Diagnostic accuracy of a brief screening tool for attention deficit hyperactivity disorder in UK prison inmates.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is overrepresented in prison, making it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder. We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was then developed in order to simplify its use in the prison context, and maximize its diagnostic properties. METHOD: A cross-sectional study of 390 male prison inmates was performed in the UK, all participants were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2). RESULTS: A total of 47 (12.1%) inmates screened positive for ADHD using the full BAARS-IV, and 96 (24.6%) were clinically diagnosed, for a sensitivity of 37.9 and a specificity of 96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted odds ratios ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84, respectively, for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation. Weighted probability scores produced an area under the curve of 0.89 for development, and 0.82 for validation of the brief scale. CONCLUSIONS: The original BAARS-IV performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially improved diagnostic accuracy. The brief screening instrument has great potential to be used as an accurate and resource-effective tool to screen young people and adults for likely ADHD in the criminal justice system.

Health and school performance of teenagers born before 29 weeks gestation.

OBJECTIVE: To ascertain the health and school performance of teenagers born before 29 weeks gestation (extremely low gestational age (ELGA)) and to compare those in mainstream school with classroom controls. METHODS: Three geographically defined cohorts of babies born in 1983 and 1984 were traced at the age of 15-16 years. Their health, abilities, and educational performance were ascertained using postal questionnaires to the teenagers themselves, their parents, their general practitioners, and the teachers of those in mainstream school. Identical questionnaires were sent to classroom controls. RESULTS: Of the 218 teenagers surviving to the age of 16 years, information was obtained on 179. Of these, 29 were in special schools and 150 in mainstream school, 10 of whom had severe motor or sensory impairment. Using the Child Health Questionnaire, parents of teenagers in mainstream school reported a higher incidence of problems than controls in physical functioning (difference in mean scores 9.0 (95% confidence interval (CI) 4.9 to 13.1)) and family life (difference in mean scores for family cohesion 7.0 (95% CI 1.6 to 12.4)). In all areas of learning, teachers rated the ability of the ELGA teenagers in mainstream school lower than the control group. Parents of teenagers in special schools reported a higher rate of problems in most areas. CONCLUSIONS: One in six ELGA survivors at age 16 years have severe disabilities and are in special schools. Most ELGA survivors are in mainstream school and are coping well as they enter adult life, although some will continue to need additional health, educational, and social services.

Direct amplification of nodD from community DNA reveals the genetic diversity of Rhizobium leguminosarum in soil.

Sequences of nodD, a gene found only in rhizobia, were amplified from total community DNA isolated from a pasture soil. The polymerase chain reaction (PCR) primers used, Y5 and Y6, match nodD from Rhizobium leguminosarum biovar trifolii, R. leguminosarum biovar viciae and Sinorhizobium meliloti. The PCR product was cloned and yielded 68 clones that were identified by restriction pattern as derived from biovar trifolii [11 restriction fragment length polymorphism (RFLP) types] and 15 clones identified as viciae (seven RFLP types). These identifications were confirmed by sequencing. There were no clones related to S. meliloti nodD. For comparison, 122 strains were isolated from nodules of white clover (Trifolium repens) growing at the field site, and 134 from nodules on trap plants of T. repens inoculated with the soil. The nodule isolates were of four nodD RFLP types, with 77% being of a single type. All four of these patterns were also found among the clones from soil DNA, and the same type was the most abundant, although it made up only 34% of the trifolii-like clones. We conclude that clover selects specific genotypes from the available soil population, and that R. leguminosarum biovar trifolii was approximately five times more abundant than biovar viciae in this pasture soil, whereas S. meliloti was rare.

Epidemiology of cerebral palsy in England and Scotland, 1984-9.

AIMS: To report on the epidemiology of cerebral palsy in England and Scotland, to provide information on the prevalence of cerebral palsy and the severity of the disability or any co-morbidity. METHODS: Cerebral palsy registers were compiled from multiple sources of ascertainment covering all of Scotland and the counties of Merseyside, Cheshire, Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire in England. All cases of cerebral palsy born in 1984 to 1989, to mothers resident in the area, were included. Denominator number of live births and neonatal deaths for determining birthweight specific prevalence were obtained from birth and death registrations. Learning, manual, and ambulatory disabilities were graded for severity. Any co-existing sensory (hearing or visual) morbidity was also graded for severity. RESULTS: There were 789,411 live births in 1984-9, with 3651 neonatal deaths (neonatal mortality 4.6 per 1000 live births) and 1649 cases of cerebral palsy--a cerebral palsy prevalence of 2.1 per 1000 neonatal survivors. The birthweight specific cerebral palsy prevalence ranged from 1.1 per 1000 neonatal survivors in infants weighting > or = 2500 g to 78.1 in infants weighing < 1000 g. There was no significant time trend in prevalence of cerebral palsy in any of the birthweight groups, in contrast to the fall in neonatal mortality observed in all birthweight groups. Of the 1649 cases of cerebral palsy, 550 (33.4%) had severe ambulatory disability (no independent walking), 390 (23.7%) had severe manual disability (incapable of feeding or dressing unaided), 381 (23.1%) had severe learning disability (IQ < 50), 146 (8.9%) had severe visual disability (vision < 6/60 in the better eye) and 12 had severe hearing disability (> 70 dB loss). CONCLUSIONS: Registers fill an important gap left by the lack of routine data on the prevalence of disability in children. The ability to record trends in the prevalence and the severity of the disability should inform those who have responsibility for providing services for children with disabilities.

Comparing two methods of follow up in a multicentre randomised trial.

AIMS: To evaluate a parental questionnaire as a means of providing outcome measures for a multicentre randomised controlled trial of treatment for post-haemorrhagic ventricular dilatation. METHODS: The parents of 88 survivors were sent a questionnaire before a paediatric assessment at the age of 30 months. The parents' responses to individual questions taken mainly from the Griffiths' mental development scales and their perception of the child's ability to see and hear were compared with the paediatric findings. A model, based on the parents' responses to particular questions, allowed the categorisation of the children as normal, impaired, moderately or severely disabled; this was compared with similar categorisation based on the full paediatric assessment. RESULTS: Agreement on items concerning gross motor function ranged between 81 and 99%, concerning dressing between 77 and 80%, concerning feeding between 91 and 99%, and concerning language between 85 and 93%. Similar proportions of children were identified as disabled by the parents (60%) and by the paediatrician (66%). Of 29 children who had developmental quotients less than 70, parents identified 28 as disabled, 18 of them as severely disabled. They were not so good at identifying children with impairments without functional loss. CONCLUSIONS: Further work is required but there is sufficient encouragement from the results to pursue this methodology further for use in comparing groups in randomised trials.

Respiratory health in a total very low birthweight cohort and their classroom controls.

AIMS: To compare the respiratory health and function at 8 to 9 years of age of a total population based cohort of 300 very low birthweight (VLBW) children with that of two classroom controls (n = 590) matched for age and sex. STUDY DESIGN: Cohort study with controls. SETTING: Schools throughout Scotland. RESULTS: The VLBW children were more likely than their peers to use an inhaler, to be absent from school, and to be admitted to hospital because of respiratory illness. They were significantly shorter than their classroom controls, but even after adjusting for differences in height, the VLBW children had reduced forced vital capacity (FVC); this was associated with a history of prolonged ventilation (> 28 days) and pneumothorax in the neonatal period. There were no significant differences between the groups in forced expiratory volume in one second (FEV1)/FVC but twice as many (7.9% v 3.7%) of the VLBW children had ratios < 70%, denoting obstructive airways disease. Poor expiratory function was associated with neonatal respiratory distress syndrome, prolonged ventilation, and the need for > 40% oxygen. Exercise induced airway narrowing was increased in VLBW children (odds ratio = 2.0; 95% confidence interval 1.2 to 3.4) and was very little changed by adjustment for inhaler use and exposure to cigarette smoke. CONCLUSIONS: As in other low birthweight cohorts, respiratory morbidity was increased. Unlike previous studies, FVC was more affected than expiratory function in this VLBW population. Our findings support the hypothesis that poorer lung function is associated with very low birth weight, but not with intrauterine growth retardation.

School attainment, cognitive ability and motor function in a total Scottish very-low-birthweight population at eight years: a controlled study.

The prevalence of learning problems and of cognitive and motor impairment in a total geographically based very-low-birthweight population (N = 324) was compared at eight years of age with that in a population comprising two classroom peers, matched for gender and age (N = 590). 15 per cent of those with birthweights less than 1000g and 6 per cent of those weighing 1000 to 1499 g attended special schools. Index children in main-stream schools performed significantly less well in tests of neuromotor function than their comparison groups. Their mean IQs were 90.4 and 93.7 for those below and above 1000 g, respectively, while their comparison groups' IQs were 102.5 and 101.2. In all cognitive subscales apart from that testing short-term auditory sequential memory, both index groups were less competent. They were also less able in Word Reading and Basic Number Skills. These children placed heavy demands on mainstream schools, with 52 per cent and 37 per cent of the index groups, respectively, requiring learning support compared with 16 per cent in both comparison groups.

Patterns of neuropsychological function in a low-birthweight population.

An investigative analysis was carried out of the neuromotor and cognitive findings in a population-based study of low-birthweight infants (< 1750g) at 4 1/2 years of age to try to improve the understanding of the neuropathological basis of their deficits. Cluster analysis identified groups of children whose performance in the cognitive subscales of the British Ability Scales followed similar patterns, and also differentiated between children in neuromotor competence. Cluster membership correlated highly with language attainment, ability to copy shapes, behaviour as reported by parents and parents' and examiners' perception of attention span. Children in poorer-performing clusters were more likely to be born to mothers who had had a previous perinatal death, and were also more likely to have experienced septicaemia during the neonatal period. These findings are discussed in the light of evidence from the neuropathological and physiological literature.

Birth weight and hospital admission before the age of 2 years.

Admission rates to hospital of children born weighing 1500 g or less were compared with those born with birth weights over 1500 g in a retrospective analysis of routinely collected data from the Oxford Record Linkage Study. The children were born in the three five year periods 1968-72, 1974-8, and 1979-83 to women resident in Oxfordshire and West Berkshire. The main measures of the study were survival rates to 28 days after birth and hospital admissions of survivors up to the age of two years. Among babies weighing 1500 g or less, neonatal survival rates rose from 350.2 per 1000 total births in 1968-72 to 577.4 per 1000 among births in 1979-83. Over the same period, the proportion of children admitted to hospital at least once before the age of 2 years rose from 218.6 per 1000 survivors to 444.4 per 1000. In the children with birth weights over 1500 g, survival rates rose from 985.5 to 995.9 per 1000 births and hospital admission rates rose from 98.2 to 144.4 per 1000 survivors over the same time period. Although very low birthweight children did not contribute significantly to total hospital bed occupancy, because their numbers were small in relation to the total number of children in the population, their contribution increased between the five year periods 1968-72 and 1979-83. It should therefore be continuously monitored using routine systems.

Acid-base status at birth and neurodevelopmental outcome at four and one-half years.

Two hundred thirty term infants with measured acid-base status in umbilical arterial blood at birth were selected from 1210 consecutive deliveries for detailed neurodevelopmental follow-up at age 4 1/2 years; 203 were examined. Cutoff points approximately 1 SD from the mean (pH less than or equal to 7.10; base deficit greater than 12 mmol/L) were used to define acidosis. No statistically significant associations between acidosis and developmental outcome were found. The highest proportion of unimpaired children was found among those who were most severely acidotic at birth (pH less than or equal to 7.04; 2 SD below mean), but this finding was not statistically significant. These findings suggest that the ability of the fetus to produce an acidosis in response to the stress of labor may be beneficial to long-term outcome. The 10 nonacidotic babies with 1-minute Apgar scores of less than or equal to 3 showed statistically significant deficits in some areas. Coincident acidosis was not associated with a worse outcome for infants with low Apgar scores.

Antecedents and outcome of very early neonatal seizures in infants born at or after term.

Recent experimentally derived evidence has confirmed earlier suggestions that seizures which occur within 48 h of birth in babies born at or later than 37 completed weeks gestation are particularly likely to reflect intrapartum asphyxia. We have compared 54 cases of such seizures with 41,090 controls in a geographically defined population. Nulliparity, hydramnios, post-term pregnancy, oxytocin augmentation of labour, abnormalities of fetal heart rate and/or meconium-stained amniotic fluid, prolonged second stage of labour, emergency caesarean section, assisted vaginal delivery, low Apgar score and resuscitation at delivery and subsequent ventilatory support were all statistically significantly more common among cases than among controls. Five of the 54 babies who developed seizures died within 28 days of birth and 11 of the 49 survivors had an impairment diagnosed by 3 years of age which was usually associated with some degree of cerebral palsy. Comparison of the frequency of antecedent perinatal risk factors in the seizure babies who died, those who survived with disabilities and normal survivors failed to reveal any clear pattern.

The Oxford Database of Perinatal Trials: developing a register of published reports of controlled trials.

A database of perinatal trials is currently being established to provide a resource for reviews of the safety and efficacy of interventions used in perinatal care and to foster cooperative and coordinated research efforts in the perinatal field. The database will ultimately comprise four main elements: a register of published reports of trials; a register of unpublished trials; a register of ongoing and planned trials; and data derived from pooled overviews (meta-analyses) of trials. This article describes the development of the first of these four elements.