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PubMed2005

Can medical education rise to the challenge of the African crisis?

In the face of the worsening health crisis in Africa, educationalists there and beyond are challenged to identify their role in resolving the crisis. The training of doctors has to be re-orientated so that they are well equipped to lead the way towards improving the health situation and effectively participating in improving the general condition of the people. This can be achieved by medical schools having control of their duties and functions and using these powers to train doctors who are community-orientated, able to identify clinical and epidemiological problems and find suitable solutions. Doctors of the future should be comfortable working in the community with other members of health teams and confident in addressing all health-related matters in the community. During their formative years in medical school they should acquire the skills to continue self-education. This paper discusses some of the important steps that should be taken by medical schools, taking into account the present situation in Africa.

Adult↗
PubMed1994

Neuropsychological evaluation of children with intracranial tumors: impact of treatment modalities.

Antineoplastic treatment has a deleterious effect on intellectual functions, which is mainly attributable to radiotherapy. With the object of determining the neuropsychological disturbances associated with brain irradiation in the child, and to try to differentiate them from the effects caused by the other types of treatment (surgical and chemotherapy) as well as from the effects of the tumor itself, a cross-sectional study was carried out in 25 survivors of medial edge intracranial tumors. In order to monitor the effect of systemic chemotherapy on the cognitive functions, and the effect of prolonged absence from school, two control groups were formed, one made up of subjects treated with chemotherapy for extracranial tumors, and the other of patients with non-malignant chronic disease. Neuropsychological functions were measured using the Spanish version of the Wechsler scale, as well as the following tests: Spreen-Benton, ITPA and TALE scales, Yuste Memory Test, Thurstone Attention Test, and the Rey Complex Figure. In addition to a progressive decline found in the full scale intelligence quotient in children irradiated for intracranial tumors, variance analysis showed that these patients deteriorate mainly in visual attention and memory, but also significantly in verbal fluency and in the Performance Intelligence Quotient and all its subtests, when compared to the control groups. Visual attention and the Wechsler Picture Arrangement and Block Designs, were the tests whose decline correlated with the total radiation administered. The article relates this specific neuropsychological injury with the total brain irradiation dose but also with the structures located in the cone-down fields of irradiation to boost regions in the middle edge intracranial content.

Adolescent↗
PubMed1995

Parents' marital functioning and adolescent psychopathology.

Parents' marital functioning and adolescent psychopathology were investigated in 2 studies. The first study compared parents' marital satisfaction, conflict over childrearing, affective communication, and traditional role orientation in matched samples of psychiatric inpatient and control-group adolescents. The second study examined associations between specific dimensions of marital functioning and adolescent depression severity, suicidal ideation, and social adjustment in a larger sample of adolescent inpatients. In Study 1, parents of inpatients reported less marital satisfaction and more conflicts over childrearing than parents of control-group adolescents. In Study 2, marital conflicts over childrearing were associated with a less active or involved father-adolescent relationship and more severe school behavior and spare time problems. Marital functioning was not associated with depression severity or suicidal ideation.

Adolescent↗
PubMed2005

Weight history from birth through childhood and youth in relation to adult lung function, in Danish juvenile obese and non-obese men.

OBJECTIVE: To investigate the associations of birth weight, body mass index (BMI) during childhood and youth, and current BMI with adult lung function. DESIGN: Population-based longitudinal study of juvenile obese and non-obese men, who were identified at draft board examination (age range: 19-27 y) and who participated in a follow-up examination in 1981-1983 (age range: 25-48 y). Birth weight, childhood weight and height measurements from 7 to 13 y of age were obtained from school health records. Current BMI and lung function were assessed at follow-up. SETTING: Copenhagen and adjacent regions, Denmark. SUBJECTS: In total, 193 juvenile obese men at draft board examination and 205 randomly selected nonobese controls from the same population. MAIN OUTCOME MEASURES: Lung function measured by forced expiratory volume in 1 s (FEV(1)) and forced vital capacity (FVC), adjusted for age and height. RESULTS: After adjusting for current BMI, smoking and education, birth weight was positively related to FEV(1), although only with borderline statistical significance. BMI at age 7 y was positively associated with both FEV(1) and FVC, whereas BMI at later ages in childhood and in youth was not associated with these measures. There was a strong negative linear relation between current BMI and lung function among those currently overweight and obese (BMI 25 kg/m(2)), whereas no association was seen in the non-obese (BMI <25 kg/m(2)). CONCLUSION: Our findings confirm the detrimental effect of high current BMI on adult lung function, and further suggest that early childhood growth has a protective influence.

Adolescent↗
PubMedDate not supplied

Health-related quality of life among North Carolina adults with diabetes mellitus.

BACKGROUND: Previous research on health-related quality of life among people with diabetes used subgroups of diabetics who were not representative of a larger population and long questionnaires that are not practical for surveillance. OBJECTIVE: To identify people with diabetes in North Carolina who are at risk for a poor quality of lift based on demographic and medical characteristics using surveillance data. METHODS: Analysis of Behavior Risk Factor Surveillance System data from North Carolina, years 1998 through 2001, to examine associations between demographic and medical characteristics among people with diabetes and four different health-related quality-of-life outcome indicators, including general health status, physically unhealthy mentally unhealthy and functionally limited days. The demographic and medical characteristics studiedwere age, sex, ethnicity marital status, education, income, health insurance, obesity duration of diabetes, and insulin use. These same characteristics were also tested for independent associations with functionally limited days. RESULTS: Ethnicity and gender were not associated with any of the quality-of-life measures among people with diabetes. Those younger than age 65 were more likely to have mentally unhealthy days, but age was not related to the other outcomes. A household income of less than 20,000 dollars was related to poor general health and greater than one week each of physically unhealthy mentally unhealthy and functionally limited days. Subjects with a high school education or less, no health insurance, and those not married or cohabiting had at least one poor health-related quality-of-life outcome. Obesity duration of diabetes often or more years, and insulin use were also associated with at least one poor quality-of-life outcome. The only characteristic that was independently related to the number of functionally limited days was income. People with diabetes of working age and with low incomes were more likely to have greater than one week of functionally limited days (aOR = 10.3; 95% CI = 4.9-21.5). CONCLUSIONS: Our results suggest an association between poor quality of life and low-socioeconomic status among people with diabetes in North Carolina.

Adult↗
PubMedDate not supplied

Functional memory skills following traumatic brain injury in young children.

Traumatic brain injury (TBI) may have a profound impact on a child's ongoing development. Various risk factors have been found to predict outcome, but considerable variability remains unexplained. This study used a prospective, longitudinal design to examine recovery of memory function following TBI within the pre-school period. Forty-four children with TBI were divided according to injury severity (mild, moderate, severe), and compared to age and SES matched healthy controls (n = 26). Children were evaluated acutely and at 12 months post-injury using the Rivermead Behavioural Memory Test for Children. Results failed to show a clear dose-response relationship between injury severity and memory function during the acute phase of recovery. However, this relationship developed over time, with greater memory impairments evident for children with more severe TBI by 12 months post-injury. Children with mild TBI exhibited few memory problems.

Analysis of Variance↗
PubMed2002

Does remodelling of the airway wall precede asthma?

Bronchial asthma is very common in childhood but the occurrence of wheeze with viral infections makes asthma difficult to diagnose in the pre-school child. Longitudinal studies suggest that there is a loss of airway function associated with early childhood asthma. Extrapolating from adult disease and the few tissue-based studies of children, this would appear to be related to abnormal postnatal development or remodelling of the airway walls. This appears to be associated with persistent airway inflammation without clinical evidence of airways obstruction. Abnormally thickened airways may be the mechanism underlying both bronchial hyper-responsiveness and fixed loss of respiratory function. The challenges for the future are to identify those children among the pre-school wheezers who will become asthmatic and to construct trials of therapies that may potentially prevent the development of clinical asthma or ameliorate the associated loss of airway function.

Age Factors↗
PubMed1992

Family functions and children's postdivorce adjustment.

Data on school-age children of divorced parents were examined to determine which dimensions of family dynamics were most associated with the children's socioemotional adjustment. Those factors found to be most significant were family roles, behavior control, and affective involvement, as well as children's reaction to and insight into the divorce, and conflict in the home after the divorce. Implications for parent education and early intervention are discussed.

Adaptation, Psychological↗
PubMed2006

Asthma, atopy, and lung function among racially diverse, poor inner-urban Minneapolis schoolchildren.

As part of an assessment of schoolchildren's environmental exposures and health, a probability sample of 136 children from diverse racial/ethnic backgrounds was drawn from grades 2-5 of two inner-urban Minneapolis schools (Whittier, Lyndale). Questionnaires were administered to a parent/guardian; blood samples for IgE and lung function tests were obtained. Overall adjusted rates for lifetime asthma (15.4%; 95%CI 9.3-21.5%), asthma in the last 12 months (13.6%; 7.8-19.4%), and current asthma medication use (10.5%; 5.3-15.7%) were higher than reported US national rates. Adjusted rates for lifetime physician-diagnosed asthma differed significantly among racial/ethnic groups (P<0.01): African-Americans (25.9%), White/Others (25.8%), Hispanics (9.3%), Somalis (1.8%), Asians (0%). Corresponding rates for atopy (total IgE>100 IU/mL or an allergen-specific IgE>0.35 IU/mL) were: African-Americans (66.6%), White/Others (100%), Hispanics (77.2%), Somalis (78.1%), Asians (81.8%). Lung function (FEV1, FVC) was analyzed by linear regression using log-transformed data: significant race-specific differences in lung function were found relative to White/Others (P<0.001 for each racial/ethnic group): African-Americans (FEV1 -16.5%, FVC -16.9%), Somalis (-22.7%, -26.8%), Hispanics (-12.2%, -11.4%) and Asians (-11.1%, -12.4%). Females had significantly lower FEV1 (-8.8%) and FVC (-11.0%) than males. An unexplained, significant difference in children's lung function was found between the two schools. A history of physician-diagnosed asthma was not associated with decreased lung function. Factors other than poverty, inner-urban living, and IgE levels (atopy) need to be considered in the development of childhood asthma.

Asthma↗
PubMed1999

Unique considerations for the pediatric heart transplant recipient: the role of the school nurse.

Heart transplantation has become an accepted therapy for terminal heart conditions in children. With the increasing incidence of pediatric heart transplantation, school nurses may find cardiac recipients in their schools. The article discusses physical and psychological considerations for managing these students. Among the physical considerations are work capacity, appearance, organ rejection, and infection. The psychological considerations are emotions, cognitive functioning, quality of life, and behavioral concerns. The school nurse is a key resource in informing staff about the unique concerns of pediatric transplant recipients and in ensuring they are integrated into the school setting.

Activities of Daily Living↗
PubMed1992

Indoor air pollution and pulmonary function in children.

Pulmonary function in winter time in 1,343 school children aged 10-13 years was measured in four cities located in northern and southern part of China. The results showed that FVC, FEV1, PEF, V75, V50 and V25 in children living in homes with coal stoves were decreased by 1.5-10.7% compared with children living in homes with gas or LPG stoves in Chengde and Shanghai. In contrast to this, no significant difference in pulmonary function was found in Shenyang and Wuhan. It suggested that this phenomenon was related to indoor air pollution, and partly related to passive smoking or outdoor air pollution.

Air Pollution, Indoor↗
PubMed1999

The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France.

Up to 80% of women experience mood and physical symptoms associated with the menstrual cycle. This study assessed the impact of premenstrual symptomatology on functioning and treatment-seeking behavior for a community-based sample of women in the United States, United Kingdom, and France. A sample of 1045 menstruating women (aged 18-49) completed a telephone questionnaire that measured, at a point in time, premenstrual symptoms, impact on functioning, and treatment-seeking behavior. Results were generally consistent across the three countries. Irritability/anger, fatigue, and physical swelling/bloating, or weight gain were among the most commonly reported symptoms (approximately 80%). Functional impairment tended to be highest at home, followed by social, school, and occupational situations. Among working women, over 50% reported at least somewhat affected occupational functioning. Of women who ever missed work because of symptoms, 1-7 days were missed in the past year. Almost three fourths of the women had never sought treatment, and symptom severity was an important factor in treatment-seeking behavior. Treatment with selective serotonin reuptake inhibitors (SSRIs), which have demonstrated efficacy in this population, occurred with surprisingly low frequency. The functional impairment of premenstrual symptomatology (home, social, and occupational) and treatment-seeking behavior is consistent across countries. Women who experience more impairment are more likely to have severe symptoms and are more likely to believe, relative to women with less severe symptoms, that no treatment is available. This suggests significant unmet medical need in this more severely affected population. Improved clinical identification of these women and increasing awareness of the efficacy of SSRIs in treating premenstrual symptomatology may be of benefit.

Adaptation, Physiological↗
PubMed1991

Functional assessment, curricular revision, and severe behavior problems.

An adolescent female with multiple handicaps and a long history of severely disruptive behavior participated in a functional assessment linked directly to specific revisions in her school curriculum. During Phase 1, reversal designs were used to test hypotheses pertaining to antecedent and curricular influences on problem behavior. During Phase 2, a multiple baseline across afternoon and morning time periods demonstrated that the curricular revisions were effective in eliminating severely disruptive behavior and increasing on-task responding. Data also showed that inappropriate "psychotic" speech was reduced and appropriate social interactions were increased. Follow-up results showed that the changes were maintained throughout the school year. Questionnaire data provided social validation of the procedures and outcomes. The findings are discussed in relation to their implications for functional assessment, individualized curricula, and positive programming for students with disabilities and serious behavior problems.

Achievement↗
PubMedDate not supplied

[Characterization of the physical development of schoolchildren in different regions of Russia].

Age-related changes in some physical development (PD) indices (height, weight, chest circumference, hand dynamometry, and vital capacity) were studied in 21,500 schoolchildren aged 7 to 17 years in 5 federal areas (Central, North-western, Urals, Southern, and Siberian) of the Russian Federation. The moderate development of both morphological and functional characteristics is prevalent in the school-children of all age groups, the proportion of their low development being higher than that of their high development. The proportion of children with average weight is virtually constant in age groups of 7 to 17 years and it is about 50% of the sample. The moderate level of other characteristics is noted for age-related variations of different intensity, which are more pronounced in girls. In terms of age, the functional parameters of PD are more variable than morphological ones. Age-related variation of the ratio of PD levels may be entirely assigned due to: a) heterochronicity of processes of increasing morphological parameters (longitudinal and latitudinal); b) a great variability of functional parameters. Recommendations on correction of schoolchildren's PD with physical educational means are given.

Adolescent↗
PubMed1992

Functional and dysfunctional characteristics of the prevailing model of clinical evaluation systems in North American medical schools.

To ensure that graduates are ready to move on to residency, medical schools need systems to monitor students' progress through clinical experiences. Clinical rotations occur in geographically separated settings in a variety of disciplines that use evaluators of varying levels of experience. That this complexity lends itself to error has been documented by the Association of American Medical Colleges' ongoing Clinical Evaluation Project, begun in 1979. This paper draws from that work and a 1987-1988 survey of 77% of the U.S. and Canadian deans for student affairs. This information is subjected to an analysis that emphasizes both common and unique characteristics of evaluation systems that are based on the four-stage model employed by most medical schools. Seventeen symptoms that can be signs of system errors are identified. It is recommended that schools having these symptoms review their clinical evaluation systems to ensure effective and efficient monitoring of clinical students.

Clinical Clerkship↗