Early onset conduct problems: Does gender make a difference?

Baseline assessments of 64 girls and 158 boys (aged 4–7 yrs) diagnosed with oppositional defiant disorder or early-onset conduct problems, or both, were examined for gender-linked differences in behavioral symptoms. Child variables, parenting variables, and family variables were correlated with teacher reports of externalizing problems at school and independent observations of externalizing problems at home before treatment to determine whether there were any gender-specific differences in risk factors. Follow-up data (1–2 yrs posttreatment) were also examined for any gender differences in predictors of treatment outcome. Results indicated significant gender differences in behavioral symptoms according to independent home observations. However, reports of gender differences in behavioral symptoms were influenced by the gender of the reporting agent. The only gender-specific risk factor found was father "negativity" which was correlated with boys' behavior at home but not girls' behavior. Concerning differences in treatment outcome, variables regarding parents' psychological states and parenting style were the best predictors for girls but not for boys. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachement et problèmes de comportements intériorisés et extériori?s auto-rapportés à la période scolaire.

The association between attachment and self-reported externalizing and internalizing behavior problems was examined for a diverse SES French-Canadian sample of 108 children. Attachment classifications were assigned on the basis of reunion behavior with mother when the children were approximately 6 years old. Child problem behavior was assessed two and a half years later using the Dominic test. Results indicated that boys with disorganized attachment and children with ambivalent attachment reported a higher level of externalizing problems then did secure children. Moreover, disorganized children also reported a higher level of internalizing problems than secure children. Child assessments using the Dominic in conjunction with a measure of separation-reunion behavior at age 5 to 7 can play an important role in the identification of school-aged children at risk for aggressive or anxious-depressive adaptive problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of home visits at peritoneal dialysis centers in the United States

OBJECTIVE: To determine the frequency and characteristics of home visits in centers that provide training for peritoneal dialysis (PD). DESIGN: Mail survey sent to all dialysis centers in the United States providing home PD, using the Health Care Federal Administration (HCFA) Renal Provider list. RESULTS: Surveys were mailed to 1247 centers; 13 were undeliverable, resulting in 1234 surveys successfully delivered; 670 (54%) of those surveyed responded. Of those responding, 525 (78.4%) reported home visits were part of the care of home PD patients: 11% made a single home visit, 52% made an initial home visit with at least one follow-up visit, and 16% made visits only as needed. No home visits were made by 21% of responding centers. A registered nurse (RN) alone made the home visit in 61% of the centers, while a multidisciplinary team accompanied the RN in 35% of centers; 3% of visits were made by a licensed practical nurse, and 1% by the physician. Half of the visits required 0.5-1 hour, while 41% required 1-2 hours. Travel time was most often an hour or less one way. Staff were reimbursed for travel expenses by 90% of the centers. The 525 centers making home visits were not different than the 145 centers not making home visits in number of patients per center, number of RNs, rural or urban location, or affiliation with a university. Interpretation of the HCFA regulations concerning home visits was the most important factor influencing centers making home visits. CONCLUSIONS: Home visits to continuous ambulatory PD and continuous cycling PD patients in the United States are common. Nearly 80% of centers responding to the survey include home visits in the care of their home peritoneal dialysis patients.     

Sex differences in psychological adjustment from infancy to 8 years

The objective of this study was to explore sex differences in development from infancy to 8 years of age in a community sample. Measures of biological, social, interactive, and parental functioning as well as teacher reports were obtained. There were minimal differences in infancy, but major psychosocial differences emerged with increasing age. In the biological sphere boys were disadvantaged only in ratings of language and motor skills at 3 to 4 years old. They showed greater temperamental "difficulty" and low persistence factor scores from 5 years onward. Boys were significantly more likely to have problems with adaptive behavior and social competence and to show behavior problems of the hyperactive and aggressive type, as rated by mothers. Parent and family functioning measures did not differentiate between the sexes. Teachers rated boys as having more problems in academic and behavioral domains the first 3 years of school. Path analyses combining data sets gathered when the children were 3 to 8 years old demonstrated the differential courses of development for boys and girls although temperamental flexibility was the best predictor of behavioral adjustment for both sexes. A social learning explanation of the increased incidence of problems among males is supported, although biological influences are not ruled out.     

Binding of autoimmune cardiolipin-reactive antibodies to heparin: a mechanism of thrombosis?

As part of the well-known population study of 70-year olds in Gothenburg, 1239 persons at the age of 70 were invited to participate in an extensive investigation and Inter-Vention program of the Elderly in Gothenburg (IVEG). The probands were examined at the ages of 70, 73 and 76 years. The purpose of this study is to describe different kinds of services and informal support in the daily life activities among three large groups of people in their seventies. A cross-sectional study design was chosen in order to get as large groups as possible. A home call was made by an experienced occupational therapist, who interviewed and observed the probands' performance in the daily life activities. The probands and their relatives were asked about the extent of different services and informal support. Personal and home assistance care given by relatives almost doubled between the age of 70 and 76 years. Help organized by the Social Welfare Services only increased marginally. Of the personal activities of daily living (ADL), getting in/out of a bathtub was the activity that caused most problems. The most common walking aid was a stick or a crutch, while use of a wheelchair was quite uncommon. Between the age of 70 and 76 years, the use of the Handicap Transport Service more than doubled. This study shows that at the age of about 73 years the elderly should be offered formal support, such as the supply of assistive devices. What is noteworthy is that the help from relatives and friends increased much more than the help from the Social Welfare Services between the age of 70 and 76 years. At present, relatives and friends assist the elderly in their homes to a large extent, and frequently. Relatives are doing an important job for their elderly and for society, and should be given every possible kind of public support and relief in order to have the strength to continue.     

Behavioral symptoms of children and adolescents in Germany, the Netherlands and USA. A cross-cultural study with the Child Behavior Checklist

The goal of the study was a cross-cultural comparison of the parent ratings of behavior problems of children and adolescents aged 4-18 years in Germany, The Netherlands and the United States using the Child Behavior Checklist (CBCL). The analyses were undertaken in a German community sample (n = 1622) and a Dutch community sample (n = 2076). The results were compared with the data published by Achenbach for the national US sample. The analyses were based on the scales of the 1991 CBCL version and were performed for four age and sex groups (4- to 11-year-old boys/girls and 12- to 18-year-old boys/girls). In general, relatively minor differences could be detected between the three random samples. The range in the different samples was between -0.04 and 0.35, which is in line with other cross-cultural analyses using the CBCL. As long as no representative norms for Germany are available, the American norms can serve as an orientation for German studies using the CBCL.     

Physical health of 7-year-old children. An epidemiological study of school entrants and a comparison with their preschool health

At 7 years of age, all 649 7-year-old children in a school district underwent a physical examination, a vision screening and an auditory screening. 210 of the children were previously examined in an extensive health control at 4 years of age. The purpose of the present study was to describe the children's health situation and to evaluate the special health control performed at 4 years of age. In 15% of the children, functionally important health problems were found. Visual defects were most common, comprising 7.5%, then came physical health problems such as motor disturbances, obesity, bacteriuria in 6.5%, and hearing defects in 1%. About half of the important health problems were previously known. Children who had passed the special health control at 4 years of age had fewer newly detected important health problems and more previously known ones than other children, which means that many children with above all visual defects but also motor disturbances, bacteriuria and testis retention, were detected and treated earlier than would have happened without the special control at 4 years. It is concluded that the "ordinary" preschool Child Health Services did fulfill their purpose to detect handicapping disorders in an acceptable way; by the introduction of the special health control at 4 years of age, this function was further improved.     

The normative development of child and adolescent problem behavior.

The aim of this study was to identify normative developmental trajectories of parent-reported problems assessed with the Child Behavior Checklist (CBCL; T. M. Achenbach, 1991) in a representative sample of 2,076 children aged 4 to 18 years from the general population. The trajectories were determined by multilevel growth curve analyses on the CBCL syndromes in a longitudinal multiple birth-cohort sample that was assessed 5 times with 2-year intervals. Most syndromes showed a linear increase or decrease with age or a curvilinear trajectory, except for thought problems. Trajectories for most syndromes differed for boys versus girls, except those for withdrawn, social problems, and thought problems. These normative developmental trajectories provide information against which developmental deviance in childhood and adolescence can be detected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Home blood pressure measurement in general practice patients

In 68 consecutive patients with mild hypertension, blood pressure was measured by general practitioners during visits to the clinic, by nurse and by the patients at home. Mean age was 50 years (SD: 11) for both genders and 60% were women. Blood pressure and heart rate were significantly higher when measured by physicians than by nurse and patient (p < 0.01). During the study period of six weeks a significant decrease in blood pressures was registered by both physicians and patients. The study demonstrates the feasibility of home blood pressure monitoring as a part of the practice to diagnose hypertension in general practice.     

Construct validity of the Child Behavior Checklist: Effects of item overlap on second-order factor structure.

The broadband factor structure of the Child Behavior Checklist (CBCL) was examined for the narrowband scales as measured in practice (i.e., with items scored on more than 1 narrowband scale). On the basis of parallel and minimum average partial criteria, a 1-factor solution was indicated for boys age 4–5 yrs, girls age 4–5 yrs, and girls age 12–16 yrs and a 2-factor solution for boys age 6–11 yrs, girls age 6–11 yrs, and boys age 12–16 yrs. The implications of item overlap for research and professional practices associated with the CBCL and related materials are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complications following day case paediatric surgery

Several children have day surgery under general anaesthesia and depend on adult relatives for support and postoperative care at home. This prospective review examines the post operative problems encountered by 62 such children from the time of discharge from hospital to the first outpatient visit. The children were in the age range 3 months to 12 years. The commonest complications reported were:- Pain (18.9%), Cough/Sore throat (18.9%), Fever (16.2%), Restlessness (13.5%), Vomiting (12.2%), and Sleeplessness (6.7%). Eight patients reported more than three complications each. Day case surgery should not be regarded as "Minor Surgery" under Minor Anaesthesia", rather, the concerns for safety and comfort of the patients should extend beyond the recovery room to the ward and home.     

Confocal microscopy. Applications in research and practice of pathology

Three 4-hour bus rounds were organized as part of an international palliative care congress, to promote patient-based education both at home and in acute care hospitals. Patient cases were presented and discussed en route to and from each visit. A total of 23 medical specialists visited 16 patients (10 in three different hospitals and 6 at home). A mean of 5.3 cases were presented during each round. A total of nine journal club articles were presented, a mean of three (2-4) articles per round. A questionnaire was filled out anonymously by all 23 participants. On a scale of 1 (worst) to 5 (best) they gave the rounds an overall rating of 5 (range 4-5). These findings suggest bus rounds provide an opportunity for intensive exposure to patient-based learning, both in acute care hospitals and at home.     

Predicting Stability and Change in Toddler Behavior Problems: Contributions of Maternal Behavior and Child Gender.

This study examined the stability and continuity of early-identified behavior problems and the factors associated with this stability. Children and their mothers (N=125) were seen when the children were 2 and 4 years of age. Maternal reports of child externalizing behavior and laboratory observations of child noncompliance were stable from age 2 to age 4. Early externalizing behaviors decreased over time; however, child noncompliance in the laboratory did not. Although few associations were found between maternal positive behavior and child behavior problems, maternal controlling behavior was related to increases in child behavior problems, particularly at high levels of both prior noncompliance and prior maternal control. Child noncompliance was predictive of increases in maternal controlling behavior over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Very low birthweight boys at the age of 19

Using linked data from the Swedish Medical Birth Registry and the National Service Enrollment Register, long term follow up (to 18-19 years age) was made of 260 surviving singleton boys whose birthweight was less than 1500 g from a total of 150 229 boys born between 1973-5. These boys were shorter and lighter than boys who weighed more at birth, they had more visual and hearing impairments, were at much higher risk of cerebral palsy and other signs of mental impairment, evident as lower intelligence test scores and shorter schooling. No significant excess of asthma, back problems, or headaches were found.     

Correlates and consequences of harsh discipline for young children

OBJECTIVE: To examine the incidence, predictors, and consequences of harsh discipline in a sample of low-birth-weight children at 1 and 3 years of age. DESIGN: Analysis of data from the Infant Health and Development Program, an 8-site randomized clinical trial of low-birth-weight infants. The sample for analysis consisted of 715 children who were 3 years of age. The independent measurements of primary interest were the mother's hitting and scolding of her child as disciplinary practice. Analyses were run separately for boys and girls. Bivariate and logistic analyses were used to examine the predictors of the mother's hitting and scolding behavior. Multivariate analysis of variance was used to examine the consequences of the mother's harsh discipline on a child's IQ measured at age 3 years. MAIN OUTCOME MEASURES: The mother's self-report of whether she used more than 1 physical punishment in the past week, as well as an observer's report from 2 home visits of whether the mother hit or scolded the child during the 2-hour home visit. In addition, the Stanford-Binet Intelligence Scale was used to examine the consequences of persistent harsh discipline on child well-being. RESULTS: Findings demonstrate child, maternal, and environmental factors that might aggravate a parent's use of corporal punishment. Boys received higher amounts of harsh discipline on all outcome measures. For boys, growing up in an impoverished home was predictive of the greater likelihood of receiving harsh punishment. Using IQ at age 3 years as the outcome measure, girls were found to be vulnerable to persistent harsh discipline and lack of maternal warmth. Maternal harsh discipline in a context of low maternal warmth was associated with IQ scores for girls that are 12 points lower than the IQ scores of girls who received low punishment and high warmth.     

Painless dentistry. Fact or fiction?

The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.     

Late presentation of cryptorchidism: the etiology of testicular re-ascent

PURPOSE: We reviewed the records of 21 boys who had 23 previously documented descended testes that reascended and who underwent orchiopexy during a 2-year period. MATERIALS AND METHODS: We retrospectively reviewed a 2-year experience in 103 boys (115 undescended testes) who underwent orchiopexy in 1988 and 1989. RESULTS: In our 2-year experience 21 of the 103 boys with undescended testes had multiple recorded confirmations of testicular descent in the past. Of the boys 40% had previously been examined in the office or with general anesthesia by a pediatric urologist or pediatric surgeon for another reason, and 40% had a nurse or physician parent. Surgery was performed at ages 5 to 14 years, an average of 2 years after the initial presentation with reascent. Human chorionic gonadotropin was unsuccessful in causing testicular descent. There was no correlation with a patent processus vaginalis and no association with adhesions. The testis was located in the superficial inguinal pouch in the majority of patients, and the gubernacular attachment was in an abnormal location in all and ectopic in half of the cases. CONCLUSIONS: Our observations confirm that the etiology of this condition is a missed diagnosis at a younger age. The testis is undescended but almost completely descended. With somatic growth the distance between the terminal portion of the gubernaculum of the apparently descended testis and the scrotum increases, making the diagnosis more obvious. The potential for this condition makes it mandatory that intrascrotal testicular location be confirmed by periodic physical examination through puberty.     

GH and GnRH analog treatment in children who enter puberty at short stature

It is well known that height at the onset of puberty is closely related to final height. To improve final height of short children who enter puberty at short stature, twenty-one short boys and six short girls were treated with a combination of GH and GnRH analog. The boys started the combination treatment at a mean age of 12.0 years when their mean height was 128.5 cm (-2.74 SD) and the girls at a mean age of 10.68 years when their mean height was 126.4 cm (-2.23 SD). The boys discontinued GnRH at a mean age of 16.88 years after a mean treatment period of 4.89 years when their height was 153.7 cm (-2.75 SD), and the girls at a mean age of 13.89 years after a mean treatment period of 3.20 years when their height was 143.3 cm (-1.94 SD). Bone age maturation significantly decelerated during the combination treatment. Bone age rarely exceeded 14 years in boys and did not exceed 13 years in girls. Bone age maturation during combination treatment decelerated after bone age 12 years in boys and 10.5 years in girls. On average, bone age matured at a mean rate of 0.48 years a year in boys and 0.56 years a year in girls during the combination treatment. During the combination treatment, height velocity did not decelerate rapidly and remained at 3-5 cm/year for a longer duration because of the bone age deceleration, although a definite pubertal growth spurt was not observed. As a consequence, the mean projected height SDS for bone age increased 1.50 (+/- 0.76) SD in boys and 1.24 (+/- 0.49) SD during the combination treatment. Although most of the patients have not yet reached their final height, combined GnRH analog and GH treatment should increase the pubertal height gain and the adult height in short children who enter puberty early for height, when the post-GST growth is taken into account. The combination treatment seems more effective in boys than in girls. This improvement is attributed to the lengthening of the treatment period by slower bone maturation and maintained growth velocity.