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PubMed2006

Relationship between impaired functional stability and back pain in children: an exploratory cross-sectional study.

QUESTIONS UNDER STUDY: On surveys, about every fifth child in the school age reports back pain. There is a dearth of literature on the association between functional stability and back pain in children. OBJECTIVE: To examine the association between functional stability, measured with the Matthiasstest, and "back pain during the last week". METHODS: We used data from a cross-sectional survey on third, fourth and fifth grade school-years (128 children aged between 8 and 12 years) in seven different classes in two different rural regions of Switzerland, to evaluate in an explorative manner the association between the score of the Matthiass-test and low back pain and upper back pain in the last week with two multivariable logistic regressions. RESULTS: The Matthiass-test score, controlled for age, sex and language region of the school, was significantly associated with low back pain in the last week (adjusted odds ratio 1.77 with an 95% confidence interval from 1.08 to 2.91) and non significantly with the upper back pain in the last week (adjusted odds ratio 1.67 with an 95% confidence interval from 0.98 to 2.81). CONCLUSION: The Matthiass-test score is associated with low back pain. Because of the exploratory character of this study, these results should be regarded with caution. Whether a high score on the Matthiass-test could be a risk factor for back pain should be evaluated in prospective studies.

Back Pain↗
PubMed1999

Are school based mental health services effective? Evidence from 36 inner city schools.

In an effort to bridge the gap between service need and service utilization, an urban based, university-affiliated children's psychiatric outpatient clinic implemented a program which provides mental health services in inner city schools. Since impressions of school and mental health personnel affirmed the effectiveness of such services, an evaluation of this program was conducted, despite the difficulties inherent in implementing research in "naturalistic settings." A clinic sample of children (N = 220) was compared with a sample served in the urban schools (N = 256). The findings revealed that both sets of children showed improvement as indicated by the Children's Global Assessment Scale (C-GAS) and Global Assessment of Functioning Scale (GAF). The improvement was comparable, even though the school children were seen for a slightly shorter period of time (an average of 5 versus 8 months) but had an equally frequent level of service (3 sessions per month in each setting). This finding may have important implications for the managed care environment. These results indicate that school based mental health services show improvement comparable to the clinic-based services, and have the potential for bridging the gap between need and utilization by reaching disadvantaged children who would otherwise not have access to these services.

Adolescent↗
PubMed1993

Increased risk of coronary heart disease death in men with low total and low-density lipoprotein cholesterol in the Russian Lipid Research Clinics Prevalence Follow-up Study.

BACKGROUND: A continuously increasing risk of coronary heart disease with increasing levels of cholesterol has been reported by many observational and experimental studies. However, this type of association has not been observed in studies in the Russian Lipid Research Clinics. METHODS AND RESULTS: Twelve-year coronary heart disease mortality among 40- to 59-year-old men was analyzed in the Moscow and St Petersburg examines in the Russian Lipid Research Clinics Program. The baseline survey examined 6431 men fasting and free of prevalent coronary heart disease. Lipids and lipoproteins, blood pressure, body mass, education level, alcohol intake, and smoking history were obtained. Mortality follow-up was based on contacts with participants or their relatives or neighbors. Coronary heart disease mortality was analyzed based on risk factor levels and was further divided into rapid and nonrapid deaths. A J-shaped cholesterol-coronary heart disease risk function was present for both total and low-density lipoprotein cholesterol. Further examination showed hypocholesterolemic men to have lower low-density and higher high-density lipoprotein cholesterol, higher alcohol consumption, leaner body mass, and less education than men with normal or high cholesterol levels. When education level was considered, the J-shaped risk function was present only among men with less than a high school education. When deaths were classified into rapid (less than 24 hours after onset of symptoms) and nonrapid, the J-shaped risk function was restricted to rapid deaths. CONCLUSIONS: The results of disclose a sizeable subset of hypocholesterolemics in this population at increased risk of cardiac death associated with lifestyle characteristics.

Cholesterol↗
PubMed1992

Racial and social correlates of age-related changes in functioning.

Six waves of observations spanning a decade on a panel of 566 Black and 5,196 non-Black survivors were utilized to examine social and racial differences in age-related changes in functioning. An index consisting of three dimensions was used to assess functioning: physical functioning, self-care capacity, and self-rated well-being. Growth curve analysis was used to assess variations in trajectories of functional impairment across Black/non-Black, poor/nonpoor, male/female, and high-school/non-high-school graduate subpanels. Trajectories vary across social groups in the expected manner. However, we note that the trajectories are not linear and that substantial variability exists within both the Black and non-Black subpanels. Moreover, we note that Blacks report poorer functional status than non-Blacks even with income and education controlled. However, age changes do not differ across Black and non-Black subpanels, as predicted by the multiple-jeopardy hypothesis.

Activities of Daily Living↗
PubMed2004

Personality functioning: the influence of stature.

BACKGROUND: The Wessex Growth Study has monitored the psychological development of a large cohort of short normal and average height control participants since school entry. AIMS: To examine the effect of stature on their personality functioning now that they are aged 18-20 years. METHODS: This report contains data from 48 short normal and 66 control participants. Mean height SD score at recruitment was: short normals -2.62 SD, controls -0.22 SD. Final height SD score was: short normals -1.86, controls 0.07. The Adolescent to Adult Personality Functioning Assessment (ADAPFA) measures functioning in six domains: education and employment, love relationships, friendships, coping, social contacts, and negotiations. RESULTS: No significant effect of recruitment height or final height was found on total ADAPFA score or on any of the domain scores. Socioeconomic status significantly affected total score, employment and education, and coping domain scores. Gender had a significant effect on total score, love relationships, coping, and social contacts domain scores. Salient aspects of daily living for this sample were identified from the interviews (prevalence%): consuming alcohol (94%), further education (63%), love relationships (55%), current drug use (29%), experience of violence (28%), parenthood (11%), and unemployment (9%). Stature was not significantly related to behaviour in any of these areas. CONCLUSIONS: Despite previously reported links between short stature and poorer psychosocial adaptation, no evidence was found that stature per se significantly affected the functioning of the participants in these areas as young adults.

Adolescent↗
PubMed1969

Learning disorders as a school health problem. Neurological and psychiatric aspects.

Broadened concepts of intellectual functions have shown that many varieties of mental subnormality may be preventable or subject to improvement with proper treatment. Many types of neurologic dysfunction are accompanied by learning disorders based on specific intellectual deficits.A more refined delineation of the higher cerebral functions of each child with a learning disorder provides the basis for improved specific remedial educational techniques. Such detailed assessment of higher functions of the nervous system can be greatly enhanced by the appropriate special evaluations carried out by well trained psychologists, speech pathologists and educational consultants, working in cooperation with physicians. The varieties of adjustment problems of children and emotional impact of a learning disorder should be recognized as early as possible and treated appropriately. Motor and perceptual-motor therapies may have limited value in some cases but may be harmful if indiscriminately applied. Psychotropic drugs have a relatively limited place in the management of learning disorders but may be immensely valuable in some cases by helping to control specific behavior problems which interfere with learning processes. Physicians have a major responsibility to provide help and leadership in dealing with learning disorders.

Brain Damage, Chronic↗
PubMed2004

Liver transplantation for children--the Red Cross Children's Hospital experience.

UNLABELLED: Liver transplantation for infants and children has been available in South Africa at a single centre, the only established service in Sub-Saharan Africa, for more than a decade. Current concerns have shifted from an initial target of early post-transplant survival to quality of life in the long-term. MATERIALS AND METHODS: Since 1985, 225 infants and children have been assessed, with 146 accepted for transplantation. Sixty-nine have had 71 orthotopic liver transplants (OLTx). Biliary atresia was the most frequent diagnosis (54%) followed by acute liver failure (ALF) (15%). Waiting list mortality has remained high (23%), particularly for the ALF group (50%). Forty-three were reduced size transplants with donor: recipient weight ratios ranging from 2:1 to 11:1. Twenty-seven were <10 kg. RESULTS: Fifty (74%) survive 1 month-12 years post-transplant. Actuarial survival after 1996 since HBV core antibody positive donor livers were refused and prophylactic IV ganciclovir used has been >82%. Early post-OLTx mortality was low (5%), one primary non-function, one IVC thrombosis, one PV thrombosis, but late morbidity and mortality (20%) was mainly due to viral infection: de novo hepatitis B (five patients, three deaths), EBV-related post-transplantation lymphoproliferative disease (PTLPD) (eight patients, six deaths) and CMV disease (11 patients, five deaths). Tuberculosis prophylaxis, required in six cases, resulted in major morbidity in two and mortality in one. Poor compliance played a significant role in seven deaths. Hypertension requiring medication along with some compromise of renal function has been present in all but two patients. However, all those of school-going age (25) attend school normally and remain in good health and only three of the survivors have abnormal liver function tests. CONCLUSIONS: Successful liver transplantation is possible in a developing country with limited resources. Scarcity of virus-free donors (HBV and HIV) leading to waiting list mortality and infrequent re-transplantation along with long-term consequences of immunosuppression (infection, lymphoma and renal toxicity) remain problems. Intense education of the caregiver and close follow-up, particularly of those living at long distances has partly addressed the compliance problem.

Actuarial Analysis↗
PubMed2000

Liver transplantation in children--the Red Cross War Memorial Children's Hospital experience.

Liver transplantation for infants and children has been available in South Africa for more than a decade. Current concerns have shifted from an initial target of early post-transplant survival to quality of life in the long term. Since 1985, 175 infants and children have been assessed, with 104 accepted for transplantation. Fifty have had orthotopic liver transplants (OLTx), 48 (3 retransplants) in Cape Town and 2 abroad. Biliary atresia was the most frequent diagnosis (52%) followed by acute liver failure (ALF) (16%). Waiting list mortality has remained high (15%), particularly for the ALF group (50%). Thirty-four patients survive 1 month--14 years post-transplant. Early post OLTx mortality was low (7%) but late morbidity and mortality (23%) were mainly due to viral infection: de novo hepatitis B (5 patients, 2 deaths), EBV-related post-transplantation lymphoproliferative disease (PTLPD) (6 patients, 4 deaths) and CMV disease (9 patients, 4 deaths). Tuberculosis prophylaxis, required in 6 cases, resulted in major morbidity in 1. Hypertension requiring medication along with some compromise of renal function has been present in all but 2 patients. However, all those of school-going age (20) attend school normally and remain in good health and only 3 of the survivors have abnormal liver function tests. Successful liver transplantation is possible in a developing country with limited resources. Scarcity of virus-free donors (HBV and HIV) leading to waiting list mortality and infrequent retransplantation along with long-term consequences of immunosuppression (infection, lymphoma and renal toxicity) remain problems.

Child↗
PubMed1997

Impairment of psychological functions in children environmentally exposed to lead.

The major objective of the study was to determine whether environmental exposure to lead exerts a negative impact upon psychological functions in children. The examined group consisted fo school age children (6-15 years old, x = 9.5, SD = 1.4) living close to copper works. Out of 4548 children with measured blood lead concentrations, two groups were selected one with the highest exposure levels (12.0-27.2 micrograms/dl) and the other drawn from the remaining children, with low blood lead levels. The mean exposure level for the whole examined group equalled 10.18 mu/dl PbB (SD-4.73 micrograms/dl). To assess effects of the exposure, the following variables were measured in the examined children: intelligence, hand-eye coordination, perception, memory, reaction time and accuracy, and behaviour disorders. The moderator variables of sociodemographic character, i.e. parents' education, income, etc., were also controlled. A significant impact of lead upon psychological functions and behaviour was revealed for two variables only: intelligence and attention concentration. An increase in the exposure level by 10 micrograms/dl PbB was associated with deterioration of general IQ by 5.3 points and growth of the number of mistakes in the Simple Reaction Time test by 3.3. It was also revealed that the short-term memory deteriorates with growing level of exposure, the strength of this relationship was close to the level of statistical significance (p < 0.07).

Adolescent↗
PubMed1989

Curricula interventions for identity change: substantive and ethical considerations.

The rationale for school-based curricula interventions to promote identity formation is based on the advantages of psychological functioning associated with use of the more sophisticated identity statuses and the opportunities available in school settings to create the conditions facilitating developmental movement in that direction. A variety of education strategies pertaining to identity development are described, along with their probable impacts upon various aspects of the processes involved in forming a sense of identity. Ethical considerations for both supporting and opposing identity-related interventions are presented. Suggestions are offered as to how best to proceed when implementing identity-related education curricula.

Adolescent↗
PubMedDate not supplied

Family dimensions in anxious-depressed school refusers.

The Family Adaptability and Cohesion Evaluation Scale II (FACES II) was administered to 46 adolescents with comorbid anxiety and major depressive disorders and to their parents in a treatment study of school refusal. FACES II measures cohesion and adaptability dimensions, as well as family type (balanced to extreme). Generally, adolescents and parents reported low cohesion (i.e.. disengagement) and low adaptability (i.e.. rigidity) on FACES II. Adolescents and parents described their ideal families as significantly less disengaged and less rigid than their own families. Fifty percent of adolescents, 38% of fathers, and 24% of mothers classified their families as the extreme type. Adolescents in extreme families, when compared with adolescents in more balanced families, reported significantly higher scores on two of three depression instruments and on a measure of somatic symptoms. Family therapy to improve cohesion and adaptability and treatments focused on improving depression and somatic symptoms may improve family functioning and decrease the severity and course of school refusal.

Adolescent↗
PubMed1994

Early childhood special educators' perceptions of school psychologists' roles in their programs.

Perceived and preferred roles of 67 school psychologists in early childhood special-education programs were examined in a partial replication with 268 respondents in Illinois of Mowder, Willis, and Widerstrom's work. The most commonly cited reason for consultation with school psychologists was related to psychological assessment, with information on children's functioning as the most likely benefit. Respondents preferred the mental health model. Although respondents were satisfied with the roles of school psychologists, they presented several concerns about expanded roles for school psychologists.

Child, Preschool↗
PubMed1998

The long-term course of autistic disorders: update on follow-up studies.

The majority of children with autism show deviance and socially or psychiatrically handicapping conditions throughout life. Only a small proportion of those with classical childhood autism lead independent adult lives. Others, particularly those with 'high-functioning' autism and so-called Asperger syndrome will improve enough to live an independent adult life. The level of mental retardation and other comorbid conditions (such as medical syndromes and other neuropsychiatric disorders, including epilepsy) is important in predicting outcome. An IQ below 50 around school age predicts severe restriction of social and adaptive functioning in adult life. The absence of communicative speech at 5-6 years of age is indicative of a poorer long-term overall outcome. There is a clear co-variation between IQ and level of communication, but probably there is some prognostic factor in language development apart from this. Measures of flexibility and cognitive shifting abilities tend to be good predictors of social outcome in a few studies. There is a continued need for prospective, longitudinal studies of children with autism spectrum disorders, particularly in Asperger syndrome. The role of interventions of various kinds needs to be addressed in such studies.

Activities of Daily Living↗
PubMed2006

Süleymaniye Külliyesi: a historically important medical, scientific, and cultural center.

SCIENCE HAS MANY Western and Eastern historical roots. All of these contributed to the body of academic literature. One of the most important aspects of scientific progress is educational institutions, including hospitals, schools, and libraries. Some of these institutions may offer an identity for a city, as well as contribute to its development. Süleymaniye Külliyesi is one such institution. Süleymaniye Külliyesi, established in the 16th century, contains many centers, including a mosque, surrounded by a hospital, school of medicine, central pharmacy, and library. It once served both the Ottoman Empire and the Turkish Republic. The school of medicine of this complex was the first school of medicine in the Ottoman period that functioned in coordination with the hospital and central pharmacy. The library contains many rare books and manuscripts. Currently, it is one of the richest centers in the field of oriental studies. We conclude that Süleymaniye Külliyesi, with its health-related elements and library, contributed to the development and progress of science and deserves to be cited in the literature of the Western world.

Academic Medical Centers↗
PubMed2005

Assessment of executive function in preschool-aged children.

Assessment of the overarching self-regulatory mechanisms, or executive functions, in any age group is challenging, in part due to the complexity of this domain, in part due to their dynamic essence, and in part due to the inextricable links between these central processes and the associated domain-specific processes, such as language, motor function, and attention, over which they preside. While much progress has been made in clinical assessment approaches for measuring executive functions in adults and to some extent in adolescents and school-aged children, the toolkit for the preschool evaluator remains sparse. The past decade, however, has seen a substantial increase in attention to executive functions in very young children from a developmental neuropsychological perspective. With this has come a necessity for better, more specific, and more internally valid performance measures, many of which are now described in the experimental literature. Few such tasks, however, have adequately demonstrated psychometric properties for clinical application. We present two performance tasks designed to tap selective aspects of executive function in preschoolers that are emerging from the experimental laboratory and hold promise of appropriate reliability and validity for the clinical laboratory. Performance tests alone, however, are insufficient to develop a comprehensive picture of a child's executive functioning. Thus, we present a rating scale of preschoolers' executive function in the everyday context, and advocate a model of executive function assessment that incorporates both controlled performance tasks that target specific aspects of executive function and parent/teacher ratings that target more global aspects of self-regulation in the everyday context.

Aptitude Tests↗
PubMed2002

Gender differences in the impact of adolescent smoking on lung function and respiratory symptoms. the Nord-Trøndelag Health Study, Norway, 1995-1997.

Girls take up smoking at least as frequently as boys. Few studies have focused on gender differences in the impact of adolescent smoking. We evaluated the sex-specific effect of adolescent smoking on respiratory symptoms and lung function. All students in junior high and high schools in Nord-Trøndelag County Norway, 1995-97, were invited to participate in a cross-sectional study. Information on smoking habits and respiratory symptoms was obtained by self-administered questionnaires. Spirometry was performed in accordance with ATS standards. Eight-thousand-three-hundred and five students (83%) completed both questionnaire and spirometry. Among 6811 students aged 13-18 years (50.3% girls) with no history of asthma, 2993 (43.9%) reported never smoking, 665 (98%) reported occasional smoking, and 667 (9.9%) reported daily smoking (mean initiation age: 13.9 years). More boys than girls were heavy smokers. In all smoking categories, smokers reported a higher prevalence of respiratory symptoms than nonsmokers; symptoms increased with smoke burden. Girls reported more symptoms compared to boys with comparable smoke burden. A dose-response relation between smoking and reduced lung function was found only in girls. Girls were more vulnerable than boys to the impact of smoking on respiratory symptoms and lung function.

Adolescent↗
PubMed2005

Complex interactions between tutor performance, tutorial group productivity and the effectiveness of PBL units as perceived by students.

AIM: Tutor performance and tutorial group productivity interact with each other in a complex manner. The aim of this study was to investigate how tutor performance, tutorial group productivity and the effectiveness of a PBL unit interact with each other. Three hypotheses were tested: (1) Does the tutor performance score differ across different levels of group productivity? (2) Does the group productivity score differ across different levels of tutor performance? and (3) Is the learning effectiveness score of a PBL unit related to tutor performance and group productivity? METHOD: Students rated the tutor performance, the tutorial group productivity and the effectiveness of the PBL unit. In total 287 unique tutors were involved and were categorized as having a relatively low, average or relatively high score on tutor performance. This was also done for the group productivity score. For each combination, average effectiveness score were computed. Furthermore, partial correlation coefficients were computed. RESULTS: The results demonstrated that the average tutor performance score was higher if the productivity score was higher (hypothesis 1). The results also demonstrated that the average productivity score was higher if the tutor performance score was higher (hypothesis 2). Furthermore it was found that the effectiveness score was higher if the productivity score was higher. The effectiveness score was also higher if the tutor score was higher. The results furthermore demonstrated that the correlation coefficient between tutor performance and effectiveness of the PBL unit is 0.01 (n.s.) if the correlation between the two variables was controlled for group productivity (was 0.36). In addition, the correlation coefficient between group productivity and effectiveness became 0.39 if the correlation between these two variables was controlled for tutor performance (was 0.51) (hypothesis 3). CONCLUSION: It is concluded that tutor performance differs across different levels of group productivity and that the group productivity score differs across different levels of tutor performance. In addition, it is concluded that both group productivity and the tutor's performance have an impact on the effectiveness of a PBL unit, although the correlation between group productivity and effectiveness is higher than the correlation between tutor performance and effectiveness. This finding illustrates the importance of the group's productivity in PBL and the tutor's importance and implies that schools should put more efforts in improving tutorial group functioning as well as in improving a tutor's performance.

Education, Medical, Undergraduate↗
PubMed2006

Particulate levels are associated with early asthma worsening in children with persistent disease.

RATIONALE: Ambient particulate concentrations have been associated with variable physiologic effects in children with persistent asthma taking controller medications. OBJECTIVE: To determine whether exposure to particulate matter has immediate effects on asthma control in children with persistent disease. METHODS AND MEASUREMENTS: In a school-based cohort, 73 children, primarily with moderate and severe asthma, were followed daily over one or two winters (2001-2002, 2002-2003) in Denver, Colorado. The association among ambient fine particulate, bronchodilator use, and urinary leukotriene E4 levels was assessed. RESULTS: Daily concentrations of fine particulate peaked in the morning hours when children were commuting to school. In a multivariable analysis that controlled for meteorology, time trends, and upper respiratory infections, an increase of one interquartile range in morning maximum fine particulate levels was related to an average increase of 3.8% in bronchodilator usage at school (95% confidence interval [CI], 0.2-7.4; p = 0.04). Children with severe asthma demonstrated significantly stronger associations (8.1% increase; 95% CI, 2.9-13.4; p = 0.003) than those with mild/moderate disease (1.6% increase; 95% CI, -2.2-5.4; p = 0.41; p = 0.03 for difference between groups). Morning maximum fine particulate levels were also associated with urinary leukotriene E4 measured during school hours (average increase of 6.2% per interquartile range increase; 95% CI, 1.9-10.5; p = 0.006). These associations were not discernable when 24-h averaged concentrations were used. CONCLUSIONS: Peak concentrations of ambient fine particulate are associated with early increases in bronchodilator use and urinary leukotriene E4 levels among children with persistent asthma, despite the use of controller medications.

Adolescent↗