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PubMed2006

Measuring the development of executive control with the shape school.

Although several neurodevelopmental and psychiatric disorders can emerge during the preschool period, there are comparatively few instruments to assess executive control. Evidence for validity of the Shape School (K. A. Espy, 1997) was examined in a sample of 219 typically developing young children. There was good evidence for validity, as Shape School performance variables were interrelated and were associated to other criterion measures considered to measure aspects of executive control. Also suggesting validity, the Shape School variables varied as a function of whether the task demands (a) were executive, (b) required inhibition of a prepotent response or context-controlled selection among relevant stimulus-response sets, and (c) included unitary or concurrent processing. The Shape School may be an effective tool by which to measure executive control in young children who have atypical developmental patterns.

Attention↗
PubMed1996

The Juvenile Arthritis Functional Status Index (JASI): a validation study.

OBJECTIVE: To evaluate aspects of reliability and validity of the Juvenile Arthritis Functional Status Index (JASI). We developed this questionnaire to assess a variety of daily living and functional mobility tasks in children with juvenile rheumatoid arthritis (JRA). JASI part I consists of 100 functional items divided into 5 activity categories (self-care, domestic, mobility, school, extracurricular). A 7 point degree of difficulty rating scale is used for responses. JASI Part II is a priority function section within which the child identifies and scores important activities for improvement. METHODS: The JASI was administered to 30 children with JRA 8 to 19 years of age at baseline, 3 weeks, and 3 months to determine test-retest reliability. Various rheumatology measures were used to evaluate the JASI construct validity. RESULTS: Reliability of JASI Part I was excellent (intraclass correlation coefficients > or = 0.95) for both retest intervals. Reliability was lower for respondents with mild disease than those with polyarticular disease. JASI Part I scores correlated strongly with rheumatology measures including joint count, grip strength, hip synovitis, timed walk and run. ACR functional class, and range of motion (r > 0.50), indicating construct validity. There was fair to good agreement between scores from the child's self-report and those from therapist observation of the child's abilities on the same activities. This provides evidence that children as young as 8 years of age can realistically report on function on their own. In JASI Part II, respondents identified a mean of 5.9 functional items in the baseline priority activity list. Test-retest reliability for JASI Part II was fair (kappa = 0.57). Further work is needed to determine the most reliable and sensitive response sequence for evaluating change in priority functions with JASI Part II. CONCLUSION: JASI Part I is a reliable and valid functional measure for school age children and adolescents with JRA. Research is under way to evaluate responsiveness to change. Comparisons will be made with shorter JRA functional measures to determine differences in sensitivity.

Activities of Daily Living↗
PubMed2000

Nocturnal asthma in children affects school attendance, school performance, and parents' work attendance.

CONTEXT: Asthma symptoms that occur at night may signal worse asthma control, but the nighttime occurrence may have additional clinical significance. To date, however, there have been few studies of the impact of nocturnal awakening from asthma on children with the disease, including problems with daytime functioning. OBJECTIVE: To determine if school absenteeism and school performance in children and work absenteeism in their parents are associated with nocturnal awakenings from asthma. DESIGN: Cross-sectional survey during the winter of 1997 through 1998. SETTING: Three managed care organizations in the United States. PARTICIPANTS: Parents of 438 children with asthma, aged 5 to 17 years, who were enrolled in managed care organizations. INTERVENTION: None. MAIN OUTCOME MEASURES: Parent's reports of number of days their child missed school and parent missed work and how often the child's education suffered because of asthma in the past 4 weeks. RESULTS: Overall, more than 40% of children had nocturnal awakenings from asthma in the past 4 weeks. Multivariate analyses were performed that adjusted for child age, race, overall symptom severity, and use of reliever medications. Compared with children who did not awaken from asthma, there were greater odds of missed school days in children who awakened 1 to 3 nights (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.1-6.2), 4 to 7 nights (OR, 4.4; 95% CI, 2.0-10.0), and more than 7 nights (OR, 14.7; 95% CI, 5.9-37.0). Similarly, there were greater odds of education suffering in children who awakened 1 to 3 nights (OR, 2.3; 95% CI, 1.4-3.7), 4 to 7 nights (OR, 2.1; 95% CI, 0.9-4.6), and more than 7 nights (OR, 2.3; 95% CI, 1. 0-5.4), and parents missing work in children who awakened 1 to 3 nights (OR, 4.0; 95% CI, 2.2-7.1), 4 to 7 nights (OR, 6.5; 95% CI, 2.7-16), and more than 7 nights (OR, 3.2; 95% CI, 1.3-7.9). Greater overall symptom severity and high use of reliever mediation were also associated with missed school, education suffering, and parent absenteeism. CONCLUSIONS: Nighttime awakenings in children with asthma may affect school attendance and performance, as well as work attendance by parents. Nighttime symptoms have independent prognostic value, even when overall asthma symptom severity is accounted for. By addressing whether there are nighttime awakenings in children with asthma, clinicians may be able to tailor the therapeutic regimen to counter these symptoms.

Absenteeism↗
PubMed1994

Prevalence of affective disorder in the child and adolescent offspring of a single kindred: a pilot study.

OBJECTIVE: The study determined the prevalence of psychiatric disorders among the child and adolescent offspring of an extended family identified through a proband with bipolar affective disorder. METHODS: All of the not mentally retarded offspring (ages 6 to 17 years) of a single extended bipolar affective disorder pedigree were studied. Data regarding psychiatric diagnoses, intelligence, school achievement, temperament, and family functioning were collected using structured and standardized instruments. RESULTS: When the child and adolescent offspring were stratified by degree of genetic relationship to an adult with an affective disorder, there were no differences in demographic variables, IQ, school achievement, or most temperamental and family characteristics. In contrast, there were increases in the rates of affective disorders and disruptive behavior disorders in the offspring that correlated with the degree of genetic relationship to an affected adult. CONCLUSIONS: The risk of developing an early onset affective disorder is correlated with the degree of genetic relatedness to affected adults in this single, extended family. This pilot study demonstrates that the inclusion of extended relatives in high-risk studies can enhance the discrimination of genetic and environmental contributions to the development of affective disorders.

Adolescent↗
PubMed2003

Harry Sicher, MD, DSc.: pioneer dental anatomist.

Harry Sicher, MD, DSc (1889-1974), a world-renowned and highly respected head, neck and dental anatomist, received his MD from the University of Vienna Medical School in his native Austria in 1913. Studying under the famed Dr. Julius Tandler, Sicher received a broad and solid foundation in all aspects of anatomy. He clearly understood that anatomic structure was closely related to body function. After graduating from medical school, Dr. Sicher specialized in dentistry, where he worked in clinical practice, teaching and research. He remained associated with the University of Vienna until 1938, when Hitler's annexation of Austria forced Jewish intellectuals to flee from Europe. Sicher emigrated to Chicago in 1939 where he became a professor and chairman of the anatomy department at the Loyola Dental School until his retirement as professor emeritus in 1960. The extent of Harry Sicher's knowledge and scientific productivity was staggering. He studied and understood the complexities of many scientific disciplines, including anthropology, applied head, neck and oral anatomy, biology, bone metabolism, comparative anatomy, embryology, endocrinology, entomology, evolutionary biology, histology, occlusion, pathology and physiology. His collaborations with Drs. Balint J. Orban and Joseph P. Weinmann were especially productive. In the classroom, his teaching skills were legendary. As a roving lecturer, he spoke to dental, medical and specialty audiences worldwide for decades. He had the rare ability to make a description of the human body come vibrantly alive. Several of his books, Oral Anatomy (1949), Bone and Bones (1944) and Orban's Oral Histology and Embryology (1962, 1966, 1972) became authoritative textbooks for dentists throughout the world.

Anatomy↗
PubMedDate not supplied

Iodine and selenium deficiency in school-children in an endemic goiter area in Turkey.

Endemic goiter is one of the most important health problems in Turkey. However, there are not enough studies associated with iodine and selenium status. This study was carried out to establish the effects of iodine and selenium levels on thyroid gland size and thyroid functions in 73 healthy school-children, 7-12 years old (mean 9.56 +/- 1.77 years), 38 girls (52%) and 35 boys (48%), living in an endemic goiter area. Goiter was found in 32 of the children (43.8%) by palpation, and 56 of the children (76.7%) by ultrasonography. Mean serum T3 and TSH levels were in the upper limit of normal, and mean serum T4 levels were within the normal limits, but mean serum thyroglobulin levels were higher than the normal limits. Mean serum selenium level was 30.84 +/- 23.04 microg/l, and mean urinary iodine level was 3.91 +/- 3.77 microg/dl, appropriate for moderate iodine and selenium deficiency. Thyroid volumes of the children were negatively correlated with serum selenium levels, but there was no correlation with urinary iodine levels and thyroid hormones. In conclusion, school-children in this area had significant goiter problems, probably due to the iodine and selenium deficiencies.

Child↗
PubMed2004

Implementation of the diagnosis procedure combination in specific-function hospitals.

A Nobel medical payment system, the Diagnosis Procedure Combination (DPC), was implemented in Nippon Medical School Hospital and 81 other specific-function hospitals in 2003. This payment system depends on the length of hospital stay and diagnosis and medical procedures, and differs from the existing payment system, which depends on a piece rate. The daily payment differs for among almost 2,500 groups of DPC defined by the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and procedures, such as operations (K and J codes of the existing payment system). One of the most important outcomes may be a decrease in lengths of hospital stay, because the range of mean lengths of stay in specific-function hospitals has been officially stated to be 14 to 30 days, and the difference between the longest and shortest mean is almost double. The new medical payment system should stimulate competition among hospitals. In order to decrease the length of stay, we developed clinical pathways for patients undergoing surgery, such as laparoscopic cholecystectomy, gastrectomy, and inguinal hernia operations, as well as clinical protocols for the surgical procedures, such as percutaneous transhepatic cholangiodrainage (PTCD) and percutaneous endoscopic gastrostomy (PEG). Health care is undergoing a challenging transition, and we must improve patient care and clinical practice.

Critical Pathways↗
PubMed1991

The dimension of focussed attention: relationship to behavior and cognitive functioning in children.

A sample of 73 nonreferred school children were administered a newly developed Visual Focussed-attention Test along with other measures of attentional, cognitive, and behavioral functioning. Internal reliability and construct validity for the test were established. Children were then divided into underfocussed (distractible, n = 6), normofocussed (n = 38), and overfocussed (n = 5) groups based upon their test scores. The three groups did not differ with regard to age, intellectual functioning, or academic achievement. However, the underfocussed and overfocussed groups contained a greater proportion of behaviorally disturbed children than the normofocussed group. Underfocussed children, as a group, were rated higher than normofocussed, but not higher than overfocussed children on the Hyperactivity factor of the Conners Teacher Questionnaire. The significance of these focussed attention deficits is reviewed in relation to the more familiar concepts of distractibility and hyperactivity.

Attention↗
PubMed1998

Evaluation of external breathing in children living in a region with industrial pollution.

BACKGROUND: The changes in respiratory functions are among the most sensitive indicators available for the evaluation of the influence of air pollution on health. OBJECTIVE: The objective of the present study was to evaluate the respiratory functions of children from three schools situated at a different distance from the major sources of air pollution--an asbestos-cement plant, a fertilizer plant and a steam-power plant which utilize brown coal as a main source of energy. METHODS: Comprehensive functional investigation of breathing (FIB) was performed on 97 children from the town of Dimitrovgrad--mean age 10.4 +/- 0.1 years and height 145 +/- 0.6 cm (mean +/- Sx) in a special university medical center laboratory. The characterization of the degree of air pollution was based on the analysis of the mean yearly concentrations of particulate matter, sulfur dioxide, nitrogen dioxide, ammonia and hydrogen sulphide in the three zones of exposure in the town on the basis of the criteria outlined in the Uniform National System for Control of Air Pollution in Bulgaria. RESULTS: The mean yearly concentrations of particulate matter up to 0.19 mg/m3, of hydrogen sulphide--up to 0.07 mg/m3, of nitrogen dioxide--up to 0.025 mg/m3, of ammonia--up to 0.16 mg/m3, of hydrogen sulphide--up to 0.13 mg/m3 and lead aerosols--up to 0.00012 mg/m3 recorded at the different stations reached statistical significance at some of them. No significant differences were found in the values of lung function parameters of the healthy children from all three zones. MEF50% (94 +/- 2%) and the Single Breath Transfer Factor (TLCO = 93 +/- 1.5%) showed a tendency towards lower values. CONCLUSIONS: In the low-grade pollution that we found in the present study no significant differences were found in the lung function parameters of the children from the three regions.

Air Pollutants↗