The effect of seated positioning quality on typical 6- and 7-year-old children's object manipulation skills.

OBJECTIVE: The purpose of this study was to examine the effect of optimal seated positioning in individually fitted furniture versus suboptimal seated positioning in standard classroom furniture on typical 6- and 7-year-old children's object manipulation skills as measured by the In-hand Manipulation Test (IMT). METHOD: An experimental research design was used to compare IMT performance of two groups of 20 children. One group was positioned in standard, too-large classroom furniture that did not support an optimal seated position, and one group was positioned optimally in furniture fitted to each child for tabletop activities, which allowed for hip flexion to 90 degrees, and foot placement on the floor, and the table to be at flexed elbow height. RESULTS: Independent groups' t tests indicated that children who were optimally positioned performed significantly better (t = -2.77, df = 38, p < .01) than children who were tested in the too-large standard classroom furniture. The difference between groups was greater on the more difficult object manipulation items (t = -3.29, df = 38, p = .001) than on the easier items (t = -1.38, df = 38, p = .08). Age and gender may have differentially affected the results. CONCLUSION: The study's results suggest that the fit of furniture relative to the child's size may have a significant impact on a young, typical child's object manipulation skills. Complex hand skills, such as those involving in-hand manipulation with stabilization, appear to be more affected by the quality of the child's seated position than are simpler, more well-established skills. Findings suggest that test administrators should strive to test young children in the most optimal seated position possible, particularly when the test involves complex hand skills. Further study is needed to assess the impact of the fit of furniture on hand skills in children with disabilities and on children's performance of other tasks.     

Assessment of quality of life in children with peanut allergy

Children with a peanut allergy (PA) are faced with food and social restrictions due to the potentially life-threatening nature of their disease, for which there is no cure or treatment. This inevitably impacts upon their quality of life (QoL). QoL of 20 children with PA and 20 children with insulin-dependent diabetes mellitus (IDDM) was measured using two disease-specific QoL questionnaires (higher scores correspond to a poorer QoL). One questionnaire was designed by us and the other was adapted from the Vespid Allergy QoL questionnaire. We gave subjects cameras to record how their QoL is affected over a 24-h period. Response rates for both questionnaires were 100%. Mean ages were 9.0 and 10.4 years for PA and IDDM subjects, respectively. Children with a PA reported a poorer quality of life than children with IDDM: mean scores were 54.85 for PA subjects and 46.40 for diabetics (p = 0.004) in questionnaire 1 and 54.30 and 34.50 (p≤0.001) in questionnaire 2. PA children reported more fear of an adverse event and more anxiety about eating, especially when eating away from home. Photographs fell into seven common categories: food, management, environment, away from home, physical activities, restaurant and people. Most photographs related to food and management issues and revealed difficulties for both groups regarding food restrictions. PA subjects felt more threatened by potential hazards within their environment, felt more restricted by their PA regarding physical activities, and worried more about being away from home. However, they felt safe when carrying epinephrine kits and were positive about eating at familiar restaurants. The QoL in children with PA is more impaired than in children with IDDM. Their anxiety may be considered useful in some situations, promoting better adherence to allergen avoidance advice and rescue plans.     

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Detailed clinical assessment of neurological function in symptomatic shipyard workers

Forty eight patients with extensive occupational exposure to pneumatic grinding tools were evaluated at a university sponsored occupational health clinic. All patients were interviewed and examined by a physician and assessed neurologically with standard clinical, functional motor, quantitative vibrotactile, and electrodiagnostic tests. Sensorineural symptoms were nearly universal; 47 patients (98%) reported numbness and tingling of the hands and fingers. Among clinical tests, two point discrimination and 30 Hz vibration perception were most frequently abnormal. In order to evaluate associations between quantitative test results and sensorineural symptoms, patients were stratified into two groups of symptom severity according to a consensus sensorineural staging system. The tests that discriminated best between the groups of more and less symptomatic patients were hand strength dynamometry, and vibrotactile thresholds. Age standardised 120 Hz vibrotactile thresholds were significantly raised in digit II in 41% of hand measurements. Nerve conduction studies were neither significantly different between more and less symptomatic groups nor correlated with clinical and quantitative sensory tests. Twenty five per cent of the patients had slowing of sensory conduction velocities in the median nerve at the wrist (less than 48 m/s). Of this subset of patients only two showed abnormal slowing of the median nerve distal to the wrist, but half also showed ulnar nerve slowing (less than 47 m/s).This observation highlights the difficulty of differentiating median nerve entrapment from diffuse distal neuropathy in workers exposed to vibration and points to the need for concomitant quantitative sensory and functional motor assessment.     

Intraoperative cholangiography revisited.

The charts of 1351 patients undergoing cholecystectomy at our institutions from 1985 through 1989 were reviewed retrospectively to evaluate the indications for and the success of intraoperative cholangiography. A total of 800 patients underwent intraoperative cholangiography. They were divided into two groups based on the absence (CR-) or presence (CR+) of clinical and/or operative criteria suggestive of the existence of common bile duct stones. Intraoperative cholangiography in CR- patients was of limited benefit, being negative (normal) in 95.7%, true-positive (abnormal) in 3.3%, and false-positive in 1%. False-positive intraoperative cholangiography resulted in unnecessary common bile duct explorations. Intraoperative cholangiography in CR+ patients proved useful, avoiding unnecessary common bile duct exploration in 55%. In those select CR+ patients with palpable common bile duct stones or cholangitis, little additional information was gained by the intraoperative cholangiography. We conclude that routine screening intraoperative cholangiography in CR- patients be reconsidered, as should the use of intraoperative cholangiography in CR+ patients with a palpable common bile duct stone or cholangitis. Intraoperative cholangiography in the remainder of CR+ patients proved beneficial and should be continued.