A Comparison of the Leiter-R and the Universal Nonverbal Intelligence Test (UNIT) with Children Classified as Language Impaired

The Leiter-R and the Universal Nonverbal Intelligence Test (UNIT) were administered in counterbalanced order to 43 children (12 females, 31 males) who were classified as severely language disordered (mean age = 8.55, SD = 1.78). All standard scores were depressed and ranged from 65.07 (Leiter Fluid Reasoning Composite) to 70.00 (UNIT Symbolic Memory), suggesting global cognitive deficits that extend beyond language. Correlations and t-test analyses compared similar scores. The correlations were significant (i.e., Leiter-R Visualization and Reasoning Battery Full Scale IQ/UNIT Full Scale IQ= .80, Leiter-R Fluid Reasoning Subscale/UNIT Reasoning Subscale = .66); t-test computations were nonsignificant. Given the critical language deficiencies of this population, it was concluded that either battery provided a nonbiased assessment of cognitive abilities. Qualitative strengths and weaknesses of both tests were discussed.

Discriminant Validity of the WISC-III with Children Classified with ADHD

The purpose of this study was to explore the ability of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991a) to discriminate between a group of children classified with ADHD (n = 40) and a group of non-ADHD children (n = 40), as well as to identify which combination of WISC-III subtests resulted in the highest level of correct classifications. A stepwise discriminant function analysis indicated that four WISC-III subtests contributed significantly to the prediction of group membership: Digit Span, Information, Vocabulary, and Picture Completion. An overall classification rate of approximately 89% was attained when the four WISC-III subtests were included in the equation. Ninety percent of the children classified as ADHD and 87.5% of the non-ADHD children were correctly identified when using the four WISC-III subtests as predictors.

Does the Flynn Effect Differ by IQ Level in Samples of Students Classified as Learning Disabled?

This research examined scores from two learning-disabled (LD) samples for evidence of the Flynn Effect (FE; Flynn, 1999) to determine (a) whether the FE was evident, and (b) if the magnitude of the FE differed on IQ scores at varying levels of intelligence. Sample 1 consisted of 40 children who were administered the Woodcock-Johnson Tests of Cognitive Ability-Revised (WJ-R Cog) and the Woodcock-Johnson Tests of Cognitive Ability-Ill (WJ-III Cog) approximately 8 weeks apart. Sample 2 consisted of triennial test data for 169 students who were tested once with the Wechsler Intelligence Scale for Children-Revised (WISC-R) and 3 years later with the Wechsler Intelligence Scale for Children-Third Edition (WISC-III). After an initial analysis for the overall FE, Samples 1 and 2 were each divided into IQ level groups (e.g., 91-105) and analyzed accordingly. Results for Sample 1 (W-J) indicated that the 2+ point observed IQ change was not significant for this relatively small sample, although it appeared to be consistent with the direction and degree predicted by the FE (Flynn, 1984). Results for Sample 2 (WISC) indicated a significant IQ change consistent with the FE. Neither sample exhibited statistically significant differences for FE by IQ level. However, consistent with previous research, observed differences increased from lower to higher IQ levels. Consequently, this research cannot rule out the possibility that a child's IQ level influences the degree to which the FE is apparent.

Five to Ten Years after Placement: The Long-Term Efficacy of Retention and Pre-Grade Transition

This study examined the long-term effects of retention and transition placement on school attendance, self-esteem, academic achievement, and special education/remedial service provision of students who were completing their seventh, eighth, and ninth grades. Because the majority (65%) of the sample had been retained/transitioned at the end of their kindergarten or first-grade year, student data were collected 5 to 10 years post-placement. Comparisons were made among students who had been retained, received transitional placement, or been advanced into the next grade in the usual manner. Both the retained and transitioned groups differed significantly from the matched sample group on average number of days absent during grades one to six and on special education/remedial service provision. Results suggested that neither retention nor transition placement resolved the academic deficiencies of these children.

Correlations Among the Hiskey, K-Abc Nonverbal Scale, Leiter, and Wisc-r pErformance Scale With Public-School Deaf Children

The Hiskey-Nebraska (H-NTLA), K-ABC Nonverbal Scale (NS), Leiter, and the WISC-R Performance Scale (using Anderson and Sisco deaf norms), were administered to 31 hearing-impaired (HI) children enrolled in self-contained, hearing- handicapped programs in a public school setting. Testing spanned a 3-month interval. The group mean score on the K-ABC NV ( M = 94.10) was significantly lower than the Leiter mean score ( M = 100.71) or the WISC-R PIQ mean score ( M = 103.00), as demonstrated by significant dependent t-test analyses ( p < .01, p < .001, respectively). All other t-test results, including the K-ABC NV to the H-NTLA (M = 99.21), were nonsignificant. The Pearson product-moment cor relations among the four instruments were all significant and ranged from .57 (K-ABC NV with H-NTLA, p < .01) to .78 (K-ABC NV with Leiter, p < .0001). While results showed the K-ABC NV to have ample construct validity, it appeared to underestimate the intellectual skills of the HI population. Separate deaf norms on the K-ABC NV would be necessary for the recom mended general use of this instrument.

Long-Term Developmental Outcomes of Prenatal Cocaine Exposure

The developmental outcomes of prenatal cocaine/polydrug exposure were evaluated using a multivariate research design that controlled for the possible confounding variables of age, sex, socioeconomic status, ethnicity, and caregiver status (i.e., biological parent, relative, foster care, and adoptive parent) using an exposed (n = 41) and nonexposed (n = 35) cohort of preschool children (mean age = 4.25). Results indicated that in utero drug exposure had no effect on cognitive, social, language, and behavioral developmental outcomes as measured by the Stanford-Binet Intelligence Scale: 4th ed., the Social Skills Rating System, the Preschool Language Scale: 3rd ed., the Child Behavior Checklist, and the Vineland Adaptive Behavior Scale-Survey Form.

Exploratory Factor Analysis of the Wraml with Academically At-Risk Students

The Wide Range Assessment of Memory and Learning (WRAML) is a nationally standardized instrument designed to assess memory and learning skills in children and adolescents. Controversy about the factor structure of the instrument has resulted in researchers questioning the validity of the three WRAML composite scores (Verbal Memory, Visual Memory, and Learning). To help clarify this issue, the instrument was administered to 1 5 children referred for academic concerns (M age = 10.15). An exploratory factor analysis extracted three factors defined as Attention/Concentration, Visual Memory, and Verbal Memory. These findings are similar to the factor structure of the Wechsler Memory Scale-Revised. Implications of these data are discussed.

Figure Preference, Body Dissatisfaction, and Body Distortion in Adolescence

The present study was designed to evaluate gender and age effects on three multidimensional factors (i.e., figure preference, body dissatisfaction, and body distortion) that potentiate eating-related problems among adolescents. Data from 454 students (X age 15.03) found females preferred afigure significantly thinner than their current status, whereas males were generally pleased with their body proportions. This discrepancy resulted in significant gender differences in idealfigure preference and body dissatisfaction. School level (high school vs. middle school) by gender, two-way ANOVA comparisons found an interactional effect, with high schoolfemales evidencing significantly higher levels of body dissatisfaction and distortion than the middle schoolfemales and males. Further analysis with females found body dissatisfaction increased with age in a linear configuration, whereas body distortion followed a curvilinear pattern.

Using Gleason pattern 5 to refine risk stratification for prostate cancer patients treated with dose-escalated radiotherapy and androgen-deprivation therapy

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Background: The division of Gleason score (GS) into three categories (2-6, 7, 8-10), may not fully utilize its prognostic power as shown by recent reports demonstrating that the presence of Gleason Pattern 5 (GP5) is a strong adverse prognostic factor. Therefore, we analyzed clinical outcomes for patients treated with dose-escalated radiation therapy (RT) based upon the presence or absence of GP5 within the biopsy specimens.

Methods: Clinical outcomes were analyzed for 718 men treated for localized prostate cancer with definitive external beam RT to at least 75 Gy. We assessed the impact of GP5 as well as pre-treatment and treatment related factors on freedom from biochemical failure (FFBF), freedom from metastasis (FFM), cause-specific survival (CSS), and overall survival (OS).

Results: Median follow-up was 64 months. At biopsy, 89% of patients had no GP5 while 11% had GP5. There was no difference in age, co-morbid illness, clinical T-stage, PSA, or the use or duration of androgen deprivation therapy (ADT) between GS8 without GP5 and GS8-10 with GP5. The presence of GP5 predicted lower FFM (p<0.002 [HR: 3.4{1.7-7.1}]), CSS (p<0.0001 [HR: 12.9 {5.4-31}]), and OS (p<0.0001 [HR: 3.6 {2.0-6.5}]) when compared to GS8 (without GP5). Ten-year FFM, CSS, and OS were 89%, 98%, and 57% for those with Gleason 8 prostate cancer without GP5 as compared to 61%, 55%, and 31% for those with GP5. In addition, both FFM and CSS were strongly influenced by ADT use concurrent with RT. On multivariate analysis GP5 was the strongest prognostic factor for all clinical end-points.

Conclusions: The presence of GP5 predicts for worse clinical behavior, which therefore needs to be accounted for by risk stratification schemes. Further intensification of local and/or systemic therapy may be appropriate for such patients.

No significant financial relationships to disclose.

Prevalence of untreated asthma in a population sample of 6000 older adults in Bristol, UK

BACKGROUND

A study was undertaken to estimate the prevalence of untreated asthma in older adults.

METHODS

A cross sectional population based survey of 6000 men and women aged 65 years and over was performed in 21 general practices in north Bristol, south west England. The main outcome measure was untreated asthma as defined by a two stage process comprising a respiratory questionnaire (symptoms suggestive of asthma or doctor diagnosed asthma not receiving respiratory treatment) followed by lung function tests (significant reversibility following bronchodilators or corticosteroids and/or significant within day variability in peak expiratory flow).

RESULTS

4792 of the 6000 participants (80%) completed the respiratory questionnaire and, of those not receiving respiratory treatment, 55 reported a previous doctor diagnosis of asthma and a further 696 had symptoms suggestive of asthma. Lung function testing in 280 of 501 randomly selected individuals from these groups resulted in 38 being defined as having asthma and an estimated population prevalence for untreated asthma of 2.4% (95% CI 1.6% to 3.6%) in men and 1.2% (95% CI 0.7% to 2.1%) in women. Most subjects (84%) with untreated asthma had moderate or severe disease. Untreated asthma was most common in individuals with doctor diagnosed asthma (21%) and those with breathlessness or wheeze (13-20%).

CONCLUSION

Untreated asthma in the elderly is a common and important problem. Opportunistic use of appropriate lung function tests in older people with a history of doctor diagnosed asthma or wheeze or breathlessness at rest could identify untreated asthmatics who might benefit from treatment.

Prevalence of untreated asthma in a population sample of 6000 older adults in Bristol, UK

BACKGROUND

A study was undertaken to estimate the prevalence of untreated asthma in older adults.

METHODS

A cross sectional population based survey of 6000 men and women aged 65 years and over was performed in 21 general practices in north Bristol, south west England. The main outcome measure was untreated asthma as defined by a two stage process comprising a respiratory questionnaire (symptoms suggestive of asthma or doctor diagnosed asthma not receiving respiratory treatment) followed by lung function tests (significant reversibility following bronchodilators or corticosteroids and/or significant within day variability in peak expiratory flow).

RESULTS

4792 of the 6000 participants (80%) completed the respiratory questionnaire and, of those not receiving respiratory treatment, 55 reported a previous doctor diagnosis of asthma and a further 696 had symptoms suggestive of asthma. Lung function testing in 280 of 501 randomly selected individuals from these groups resulted in 38 being defined as having asthma and an estimated population prevalence for untreated asthma of 2.4% (95% CI 1.6% to 3.6%) in men and 1.2% (95% CI 0.7% to 2.1%) in women. Most subjects (84%) with untreated asthma had moderate or severe disease. Untreated asthma was most common in individuals with doctor diagnosed asthma (21%) and those with breathlessness or wheeze (13–20%).

CONCLUSION

Untreated asthma in the elderly is a common and important problem. Opportunistic use of appropriate lung function tests in older people with a history of doctor diagnosed asthma or wheeze or breathlessness at rest could identify untreated asthmatics who might benefit from treatment.

From policy to practice: challenges in infant feeding in emergencies during the Balkan crisis

The preparation and dissemination of policy statements are necessary but insufficient to prevent the inappropriate use of infant-feeding products in emergencies. The widespread failure of humanitarian agencies operating in the Balkan crisis to act in accordance with international policies and recommendations provides a recent example of the failure to translate infant-feeding policies into practice. This article explores the underlying reasons behind the failures which include: (1) the weak institutionalisation of policies; (2) the massive quantities of unsolicited donations of infant-feeding products: (3) the absence of monitoring systems; (4) inadequate co-ordination mechanisms; (5) the high costs of correcting mistakes; and (6) the cumulative effects of poor practice. Efforts to uphold best practice during the crisis are also documented. Finally, the article identifies actions that could be undertaken in advance of and during future emergencies to enhance the application of infant feeding policies in emergencies.

Mental health and nutritional status among the adult Serbian minority in Kosovo

CONTEXT

Since the beginning of the North Atlantic Treaty Organization intervention in Kosovo in June 1999, few objective data have been available on relevant health indicators for the Serbian ethnic minority in Kosovo.

OBJECTIVE

To determine the prevalence of undernutrition among Serbian adults aged 60 years or older and psychiatric morbidity among the adult Serbian population in Kosovo.

DESIGN, SETTING, AND PARTICIPANTS

A systematic random sample survey of 212 households was conducted between September 27 and October 2, 1999, in Pristina, the capital city, and in 10 towns in the rural municipality of Gnjilane in Kosovo. Of the 212 households surveyed, 204 adults aged 15 years or older completed the General Health Questionnaire-28 (GHQ-28) and anthropometric measurements were taken for 98 adults aged 60 years or older and for a comparison group of 51 adults aged 18 to 59 years.

MAIN OUTCOME MEASURES

Body mass index of less than 18.5 kg/m(2) in older adults; nonspecific psychiatric morbidity among adults; and self-reported use of health care services, access to food rations, and primary sources of prewar and postwar income.

RESULTS

Undernutrition was found in 11.2% (95% confidence interval [CI], 5.7%-19.2%) of Serbian adults aged 60 years or older compared with 2.0% (95% CI, 0.1%-11.8%) of Serbian adults aged 18 to 59 years. The mean (SE) total score for the GHQ-28 was 13.0 (0.52). In a comparison of the GHQ-28 scores of the Serbian adults with the Kosovar Albanian adults (data from a recent survey), the mean (SE) score adjusted for age and sex was 12.8 (0.52) vs 11.1 (0.58); P =.03, respectively. The GHQ-28 scores were also higher for the Serbians in the subcategories of social dysfunction (2.8 [0.17] vs 2.2 [0.13]; P =.008) and severe depression (1.9 [0.15] vs 0.9 [0. 09]; P<.001), respectively. Serbian women and persons living alone or in small family units were more prone to psychiatric morbidity. Of the 141 respondents reporting the need for health care services, 83 (57.6%) reported not obtaining such services; 204 of 212 (96.2%) households were on a food distribution list. The majority of prewar income came from government jobs compared with farming and humanitarian aid for postwar income.

CONCLUSIONS

The undernutrition of older Serbian adults in Kosovo should be monitored. The high prevalence of symptoms of social dysfunction and severe depression suggest the need for implementation of mental health programs in the Serbian community. JAMA. 2000;284:578-584

Respiratory symptoms in older people and use of domestic gas appliances

BACKGROUND

Studies in children and young women have indicated an increased risk of respiratory illness in association with the use of domestic gas appliances, possibly caused by oxides of nitrogen generated when gas is burned. It is not known whether risks are similarly increased in older subjects.

METHODS

A questionnaire about respiratory symptoms in the past year and potential risk factors for respiratory disease was mailed to 6000 men and women aged 65 years and older who were selected at random from the lists of general practices in North Bristol, UK. Associations between symptoms and the use of gas appliances were examined by logistic regression with adjustment for age, sex, social class, and smoking habits.

RESULTS

Questionnaires were completed by 4792 (80%) of those mailed. The most common symptoms were exercise induced breathlessness, wheeze, or chest tightness (51%); wheeze (27%); morning phlegm (20%); and daytime breathlessness at rest (19%). In an analysis that included all subjects only weak associations were found with use of gas appliances, odds ratios all being 1.2 or less. The risks associated with use of a gas hob tended to be higher in women, with odds ratios of 1.36 (95% CI 1.01 to 1.83) for wheeze and 1.33 (95% CI 0.56 to 3.17) for morning chest tightness, but were lower than had been reported previously in younger women.

CONCLUSION

The absence of stronger associations cannot readily be explained by bias or confounding. Gas cookers and fires are unlikely to be an important cause of respiratory illness in the elderly. If they do cause such illness, the largest risks are likely to be in women who use gas hobs.

Plasmodium vivax: a cause of malnutrition in young children

We studied the aetiology of malnutrition in a cohort of 1511 children < 10 years old in Espiritu Santo, Vanuatu. Malnutrition was categorized using standard anthropometric criteria as: underweight [weight-for-age (WA) Z score < -2], wasting [weight-for-height (WH) Z < -2], or stunting [height-for-age (HA) Z < -2]. On multiple logistic regression analysis, the only factors significantly associated with wasting were age < 5 years [OR (95% CI) 1.8 (1.2-2.9), p = 0.01] and having suffered one or more episodes of clinical P. vivax malaria in the 6 months preceding nutritional assessment [OR 2.4 (1.3-4.4), p = 0.006]. The incidence of P. vivax infection was significantly higher during the 6 months preceding assessment in underweight vs. non-underweight children [incidence rate ratio (IRR) 2.6 (1.5-4.4), p < or = 0.0001). These groups had similar incidences of clinical P. falciparum infection during the same period [IRR 1.1 (0.57-2.1) p = 0.8] and of either species during the 6 months following assessment [IRR P. vivax 1.3 (0.9-2.0) p = 0.2; IRR P. falciparum 1.3 (0.9-1.9) p = 0.2]. In these children, P. vivax malaria was a major predictor of acute malnutrition; P. falciparum was not. Wasting neither predisposed to nor protected against malaria of either species. Although P. vivax malaria is generally regarded as benign, it may produce considerable global mortality through malnutrition.

Prevalence of self-induced vomiting and laxative/medication abuse among female adolescents: a longitudinal study

In order to assess the prevalence and stability of weight reduction techniques utilized by adolescent females, three comprehensive samples of middle school and high school students (ages 12-18) were surveyed in the springs of 1984, 1989, and 1992. All participants were enrolled in the same school district to ensure that the groups were demographically equivalent. The results demonstrated a significant decrease in the use of appetite suppressants among high school students. However, middle school females reported a significant increase in medication use and self-induced vomiting during the same 7-year period. Laxative abuse has persisted unchanged for a small segment of both populations.

Eating Disorders Inventory-2: cognitive-behavioral dimensions with nonclinical adolescents

The EDI-2 was administered to 122 nonclinical females aged 12 to 18 years. Although group means were within the normal range, 30% of the subjects were abnormally preoccupied with body proportions, and 4% were pathologically weight fixated. Three risk groups were identified on the basis of high composite factor scores: (a) the Psychological Distress group indicated substantial apprehension about social adequacy, personal intimacy, emotional security, and anger control; (b) the Body-image Dysphoria group were all preoccupied with weight and body proportions at levels commensurate with diagnosed anorexics; and (c) the Behavioral Disparity group endorsed unrealistically high standards for behavior and feelings of virtue/power through behavioral restraint, yet a willingness to engage in binging and/or purging behaviors.