Fear of hypoglycemia in children and adolescents with diabetes

Extended a study of diabetic adults which showed that fear of hypoglycemia is common and may affect diabetic control. That study evaluated the psychometric properties of the Hypoglycemic Fear Survey (HFS), an instrument designed to measure fear of hypoglycemia. The present study evaluated the psychometric properties of the HFS with diabetic youth. The HFS was completed by 128 Ss on arrival at a diabetes summer camp, by 127 Ss at the end of the 7-day camp, and by 74 Ss 12 weeks after camp. The results support the internal consistency and test-retest reliability of the HFS with this age group. Factor analytic and multiple regression techniques support the construct validity of the scale. HFS scores enhanced prediction of diabetic control. The HFS appears to be useful as a research tool with children and adolescents, although cross-validation is needed before clinical use can be justified.     

Brief report: effect of intravenous methotrexate dose and infusion rate on neuropsychological function one year after diagnosis of acute lymphoblastic leukemia

OBJECTIVE: To compare the effects of two intravenous (IV) methotrexate (MTX) infusion protocols on cognitive function in children newly diagnosed with acute lymphoblastic leukemia (ALL). METHODS: We compared 19 children treated with 1 g/m(2) of IV MTX over 24 hr (Group 1) to 13 children treated with 2 g/m(2) of IV MTX over 4 hr (Group 2) on measures of working memory, nonverbal, and verbal skills shortly after diagnosis (Time 1) and 1 year later (Time 2). RESULTS: A significant GroupxTime interaction was found for a composite measure of working memory with Group 2 declining from Time 1 to Time 2. Group 2 performed significantly worse than Group 1 on a composite measure of nonverbal skills at both time points. CONCLUSIONS: Findings suggest that difficulties in working memory and nonverbal skills may be evident during the first year of treatment for ALL and that severity may be dependent on IV MTX dose and/or infusion rate.     

Intellectual, Motor, and Language Sequelae Following Closed Head Injury in Infants and Preschoolers

Examined cognitive and motor performance during the subacutestage of recovery and 8 months postinjury in 21 infants andpreschoolers who sustained a closed head injury (CHI). Childrensustaining severe CHI, who exhibited impaired consciousnessfor at least 1 day, were impaired on measures of intelligence,motor, expressive language, and receptive language functionson the baseline and follow-up evaluations relative to childrenwith mild-moderate injuries. Irrespective of injury severity,motor and expressive language functions were the most vulnerableto the effects of CHI. Results are discussed in terms of therate of development of cognitive functions.     

Neuropsychological Test Performance of Pediatric Cancer Patients at Diagnosis and One Year Later

More children with cancer are surviving, and the effects ofmedical treatments are of interest to patients, parents, educators,and the treatment team, since results may influence furthertreatment planning and delivery of educational services. Longitudinalinvestigations employing baseline measures are essential todistinguish preexisting learning problems from treatment effectsand transient effects from long-term sequelae. In this report,neuropsychological test performance is compared at baselineand 1 year postdiagnosis between 19 leukemia patients who receivedcentral nervous system and systemic chemotherapy and 19 patientswho received only systemic chemotherapy. Patients were evaluatedwith a comprehensive test battery developed for children toassess general intelligence, memory, language, academic achievement,and visual-spatial and constructional, tactile-perceptual, andfine-motor skills. No significant treatment group, time, orinteraction effects were obtained for higher order cognitiveabilities (intelligence, memory, language, academic achievement).Mean scores for both groups on these measures were within thenormal range. Significant treatment group effects were obtainedon tasks requiring fine-motor and tactile-perceptual skills.An interaction effect was noted on the tactile-perceptual test,in which the performace of one group improved, while that ofthe other group declined. Results are discussed in relationto the preservation of higher order cofnitive abilities andthe peripheral effects of systemically administered chemotherapies.     

Declining immune function in children and adolescents with hemophilia and HIV infection: effects on neuropsychological performance. Hemophilia Growth and Development Study

OBJECTIVE: To determine whether declines in immune functioning are associated with changes in neuropsychological performance in children and adolescents with hemophilia who are infected with the human immunodeficiency virus (HIV). METHODS: Participants were 333 males with hemophilia, ages 6-19 years at entry. A baseline and four annual neuropsychological evaluations were given. A longitudinal growth curves analysis of data was performed to detect changes associated with declining immune function. The cohort was stratified into four groups: (1) HIV- (n = 126); (2) HIV+, average of first two and last two CD4 counts > or = 200, (n = 106; High CD4 group); (3) HIV+, average first two counts > or = 200, average last two counts < 200 (n = 41; CD4 Drop group); and (4) HIV+, average first two and last two counts < 200 (n = 60; Low CD4 group). RESULTS: There were significant differences among the four groups over time in nonverbal intelligence, perceptual/performance skills, nonverbal memory, academic achievement, and language. The Low CD4 group consistently showed the greatest decrement in performance. On measures showing a practice effect for repeated measurements, the Low CD4 group participants' scores remained stable over time, suggesting opposing effects of practice and HIV-related declines. Lowered academic performance relative to IQ was found in all groups. CONCLUSIONS: Declines in neuropsychological functioning are directly related to declines in immune functioning in HIV+ children, adolescents, and young adults with hemophilia. Hemophilia itself may be a risk factor for academic underachievement.     

Effects of one year of near-normoglycemia on peripheral nerve function in type 1 (insulin-dependent) diabetic patients

Summary Ninety poorly controlled C-peptide negative type 1 (insulin-dependent) diabetic patients with chronic complications were allocated to intensified insulin treatment with either continuous subcutaneous insulin infusion or multiple insulin injections; 83 were studied over 1 year (seven patients dropped out of the study). Peripheral nerve function was assessed by clinical examination, malleolar vibration perception threshold, and motor and sensory nerve conduction velocities (MNCV; SNCV) in the median, ulnar, peroneal, and sural nerves. In order to assess the effect of metabolic control on peripheral nerve function, the results in patients with normal mean HbA₁ levels during months 3–12 of the study <8.6% (tight control (tc);n=50) were compared with those with abnormal mean HbA₁ 8.6% (poor control (pc);n=33). Mean blood glucose was significantly higher in pc than in tc at months 2–9 and 11 (P<0.05). In pc median and ulnar SNCV were significantly lower at 6 and 12 months, and ulnar and peroneal MNCV at 12 months than in tc (P<0.05). No significant differences between the groups were observed for median MNCV, sural SNCV, and vibration sensation. Further analysis revealed that in well-controlled patients who showed abnormal peripheral nerve tests at baseline, median, and ulnar MNCV and SNCV but not peroneal MNCV, sura SNCV, and vibration sensation were significantly improved after 12 months as compared with poorly controlled patients with initially abnormal tests (P<0.05). There were no differences in nerve function between well- and poorly-controlled patients who had normal nerve tests at baseline. These results provide evidence that near-normoglycemia over 1 year does not have uniform effects on peripheral nerve function in type 1 diabetic patients. Impaired motor and sensory nerve conduction seems to be more susceptible to improvement under strict glycemic control in the upper than in the lower extremities.Abbreviations at Abnormal tests - CSII Continuous subcutaneous insulin infusion - GM Geometrical mean - ICT Intensified conventional therapy - MNCV Motor nerve conduction velocity - pc Poor control - SEF Standard error factor - SNCV Sensory nerve conduction velocity - tc Tight control - VPT Vibration perception threshold Members of the Study Group: H. Berger, I. Cicmir, K. Dannehl, K. Dopstadt, F.A. Gries (coordinator), A. Hübinger, Th. Koschinsky, P. Mayer, W. Schäfer, B. Schleppinghoff, M. Toeller, D. Tschöpe, K. Wiefels, and D. Ziegler     

Cognitive effects of childhood leukemia therapy: a case for four specific deficits

Prophylactic treatment of the central nervous system (CNS) with cranial irradiation and antineoplastic drugs has made childhood acute lymphoblastic leukemia (ALL) a survivable disease, but at the same time there have been many reports of iatrogenic effects, including deficits in cognitive functioning. Previous research suggests a particular effect on the Freedom from Distractibility factor of the WISC-R, memory, and attention. These particular abilities are tested in a group of 43 ALL survivors, with comparisons against solid tumor as well as sibling controls. The results indicate that four cognitive processes are affected by CNS prophylaxis for ALL: short-term memory, speed of processing, visuomotor coordination, and sequencing ability. Younger children have a more severe speed of processing deficit and children treated with a less rigorous protocol appear to be slightly less affected generally. The specific cognitive deficits found are related to neurological evidence on both theoretical and empirical grounds. Results suggest that children who have received CNS prophylaxis are able to learn, but may be slower to acquire new material and may benefit from bimodal presentation.     

Preliminary investigation of the direct and moderating effects of family and individual variables on the adjustment of children and adolescents with diabetes.

Investigated the direct and stress-moderating effects of mother and child coping skills, child Type A behavior, and mother's report of disease-related family interruption on both psychological and physiological adjustment in 64 children with insulin-dependent diabetes. Using hierarchical multiple regression analyses, relevant demographic variables (age, gender, disease duration) were first evaluated for effects on the outcome measures, followed by the stress variable, the individual difference and family factors, and the interaction term. Several direct relationships between demographic, individual and family factors, and outcome were identified, as well as one moderating relationship. Implications for research design and future study of children and adolescents with diabetes are discussed.     

Some recruitment aspects of population photoscreening of amblyogenic factors at children younger one year

The aim of the study was to evaluate the keystone role of paediatric general practitioners (PGPs) in our system of photoscreening of amblyogenic factors at children younger one year. The parental involvement on the participation of their children at photoscreening was also analysed. From June 2000 to February 2001 we have performed 780 photoscreening tests of children aged from 3 months to 31 months (mean age 9.7 months). The photoscreening test was voluntary. Parents was invited to visit screening center by PGP's recommendation and by offering the Invitation/information brochure. The brochure was distributed by 56 paediatric general practitioners during obligatory examinations at 5., 8. resp. 12. month of age from June to November 2000. Based on the questionnaire (return rate 89%) we documented following data: the number of children of particular age in the care of PGPs was 2060, 1458 Invitation/information brochures was distributed by PGPs. PGPs attended for more children at particular age distributed relatively less number of brochures if compared to PGPs with lower number of relative children. The willingness to the photoscreening programe participance of parents of children belonging to PGPs attended our educational seminary exhibited independence on distance between PGP office and our department in the strong contrast to families belonging with PGPs not participating on educational programme. Our further effort on elevating the percentage of children population participation on screening must be focused on education of PGP with large number of children at particular age and on ensuring the issuing of brochures or other forms of invitation at PGPs' offices.     

A preliminary examination of the construct validity of the KABC-II in Ugandan children with a history of cerebral malaria

Background

Several diseases and adverse conditions affect the cognitive development of children in Sub-Saharan African. There is need to assess these children to determine which abilities are affected and the severity of the damage so as to plan interventions accordingly. However most psychological tests developed in the West have not been validated in this region making it impossible to know whether they measure what they were intended to in African children.

Objective

To examine the construct validity of the Kaufman Assessment Battery for Children, Second Edition (KABC-II) in Ugandan children.

Methods

Sixty five Ugandan children aged 7 to 16 years (Mean=9.90, SD=2.46) were tested using the KABC-II 44.59 months (SD=2.82) after an episode of cerebral malaria. The KABC-II scales of Sequential Processing, Simultaneous Processing, Planning and Learning were administered. In order to identify which factors result from administering the KABC-II in these children, factor analysis using principal component analysis with Varimax rotation was applied to the subtests making up the above scales.

Results

Five factors emerged after factor analysis comprising of subtests measuring Sequential Processing, Simultaneous Processing, Planning and Learning. The fifth scale comprised of subtests measuring immediate and delayed recall.

Conclusion

This preliminary study in Ugandan children shows the KABC-II to have good construct validity with subtests measuring similar abilities loading on the same factor. The KABC-II can be used in assessing Ugandan children after a few modifications. Further analysis of its psychometric properties in Ugandan children is required.     

Understanding of hypo- and hyperglycemia by youngsters with diabetes and their parents

Fifty-nine patients with insulin-dependent diabetes and 50 oftheir parents were asked whether or not they could detect hyperglycemiaand hypoglycemia. They then identified from a mixed symptomchecklist those symptoms that they used to recognize each state.Patients and parents also rated their subjective judgment ofthe youngster's current blood glucose level and reported currentsymptoms. There was a marked discrepancy between the proportionof patients and parents who believed that they could recognizehyperglycemia and hypoglycemia and the proportion who chosephysician-selected symptoms as the basis for their judgment.Patients' and parents1 subjective ratings of current blood glucoselevels showed no relationship to patients' actual blood glucoselevels nor was there a relationship between blood glucose levelsand current symptoms reported. On the basis of these findings,several clinical/educational/research interventions are proposed.These include a paradigm for evaluating individual variationin symptomatology and for teaching patients the major symptomsof glycemic states in the context of behavioral patterns anddaily life events.     

Cytokines in sera from insulin-dependent diabetic patients at diagnosis.

Cytokines are known to play an important role in autoimmunity and have been suggested to be involved in the pathogenesis of insulin-dependent diabetes (IDDM). In the present study we have measured IL-1, IL-2, IL-4, IL-6, interferon-gamma (IFN-gamma) and tumour necrosis factor (TNF) (using both immunoassays and bioassays) in sera from 50 patients affected by IDDM at the time of clinical diagnosis and 51 age and sex matched controls. Detectable levels of IL-1, IL-2, IL-6 and IFN-gamma were found in the serum of a small percentage of subjects and were not significantly different between patients and controls. IL-4 was detectable in a higher number of both patients and controls and circulating TNF-alpha (greater than 1 U/ml) was found in a percentage of patients (24%) significantly higher than controls (P less than 0.01). Raised levels of TNF-alpha were detectable using an immunoenzymatic assay whereas TNF bioactivity in these samples was negligible. We conclude that the presence of immunoreactive TNF-alpha in the patient's sera may reflect an increased localized production of this cytokine at pancreatic level. However, the measurement in serum of other cytokines does not add information on the role that they may play in the pathogenesis of IDDM.     

Understanding unintentional injury-risk in young children I. The nature and scope of caregiver supervision of children at home

Objective To examine the supervision that young children routinelyreceive when awake and at home with a parent. Methods Motherswere trained to complete continuous recordings about supervisionof their young child (2–5 years) when at home on eachof 10 randomly selected days within a 3-week period. ResultsChildren were supervised more often than unsupervised but werecompletely out of view of supervisors about 20% of their awaketime, and supervision was poorer when out of view of supervisors.Older children (4–5 years) were unsupervised (8% of awaketime) more often than younger children (2–3 years; 1%),were more often out of view of supervisors than younger children,and received poorer supervision than younger children when outof view of supervisors. Few sex differences were found. ConclusionsThese data provide insights into the nature and scope of supervisionthat young children routinely experience when at home. Implicationsof these findings for identifying patterns of supervision thatelevate children’s risk of injury are discussed.     

Development of a new fear of hypoglycemia scale: preliminary results

OBJECTIVE: To provide preliminary psychometric data on the Children's Hypoglycemia Index (CHI), a new scale was designed to measure fear of hypoglycemia (FH) in children. METHODS: One hundred and nine children with type 1 diabetes attending a diabetes summer camp completed the CHI, and 57 of these children completed the CHI 2 weeks later. All participants also completed the Children's Hypoglycemia Fear Survey (CHFS), the Revised Children's Manifest Anxiety Scale (RCMAS), and a Hypoglycemia History Form. Parents of the children also completed a Hypoglycemia History Form. RESULTS: The CHI demonstrated good factor structure, internal consistency, test-retest reliability, and criterion-related validity with established measures. Frequency of severe hypoglycemic episodes since diabetes diagnosis also predicted scores on the Situation- and General-Fear subscales of the CHI. CONCLUSIONS: The CHI demonstrated reliability and validity as a measurement of children's FH. The use of this measure offers important clinical and research implications.     

Brief report: parent perceptions of hypoglycemic symptoms of youth with diabetes; disease disclosure minimizes risk of negative evaluations

OBJECTIVE: Based on a theoretical model, this study explored the effects that the disclosure of diabetes has on parental perceptions of a hypothetical child experiencing hypoglycemia. METHODS: Parents (N = 610) first read vignettes that varied in a 2 x 2 design (Male vs. Female Character x Preventative Disclosure of Illness vs. Nondisclosure) and then answered several questions regarding the hypothetical child, resulting in four subscales that were validated using confirmatory factor analysis. RESULTS: Disclosure of diabetes significantly increased perceptions of a medical problem, decreased suspicions of drug use, and presented a lower risk of parental restrictions on future contact with their child. CONCLUSIONS: Individuals who disclose their diabetes may prevent negative social consequences and restrictions on social contact. Those who choose not to disclose may risk having a hypoglycemic event perceived as a drug or alcohol problem, which may ultimately interfere with appropriate medical intervention in a hypoglycemic event.     

Learning and behavioral--emotional problems of children born preterm at second grade.

A longitudinal prospective study examined the question, "which child and family factors discriminate between children born preterm who are characterized by the presence or absence of learning or behavioral-emotional problems at second grade?" Assessments were completed during the child's hospital stay at birth, at 4, 8, and 24 months, and 8 years of age for 68 children born preterm and their mothers. Discriminant analyses identified the variables that statistically maximized the differentiation between two groups of children defined to exhibit or not exhibit school age problems. Three categories of discriminators were used in the analyses: infant status, family interactive quality, and family context. The three significant discriminators were variables from the family categories. The results of this study highlight the importance of understanding the presence or absence of school age problems from a multivariate model of development that takes into account the quality of the child's interactions within the family during early childhood and school age and the current stress levels in the family context.     

Innervation of the humerus metaepiphysis in newborn and one year old children

Analysis of home and foreign literature on metaepiphyseal cartilage innervation and blood supply was presented, data on these organ diseases substantiate theoretical and clinical significance of the study was performed. Using macro-microscopic preparation, histological study, automatic image analyzer branches of humerus proximal metaepiphysis were shown to originate from axillary and subscapulary nerves. Nerves and vessels penetrating in the cartilaginous canals form neurovascular complexes. Cartilaginous canals are located unevenly. Nervous structures were found in the canals and their characteristics was given.     

精神分裂症子女个性行为特征的对照研究

目的 探索材神分裂症子女的个性和行为特征。方法 分别用艾森克个性问卷(EPQ)和Achenbach儿童行为量表(CBCL)，对研究组53例精神分裂症子女，对照组50例正常儿童评定。结果 两组儿童EPQ各项因子分无显著差异，在CBCL分析中，研究组退缩、社交问题和内向因子分显著高于对照组。研究组男童焦虑抑郁，女童躯体主诉分值也显著高于对照组。结论 精神分裂症子女个性无异常。存在有内向，退缩．社交困难等行为问题．应对其早期干预。     

Dental and skeletal maturity in adoptive children: assessments at arrival and after one year in the admitting country

Seventy-one adoptive children from Asian countries, mainly Korea, were adopted by Danish parents. Height and weight were measured and dental and skeletal maturity assessed immediately after arrival and one year later. Increase in dental age was in complete concordance with the time interval between the two examinations. With regard to skeletal age, the majority of children showed an increased maturation rate although some of the youngest children seemed to be further retarded in maturation rate during their first year in Denmark. Comparison between two methods for assessing skeletal maturity revealed that the 'catch up' observed for children above one year of age was significantly more pronounced when assessed by the TW-2 method than when applying the G-P method. For the Korean children height and weight measurements increased more than the average values for the Danish population.     

Observation of family functioning at mealtime: a comparison between families of children with and without overweight

OBJECTIVE: To examine differences between families of children with and without overweight on parental control and support. METHODS: Twenty-eight families with an overweight child and a control group of 28 families with a normal weight child (age range 7-13 years) participated in the study. Observations and self-reports of mealtime family functioning were administered and analyzed. RESULTS: Parents of children with overweight reported to exert more control on their children's feeding behavior and an equal amount of parental support in comparison with parents of children without overweight. However, observations at mealtime indicated that in families with an overweight child, maladaptive control strategies were twice as prevalent, and less parental support was displayed. CONCLUSIONS: Self-reports and observations provide complementary information on how parents interact with their overweight children. Family-based treatment programs should include discussions on the adequate amount of parental control and support.