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PubMed1999

The association between demographic factors, disease severity and the duration of symptoms at clinical presentation in elderly people with dementia.

OBJECTIVE: To determine the association between factors unrelated to the disease process, the duration of symptoms and the degree of cognitive or functional impairment in elderly patients presenting with dementia. METHOD: The living situation, educational level, age, gender and diagnosis based on standardized criteria were recorded for 209 elderly patients presenting to a memory clinic with dementia. Cognitive and functional deficits were measured with the cognitive section of the Cambridge Mental Disorders of the Elderly Examination combined with the Mini-Mental State Examination and the abbreviated version of the Blessed dementia scale, respectively. RESULTS: 129 patients had a diagnosis of probable Alzheimer's disease, 19 had probable ischaemic vascular dementia and 61 had mixed dementia. There was no effect of diagnosis on duration of symptoms or dementia severity at the time of presentation. Patients living with a son or daughter were more functionally impaired than those living alone or with a spouse. Males had higher cognitive scores but did not have milder functional deficits. Patients with only a primary-school education had a trend towards lower cognitive scores at presentation but did not have more functional deficits. CONCLUSIONS: The gender of the patient and the relationship to the carer are associated with cognitive and functional scores at the time of presentation in patients with dementia.

Age Factors↗
PubMed1995

Determinants of functional abilities in dementia.

OBJECTIVES: To determine the extent to which selected variables within demographic, psychometric, and memory domains can predict functional abilities in dementia. DESIGN: Hierarchical regression analyses were employed to predict functional abilities, while controlling for disease severity, using the Mini-Mental State Exam (MMSE). SETTING AND PARTICIPANTS: A total of 2368 inhabitants of Kungsholmen parish in Stockholm, Sweden, aged 75 years of age or older. Eighty-one subjects with confirmed dementia (MMSE, M = 17.9; SD = 5.26) were selected from the study population. The mean age was 84.5 years (SD = 5.58), and 72% were female. MEASUREMENTS: Participants received a battery of standardized neuropsychological instruments and selected experimental tasks that measured visuospatial ability as well as primary and episodic memory. Self-care was assessed using the Katz index of activities of daily living (ADL); instrumental activities of daily living (IADL) were assessed through the primary caregiver, who responded to questions related to functional competence of the participant. RESULTS: Hierarchical regression procedures revealed that disease severity was the strongest predictor of ADL and IADL performance. Controlling for disease severity, a measure of visuoperception (Poppelreuter's figures) also made a significant contribution to the explanatory variance in both ADL and IADL function. Beyond disease severity and visuoperception, years of schooling and disease duration were marginally predictive of IADL performance. CONCLUSION: It is possible to predict functional abilities in dementia on the basis of individual difference variables. Multiple variables were initially correlated with ADL and IADL performance; however, after controlling for disease severity, visuoperception was the only predictor of ADL scores. In addition to visuoperception, IADL scores were also marginally predicted by education and disease duration. These findings highlight the importance of peripheral sensory processes in adaptive function in dementia. They also suggest that although many variables may be correlated with functional ability, their explanatory role, particularly with regard to self-care skills, is diminished in the presence of the disease.

Activities of Daily Living↗
PubMed2006

Mucus properties in children with primary ciliary dyskinesia: comparison with cystic fibrosis.

OBJECTIVE: It has been assumed that cystic fibrosis (CF) lung disease is due in part to abnormal airway mucus. Primary ciliary dyskinesia (PCD) is a form of bronchiectasis that is similar to CF in many ways but is caused by congenital defects in mucociliary clearance. Our objective was to compare the biophysical and transport properties of CF and PCD sputa in subjects matched for age and degree of lung function impairment. DESIGN, SETTING, PARTICIPANTS: PCD patients (n = 19; mean age, 9.5 +/- 3.0 years [+/- SD]; FEV1, 65.0 +/- 7.8 L) were recruited from the clinic at the Royal Brompton Hospital. Patients with CF (n = 30, mean age, 10.8 +/- 2.6 years; FEV1, 61.8 +/- 22.8 L) were identified from the Wake Forest University School of Medicine CF Center. Pulmonary function testing and sputum collection were performed as part of routine, scheduled clinic visits. MEASUREMENTS: Pulmonary function was measured by spirometry, and sputum was collected during the pulmonary function test maneuver. Some patients were longitudinally assessed at visits during the course of 3 years. Sputum properties measured were dynamic viscoelasticity, wettability, cohesivity, interfacial (surface) tension, solids composition, DNA and interleukin (IL)-8 concentration, in vitro mucociliary transportability, and cough transportability. RESULTS: Inflammation as measured by IL-8 concentration was three times greater in the PCD sputa (p < 0.0001). There were no significant differences in the sputum biophysical or transport properties comparing CF with PCD sputum. CONCLUSIONS: It is unlikely that established CF lung disease is principally due to abnormal sputum properties, and it is more likely that the biophysical and transport properties reflect disease severity regardless of whether bronchiectasis is due to CF or PCD.

Biomarkers↗
PubMed2000

[Achilles tendon rupture].

The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques.

Achilles Tendon↗
PubMed2004

Brief report: Academic attainment in children with sickle cell disease.

OBJECTIVE: To examine the impact of sickle cell disease (SCD) on academic attainment; the relation between academic attainment and achievement in SCD; and determinants of attainment in SCD. METHODS: Children with SCD and demographically matched peers were compared on academic attainment. Hematocrit, illness frequency, cognitive ability, and socioeconomic status were used to model the predictors of attainment problems. RESULTS: Attainment problems were more frequent in children with SCD (> or =31% vs. 14%). A significant number of children showed difficulties with only attainment or academic achievement. Cognitive ability was a strong predictor of both academic outcome measures. Illness-related school absences predicted academic attainment but not achievement. CONCLUSIONS: Academic attainment is affected by SCD. Tests of academic achievement are meaningful predictors of functional impairments for children with SCD; however, school outcomes are best evaluated with both achievement and attainment measures.

Achievement↗
PubMed1996

Fine motor outcomes in preschool children who receive occupational therapy services.

OBJECTIVE: This study examined preschool children's acquisition of fine motor skills and functional performance when occupational therapy services are included as part of the educational program. It also investigated the relationships among fine motor skills and functional performance in self-care, mobility, and social function. METHOD: Twenty-six preschool children who received weekly occupational therapy were studied. Measurements of their in-hand manipulation, tool use, eye-hand coordination, grasping strength, and functional performance in self-care, mobility, and social function were taken at the beginning and end of the school year. RESULTS: Raw and scaled scores showed significant improvements in all skill areas; standard scores showed slight improvement in eye-hand coordination and mobility function. Correlations of the motor skill tests with the functional performance scales using year-end data revealed significant correlations for in-hand manipulation, eye-hand coordination, and grasping strength with self-care function and mobility. CONCLUSIONS: The results demonstrate the level of change that occurs in fine motor skill and self-care, mobility, and social function during the course of the school year for preschoolers with moderate fine motor delays. The relationships found in the year-end testing imply that performance in underlying fine motor skills as the focus of occupational therapy intervention is associated with self-care and mobility function.

Achievement↗
PubMed1989

The effect of respiratory viral infections on patients with cystic fibrosis.

We examined, in a 2-year prospective study, the frequency of respiratory viral infections in 19 school-age patients with cystic fibrosis and their unaffected siblings. At 2-month intervals throughout the study period, pulmonary function tests, oropharyngeal cultures, and serologic tests for respiratory viruses were performed in all subjects. Quantitative sputum cultures for bacteria were performed in subjects with cystic fibrosis. The same laboratory specimens were also collected at the time of all acute respiratory illnesses. Over the 2-year period, 398 viral cultures and serum samples were collected, 210 from patients with cystic fibrosis and 188 from their siblings. The frequency of culture-documented and seropositive viral infections was not significantly different between patients with cystic fibrosis and their siblings. The patients with the highest frequency of viral infection were younger and had the lowest rate of decline in lung function and severity score. We conclude that school-age patients with cystic fibrosis are no more susceptible to viral infections than their unaffected siblings. We were unable to demonstrate any significant adverse effect of respiratory viral infections on pulmonary function in 19 patients with cystic fibrosis aged 5 to 21 years.

Acute Disease↗
PubMed2003

Attention deficit hyperactivity disorder, combined type: better executive function performance with longer-term psychostimulant medication.

OBJECTIVE: Executive function deficits are evident in primary school-age children with attention deficit hyperactivity disorder, combined type (ADHD-CT) and are possibly improved by longer-term psychostimulant medication. In contrast, a substantial subgroup of children with ADHD-CT become symptomatic despite longer-term psychostimulant medication use. We investigated the hypothesis that better executive function performance is associated with the use of longer-term psychostimulant medication in primary school-age children with ADHD-CT who are again symptomatic of ADHD-CT, despite its use. METHOD: A cross-sectional study of 40 primary school-age psychostimulant medication-naïve children with ADHD-CT, 26 with symptomatic ADHD-CT and treated with psychostimulant medication, and 26 control children without ADHD-CT was conducted. Nonverbal tasks of executive function were compared across the three groups. RESULTS: The longer-term psychostimulant medication-treated group had a better executive function performance, despite being symptomatic for ADHD-CT, than the psychostimulant medication-naïve group. CONCLUSION: Improved executive function may be a marker of psychostimulant medication effect in children with ADHD-CT treated in the longer term. This improvement may not correlate with that of the ADHD-CT symptoms. Longitudinal studies are required.

Attention Deficit Disorder with Hyperactivity↗
PubMed1998

Epidemiology of tension-type headache.

CONTEXT: Tension-type headache is a highly prevalent condition. Because few population-based studies have been performed, little is known about its epidemiology. OBJECTIVES: To estimate the 1-year period prevalence of episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) in a population-based study; to describe differences in 1-year period prevalence by sex, age, education, and race; and to describe attack frequency and headache pain intensity. DESIGN: Telephone survey conducted 1993 to 1994. SETTING: Baltimore County, Maryland. PARTICIPANTS: A total of 13 345 subjects from the community. MAIN OUTCOME MEASURES: Percentage of respondentswith diagnoses of headache using International Headache Society criteria. Workdays lost and reduced effectiveness at work, home, and school because of headache, based on self-report. RESULTS: The overall prevalence of ETTH in the past year was 38.3%. Women had a higher 1-year ETTH prevalence than men in all age, race, and education groups, with an overall prevalence ratio of 1.16. Prevalence peaked in the 30- to 39-year-old age group in both men (42.3%) and women (46.9%). Whites had a higher 1-year prevalence than African Americans in men (40.1% vs. 22.8%) and women (46.8% vs 30.9%). Prevalence increased with increasing educational levels in both sexes, reaching a peak in subjects with graduate school educations of 48.5% for men and 48.9% for women. The 1-year period prevalence of CTTH was 2.2%; prevalence was higher in women and declined with increasing education. Of subjects with ETTH, 8.3% reported lost workdays because of their headaches, while 43.6% reported decreased effectiveness at work, home, or school. Subjects with CTTH reported more lost workdays (mean of 27.4 days vs 8.9 days for those reporting lost workdays) and reduced-effectiveness days (mean of 20.4 vs 5.0 days for those reporting reduced effectiveness) compared with subjects with ETTH. CONCLUSIONS: Episodic tension-type headache is a highly prevalent condition with a significant functional impact at work, home, and school. Chronic tension-type headache is much less prevalent than ETTH; despite its greater individual impact, CTTH has a smaller societal impact than ETTH.

Absenteeism↗
PubMed1993

Psychological distress, work attitudes and intended year of leaving school.

Recent studies in both Australia and the U.K. have shown high levels of psychological distress and anxiety in secondary school pupils, increasing over the final three years of school. Indeed, the levels observed in final year pupils have been just as high as those observed in unemployed young people. It has been suggested that the discrepant findings in some longitudinal studies reported during the past few years might be due to the inappropriate use of at-school baseline measures, where disproportionate numbers of pupils at different levels could have affected the conclusions. In response to this suggestion data are reported from a longitudinal study of school leavers, in which 1980 at-school measures were analysed as a function of year level and intended year of leaving. The findings gave no support to the hypothesis that stress level increased from over the last three years, and therefore the use of baseline measures was vindicated. It was concluded that a decade of sustained high youth unemployment is the reason why those about to leave school seem prone to greater stress and anxiety than was the case ten years ago.

Adolescent↗
PubMedDate not supplied

The University of Akron study on air pollution and human health effects I. Methodology, baseline data, and aerometrics.

This study determined the health effects of ambient air pollutants in two grade school populations in Akron, Ohio. One school is adjacent to industry and has elevated levels of sulfur dioxide (SO2) and moderate levels of nitrogen dioxide (NO2), while the other school is 4 km east and unpolluted. This study was designed in this manner for two purposes: (1) to identify and monitor ambient levels of air pollutants in an area proximal to the grade school so that the levels could be accurately assessed, and (2) to determine baseline pulmonary function values and questionnaire responses from the parents indicating any acute and/or chronic respiratory problem in the child. Ninety-five percent of the children enrolled in this study liver within 2 km of the schools and aerometric stations, thus providing for careful control in the study design. The results of this study indicate that SO2 and NO2 levels are significantly higher in the school adjacent to industry. Although pulmonary function data were not significantly different between schools, the frequency of questionnaire responses to acute and chronic pulmonary problems was greater in the children at the school adjacent to industry. The data tend to indicate early pulmonary effects of air pollution in children living adjacent to industry and exposed to elevated levels of SO2 and NO2. We suggest that additional longitudinal work that carefully monitors total suspended particulates, NO2, SO2, and health data should be conducted to confirm these results.

Air↗
PubMed1996

[The age-related characteristics of neurodynamic functions in schoolchildren under long-term physical training].

Five-years lasting longitudinal investigation of the neurodynamic functions of the boys of the middle school age in the control and sport classes have been carried out. A comparative analysis of experimental materials showed substantial differences of the neurodynamic functions in the boys of control and sport classes. These indexes were elevated in persons trained in swimming. Direct positive significant correlation was established between the level of functional mobility of basic neural processes and attention functions that were studied. All the analyzed parameters of neurodynamic functions of schoolboys have been changed with the age and the character of these changes depends on the duration of physical training. In the schoolboys of the sport classes under the influence of long-lasting training positive modifications of the neurodynamic functions were observed.

Adolescent↗
PubMedDate not supplied

Quality time: how parents' schooling affects child health through its interaction with childcare time in Bangladesh.

A child health production function is presented with the key feature being an interaction term between a caregiver's schooling and their exposure time to the child. The production function is estimated using a 2SLS fixed effects model with lagged childcare time, resource allocation and child health as instruments for the first differences of these same endogenous variables. The 1978 Intrafamily Food Distribution and Feeding Practices Survey dataset from Bangladesh is used together with census data. The production function estimates indicate that part of the salutary effects of parental education on child health require that the child actually be exposed to the educated parent. Given the demographic makeup of the study sample and the assumption that age education and gender completely account for productivity, teenage brothers and fathers would have the highest marginal productivity for child health and mothers and grandmothers the least. If economic opportunity draws mothers away from childcare, the presence of other household members with higher schooling levels offers the potential for an improvement in the overall quality of childcare time. In the present study the households failed to set the marginal labour product of child health for each of the caregivers equal. Thus, the quality of childcare may not be the household's sole concern in determining time allocation.

Adolescent↗
PubMed2005

Clustering of fast-food restaurants around schools: a novel application of spatial statistics to the study of food environments.

OBJECTIVES: We examined the concentration of fast food restaurants in areas proximal to schools to characterize school neighborhood food environments. METHODS: We used geocoded databases of restaurant and school addresses to examine locational patterns of fast-food restaurants and kindergartens and primary and secondary schools in Chicago. We used the bivariate K function statistical method to quantify the degree of clustering (spatial dependence) of fast-food restaurants around school locations. RESULTS: The median distance from any school in Chicago to the nearest fast-food restaurant was 0.52 km, a distance that an adult can walk in little more than 5 minutes, and 78% of schools had at least 1 fast-food restaurant within 800 m. Fast-food restaurants were statistically significantly clustered in areas within a short walking distance from schools, with an estimated 3 to 4 times as many fast-food restaurants within 1.5 km from schools than would be expected if the restaurants were distributed throughout the city in a way unrelated to school locations. CONCLUSIONS: Fast-food restaurants are concentrated within a short walking distance from schools, exposing children to poor-quality food environments in their school neighborhoods.

Adolescent↗
PubMed1987

Adaptive significance of small body size: strength and motor performance of school children in Mexico and Papua New Guinea.

The postulated superior functional efficiency in association with reduced body size under conditions of chronic protein-energy undernutrition was considered in school children from rural Mexico and coastal Papua New Guinea. Grip strength and three measures of motor performance were measured in cross-sectional samples of children 6-16 years of age from a rural agricultural community in Oaxaca, Mexico, and from the coastal community Pere on Manus Island, Papua New Guinea. The strength and performance of a mixed-longitudinal sample of well nourished children from Philadelphia was used as a reference. The Oaxaca and Pere children are significantly shorter and lighter and are not as strong as the well nourished children. Motor performances of Pere children compare favorably to those of the better-nourished Philadelphia children, whereas those of the Oaxaca children are poorer. Throwing performance is more variable. When expressed relative to body size, strength is similar in the three samples, but the running and jumping performances of Pere children per unit body size are better than the relative performances of Oaxaca and Philadelphia children. Throwing performance per unit body size is better in the undernourished children. The influence of age, stature, and weight on the performance of Oaxaca and Pere children is generally similar to that for well nourished children. These results suggest that the hypothesized adaptive significance of small body size for the functional efficiency of populations living under conditions of chronic undernutrition varies between populations and with performance tasks.

Adolescent↗
PubMed1975

The school health team and school health physician: new role and operation.

A new concept of school health redefines the school physician's role as dealing primarily with behavior and learning disorders in children. It is an on-site operation, using a multidisciplinary team of professionals. We outlined internal team operations, as well as modes of remediation. Many types of behavior and learning problems were seen by our school health team during the first year of operation. It is important to recognize the multiplicity of diagnoses on individual elementary school children, as well as the differentiation of early organics from late functional primary causes. We need to reassess the delivery of school health care. The expansion of school health to include the multidisciplinary team approach to behavior and learning problem is a primary priority. We suggest using outside medical agencies for periodic physical illness.

Adolescent↗
PubMed1992

Psychosocial functioning in adolescents with complex partial seizures.

This pilot study examined psychosocial functioning in adolescents (age 12.5-18.5 years) with complex partial seizures. Twenty-five subjects were divided into three groups: Group I (N = 11), medically treated with uncontrolled seizures; Group II (N = 6), medically managed with controlled seizures; and Group III (N = 8), epilepsy refractory to medical management with seizure control following surgery. Psychosocial functioning was measured using the "Adolescent Psychosocial Inventory" of Batzel and Dodrill. Findings revealed significant differences (F 4.80. p less than 0.02) in psychosocial functioning between the three groups. Group I showed the poorest overall adjustment; Group II, the best adjustment; Group III was better adjusted than Group I, but less than Group II. Significant difficulties were evident in the areas of school, interpersonal, emotional, seizure adjustment and overall psychosocial functioning in Group III. No problems were evident in Group II. School, emotional and overall adjustment were moderately problematic in Group III. Analysis of biological and demographic data revealed a significant association between increased numbers of medications and poorer psychosocial functioning (r = 58, p less than 0.02). The study results provide direction for clinic and community nurse specialists to set priorities with regard to assessment and supportive interventions.

Adolescent↗
PubMed1997

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program.

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.

Adolescent↗