RESUMEN
OBJECTIVE: To describe the demographic characteristics and patterns of service utilization in the Hunter region (NSW, Australia) of families caring for a child manifesting disruptive behaviour. METHODOLOGY: Families were eligible to participate in the survey if they had at least one child known to have one of the DSM-IV disruptive behaviour disorders, autistic spectrum disorders, behaviour problems associated with rarer forms of brain disease, brain injury or mild intellectual disability, or identified by school personnel as having significant behaviour problems. Families were recruited to the survey via schools, early education centres and clinical services. Parents completed a mail survey about demographic details and service utilization. RESULTS: In total, 1412 families responded to the survey, a participation rate of approximately 65%. The demographic characteristics of respondent families were similar to those of the regional population. A high proportion (85%) of children from respondent families were receiving treatment. Nearly half those children attending clinical services were attending two or more services. Approximately one-third each of the sample was attending public clinics, private clinics or a combination of both. Children were more likely to be treated by a paediatrician (64%) than a child psychiatrist (39%) or a psychologist (23%). Compared with a normative Australian sample, parents of children manifesting disruptive behaviour reported a high level of family stress. CONCLUSIONS: Families of children manifesting disruptive behaviour are a highly stressed group who often access several clinical services. Paediatricians make a significant contribution to the management of children with disruptive behaviours and need to be considered in service planning.
Asunto(s)
Servicios de Salud del Adolescente/estadística & datos numéricos , Déficit de la Atención y Trastornos de Conducta Disruptiva/epidemiología , Servicios de Salud del Niño/estadística & datos numéricos , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Adolescente , Déficit de la Atención y Trastornos de Conducta Disruptiva/clasificación , Déficit de la Atención y Trastornos de Conducta Disruptiva/diagnóstico , Déficit de la Atención y Trastornos de Conducta Disruptiva/terapia , Niño , Preescolar , Comorbilidad , Recolección de Datos , Femenino , Humanos , Masculino , Nueva Gales del Sur/epidemiologíaRESUMEN
OBJECTIVE: To assist in health service planning by determining the perceived clinical and community service needs of families resident in the Hunter region who care for a child manifesting disruptive behaviour. METHODOLOGY: Families were eligible to participate in the survey if they had at least one child known to have one of the DSM-IV disruptive behaviour disorders, autistic spectrum disorders, behaviour problems associated with rarer forms of brain disease, brain injury or mild intellectual disability or were identified by school personnel as having significant behaviour problems. Families were recruited to the survey via schools, early education centres and clinical services. Parents completed a questionnaire, mailed to them by educational and/or clinical services. Parents were asked to prioritize options for improving or expanding clinical services and for reducing their treatment costs. RESULTS: A total of 1412 families responded to the survey. The highest-ranked clinical service options involved the expansion of mainstream community treatment services for children with disruptive behaviour problems and their families, with a particular emphasis on counselling services. Respite care and in-patient services were given relatively low priority. Subgroup analyses showed that disadvantaged and stressed families gave higher rankings to out of home options, such as respite care, in-patient care and subsidised holiday camps, than the aggregate sample. CONCLUSIONS: Enhancement of community based counselling services would meet the needs of the greatest number of participating families. Resource-intense residential services are required by a small but important group of families who experience disadvantage and high levels of stress.
Asunto(s)
Servicios de Salud del Adolescente , Déficit de la Atención y Trastornos de Conducta Disruptiva/epidemiología , Servicios de Salud del Niño , Servicios Comunitarios de Salud Mental , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Evaluación de Necesidades , Adolescente , Déficit de la Atención y Trastornos de Conducta Disruptiva/economía , Déficit de la Atención y Trastornos de Conducta Disruptiva/terapia , Niño , Preescolar , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Nueva Gales del Sur/epidemiología , Clase Social , Factores SocioeconómicosRESUMEN
Adolescents with asthma, their peers, and their teachers were studied in order to establish the level of knowledge concerning asthma and its management, their attitudes towards asthma, and the degree quality of life impairment due to asthma. A community survey was conducted among year 8 high school students (n = 4161) and their teachers (n = 1104). There was a good response rate to the questionnaires from students (93%) and teachers (61%). Twenty three per cent of students had asthma and this caused mild to moderate quality of life impairment, particularly with strenuous exercise. Asthma was provoked by passive smoke exposure in 30% of asthmatic students and up to 51% of students avoided situations because of asthma triggers. Asthma knowledge was low in teachers (mean score 14.90 out of a possible 31), students without asthma (11.25) and students with asthma (14.50). Specific knowledge on the prevention and treatment of exercise induced asthma was poor. There was a moderate degree of tolerance towards asthma among all three groups. Most considered internal locus of control as important, although students without asthma also considered chance to be a determinant of outcomes for people with asthma. Asthma is a common cause of quality of life impairment among year 8 high school students. Although specific knowledge on asthma is low, students and teachers hold favourable attitudes towards asthma. There are opportunities to intervene and improve asthma management among adolescents.
Asunto(s)
Asma , Conocimientos, Actitudes y Práctica en Salud , Calidad de Vida , Adolescente , Asma/psicología , Actitud Frente a la Salud , Femenino , Humanos , Masculino , Grupo Paritario , EnseñanzaRESUMEN
Early childhood exposure to environmental lead may result in subtle deficits in neuropsychological development. Most studies, however, have reported global measures of development, and the findings have not been consistent. In this report, we examine the association between blood lead concentration and a specific aspect of neuropsychological development, visual-motor integration. Each child in a cohort of 494 children living in and around the lead smelting town of Port Pirie, South Australia, was followed for its first 7 years of life. Serial blood samples were collected at various ages to estimate the lifetime burden of each individual. At the time of each blood sampling, systematic information was obtained on a wide range of other variables relevant to child development. We evaluated visual-motor integration at age 7 with the Beery Developmental Test of Visual-Motor Integration (mean score: 13.4). There was an inverse relation between blood lead concentration and visual-motor performance. After adjustment for potential confounding factors, both prenatal and postnatal blood lead concentrations exhibited a dose-related inverse association with children's visual-motor performance. For an increase in life-time average blood lead concentration from 10 micrograms per dl (0.48 mumol per liter) to 30 micrograms per dl (1.45 mumol per liter), the estimated deficit in children's visual-motor performance was 1.6 points (95% confidence interval = 0.3-2.9). The results indicate that visual-motor integration may be a more sensitive index than global measures of development, such as intelligence quotient, for the assessment of lead effects on child development.
Asunto(s)
Exposición a Riesgos Ambientales , Plomo/efectos adversos , Desempeño Psicomotor/efectos de los fármacos , Niño , Femenino , Humanos , Inteligencia , Plomo/sangre , Masculino , Estudios Prospectivos , Australia del SurRESUMEN
The development of educational packages on health-related topics has become common in school curricula. This paper describes an integrated health and education input in the development of an educational package about asthma for Year 8 high school students. Ownership and educational relevance of the package (ensuring its appropriateness for inclusion within the Personal Development/Health/Physical Education curriculum) was achieved by collaboration between teachers with an understanding of the principles of curriculum design and health professionals with content knowledge about asthma. The model used for the production of the package about asthma could be extended to other health topics.
Asunto(s)
Asma , Educación en Salud/métodos , Servicios de Salud Escolar , Materiales de Enseñanza , Adolescente , Curriculum , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Educacionales , Nueva Gales del Sur , Educación del Paciente como Asunto/métodos , Proyectos Piloto , Desarrollo de ProgramaRESUMEN
The relation between lead concentration in deciduous central upper incisor teeth and intellectual functioning was examined in 262 children who were followed from birth to age 7 years in the lead smelter town of Port Pirie, South Australia, and its environs. Intellectual functioning of the children was assessed over the 3-year period from 1986 to 1989 with the revised Wechsler Intelligence Scale for Children (WISC-R) while each child was in his or her eighth year. There was an inverse relation between tooth lead concentration and intellectual development; the intelligence quotient declined by 2.6 points (90% confidence interval (CI) 0.13-4.9) for each natural-log unit increase in tooth lead concentration, expressed in parts per million. Some WISC-R subscales were more strongly associated with lead exposure than others. In particular, tooth lead was significantly negatively associated with scores for the "Block Design" test (partial regression coefficient -1.25 points per unit of natural-log tooth lead; 90% CI -0.61 to -1.89). No statistically significant interaction between a child's sex and tooth lead concentration was found for any of the WISC-R scales. These findings are in agreement with previously published results from this cohort for which serial blood lead concentrations were used to estimate lifetime lead burden.
Asunto(s)
Exposición a Riesgos Ambientales/análisis , Inteligencia/fisiología , Intoxicación por Plomo/fisiopatología , Plomo/análisis , Diente/química , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Análisis Multivariante , Análisis de Regresión , Australia del Sur , Escalas de WechslerRESUMEN
BACKGROUND: Exposure to lead in early childhood is thought to result in delayed neuropsychological development. As yet there is little longitudinal evidence to establish whether these effects persist into later childhood. METHODS: We measured IQ scores in 494 seven-year-old children from the lead-smelting community of Port Pirie, Australia, in whom developmental deficits associated with elevated blood lead concentrations had already been reported at the ages of two and four years. Exposure to lead was estimated from the lead concentrations in maternal blood samples drawn antenatally and at delivery and from blood samples drawn from the children at birth (umbilical-cord blood), at the ages of 6 and 15 months and 2 years, and annually thereafter. Data relating to known covariates of child development were collected systematically for each child throughout the first seven years of life. RESULTS: We found inverse relations between IQ at the age of seven years and both antenatal and postnatal blood lead concentrations. After adjustment by multiple regression for sex, parents' level of education, maternal age at delivery, parents' smoking status, socioeconomic status, quality of the home environment, maternal IQ, birth weight, birth order, feeding method (breast, bottle, or both), duration of breast-feeding, and whether the child's natural parents were living together, the relation with lead exposure was still evident for postnatal blood samples, particularly within the age range of 15 months to 4 years. For an increase in blood lead concentration from 10 micrograms per deciliter (0.48 mumol per liter) to 30 micrograms per deciliter (1.45 mumol per liter), expressed as the average of the concentrations at 15 months and 2, 3, and 4 years, the estimated reduction in the IQ of the children was in the range of 4.4 points (95 percent confidence interval, 2.2 to 6.6) to 5.3 points (95 percent confidence interval, 2.8 to 7.8). This reduction represents an approximate deficit in IQ of 4 to 5 percent. CONCLUSIONS: Low-level exposure to lead during early childhood is inversely associated with neuropsychological development through the first seven years of life.
Asunto(s)
Inteligencia , Plomo/toxicidad , Australia , Niño , Preescolar , Estudios de Cohortes , Discapacidades del Desarrollo/inducido químicamente , Exposición a Riesgos Ambientales , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Plomo/sangre , Intoxicación por Plomo/psicología , Masculino , Análisis MultivarianteRESUMEN
A long-term prospective cohort study was conducted to examine the association between prenatal and postnatal exposure to environmental lead and childhood neuropsychological development. The possible interactive effects of blood lead and some covariates on early development were explored in this study. Our data suggest that gender of the child modifies the effect of lead on the neuropsychological development during early childhood. At the ages of 2 and 4 years, girls appear to be more sensitive than boys to the neuropsychological effects of lead. However, there is no significant modification of the effect of lead by some other covariates, such as parental smoking, socioeconomic status, home environment, birth weight, and the kind of infant feeding. Evidence of interactions between environmental lead exposure and other covariates in the causation of neuropsychological deficits in childhood underscores the desirability of considering both main effects and interactions in this area of research. Such effects, if confirmed, may have implications for public health intervention strategies.
Asunto(s)
Desarrollo Infantil , Demografía , Exposición a Riesgos Ambientales , Plomo , Efectos Tardíos de la Exposición Prenatal , Factores Socioeconómicos , Análisis de Varianza , Australia , Preescolar , Cognición , Estudios de Cohortes , Femenino , Humanos , Plomo/sangre , Masculino , Padres , Embarazo , Desempeño Psicomotor , Análisis de Regresión , Caracteres Sexuales , FumarAsunto(s)
Personas con Discapacidad , Familia , Necesidades y Demandas de Servicios de Salud , Australia , Niño , HumanosRESUMEN
Sources of variation and some principal determinants of blood lead concentration (PbB) were investigated in a cohort of children, followed to age 5 y, who were born near a lead smelter in Port Pirie, South Australia. The child's age and place of residence were the two variables most strongly predictive of PbB. A sharp increase in PbB occurred between 6 and 15 mo of age and was followed by a peak concentration that occurred at approximately 2 y of age, after which PbB steadily and consistently declined. Irrespective of age, the PbBs in children who lived in Port Pirie were significantly higher than levels identified in children who resided outside the city. There was no significant difference in PbB between boys and girls. Elevated PbB at each specific age was associated mainly with increased lead concentrations in the topsoil of the local residential area, employment of the father in the lead industry, parental smoking, and behaviors likely to cause ingestion of dirt. Blood samples taken from children at certain ages and during the warmer months contained more lead than samples obtained during the cooler months. The effects of these determinants on PbB during early childhood were basically consistent in both single and multivariable analyses.
Asunto(s)
Exposición a Riesgos Ambientales , Monitoreo del Ambiente/normas , Intoxicación por Plomo/sangre , Metalurgia , Factores de Edad , Preescolar , Estudios de Cohortes , Escolaridad , Monitoreo del Ambiente/métodos , Monitoreo Epidemiológico , Femenino , Humanos , Lactante , Intoxicación por Plomo/epidemiología , Masculino , Ocupaciones , Padres , Pica/complicaciones , Valor Predictivo de las Pruebas , Características de la Residencia , Estaciones del Año , Estudios Seroepidemiológicos , Fumar/efectos adversos , Factores Socioeconómicos , Contaminantes del Suelo/análisis , Australia del Sur/epidemiología , Conducta en la Lactancia , Abastecimiento de Agua/normasRESUMEN
High technology has introduced a new dimension to medical treatment. There are inevitable social costs as well as benefits, and the allocation of resources to high technology, as opposed to other areas of health care, is a contentious issue. The current balance in health service funding between high technology and low technology is not appropriate. It is driven by the technological imperative and only offers solutions to a limited number of problems. There is a scarcity of health resources left to develop intersectoral responses and provide adequate funding for research into person-intensive interventions suitable for many problems. Arguments against allocating too many resources to high technology in paediatrics are examined in this paper.
Asunto(s)
Asignación de Recursos para la Atención de Salud , Pediatría , Asignación de Recursos , Tecnología de Alto Costo , Australia , Educación de Pregrado en Medicina , Ética Médica , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Cuidado Intensivo Neonatal , Calidad de Vida , Medición de Riesgo , Evaluación de la Tecnología Biomédica , Tecnología de Alto Costo/economía , Valor de la VidaRESUMEN
As part of a cohort study of the effects of chronic exposure to lead on pregnancy outcome and child development, lead concentrations in the umbilical cord and placental tissues (body and membranes) from 9 late fetal deaths, 23 preterm births, and 18 births associated with premature rupture of the amniotic membranes were compared with the lead concentrations in the tissues obtained at 22 normal births. Modest elevations in lead concentration were found in the placental body of late fetal deaths (stillbirths) and preterm births as well as in the cord tissue associated with preterm births and premature rupture of membranes. The geometric mean lead concentration in the membranes from late fetal deaths was 2.73 micrograms/g of dry tissue (95% confidence limits 0.69-10.8), which was 3.5 times higher than the mean found in normal births (0.78 micrograms/g, 95% confidence limits 0.61-1.00). The concentration in the membranes of preterm births was also significantly high, being 1.24 micrograms/G (0.91-1.67). Low correlations of membrane and antenatal blood lead concentrations suggest that other factors in addition to exposure to environmental lead may influence the amount of lead accumulated in the placental membranes.
Asunto(s)
Industria Química , Membranas Extraembrionarias/metabolismo , Intoxicación por Plomo/metabolismo , Placenta/metabolismo , Resultado del Embarazo , Cordón Umbilical/metabolismo , Estudios de Cohortes , Exposición a Riesgos Ambientales , Femenino , Muerte Fetal/metabolismo , Rotura Prematura de Membranas Fetales/metabolismo , Humanos , Trabajo de Parto Prematuro/metabolismo , Embarazo , Control de CalidadRESUMEN
The Port Pirie Cohort Study is an ongoing prospective study of the relationship between exposure to environmental lead within a lead smelter community, and neuropsychological development in early childhood. Over 600 children, originally recruited during antenatal life, underwent serial blood lead estimations up to two years of age. Systematic interview information was collected on a range of variables, and formal developmental assessment (Bayley Scales of Infant Development) was carried out at 24 months of age. Blood lead concentrations measured antenatally (maternal), at delivery (maternal and umbilical cord) and postnatally at 6, 15 and 24 months were negatively correlated (p less than 0.05) with mental development at 24 months of age. Geometric mean blood lead concentrations (microgram/dl) were 14.3, 20.8 and 21.2 at 6, 15 and 24 months of age respectively. When multiple covariates, including maternal IQ, were controlled for in multiple regression analysis, a statistically significant (p less than 0.01) inverse association was observed between blood lead concentration (PbB) measured at 6 months of age and mental development at 2 years of age. No such association was evident for psychomotor development. When the quality of the home environment (HOME Score) was added to the multiple regression model, the inverse association between blood lead concentration at 6 months of age and mental development at 2 years persisted, albeit less strongly (p = 0.07). From this analysis, it is estimated that a child with with PbB of 30 micrograms/dl at age 6 months will have a deficit of 3.3 points (approximately 3%) on the Bayley Mental Development Scale relative to a child with PbB of 10 micrograms/dl.
Asunto(s)
Desarrollo Infantil/efectos de los fármacos , Plomo/sangre , Procesos Mentales/efectos de los fármacos , Preescolar , Estudios de Cohortes , Femenino , Sangre Fetal/análisis , Humanos , Lactante , Recién Nacido , Embarazo , Estudios Prospectivos , Desempeño Psicomotor/efectos de los fármacos , Análisis de Regresión , Australia del SurRESUMEN
We studied the effect of environmental exposure to lead on children's abilities at the age of four years in a cohort of 537 children born during 1979 to 1982 to women living in a community situated near a lead smelter. Samples for measuring blood lead levels were obtained from the mothers antenatally, at delivery from the mothers and umbilical cords, and at the ages of 6, 15, and 24 months and then annually from the children. Concurrently, the mothers were interviewed about personal, family, medical, and environmental factors. Maternal intelligence, the home environment, and the children's mental development (as evaluated with use of the McCarthy Scales of Children's Abilities) were formally assessed. The mean blood lead concentration varied from 0.44 mumol per liter in midpregnancy to a peak of 1.03 mumol per liter at the age of two years. The blood lead concentration at each age, particularly at two and three years, and the integrated postnatal average concentration were inversely related to development at the age of four. Multivariate analysis incorporating many factors in the children's lives indicated that the subjects with an average postnatal blood lead concentration of 1.50 mumol per liter had a general cognitive score 7.2 points lower (95 percent confidence interval, 0.3 to 13.2; mean score, 107.1) than those with an average concentration of 0.50 mumol per liter. Similar deficits occurred in the perceptual-performance and memory scores. Within the range of exposure studied, no threshold dose for an effect of lead was evident. We conclude that postnatal blood lead concentration is inversely related to cognitive development in children, although one must be circumspect in making causal inferences from studies of this relation, because of the difficulties in defining and controlling confounding effects.
Asunto(s)
Desarrollo Infantil/efectos de los fármacos , Contaminantes Ambientales/toxicidad , Plomo/toxicidad , Australia , Preescolar , Cognición , Femenino , Humanos , Residuos Industriales/toxicidad , Lactante , Recién Nacido , Plomo/sangre , Masculino , Memoria , Destreza Motora , Percepción , Análisis de RegresiónRESUMEN
The blood pressures of 6346 children who were between the ages of seven and 17 years were measured under standardized conditions. Blood pressures were similar in prepubertal boys and girls. After puberty, the systolic blood pressures of the girls remained unchanged whereas those of the boys continued to rise. The difference between the fourth and fifth Korotkoff sounds was 2 mm at both the 50th and 95th percentiles. The systolic blood pressure was observed to fall over a 10-min period by 4-9 mmHg at the 50th percentile and 9-15 mmHg at the 95th percentile. Over the same period of time, the diastolic blood pressure was seen to fall by 2-3 mmHg and 3-6 mmHg at the 50th and 95th percentiles, respectively. There was no further fall in blood pressure after 10 min. The conditions and timing of measurement are important in blood-pressure evaluation and may explain the differences in blood pressure that have been reported for different populations.