Challenging behaviour and its risk factors in children and young people in a special school setting: A four wave longitudinal study

Background

Longitudinal research is needed to strengthen evidence for risk factors for challenging behaviour in children with intellectual disabilities and to understand patterns of change over time.

Methods

Data on challenging behaviour were collected for 225 students in one school over four annual time points and a range of potential risk correlates. Data were analysed using Generalised Estimating Equations.

Results

Prevalence of challenging behaviour, aggression and self-injury did not vary significantly over time. Stereotyped behaviours increased over the 4-year period. Challenging behaviour was associated with lower levels of adaptive skills and autism. Stereotyped behaviour increased with age. Self-injurious behaviour was less likely to be shown in children with profound intellectual disabilities over time.

Conclusions

These findings are consistent with previous research in terms of potential risk factors identified. Implications for schools include proactive interventions for children with intellectual disabilities at high risk; especially those with autism and poorer adaptive skills.     

Prediction of hospital mortality from admission laboratory data and patient age: A simple model

Objective: To devise a simple clinical scoring system, using age of patients and laboratory data available on admission, to predict in‐hospital mortality of unselected medical and surgical patients. Methods: All patients admitted as emergencies to a large teaching hospital in Liverpool in the 5 months July–November 2004 were reviewed retrospectively, identifying all who died in hospital and controls who survived. Laboratory data available on admission were extracted to form a derivation dataset. Factors that predicted mortality were determined using logistic regression analysis and then used to construct models tested using receiver operating characteristic curves. Models were simplified to include only seven data items, with minimal loss of predictive efficiency. The simplified model was tested in a second validation dataset of all patients admitted to the same hospital in October and November 2004. Results: The derivation dataset included 550 patients who died and 1100 controls. After logistic regression comparisons, 22 dummy variables were given weightings in discriminant analysis and used to create a receiver operating characteristic curve with area under the curve (AUC) of 0.884. The model was simplified to include the seven most discriminant variables, which can each be assigned scores of 2, 3 or 4 to form an index predicting outcome; a validation dataset contained 4828 patients (overall mortality 4.7%), showed this simplified scoring system accurately predicted mortality with AUC 0.848, compared with an AUC of 0.861 in a model containing all 23 original variables. Conclusion: A simple scoring system accurately predicts in‐hospital mortality of unselected hospital patients, using age of patient and a small number of laboratory parameters available very soon after admission.     

Making the Pack the Hero, Tobacco Industry Response to Marketing Restrictions in the UK: Findings from a Long-Term Audit

The Tobacco Advertising and Promotion Act (TAPA), introduced between 2003 and 2005 in the UK, prohibits all tobacco advertising, promotion and sponsorship. Packaging, however, is not covered in the Act. Two strands of a long-term audit (trade press review and panel of smokers) are examined to monitor change in tobacco packaging from January 2002 to January 2009. The trade press provides numerous examples of value based (altered pack size or price marked packaging), image based (altered pack design) and innovation based (pack additions or modifications) packaging. Some examples of value, image and innovation based packaging are reported in the trade press from 2002 to 2004, but mention of all three forms of packaging increases markedly from 2005 onwards, as other forms of marketing were restricted. These developments have been observed by a panel of smokers, from across the UK, who have been particularly attentive to, and aware of, value based packaging. Packaging has become an increasingly important promotional tool for the tobacco industry as other channels have been shut off. It is clear therefore that any comprehensive and consistent tobacco strategy should include a mandatory move to generic packaging.     

Total cavopulmonary anastomosis using atrial septal flap: technique and early results

Introduction The Fontan procedure has undergone many modifications to avoid atrial arrhythmias and thrombus formation. We used patient’s interatrial septum as a flap to direct the inferior venacaval blood to the superior venacava. Methods Seventeen patients, aged 1 to 17 years, underwent modified total cavopulmonary anastomosis. Interatrial septum was used to create the inner half of the atrial tunnel, outer half being formed by right atrial free wall. Post-operatively, all patients underwent echocardiography. Seven patients underwent 24 hour ambulatory Holter monitoring and 6 patients underwent cardiac catheterization and cineangiography. Results There was one early death due to low cardiac output. One patient had transient supraventricular arrhythmia. Two patients had singnificant pleural effusion. Holter Monitoring reveled sinus rhythm in all 7 patients studied. Follow up ranged from 18 to 60 months and patients were evaluated as they came for follow up. Long term follow up is currently being compiled. There was one late death from a non-cardiac cause. The remaining patients were in New York Heart Association (NYHA) Class I or II. All patients were in sinus rhythm. Echocardiography and cineangiography revealed absence of obstruction or leak. Conclusions Total cavopulmonary anastomosis using autogenous atrial septum is a useful modification for classical cavopulmonary anastomosis and provides good early results.