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The effects of infantile malnutrition on behavioral development: a follow-up study.

Thirty-one children and young adults who had been severely malnourished in infancy due to intestinal disease, were compared with sibling controls for psychometric intelligence, academic performance as judged by teacher ratings, and developmental history as judged by parental questionnaires. Older members of the sample were also examined on the Lincoln-Oseretzky Motor Development Scale and by a brief psychiatric interview. There were no significant differences between patients and controls on any outcome measure. Furthermore, previously malnourished individuals were performing at or above age equivalent norms on all psychological tests. The findings suggest that the adverse behavioral effects of severe infantile malnutrition observed in children below the age of 5 yr are, to a large extent, compensated during development when the children are raised in supportive home and school environments.

Child Behavior↗

Breakfast habits of adolescents in for South African populations.

Breakfast habits by using questionnaires, were established in a total of 4717 South African pupils of 16 to 18 yr. In the groups of rural and urban Black, Indian, European-African-Malay, and white pupils studied, respective proportions who had no solid breakfast (both sexes combined) were approximately 21, 19, 13, 13, and 14%. Proportions who had only porridge or bread (or toast) plus drink were 77, 73, 61, 71, and 56%. Such breakfast provided ranges of means of 223 to 345 kcal, 9 to 14 g protein, 7 to 18 g fat, 51 to 185 mg calcium, and 3.2 to 5.1 mg iron. Proportions who had a cooked breakfast (including egg, meat, fish), eaten with or without a cereal food, were 1, 4, 17, 8, and 29%. Such meals contributed means of 495 to 704 kcal, 11 to 26 g protein, 24 to 39 g fat, 110 to 225 mg calcium, and 3.9 to 5.5 mg iron. In the South African groups studied, the issue of breakfast or no breakfast had no clear-cut bearing on weight, height, class position, or frequency of absence from school. The degree by which, in a given community, nutrition in general and breakfast in particular, regulates health and/or academic performance, needs proper research in prospective studies.

Adolescent↗

Association of serum cholesterol and history of school suspension among school-age children and adolescents in the United States.

The dietary guidelines developed for adults have been extended to children, but the role of serum cholesterol in the neurodevelopment of children is poorly understood. In the Third National Health and Nutrition Examination Survey (1988-1994), serum total cholesterol was measured in 4,852 children aged 6-16 years. Psychosocial development was evaluated by interviewing the mother regarding the child's history of school suspension or expulsion and difficulty in getting along with others. After adjustment for family socioeconomic status, maternal marital status and education, children's nutrition, and academic performance, the odds ratios of children with various concentrations of total cholesterol showed the children to be equally comfortable in their own peer subculture and not to be different in the proportion that had seen a mental health professional. However, non-African-American children with a serum total cholesterol concentration below the 25th percentile (<145 mg/dl) were almost threefold more likely to have been suspended or expelled from schools than their peers with total cholesterol at or above the 25th percentile (odds ratio = 2.96, 95% confidence interval: 1.55, 5.64). The authors concluded that, among non-African-American children, low total cholesterol is associated with school suspension or expulsion and that low total cholesterol may be a risk factor for aggression or a risk marker for other biologic variables that predispose to aggression.

Adolescent↗

Reported levels of alcohol consumption and binge drinking within the UK undergraduate student population over the last 25 years.

Results of a literature review of 18 studies investigating the drinking behaviour of undergraduate students at UK universities over a period of 25 years are presented. While comparison between studies is complicated by inconsistencies in the terms employed to describe drinking behaviour, it is concluded that significant numbers of both male and female students are reported to exceed sensible weekly consumption guidelines. Recorded levels of binge drinking among both female and male students are extremely variable between studies. Further research is needed to clarify this position. However, if the most recent research evidence is substantiated, female and male binge drinking levels may exceed those of their peers in the general population and their US counterparts. The reported ramifications of harmful drinking for the health and well-being of students are reviewed. A possible link between poor academic performance and alcohol consumption appears tenuous and merits further investigation. Evidence relevant to the view that the drinking behaviour of female students is changing is considered.

Adolescent↗

"To grandmother's house we go": health and school adjustment of children raised solely by grandparents.

This study uses data from the 1988 National Children's Health Supplement (N = 17,110) to the National Health Interview Survey to examine the health and school adjustment of children raised solely by grandparents. We find that these children fare quite well relative to children in families with one biological parent present, a category which includes both single-parent and blended families. Furthermore, children raised solely by grandparents are not significantly different, except for academic performance, from children raised in traditional families where two biological parents are present.

Adult↗

Outcome evaluation of a multi-component violence-prevention program for middle schools: the Students for Peace project.

This study evaluated the effect of Students for Peace, a multi-component violence-prevention intervention, on reducing aggressive behaviors among students of eight middle schools randomly assigned into intervention or control conditions. The intervention, based on Social Cognitive Theory, included the formation of a School Health Promotion Council, training of peer mediators and peer helpers, training of teachers in conflict resolution, a violence-prevention curriculum, and newsletters for parents. All students were evaluated in the spring of 1994, 1995 and 1996 (approximately 9000 students per evaluation). Sixth graders in 1994 were followed through seventh grade in 1995 or eighth grade in 1996 or both (n = 2246). Cohort and cross-sectional evaluations indicated little to no intervention effect in reducing aggressive behaviors, fights at school, injuries due to fighting, missing classes because of feeling unsafe at school or being threatened to be hurt. For all variables, the strongest predictors of violence in eighth grade were violence in sixth grade and low academic performance. Although ideal and frequently recommended, the holistic approach to prevention in schools in which teachers, administrators and staff model peaceful conflict resolution is difficult to implement, and, in this case, proved ineffective. The Students for Peace experience suggests that interventions begin prior to middle school, explore social environmental intervention strategies, and involve parents and community members.

Adolescent↗

Estimating rates of psychosocial problems in urban and poor children with sickle cell anemia.

The risk of adjustment problems increases when a child has a serious life-threatening illness. This article estimates the frequency of adjustment problems across multiple domains for children and adolescents with sickle cell anemia (SCA). Parents provided information on the social, emotional, academic, and family adjustment of 327 children with SCA who were being treated at a comprehensive sickle cell clinic serving a predominantly poor and urban population. More than 25 percent of these children had emotional adjustment problems in the form of internalizing symptoms such as anxiety and depression. In addition, at least one child in five had problems related to social functioning and academic performance. These impairments were related significantly to the frequency of serious pain episodes but not to absolute family income. No significant differences in the data were found based on family income. The data also showed that the disruptive effects of the illness were related to gender and age.

Adaptation, Psychological↗

An investigation of the effects of daily physical activity on the health of primary school students in South Australia.

Studies of the health effects of a daily physical activity programme have been carried out in 10-year-old school children in Adelaide, South Australia. In the first phase (1978) observations on endurance fitness, four skin folds, blood pressure and blood lipids were made before and after a randomized trial over a period of 14 weeks. Comparisons were made on over 500 children drawn from classes in seven Primary schools involved in an endurance fitness programme (1 1/4 hours per day), a skill programme and the previous physical education programme (controls). The fitness group experienced significant gains in physical work capacity (PWC) and showed significant decreases in body fat compared to the other two groups. No significant differences were observed in plasma cholesterol, triglycerides and HDL cholesterol. Subsequently in the second phase (1980) observations were made on a group of 216 10-year-old children who had already experienced two years of the physical activity programme adopted after phase one. Comparison with the observations in the 10-year-old children in 1978 made prior to the intervention revealed significantly smaller skin folds and greater PWC, with lower blood pressure reaching statistical significance for diastolic pressure in boys. The findings suggest beneficial effects on health of daily physical activity programmes within existing primary school curricula. There was no evidence of any loss of academic performance as measured by arithmetic and reading tests in spite of 45-60 minutes' loss of formal teaching time each day.

Australia↗

The correlates of comorbid antisocial personality disorder in schizophrenia.

More than 15 years ago, findings from the Epidemiological Catchment Area Study indicated that antisocial personality disorder (APD) is more prevalent among persons with schizophrenia than in the general population. The present study analyzed data from a multisite investigation to examine the correlates of APD among 232 men with schizophrenic disorders, three-quarters of whom had committed at least one crime. Comparisons of the men with and without APD revealed no differences in the course or symptomatology of schizophrenia. By contrast, multivariate models confirmed strong associations of comorbid APD with substance abuse, attention/concentration problems, and poor academic performance in childhood; and in adulthood with alcohol abuse or dependence and deficient affective experience (a personality style indexed by lack of remorse or guilt, shallow affect, lack of empathy, and failure to accept responsibility for one's own actions). At first admission, men with schizophrenia and APD presented a long history of antisocial behavior that included nonviolent offending and substance misuse, and an emotional dysfunction that is thought to increase the risk of violence toward others. Specific treatments and management strategies are indicated.

Antisocial Personality Disorder↗

Friends after traumatic brain injury in children.

OBJECTIVE: To determine whether a dose-response relation exists between the number of reported close friends and traumatic brain injury (TBI) severity in the postacute phase in school-age children. DESIGN: A retrospective relational study. SETTING AND PARTICIPANTS: Primary care hospital/medical center-based study on parental perspectives of recovery following TBI in school-age children (14 with severe TBI; 10 with moderate TBI; 36 with mild TBI; and 16 trauma controls). MAIN OUTCOME MEASURES: Parental ratings on the Child Behavior Checklist and selected neuropsychological test findings and ratings of academic performance. RESULTS: Seventy-five percent of trauma controls but only 38.9% of children with mild and 20% of children with moderate TBI reportedly had 4 or more friends. Only 14.3% of children with severe TBI reportedly had 4 or more friends. Glasgow Coma Scale score at admission correlated with the number of friends postacutely (by parental reports) (r = +0.307, N = 76, P = .007). CONCLUSION: More severe brain injury is associated with fewer friends in the postacute phase following TBI. The relation, however, was not purely linear and the hypothesis was supported only partially. Broadening the social network of children with moderate and severe TBI should be a major goal of neuropsychological rehabilitation.

Brain Injuries↗

A look at a deviant group of medical school applicants.

A total of 246 physicians who either had graduated from or had matriculated without graduating from dental school prior to entering a medical school were identified, and a combination multiple-choice, open-ended questionnaire was mailed to the group. Completed questionnaires were recived from 194 subjects for a 79 percent response rate. The questionnaire was designed to elicit information about the decision to study dentistry and the subsequent decision to study medicine. The authors were also interested in the process of admission to medical school, in academic performance in both schools, in choice of medical specialty, and in attitudes toward dentistry and medicine.

Achievement↗

Some predictive implications of premedical scientific competence and preferences.

Current medical school admissions criteria favor candidates with superior scientific aptitude and strong interests in scientific subjects. Four measures of this cluster were studied: Medical College Admission Test Science subtest scores, premedical grades in scientific subjects, preference for scientific subjects, and an equally weighted composite of these three. In a sample of 1,135 medical school graduates the four predictors were moderately related to academic performance in the first two years of medical school but almost completely unrelated to performance in the fourth year and to faculty ratings of general and clinical competence. The scientifically oriented graduates tended to enter specialties such as anesthesiology, pathology, and surgery, whereas graduates ranking lower on the overall index showed a slight tendency to prefer internal medicine, pediatrics, and psychiatry. Ratings and adjectival descriptions of premedical students with above average scores on the four measures revealed them to be narrower in interests, less adaptable, less articulate, and less comfortable in interpersonal relationships than their lower scoring peers.

California↗

An analysis of empathy in medical students before and following clinical experience.

The nature and direction of changes in empathy as measured by Hogan's empathy scale was explored over time (1975, 1976, and 1979) for medical students in the class of 1979 at the Bowman Gray School of Medicine. Results indicated that empathy scores declined slightly over time, correlated negatively with Medical College Admission Test scores, and were unrelated to academic performance or performance on Part I or Part II examinations of the National Board of Medical Examiners.

Achievement↗

The question of stress among first-year medical students.

In a study reported in this article, the authors investigated the presence of stress in two successive classes of first-year medical students at a private midwestern medical school. Support groups, didactic sessions, and no-contact control conditions were used. Few differences in personality measures were found among the groups, and all group means were within the normal range. Support groups did not facilitate academic performance. The results bring into question the previously reported extent of chronic stress among students in the first year of medical school as well as the need for support groups in this population.

Anxiety↗

Stress, coping, and well-being among third-year medical students.

BACKGROUND: Medical school is recognized as a stressful environment that often exerts a negative effect on the academic performance, physical health, and psychological well-being of the student. METHOD: Stress, coping, depression, and somatic distress were examined among 69 third-year students completing a psychiatry clerkship in 1992-93 at the University of Mississippi School of Medicine. Stress was assessed using the Medical Education Hassles Scale-R. Coping was assessed using the Coping Strategies Inventory. Depression was assessed using the Center for Epidemiologic Studies-Depression Scale, and somatic distress was assessed using the Wahler Physical Symptoms Inventory. Statistical methods included correlational analysis and hierarchical regression. RESULTS: Clinical levels of depression were found in 16 (23%) of the students, and 39 (57%) endorsed high levels of somatic distress. Stress accounted for a large percentage of the distress variance (i.e., 29% to 50%). Coping efforts contributed significant variance to the prediction of distress above and beyond that accounted for by stress alone, especially in relation to depression. Coping efforts classified by Engagement strategies were associated with fever depressive symptoms, while coping efforts classified by Disengagement strategies were associated with higher levels of depressive symptoms. CONCLUSIONS: Because students who employed coping efforts characterized by Engagement strategies suffered from fewer depressive symptoms, the results suggest that training in these types of strategies may be a useful intervention to lessen the negative consequences of stress among medical students.

Adaptation, Psychological↗

Effect of debt on U.S. medical school graduates' preferences for family medicine, general internal medicine, and general pediatrics.

The authors assess the importance of educational debt in graduates' primary care specialty choices, and the variety of mechanisms through which debt may influence career decisions. Logistic regression models were used to identify significant predictors of the primary care specialty choices made by the 1991 and 1992 graduates of U.S. medical schools. These predictors were debt itself; other financial indicators; certain medical school characteristics; certain practice location plans; certain demographic factors; aspects of academic performance; and students' predisposition to a primary care specialty. Data for this study were gathered from a variety of sources at the Association of American Medical Colleges and from the Health Education Assistance Loans program. Both direct and indirect effects of debt were identified under specific conditions. The study revealed complex relationships between debt and the other predictors identified. For example, debt operated in relation to the levels of the graduates' expected incomes; debt from subsidized loan sources was significant for women who chose general internal medicine; debt was important in choices of family practice; and debt by itself was significant for those planning to practice in the West and who chose general internal medicine. Also, seemingly opposing effects of debt occurred. For example, in the family practice model used in this study, the threshold effect of debt was positive, while the linear effect of debt above the threshold was negative. Such vriations help explain the conflicting findings of some past research. These and other findings prompt the authors to state that when investigating the effects of debt, it is not fruitful to ask what the effect of the debt is on all three primary care fields as a group. It is more appropriate to ask several questions, such as: under what conditions does debt influence specialty plans? Among which groups of students does debt have an impact on specialty plans? Are all of the primary care specialties similarly affected by the issues surrounding debt? Does the effect of debt change over time? The authors conclude by indicating possible policy implications of their findings.

Career Choice↗

A pilot study of the use of the analytic hierarchy process for the selection of surgery residents.

PURPOSE: To compare a specific decision-making process-the analytic hierarchy process (AHP)-with the traditional informal selection process in the selection of general surgery residents. METHOD: The study focused on 1994 and 1995 applicants for the four positions in the five-year general surgery residency program at the Graduate Hospital in Philadelphia. Three criteria were used: academic performance, personal fit, and surgical appropriateness. The relative importance of each was determined by pairwise comparison. For each hierarchy level, these comparisons were combined into a pairwise comparison matrix, and weights were determined for each criterion and rating category. The rating-category weights for each criterion were scaled so that outstanding received the full criterion weight. Each applicant was interviewed by three committee members and rated with both the AHP system and the traditional 0-10 scoring system. In both cases the rating scores were averaged to create a single score for each applicant. The final ranking list (advocacy ranking) was compiled at a meeting of the entire selection committee, during which each member spoke on behalf of the candidates he or she had interviewed. RESULTS: Significant Spearman correlations were found between the AHP ranking and the traditional ranking in both years (1994: n = 26, r = .63, p = .0005; 1995: n = 25, r = .061, p = .0012). The AHP ranking was also significantly correlated with the advocacy ranking in 1994 (n = 26, r = .43, p = .0273); however, there was no significant correlation found in 1995. In 1994 the traditional ranking significantly correlated with the advocacy ranking (n = 26, r = .40, p = .0423). This was not the case in 1995, suggesting that the results of the interviewing process had minimal influence on the outcome of the selection process that year. CONCLUSION: The findings from this pilot study support the use of the AHP as a viable alternative for the selection of surgical residents. Although the small sample size limits the generalizability of the results, the AHP is a quantitative alternative to the traditional, unwieldy, and subjective selection process. Quantitative assessment and ranking of all aspects of a candidate's attributes and performance allow a program to more closely match a candidate to that particular institution.

Decision Making↗

The role of the medical school admission process in the production of generalist physicians.

Medical education research has identified a number of medical student characteristics that are related to graduates' entering generalist careers. These include initial specialty preference, geographic background, gender, age, ethnicity, economic and lifestyle factors, attitudes and personal values, service orientation, and premedical academic performance. Identifying and giving weight to these factors in the medical school admission process is likely to increase the number of graduates who choose generalist specialties. This paper discusses these medical student characteristics and presents strategies that medical schools could use in the selection process to enhance the matriculation of students who are most likely to become generalists. In this way, medical schools will be able to recruit and select students who are most likely to become excellent physicians, and also produce a more appropriate balance of all specialists to meet the needs of the population.

Career Choice↗