Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study.

BACKGROUND: Early life exposures can have an impact on a child's developmental trajectory and children born late preterm (34-36 weeks gestational age) are increasingly recognized to have health and developmental setbacks that extend into childhood. OBJECTIVES: The purpose of this study was to assess whether late preterm birth was associated with poorer developmental and educational outcomes in the early childhood period, after controlling for health and social factors. METHODS: We conducted a retrospective cohort study using administrative databases housed at the Manitoba Centre for Health Policy, including all children born late preterm (34-36 weeks gestational age (GA)) and at full-term (39-41 weeks GA) between 2000 and 2005 in urban Manitoba (N = 28,100). Logistic regression was used to examine the association between gestational age (GA) and outcomes, after adjusting for covariates. RESULTS: Adjusted analyses demonstrated that children born late preterm had a higher prevalence of attention deficit hyperactivity disorder (ADHD) (aOR = 1.25, 95% CI [1.03, 1.51]), were more likely to be vulnerable in the language and cognitive (aOR = 1.29, 95% CI [1.06, 1.57]), communication and general knowledge (aOR = 1.24, 95% CI [1.01, 1.53]), and physical health and well-being (aOR = 1.27, 95% CI [1.04, 1.53]) domains of development at kindergarten, and were more likely to repeat kindergarten or grade 1 (aOR = 1.52, 95% CI [1.03, 2.25]) compared to children born at term. They did not differ in receipt of special education funding, in social maturity or emotional development at kindergarten, and in reading and numeracy assessments in the third grade. CONCLUSIONS: Given that the late preterm population makes up 75% of the preterm population, their poorer outcomes have implications at the population level. This study underscores the importance of recognizing the developmental vulnerability of this population and adequately accounting for the social differences between children born late preterm and at term.

Long-term benefits of full-day kindergarten: a longitudinal population-based study.

In the first longitudinal, population-based study of full-day kindergarten (FDK) outcomes beyond primary school in Canada, we used linked administrative data to follow 15 kindergarten cohorts (n ranging from 112 to 736) up to grade 9. Provincial assessments conducted in grades 3, 7, and 8 and course marks and credits earned in grade 9 were compared between FDK and half-day kindergarten (HDK) students in both targeted and universal FDK programmes. Propensity score matched cohort and stepped-wedge designs allowed for stronger causal inferences than previous research on FDK. We found limited long-term benefits of FDK, specific to the type of programme, outcomes examined, and subpopulations. FDK programmes targeted at low-income areas showed long-term improvements in numeracy for lower income girls. Our results suggest that expectations for wide-ranging long-term academic benefits of FDK are unwarranted.

Trial marriage: Florida's experience in consolidating HIV/AIDS, STD, and TB programs.

After a three-year experiment in consolidating services, the Florida Department of Health has again separated programs for the prevention and control of HIV/AIDS, sexually transmitted diseases (STDs), and tuberculosis. The authors report that while there were some clear advantages to consolidating services, especially programs dealing with HIV and other STDs, the individual programs suffered in some important ways. The authors describe Florida's effort to preserve the positive programmatic and administrative aspects of the consolidated approach and to apply the lessons learned.

The course of aggression in first-grade children with and without comorbid anxious symptoms.

We studied the course of aggressive behavior in an epidemiologically defined sample of first graders with and without comorbid anxious symptoms. Our primary purpose in doing so was to understand whether the stability of aggression in young children was attenuated or strengthened in the presence of comorbid anxiety. Previous studies of older children and adolescents had produced equivocal findings in this regard. Data on anxious symptoms were obtained through an interview of the children, whereas aggressive behavior was assessed through the use of a teacher interview and peer nominations. Assessments were performed in the fall and spring of first grade. In contrast to children classified as aggressive alone in the fall of first grade, boys and girls classified as aggressive and anxious in the fall of first grade were significantly more likely to be classified as aggressive in the spring in terms of teacher ratings and/or peer nominations of aggression. Thus our findings suggest that the link between early and later aggression may be strengthened in the presence of comorbid anxious symptoms, rather than attenuated. Future studies are needed to identify the mechanisms by which the course of aggression is influenced by the presence of comorbid anxiety.

Timing of first sexual intercourse: the role of social control, social learning, and problem behavior.

PIP: Research has suggested the roles of several factors and processes which may affect the timing of first intercourse among adolescents. The roles of pubertal timing, family socialization, psychosocial adjustment, bonds to conventional institutions, problem behavior, and socioeconomic status in the timing of first intercourse were assessed in a sample of 123 male and 166 female White rural adolescents in one rural school district in the eastern US. The sample comprised all students in grades 7-9 in the district's two junior high schools. Respondents' median household income was $14,000, with 12% of families under the poverty level. Most of the written survey questionnaire data is from a 1985 sampling. The majority of students in this longitudinal study had experienced sexual intercourse by age 17. Family socialization and problem behavior were important determinant factors of the timing of first intercourse for both sexes. For boys, the earlier timing of puberty was associated with earlier timing of first intercourse, while social control processes were important for girls. Social class and poor psychosocial adjustment were found to be important for neither gender. Multiple processes influence the timing of first intercourse.^ieng

The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade.

In an earlier study of an epidemiologically defined sample of first grade children, primarily between the ages of 5 and 6, self-reported anxious symptoms proved relatively stable and were significantly related to adaptive functioning. In the present study we follow that cohort of first graders longitudinally and assess the prognostic value of self-reports of anxious symptoms in first grade with respect to anxious symptoms and adaptive functioning in the late elementary school years or at about age 10. First grade anxious symptoms were found to have significant prognostic value in terms of levels of anxious symptoms and adaptive functioning in fifth grade.

The significance of self-reported anxious symptoms in first-grade children.

It is generally believed that prior to the middle to late elementary school years children's reports of anxious symptoms represent nothing more than transient developmental phenomena. In light of the limited empirical study of this issue and its import to the allocation of mental health resources, the present study seeks to provide empirical evidence of the significance of anxious symptoms in children younger than 7. Specifically, utilizing an epidemiologically defined population of 1197 first-grade children, followed longitudinally from the fall to spring of first grade, we examine the stability, prevalence and caseness of children's self-reports of anxious symptoms. Self-reported anxious symptoms proved relatively stable over 4-month test-retest interval. In addition, they appeared to have a significant impact on academic functioning in terms of reading achievement. These findings on stability, caseness, and prevalence suggest children's self-reported anxious symptoms in the early elementary school years may have clinical significance. However, further study is necessary before firm conclusions can be drawn.

Self-reported depressive symptoms in first-grade children: developmentally transient phenomena?

The question of whether self-reported depressive symptoms in young children represent more than transient developmental phenomena was examined in an epidemiologically defined sample of 1,313 first graders. Children's reports of depressive symptoms were relatively stable over a 4-month interval. The level of stability was particularly impressive for children initially in the highest quartile of depression, of all whom remained in the highest quartile at retest, 4 months later. In addition, depressive symptoms were significantly related to the negotiation of a number of salient developmental tasks at entrance to first grade, including academic achievement, peer relations, and attention/concentration in the classroom. Moreover, the relationships between depressive symptoms and the various indices of social and academic functioning remained stable over the 4-month test-retest interval.

Antecedents of rural adolescent alcohol use: a risk factor approach.

The present study examines the association between risk factors and alcohol use for a sample of young adolescents in a rural eastern community. Family relations, family structure, marks in school, participation in academic activities, frequency of church attendance, and deviant behavior were found to be significantly associated with alcohol use two years later. No gender or age differences were found in these predictors of alcohol use. These six risk variables were combined to form a risk index. A 3 x 2 x 2 (User group by Gender by Grade) ANOVA was used to examine the association between the risk index score at Year 1 and level of alcohol use at Year 3. Only the main effect for User group was significant. Thus, the number of risk factors at Year 1 was predictive of alcohol use at Year 3. The risk index also predicted frequency of alcohol use in a replication sample. Implications for the risk factor approach, prevention, and intervention are discussed.

Patterns of adult male coresidence among young children of adolescent mothers.

This article uses data from the National Longitudinal Survey of Youth to examine the coresidence patterns of children and adult males during the first three years of a child's life, with special attention to the children of adolescent mothers. Overall, the most common experience was for the children to have an adult male present over the full period. However, there were differences by race and the mother's age when she gave birth. For example, 83 percent of white children and 47 percent of black children born to mothers aged 20 or older lived with an adult male during their entire early childhood, while three quarters of white children and fewer than one-third of black children born to mothers younger than 18 had a male present in their household over their first three years. Among both races, children of older mothers were significantly more likely than others to be born into a household where an adult male was present. The stability of male coresidence varied significantly by the mother's age among white children, but not among blacks. Overall, black children experienced more changes in male coresidence than whites. Finally, the likelihood that the adult male would be married to the mother was positively associated with white race and the age of the mother when she gave birth.

A self-report measure of pubertal status: Reliability, validity, and initial norms.

Puberty is a central process in the complex set of changes that constitutes the transition from childhood to adolescence. Research on the role of pubertal change in this transition has been impeded by the difficulty of assessing puberty in ways acceptable to young adolescents and others involved. Addressing this problem, this paper describes and presents norms for a selfreport measure of pubertal status. The measure was used twice annually over a period of three years in a longitudinal study of 335 young adolescent boys and girls. Data on a longitudinal subsample of 253 subjects are reported. The scale shows good reliability, as indicated by coefficient alpha. In addition, several sources of data suggest that these reports are valid. The availability of such a measure is important for studies, such as those based in schools, in which more direct measures of puberty may not be possible.

An outbreak and review of cave-associated histoplasmosis capsulati.

Three male college students from Florida developed acute onsets of fever, chills, shortness of breath, and cough within one day of each other, and all were eventually hospitalized for four to 29 days. All chest x-ray films showed diffuse reticulonodularities in both lung fields. Laboratory studies confirmed the diagnosis of histoplasmosis. The three students had been 'spelunking' (cave exploring) 6 to 7 days before their onset of symptoms. One of four soil samples collected in the caves was positive for Histoplasma capsulatum by the indirect mouse inoculation procedure. Of three investigators who entered the implicated caves, two developed acute febrile illness within 15-21 days. One investigator was hospitalized for 18 days with a confirmed diagnosis of histoplasmosis. Investigation identified an additional case (the person had entered the caves 6 months before this episode), but was not reported to health authorities. Spelunkers should be aware of the potential risk of histoplasmosis and how to avoid infection. Physicians should be cognizant of cave-associated histoplasmosis, inquire about spelunking in persons who develop febrile respiratory illnesses with diffuse nodularities on chest x-ray films, and report such cases to their health department. A review of 42 reported outbreaks of cave-associated histoplasmosis and the approach to environmental control of infected caves are included.

Pubertal timing and grade effects on adjustment.

Effects on adjustment of biological maturation and social timing were compared using data from a longitudinal sample of 335 young adolescents, who were followed from the sixth through eighth grades. Biological maturation was estimated from the relative timing of the adolescent growth spurt. Social timing was assessed by grade in school. Five adjustment constructs were examined: school achievement (course grades in five subjects), family relations (a 17-item scale), peer relations (a 10-item scale), body image (an 11-item scale), impulse control (an 8-item scale), and psychopathology (an 11-item emotional tone scale and an 11-item general psychopathology scale). All but one adjustment construct showed grade effects, but only three of the six constructs showed pubertal timing effects. There were no grade by pubertal timing effects. Although there were gender differences for some of the adjustment constructs, there were no gender by pubertal timing effects. The results are discussed in terms of the life-span developmental perspective.

Abortion.

PIP: This chapter addresses the role of health professionals in providing abortions and examines the dynamic technology of this field. Once the decision to perform an abortion is made, the proper procedure must be selected. Gestational age is the fundamental determinant but the experience and capability of the practitioner are also crucial. Suction curettage is the safest and most effective procedure available for abortions performed within 10 weeks of conception. Evaluation of the abortion patient should include, at a minimum, tests for hemoglobin, presence of gonococci, and Rh type. One of the most important parts of preparation for an abortion is sensitive and searching counseling. A potentially serious complication of suction curettage is perforation of the uterus. Dilatation and evacuation (D and E), is similar to the suction curettage procedure. This method may be used for gestations of 20 or more weeks after conception and requires greater operator expertise and experience. The complications of D and E are similar to those of suction curettage but are more frequent. Amnioinfusion is currently the most widely used method of pregnancy termination after 14 weeks in the US. The abortifacient agent that has had the greatest use is hypertonic saline. Morbidity associated with saline amnioinfusion includes hemorrhage requiring transfusion, retained tissue requiring manual or surgical removal infection, coagulopathy, and hypernatremia. Prostaglandins are alternative abortifacient agents. A disadvantage of using prostaglandins to induce abortion is that they frequently require repeat doses to be effective. Other disadvantages include nausea, vomiting, diarhea, and bronchospasm. Urea is anther effective abortifacient agent.^ieng