Comparing long-term educational effects of two early childhood health interventions

We compare the educational effects of two medical protocols that mitigate long-term consequences of prematurity or low birth weight. The two protocols are Traditional Care (TC), which uses incubators, and Kangaroo Mother Care (KMC) which replaces incubators for 24-hour skin-to-skin contact between newborns and caregivers. We concentrate on educational outcomes addressing contradictory results in previous contributions. We use a randomized controlled trial implemented in 1993 that randomly assigned children to either TC or KMC. OLS results suggest that KMC children spent more time in preschool, had fewer temporary school absences, and showed lower math test scores. Both groups observed similar effects on high-school graduation and language test scores. We correct for attrition, small sample, and multiple outcomes. Effects on preschool attendance and school absenteeism are robust, particularly for more vulnerable infants (birth weight ≤ 1,800 g). The other effects lose statistical significance due to multiple outcome testing or attrition corrections.

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm

Aim

The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood.

Method

Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20‐year‐old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure.

Results

The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct relationship between brain volumes and duration of KMC, after controlling for potential confounders.

Conclusion

Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.

Psychometric characteristics of a brief measure of pain-related functional impairment

This study presents reliability and validity data from two samples (pain clinic vs medical clinic) on a five-item self-report scale, termed the Functional Interference Estimate (FIE), designed to measure functional impairment associated with chronic pain. Results from the pain clinic sample demonstrated that the FIE is internally consistent and has satisfactory levels of test-retest reliability, item-total score correlations, and convergent validity. Results from the medical clinic sample demonstrated that the FIE discriminated between medical clinic patients without pain and both medical clinic patients with pain and pain clinic patients. The data support the use of the FIE as one of several available assessment methods for evaluation of pain-related functional impairment.

Pain locus of control scores in chronic pain patients and medical clinic patients with and without pain

OBJECTIVE

We investigated the association between treatment setting and pain control attributions as assessed by the Pain Locus of Control Scale (PLOC).

DESIGN

Nonrandomized consecutive samples.

PATIENTS AND SETTING

The patient groups included an outpatient pain clinic sample of chronic pain patients (n = 48), a group of medical clinic outpatients with chronic pain (n = 28), and a group of medical clinic outpatients without current pain (n = 22). Medical clinic patients without current pain were asked to reply to the PLOC items in terms of their usual response when experiencing pain.

RESULTS AND CONCLUSIONS

Results indicated that pain clinic patients were the least likely of the three groups to report predictable control of their pain as reflected by their significantly lower "powerful other" and higher "chance" dimension scores. Medical clinic patients without pain reported greater personal control of pain than the other two groups as evidenced by their higher "internality" dimension score and lower "chance" dimension score. Results indicate that pain control appraisals differ among patients with chronic pain and illness as a function of the treatment setting and suggest that differences in cognitive appraisal can affect treatment efficacy.

The effects of child abuse and race on risk-taking in male adolescents

This study explores the effects of abuse on the risk-taking behaviors of 2973 black and white adolescent males, 412 of whom were sexually or physically abused. Surveys on mental and physical health, risk-taking behaviors and attitudes, and family living were administered to 9th and 12th graders in an urban midwestern state. The surveys included questions on past history of sexual and physical abuse. More black than white males reported experiencing incest, extrafamilial sexual abuse, and physical abuse. As for outcome risk-taking behaviors, blacks were more likely to use illegal substances, run away, skip school, attempt suicide, force partners into sex, and commit violent acts; however, the racial effects decreased when abuse histories were taken into consideration. Whites were more likely to drink and drive, and to drink before having sex; abuse history did not decrease this racial effect. Abuse but not race was predictive of drinking and of having serious drinking problems. The results point to the importance of pediatricians, psychologists, and other healthcare workers, as well as those in the legal and criminal justice system screening for a history of abuse among adolescents who demonstrate these or other risk-taking behaviors.

The effect of drug exposure on thyroid hormone levels of newborns

This study examines the effect of women's alcohol abuse during pregnancy on the thyroid-stimulating hormone (TSH) and thyroxine (T4) levels of their babies at birth. Forty-seven babies were born to mothers identified as substance abusers. Maternal use of marijuana and/or cocaine did not result in newborns' TSH and T4 hormone levels being significantly different from non-substance-abusing controls' TSH and T4 levels. Alcohol use, however, was significantly linked to lower newborn TSH levels, lower than TSH levels of a control sample of newborns whose mothers used marijuana and/or cocaine, and lower than a control sample of newborns whose mothers abused no substances. This finding suggests further investigation of possible links between thyroid functioning and fetal alcohol syndrome (FAS).

Substance abuse among sexually abused adolescents and their families

The concurrence of substance abuse and history of sexual abuse among adolescents has prompted this study of substance abuse patterns among families of adolescents who report incest or extrafamilial sexual abuse. A total of 3,179 ninth-grade students in a rural midwestern state completed a survey that included questions about individual and family substance abuse. Adolescents who had been sexually abused were more likely to report substance abuse for themselves as well as for members of their immediate families. They were also more likely to report that they used substances because of family problems, school problems, and because they were sad, lonely, or angry. Adolescents reporting a parent with an alcohol or a drug problem were more likely to use cigarettes, marijuana, alcohol, or "speed." Adolescents experiencing extrafamilial abuse reported more alcohol abuse and more alcohol-related problems than those who experienced incest. There were similar reports of parental and familial alcohol and drug problems among these experiencing incest and those experiencing extrafamilial abuse. Those with drug-abusing parents, however, were most likely to report some kind of sexual abuse history.

Self-control and ego identity development as predictors of unprotected sex in late adolescent males

Male college students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, moral development, personality factors and behaviors. Bivariate analyses were used to identify factors associated with high-risk sexual intercourse. Significant demographic psychosocial and behavioral predictors were entered into a logistic regression analysis to evaluate the independent influence of each predictor on unprotected sexual intercourse. Behavioral factors were the most powerful predictors of unprotected sexual intercourse. Adolescents reporting multiple sex partners, drinking and picking-up sex partners were significantly more likely to engage in sex without condoms. Examining psychosocial factors alone, it was found that adolescents who had low scores for ego-development (goal-directedness) and self-control were significantly more likely to engage in sex without condoms. Identification of two personality constructs as underlying predictors of high-risk behavior, while potentially important for the development of effective HIV prevention programs, needs corroboration to further define the interrelationships between these factors and other psychosocial constructs.

Development of an innovative child and youth mental health training and services delivery project

In 1989 North Carolina began funding a mental health demonstration training and services project to serve severely emotionally disturbed children and youth in the community. During the first two years of this state-university collaboration, consultation and direct services provided by faculty and student trainees have been linked to preexisting services at a mental health center serving three counties. The project has met initial goals of developing new and expanded services, building relationships with other agencies, and integrating university and mental health center staff. More formal process and outcome evaluations are under way. Areas of probable long-standing concern include the need for more cordial working relationships with other agencies and for more participation of parents in treatment and education programs.

Inconsistencies and misperceptions putting college students at risk of HIV infection

College students are often viewed as being at high risk for human immunodeficiency virus (HIV) infection, due to their needs to engage in exploratory behavior and their needs for peers' social approval, and their sense of invulnerability. The proportion of adolescents who are sexually active is known to be relatively stable; however, the amount of unsafe sex taking place on the college campus is still in question, as well as the relationship between dating patterns and HIV-risk behavior. In this study college students' self-reports of sexual and dating practices were related to sexual frequency and condom use. The results highlight the amount of unprotected sexual behavior in the college group and the difficulty in assessing adolescents' risk of HIV transmission on the basis of self-reported sexual activity and dating behavior. Key issues to target in educating college students about HIV infection are the roles of planning and spontaneity in dating and the fact that inaccurate self-perceptions of monogamy and abstinence may lead them to assume falsely that they are safe from sexually transmitted diseases.