Differential effects of preterm birth and small gestational age on cognitive and motor development

AIMS: To determine the differential effects of preterm birth and being small for gestational age on the cognitive and motor ability of the child. METHODS: A longitudinal cohort of all infants of gestational age < or = 32 weeks born to mothers resident in the counties of Cheshire and Merseyside in 1980-1 was studied. The children were assessed at the age of 8 to 9 years using the Wechsler Intelligence Scale for Children, the Neale analysis of reading ability, and the Stott-Moyes-Henderson test of motor impairment. Adequacy of fetal growth was determined by the birthweight ratio--that is, the ratio of the observed birthweight to the expected birthweight for a given gestational age. Children with clinically diagnosed motor, learning or sensory disabilities were excluded. Information on social variables was obtained by a questionnaire completed by the parents. Of the 182 children, 158 were assessed. RESULTS: IQ was positively correlated with birthweight ratio but not with birthweight or gestational age. Motor ability was associated with birthweight, gestational age, and birthweight ratio. Reading comprehension was associated with birthweight ratio, but reading rate and accuracy were best explained by social variables and sex. IQ remained associated with birthweight ratio, after adjusting for maternal education, housing status, and number of social service benefits received. Reading ability was related to these social variables but motor ability was not. CONCLUSIONS: The effects of SGA and preterm birth differed: SGA was associated with cognitive ability, as measured by IQ and reading comprehension; motor ability was additionally associated with preterm birth. Reading rate and accuracy were not associated with SGA or preterm birth but were socially determined.     

Nullification of a positive correlation between urinary contents of alpha1-microglobulin and ulinastatin with intracerebroventricularly administered 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and 1-methyl-4-phenylpyridinium (MPP+) in mice

BACKGROUND: Wolff-Parkinson-White syndrome is thought to be a congenital disease, however, its exact prevalence is not known. This may be because of the intermittent activity of accessory pathways in some cases and fluctuations in autonomic tone. AIMS: To investigate the prevalence of ventricular preexcitation by electrocardiography and reported symptoms in each school age child in Yamanashi prefecture. METHODS: From 1994 to 1996, answers to a questionnaire, results of physical examination, and electrocardiography were obtained from all schoolchildren in Yamanashi prefecture (n = 92,161; total population 880,000) on admission to elementary school (age 6 to 7 years, n = 28,395), junior high school (age 12 to 13 years, n = 31,206), and high school (age 14 to 15 years, n = 32,837). RESULTS: Elementary and junior high school students had a significantly lower prevalence of preexcitation than high school students (0.073% and 0.070% v 0.174%, p < 0.001). The prevalence of left free wall pathway was highest in high school students (n = 27) compared with elementary (n = 6) and junior high school students (n = 5) (p < 0.005). The only symptom noted in the answers to the questionnaire was palpitations. The symptomatic cases were more frequent in high school (n = 13) than in elementary (n = 1) and junior high school (n = 2) children, but not significantly. No student with preexcitation had associated heart disease or family history of Wolff-Parkinson-White syndrome or sudden death. CONCLUSIONS: The prevalence of preexcitation in younger schoolchildren was less frequent than previously reported. The prevalence of preexcitation and left free wall pathways increased with age. The symptoms were few and there was no significant morbidity.     

Infant auditory discrimination in preterm and full-term infants as a predictor of 5-year intelligence.

Examined the relation between responsiveness to auditory novelty in full-term and preterm infants at 4 mo and subsequent intellectual performance at 5 yrs of age. At 4 mo, cardiac response to repetitive and novel auditory stimulation was assessed using a variable-trials habituation procedure for 9 full-term and 19 preterm infants. Ss were followed until the age of 5 yrs, and intellectual performance was measured using the Stanford-Binet Intelligence Scale. A statistically significant correlation of .60 was found between infant novelty response scores and 5-yr intelligence scores. Mother's education also related to 5-yr performance, although not significantly when the novelty response was partialed out. Results suggest that measures of early perceptual-memory development may reflect early cognitive processes necessary for later intellectual performance. Within the preterm group, there was a sample of male infants with below-average intelligence at 5 yrs. These Ss failed to respond to novelty, and their mothers had not completed high school. Thus, a subsample of high-risk Ss can be identified early in life. A significant positive relation was also found between scores on the Bayley Scales of Infant Development and intelligence at 5 yrs of age. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speech and language development of children born at < or = 32 weeks' gestation: a 5-year prospective follow-up study

Speech and language comprehension and production were assessed at the age of 5 years in a cohort of children born preterm at < or = 32 weeks' gestational age (N=55) in comparison with children born at term and of similar age, sex, and social backgrounds. Data both including and excluding major neurological disabilities are presented. Mean performance for the entire group of preterm children was significantly lower than for the controls on most of the measures including the composite IQ scores. When the nine children who had major neurological disabilities were excluded from the preterm group, statistically significant differences were found on four of the total 12 speech and language measures. Intellectually normal preterm children without major neurological disability were slower than the controls on rapid word retrieval. In addition, difficulties in comprehending relative concepts were typical for the preterm children. The results suggest 'subtle dysnomia', which is indicative of later reading problems. On global verbal measures and on the basic speech and language aspects the study groups did not differ. Specific language impairment, defined as a discrepancy of > 1SD between Performance IQ and Verbal IQ scores, showed a tendency to be more common in the control group. Within both the study groups, the boys showed a tendency for a greater discrepancy between their Performance and Verbal IQ scores.     

Synthesis and activity of partial retro-inverso analogs of the antimetastatic laminin-derived peptide, YIGSR-NH2

Very low birth weight (VLBW) children at school age show variability in their outcome, compared with normal birth weight children, although many early physical and health differences are equalized by middle childhood. Studies of nonhandicapped VLBW children have found a higher rate of school retention and school problems in this population. Differences in intelligence have been reported, although these are often confounded by socioeconomic factors such as educational level of the parent. Few studies today of children born in the late 1970s and early 1980s have related school age outcome to central nervous system (CNS) status, yet for learning disabilities or other neuropsychological deficits, this may be highly relevant. Better understanding of medical risk factors, however, will not affect the decisive influence of social factors on their expression in the school age child.     

Can school teachers improve the management and prevention of skin disease? A pilot study based on head louse infestations in Guerrero, Mexico

BACKGROUND: The effect of health education provided by teachers, in three primary schools of Guerrero, Mexico, on the prevalence of head louse infestation was compared. METHODS: A cross-sectional survey and rapid appraisal methods were performed, including a child questionnaire and qualitative data from teachers and focus groups of mothers in the same schools. RESULTS: Nine hundred and forty-four students and 33 teachers were interviewed; a focus group discussion with 6-8 mothers per school was performed. In the self-diagnosis of pediculosis, the prevalence was 22% (range, 18%-33%) with a sensitivity of 68% and a specificity of 86%. In one school, 100% of the teachers applied a health program, whereas in the other two schools this percentage was only 20%. A child under 9 years of age who attended a school without information on health was 3.6 times more likely to have head louse infestation (OR = 3.6, CI 95% = 2.1-6) than a child of the same age who attended a school where information was given. In older children the effect and potential impact were lower. The difference between the two age groups is unlikely to be explained by chance (X2 het = 5.7, df = 1, p = 0.01). CONCLUSIONS: This study emphasizes the potential value of simple, but effective, health education provided by school teaching staff through liaison with patents in the amelioration of endemic disease.     

Health research literacy: a new approach to involving rural general practitioners in research and evaluation

The aim of this study was to determine the physical activity levels of a sample of young children. Data were collected using direct, continuous observation by trained observers. The observational method utilised a points system to differentiate intensity of physical activity. Observations were carried out during school break times, lunch times and physical education lessons and during free time outside of school. The sample consisted of 93 girls and 86 boys aged between 5 and 11 years. Only 38 children (21%) engaged in a sustained 20-min period of moderate to vigorous physical activity (MVPA), but nearly all children (95%) took part in a 5-min period of MVPA. The highest recordings of MVPA occurred during school break times but MVPA was less prominent during free time outside of school. One hundred and seventy eight children were observed during school physical education lessons. Sustained MVPA was particularly low during physical education lessons with only 13 children (8%) participating in at least one sustained 10-min period. There appeared to be no difference in activity levels between boys and girls or between children of differing ages. During all observation periods the main activity of the child was recorded. Soccer, brisk walking, general play and chasing games were the most common activities. The results are disturbing since preadolescent children appear to be engaging in very little sustained, playful physical activity during their free time outside of school. If childhood is considered to be the most active stage of life there must be concern for the future. There is a need for health professionals to promote active lifestyles from birth.     

The challenge of providing psychological services for young handicapped children.

Examines the challenge faced by psychologists to ensure adequate and appropriate assessment and intervention for young children (birth–6 yrs of age) who have developmental disabilities including emotional, cognitive, sensory, and physical handicaps. Three major problem areas are considered: (1) determining who should provide services, (2) defining what clinical procedures are both appropriate and nondiscriminatory, and (3) obtaining training for assessment and treatment. It is concluded that as health care providers and trainers of practitioners, psychologists must seriously consider the challenge of providing the services to handicapped infants and young children. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infant physiological regulation and maternal risks as predictors of dyadic interaction trajectories in families with a preterm infant.

This longitudinal study examined predictors of rates of growth in dyadic interaction quality in children born preterm who did not experience significant neurological findings during neonatal intensive care unit (NICU) hospitalization. Multiple methods were used to collect data from 120 preterm infants (48% girls, 52% boys) and their mothers. Infant heart rate variability (HRV), gestational age, neonatal health, feeding route, and maternal socioeconomic (SES) risks were assessed at NICU discharge (mean of 36 weeks postconception). Mother–child interactions were observed at 4, 9, 16, and 24 months postterm and analyzed with hierarchical linear modeling. On average, children's quality of play, interest, and attention increased over time while their dysregulation and irritability decreased, whereas average maternal positive affect and involvement declined in quality (ps     

Urachal remnants

OBJECTIVE: Three a priori hypotheses were tested: (1) There are significant differences in sociosexual behaviors of women with physical disabilities compared with women without disabilities; (2) the sexual functioning of women with disabilities is significantly related to age at onset of disability; (3) psychological factors explain more of the variance in the sexual functioning of women with physical disabilities than do disability, social and environmental factors. DESIGN: Case-comparison study using written survey. SETTING: General community. PARTICIPANTS: The questionnaire was mailed to 1,150 women with physical disabilities who were recruited as volunteers or through independent living centers. Each woman gave a second copy of the questionnaire to an able-bodied female friend, which comprised the comparison group. The response rate was 45%, with 475 cases and 425 comparisons eligible to participate. The most common disability type was spinal cord injury (24%), followed by polio (18%), muscular dystrophy (11%), cerebral palsy (11%), multiple sclerosis (10%), joint disorders (7%), and skeletal abnormalities (5%). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sexual-functioning, consisting of four factors: (1) sexual desire, (2) sexual activity, (3) sexual response, (4) sexual satisfaction. RESULTS: Highly significant differences were found in level of sexual activity (p = .000001), response (p = .000009), and satisfaction (p=.000001) between women with and without disabilities. No significant differences were found between groups on sexual desire. Severity of disability was not significantly related to level of sexual activity. CONCLUSIONS: Psychological and social factors exert a strong impact on the sexual functioning of women with physical disabilities. Further investigations is needed of the effect of social environment on development of self-esteem and sexual self-image, and how these influences affect levels of sexual functioning in women with physical disabilities.     

The use of oral contraceptives by adolescents for contraception, menstrual cycle problems or acne

BACKGROUND: Oral contraceptives are prescribed as contraception but also as therapy for menstrual cycle disturbances and acne. We studied the prevalence of oral contraceptive (OC) use and the indications to start OC use among adolescents. METHODS: A cohort consisting of ninth grade secondary school girls (mean age 15.3+/-0.6 (s.d.) years) answered a questionnaire on their menstrual cycle. OC users were asked about duration and reasons for OC-use and the name of the preparation they used. The influence of calendar age, gynecological age and level of education on the prevalence of OC was studied by multiple logistic regression analysis. RESULTS: The response on the questionnaire was 92%. Of 2248 responders 248 (11%) used oral contraceptives: 74% used low dose 'sub 50' preparations, 3% pills with 50 microg estrogen, 3% tri-phase preparations and 17% pills with antiandrogens. Of girls aged 14, 15 and 16 years 4%, 12% and 28% respectively, used OC. Of the 15-year-olds 31% mentioned contraception as most important reason for OC use, 18% menstrual cycle irregularity, 26% dysmenorrhea, 10% acne and 5% other reasons. Calendar age, gynecological age and level of education were independent variables for OC use in general and for OC use for contraception or dysmenorrhea, but less so for OC use for menstrual cycle irregularity or acne. CONCLUSIONS: During adolescence low dose OC's were frequently used. In The Netherlands OC use among girls aged 15 and 16 years doubled in comparison with 1982. One third of the adolescent OC-users mentioned contraception as most important reason to start OC. Gynecological age (a determinant of biological maturation), calendar age (a determinant of biological maturation and lifestyle in peer groups), and level of education (a determinant of lifestyle in peer groups) were associated with OC use.     

Children conceived by in vitro fertilisation after fresh embryo transfer

AIMS: To compare the outcome in in vitro fertilisation (IVF) children (after fresh embryo transfer) from multiple and singleton births with one another, and with normally conceived control children. METHODS: A cohort of 278 children (150 singletons, 100 twins, 24 triplets and four quadruplets), conceived by IVF after three fresh embryos had been transferred, born between October 1984 and December 1991, and 278 normally conceived control children (all singletons), were followed up for four years after birth. They were assessed for neonatal conditions, minor congenital anomalies, major congenital malformations, cerebral palsy and other disabilities. Control children, all born at term, were matched for age, sex and social class. RESULTS: The ratio of male:female births was 1.03. Forty six per cent of IVF children were from multiple births; 34.9% were from preterm deliveries; and 43.2% weighed less than 2500 g at birth. The IVF singletons were on average born one week earlier than the controls, weighed 400 g less, and had a threefold greater chance of being born by caesarean section. The higher percentage of preterm deliveries was largely due to multiple births and they contributed to neonatal conditions in 45.0% of all IVF children. The types of congenital abnormalities varied: 3.6% of IVF children and 2.5% of controls had minor congenital anomalies, and 2.5% of IVF children and none of the controls had major congenital malformations. The numbers of each specific type of congenital abnormality were small and were not significantly related to multiple births. IVF children (2.1%) and 0.4% of the controls had mild/moderate disabilities. They were all from multiple births, including two children with cerebral palsy who were triplets. CONCLUSIONS: The outcome of IVF treatment leading to multiple births is less satisfactory than that in singletons because of neonatal conditions associated with preterm delivery and disabilities in later childhood. A reduction of multiple pregnancies by limiting the transfer of embryos to two instead of three remains a high priority.     

Graduate nursing education: developmental disabilities and special health care needs

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) genetic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical experiences with preceptors. The authors recommend the development of interdisciplinary graduate programs designed to prepare nurses to assume leadership roles in school health, public health, home health care, and systems management that will affect public policy and, ultimately, promote change in the systems charged with responsibility to serve this population.     

Audit of care of newly diagnosed children with diabetes mellitus in East Anglia

The aim of this study was to audit the organization of services and management at diagnosis of Type 1 diabetes mellitus (IDDM) in children in the eight districts of East Anglia. Representatives of each district met and agreed indicators of good practice. Service organization was assessed by questionnaire. Provision of care was audited using a proforma completed prospectively for every newly diagnosed child. Outcomes were audited by an anonymous questionnaire to families at the first outpatient appointment to assess satisfaction with care, the education received, and confidence in basic skills needed for home care of diabetes. All districts had a designated paediatric diabetic clinic, all but one led by a paediatrician. All had nurse specialists, but the posts varied widely. Only three units had joint clinics for adolescents. In total, 75% of the families returned the questionnaire. Satisfaction with support by health professionals was high. Education was good for injection technique, blood testing and diet management. Home visits by nurses were variable. Contact with schools and introduction to support groups was poor. Confidence in management was best when there was a dedicated paediatric specialist nurse with adequate cover within the team to allow home and school visits. Following peer review and implementation of an action plan, reaudit was undertaken one year later. Modest improvements were achieved in problem areas; solutions varied in different districts. Collaborative, multi-district audit allows comparison between demographically similar districts. Audit encourages improved practice within existing teams and allows an informed bid for scarce resources.     

Sickle cell disease pain in children and adolescents: change in pain frequency and coping strategies over time

Examined 9-month follow-up data obtained from children and adolescents with sickle cell disease (SCD) and their parents participating in a longitudinal study of pain coping strategies. Of 87 subjects completing the baseline assessment of pain coping strategies, 70 (80%) of their parents completed a structured pain interview assessing their child's health care use and activity reduction during painful episodes over the follow-up period. Regression analyses controlling for age and pain frequency revealed that baseline Coping Attempts were associated with higher levels of school, household, and social activity during painful episodes. Baseline Passive Adherence was associated with more frequent health care contacts during the subsequent 9 months. Increases in Negative Thinking over time were associated with further increases in health care contacts during the follow-up period. Comparing pain coping strategies assessed at baseline to pain coping strategies measured at follow-up revealed that pain coping strategies were relatively stable over time for younger children but changed more for adolescents.     

Rural school nurses' attitudes about AIDS and homosexuality

The AIDS epidemic has spread to rural areas of the United States. Conservative rural communities are facing the challenge of having children with HIV entering school. School nurses, as the only health care providers in the schools, are in a strong position to facilitate the education of children with HIV and to provide AIDS education to students, faculty, and parents. School nurses' knowledge and attitudes about AIDS and people with AIDS influence their effectiveness in prevention activities and care of HIV-infected children. This study examined the relationship between specific demographic, practice, and cultural variables and rural school nurses' attitudes about AIDS and homosexuality. Sixty-nine school nurses responded to a mailed questionnaire as part of a larger study of rural nurses. Results indicate attitudes about homosexuality were related to nurses' homosexual knowledge and religious beliefs while attitudes about AIDS were related to nurses' willingness to care for people with AIDS and feeling prepared to do so.     

Health registers as a feasible means of measuring health status in childhood--a 7-year follow-up of the 1987 Finnish birth cohort

Follow-up studies on health have usually been based on ad hoc cohort studies in which detailed information is collected specifically for research purposes on a certain group of people. The increasing collection of routine health data provides an alternative method of gathering follow-up data. In this study, the feasibility of using routinely collected health-register data and data linkages to follow up children's health was investigated. Five nationwide registers, 18 regional registers of intellectually disabled children and school administration data in one county were found to be of use for our follow-up and were combined with the 1987 Finnish Medical Birth Register (n = 60,254 births). In the follow-up, 62 children were untraced (0.1%), 327 were stillborn (0.5%), 440 died after birth (0.7%) and 287 emigrated (0.5%) before the age of 7 years. The cumulative incidences for all diseases (8.9% of all children living in Finland at the age of 7 years), for diabetes (3.0/1000), for epilepsy (6.8/1000) and for asthma (34.2/1000) correspond to the estimates of other studies, but our estimate for intellectual disabilities (18.0/1000, of whom 18% were reported to have an IQ of 70 or less) seems to be an underestimate. Our data collection did not provide reliable information on institutionalised children or children taken into care. Data collection conducted by using health registers is a feasible method, and it saves both time and financial resources compared with cohort studies. Potential problems with data linkage studies are variation in the content of data and in data quality of different registers and data protection issues.     

Smoking: high hazards in high school

BACKGROUND: Young people in school are at an impressionable age, peer pressures are intense, and the probability that they will pick up a high-risk behavior, such as smoking, is high. The key to reduction of smoking among adults is to target our prevention efforts at young adults and teens. OBJECTIVE: To study the prevalence and trend of smoking among young adults and teens and to formulate guidelines on smoking reduction to guide those who counsel young people. STUDY DESIGN: The study design is cross sectional. METHODS: This study is based on the data from the Oklahoma Behavioral Risk Factor Surveillance System and the National Youth Risk Behavioral Surveillance System - the two systems that monitor the prevalence of behaviors that most influence health. RESULTS: The prevalence of smoking among young adults (age 18-24) in Oklahoma is high at more than 21%. The disturbing feature is that it is higher among young females than among young males. The prevalence of smoking among young adults is the highest among high school dropouts and is more than 38%. It is lower among high school graduates (about 28%) and lowest among college graduates (about 18%). The percentage of smoking among students who classify themselves as current smokers rises from 23% to 30% as the students progress from grade 9 to 12 and the percentage of frequent smokers increases from 8% to 16%. CONCLUSIONS: Guidelines suggested for counselors are: 1. Along with smoking, look for comorbid behaviors such as alcohol use, drug abuse, and high-risk sexual behavior. 2. Ask whether the student has easy access to free cigarette samples. 3. Check whether the teen is trying to lose weight; suggest appropriate methods for losing weight if smoking is being used for losing weight. 4. Target health education efforts early in a student's school career starting in elementary school, but concentrate especially at the 8th or 9th grade level to have maximum preventive impact.     

Impact of grade retention on the social development of elementary school children.

When children do not exhibit certain minimum academic competencies, they are retained in grade. Despite the pervasiveness of this school practice, little is known about the effects of grade retention on children's social development. The present study explored the hypotheses that peer discrimination may be one factor contributing to the negative effects of grade retention reported in the previous literature. Specifically, it was expected that retained children would (a) receive unfavorable peer attributions, (b) be assigned lower social status, (c) be the targets of peer discrimination, and (d) have lower expectations for themselves and for school. Evidence for peer discrimination against retained children was found, but effects were moderated by the age, gender, relative physical size, and retention status of the rater. Contrary to prediction, retained children had higher self-esteem than did nonretained children. These and other findings were discussed in terms of school and peer influence on social development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elevated heart rate variability in physically active young and older adult women

OBJECTIVE: To determine if participation in group sessions as part of health supervision visits for infants improves outcomes compared with individual visits in high-risk mothers. STUDY DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Mothers of young infants who had at least 1 of the following risk factors: aged younger than 20 years at delivery, participation in Medicaid, less than a high school education, previous or ongoing substance abuse, or history of abuse as a child. SETTING: Two urban university pediatric clinics in Seattle, Wash. INTERVENTIONS: Mother-infant dyads were randomized to receive group well-child care (GWCC) or individual well-child care (IWCC) before the infant was 4 months old; the intervention continued until the child was 15 months old. Mothers completed the Sense of Competence and Social Isolation subscales from the Parenting Stress Index and Sarason's Social Support Questionnaire at enrollment and again on completion of the study. During the 11-month study period, 7 health supervision visits were scheduled for each mother-infant dyad. Social workers met periodically with mothers during the study and assessed the following functional outcomes: return to school, return to work, enrollment in a substance abuse treatment program, and becoming pregnant. In addition, data on study children were collected from Child Protective Services to assess referrals because of suspected abuse and/or neglect. RESULTS: Data were collected on 213 mother-infant dyads, including 108 who received GWCC and 105 who received IWCC. At the conclusion of the study period, similar proportions of GWCC and IWCC mothers scored in the high-risk range on the Sense of Competence subscale, Social Isolation subscale, and the Social Support Questionnaire (P=.57, .32, and .59, respectively). For more than 50% of the mothers, scores on the Sense of Competence and Social Isolation subscales deteriorated during the study period from the not-high-risk range to the high-risk range, regardless of assignment to GWCC or IWCC. No differences were noted between GWCC and IWCC mothers for any functional outcome. During the study period, 8.8% of children receiving GWCC were referred to Child Protective Services vs 8.3% of those receiving IWCC (P=.85). CONCLUSION: The format of well-child care may not be an important determinant of outcomes among high-risk mothers.