Finding Keys: A Systematic Review of Barriers and Facilitators for Refugee Children's Disclosure of Their Life Stories.

The systematic review presented in this article aims to reveal what supports and hampers refugee children in telling their, often traumatic, life stories. This is important to ensure that migration decisions are based on reliable information about the children's needs for protection. A systematic review was conducted in academic journals, collecting all available scientific knowledge about the disclosure of life stories by refugee minors in the context of social work, guardianship, foster care, asylum procedures, mental health assessment, and therapeutic settings. The resulting 39 studies were thoroughly reviewed with reference to what factors aided or hampered the refugee children's disclosure of their life stories. The main barriers to disclosure were feelings of mistrust and self-protection from the side of the child and disrespect from the side of the host community. The facilitators for disclosing life stories were a positive and respectful attitude of the interviewer, taking time to build trust, using nonverbal methods, providing agency to the children, and involving trained interpreters. Social workers, mentors, and guardians should have time to build trust and to help a young refugee in revealing the life story before the minor is heard by the migration authorities. The lack of knowledge on how refugee children can be helped to disclose their experiences is a great concern because the decision in the migration procedure is based on the story the child is able to disclose.

Recently arrived refugee children: The quality and outcomes of Best Interests of the Child assessments.

Best Interests of the Child (BIC) assessments provide migration authorities with behavioral information about which interests of the child could be taken into account before a decision is made on the request for a residence permit. This study provides insight into the quality and outcomes of BIC assessments with 16 unaccompanied children (15-18 years) and 11 accompanied children (4-16 years) who have recently arrived in the Netherlands and requested asylum (N = 27). The results suggest that BIC assessments provide relevant information that enables assessors to determine the best interests of recently arrived refugee children. The inter-rater reliability of the BIC-Questionnaire, an instrument that evaluates the child-rearing environment and that is one of the components of the BIC assessment, was fairly good. The children in the sample had experienced a high number of stressful life events and a majority reported trauma related stress symptoms or other emotional problems. The quality of the child-rearing environment in the country of origin had protected their development insufficiently in the past and would not protect their development sufficiently in the future. The results show that in many cases forced return to the country of origin can put children's development at risk.

Knowledge of the Unknown Child: A Systematic Review of the Elements of the Best Interests of the Child Assessment for Recently Arrived Refugee Children.

Decision-making regarding an asylum request of a minor requires decision-makers to determine the best interests of the child when the minor is relatively unknown. This article presents a systematic review of the existing knowledge of the situation of recently arrived refugee children in the host country. This research is based on the General Comment No. 14 of UN Committee on the Rights of the Child. It shows the importance of knowing the type and number of stressful life events a refugee child has experienced before arrival, as well as the duration and severity of these events. The most common mental health problems children face upon arrival in the host country are PTSD, depression and various anxiety disorders. The results identify the relevant elements of the best interests of the child assessment, including implications for procedural safeguards, which should promote a child rights-based decision in the asylum procedure.

Risk factors associated with challenging behaviour in people with profound intellectual and multiple disabilities.

BACKGROUND: Several factors that correlate with the onset or continuation of challenging behaviour are mentioned in research. These are factors related to persons with ID, but also to direct support professionals and the context. Although many of these factors seem to affect the onset or continuation of challenging behaviour in people with ID in general, results are often inconclusive and have little focus on people with profound intellectual and multiple disabilities (PIMD). The present study aimed to assess the extent to which known factors related to challenging behaviour are also applicable to a group of 198 people with PIMD. METHOD: To determine which factors were associated with challenging behaviour, univariate analyses on associations between known risk factors and challenging behaviour were conducted. The associated factors were then subject to a regression analysis to determine the extent to which they explain the prevalence of challenging behaviour and can thus be seen as factors associated with challenging behaviour. RESULTS: The results show that, in particular, factors concerning the personal characteristics of people with PIMD, such as sleeping problems and auditory problems, were related to the variance in mean frequency of challenging behaviour. Only one factor related to the direct support professionals was found: when these professionals had been offered training on the subject of challenging behaviour in people with intellectual disabilities in general, they identified significantly more withdrawn behaviour. We found no contextual factors related to challenging behaviour. CONCLUSION: These findings are generally consistent with findings reported in other studies, especially concerning the personal characteristics of people with PIMD. Further research should focus on the effects of providing safe auditory environments and appropriate sleep schedules for people with PIMD on the occurrence of challenging behaviour.

Informal social networks of people with profound intellectual and multiple disabilities: relationship with age, communicative abilities and current living arrangements.

BACKGROUND: People with profound intellectual and multiple disabilities (PIMD) have limited informal social contacts. Research to determine the factors which can positively influence establishing sound informal social contacts is required. MATERIALS AND METHODS: Regression analysis for 200 people with PIMD was used to analyse how age, communicative abilities and current living arrangements were related to the number and frequency of their contacts. RESULTS: Only age was negatively related to both the number and frequency of social contacts. Current living arrangements related only to the frequency of contacts. Communicative abilities related to neither. CONCLUSIONS: Like people with intellectual disabilities, age and living arrangements are related to the informal social networks of people with PIMD. However, for people with PIMD, these networks are already more limited. Therefore, professionals need to be attentive to the maintenance and/or expansion of the social networks of people with PIMD at an early stage.

Recovery of mouth-opening after closed treatment of a fracture of the mandibular condyle: a longitudinal study.

The aim of this retrospective study was to assess recovery of mouth opening after closed treatment of fractures of the mandibular condyle, and analyse which characteristics might influence recovery. We measured mouth opening in 142 patients (mean (SD) age 30 (14) years, 96 of whom were male) during follow-up at 3, 6, 13, 26, and 52 weeks after the injury. Fractures were assessed on radiographs. Data were analysed using a multilevel analysis. Half the fractures were of the low condylar neck (n=71). Thirty-seven patients had bilateral condylar fractures, 29 had dislocated fractures, and in 80 the fracture was displaced. One or more additional mandibular fractures were present in 68. During follow-up mean (SD) mouth opening increased to: 33.6 (9.6) at 3 weeks, 40.1 (10.0) at 6 weeks, 45.1 (9.6) at 13 weeks, 49.8 (9.5) at 26 weeks, and 52.6 (7.5) at 52 weeks. Older age, female sex, displaced fracture, bilateral fractures, additional mandibular fractures, and the interaction between follow-up time and additional mandibular fractures, were predictors of a less favourable recovery of mouth opening. Clinicians can use the results of this study to predict recovery of mouth opening after closed treatment of fractures of the mandibular condyle at first consultation.

Does the patch fit the stoma? A study on peristoma geometry and patch use in laryngectomized patients.

OBJECTIVE: To determine the geometry of (peri)stomas of laryngectomized patients in relation to patch use. This data will enable improvement of tracheostoma interfaces, specifically addressing patients currently unable to use stoma patches. The low use of Heat-and-Moisture-Exchange (HME) filters and (hands-free) speech valves, although very important to the quality of life of laryngectomized patients, is mainly attributed to poor fit of the adhesive patches to the stoma site. Current patch shapes are not based upon an objective (peri)stoma geometry because this geometry is unknown. DESIGN: Observational anthropometric study of the (peri)stoma of laryngectomized patients. SETTING: Ten hospitals or institutes in eight countries. PARTICIPANTS: About 191 laryngectomized patients, at least 1 year post operative. MAIN OUTCOME MEASURES: (Peri)stomas were photographed and measured. Patients completed a questionnaire on patch-use. Concavity of commercially available patches was measured. RESULTS: In countries with a financial reimbursement system 58% of the patients use patches, compares to only 9% in other countries. Patches stay in situ for an average of 33.3 h. Patch and non-patch users differ on five out of ten measured geometrical parameters. Most striking differences are that patch users have much shallower peristomas (13 versus 18 mm), and stomas far more parallel to the anterior neck plane. The deepest commercially available patch is only 7 mm deep. CONCLUSIONS: This study provides detailed (peri)stoma geometry data of a divers population, and for the first time in relation to patch-use. It reveals a serious mismatch between patients and patches. With these data new patches can be developed that could dramatically improve rehabilitation after laryngectomy.

Phonetic and phonemic acquisition: normative data in English and Dutch speech sound development.

OBJECTIVE: Comparison of normative data in English and Dutch speech sound development in young children. Research questions were: Which normative data are present concerning speech sound development in children between two and six years of age? In which way are the speech sounds examined? What are the differences and similarities between the development of speech sounds in different languages? METHODS: A literature study on the subject was performed to be able to answer the research questions. RESULTS: The presented normative English data showed that all vowels are present at three years of age, and most consonants (singletons) already at four years of age, except for/ʃ, ɹ, θ, ð/. Consonant clusters develop between 4.5 and 5.5 years of age. The phonological error patterns gliding can be present until six years of age. According to information regarding the Dutch speech sound system, the same ages are found for vowels and single consonants. The age of acquisition of most consonant clusters is present at about six years of age, but the development goes on until ten years of age. CONCLUSION: The data from the development of the English and Dutch speech sound system show many similar tendencies. Vowels are mastered by the age of three, most consonants by the age of four and most consonant clusters between 5 and 6-8 years of age. Perhaps, there is a universal trend in speech sound development like there is in language development.

Behavioural problems in young children with language problems.

OBJECTIVE: Analysis of behavioural problems in young children with language problems. MATERIALS AND METHODS: From 38 children diagnosed with a language problem, the opinion of the parents about the behaviour of their child, scored by the Child Behaviour Checklist 1.5-5 was compared with the behavioural problems in the Dutch population with the Chi-square test. T-tests and Mc Nemar tests were used to compare the opinion of the fathers about the behavioural problems with the opinion of the mothers and to compare the scores on internalizing problems with scores on externalizing problems. Plots display the measurement of the mean behavioural problems of the parents against the discrepancy between the parents and of the total behavioural problems against the discrepancy between internalizing and externalizing problems. The relation between the behavioural problems, the language score and the non-verbal intelligence score was also compared and is presented in a bar chart. RESULTS: All children had an inadequate language production (GDS). Twenty-seven children had an adequate and 11 children had an inadequate Language Comprehension Quotient (LCQ). Twenty-eight children had an adequate and 10 children had an inadequate non-verbal IQ (SON-IQ). In the clinical population mothers report more internalizing behavioural problems than in Dutch peers. The fathers also experience differences, but these are not significant. There is agreement between the parents in how they experience problems on the internalizing, externalizing and total problem scale. And there are no significant differences between the internalizing and externalizing problem scales, between boys and girls, and in behavioural problems in children with both adequate LCQ and SON-IQ and with inadequate LCQ and/or SON-IQ. CONCLUSION: Compared to their peers in the Dutch population, young children with language problems show more internalizing problems according to their mothers. The fathers also experience differences, but these are not significant. Fathers and mothers agree on the behaviour analysis of their child and there are no differences between the occurrences of internalizing or externalizing problems and between boys and girls. There is also no relation between the behavioural problems and the severity of the language problem or the level of non-verbal functioning.

Self-assessed tactical skills in elite youth soccer players: a longitudinal study.

Self-assessed tactical skills were investigated among 191 youth soccer players from ages 14 through 18 playing in different field positions. On a yearly basis, all players completed the Tactical Skills Inventory for Sports with scales for attacking and defensive situations and for declarative and procedural knowledge. A model to assess whether tactical skills change over time in each field position was developed using multilevel analysis. The models indicated that defenders and midfielders did not improve their tactical skills, whereas attackers increased their tactical skills from ages 14 to 18 years. The representing part of tactical skills for defenders is Acting in Changing Situations, for midfielders Positioning and Deciding, whereas Knowing About Ball Actions was the qualifying factor for attackers. Possible explanations for these differences in tactical skills among elite youth soccer players are the selection procedures at a younger age and task-specific experiences.

Modest effect of p53, EGFR and HER-2/neu on prognosis in epithelial ovarian cancer: a meta-analysis.

BACKGROUND: P53, EGFR and HER-2/neu are the most frequently studied molecular biological parameters in epithelial ovarian cancer, but their prognostic impact is still unequivocal. We performed a meta-analysis to more precisely estimate their prognostic significance. METHODS: Published studies that investigated the association between p53, EGFR and HER-2/neu status and survival were identified. Meta-analysis was performed using a DerSimonian-Laird model. Publication bias was investigated using funnel plots and sources of heterogeneity were identified using meta-regression analysis. RESULTS: A total of 62 studies were included for p53, 15 for EGFR and 20 for HER-2/neu. P53, EGFR and HER-2/neu status had a modest effect on overall survival (pooled HR 1.47, 95% CI 1.33-1.61 for p53; HR 1.65, 95% CI 1.25-2.19 for EGFR and HR 1.67, 95% CI 1.34-2.08 for HER-2/neu). Meta-regression analysis for p53 showed that FIGO stage distribution influenced study outcome. For EGFR and HER-2/neu, considerable publication bias was present. CONCLUSIONS: Although p53, EGFR and HER-2/neu status modestly influences survival, these markers are, by themselves, unlikely to be useful as prognostic markers in clinical practice. Our study highlights the need for well-defined, prospective clinical trials and more complete reporting of results of prognostic factor studies.

Is there an indication for computed tomography and magnetic resonance imaging in the evaluation of coronary artery bypass grafts?

This meta-analysis evaluates the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for bypass graft occlusion and stenosis detection compared with coronary angiography in post-coronary artery bypass graft patients. The indication for noninvasive imaging in post-coronary artery bypass graft patients with these techniques is discussed. Overall, MRI had significantly lower sensitivity (81%) and specificity (91%) for occlusion detection than MDCT (96% and 98%, respectively). Only 2 studies assessed the accuracy of stenosis detection with MRI. Stenosis detection with MDCT had a pooled sensitivity of 89% and specificity of 97%. Multidetector computed tomography is therefore superior to MRI for the noninvasive detection of coronary bypass graft occlusion and stenosis. For stenosis detection, the accuracy of MDCT is, however, not sufficient to warrant a wide clinical use. The remaining indication for MRI-guided bypass graft assessment is in combination with myocardial evaluation such as magnetic resonance perfusion, wall motion, and stress test as a "one-stop-shop" procedure.

Problems in speech sound production in young children. An inventory study of the opinions of speech therapists.

OBJECTIVE: Analysis of examination procedure and diagnosis of articulation problems by speech therapists. STUDY DESIGN: Survey study. MATERIALS AND METHODS: Eighty-five Dutch speech therapists (23% response), working in private practises or involved in language screening procedures in Youth Health Care, were questioned regarding the incidence of articulation problems in their practices, the manner of examination, the normative data used, and the importance attached to identifying articulation problems. RESULTS: According to the speech therapists, articulation problems are present in the majority of children (90%) in their practices. In children between 2 and 5 years of age, 45%; in children between 5 and 8 years of age, 36%; above age 8, about 14% of the children still have articulation problems. Despite their opinion that articulation problems often form a separate aspect of language development, all respondents indicated that they always investigate the speech sound development as part of a total speech and language examination. Frequently, more than one instrument is used. However, none of these instruments are standardised. The speech therapists prefer to examine the children at about 4 years of age, despite their opinion that the speech sounds develop until about 6 years of age. For them, this raises the problem to distinguish between articulation in development and articulation problems. They have the opinion that early treatment is important because of assumed relations with social-emotional development and reading and writing abilities later on. CONCLUSION: The speech therapists taking part in this study have a good view of the speech sound development of young children. However, due to their concern about communication, social-emotional development, and reading and writing abilities later on, they prefer to identify and treat articulation problems at an early age. More detailed research into the variations in speech sound development, in relation to language development, is needed in order to arrive at effective normative data.

Soccer skill development in professionals.

The purpose of this study was to investigate the relationship between the development of the technical skill dribbling during ages 14-18 and adulthood playing level. The results gained insight in the required level of the technical skill dribbling during adolescence to be capable of becoming a professional soccer player. Talented players (n=131), aged 14-18 were measured while they were part of a developmental soccer program, testing took place annually. The players were identified as professional (n=54) or amateur (n=77) later on in their career (age>20). In total 238 measurements of dribbling performance were assessed by means of the Shuttle Dribble Test. A longitudinal model estimated the development for optimal dribbling performance (peak dribbling) and for dribbling performance under fatigue (repeated dribbling), for players ultimately reaching professional status and for players reaching amateur status. The longitudinal results showed that during adolescence the talented players who ultimately became professionals were on average 0.3 s faster on 30m peak dribbling performance and on average 1 second faster on 3 x 30m repeated dribbling performance than the players who ultimately turned amateur (p=0.001). It is concluded that during adolescence dribbling performance can assist in identifying the best players for the future.

Effect of different treatments in young children with language problems.

OBJECTIVE: Analysis of the relationship between treatment and improvement on language scores in children with language problems. DESIGN: Observational longitudinal study. MATERIALS AND METHODS: 123 children between 2 and 5 years of age, diagnosed as having a language problem were followed for 1 year. By means of monthly questionnaires, the form of intervention received was recorded. Language abilities were measured at baseline and after 1 year. Mixed model analysis was used to determine the relationship between improvement and language scores. RESULTS: During the year 119 parents returned the monthly questionnaires and four treatment groups were subsequently able to be categorized: language treatment (n=21, 18%), surgical hearing improvement (n=16, 13%), language treatment and surgical hearing improvement (n=42, 35%) and a three-combination group (language treatment, surgical hearing improvement and developmental guidance, n=40, 34%). For the four treatment groups there were no significant differences at baseline for the Language Comprehension Quotient (LCQ) (p=0.07) and Sentence Development Quotient (SDQ) (p=0.09). In all treatment groups the mean Sentence Development Quotient improved significantly (p=0.001). The mean Language Comprehension Quotient did not improve in the surgical hearing improvement group (p=0.42), but improved significantly in the language treatment group, in the language treatment and surgical hearing improvement group and in the three-combination group (p=0.002, 0.040, 0.001). From all included children 38 children (32%) moved from an inadequate to an adequate language score. CONCLUSION: All distinguished forms of treatment were effective. However, only for a proportion of the children this meant a clinical relevant improvement. For the improvement of language comprehension targeted language therapy seems essential, as children without this (children receiving surgical hearing impairment) did not improve their LCQ.

Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis.

PURPOSE: The purpose was to establish the impact on survival of early detection of a local recurrence of breast cancer as compared to late detection. DESIGN: A meta-analysis was carried out using Cochrane review manager software (RevMan version 4.2). Studies were included if women were treated for primary breast cancer without evidence of distant metastasis at primary diagnosis and if these concerned routine follow-up strategies focusing on the early detection of curable recurrences. Data regarding the risk for death were derived from each study. Multi level models were used to study heterogeneity by using MLWin. RESULTS: Thirteen studies concerning 2,263 patients were included. Early detection of breast cancer recurrences during follow-up gave a significantly better survival as compared to late detected recurrences (HR: 1.68 (95% CI: 1.48-1.91)). Survival was better when the recurrence was found by mammography instead of physical examination or in patients without symptoms as compared to those with symptoms (HR: 2.44 (95% CI: 1.78-3.35); HR: 1.56 (95% CI: 1.36-1.79), respectively). If all breast cancer recurrences would be detected earlier, that 5-8 deaths (i.e. an absolute reduction in mortality of 17-28%) would be avoided by performing routine follow-up during a 10 year-period for 1,000 breast cancer patients. CONCLUSION: These data support the hypothesis that detection of isolated loco-regional or contra-lateral breast cancer recurrences in patients without symptoms has beneficial impact on survival of breast cancer patients when compared to late symptomatic detection.

Cardiovascular and eye activity measures as indices for momentary changes in mental effort during simulated flight.

This study examines effects of momentary changes in mental effort on cardiovascular and eye activity measures. A total of 19 male pilots performed an instrument flight task. Task load was manipulated by having the pilots perform flight manoeuvres of varying complexity. Multilevel analyses demonstrated clear effects of momentary changes in mental effort on both the cardiovascular and the eye activity measures. An increase in task load resulted in an increase of heart rate and a decrease in heart rate variability, mean dwell time and fixation duration. Heart rate differentiated between resting period and task execution. Heart rate variability from short data segments provided more insight in intermediate levels of mental effort. The eye activity measures were sensitive to intermediate levels of mental effort as well. Attitude changes resulted in an increase of mean dwell time and mean fixation duration. Task analysis is required to use eye measures as valid indices of mental effort. Having indications of the effects of changing mental demands during daily work of operators is of great importance nowadays. This paper presents an approach to estimate such effects on the basis of heart rate and eye activity measures. In particular, the use of averaged short-term heart rate variability measures is a relatively new aspect.

Assessment of the clinical relevance of quantitative sensory testing with Von Frey monofilaments in patients with allodynia and neuropathic pain. A pilot study.

BACKGROUND: Allodynia is a common and disabling symptom in many patients with neuropathic pain. Whereas quantification of pain mostly depends on subjective pain reports, allodynia can also be measured objectively with quantitative sensory testing. In this pilot study, we investigated the clinical relevance of quantitative sensory testing with Von Frey monofilaments in patients with allodynia as a consequence of a neuropathic pain syndrome, by means of correlating subjective pain scores with pain thresholds obtained with quantitative sensory testing. METHODS: During a 4-week trial, we administered a cannabis extract to 17 patients with allodynia. We quantified the severity of the allodynia with Von Frey monofilaments before, during and after the patients finished the trial. We also asked the patients to rate their pain on a numeric rating scale at these three moments. RESULTS: We found that most of the effect of the cannabis occurred in the last 2 weeks of the trial. In this phase, we observed that the pain thresholds, as measured with Von Frey monofilaments, were inversely correlated with a decrease of the perceived pain intensity. CONCLUSION: These preliminary findings indicate clinical relevance of quantitative sensory testing with Von Frey monofilaments in the quantification of allodynia in patients with neuropathic pain, although confirmation of our data is still required in further studies to position this method of quantitative sensory testing as a valuable tool, for example, in the evaluation of therapeutic interventions for neuropathic pain.

Children with language problems in a speech and hearing clinic: background variables and extent of language problems.

OBJECTIVE: Analysis of a clinical population referred for language analysis in terms of background variables and extent of language problems. DESIGN: Descriptive study. MATERIALS AND METHODS: Children referred to a speech and hearing clinic because of assumed language problems were analyzed with standardized tests for language comprehension (Dutch version of the Reynell Developmental Comprehension Scale) and language production (Schlichting test for sentence development). A language problem was defined when the language quotient score differed 1.3S.D. from the mean (quotient scores< or =80). Furthermore, potential risk factors for language problems were compiled (gender, prematurity, birth weight, family composition, familial aggregation, parental education and daycare/home care). RESULTS: Two hundred forty children, aged between 2 and 5 years of age were included in the study. A reliable language comprehension quotient (LCQ) was obtained in 204 children (85%) and a reliable sentence development quotient (SDQ) in 206 children (85%). In 35% of the children who were assumed to have language problems, adequate language development was found. The children with language problems differed from the children without language problems with regard to language problems in the family (more family aggregation). Also the former more frequently had parents with a low level of education and more often did not attend daycare. The total referred group differed from the Dutch population with regard to gender (more boys), more instances of low birth weight, more parents with middle and high educational level, more two-parent households, fewer siblings, and more frequent attendance at daycare. CONCLUSION: Parents with a low level of education more frequently have children with language problems. However, parents with a middle and high level of education are more often concerned about the language development of their child. As a consequence, the overestimation of language problems is a real issue in clinical practice. Normal variations in language development often are not considered. The analysis of compiled background variables indicates that language problems are genetically influenced (gender and family aggregation). Language input also is of importance (interactions with a language-competent parent or caregiver and peers): children with language problems less often attended daycare.