The association of preterm birth and small birthweight for gestational age on childhood disability screening using the Ten Questions Plus tool in rural Sarlahi district, southern Nepal

Context The Ten Questions tool was developed in 1984 as a low‐cost, simple screen for childhood disability and referral for diagnosis in low‐resource settings, and its use in Nepal has not been previously evaluated. Preterm birth and intrauterine growth restriction are potential risk factors for child disability and loss of developmental potential, but there are few studies examining this relationship from developing settings. Objective To examine the associations of small for gestational age and preterm birth as predictors of Ten Questions Plus positivity. Design, setting and participants The Ten Questions Plus questionnaire was administered to caregivers of 680 children between 2 and 5 years of age from August 2007 to March 2008 in rural Sarlahi, southern Nepal. Participants had previously been enrolled in a randomized trial of chlorhexidine cleansing at birth. At 1 month of age, children were then enrolled into a randomized 2 × 2 factorial trial of daily iron and zinc supplementation between October 2001 and January 2006. Intervention None. Main outcome measure Positive screen on the Ten Questions Plus tool defined as a positive response to one or more questions. Results Of preterm children, 37 (33.6%) had a positive response to at least one question on the Ten Questions Plus and were considered at risk for disability. One hundred and seventy term children (29.8%) were at risk for disability. Conclusions The Ten Questions Plus tool can be used in this rural Nepali setting to identify children at increased risk for mental and physical disability to be targeted for further examination. The prevalence of parent‐reported disabilities is high in this population (almost one‐third of children); children who are both preterm and small‐for‐gestational age are at increased risk for motor milestone delay, reported learning difficulty, speech and behavioural problems. Intrauterine growth restriction may affect child development and result in disabilities later in childhood.     

The ten questions screen for childhood disabilities: its uses and limitations in Pakistan.

OBJECTIVE--To assess the accuracy of the ten questions screen as a measure of childhood disability for epidemiologic studies in populations lacking resources for professional assessment of children's development and functioning. DESIGN--Household survey and screening of children in phase one followed by clinical assessments in phase two. SETTING--Karachi, Pakistan. PARTICIPANTS--A cluster sample of 6365 children, aged 2 to 9 years, screened using the ten questions and a subsample referred for clinical assessments. MAIN RESULTS--Although the sensitivity of the ten questions as a global screen for serious cognitive, motor, and seizure disabilities is high (84-100%), its sensitivity for identifying and distinguishing specific types of disability and for detecting vision, hearing, and mild disabilities, overall, is limited (generally < 80% and as low as 4% for mild vision disability). The predictive value of a positive screening result is also limited-using the ten questions in surveys without clinical confirmation results in overestimation of the prevalence of serious disability by more than 300%. CONCLUSIONS--The ten questions screen is not an assessment tool. Its utility lies in its ability to screen or select a fraction of the population at high risk for serious disability. As a screening tool, it allows scarce diagnostic and other professional resources to be efficiently directed toward those at high risk.     

Association between nutritional status and positive childhood disability screening using the ten questions plus tool in Sarlahi, Nepal

The study was conducted to examine the association between the indicators of malnutrition and disability of children as reported by caregivers. The Ten Questions Plus questionnaire was administered to caregivers of 1,902 children aged 1-9 years, during August 2007-March 2008, in rural Nepal. Height and weight of children were also measured. The main outcome was a positive response to one or more questions. In total, 514 (27%) children had a positive response to at least one question. Moderate stunting [odds ratio (OR)=1.47, 95% confidence interval (CI) 1.02-2.12) and severe (OR=2.39, 95% CI 1.60-3.57) stunting were independently associated with reported delay in sitting, standing, or walking. Severe stunting was also associated with report of delayed learning compared to other children of similar age (OR=2.01, 95% CI 1.27-3.20). Parental report of disability was quite prevalent in this setting, with over a quarter of the sample screening positive. Chronic malnutrition may be associated with delayed motor and mental development.     

Estimation of the misclassification rate of self-reported visual disability

PURPOSE: To estimate the misclassification rate of self-reported visual disabilities in a hospital-based population with known visual impairment. METHODS: Subjects (N=570) were recruited among patients aged 50 years and more and classified to three categories of visual impairment level. The questionnaire was administered to consenting patients through a telephone interview. Data collected from questionnaires and medical records were compared regarding severity of visual impairment. Sensitivity and specificity were determined for each question. Predictive ability and misclassification rates were computed for various prevalences. RESULTS: Questions related to near and far distance visual acuity with glasses have both a good sensitivity (82.6% and 81.8%) and a good specificity (85.6% and 88.9%) for the presence of severe visual impairment. CONCLUSION: The findings allow the determination of the misclassification rate and predictive ability. This could be useful to estimate the prevalence of visual impairment from health surveys.     

东北某城市小学生家长不良亲职教育方式的调查

目的了解东北某城市小学生家长不良亲职教育方式的现状及其影响因素,为在小学生父母中开展亲职教育提供参考。方法对东北某城市地区1 134名小学生家长进行不记名自填式问卷调查,调查内容包括学生和家长的一般人口学特征、家长不良亲职教育方式、社会支持度、童年期受虐经历等。结果被调查的1 134名小学生家长,不良亲职教育方式过度反应轻、中、重度检出率分别为14.2%、6.3%、1.1%,敌意轻、中、重度检出率分别为6.3%、3.5%、0.9%。多元逐步回归分析结果显示:孩子的学习成绩、家长的社会支持、自评健康状况与过度反应得分和敌意得分均呈负相关。童年期躯体虐待、情感虐待经历与过度反应得分呈正相关。童年期情感虐待经历与敌意得分呈正相关。结论城市小学生家长的不良亲职教育方式问题较严重,需要引起重视。     

Diagnostic Value of Urine Strip Testing for White Blood Cells: an Implication for Screening in Individuals with Spinal Cord Injury

Urinary tract infection (UTI) is an important health problem affecting millions of people each year. A significant high incidence of UTI can be seen in individuals with disabilities, especially those with paralysis due to spinal cord injury. Dip stick screening tests may offer promise as an early warning system of UTI since they are easy to perform and can be self-administered. Here, we report our experience of the diagnostic value of the urine strip test for white blood cell count in medical laboratory practice. The sensitivity of urine strip test was 100%, the specificity 92.2%, the positive predictive value 33.8% and the negative predictive value 100%. False positive was 7.8% and false negative 0%. This can confirm the needs for further examination in cases with positive urine strip screening test. Hence, the usage of urine strip examination as a screening tool for pyuria, an early sign of UTI among people with disabilities is recommended.     

Psychopathology in Young Children With Developmental Disabilities

Children and adults with developmental disorders have significantly higher rates of psychopathology than those without developmental disabilities In this report young children presenting to a developmental assessment center were evaluated for psychopathology High rates of psychiatric disorder were found There was a clustering of the more severe psychiatric conditions of childhood in the more cognitively delayed children Recommendations for mental health intervention were made for 70% of children seen at the center.     

Sleep problems and the need for parental night-time attention in children with physical disabilities

Background The aim of the study was to investigate the frequency and predictors of sleep problems and the need for parental night‐time attention in children with physical disabilities. Methods A questionnaire on sleep problems and need for parental night‐time attention was completed by 505 parents of children with physical disabilities aged 1–16 years (mean 9 years 3 months) with moderate to severe motor disabilities. General characteristics of the children were analysed by frequencies and cross‐tabulations. Logistic regression analysis was used to identify factors associated with sleep problems and the need for parental night‐time attention. Results The results showed a high prevalence of sleep problems, which in general were chronic. Currently 48% of the children had sleep problems, of which 23% estimated the problems to be serious. About one‐third (37%) needed parental night‐time attention every night, and 10% needed help five times or more. No significant differences were found between younger children and school‐aged children regarding sleep problems and the need for parental night‐time attention. Having pain [odds ratio (OR) = 3.4] was associated with sleep problems, as was having problems eating and drinking (OR = 3) and the diagnosis of cerebral palsy (OR = 2.5) (P < 0.05). Children with muscular dystrophy (OR = 68.5), cerebral palsy (OR = 26.7) and ‘other diagnosis’ (OR = 18.5) were more likely to need support at night than were children with spina bifida, P < 0.001. Pain (OR = 7.6) was also associated with need for support at night, P < 0.001. Conclusions The prevalence of sleep problems and need for parental night‐time attention is high among children with physical disabilities. This in turn affects the whole family, and paediatric caregivers must keep this in mind. Besides certain diagnoses, the results suggest that children who have pain should be prioritized.     

A prospective study of response error in food history questionnaires: implications for foodborne outbreak investigation.

To explore the problem of response error in food history data, a prospective study examined the validity of food questionnaire data obtained five days after the study meal. Unobtrusive observation of 64 persons selecting two different foods at a buffet-style luncheon were compared with subsequent histories of food consumption. The predictive value of a positive response was 0.73 for one food and 0.82 for the second food. The response error measures obtained were then applied to data from a published foodborne outbreak to illustrate the impact of predictive value positive and predictive value negative levels on the significance of a food-illness association. Public health workers engaged in food questionnaire administration and analysis must consider response error and should explore methods of reducing this problem through attention to both interviewer-respondent interaction and questionnaire design.     

Validation of a questionnaire for epilepsy diagnosis in primary care services]

OBJECTIVE: To evaluate the usefulness of a questionnaire in primary health care services for establishing the diagnosis of epilepsy in children from 1 to 10 years old and for classifying their epileptic seizures. METHODS: This cross-sectional observational study was conducted in 2004. There were 204 children in the study (102 diagnosed with epilepsy and 102 without epilepsy). The children were randomly selected at the Regional Center of Epilepsies and the Vincent Corral Moscoso Hospital, which are both in the city of Cuenca, Ecuador. For the study, each child with epilepsy was matched with a child without epilepsy, in two age groups: 1 to 5 years old and 6 to 10 years old. Four students who were in their last academic year in the School of Medicine of Cuenca and who did not know the child's diagnosis utilized the questionnaire with a family member or other guardian of the child. The validity, sensitivity, specificity, positive predictive value, and negative predictive value of the questionnaire were calculated, with 95% confidence intervals (95% CIs). The clinical diagnosis carried out by specialists was used as the gold standard. RESULTS: The assessment showed that the questionnaire had good sensitivity (95.10%; 95% CI: 94.58%-95.61%) and good specificity (97.06%; 95% CI: 96.58%-97.59%). Validity was 96.08% (95% CI: 95.84%-96.36%), with a positive predictive value of 97.00% (95% CI: 96.48%-97.52%) and a negative predictive value of 95.19% (95% CI: 94.74%-95.74%). The level of agreement in the classification of the epileptic seizures carried out by the neurologists and by the medical students who used the questionnaire was satisfactory for the generalized seizures (kappa = 0.67). Upon testing for interobserver agreement among the specialists, the kappa value for the diagnoses was 0.80 among the neurologists and 0.89 among the pediatricians. CONCLUSIONS: The diagnostic questionnaire that was assessed has good sensitivity and adequate specificity, and, after brief training, primary health care general practitioners can use it to help them diagnose epileptic seizures.     

Pilot survey of the prevalence of neurologic disorders in the Parsi community of Bombay

There is a paucity of trained neurologists in developing countries. We designed a questionnaire to rapidly screen a community of 851 people (Parsis living in a colony in Bombay, India) for possible neurologic diseases. This questionnaire was pretested and found to have a sensitivity of 100 percent for detecting epilepsy, febrile seizures (only in children), completed stroke, peripheral neuropathy, movement disorders, cerebral palsy, mental retardation, and severe dementia. The screening questionnaire was administered by trained lay health workers. One hundred and sixty-three people were identified by this questionnaire as possibly having neurologic disease. Neurologists later examined these 163 people and found that 80 of them actually suffered from at least one of the neurologic diseases of interest (positive predictive value = 48 percent). The most common neurologic disorders were peripheral neuropathy (32 cases), essential tremor (13 cases), stroke (12 cases), Parkinson's disease (six cases), and epilepsy (four cases).     

成都金牛区幼儿园儿童心理行为预警征筛查现状及相关因素

目的 了解成都市金牛区幼儿园幼儿心理行为发育问题预警征筛查现状并分析可能的影响因素,为制定有效的防治策略提供参考。方法 2021年10—12月,以成都市金牛区幼儿园20 417名儿童为研究对象。采用适应年龄组的儿童心理行为发育问题预警征象(预警征)分别进行发育筛查。采用Logistic回归用于预警征筛查阳性的多因素分析。结果2岁儿童预警征筛查阳性率最高为语言能区(6.12%),2.5,3岁儿童最高为个人社交能区(1.70%,1.76%),4,5岁儿童预警征筛查阳性率最高为精细运动能区(2.04%,1.03%);单因素和多因素分析表明预警征筛查阳性的相关因素有性别、家庭结构、异常出生史、每天电子屏幕暴露时间>2 h、每天夜间睡眠时长、年龄等(P值均<0.05)。结论 在幼儿园定期进行预警征筛查十分必要。应结合儿童各年龄阶段有针对性地对照护人、幼儿园教职人员开展健康教育,帮助其建立正确的育儿观念;同时应重视儿童睡眠健康,减少电子屏幕暴露时间,从而促进儿童身心健康发展。     

The health of caregivers for children with disabilities: caregiver perspectives

BACKGROUND: There are an estimated 5.9 million children with severe disabilities in the USA, and most of them are cared for at home by their parents and families. Indirect evidence suggests that poor caregiver health may contribute to recurrent hospitalizations and out-of-home placements for children with chronic conditions and disabilities. Greater knowledge of caregiver health-related needs would allow for the improvement of existing services and the development of new strategies to sustain caregivers in their vital roles. This study explores caregiver perspectives of the health implications of long-term informal caregiving for children with disabilities. METHODS: Forty parents/caregivers of children with disabilities residing in urban, suburban and rural regions of Utah completed questionnaires and participated in focus groups that explored their feelings regarding their current physical and emotional health and the factors that they viewed as either impairing or promoting their health. The sessions were audiotaped and transcribed. Summary statistics were generated for the questionnaire responses. Focus group content was analysed according to emerging themes and patterns in clusters of information. RESULTS: The caregiving experience was captured by five themes: (i) stress of caregiving; (ii) negative impact on caregiver health; (iii) sharing the burden; (iv) worry about the future; and (v) caregiver coping strategies. Forty-one per cent of the caregivers reported that their health had worsened over the past year, and attributed these changes to a lack of time, a lack of control and decreased psychosocial energy. CONCLUSIONS: Caregivers of children with disabilities describe negative physical, emotional and functional health consequences of long-term, informal caregiving. They have important insights regarding those aspects of caregiving that have positive and negative influences on their health. Interventions that address these issues may have the potential to positively impact caregiver health.     

A pilot study on attitudes toward making reasonable accommodations for occupational therapists with disabilities

The Americans with Disabilities Act (ADA) ensures that persons with disabilities in the United States are entitled to reasonable accommodations in five areas including employment. This pilot study (1) tested the reliability and validity of a questionnaire, which (2) explored how much training American occupational therapists had in the ADA and (3) investigated the attitudes of occupational therapist supervisors toward occupational therapist employees with disabilities. A questionnaire consisting of 20 statements was designed by the researcher. The questionnaire was mailed to 18 occupational therapy administrators. Ten participants who completed the mailed questionnaire were included in the results. Participants with ADA training had a more positive attitude towards making reasonable accommodations than those without training. Only participants working in psychosocial settings claimed to have occupational therapy employees with disabilities. Six of the administrators made reasonable accommodations for employees who had disabilities. Further study of a larger sample of occupational therapy administrators is recommended to determine the attitude towards reasonable accommodations for employees with disabilities. Copyright © 1996 Whurr Publishers Ltd.     

Pure tone audiometry and impedance screening of school entrant children by nurses: evaluation in a practical setting.

BACKGROUND: Screening for hearing loss in English children at entry to school (age 5-6 years) is usually by pure tone audiometry sweep undertaken by school nurses. This study aimed to compare the validity and screening rates of pure tone audiometry with impedance screening in these children. METHODS: Two stage pure tone audiometry and impedance methods of screening were compared in 610 school entry children from 19 infant schools in north east England. Both procedures were completed by school nurses. The results of screening were validated against subsequent clinical assessment, including otological examination and actions taken by an independent assessor. RESULTS: Both methods produced broadly similar validation indices after two stages of screening: sensitivity was 74.4% for both methods; specificity was 92.1% and 90.0%; and predicted values of a positive test 43.2% and 37.6% respectively for pure tone audiometry and impedance methods. Single stage screening in both methods produced higher sensitivity but lower specificity and predictive values of a positive test than two stage screening. Screening rates were appreciably higher with impedance methods than with pure tone audiometry. CONCLUSIONS: In choosing the method to be used, it must be borne in mind that the impedance method is technically more efficient but takes longer than pure tone audiometry screening. However, the latter method allows opportunity for other health inquiries in these children.     

Prevention of childhood disability in the People's Republic of China

Summary With a dramatic decrease in infant mortality, an emerging challenge facing modern medicine in China is chronic disabling conditions in infants and young children. According to the results of a national sampling survey in 1987, it is estimated that there are over 51 million people of all ages with disabilities, which accounts for 4·9% of the total population. One out every five families in China has a member who is disabled. For children under 14 years of age, the overall prevalence rate of disability is 2·66%. The prevalence rate of mental retardation is 1·8% which accounts for 66% of all disabled children. Mental retardation is the most frequent childhood disability. Research on factors contributing to disability indicates the complexity of the problem. The etiology of 47% of cases is unknown, 21% of cases result from damage prenatally, 3% are due to perinatal factors, 29% are acquired during infancy and early childhood. Efforts to prevent developmental disabilities among children can be classified in terms of primary, secondary and tertiary activities. The most important primary prevention activities consist of genetic counselling, immunization programmes, improved prenatal, perinatal and postnatal health care, and legislation. On the secondary preventive level, focus is primarily on prenatal diagnosis and newborn screening. Tertiary preventive efforts include special education and comprehensive rehabilitation services. While these prevention efforts have been established, they are insufficient to meet the the needs of disabled children and their families. In the context of the one child per family policy in China, much more is needed, much more can be done to reduce childhood disability. In addition to strengthening prevention efforts at all 3 levels, special emphasis should be placed on (a) intervention programmes remains an essential issue for the future’ (Guralnick & Bennett 1987). At one level, the need for professionals having the clinical skills of their own discipline and the specialist knowledge of children with disabilities, continues to increase with the growing number of disabled children and diversity of service programmes. At another level, training teachers in early childhood and special education is particularly pressing and there is a need to establish the credentials and training programmes for professions in this field. Health professions at all levels should be trained to identify developmental disabilities in individual children. Early diagnosis and management of disabilities is crucial to maximize the full growth potential of disabled children. The basic techniques of developmental surveillance and screening should be incorporated into the training curriculum of health workers. Courses for early intervention at the college level or graduate level should be developed. An underlying consideration in regard to training, however, is to balance the need for speciality preparation with the need for widely available services. This is a concern for any country but which may vary in its expression depending upon whether it is a western country such as Germany (Schindele 1985) or an eastern country such as China.     

Early detection of developmental dysplasia of the hip in The Netherlands: the validity of a standardized assessment protocol in infants.

OBJECTIVES: This study evaluated the validity of the traditionally recommended screening protocol for developmental dysplasia of the hip in infants. METHODS: Study children (n = 1968) underwent a standardized screening examination. RESULTS: The incidence of developmental dysplasia of the hip was 3.7%. The sensitivity of the test protocol was 86%, the specificity was 82%, and the predictive values of positive and negative tests were 16% and 99%, respectively. CONCLUSIONS: The validity of the screening protocol for developmental dysplasia of the hip is disappointingly low. The yield of adding an ultrasonographic examination to current screening activities needs further study.     

Screening Children's Entry Characteristics in Kindergarten

Screening children's entry characteristics in kindergarten may help parents and teachers to support the development of every child. To concretize this potential assistance, a pilot screening questionnaire was developed for parents as well as kindergarten teachers. To evaluate the reliability and predictive validity of this questionnaire for four-year-old children, longitudinal research was carried out. For the pilot instrument as well as for criterion instruments and biographical variables, data on 778 children in 63 classes of 24 Dutch kindergartens were collected. Factor analysis, alpha scale analysis, and multilevel analysis were used to reveal psychometric qualities. Reliability and predictive validity of the screening questionnaire turn out to be acceptable. While checking on co-variables at pupil level and non-specified variance at class level, parents can accurately screen at entry the language proficiency level, the pre-arithmetic level, and the degree of extraversion of their child. Also, teachers are able, at the end of the first month in kindergarten, to predict a child's level of language proficiency, degree of extraversion, and work attitude. Early screening can therefore contribute to the child-oriented cooperation between parents and teachers from a child's entry in kindergarten onwards.     

婴幼儿孤独症筛查问卷的初步编制和信效度分析

目的 编制适合中国文化背景的婴幼儿孤独症筛查问卷,并检验其信效度.方法 借鉴国内外相关研究成果和参考DSM-5孤独症谱系障碍(ASD)症状标准,编制婴幼儿孤独症筛查问卷(SQAT),选取门诊或体检儿童238名和康复训练机构患儿392名进行初测,2～4周后对其中28名被试进行重测,部分儿童接受校标检测.通过专家评价、条目...     

Early childhood caries: the influence of socio-behavioral variables and health locus of control in a group of children from Araraquara, São Paulo, Brazil

The aim of this study was to evaluate the relationship between early childhood caries and socio-behavioral variables and the health locus of control in a group of children 24 to 35 months of age in Araraquara, S?o Paulo, Brazil. All children of both sexes enrolled in 7 municipal daycare centers were evaluated (n = 110). Exams were performed by an examiner previously trained to apply WHO criteria for determination of dental status. A questionnaire was completed by the mothers, with information on socioeconomic background, behaviors, and attitudes related to the child's oral health and the multidimensional health locus of control. Prevalence of early childhood caries (cavitated or non-cavitated lesions) was 28.2%; there was a significant association between paternal educational level and severe early childhood dental caries (p = 0.01); there were no statistically significant differences between the means for each health locus of control sub-scale and early childhood caries. The results suggest that fathers should be viewed not merely as providers but as an important influence on the child's development as a whole.