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PubMedDate not supplied

A weekly group meeting for children on a pediatric ward: therapeutic and practical functions.

The multiple sources of psychological stress to the hospitalized child are reviewed with references to the literature. The Hahnemann Pediatric Ward and patient population are described as are the functions of a weekly group meeting for school aged hospitalized children led by a child psychiatrist. Efforts are made to use knowledge gained from the children for therapeutic purposes within the group as well as for teaching the inpatient pediatric staff how the hospitalized child's behavior reflects his inner thoughts and feelings. Aspects of the children's behavior and verbal productions in the group are discussed from a psychodynamic viewpoint. Conflict, ambivalence, fantasy distortion, denial and displacement are exemplified, as is the children's ever-present need to simultaneously express, defend against and master anxiety. Questions are raised about outcome and future avenues of investigation.

Attitude to Health↗
PubMedDate not supplied

Predictors of outcome following severe head trauma: follow-up data from the Traumatic Coma Data Bank.

Outcome as a function of employment status or return to school was evaluated in severely head-injured patients. A priori we selected the most salient demographic, physiological, neuropsychological and psychosocial outcome predictors with the aim of identifying which of there variables captured at baseline or 6 months would best predict employability at 6 or 12 months. Based on the patients evaluated at 6 months, 18% of former workers had returned to gainful employment and 62% of former students had returned to school. For those not back to work or school at 6 months, 31% of the former workers and 66% of the former students had returned by 12 months. Age, length of coma, speed for both attending and motor movements, spatial integration, and intact vocabulary were all significantly related to returning to work or school. The three most potent predictors for returning to work or school were intactness of the patient's verbal intellectual power, speed of information processing and age.

Activities of Daily Living↗
PubMed2005

Spinal lesion level in spina bifida: a source of neural and cognitive heterogeneity.

OBJECT: The aim of this study was to evaluate whether the level of a spinal lesion is associated with variations in anomalous brain development and neurobehavioral outcomes in children suffering from the meningomyelocele form of spina bifida and hydrocephalus (SBM-H). METHODS: Two hundred sixty-eight children with SBM-H were divided into upper (T-12 and above; 82 patients) and lower (L-1 and below; 186 patients) lesion-level groups. Magnetic resonance images were qualitatively coded by radiologists and quantitatively segmented for cerebrum and cerebellum volumes. Psychometric assessments of handedness, intelligence, academic skills, and adaptive behavior were compared between lesion-level groups and also used to determine the number of children who met research-based criteria for mental retardation, attention deficit hyperactivity disorder, and learning disabilities. The magnetic resonance images obtained in children with upper-level spinal lesions demonstrated more qualitative abnormalities in the midbrain and tectum, pons, and splenium, although not in the cerebellum, compared with images obtained in children with lower-level spinal lesions. Upper-level lesions were also associated with reductions in cerebrum and cerebellum volumes, lower scores on measures of intelligence, academic skills, and adaptive behavior, and with a higher frequency of individuals meeting the criteria for mental retardation. Hispanic children (who were also more economically disadvantaged) were more likely to have upper-level lesions and poorer neurobehavioral outcomes, but lesion-level effects were generally independent of ethnicity. CONCLUSIONS: A higher level of spinal lesion in SBM-H is a marker for more severe anomalous brain development, which is in turn associated with poorer neurobehavioral outcomes in a wide variety of domains that determine levels of independent functioning for these children at home and school.

Adolescent↗
PubMed2000

[Competitiveness in science. Today, tomorrow, and forever].

Paternalistic governments and highly bureaucratized administrations produce mediocre science policy decisions that often allow for the co-existence of potentially competitive scientists alongside with those that are not. This invariably results in failure to produce significant research. It seems apparent therefore, that policy change aiming at improving science and technology must begin with intensification of the level of individual competitiveness. Nations that have internationally competitive levels of technical and scientific activity such as Japan, USA and Canada, share in common certain features that foster individual competitiveness despite the fact that their socioeconomic basis are vastly different. These common features include administrative continuity, very high academic standards and a highly educated work force. The scientist's emotional cost in competitive environments is high but there seems to be no alternative given the sophistication of the topics that are dealt with in formerly purely descriptive sciences such as biomedicine, and given the enormous speed of electronic communications. The role of governments in fostering science and technology should be mainly concerned with conducting a sound fiscal policy in order to provide for the needs of education and scientific activity. Governments can also play a key role in insuring that science remains competitive through the delineation of rules that increase individual competitiveness rather than with policy schemes that fail to directly address the responsibility of the individual. Policies to increase individuals' performance may prove costly to politicians given that these adjustments imply unpopular decisions regarding an increase in academic performance expectation beginning in high school and the re-assignment of functions of individuals or institutions that do not meet international productivity criteria.

Academies and Institutes↗
PubMed2001

The impact of child maltreatment and psychopathology on neuroendocrine functioning.

Cortisol regulation was investigated in a sample of school-aged maltreated (n = 167) and demographically comparable low-income nonmaltreated (n = 204) boys and girls in the context of a day camp research program. The presence of clinical-level internalizing and clinical-level externalizing symptomatology was determined through adult report and child self report. Children who exhibited clinical-level internalizing problems only, clinical-level externalizing problems only, and comorbid clinical-level internalizing and extemalizing problems were identified. Clinical-level cases were more prevalent among the maltreated children. Maltreated children with clinical-level internalizing problems were distinguished by higher morning, afternoon, and average daily cortisol levels across the week of camp attendance. In contrast, nonmaltreated boys with clinical-level externalizing problems emerged as distinct in terms of low levels of morning and average daily levels of cortisol. Maltreated children with comorbid clinical-level internalizing and externalizing problems were more likely not to show the expected diumal decrease in cortisol. The findings are discussed in terms of the joint impact of maltreatment and different forms of psychopathology on neuroendocrine regulation.

Arousal↗
PubMed2002

[The use of instenon in children with minimal brain dysfunction].

Minimal brain dysfunction (MBD) represents the most common type of neuropsychic disorders in childhood. Resulting in focal damages, underdevelopment and dysfunction of one or another cortical regions of brain hemispheres, MBD manifested in children as movement and speech disorders, dysgraphy, dyslexia, dyscalculia and attention deficit hyperactivity disorder. In the open controlled study, an efficacy of the complex nootropic medication "Instenon" was evaluated in the treatment of 59 MBD patients, aged 4-12 years. Control group included 27 children with MBD assigned to low polyvitamin (Sana Sol) doses. The treatment duration was 1 month. Before and after treatment, children with MBD underwent complex examination, which included parent's interviewing using structured questionnaire, general examination, with detailed analysis of complaints, neurological status investigation and psychological study. In the children taken instenon, distinct positive effect has been achieved in 71% of the cases, in control group--in 15%. Positive effect emerged in improvement of behavior characteristics, better school marks, movement, attention and memory indices, functions of psychic activity, organization, programming and control. When strictly keeping a scheme prescribed (gradual dose increase, drug taking in morning and day time), a risk for unfavorable side effects is minimal.

Ammonium Chloride↗
PubMedDate not supplied

[Migraine in childhood: a trivial condition?].

INTRODUCTION: Migraine is seen as being a trivial disease, and more so in childhood, but in many cases it has a detrimental effect on the patient's quality of life. PATIENTS AND METHODS: Prospective study. All the patients were evaluated by the same neuropaediatrician and all of them satisfied diagnostic criteria for migraine. 127 children were examined. The mean age was 9.4 years, with an interval of 3-14 years; there were no differences between sexes. 67 males and 60 females. RESULTS: The mean length of time the episodes lasted was 22.5 h. The most frequently observed clinical features were: hemicranial localisation, 44.4%; throbbing, 74.4%; photophobia, 74.8%; phonophobia, 83.5%; nausea-vomiting, 63.5%; and aura, 14.3%; with predominance of acutely intense visual and sensory symptoms (74%), functional repercussions in 87% and absence from school in up to 36.9% of cases. 16% of patients have had episodes of status migrainous. At the time of the visit 46% had several attacks a week; 13.7% once a week; 16.1% fortnightly; 13.7 % monthly; 5.6% every three months; and others, 4.8%. 48.7% of the patients were given preventive treatment, which was wholly effective in 48%, partially effective in 35% and not at all effective in 15.4%. CONCLUSIONS: Migraine in childhood is not a trivial pathology. It is disabling: it interferes with their daily life in 85% of cases, causes them to miss school in almost 40% of patients and nearly 50% of them have several episodes a week. A similar figure required prophylactic treatment that was seen to be very effective.

Adolescent↗
PubMed1990

Occupational therapy in pediatric rehabilitation.

Occupational therapy in pediatric rehabilitation focuses on the effects of diseases and of the environment on a child's abilities to function successfully in daily life settings (home, school and playground) and roles (family member, student, etc.). In this paper, the process of pediatric occupational therapy, from assessment to discharge planning, is briefly described. Pediatric occupational therapy intervention strategies including treatment, environmental adaptation, and systems change are presented and illustrated. Three case studies highlighting occupational therapy intervention are discussed.

Child↗
PubMed1990

The school breakfast program and cognition in adolescents.

We studied cognitive function and metabolic status in a group of healthy adolescents fed the government supplied breakfast (n = 18) versus a control group (n = 16) fed a very low calorie meal. Serum glucose and beta-hydroxybutyrate levels were repeatedly measured at predetermined intervals throughout the testing period. Acute cognitive and mood effect were evaluated in all subjects on a pre-post basis. No significant group differences emerged on a battery of psychological measures that assessed short-term auditory memory, vigilance, impulsivity, and mood. Neither serum glucose or beta-hydroxybutyrate levels correlated significantly with any behavioral measure. Results are discussed in the context of previous studies of nutrition and cognition.

3-Hydroxybutyric Acid↗
PubMed1989

[Surgical treatment of patients with triple valvular heart disease--a clinical study of triple valve replacement].

Triple valve replacement were performed on 14 cases from 1972 to 1987 in our department in Nihon University School of Medicine. Hemodynamic data and the function of other organs were analysed. 5 cases were dead. Causes of death were LOS in four and respiratory failure in one. Although preoperative clinical status were class III and IV in NYHA, postoperative clinical status improved in I and II except dead cases. There were significant differences between pre and postoperative valves of PAm, PCWP and CI, but of RAm RVEDP and EF. The reason why these cardiac function did not recover enough was myocardial degeneration. The respiratory, renal and liver function was clearly improved after operation except hemolysis. In conclusion, it is recommended that, in cases of severe triple valve disease, triple valve replacement should be performed with SJM valve to get satisfactory hemodynamic improvement.

Adult↗
PubMed1986

Case of congenital short small intestine: survival with use of long-term parenteral feeding.

Isolated congenital short small intestine is a rare anomaly. Of six (one male, five females) previously reported cases, four died in infancy from intractable diarrhea. We report the case of 7-year-old boy with this syndrome in whom a 2-year period of parenteral feeding at home allowed normal weight gain, growth, and development while intestinal adaptation occurred. Parenteral feeding was discontinued at age 2 1/3 years, and for the past 5 years his weight has remained between the tenth and 25th percentiles and his stature between the 25th and 50th percentiles. His development has been normal and he functions at or above grade level at school. Coefficient of fat absorption has increased from 54% to 81%. Vitamin B12 absorption has improved but has not normalized. He remains lactose intolerant. We believe his survival, growth, and development would have been compromised if he had not received a prolonged period of parenteral feeding.

Child Development↗
PubMed1988

Epidemiology of head lice infestation in school children at Peshawar, Pakistan.

An epidemiological survey of head lice infestation among school children at Peshawar (Pakistan) was conducted from April to December 1986. Lice were detected by visual inspection and combing of the head. A total sample of 2287 students (1499 girls, 788 boys) aged 8-16 years from six schools revealed an overall prevalence of 46%, with girls showing a higher infestation rate (49%) than the boys (40%). The infestation in girls was more common in one of the three girls' schools surveyed, while in boys it did not differ significantly among different schools. The prevalence decreased as a linear function of age in both sexes. Pediculosis was directly related to hair length, and the rate of decrease with age was uniform in the three hair length categories compared. The infestation was directly related to crowding at home, and was negatively associated with dandruff. Like prevalence, the degree of infestation was higher in girls than in boys and decreased linearly with age in both sexes.

Adolescent↗
PubMed1988

Children referred for pleoptic treatment. A survey on aspects considering referral for examination, role of screening programmes, previous therapy and compliance.

The patient histories of 53 unselected children referred for pleoptic treatment were evaluated. The age of the patients ranged from 7 to 12 years, and the mean age was 8.8 years. Information concerning the history was obtained from a questionnaire answered by the parents. The data concerning the ocular conditions were available in the case records. In 83% of the children the diagnosis of functional amblyopia had already been made before school age. During the first 3 years of life altogether 38% were diagnosed outside of routine screening programmes. When the children caught by screening were added, the proportion of those diagnosed before the age of four was 45%. The practice of referring patients from the child health center to the ophthalmological examination was unsatisfactory in some children (19%). Poor compliance was noted still more often (at least in 58%). Occlusion therapy had been used by 92% of the children, and in 42% alternating complete occlusion had been prescribed.

Amblyopia↗
PubMed1987

The distribution of services to the underserved. A comparison of minority and majority medical graduates in California.

We assessed the belief that minority physicians are more likely to serve traditionally underserved minority populations by examining the medical practice profiles of minority and majority physicians who graduated from seven California medical schools in 1974 and 1975. The results indicate that minority graduates are more likely to locate their practices in areas with health care personnel shortages (53%) than are majority graduates (26%). Minority physicians had a higher proportion of Medicaid or Medi-Cal patients, and they saw a greater percentage of minority patients (60%) than did majority physicians (21%). We conclude that minority graduates of US medical schools, at least those from California, serve traditionally underserved populations to a greater degree than do their majority graduate colleagues. These findings lend strong support to the contention that aggressive affirmative action programs by medical school admission committees serve the important utility function of improving the distribution of medical services.

California↗
PubMed1995

Factors associated with sexual behavior among adolescents: a multivariate analysis.

Multiple factors associated with engaging in sexual intercourse among a sample of adolescents were examined. A self-administered survey was completed by 1,026 high school students in a classroom setting. Discriminant function analyses were performed to discriminate factors most important in predicting the sexual status of the adolescent. Compared to males who had never engaged in sexual intercourse, sexually active males reported more frequent use of alcohol, had higher levels of stress, were less likely to use seat belts, were more likely to engage in physical fights, and were more likely to worry about the spread of AIDS. Sexually active females reported more frequent use of alcohol and cigarettes, and had higher levels of stress than did female adolescents who had never had sexual intercourse. These findings suggest that effective interventions to address teenage pregnancy need to utilize a multifaceted approach to the prevention of high-risk behaviors.

Adolescent↗
PubMed1993

[Providing educational goals in social medicine for the practicing physician in basic medical education].

Social Medicine has a long and successful tradition in providing public medical care, but it does not have a long-standing academic tradition. To this very date, some medical faculties have neither a representative of the discipline nor a corresponding institute. Although the topics of Social Medicine are manifold, there is a discrepancy in the time allotted for teaching within the medical curriculum. Social Medicine must offer practical and orientational knowledge. In the medical faculties, Social Medicine also represents the health sciences, and in the Schools of Public Health it has the function of a bridge discipline and is the most prominent representative of medicine.

Clinical Competence↗
PubMedDate not supplied

Reciprocity, credentials, or the same old politics?

In Wyoming--and in view of the ADA's policy, probably throughout the United States--dentists and dental hygienists are dissatisfied with current licensing procedures. That is not to imply that state licensing boards should be eliminated. They should continue to oversee licensure and perform their other important functions. Accreditation involves strict requirements for dental schools. In turn, the schools require their students to pass the National or Regional Board Examinations, or both. That seems sufficient to ensure professional competence of new graduates. The dental schools should be permitted to act as the principal screening mechanism; successful completion of their requirements should be sufficient for licensure, after the other requirements are met. We urge the Wyoming Board of Dental Examiners and other state boards to adopt new standards for licensure, with successful completion of National Board examinations and any of the Regional Board examinations as the standard.

Attitude of Health Personnel↗
PubMed1997

Social categorization and the formation of intergroup attitudes in children.

The study was designed to test several hypotheses derived from intergroup theory concerning the effects of the presence of a novel social category on the formation of intergroup attitudes. Elementary school children (N = 61; aged 6-9) were given measures of classification skill and self-esteem and assigned to 1 of 3 types of school classrooms in which teachers made: (1) functional use of "blue" and "yellow" groups assigned on the basis of a biological attribute, (2) functional use of "blue" and "yellow" groups assigned on the basis of a random drawing, or (3) no explicit groups (despite the presence of blue and yellow groups). After 4 weeks, children completed measures of intergroup attitudes and behavior. As predicted, the functional use of color groups affected children's attitudes toward group members, with children showing consistent biases favoring their own group. Children with higher levels of self-esteem showed higher levels of intergroup stereotyping.

Child↗