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PubMed2004

Psycho-educational interventions for children with chronic disease, parents and siblings: an overview of the research evidence base.

BACKGROUND: The role of psycho-educational interventions in facilitating adaptation to chronic disease has received growing recognition and is in keeping with policy developments advocating greater involvement of patients in their own care. The purpose of this paper is to provide an overview of the current literature regarding the effectiveness of psycho-educational interventions for children and adolescents with chronic disease, their parents and siblings. METHODS: Electronic searches were conducted using AMED, CINAHL, Cochrane Database, DARE, HTA, MEDLINE, NHS EED, PsycLIT, PsycINFO, and PubMED. Inclusion criteria were systematic reviews, meta-analyses and overviews based on traditional reviews of published literature. The titles of papers were reviewed, abstracts were obtained and reviewed, and full copies of selected papers were obtained. RESULTS: No reviews of psycho-educational interventions were found for either parents or siblings. Twelve reviews of interventions for children and adolescents were identified: chronic disease in general (three); chronic pain (one); asthma (three); chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) (one); diabetes (two); juvenile idiopathic arthritis (JIA) (one) and one informational intervention for paediatric cancer patients. The main focus was on disease management (particularly in asthma and diabetes) with less attention being paid to psychosocial aspects of life with a chronic condition. Overall, there is evidence of effectiveness for interventions incorporating cognitive-behavioural techniques on variables such as self-efficacy, self-management of disease, family functioning, psychosocial well-being, reduced isolation, social competence, knowledge, hope, pain (for chronic headache), lung function (asthma), days absent from school (asthma), visits to A & E (asthma), fatigue (CFS), and metabolic control (diabetes). A number of gaps and limitations were identified across all disease categories, such as inadequate description of interventions, small sample sizes, and lack of evidence regarding cost-effectiveness. CONCLUSION: This overview has highlighted the need to extend the evidence base for psycho-educational interventions, particularly in a UK context. It is essential that effective interventions are implemented and embedded in service provision in order to maximize empowerment through self-care for children, adolescents and their parents.

Adaptation, Psychological↗
PubMed1986

Adam--a severely-deprived Colombian orphan: a case report.

The case study of Adam, a severely-deprived Colombian orphan, is presented. At 16 months of age the child was suffering from severe marasmic malnutrition, his development was about the level of a 3-month old, he had been physically neglected and was emotionally withdrawn. Adam was adopted at 34 months of age. At 8 years of age his Full-Scale WISC-R-IQ was 113 and at 10 years of age he scored 100% on the Michigan Assessment Test. Now at 13 years 10 months he is functioning at the 8th grade school level, which is appropriate for his age, and his weight and height are in the 50th centile range.

Adoption↗
PubMed1993

Structured interviews for assessing children.

Structured interviews provide a valuable means of obtaining and quantifying information about the mental status of children. This review indicates that children can reliably self-report and that the information they provide can concur with the opinion of adults knowledgeable about them. However, considerably more research is warranted before it may be assumed that these interviews are adequately reliable and valid. In general, it appears that the task of documenting the psychometric soundness of these interviews has not been taken seriously, as if content validity were sufficient. For example, except for the CAS and the DISC, there has been little effort to study contrast group validity (i.e. whether the interview even differentiates "known groups"). More specifically, review of the reliability and validity data relevant to DSM-III-R diagnoses provides support for the CAS, DICA, ISC and K-SADS, with the validity data for the DICA being weaker than for the others. One limitation of these data for the DICA, ISC and K-SADS is that the diagnoses were clinician-generated, rather than algorithm-generated. Unfortunately the processes for generating clinical diagnoses were not specified, except for criterion reference to DSM-III-R. The findings for the DISC and the DISC-R are notably weak. There is no evidence for DISC reliability, except for adolescents, and the validity studies have demonstrated only weak relationships. There has been limited study of the psychometric properties of symptom scales. In fact, for two interviews (i.e. DICA and ISC), there are no data available. Reliability for the DISC scales is adequate only for adolescents. Psychometric data have been generated for the CAS and the K-SADS, with considerably more studies conducted with the CAS. The relative paucity of interest in scale scores is striking given that they provide a continuous variable which can indicate extent of symptoms. Other measures of mental status, besides presence/absence of diagnosis, will become increasingly important as research in child psychopathology progresses toward more sophisticated studies (i.e. treatment effects, risk factors). These interviews are labor intensive and costly to the researcher as well as time-consuming and tedious for the children and parents. Given this commitment, researchers should invest in developing other ways of exploiting the richness of the data generated. An example is the CAS "content" scales, which generate scores reflecting on the child's functioning in various areas (e.g. school, friends, family). As the evolution of these interviews continues, it will be important to remain attentive to the developmental limitations of children.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1996

Screening of amblyopic children and long-term follow-up.

A prospective study of amblyopic children was carried out in 1982-1992 in the ophthalmology unit of a community health center, a referral center for 14,000 preschool children. Five hundred and twenty-six children in 1982-1983 were referred to an ophthalmologist because of a suspicion of amblyopia, strabismus or other visual disorders. Amblyopia was diagnosed in 109 children. In 18 children amblyopia was on an organic basis and among them 4 children had X-chromosomal retinoschisis. Risk factors for functional amblyopia were convergent strabismus, spherical equivalent of the refractive error of 3.5 dioptres or more or anisometropia of 1.0 dioptres or more. The children with established functional amblyopia (91 children) were treated with a full-time occlusion, or, at the age of younger than 18 months, with 0.5% atropin, and, at the minimum of 6 years, with pleoptics when indicated. One hundred amblyopic children were followed for a minimum of 4 years, reinstituting the occlusion therapy if visual acuity deteriorated. Seventy-two children with functional amblyopia (79%) were available for a detailed ophthalmological examination 9.7 years, on the average, after the initial examination. Only three of these children (4%) had visual acuity of less than 0.4 at that time. Well-functioning child health centers and school health care, as well as the availability of ophthalmological services, are important for a good final visual result of amblyopic children.

Amblyopia↗
PubMed1984

Nine-year follow-up of infants weighing 1 500 g or less at birth.

A nine-year follow-up of 116 children born consecutively in 1971-74 with a birthweight of 1 500 g or less showed that 59 had died. Of those who were alive, four had severe motor and/or mental handicaps and three were blind because of retrolental fibroplasia. The low birthweight children without severe handicaps were found to have impaired motor function, speech defects and impaired school achievement more often than the controls. There was a significant correlation between the test results at the age of five and nine years, which indicates that children with school failure can be recognized and early remedial treatment started before school or on starting school.

Birth Weight↗
PubMed2001

Understanding and caring for the child with Asperger syndrome.

Nurses in a variety of settings encounter children with the unfamiliar diagnosis of Asperger syndrome (AS). This disorder, which falls clinically along the autism spectrum, is receiving increasing attention because of its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as one of the pervasive developmental disorders. The characteristic features of AS include deficits in social skills, atypical understanding of and use of pragmatic language, behavior problems, and a restricted set of interests. Cognitive abilities vary, and some children with AS have high intelligence. In addition, many children with AS have other conditions, such as attention deficit hyperactivity disorder, Tourette's syndrome, obsessive-compulsive disorder, and depression. The disorder can result in significant functional difficulties in the home, school, and community contexts. A case study highlights the features of AS, and a related individualized school health care plan demonstrates the school nurse's role in family and staff education, monitoring for comorbidities, behavioral management, medication management, support to family members, and referral.

Asperger Syndrome↗
PubMed2000

Motivation in action: towards a process-oriented conceptualisation of student motivation.

BACKGROUND: This paper focuses on the temporal dimension of student motivation; that is, rather than considering motivation a stable emotional or mental state, the emphasis is placed on portraying motivation processes as they happen in time. AIMS: 1. To account for the dynamic development of motivation in prolonged learning processes such as the mastery of school subjects. 2. To discuss the practical implications of a process-oriented approach for professional practice. METHOD: Theoretical analysis and model building, drawing on the findings of empirical investigations. ANALYSIS: It is argued that the 'time' dimension is relevant to the study of motivation in at least two crucial areas: to account for (a) how motivation is generated and (b) how it fluctuates and further develops over time. A focus on the temporal dimension is particularly important for the understanding of student motivation because in prolonged learning activities such as mastering a school subject a major motivational function is to maintain the motivational impetus for a considerable period (often several years) against a number of distracting influences. In order to illustrate the temporal conception of motivation, a 'Process Model of Student Motivation' is presented and various theoretical pros and cons are discussed. Finally, practical implications are demonstrated by providing a taxonomy of motivational strategies rooted in the process-oriented approach, with one specific aspect, the students' action control and self-motivation, specially highlighted in order to show the compatibility of the approach with current research on student self-regulation.

Adolescent↗
PubMed2006

Quality of life for children with functional abdominal pain: a comparison study of patients' and parents' perceptions.

OBJECTIVE: Children with chronic abdominal pain of nonorganic origin, termed functional abdominal pain (FAP), experience school absences and social withdrawal and report impaired physical ability. The aim of this study was to assess patients' and parents' perceptions of health-related quality of life (QoL) for children with FAP. METHODS: Between October 2002 and November 2003, 209 children (including 125 girls; age: 11.2 +/- 3.5 years) and 209 parents were recruited from a pediatric referral center. At the time of their initial evaluations, participants completed a validated, health-related QoL instrument (Pediatric Quality of Life Inventory), which was scored on a scale of 0 (poor) through 100 (best). Children with FAP (n = 65) and their families were compared with control groups of healthy children (n = 46) and children with histologically proven inflammatory bowel disease (IBD) (n = 42) or gastroesophageal reflux disease (GERD) (n = 56). RESULTS: Children with FAP had self-reported QoL scores (score: 78) that were similar to those for children with GERD (score: 80) or IBD (score: 84). Children with FAP had lower QoL scores than did healthy children (score: 88). Parents of children with FAP reported lower QoL scores, compared with their children's scores (scores: 70 vs 78). CONCLUSIONS: Children with FAP reported lower QoL, compared with their healthy peers, and had the same QoL scores as did children with IBD or GERD. Parents' perceptions of QoL for children with FAP were lower than their children's self-reported scores. These findings highlight the clinical significance of FAP and may provide insight into one facet of the disease's biopsychosocial etiology.

Abdominal Pain↗
PubMed2006

Snore-associated sleep fragmentation in infancy: mental development effects and contribution of secondhand cigarette smoke exposure.

OBJECTIVE: The link between sleep-disordered breathing and neurocognitive functioning in preschool and school-aged children now has been established clearly. Within these age groups, isolated studies have examined the potential effect of snoring without gas exchange abnormalities on aspects of cognitive competence. The goal of the study was to test the potential association between snoring and decrements in developmental performance among infants. METHODS: Thirty-five healthy community infants (8.2 +/- 0.4 months) were administered the Bayley Scales of Infant Development, including the Mental Development Index (MDI), after standard, overnight research polysomnography. RESULTS: The apnea-hypopnea index for all infants was 0. Respiratory arousal index was significantly correlated with MDI. Snoring-associated arousals accounted exclusively for this relationship; spontaneous arousals and those that were associated with central apnea and oxyhemoglobin desaturation episodes (> or =4%) were not significantly correlated with MDI. Living in a smoking household was not significantly associated with the presence of objectively recorded snoring but was associated with an increase in arousal frequency in snoring infants. CONCLUSIONS: Infants with lower scores on a standardized mental development assessment had higher snoring-arousal indices. Because neither apnea nor hypopnea was present, these findings constitute additional evidence that snoring is not just an innocent noise during sleep in infants but may in fact represent the lower end of the disease spectrum associated with sleep-disordered breathing. Secondhand exposure to cigarette smoke may increase the deleterious effects of infant snoring.

Arousal↗
PubMed1969

Setting generality: some specific and general effects of child behavior therapy.

The present study attempted to assess experimentally, functional relationships between home and school settings. Two children, both considered deviant in their homes and in their schools, were observed in both settings. The observations revealed that the children's deviant behaviors at home were quite similar to their deviant behaviors at school. Contingency operations were then performed in the children's homes. Results showed that the children's behavior changed predictably in the homes and remained at baseline level in school.

Journal Article↗
PubMed1993

Taking stock: The first 25 years of the Journal of Applied Behavior Analysis.

Some aspects of the performance of the Journal of Applied Behavior Analysis (JABA) are described on the occasion of the journal's 25th anniversary. Comparative circulation data are presented. JABA's influence on the scientific community is measured by examining the citation history of articles that it has published, with attention to both frequency and source of the citations. The influence that other journals have on JABA's authors is assessed through an analysis of citations made by those authors in this journal's reference lists. The citation history indicates clearly that JABA has made substantial contributions toward producing methods useful in coping with a wide variety of problem behaviors, from profound developmental disabilities (such as autism) to the simpler behavioral problems that interfere with normal functioning in home and at school. Recently, the journal has devoted many issues and parts of issues to special topics, in a concerted effort to reflect the increasing breadth of applied behavioranalysis.

Journal Article↗
PubMed2005

Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl.

In this investigation, we evaluated the effectiveness of surface electromyography (EMG) biofeedback to treat paradoxical vocal fold motion in a 16-year-old girl. EMG biofeedback training occurred once per week over the course of 10 weeks. In a changing criterion design, muscle tension showed systematic changes that corresponded with changes in the criterion. Overall, baseline muscle tension levels were reduced over 60%, with corresponding reductions in episodes of respiratory distress and chest pain. Subjective reports by the patient and the patient's mother indicated improvements in school attendance and overall adaptive functioning.

Adaptation, Physiological↗
PubMed1992

Aggressive surgical management of craniopharyngiomas in children.

The cases of 50 patients with craniopharyngioma operated on at The Hospital for Sick Children in Toronto between January, 1975, and December, 1989, are reviewed. All patients were under 18 years of age (mean 9.39 years). Headaches, endocrine deficiencies, and visual deficits were the most common symptoms on admission. Forty-five patients underwent what was considered by the surgeon to be total excision of their tumor, and five had subtotal excision. Tumors recurred in 17 patients (mean time of recurrence 32.6 months after surgery). One patient died in the postoperative period and three have been lost to follow-up study. Of the remaining 46 patients, 28 are leading a normal or nearly normal life, although all are receiving endocrine replacement and some have required help to overcome mild deficits in memory or visual acuity. Twelve patients are able to function reasonably well and attend school despite being hampered by intellectual or visual deficits or problems with weight control; four have a significant handicap, and two have died.

Actuarial Analysis↗
PubMed1987

Using technology to control the environment.

Over the last 5 years, technological advances have resulted in specialized technical aids, such as electronic communication devices, computer input devices, and environmental control systems, which have made it possible for many persons who are severely physically disabled to enjoy greater functional independence within the home, school, workplace, and the community. This paper focuses on environmental control systems and discusses how occupational therapists match environmental control systems with clients' needs.

Adult↗
PubMed2003

Future role of large neutral amino acids in transport of phenylalanine into the brain.

OBJECTIVE: The treatment of phenylketonuria (PKU) in children and adults has been difficult because of erosion of dietary adherence, leading to poor school performance, impairment of executive functioning, loss of IQ, and deterioration of white matter in the brain. Mutant PKU mice produced by exposure to N-ethyl-N'-nitrosourea (ENU) were used to examine the effect of large neutral amino acid (LNAA) supplementation on brain and blood phenylalanine (Phe). METHODS: Mice with PKU, genotype ENU 2/2 with features of classical PKU, were supplemented with LNAA while on a normal diet. Two dosages of LNAA were given 0.5 g/kg and 1.0 g/kg by gavage. Blood Phe was determined in the experimental, control, and sham-treated mice. Brain Phe was determined by magnetic resonance spectroscopy after perchloric acid extraction. Branched-chain amino acid transferase (BCAT) was determined in brain as a marker for energy metabolism. RESULTS: Blood Phe was reduced in the LNAA-treated mice by an average of 15% (0.5 g/kg) and 50% (1.0 g/kg) in 48 hours. There was a sustained decrease in the blood Phe levels over a 6-week trial. The untreated mice and sham-treated mice maintained high blood Phe throughout the experiments. Brain Phe level determined by magnetic resonance spectroscopy showed a decline of 46% after the LNAA treatment. BCAT levels were lower (33%) in the ENU 2/2 mice compared with wild-type. The BCAT normalized in mice with PKU that were treated with LNAA. CONCLUSION: The results suggest that giving LNAA lowered brain and blood Phe levels in mice with PKU. Energy metabolism generated from BCAT also improved in mice with PKU after treatment with LNAA. Data from the mice suggest that LNAA should be considered among the strategies to treat PKU in humans.

Amino Acids, Neutral↗
PubMed2004

Recognizing sleep disorders in a primary care setting.

As many as one third of the general population suffers from some form of sleep disorder. Although sleep disorders are widespread in society, few patients present with overt sleep complaints; they instead present with symptoms of fatigue, excessive sleepiness, and impaired waking function. Untreated sleep disorders, particularly insomnia, can lead to potentially life-threatening automobile crashes and industrial accidents. In addition, poor motor, mental, and cognitive function at home, work, and school can negatively impact a patient's quality of life. Therefore, physicians must maintain a high index of suspicion for sleep disorders whenever they see patients, and they must ask sleep-related questions during office visits for acute conditions, chronic conditions, and annual physical examinations. Today's "24/7" society experiences sleep disorders in ever-increasing numbers, and people who work shifts are at risk for developing circadian rhythm sleep disorder, particularly shift work sleep disorder. Physicians must engage their patients in a discussion of their occupations and sleeping habits in order to detect and treat sleep disorders.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed1991

[Prosthetic care of reduced dentition].

The treatment of replacing missing functional teeth (due to various schools of concepts), as well as the extensive possibilities of gaps, that may occur in the oral cavity makes it often extremely difficult for the dentist in the practice, to decide which form of prosthesis is right. In this study 996 laboratory work procedures from 5 laboratories in Germany were photographed after completion and evaluated for construction faults. Although a large percentage of the work was extensure prosthesis (more than 50% combined fixed--removable and telescopic procedure) 33.4% showed construction faults, whereas 65% of the work was rated acceptable.

Denture Design↗
PubMedDate not supplied

Modified functional bracing in the ambulatory treatment of femoral shaft fractures in children.

Thirty children aged between 2 and 10 years with fractures of the femoral shaft were involved in a prospective study of a treatment method that requires a short period of traction followed by full weightbearing with a modified hinged functional brace and return to school after an average of 32.5 days. At an average follow-up period of 2 years, no case has shown residual angulation or rotational deformities greater than 10 and 15 degrees. No shortening was demonstrated. Overgrowth of the fractured femur was common, with a maximum of 1.5 cm. No strong correlation between overgrowth and age, site, and type of fracture was found. Results were uniformly good for proximal, middle, and distal third fractures.

Ambulatory Care↗