 39 and 59% of clinical geneticists did not object to these views. Both groups felt that the task of discussing the consequences of HCM for offspring and that of discussing the results of DNA diagnostics should be shared or performed by clinical geneticists. Both groups considered co-ordination of family screening the sole responsibility of clinical geneticists. Opinions on who should request DNA diagnostics in asymptomatic relatives were divided: 86% of clinical geneticists considered it their exclusive responsibility, 10% of cardiologists believed that this task could be performed individually by either group and 30% preferred to collaborate. Most professionals said that they would appreciate education programmes and clinical guidelines. Both cardiologists and clinical geneticists prefer to share rather than divide most cardiogenetic responsibilities in caring for HCM patients. Consequently, capacity problems in both groups are to be expected. To safeguard current professional standards in genetic counselling and testing, deployment of non-medical personnel might be essential.

Attitude of Health Personnel↗