Quebec-based Parents' Attitudes Towards Childhood Multilingualism: Evaluative Dimensions and Potential Predictors.

This is the first large-scale, quantitative study of the evaluative dimensions and potential predictors of Quebec-based parents' attitudes towards childhood multilingualism. Such attitudes are assumed to constitute a determinant of parental language choices, and thereby influence children's multilingual development. The newly-developed Attitudes towards Childhood Multilingualism Questionnaire was used to gather data from 825 participants raising an infant/toddler aged 0-4 years with multiple languages in the home. The results revealed three separate dimensions: status and solidarity (the same dimensions found in attitudes towards individual languages) as well as cognitive development (not previously attested as a separate dimension). Participants' approach to promoting multilingualism (specifically, whether they used the one-person-one-language-approach) and the combination of languages transmitted (specifically, whether this included a heritage language) correlated significantly with parental attitudes towards childhood multilingualism. Parents' linguistic background and location within Quebec were not significant predictors of attitudes. The paper discusses implications and directions for further research.

Family language policy among Québec-based parents raising multilingual infants and toddlers: A study of resources as a form of language management.

This is the first large-scale study of resources as a form of language management - that is, a way of influencing children's language practices. We introduce the distinction between child-directed resources (i.e., those providing parents with opportunities to engage with their children in the languages they are transmitting) and parent-directed resources (i.e., those providing parents with information about multilingual child-rearing). This study focused on the awareness and use of, as well as the desire for, such resources among Québec-based parents (n=819) raising infants/toddlers (0-4 years) with multiple languages in the home. Data were collected with a questionnaire. Quantitative data were analyzed statistically, and qualitative data were analyzed using a computer assisted discourse study. We compared parents transmitting at least one immigrant heritage language - usually in addition to English and/or French (HL parents), and parents transmitting only English and French (non-HL parents). Overall, the findings show that non-HL parents were comparatively satisfied with existing child- and parent-directed resources in English and French. By contrast, HL parents had a stronger desire for additional resources in their HLs. All parents desired multilingual resources. The paper discusses the theoretical and practical contributions of this study as well as directions for further research.

Quebec-based parents' concerns regarding their children's multilingual development.

Many parents express concerns for their children's multilingual development, yet little is known about the nature and strength of these concerns - especially among parents in multilingual societies. This pre-registered, questionnaire-based study addresses this gap by examining the concerns of 821 Quebec-based parents raising infants and toddlers aged 0-4 years with multiple languages in the home. Factor analysis of parents' Likert-scale responses revealed that parents had (1) concerns regarding the effect of children's multilingualism on their cognition, and (2) concerns regarding children's exposure to and attainment of fluency in their languages. Concern strength was moderate to weak, and cognition concerns were weaker than exposure-fluency concerns. Transmission of a heritage language, transmission of three or more languages, presence of developmental issues, and less positive parental attitudes towards childhood multilingualism were associated with stronger concerns. These findings have both theoretical and practical implications: they advance our understanding of parental concerns and facilitate the development of support for multilingual families.

Acute pulmonary histoplasmosis in a patient with uveitis after infliximab therapy.

The purpose of this study is to report a case of disseminated histoplasmosis in a patient with uveitis, after treatment with infliximab. The method employed in this study is single case report. Infliximab can be useful in controlling idiopathic uveitis, but can give rise to disseminated histoplamosis, especially in patients living in geographic areas where histoplasmosis is endemic. Clinicians should be aware of the possibility of rapid onset histoplasmosis in patients receiving anti-tumor necrosis factor agents. In such cases, these agents should be immediately stopped, investigations performed, and appropriate treatment started.

Preliminary validation and clinical meaning of the Cutaneous Assessment Tool in juvenile dermatomyositis.

OBJECTIVE: To provide preliminary validation of the Cutaneous Assessment Tool (CAT), a new tool to assess cutaneous manifestations of juvenile dermatomyositis (DM), and to explore the clinical meaning of CAT scores. METHODS: Children with juvenile DM (n = 113) were assessed at baseline and 7-9 months later (n = 94). Internal consistency, redundancy, construct validity, and responsiveness of the CAT were examined. CAT scores corresponding to ordinal global assessments were determined. RESULTS: Item-total correlations ranged from 0.27-0.67 for activity lesions present in > or =10% of patients; item-domain and domain-total correlations ranged from 0.25-0.99. Cronbach's alpha was 0.79 for the CAT activity score and 0.74 for the CAT damage score. As predicted, the CAT activity score correlated strongly with both global disease activity and skin disease activity and moderately with the Childhood Myositis Assessment Scale, whereas the CAT damage score correlated moderately with the physician global disease and skin disease damage scores. Median CAT activity scores of 1, 7, 13, 18, and 31 corresponded to absent, mild, moderate, severe, and extremely severe skin disease activity, respectively. Median CAT damage scores of 0, 1, 2, and 5 correlated with the same descriptions of damage (severe and extremely severe combined). CONCLUSION: Preliminary validation of the CAT demonstrated good internal consistency, nonredundancy, good construct validity, and appropriate responsiveness. The CAT is a comprehensive, semiquantitative assessment tool for skin disease in juvenile DM.

US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children, with frequent involvement of the metacarpophalangeal joints (MCPJ). OBJECTIVE: To compare US findings with those of radiography and clinical examination. MATERIALS AND METHODS: All MCPJs in 20 children with JIA (17 females, median age 9.7 years, range 3.6 to 16.8 years) were evaluated clinically and imaged with gray-scale and color Doppler US, and 90 MCPJs were also imaged radiographically. Each MCPJ was graded on physical examination from 0 (normal) to 4 (severe) by the patient's rheumatologist. RESULTS: US demonstrated abnormalities in 64 of 200 MCPJs (32.0%), including pannus vascularity and/or tenosynovitis in 55 joints (27.5%) (pannus vascularity in 43, tenosynovitis in 40) and bone destruction in 25 joints (12.5%). Overall, US abnormalities and physical examination scores were significantly associated (P < 0.001). However, interobserver agreement between US and clinical evaluation was poor (kappa 0.1) and between US and radiography was only fair (kappa 0.4). CONCLUSION: US of the MCPJ in children with JIA can demonstrate cartilage thinning, bone erosions, and pannus vascularity. Abnormal US findings are significantly correlated with severity of disease as evaluated clinically.

Henoch-Schonlein purpura.

PURPOSE OF REVIEW: The purpose of this review is to educate the reader about the one of the most common vasculitides of childhood: Henoch-Schonlein purpura. Although the disease has been described for over a century, the etiology has yet to be discovered. Adult-onset Henoch-Schonlein purpura is unusual, but through case studies, this review examines some of the common manifestations of this presentation of disease. Long-term outcome studies are still defining how this disease affects a small but significant percentage of patients afflicted with Henoch-Schonlein purpura. RECENT FINDINGS: This article will summarize recent work in molecular biology and genetics evaluating predisposing factors in the development of Henoch-Schonlein purpura. Further illustrations of the various complications of Henoch-Schonlein purpura will be reviewed. Recent long-term studies of outcomes of patients with renal disease from Henoch-Schonlein purpura will be summarized. SUMMARY: After reading this review, the clinician will be able to elucidate the manifestations of Henoch-Schonlein purpura, determine appropriate treatment of the disease, and, most importantly, give the patient information about long-term consequences of Henoch-Schonlein purpura.

Implementing wireless evaluation in a hospital-based OSCE center.

To provide an effective and efficient means to gather assessment data during Objective Structured Clinical Examinations [OSCEs] and integrate the data into ANGEL, the Indiana University School of Medicine's [IUSM] curriculum management system, a wireless approach using PDAs was selected, configured and evaluated. Following a systems architecture and human-computer interface analysis of the project, a system with less functionality but greater reliability was designed and implemented.

Validation and clinical significance of the Childhood Myositis Assessment Scale for assessment of muscle function in the juvenile idiopathic inflammatory myopathies.

OBJECTIVE: To examine the measurement characteristics of the Childhood Myositis Assessment Scale (CMAS) in children with juvenile idiopathic inflammatory myopathy (juvenile IIM), and to obtain preliminary data on the clinical significance of CMAS scores. METHODS: One hundred eight children with juvenile IIM were evaluated on 2 occasions, 7-9 months apart, using various measures of physical function, strength, and disease activity. Interrater reliability, construct validity, and responsiveness of the CMAS were examined. The minimum clinically important difference (MID) and CMAS scores corresponding to various degrees of physical disability were estimated. RESULTS: The intraclass correlation coefficient for 26 patients assessed by 2 examiners was 0.89, indicating very good interrater reliability. The CMAS score correlated highly with the Childhood Health Assessment Questionnaire (C-HAQ) score and with findings on manual muscle testing (MMT) (r(s) = -0.73 and 0.73, respectively) and moderately with physician-assessed global disease activity and skin activity, parent-assessed global disease severity, and muscle magnetic resonance imaging (r(s) = -0.44 to -0.61), thereby demonstrating good construct validity. The standardized response mean was 0.81 (95% confidence interval 0.53, 1.09) in patients with at least 0.8 cm improvement on a 10-cm visual analog scale for physician-assessed global disease activity, indicating strong responsiveness. In bivariate regression models predicting physician-assessed global disease activity, MMT remained significant in models containing the CMAS (P = 0.03) while the C-HAQ did not (P = 0.4). Estimates of the MID ranged from 1.5 to 3.0 points on a 0-52-point scale. CMAS scores corresponding to no, mild, mild-to-moderate, and moderate physical disability, respectively, were 48, 45, 39, and 30. CONCLUSION: The CMAS exhibits good reliability, construct validity, and responsiveness, and is therefore a valid instrument for the assessment of physical function, muscle strength, and endurance in children with juvenile IIM. Preliminary data on MID and corresponding levels of disability should aid in the clinical interpretation of CMAS scores when assessing patients with juvenile IIM.

Normal scores for nine maneuvers of the Childhood Myositis Assessment Scale.

OBJECTIVE: To document and evaluate the scores that normal, healthy children achieve when performing 9 maneuvers of the Childhood Myositis Assessment Scale (CMAS). METHODS: A total of 303 healthy children, 4-9 years of age, were scored as they performed 9 CMAS maneuvers. The data were then evaluated to determine whether normal scores for some maneuvers are age and sex dependent. RESULTS: All children were able to achieve maximum possible scores for the supine to prone, supine to sit, floor sit, floor rise, and chair rise maneuvers. All but 2 4-year-olds achieved a maximum possible score for the arm raise/duration maneuver. Performance of the head lift and sit-up maneuvers varied significantly, depending primarily on age. Children in all age groups had less difficulty performing the leg lift than the head lift or sit-up. CONCLUSION: The normative data generated by this study are of value for interpreting the serial CMAS scores of children with idiopathic inflammatory myopathies.