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PubMed2004

Larger corpus callosum size with better motor performance in prematurely born children.

The objective of this study is to determine the relation between the size of the corpus callosum (CC) and motor performance in a population-based cohort of preterm children. Preterm born children (n = 221) with a gestational age less than or equal to 32 weeks and/or a birth weight below 1500 g were eligible for this study. At the age of 7 or 8 years, frontal, middle, posterior, and total areas (mm2) of the corpus callosum were measured on true midsagittal MRI. Due to anxiety of 10 children and motion artifacts in 7 other children, 204 MRIs could be assessed in the preterm group (mean GA 29.4 weeks, sd 2.0,mean BW 1200 g, sd 323). The preterm group consisted of 15 children with cerebral palsy (CP) and 189 children without CP. Motor function was established by using the Movement Assessment Battery for Children, and the Developmental Test of Visual Motor Integration was obtained. The same examinations were performed in 21 term born children. The mean total cross-sectional CC area was significantly smaller in preterm born infants compared with their term born controls (338 mm2 versus 422 mm2, P < 0.0001). The preterm children with CP had significantly smaller mean CC areas compared with the preterms who did not develop CP (P < 0.0001-P < 0.002). However, the preterms born without CP also had significantly smaller body, posterior, and total CC areas compared with term born controls (P < 0.0001-P < 0.002). Only the difference in frontal area measurements dilrc) -3.3 mm2/score point (95% CI -4.5, -2.1). The association existed in all parts of the CC but increased in the direction of the posterior part: frontal: lrc -0.8 mm2/score point (-1.2, -0.4), middle: lrc -1.1 mm2/score point (-1.7, -0.5) and posterior: lrc -1.4 mm2/score point (-1.8, -0.9). An association between CC area and its subareas and the standard scores of the VMI was also found. A larger CC was strongly related t o better scores onthe VMI test total area CC: lrc 0.05 score/mm2 (95% CI 0.03, 0.07), frontal: lrc 0.12 score/mm2 (0.05,0.19), middle: lrc 0.10 score/mm2 (0.05, 0.15) and posterior: lrc 0.12 score/mm2 (0.06, 0.18). After adjustment for gestational age, birth weight, and total cerebral area, these associations were still significant. There is a strong association between the size of the corpus callosum (total midsagittal cross area as well as frontal, middle, and posterior area) and motor function in preterm children, investigated at school age. A poorer score on the Movement ABC was related to a smaller CC. A larger CC was strongly associated with better VMI standard scores.

Brain Mapping↗
PubMed2003

Concurrent and 2-year longitudinal relations between executive function and the behavior of 1st and 2nd grade children.

Abstract Concurrent and 2-year longitudinal relations were investigated between two indicators of children's ( n =60; mean age = years 11 months) executive function, inhibitory control and sequencing ability, and behavior problem symptomatology. Dependent measures were parent and teacher reported internalizing and externalizing behavior. Hierarchical multiple regression analyses demonstrated few significant concurrent associations between either inhibitory control or sequencing ability, and behavior problem symptoms. In contrast, baseline inhibitory control predicted decreased teacher reported externalizing, and parent reported externalizing and internalizing behavior problems over a 2-year period. Baseline sequencing ability also predicted decreased teacher reported externalizing and parent reported internalizing behavior over this same time period. Results suggest that some aspects of executive function in early elementary grade-school children may be more strongly associated with change in behavior over time than concurrent behavior. Implications of these findings for the prevention of behavior problems are discussed.

Child↗
PubMed2004

What can we learn today from the Central European smog episode of 1985 (and earlier episodes)?

In January 1985 an extended smog episode occurred in Central Europe. The Rhine-Ruhr area (Western Germany) was affected for 5 days with maximum concentrations of 0.8 mg/m3 SO2 and 0.6 mg/m3 TSP (24h averages). Health effects were investigated during the smog period and a control period before and after the smog. Daily mortality increased by 8%, hospital admissions (for respiratory and cardiovascular causes, RC) by 15%, outpatients (RC) by 12% and ambulance transports (RC) by 28%. Patients with chronic bronchitis from the Ruhr area cities showed more exacerbations during the episode, and in school children from the Netherlands lung function was reduced. In Augsburg (Southern Germany) the smog episode was less severe (maximum concentrations 0.2 mg/m3 SO2 and 0.1 mg/m3 TSP, 24 h averages). Here--by chance--the prospective MONICA study was ongoing. During the episode a significant increase of plasma viscosity, C-reactive protein and heart rate was observed in the participants. The highest ambient concentrations (maximum 24h average of 3.6 mg/m3 SO2) were measured in Erfurt (Eastern Germany). Surprisingly, no measurable increase of mortality occurred. This was explained by premature deaths during the period before the smog, were the concentrations had already been clearly above 1 mg/m3 SO2. An earlier episode took place in December 1962 in the Rhine-Ruhr area for 5 days with maximum concentrations of 5.0 mg/m3 SO2 and 2.4 mg/m3 TSP (24 h average). Daily mortality on average increased by 19%. In 1962 and 1985 the effects were stronger in cities with pollution mainly from traffic than in areas with pollution from industrial sources. In total, between 1962 and 1987 two major and several smaller smog episodes occurred in Central Europe. Patients with cardiovascular diseases were more severely affected than patients with respiratory diseases. Health effects were more strongly correlated with TSP than with SO2.

Air Pollutants↗
PubMed2002

The analysis of a pre-adolescent girl with primal scene fantasies.

This paper presents the analysis of Daphne, a ten-year-old girl whose prominent primal scene fantasies organized the analytic process in a rather unusual way, creating challenging technical problems and offering the analyst the opportunity to learn more about the formation of primal scene fantasies and their potential impact on psychic development and function. The data are consistent with the view that primal scene fantasies become organized in response to the cognitive requirements of development--to answer the enigmas of sexual difference, genital sensations, procreation, and parental rejection; that these fantasies arise from phase-specific libidinal and aggressive struggles such as voyeurism, exhibitionism, sadism, and homoerotic fantasy; and that they influence superego development. Daphne, however, appeared to have used the primal scene fantasy in a rather extraordinary way to organize and integrate the vicissitudes of development and especially to master conflict. Moreover, the analytic work demonstrates the technical difficulty of distinguishing between primal scene fantasy and primal scene exposure. Another technical issue was raised by the remarkable discrepancy between this little girl's relatively high functioning behavior and demeanor both in school and at home, and the outpouring of sexual material that emerged and flooded our sessions. Why was there such a discrepancy? How should I manage the sexualized nature of the material? Several colleagues, reflecting on the overstimulated quality of the analytic productions, questioned whether I "should have done something" to stop it. In the hours, I certainly felt perplexed by the discontinuity between her presentation and her fantasies. Thus, I ask the reader to follow me in the process of uncovering the particular way in which the analytic data revealed themselves.

Child↗
PubMed2002

Management of data from clinical trials using the ArchiMed system.

Clinical trials constitute a key source of medical research and are therefore conducted on a regular basis at university hospitals. The professional execution of trials requires, among other things, a repertoire of tools that support efficient data management. Tasks that are essential for efficient data management in clinical trials include the following: the design of the trial database, the design of electronic case report forms, recruiting patients, collection of data, and statistical analysis. The present article reports the manner in which these tasks are supported by the ArchiMed system at the University of Vienna and Graz Medical Schools. ArchiMed is customized for clinical end users, allowing them to autonomously manage their clinical trials without having to consult computer experts. An evaluation of the ArchiMed system in 12 trials recently conducted at the University of Vienna Medical School shows that the individual system functions can be usefully applied for data management in clinical trials.

Austria↗
PubMed1988

Survey on curriculum committees at U.S. and Canadian medical schools.

A 27-item questionnaire was sent to 144 U.S. and Canadian medical schools to identify prevailing patterns in the organization, philosophy, and function of curriculum committees. Overall, 76 percent responded, with 67 percent of the respondents being school administrators and 33 percent being faculty members. Fifty-one percent rated their school's committee as exerting a significant impact on the educational program over the previous five years. Fifty-six percent of the committees had a routine procedure for course review and used data from multiple sources when conducting curriculum evaluations. The committees that annually received a specific assignment from the dean were the most likely (91 percent) to be rated as having a significant impact, followed by committees that conducted frequent course reviews (66 percent). Thirty-eight percent of the committees were primarily faculty oriented, 29 percent were decidedly administrative in composition, and the remaining committees exhibited a mixture of membership.

Administrative Personnel↗
PubMed2001

Mediators of behavioral problems in 7-year-old children born after 24 to 28 weeks of gestation.

We tested the hypothesis that prematurity acts through its association with neuromotor and intellectual functioning to explain behavior problems at school age. Sixty-one extremely preterm (EP) very low birth weight (VLBW) children (< 29 wk and < 1,500 g) born in 1987-1990 and 44 normal birth weight children (NBW) (> 37 wk and > 2,500 g) were matched for age, sex, and socioeconomic status (SES). Mediator variables were evaluated at a hospital at 5 years and 9 months. Behaviors were evaluated at school at 7 years by peers, teachers, and parents. When compared with NBW children, EP/VLBW children had poorer IQ and neuromotor development. At school, EP/VLBW children were evaluated by peers as more sensitive/ isolated, and by teachers and parents as more inattentive and hyperactive than NBW. When mediators were introduced, the previously significant relation between prematurity and behavior problems disappeared. Hyperactive and inattentive behaviors were explained by a specific working memory factor for the latter, and by a general intellectual delay for the former, whereas sensitive/isolated behaviors were best explained by neuromotor delays. Inattentive behaviors were also related to family adversity. At school age, extreme prematurity had thus an indirect effect on behaviors via specific and nonspecific intellectual and neuromotor delays.

Age Factors↗
PubMed2000

The presumed influence of attention on accuracy in the developmental eye movement (DEM) test.

BACKGROUND: The developmental eye movement (DEM) test is a clinical test used widely to evaluate ocular motility function (accuracy and speed) in school-age children. PURPOSE: The purpose of this study was to investigate, retrospectively, the change in accuracy over time while performing the DEM horizontal reading task in children. METHODS: The charts from children who had performed the DEM test during a routine eye examination in a pediatric optometry service were reviewed. The study included 22 patients (6 to 11 years old, 12 boys, 10 girls) who had a routine eye examination that was precepted by one of the authors (R.C.) during the period of 1995 to 1999. Patients were divided into two categories: 1) those with abnormal DEM test results and 2) a control group consisting of those with normal DEM test results. Chart review was done consecutively within each category. Collected data included patient age, gender, refractive error, and DEM test results. For analysis, the horizontal task of the DEM was divided into two halves (I and II), Part I always preceded part II, and data was sorted as the number of errors per part. RESULTS: More errors in accuracy occurred in part II than in part I (Wilcoxon signed rank test, p < or = 0.01) of the horizontal DEM test in the group of subjects with an abnormal DEM test. No differences in the number of errors in parts I and II of the horizontal task of the DEM were found in the control group. CONCLUSIONS: Findings showed that when excessive errors in accuracy occurred, the number of errors increased over time. If the errors were caused by an oculomotor dysfunction found in the DEM, errors should be equally distributed throughout the text. If errors were caused by fatigue, a difference in parts I and II should have occurred in both the test and the control group. These findings suggest that attention may influence accuracy over time in those patients that do poorly on the DEM test.

Aging↗
PubMed2003

Beyond the debate: Why some adolescents report stable self-worth over time and situation, whereas others report changes in self-worth.

Within the field of personality and social psychology, there has been historical controversy over whether constructs such as self-esteem are stable over time and situation or whether they are changeable. One response to this question has been to invoke two types of self-esteem or self-worth, trait self-esteem and state self-esteem. Thus it has been asserted that adolescents, the participants in this paper, have both a baseline self-esteem as well as a barometric self-esteem that represents short-term fluctuations (Rosenberg, 1986). In this paper, we contend that constructs such as self-esteem are not, in and of themselves, trait-like or state-like in nature. Rather, certain individuals display trait-like behavior, whereas others demonstrate change in self-esteem or self-worth across relatively long periods of time, on a short-term basis, and across situations. Three studies document these claims. The first addresses self-worth as a function of the transition from high school to college. The second examines short-term fluctuations in self-worth. The third investigates variability in self-worth across relational contexts, namely, relational self-worth. In each study, findings reveal that certain adolescents report stability in self-worth whereas others report change, fluctuations, or variability. Social causes of these individual differences are identified in each study, as are mental health implications. It is argued that such approaches provide a clearer understanding of the complexity of self-processes.

Adolescent↗
PubMed1992

Psychological effects of sodium valproate and carbamazepine in epilepsy.

Information from standardised tests of intelligence, school attainments, attention, memory and visuomotor function, together with parent and teacher questionnaire information about various aspects of behaviour, was obtained for 63 schoolchildren with newly diagnosed epilepsy before treatment with sodium valproate or carbamazepine, and again at intervals for a total period of 12 months. The same information was collected on 47 matched controls. The children with epilepsy represented those under non-specialised paediatric care. The result showed that both drugs were effective in most cases at modest dosage without causing notable psychological effects 12 months into treatment. Modest and temporary adverse cognitive effects seen earlier in treatment could have been the result of uncontrolled seizure discharge. Improved function was the same in children with epilepsy and controls. Some psychological abnormalities in the children with epilepsy were evident before treatment suggesting early unwanted effects of the epileptic process itself.

Carbamazepine↗
PubMed1977

Head injuries in children: a prospective five year follow-up.

A five year follow-up study was conducted with two groups of head-injuried children. 131 younger than 9 years old at time of injury and 100 older than 9 years. The four aspects studied were neuropsychological function, neurological status, EEG status, and school progress. There was an extended recovery process over time, as well as evidence of a differential rate of recovery for the four aspects measured.

Adolescent↗
PubMed1999

Immunization registries in the United States: implications for the practice of public health in a changing health care system.

Although immunization rates among children are rising across the country, rates in inner-city areas have remained at approximately 50%-60%, < or = 30% lower than corresponding suburban or state immunization levels. The failure to raise immunization levels in poor, underserved populations is caused in part by the lack of timely and accurate child-specific immunization information for providers and parents. Immunization registries are a new tool in health care that can be used to address these and other barriers to effective immunization delivery. Moreover, immunization registries have the potential to help health care officials track and improve delivery for a broad range of important child health services. An immunization registry is a computerized database of information on children (usually preschool-age children) in a defined population (e.g. those enrolled in a health maintenance organization or living in a specific geographic area), which is used to record and track all immunizations received by each child. The registry receives the information primarily from public and private providers that administer immunizations, as well as from parents, schools, and other agencies. A fully functioning immunization registry can be used to identify individual children in need of immunizations and to report on immunization rates by population characteristics such as child age, assigned provider, or geographic area (e.g. neighborhood, city). Today, > 250 local public health departments have immunization registries that are in various stages of planning or development. Only a small number of these registries meet the minimum functional criteria of maintaining records on 95% of all eligible 2-year-old children in the target population and providing an electronic immunization record that is accessible to providers. Nascent immunization registries represent innovative technologic solutions to the challenge of monitoring health problems and health care access on a population basis. This is a fundamental activity of public health agencies, but one that is increasingly shared by large health maintenance organizations. The study of the development of immunization registries across the United States provides an important case study for how public health agencies will use the rapidly developing health information infrastructure to perform health assessment and health assurance activities in a managed care environment.

Child, Preschool↗
PubMed1987

Subdural empyemas in children.

Subdural empyema is a neurosurgical emergency which is rapidly fatal if not recognized and managed promptly. Most series report a 30-40% mortality, and recommend a craniotomy along with aggressive medical therapy. Between 1978 and 1986, 8 children (2 months to 13 years) with subdural empyemas were diagnosed and treated at our institution, and form the basis for this study. Burr hole and catheter drainage was the treatment of choice in 5 children, while craniotomy was required in 1 case of sinusitis with osteomyelitis. Three infants received multiple subdural taps via the anterior fontanel. All patients responded to surgical intervention and antibiotic therapy. The average follow-up period was 29 months, and 5 children had no developmental delay, decrease in school performance, or impairment of intellectual function. There were no deaths in our series. Although the surgical management of subdural empyemas remains controversial, it appears that burr hole and catheter drainage is sufficient in most cases. With earlier diagnosis, aggressive antibiotic therapy, and timely surgical intervention, the morbidity and mortality of subdural empyemas have significantly diminished in recent years.

Adolescent↗
PubMed1988

Cognitive-behavioral and insight-oriented psychotherapy of an eleven-year-old boy with obsessive-compulsive disorder.

This article describes the use of combined cognitive-behavioral and insight-oriented psychotherapy with an 11-year-old boy who had severe obsessive-compulsive disorder of recent onset. Treatment was well accepted by the child and his parents and resulted in rapid relief of symptoms. At 12- and 18-month follow-ups this child was functioning well at home and in school.

Awareness↗
PubMedDate not supplied

Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation.

Seven patients (average age, 26.3 years) with traumatic knee dislocations were retrospectively evaluated more than 2 years (average, 51 months) after having fresh-frozen allograft anterior and posterior cruciate ligament reconstructions. All patients were treated consecutively at an average of 9.6 days after injury. Two patients had arterial injuries and three patients had or developed common peroneal nerve palsy. Five patients had 20 additional injuries. All patients were enlisted in an early, aggressive physical therapy regimen with early protected weightbearing. Four patients required a manipulation under anesthesia for arthrofibrosis at an average of 16.8 weeks postoperatively (range, 6 to 33 weeks). At followup, only one patient had significant pain, three patients had rare or occasional giving way, and all seven were able to return to school or to the workplace. The functional grading was excellent in three patients, good in three patients, and fair in one patient. No patient had a significant flexion contracture; the average flexion arc was 118 degrees (range, 105 degrees to 135 degrees). Knee dislocation is a very traumatic injury, often resulting in a painful, dysfunctional knee. Anterior and posterior cruciate ligament reconstructions in young, active patients can minimize pain and optimize functional outcome. Arthrofibrosis is a common occurrence in these patients, and manipulation under anesthesia is frequently required.

Accidents, Traffic↗
PubMed2003

Test reliability and stability of children's cognitive functioning.

This study addresses the test reliability of a screening test and stability of children's cognitive functioning. Children aged 5 to 8 years in western Sydney were assessed on three occasions. The first assessment provided a baseline, with the second assessment at 2-, 4-, or 12-week intervals. The final assessment was 4 weeks later. Indicators of reliability and stability suggested that a distinction can be made between test reliability and the phenomenon (cognitive functioning) stability Cognitive functioning was assessed using the School-Years Screening Test for the Evaluation of Mental Status (SYSTEMS). The findings have implications for indicators of reliability and stability of cognitive assessments in developmental research and clinical practice.

Child↗