Arithmetic fluency and number processing skills in identifying students with mathematical learning disabilities.

BACKGROUND: Students with mathematical learning disabilities (MLD) struggle with number processing skills (e.g., enumeration and number comparison) and arithmetic fluency. Traditionally, MLD is identified based on arithmetic fluency. However, number processing skills are suggested to differentiate low achievement (LA) from MLD. AIMS: This study investigated the accuracy of number processing skills in identifying students with MLD and LA, based on arithmetic fluency, and whether the classification ability of number processing skills varied as a function of grade level. METHODS AND PROCEDURES: The participants were 18,405 students (girls = 9080) from Grades 3-9 (ages 9-15). Students' basic numerical skills were assessed with an online dyscalculia screener (Functional Numeracy Assessment -Dyscalculia Battery, FUNA-DB), which included number processing and arithmetic fluency as two factors. OUTCOMES AND RESULTS: Confirmatory factor analyses supported a two-factor structure of FUNA-DB. The two-factor structure was invariant across language groups, gender, and grade levels. Receiver operating characteristics curve analyses indicated that number processing skills are a fair classifier of MLD and LA status across grade levels. The classification accuracy of number processing skills was better when predicting MLD (cut-off < 5 %) compared to LA (cut-off < 25 %). CONCLUSIONS AND IMPLICATIONS: Results highlight the need to measure both number processing and arithmetic fluency when identifying students with MLD.

Health-related quality of life of head and neck cancer patients with successful oncological treatment.

Oncological treatment of head and neck carcinoma is associated with high morbidity. Measuring of health-related quality of life (HRQoL) is crucial in this patient group but there is no consensus on which measure would be preferable to be used. In this study, HRQoL was measured with the generic 15D, which has not been used before for assessing this patient population. It is a prospective cohort study among 64 patients with laryngeal, pharyngeal or nasal cavity carcinoma treated with definitive (chemo) radiotherapy between November 2007-July 2012. HRQoL was assessed with the 15D before and at 3, 6 and 12 months after the treatment onset. HRQoL results of the patients were compared with those of the age-standardized general population. Overall HRQoL declined significantly during the first 3 months after the treatment onset but then gradually improved towards the end of the follow-up. At baseline or at 12 months, no significant differences were detected in overall HRQoL between the patients and the general population. Dimensions reflecting mental well-being showed gradual improvement, exceeding the baseline scores at the end of the follow-up. Nevertheless, on these dimensions, the patient group presented with consistently lower scores compared with the general population. The mean HRQoL was lower among patients with pharyngeal carcinoma compared with the laryngeal carcinoma patients. The 15D instrument is feasible for evaluation of HRQoL in oncologically treated head and neck cancer patients. It seems to detect differences among different patient subgroups. Multidisciplinary supportive management of this patient population is recommended to ensure improved mental well-being.

Body size at birth and psychiatric disorders among adolescents: a clinical study of 310 under-age inpatient adolescents in Northern Finland.

BACKGROUND: Deviant birth measure is a risk factor for later somatic illness but also for later psychiatric disorders of the offspring. Only a few studies have examined the association of birth measures to later psychiatric disorders among adolescents. Studies on sex differences in these associations are scarce as well. METHODS: The cases consisted of 508 adolescents (208 boys and 300 girls) aged 12-17 years, who were admitted to inpatient psychiatric hospitalization between 2001 and 2006. In addition, 478 healthy controls were derived from the Northern Finnish Birth Cohort 1986, born in approximately the same period and same area as the cases. Data of birth measures were collected from the National Birth Register for cases and from antenatal clinics for controls. Both cases and controls were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) to assess psychiatric disorders. RESULTS: The adolescent patients were statistically significantly shorter and had higher ponderal index at birth compared to healthy controls. In addition, the age of the mothers at adolescent's birth was significantly younger in the patients than the controls. After controlling for various covariates, a 2.4-fold increased likelihood for internalizing disorders was seen among male adolescents with high ponderal index. CONCLUSIONS: The association of birth measures to psychiatric disorders was confirmed in our study, particularly among male adolescents suffering from internalizing disorders. Further studies in larger adolescent samples are needed to confirm our findings and clear up the association of high ponderal index to specific psychiatric disorders.

The association between anxiety and C-reactive protein (CRP) levels: results from the Northern Finland 1966 birth cohort study.

BACKGROUND: Anxiety frequently accompanies low-grade inflammation-associated conditions like depression, insulin resistance, coronary heart disease and metabolic syndrome. The association between anxiety and low-grade inflammation is, unlike between depression and low-grade inflammation, a very sparsely studied area in general populations. The aim of the present study was to investigate whether anxiety symptoms as well as comorbid anxiety and depressive symptoms are associated with low-grade inflammation at population level. METHODS: The general population-based Northern Finland 1966 Birth Cohort was followed until age 31 (n=2688 males and 2837 females), when the highly sensitive CRP concentrations were measured. Anxiety and depressive symptoms were defined by Hopkins Symptom Checklist-25 (HSCL-25). RESULTS: After adjusting for confounders, logistic regression analyses showed that anxiety symptoms alone increased the probability for elevated hs-CRP levels (>3.0mg/L) in males over two-fold (2.19 CI 95% 1.08-4.46), while comorbid anxiety and depressive symptoms caused a 1.7-fold (1.76 CI 95% 1.13-2.74) increase in the probability for elevated hs-CRP levels (1.0-3.0mg/L). CONCLUSIONS: Our results support the hypothesis that anxiety as well as comorbid anxiety and depression can be associated with an increased risk for low-grade inflammation in males at population level.

Overweight of adolescent girls is associated with self-mutilative behavior.

BACKGROUND: The purpose of the present study was to examine the association of overweight with suicide ideation, self-mutilative behavior (SMB) and suicide attempts among underage psychiatric inpatient adolescents. SAMPLING AND METHODS: Data were collected from 439 adolescents (age = 12-17 years) admitted to psychiatric hospitalization between April 2001 and March 2006. Information on adolescents' suicidal behavior and psychiatric DSM-IV diagnoses was obtained by using the Schedule for Affective Disorder and Schizophrenia for School-Age Children. An adolescent was defined as overweight if his/her BMI exceeded the 85th percentile BMI in the age- and sex-matched Finnish population. RESULTS: Compared to adolescents without overweight, a 2.5-fold likelihood for SMB was found among overweight girls, but not among boys. CONCLUSIONS: Low self-esteem, depression or dysfunctional emotion regulation may be possible mediating factors between overweight and SMB.

Perceived burden of illness in patients entering for treatment in a university hospital--is the threshold to secondary care higher for patients with depression than for those with somatic disorders?

BACKGROUND: The threshold to secondary health care should be similar for all patients independent of the underlying disease. This study compared, using a validated health-related quality of life (HRQoL)-instrument, whether the perceived burden of illness is similar in patients admitted for secondary care treatment into a university hospital because of one of six common conditions. METHODS: HRQoL, assessed by the generic 15D instrument before elective treatment, was compared in six groups: operative treatment of cataract (n=219), operative treatment of cervical or lumbar radicular pain (n=270), hysterectomy due to benign uterine conditions (n=337), hip or knee replacement surgery (n=223), coronary angiography due to suspected coronary artery disease (n=261), and secondary care treatment of depression (n=89). RESULTS: Mean (±SD) HRQoL score was clearly highest in patients with benign uterine conditions (0.908±0.071) and lowest in patients with depression (0.729±0.120) (P<0.001 between the groups). Also all the other groups had a significantly (P<0.001) higher baseline HRQoL score (ranging from 0.802 to 0.824) than patients with depression. Outcome of treatment, in terms of HRQoL improvement, was in depressive patients at least equal, and in some cases even better, than that in the other groups. DISCUSSION: Our results imply that, at least concerning perceived burden of illness, patients with depression are worse off when admitted to secondary care treatment than patients with many somatic conditions. That may be a consequence of poor motivation of depressive patients to seek treatment or that, contradictory to guidelines, the health care system does nor give priority to those worst off and sets a higher threshold for specialized care of patients with depression than of those with common somatic disorders.

Health-related quality of life of children with specific language impairment aged 8-11.

OBJECTIVE: To evaluate, in a clinical sample of children with a diagnosis of specific language impairment (SLI), the health-related quality of life (HRQoL). SUBJECTS AND METHODS: Fifty-five children, aged 8-11 years, filled out a generic HRQoL questionnaire, 17D, and another questionnaire about school and rehabilitation. The HRQoL comparison group was a sample of 244 typically developing schoolchildren. RESULTS: Response rate was 86%. Of the respondents, 80% were male. The total 17D score of the subjects did not differ from that of controls. The 17D profiles of the groups differed on several dimensions, but significant differences emerged only on the dimensions concerning speech, where the study group was worse off, and sleep, where the controls reported more problems. Respondents with low verbal IQ reported more distress. The vast majority of respondents were in special education or received extra educational support and one-third were still having speech therapy. CONCLUSION: In this clinical sample, despite the persisting need for extra support, the overall well-being of children with SLI was at age level. Still, some differences existed, and HRQoL measurement may prove a good tool for professionals to find those children with SLI at risk for diminished well-being and for later problems.

Fusion of dispatching centres into one entity: effects on performance.

BACKGROUND: Dispatching centres were fused into one of the 112 entity, which caused concerns regarding whether the medical calls could be processed effectively also in the new centre. We evaluated the effects of the reform on key performance criteria in medical calls. METHODS: This observational study in the Helsinki Dispatching Centre consisted of two periods: Period I 2 years before the reform and Period II 2 years after. The main outcome measures were answering and call processing times, accuracy of risk assessment and appropriate use of ambulances. RESULTS: In Period I (n=574,276), 92.2% of all incoming phone calls were answered within 10 s and in Period II (n=758,022) 82.8% (P<0.0001). Time to dispatch a first responding fire unit increased from 98 to 113 s (P<0.0001) and an advanced life support unit in category A calls increased from 73 to 84 s (P<0.0001). In Period I 47.7%, 34.8% and 17.5% of phone calls were completed in <3, 3-5 and >5 min and in Period II 29.8%, 36.1% and 34.1% (P<0.0001). The number of three studied non-transportation call types and unnecessary lights-and-siren responses increased significantly (P<0.0001 and 0.0001, respectively). Neither the accuracy of risk assessment in the three studied call types nor the rate of telephone-guided cardiopulmonary resuscitation changed. CONCLUSIONS: The reform increased the total number of ambulance dispatches, prolonged answering and call processing times and had a negative effect on the appropriate use of ambulances. The accuracy of risk assessment was not affected. Evidence-based data should be the basis for the future as dispatching centre processes are shown to be vulnerable during organisational reforms.

Bullying behaviour and substance abuse among underage psychiatric inpatient adolescents.

BACKGROUND AND OBJECTIVE: Only a few studies have examined the putative association between substance use and bullying others, and to our knowledge none of the previous studies have investigated substance abuse among victims or those who are both bullies and victims. The aim of our study was to investigate substance use among all of these three bullying subgroups and to examine the putative association between substance use and bullying behaviour. METHODS: The study sample consisted of 508 Finnish adolescents (age 12-17) admitted to psychiatric inpatient care between April2001 and March2006. We used the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) to obtain DSM-IV psychiatric diagnoses, information about bullying behaviour and substance abuse of the adolescents. The level of nicotine dependence (ND) was assessed by using the modified Fagerström Tolerance Questionnaire (mFTQ). RESULTS: Our study showed that both among boys and girls, regular daily smoking and alcohol use among boys were statistically significantly associated with bullying behaviour. Further, among girls, but not among boys, there was also an association between bullying behaviour and more severe substance use, such as ND, use of cannabis and hard drugs. CONCLUSION: Since an association between bullying and severe substance use was found in this study, our novel finding needs replication in adolescent general population samples.

Cost-utility of breast reduction surgery--a prospective study.

OBJECTIVE: To assess the cost-utility of routine breast-reduction surgery in the setting of a large university hospital. METHODS: In the framework of a large trial exploring the feasibility of routine health-related quality of life (HRQoL) assessment, 80 patients (mean age: 45 years) entering the Department of Plastic Surgery for operative breast reduction filled in the 15-dimension (15D) HRQoL survey before and 6 months after surgery. Data on hospital costs were obtained from the hospital records. RESULTS: Mean (+/-SD) HRQoL score (on a 0-1 scale) increased as a result of surgery from the preoperative 0.916+/-0.075 to 0.939+/-0.076 (p<0.001) 6 months after surgery, corresponding to a mean (+/-SD) gain of 0.930+/-2.117 quality-adjusted life years (QALYs). Of the 15 health dimensions, discomfort and symptoms showed the greatest improvement (p<0.001). A statistically significant improvement was also seen on the dimensions of breathing, sleeping and distress. Mean hospital cost of treatment was 3383 euro+/-1744, and the cost per QALY was 3638 euro. Using 5% discounting for QALYs, the cost per QALY increased to 8973 euro. CONCLUSION: Breast-reduction surgery improved HRQoL in a statistically significant manner and at a reasonable cost, as the cost per QALY was in the same range as that observed in our material, for example, for hip-replacement surgery.