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PubMed1996

Implementing community-based education: essential elements and recommendations.

Two elements are essential for implementing community-based educational programs: a vision of how community experiences fit into the training of the health professionals of the future and a local environment that will support innovation, change, and growth. Change cannot occur unless very basic assumptions regarding medical education are challenged. What is "quality education"? Can programs oriented toward tertiary and specialty care adequately provide the training that should be the core of a 3-year general training program? Do schools and programs select and train physicians to function within the microcosm of the academic center, or do they prepare physicians to manage the country's health care needs? National consensus has had little influence over local environments. Each medical school, training program, and teaching facility must reexamine its values and its culture. Each must have a vision of the physicians of the future and a commitment to train them appropriately. The role of vision and culture in creating successful programs has been clearly described. Several key elements have been found to be consistent with success, the first being vision. Four basic principles will bring the vision to fruition: (1) preserving core values while still stimulating progress; (2) emphasizing the process by which programs are created, implemented, and changed rather than the product; (3) avoiding the "tyranny of the or," learning to be inclusive with a broad vision rather than limited to an "either-or" approach; and (4) aligning the process, management, and values in working toward envisioned progress for the future. Effective leadership is essential for a group or organization to accomplish its mission, as is an organizational structure that aligns responsibility, authority, resources, and accountability.

Community Medicine↗
PubMedDate not supplied

Grade 1 or "ding" concussions in high school athletes.

BACKGROUND: Recent concussion management guidelines have suggested that athletes with mild (grade 1) concussions may be returned to play if asymptomatic for 15 minutes. The purpose of this study was to assess the utility of a current concussion management guideline in classifying and managing mild concussion. HYPOTHESIS: High school athletes diagnosed with a grade 1 concussion will demonstrate measurable decline in neuropsychological functioning that persists during the 1st week of recovery. STUDY DESIGN: Prospective study designed to evaluate neuropsychological functioning both prior to and following concussion. METHODS: Forty-three high school athletes completed neuropsychological test performance and symptom ratings prior to the season and at two times during the 1st week following mild concussion. RESULTS: Thirty-six hours after injury, mildly concussed high school athletes demonstrated a decline in memory (P < 0.003) and a dramatic increase in self-reported symptoms (P < 0.00001) compared to baseline performance. CONCLUSIONS: Athletes with grade 1 concussion demonstrated memory deficits and symptoms that persisted beyond the context in which they were injured. These data suggest that current grade 1 return-to-play recommendations that allow for immediate return to play may be too liberal. CLINICAL RELEVANCE: A reconsideration of current concussion grading systems appears to be warranted.

Adolescent↗
PubMed1990

Redistribution of cerebral activity during childhood.

Data on the functional development of brain structures in early childhood are scarce. Cognition changes markedly from pre-school age to school age, and we thought it of interest to examine the level of functional activity of selected brain regions. Nine preschool children were studied and compared with eight school children and eighteen adults. Xe133 emission tomography was used for determination of regional cerebral blood flow (rCBF). It was demonstrated that activity in the striatal regions is low in early childhood. In school age the proportion of flow to these regions is increased by about 11-14 per cent (difference between medians). Perfusion of the occipital lobes decreased with age when studied with open eyes and closed eyes, possibly reflecting loss of synapses and decreased plasticity.

Adolescent↗
PubMed2005

Predictors of resilience in maltreated and nonmaltreated Latino children.

To date, few studies have sought to investigate the effects of child maltreatment and processes influencing maladaptation and resilience in Latino children. In the current investigation, multiple aspects of functioning, personal resources, and relationship features were examined in school-age maltreated and nonmaltreated Latino children. Maltreated Latino children were found to have fewer areas of resilient functioning. Ego-resiliency and ego-control, as personal resources, and the ability to form a positive relationship with an adult figure outside of the immediate family predicted resilience. However, certain aspects of interpersonal functioning were differentially related to resilience for maltreated and nonmaltreated Latino children. These findings have implications for understanding how resilience can be promoted in maltreated and nonmaltreated Latino children.

Child↗
PubMed2005

School-based mental health programming for children with inattentive and disruptive behavior problems: first-year treatment outcome.

This article examines the effectiveness of an evidence-based behavioral treatment package for children with inattentive and disruptive behavior problems when delivered in the context of a school-based mental health program. Child symptomatology and functioning are assessed in a treatment group (n = 30) and a waitlist control group (n = 12) across multiple time points (fall, winter, and spring). Treatment includes a daily report card procedure, year-long teacher consultation, and parenting sessions. According to the parent report, treated children show marked reductions in hyperactive and impulsive, oppositional or defiant and aggressive behavior, and marked improvement in peer relationships. Teachers observe treatment-related group differences in inattention, academic functioning, and the student-teacher relationship. Feasibility and acceptability data have implications for transporting evidence-based treatments to community settings and for integrating mental health services into the culture of the school community.

Achievement↗
PubMed2006

Mental health in adolescence: is America's youth flourishing?

A continuous assessment and a categorical diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, are proposed and applied to data from the second wave of the Child Development Supplement (CDS-II) of the Panel Study of Income Dynamics (PSID), in which a comprehensive set of subjective well-being items were administered to a sample of 1,234 youth ages 12-18. Flourishing was the most prevalent diagnosis among youth ages 12-14; moderate mental health was the most prevalent diagnosis among youth ages 15-18. Depressive symptoms decreased as mental health increased. Prevalence of conduct problems (arrested, skipped school, alcohol use, cigarette smoking, and marijuana use) also decreased and measures of psychosocial functioning (global self-concept, self-determination, closeness to others, and school integration) increased as mental health increased. Findings suggest the importance of positive mental health in future research on adolescent development.

Adolescent↗
PubMed1990

[Health-related assessment of the work training of 5-7th-form pupils].

The present investigation is devoted to the study of the influence of labour on the functional state of the organism of medium school-aged pupils. It has been found out that engagement of schoolchildren in the workships and study rooms of service labour are not tiring, which creates reserves for the active development of the motor functions of schoolchildren. At the same time it has been found out that the types of labour which they encounter for the first time (joinery in the 5th form, electrotechnical work) lead to unfavourable changes in the functional state of schoolchildren organisms. The data obtained in the course of investigation on the organization of labour lesson (density of working and lessons structure) have been used in the development of 'Concept of labour preparation of the rising generation and studying young people in the system of continuous education'.

Adolescent↗
PubMed2006

Comparison of asthma-related functional consequences and health care utilization among children with and without upper respiratory infection-triggered wheezing.

OBJECTIVE: We compared differences in functional consequences and health care utilization in middle school-age children, based on whether they reported wheezing triggered by upper respiratory infections (URI-TW). METHODS: Information on asthma symptoms, URI-TW, and functional consequence and health care use outcomes was collected from approximately 128,000 children; symptomatic participants were included in the analysis. Adjusted prevalence odds ratios were used to make comparisons. RESULTS: URI-TW was significantly associated with most outcomes examined, with stronger associations at increasing levels of outcomes for sleep disturbances, school absences, activity limitations, physician visits, emergency room visits, hospitalizations, inhaler use, and tablets/pills to help breathing. CONCLUSION: Children who report URI-TW during their middle school years experience substantial morbidity and high health care utilization compared with symptomatic children without URI-TW.

Absenteeism↗
PubMed1997

The free-running asthma screening test: an approach to screening for exercise-induced asthma in rural Alabama.

This study documented the prevalence of exercise-induced asthma (bronchospasm) in rural elementary schools and described the use of a free-running asthma screening test (exercise-challenge) and peak expiratory flow rate measurements for screening in a school setting. Of 437 children screened, 25 (5.72%) had a > or = 15% decrease in post-exercise peak expiratory flow rate which is indicative of exercise-induced asthma. Absenteeism and poverty were associated with findings of exercise-induced asthma. Early detection of exercise-induced asthma in school-age children through screening would facilitate early treatment, enhance exercise-related activities, and decreases school absences.

Absenteeism↗
PubMed1985

The clinical interview.

Subjects were given in-depth interviews aimed at assessing their level of functioning within their families, with peers, at school, and in leisure activities. Subjects were interviewed when the mean age of the study population was 11 and again at mean age 16. At the time of the first interview, index subjects were impaired relative to controls in interpersonal relations, work and play activities, self-esteem, and mood. There were no apparent differences due to rearing environment or sex, and no interactions with genetic background. At the time of the second interview, index-control differences were even more widespread, with index children showing impairment in virtually all examined areas of psychosocial function. Again, there were no group differences or interactions involving environment or sex. While index and control subjects remained highly discriminable from preadolescent to adolescent periods, there was less evidence of symptom stability in individual subjects over the 5-year period.

Adolescent↗
PubMed2005

Molds in floor dust, building-related symptoms, and lung function among male and female schoolteachers.

UNLABELLED: Five hundred and twenty-two teachers from 15 public schools, eight 'water-damaged' schools, and seven 'non-damaged' schools with no visible water damage were included in a cross-sectional design. Mold growth was assessed by recording the amount of dust on the floor and in the air in classrooms and the content of a number of mold species in the dust (CFU/g dust). The evaluation of health symptoms included symptoms recorded by questionnaire and spirometry, bronchial challenge, and CO-diffusion capacity. Nasal lavage fluid was analyzed for IL-8 and ECP. Personal and psychosocial factors were included as confounders. In this study population mucus membrane irritation symptoms (MMI) and general symptoms were reported more frequently by women than by men with odds ratios ranging from 1.4 to 2.1. Women's reports of symptoms from mucous membranes and skin and general symptoms were positively associated with mold exposure. Odds ratio for 'difficult to concentrate' after adjustment for confounders was 11.2 (1.4-90.1, 95% CI) at high levels of mold exposure. None of the lung function tests performed in this study were associated with mold exposure, to the 'water damaged' vs. 'non-damaged' classification, or to the symptoms reported. IL-8 and ECP were not associated either. PRACTICAL IMPLICATIONS: Psychosocial and personal reasons dominate in MMI and general symptoms. Headache and difficulties to concentrate associated with indoor mold exposure, mainly for women. No lung function impairment associated with indoor mold exposure.

Adult↗
PubMed1984

Psychosocial functioning at 1 month after head injury.

The authors examined the psychosocial sequelae of head trauma at 1 month after injury in a group of 102 adult head-injured patients representing a broad range of severity of trauma. One hundred two control subjects selected from friends of the head-injured patients were used for comparison purposes. Outcome was determined with a battery of psychosocial measures assessing a number of different areas of daily functioning. The results support the following conclusions: (a) at 1 month after injury, head-injured patients experience difficulties in a number of areas of psychosocial functioning, especially the resumption of major role activities (i.e., work, school, and home management) and leisure/recreational activities; (b) the relationship between head injury severity level and the adequacy of psychosocial functional differs for the various measures; and (c) in determining the psychosocial consequences of head trauma, the use of an appropriate control group is essential.

Activities of Daily Living↗
PubMedDate not supplied

School phobia with separation anxiety disorder: a comparative 20- to 29-year follow-up study of 35 school refusers.

The outcome of school phobia after age 30 years was studied with the hypothesis that school phobia cases would have persisting psychiatric problems, but would function better than nonschool refusal psychiatric patients. The subjects consisted of three groups. Thirty-five individuals treated for school phobia at ages 7 to 12 years were compared with age- and sex-matched nonschool refusal child psychiatric patients (n = 35) and a sample from the general population (n = 35). School phobia cases had had more psychiatric consultation, lived with their parents more often than the general population group, and had fewer children than both comparison groups. The nonschool refusal child psychiatric patients had poorer psychosocial adjustment and higher rates of criminal offenses. The implications of the findings are discussed.

Adult↗
PubMed1996

The affective dimension of low-back pain: its influence on the outcome of back school.

OBJECTIVE: Back School is a rehabilitation treatment for back pain that requires patients to understand an educational message and motivate themselves to modify their behavior to prevent relapses. In examining failed cases, the question arose as to whether the failures could be attributed to affective dimensions of pain that could be reducing tolerance to the pain itself and jeopardizing patients' compliance. We studied the role of the affective component of back pain in Back School failures to see whether this component can be used to predict the treatment's negative results and whether it can be conditioned by the treatment itself. DESIGN: Inception cohort. SETTING: Forty-two subjects with low back pain were treated with Back School at our rehabilitation department. MAIN OUTCOME MEASURES: Evaluation was carried out before Back School treatment and after 2 months, through functional clinical examination and Short Form-McGill Pain Questionnaire (affective and sensory pain indexes). RESULTS: As outcome of the treatment, we considered the modification of spontaneous and evoked pain and the motility of the spine. Unexpectedly, the nonparametric tests did not show a significant correlation between the affective indicators before and after the treatment. As expected, the two dimensions of pain, affective and sensory, are significantly related to each other, both before and after treatment, but this correlation increases after treatment (from r = .50 to r = 88). CONCLUSIONS: The initial hypothesis was not proven. These results show that high affective scores before Back School do not influence the success of the treatment and that the Back School itself is able to modify both the sensorial and affective pain descriptors.

Adult↗
PubMed2002

School performance as a premorbid marker for schizophrenia: a twin study.

Evidence is accumulating that developmental abnormalities, poor neuromotor function, and increased problem behavior precede the manifestation of schizophrenia itself. Information on school performance and behavioral development was obtained for 49 pairs of twins in which at least one twin suffered from schizophrenia (20 monozygotic [MZ], 29 dizygotic [DZ]) and for 43 pairs of healthy control twins (25 MZ, 18 DZ). Cox regression was used to analyze the contribution of schizophrenia, zygosity, sex, and year of birth to the age at which developmental divergence occurred. In both MZ and DZ twin pairs with schizophrenia, divergence in school performance occurred about 7.5 years earlier than it did in control twins, at 12 years of age, preceding the onset of psychosis by 10 years. This suggests that the first prodromal signs of schizophrenia manifest themselves as cognitive symptoms at the onset of puberty. Underperformance at school might therefore be considered one of the first signs of an until then latent vulnerability for schizophrenia.

Adult↗
PubMed2004

Electronic curriculum implementation at North American dental schools.

Electronic curriculum, or E-curriculum, refers to computer-based learning including educational materials available on CD or DVD, online courses, electronic mechanisms to search the literature, email, and various applications of instructional technology including providing laptops to students, multimedia projection systems, and Internet-compatible classrooms. In spite of enthusiasm about the potential for E-curriculum to enhance dental education, there is minimal guidance in the literature to assist schools with implementation. The study objectives were: 1) identify U.S. and Canadian dental schools that have initiated mandatory laptop programs and assess cost, faculty development issues, extent of curricular use, problems, and qualitative perceptions; 2) determine the extent to which twenty-two other E-curriculum resources were available and used at North American dental schools; and 3) identify factors that influenced E-curriculum implementation. A twenty-six item questionnaire, known as the Electronic Curriculum Implementation Survey (ECIS), was mailed to all sixty-six North American dental schools (ten Canadian and fifty-six U.S. schools) during 2002-03 with a response rate of 100 percent. Twenty-five of the twenty-six ECIS questions employed a menu-driven, forced choice format, but respondents could provide amplifying comments. Fifty-three questionnaires were completed by associate deans for academic affairs, three by deans, and ten by instructional technology (IT) managers, IT committee chairs, or directors of dental informatics departments. The survey found that E-curriculum implementation among North American dental schools is following the classic innovation pattern in which a few early adopting institutions proceed rapidly while the majority of potential adopters make modifications slowly. Fourteen U.S. dental schools have established mandatory laptop programs for students. Ten of these laptop programs were created in the past two years; respondents reported numerous growing pains but were generally pleased with their progress. Other E-curriculum capabilities were incorporated into courses more frequently at laptop schools than the fifty-two non-laptop schools including websites, online course evaluations, and instructor use of email to communicate with students. Few dental schools use online courses, and at most schools, few faculty have received training in online instructional techniques. Virtually all North American dental schools have provided substantial instructional technology resources to their faculty, but use of twenty-two components and capabilities of E-curriculum was limited, especially at schools without laptop programs. Various faculty-related issues were reported as implementation barriers including lack of time, skill, and incentive to develop educational software. We conclude that many North American dental schools, especially those with laptop programs, are functioning at the "learn by doing" phase of initial implementation in a four-stage innovation adoption model. E-curriculum planners should pay close attention to implementation problems that occur at this stage where many innovation efforts break down.

Canada↗
PubMed1989

Dietary restraint in young adolescent girls: a functional analysis.

An investigation of dietary restraint during adolescence was conducted in two phases. First, two school classes of 12- and 14-year-old girls completed a restraint questionnaire. Second, the functional nature of the restraint scores was assessed in 24 girls from each age group using a procedure previously shown to lead to overeating in restrained adults. A wide distribution of restraint scores was found, with restrained individuals present in both age groups. Restraint was found to be functional, predicting higher food consumption in a taste test after imagining eating highly palatable foods. Hunger ratings were elevated by the imagination procedure, although the extent of this increase was similar for both restrained and unrestrained girls. The girls' body weight index was significantly correlated with degree of restraint. The existence and breakdown of restraint at this young age is regarded with concern, particularly in view of the links between dieting and eating disorders.

Adolescent↗