RESUMO
OBJECTIVES: It has long been speculated that effortful listening places children with hearing loss at risk for fatigue. School-age children with hearing loss experiencing cumulative stress and listening fatigue on a daily basis might undergo dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity resulting in elevated or flattened cortisol profiles. The purpose of this study was to examine whether school-age children with hearing loss show different diurnal salivary cortisol patterns than children with normal hearing. DESIGN: Participants included 32 children with mild to moderate hearing loss (14 males; 18 females) and 28 children with normal hearing (19 males; 9 females) ranging in age from 6 to 12 years. Saliva samples were obtained six times per day on two separate school days. Cortisol levels were measured by mass spectrometric detection after liquid-liquid extraction. Salivary cortisol levels between children with hearing loss and children with no hearing loss over the course of the day were examined with hierarchical linear modeling using mixed model statistical analysis. Between-group comparisons were also computed for the area under the curve, an analytical approach for calculating overall cortisol secretion throughout the day. RESULTS: Significant differences in the cortisol awakening response (CAR) were observed between children with hearing loss and children with normal hearing; however, no differences were observed between the two groups subsequent to the cortisol awakening response (60-min postawakening, 10:00 A.M., 2:00 P.M., and 8:00 P.M.). Compared with children with normal hearing, children with hearing loss displayed elevated cortisol levels at awakening and a reduced growth in cortisol secretion from awakening to 30-min postawakening. No significant differences in overall cortisol secretion throughout the day were found between groups (area under the curve). Finally, cortisol levels increased with increasing age for children with hearing loss but not for children with normal hearing. CONCLUSIONS: Results of this preliminary study indicate a possible dysregulation in HPA axis activity in children with hearing loss characterized by elevated salivary cortisol levels at awakening and a diminished increase in cortisol from awakening to 30-min postawakening. The pattern of elevated cortisol levels at awakening is consistent with some studies on adults with burnout, a condition characterized by fatigue, loss of energy, and poor coping skills. These findings support the idea that children with hearing loss may experience increased vigilance and need to mobilize energy promptly in preparation for the new day.
Assuntos
Fadiga/metabolismo , Perda Auditiva/metabolismo , Hidrocortisona/metabolismo , Saliva/química , Estresse Psicológico/metabolismo , Estudos de Casos e Controles , Criança , Fadiga/psicologia , Feminino , Perda Auditiva/psicologia , Humanos , Masculino , Índice de Gravidade de Doença , Estresse Psicológico/psicologiaRESUMO
PURPOSE: The goals of the present study were to investigate whether (1) the speech disfluencies of preschool-age children are normally distributed; (2) preschool-age children who do (CWS) and do not stutter (CWNS) differ in terms of non-stuttered disfluencies; (3) age, gender, and speech-language ability affect the number and type of disfluencies children produce; and (4) parents' expressed concern that their child stutters is associated with examiners' judgments of stuttered disfluency. METHOD: Four hundred and seventy two children participated, of which 228 were CWS (56 girls), and 244 CWNS (119 girls). Participants provided conversational speech samples that were analyzed for frequency of occurrence of (a) stuttered disfluencies, (b) non-stuttered disfluencies, and (c) total disfluencies. RESULTS: Results indicated that the underlying distributions of preschool-age children's stuttered and non-stuttered disfluency counts followed a negative binomial distribution (i.e., were not normal), with more children "piling up" at the low end [none or few disfluencies] and fewer children scoring in the upper [more severe stuttering] end of the distribution. Findings also indicated that non-stuttered disfluencies significantly predicted CWS/CWNS talker group classification, information that may be helpful to augment, but not supplant, talker group classification criteria based on stuttered disfluencies. Moreover, expressed parental concern about stuttering was strongly associated with frequency of stuttered disfluencies. CONCLUSION: Findings suggest that the entirety of preschool-age CWS' speech disfluencies - non-stuttered as well as stuttered - differs from that of their CWNS peers and that because these disfluencies are not normally distributed statistical analyses assuming normality of distribution are not the most appropriate means to assess these differences. In addition, certain "third-order" variables (e.g., gender) appear to impact frequency of children's disfluencies and expressed parental concerns about stuttering are meaningfully related to examiners' judgments of stuttered disfluencies. LEARNING OUTCOMES: The reader will recognize differences in speech disfluencies of preschool-age children who do and do not stutter. The reader will recognize whether age, gender and speech-language ability affect the number and type of disfluencies children produce. The reader will describe whether parental concern about stuttering is associated with examiners' judgments of stuttering.
Assuntos
Distúrbios da Fala/diagnóstico , Medida da Produção da Fala , Gagueira/complicações , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Modelos Logísticos , Masculino , Modelos Estatísticos , Pais/psicologia , Fatores SexuaisRESUMO
BACKGROUND: We conducted a comparative effectiveness analysis to evaluate the difference in the amount of physical activity children engaged in when enrolled in a physical activity-enhanced after-school program based in a community recreation center versus a standard school-based after-school program. METHODS: The study was a natural experiment with 54 elementary school children attending the community ASP and 37 attending the school-based ASP. Accelerometry was used to measure physical activity. Data were collected at baseline, 6 weeks, and 12 weeks, with 91% retention. RESULTS: At baseline, 43% of the multiethnic sample was overweight/obese, and the mean age was 7.9 years (SD = 1.7). Linear latent growth models suggested that the average difference between the two groups of children at Week 12 was 14.7 percentage points in moderate-vigorous physical activity (P < .001). Cost analysis suggested that children attending traditional school-based ASPs-at an average cost of $17.67 per day-would need an additional daily investment of $1.59 per child for 12 weeks to increase their moderate-vigorous physical activity by a model-implied 14.7 percentage points. CONCLUSIONS: A low-cost, alternative after-school program featuring adult-led physical activities in a community recreation center was associated with increased physical activity compared to standard-of-care school-based after-school program.
Assuntos
Serviços de Saúde Comunitária , Promoção da Saúde , Estilo de Vida , Atividade Motora , Obesidade Infantil/prevenção & controle , Comportamento de Redução do Risco , Instituições Acadêmicas , Actigrafia , Adolescente , Criança , Pré-Escolar , Pesquisa Comparativa da Efetividade , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Obesidade Infantil/diagnóstico , Obesidade Infantil/economia , Obesidade Infantil/epidemiologia , Estudos Prospectivos , Recreação , Tennessee/epidemiologia , Fatores de TempoRESUMO
The study examined the effect of gestational (GA) and postnatal (PNA) age on speech sound perception in infants. Auditory event-related potentials (ERPs) were recorded in response to speech sounds (syllables) in 50 infant NICU patients (born at 24-40 weeks gestation) prior to discharge. Efficiency of speech perception was quantified as absolute difference in mean amplitudes of ERPs in response to vowel (/a/-/u/) and consonant (/b/-/g/, /d/-/g/) contrasts within 150-250, 250-400, 400-700 ms after stimulus onset. Results indicated that both GA and PNA affected speech sound processing. These effects were more pronounced for consonant than vowel contrasts. Increasing PNA was associated with greater sound discrimination in infants born at or after 30 weeks GA, while minimal PNA-related changes were observed for infants with GA less than 30 weeks. Our findings suggest that a certain level of brain maturity at birth is necessary to benefit from postnatal experience in the first 4 months of life, and both gestational and postnatal ages need to be considered when evaluating infant brain responses.
Assuntos
Envelhecimento/fisiologia , Idade Gestacional , Unidades de Terapia Intensiva Neonatal , Percepção da Fala/fisiologia , Interpretação Estatística de Dados , Eletrodos , Eletroencefalografia , Potenciais Evocados/fisiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Fonética , Caracteres SexuaisRESUMO
BACKGROUND: In 2005, 40% of motor-vehicle occupant deaths in the group aged 16-19 years involved passengers. Although seatbelts can reduce crash mortality by 50% or more, little is known about the differences in driver-versus-passenger seatbelt use among teens. METHODS: In 2007, data from the 2001 and 2003 Youth Risk Behavior Surveys were analyzed for 12,731 black, white, and Hispanic high school students aged >or=16 years reporting seatbelt use as both drivers and passengers. Seatbelt use was compared for driver- and passenger-seat positions, and stratified by age, gender, race/ethnicity, school grades, and histories of either drinking and driving or riding with a drinking driver. RESULTS: Overall, 59% of students always used seatbelts when driving, but only 42% always buckled up as passengers. Across all covariate strata, passenger seatbelt use was significantly less prevalent than driver seatbelt use (p<0.001). A concordance analysis showed that only 38% of students always wore seatbelts both when driving and while riding as a passenger. Multivariate analyses indicated that, regardless of seat position, seatbelt use was lower for young men, blacks, students with poor grades, and students who reported either drinking and driving or riding with a drinking driver. CONCLUSIONS: U.S. high school students aged >or=16 years are significantly less likely to wear seatbelts as passengers than as drivers. Interventions designed to promote seatbelt use among teens need to address this disparity.
Assuntos
Condução de Veículo/estatística & dados numéricos , Assunção de Riscos , Instituições Acadêmicas/estatística & dados numéricos , Cintos de Segurança/estatística & dados numéricos , Estudantes , Adolescente , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Projetos Piloto , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: To determine the effectiveness of providing synthesized research evidence to inform patient care practices via an evidence based informatics program, the Clinical Informatics Consult Service (CICS). DESIGN: Consults were randomly assigned to one of two conditions: CICS Provided, in which clinicians received synthesized information from the biomedical literature addressing the consult question or No CICS Provided, in which no information was provided. MEASUREMENT: Outcomes were measured via online post-consult forms that assessed consult purpose, actual and potential impact, satisfaction, time spent searching, and other variables. RESULTS: Two hundred twenty six consults were made during the 19-month study period. Clinicians primarily made requests in order to update themselves (65.0%, 147/226) and were satisfied with the service results (Mean 4.52 of possible 5.0, SD 0.94). Intention to treat (ITT) analyses showed that consults in the CICS Provided condition had a greater actual and potential impact on clinical actions and clinician satisfaction than No CICS consults. Evidence provided by the service primarily impacted the use of a new or different treatment (OR 8.19 95% CI 1.04-64.00). Reasons for no or little impact included a lack of evidence addressing the issue or that the clinician was already implementing the practices indicated by the evidence. CONCLUSIONS: Clinical decision-making, particularly regarding treatment issues, was statistically significantly impacted by the service. Programs such as the CICS may provide an effective tool for facilitating the integration of research evidence into the management of complex patient care and may foster clinicians' engagement with the biomedical literature.
Assuntos
Tomada de Decisões , Medicina Baseada em Evidências , Bibliotecas Médicas , Serviços de Biblioteca , Informática Médica , Administração dos Cuidados ao Paciente , Centros Médicos Acadêmicos , Pesquisa Biomédica , Medicina Clínica , Humanos , Bibliotecários , Encaminhamento e Consulta , TennesseeAssuntos
Serviços de Saúde Mental , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Criança , Análise Custo-Benefício , Humanos , Massachusetts , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administraçãoRESUMO
OBJECTIVE: This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain not associated with identifiable organic disease. METHOD: The Children's Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6-18 years old) seen in a pediatric gastroenterology clinic. Individual trajectories were empirically grouped and correlates of trajectory group membership at baseline were evaluated. RESULTS: A model with three unique trajectories was found to adequately fit both symptom and impairment data. Two trajectories indicated relatively long-term improvement and one indicated continued high levels of symptoms and impairment. At baseline, the long-term risk group did not have the most severe pain but had significantly more anxiety, depression, lower perceived self-worth, and more negative life events. CONCLUSIONS: These results indicate that several distinct trajectories of relatively long-term outcomes may exist in children with functional abdominal pain. One trajectory indicated long-term risk for a high level of symptoms and impairment. Psychosocial correlates of long-term risk for physical symptoms and impairment, such as child-reported stress and internalizing symptoms, may be useful for treatment planning.
Assuntos
Dor Abdominal/diagnóstico , Dor Abdominal/fisiopatologia , Avaliação da Deficiência , Transtornos Somatoformes/fisiopatologia , Adolescente , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Somatoformes/diagnósticoRESUMO
This study examines interventions designed to improve communication between individuals who take care of children with ADHD. A teacher rating of 6,171 elementary school children identifies 1,573 children with ADHD or with high risk for ADHD. Parent interviews and information from teachers are collected on 243 children who are randomized into treatment and control conditions and followed for 39 months. The interventions consisted of group workshops and single one-on-one tutorials with parents, teachers, and providers about the evaluation and treatment of ADHD that stressed the need for communication between the three parties. There are few significant effects on communication that are short lived. Results suggest that the interventions are insufficient to cause significant increase in communication. Future attempts to improve parent-teacher-provider coordination should be continuing rather than single-session interventions.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Comunicação , Pessoal de Saúde , Atenção Primária à Saúde , Relações Profissional-Família , Relações Profissional-Paciente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Criança , Comportamento do Consumidor , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Therapeutic alliance (TA), the helping relationship that develops between a client and clinician, has received little attention in child treatment studies until recently, though it is the factor found to be most predictive of clinical outcomes. Furthermore, TA is cited as one of the most important components to effective therapy according to practicing clinicians. This study examines the TA that develops between teacher/counselors and children in 2 settings, a partial hospital/day school and a wilderness camp. An important finding in this study is the lack of relationship between the teacher/counselor's view of TA and the youth's view. Moreover, this correlation does not improve according to how long the counselors have known or have treated the youth. The implications of this and other findings are discussed.
Assuntos
Transtornos do Comportamento Infantil/terapia , Relações Profissional-Paciente , Psicoterapia/métodos , Adolescente , Adulto , Acampamento , Criança , Clínicas de Orientação Infantil/organização & administração , Aconselhamento , Hospital Dia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Pennsylvania , Reprodutibilidade dos Testes , Autoavaliação (Psicologia) , Índice de Gravidade de DoençaRESUMO
This study examines the impact of interrater reliability on the diagnosis of attention-deficit hyperactivity disorder (ADHD). A screening of 6171 elementary school children identified 1573 children with a high risk for ADHD according to teacher rating. Follow-up parent interviews and information from teachers were collected on 243 children. Before screening, health care professionals had diagnosed ADHD in 40% of the identified children. There was low agreement between the parent and teacher reports of ADHD symptoms according to DSM-IV-based questionnaires: Inattentive (r =.34, kappa = 0.27), Hyperactive/Impulsive (r =.27, kappa = 0.22), and Performance Impairment (r =.31, kappa = 0.07). When the two-setting requirement was strictly enforced, poor interrater agreement decreased diagnostic rates for all three types of ADHD in this clinical sample: Inattentive (15%-5%), Hyperactive/Impulsive (11%-3%), and Combined (23%-7%). Parent and teacher agreement was low concerning ADHD symptoms and performance. The recommendation of multiple informants significantly decreased the prevalence. Allowing for observer disagreement by using more lenient core symptom scores could reduce the effect.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Determinação da Personalidade , Relações Profissional-Família , Meio Social , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Estudos Transversais , Feminino , Humanos , Comportamento Impulsivo/diagnóstico , Comportamento Impulsivo/epidemiologia , Comportamento Impulsivo/psicologia , Estudos Longitudinais , Masculino , Variações Dependentes do Observador , Determinação da Personalidade/estatística & dados numéricos , Psicometria , Reprodutibilidade dos Testes , Medição de Risco , Estados UnidosRESUMO
Previous research has demonstrated the ability of the Cognitive Behavioral Driver's Inventory (CBDI) to detect neuropsychological malingering [Arch. Clin. Neuropsychol. 12 (5) (1997) 491.], however, the present study tests if the CBDI can discern malingerers when they are "coached" on how brain-damaged patients actually perform on neuropsychological tests. Ninety-eight college student participants were given financial incentive to fake brain damage on the CBDI. Fifty-three of these subjects were "coached" and 45 were not. The coached and uncoached subjects performed indistinguishably on the CBDI. Both types of malingerers were discernable from real brain-damaged patients (99.2% accuracy area under the sensitivity-specificity curve). Further, CBDI profiles of five actual plaintiffs judged to be malingering were compared to CBDI profiles of experimental subjects. In each case, the malingering plaintiff's CBDI profile was indistinguishable from that of malingering experimental subjects and was clearly discernable from that of actual brain-damaged patients.
Assuntos
Lesões Encefálicas/complicações , Transtornos Cognitivos/diagnóstico , Simulação de Doença/diagnóstico , Prática Psicológica , Adulto , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Motivação , Testes Neuropsicológicos , Valor Preditivo dos Testes , Psicometria , Reprodutibilidade dos Testes , Análise e Desempenho de TarefasRESUMO
This study evaluates a measurement model for Attention Deficit/Hyperactivity Disorder (ADHD). The DSM-IV divides 18 symptoms into two groups, inattentive and hyperactive/impulsive. Elementary school teachers rated 21,161 children in 4 locations: Spain, Germany, urban US, and suburban US. Confirmatory factor analysis suggested that the 2-factor model (inattention, hyperactivity/impulsivity) shows the best fit. A third factor, impulsivity, was too slight to stand-alone. Children with academic performance problems were distinguished by inattention, but children with behavior problems typically had elevations in inattention, hyperactivity, and impulsivity. Between-site differences were statistically significant, but so small that we conclude that same measurement model fits all 4 samples in 2 continents.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Docentes , Inquéritos e Questionários , Área Programática de Saúde , Criança , Comparação Transcultural , Manual Diagnóstico e Estatístico de Transtornos Mentais , Escolaridade , Alemanha/epidemiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Reprodutibilidade dos Testes , Espanha/epidemiologia , Tennessee/epidemiologiaRESUMO
This study examines the dose-response relationship, the correlation between the amount of mental health treatment a child receives (dose) and the outcome (response) in a community setting. Participants were 125 children treated in the Stark County Child and Adolescent Mental Health System. Study methods include multiple outcomes, multiple-dose definitions, longitudinal hierarchical analysis of repeated measures, and instrumental variable estimation to control for possible confounding between outcome and treatment dose. Results show no statistically significant dose response. The results do not support the existence of a dose response for children and adolescents consistent enough to guide clinicians, administrators, or policymakers.