Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations.

BACKGROUND: Rater reproducibility of the Bristol Stool Form Scale (BSFS), which categorizes stools into one of seven types, is unknown. We sought to determine reliability and agreement by individual stool type and when responses are categorized by Rome III clinical designation as normal or abnormal (constipation or diarrhea). METHODS: Thirty-four gastroenterology providers from three institutions rated 35 stool photographs using the BSFS. Twenty rerated the photographs. KEY RESULTS: 1190 individual stool type ratings were completed. Though only four photographs had absolute agreement (all Type 1 or Type 7), general agreement was high with 1132 (95.1%) of ratings being within one category type of the modal rating. Inter-rater and intra-rater reliability of the BSFS by individual stool type was excellent with intraclass correlations of 0.88 (95% CI: 0.86-0.90, p < 0.001) and 0.89 (95% CI: 0.86-0.91, p < 0.001), respectively. However, agreement decreased when using Rome III designations with 13 (37%) photographs having significantly diverging classifications (semi-interquartile range = 0.5). These 13 photographs were rated by the majority of raters as either type 2 vs type 3 or type 5 vs type 6 stools, representing the boundaries of normal vs abnormal stools. Inter-rater and intra-rater reliability of the BSFS by Rome III clinical categorization decreased with intraclass correlations of 0.75 (95% CI: 0.69-0.81, p < 0.001) and 0.65 (95% CI: 0.49-0.81, p < 0.001), respectively. CONCLUSIONS & INFERENCES: The Bristol Stool Form Scale has excellent reliability and agreement when used to rate individual stool type by raters. However, BSFS reliability and agreement decreases when determining Rome III stool form categories.

The interpretation of Rome III criteria and method of assessment affect the irritable bowel syndrome classification of children.

BACKGROUND: Paediatric classification of irritable bowel syndrome (IBS) is complicated by the potential discrepancy between parent and child report and by the interpretation of pain-stool relations in the Rome III classification system. AIM: To compare IBS classification by diary and by child and parent respondents. METHODS: Children (ages 7-10 years, n = 90) with recurrent abdominal pain and their parents completed IBS symptom questionnaires and 2-week pain and stool diaries. Diaries were coded with two algorithms, one defining stool changes individually and one defining changes normatively. Proportions of dichotomous classifications (IBS vs. not IBS) between pairs of classification methods/respondents were evaluated using Chi-squared tests (χ²) to determine whether coding methods were significantly related, the degree of inclusiveness, and whether differences in classification were randomly distributed. RESULTS: Individual and normative diary classifications were congruent in 62% of cases, but the individual method classified more children with IBS, 53% vs. 18%. Parent and child questionnaire reports were not correlated. The normative diary classifications and parent questionnaire were the most congruent pair of methods (76% of cases). CONCLUSIONS: Poor congruence among methods suggests that Rome III IBS criteria need better specification, and efforts to improve parent-child agreement are necessary.

Functional neuroimaging with MEG: normative language profiles.

The reliability of language-specific brain activation profiles was assessed using Magnetoencephalography (MEG) in five experiments involving ninety-seven normal volunteers of both genders ranging in age from seven to eighty-four years. MEG data were analyzed with a fully automated method to eliminate subjective judgments in the process of deriving the activation profiles. Across all experiments, profiles were characterized by significant bilateral activity centered in the superior temporal gyrus, and in activity lateralized to the left middle temporal gyrus. These features were invariant across age, gender, variation in task characteristics, and mode of stimulus presentation. The absolute amount of activation, however, did decline with age in the auditory tasks. Moreover, contrary to the commonly held belief that left hemisphere dominance for language is greater in men than in women, our data revealed an opposite albeit a not consistently significant trend.

Impairment and recovery in inhibitory control after traumatic brain injury in children: effect of age at injury, injury severity and lesion location.

We examined the effect of traumatic brain injury (TBI) on inhibitory control, trajectories of recovery of inhibitory control, and the effect of age at injury, severity, and lesion location on recovery. Participants were 127 children with TBI aged 5-16 years and 117 controls of similar age. Latency of response inhibition was measured with the stop signal task within 1 month of the injury and again at 3, 6, 12, and 24 months. Performance of children with TBI was compared with that of controls. Growth curve analyses showed impairments in response inhibition postinjury. Compared with controls, TBI children improved over time in response inhibition. Younger TBI children recovered better on response inhibition than older TBI children. No significant effect of severity or right frontal lesion on recovery of response inhibition was found. TBI has an acute effect on inhibitory control but which recovers over time.

Does magnetoencephalography add to scalp video-EEG as a diagnostic tool in epilepsy surgery?

OBJECTIVE: The authors evaluated the sensitivity and selectivity of interictal magnetoencephalography (MEG) versus prolonged ictal and interictal scalp video-electroencephalography (V-EEG) in order to identify patient groups that would benefit from preoperative MEG testing. METHODS: The authors evaluated 113 consecutive patients with medically refractory epilepsy who underwent surgery. The epileptogenic region predicted by interictal and ictal V-EEG and MEG was defined in relation to the resected area as perfectly overlapping with the resected area, partially overlapping, or nonoverlapping. RESULTS: The sensitivity of a 30-minute interictal MEG study for detecting clinically significant epileptiform activity was 79.2%. Using MEG, we were able to localize the resected region in a greater proportion of patients (72.3%) than with noninvasive V-EEG (40%). MEG contributed to the localization of the resected region in 58.8% of the patients with a nonlocalizing V-EEG study and 72.8% of the patients for whom V-EEG only partially identified the resected zone. Overall, MEG and V-EEG results were equivalent in 32.3% of the cases, and additional localization information was obtained using MEG in 40% of the patients. CONCLUSION: MEG is most useful for presurgical planning in patients who have either partially or nonlocalizing V-EEG results.

How do mothers' childrearing histories, stress and parenting affect children's behavioural outcomes?

BACKGROUND: Information is needed to understand the role of low to moderate levels of mothers' emotional stress and child characteristics (i.e. prematurity) on parenting behaviours and their impact on children's behaviour that might be deemed 'challenging' but not 'disordered'. METHODS: The direct and indirect relations of maternal childrearing history and emotional stress, and observed parenting practices when children were 3 years of age on 4-year child behavioural outcomes was examined in a sample of low-income families with a term (n=112) or preterm (n=180) child. Parenting practices included displays of warmth and restrictiveness when interacting with their children. Child outcomes at 4 years included observation of social initiations with their mothers and maternal report of social and attentional problems. RESULTS: A Structural Equation Model building approach guided by specific hypotheses indicated that preterm as compared to full-term children had more maternal reported social and attentional problems but did not differ in observed social initiating skills. Greater negative maternal childrearing history indirectly influenced social initiating skills through its direct influence on maternal emotional stress. Greater maternal emotional stress directly influenced mothers' parenting that, in turn, directly influenced social initiating. Prematurity and a more negative childrearing history had a direct negative influence on the maternal report of social and attentional behavioural outcomes. CONCLUSIONS: These findings delineate the effects of prematurity and maternal parenting on the behaviour of 4-year-old-children and extend current knowledge of the influence of parental emotional stress on parenting. Even milder levels can negatively influence parenting, and in turn, contribute to children's less well developed social skills. The issues raised in this study could help with the identification and prioritization of medical and psychological services.

Reducing conduct problems among children of battered women.

This study was an experimental evaluation of an intervention designed to reduce conduct problems among children of battered women. Participants were 36 families (mothers and children) in which the mother had sought shelter because of relationship violence and had at least 1 child (4-9 years old) with clinical levels of conduct problems. The intervention consisted of 2 primary components: (a) providing instrumental and emotional support and (b) teaching child management skills to mothers. Families were randomly assigned to either the intervention condition or the existing services comparison condition and were assessed on 5 occasions over 16 months after shelter departure. Compared with families receiving existing services, children in the intervention condition improved at a faster rate, the proportion of children displaying clinical levels of conduct problems was greatly diminished, and mothers displayed greater improvements in child management skills.

Use of the Disability Rating Scale Recovery curve as a predictor of psychosocial outcome following closed-head injury.

Rapid rate of recovery has been associated with better outcome following closed-head injuries, but few studies have compellingly demonstrated this. This study used growth curve analyses of Disability Rating Scale (DRS) scores at acute hospitalization discharge, 1, 3, and 6 months post injury in a sample of 55 patients with a closed-head injury. Six month post-injury outcome measures were taken from significant other (SO) responses on the NYU Head Injury Family Interview (NYU-HIFI) including severity and burden ratings of affective/neurobehavioral disturbance, cognitive deficits, and physical/dependency status. Rate of recovery (linear and curvilinear recovery curve components) was significantly related to the level of affective/neurobehavioral severity, and the severity and burden of SO-perceived cognitive deficits. Only the intercept of the DRS recovery curve was associated with the SO-perceived severity and burden of physical/dependency status. Growth curve modeling is a meaningful and powerful tool in predicting head injury outcome.

Does early responsive parenting have a special importance for children's development or is consistency across early childhood necessary?

The role of early versus ongoing maternal responsiveness in predicting cognitive and social development was examined in home visits for mothers, full-term children (n = 103), and medically low-risk (n = 102) and high-risk (n = 77) preterm children at 5 ages. There were 4 maternal clusters based on warm and contingent responsiveness behaviors observed early (at 6, 12, and 24 months) and late (at 3 and 4 years): high early, high late; high early, low late; low early, moderate late; and low early, low late. Children, especially preterm children, showed faster cognitive growth when mothers were consistently responsive. Social growth was similar in the consistently responsive (high-high) and the early-responsive inconsistent (high-low) clusters, but greater deceleration at 4 years among children with mothers in the inconsistent cluster refuted the notion of a unique role for early responsiveness. The importance of consistent responsiveness, defined by an affective-emotional construct, was evident even when a broader constellation of parenting behaviors was considered.

Association of early bilateral middle ear effusion with language at age 5 years.

OBJECTIVE: This study tested the hypothesis that children with early persistent middle ear effusion (MEE) are at risk for later language deficit. METHOD: We recruited 698 newborns and monitored them for MEE every 2 to 4 weeks at home until age 3 years. Language skills were assessed on 294 subjects at age 5, while controlling for 8 demographic and environmental factors. Language outcomes at age 5 years were studied as a function of duration of bilateral MEE from birth to age 3 years. RESULTS: A significant relation was found between duration of bilateral MEE and speech sound sensitivity (Carrow Elicited Language Inventory) and articulation (Goldman-Fristoe Articulation). Children's ability to discriminate speech sounds in a quiet environment (Carrow Auditory Visual Abilities Test) was less affected by early prolonged MEE in homes that provided more cognitive stimulation. CONCLUSIONS: These exploratory results indicate that prolonged early MEE may predispose children to language deficits at age 5 years. The language deficits are of small magnitude and may or may not be clinically significant. Language stimulation at home may protect against some of the effects of prolonged MEE.

Validation of an instrument measuring patient satisfaction with chest physiotherapy techniques in cystic fibrosis.

OBJECTIVES: Chest physiotherapy (CPT) has been an important part of cystic fibrosis (CF) treatment regimens for > 40 years. Techniques with different perceived costs, benefits, and patient satisfaction exist. An instrument measuring patient satisfaction with CPT has not been reported. Our goal was to develop and validate such an instrument. DESIGN: A cross-sectional survey sent to 349 patients seen at a large, urban, academic CF care center. The two-page survey asked 17 questions related to CPT satisfaction (efficacy, convenience, comfort, overall satisfaction), followed by 4 general CF-care questions (disease severity, importance of therapies, prescribed vs missed therapies). A 5-point Likert-type scale was used for responses. Psychometric analysis included itemetric performance, confirmatory factor analysis, test-retest reliability, and evaluation of subject's responses to the general CF-care questions. RESULTS: One hundred twenty-nine individuals returned completed surveys (39%; 66 males and 63 females; age range, 2 months to 47 years). FEV(1)values were 21 to 155% predicted (mean, 76%; n = 82). Disease severity was as follows: 60 mild, 47 moderate, and 14 severe. Seventy-nine subjects used postural drainage, percussion, and vibration (PDPV), 21 used a flutter device, and 14 used high-frequency chest wall oscillation (HFCWO). Five subjects used more than one technique. Internal consistency analysis found an overall coefficient alpha of 0.87 (range, 0.74 to 0.89 for four domains). Factor analysis demonstrated domains for efficacy, convenience, comfort, and overall satisfaction. Mean total satisfaction scores differed significantly among therapies (R(2) = 0. 118; F[ 2,111] = 7.56; p = 0.0008): PDPV, 3.8 (SD = 0.6); Flutter, 4. 3 (SD = 0.5); and HFCWO, 4.1 (SD = 0.5). Therapies also differed significantly on all subscores. Perceived importance of CPT and compliance with CPT increased linearly with disease severity. Overall satisfaction was positively correlated with CPT compliance. CONCLUSIONS: The CPT satisfaction survey has good reliability and content validity. Significant differences in patient satisfaction exist among therapies. Sicker patients recognize the importance of, and demonstrate better compliance with prescribed CPT. Increased satisfaction is associated with better compliance with therapy.

Early maternal and child influences on children's later independent cognitive and social functioning.

The present study examined whether parenting and child characteristics of 2- and 3 1/2-year-old children had common paths of influence on their 4 1/2-year independent cognitive and social functioning. Structural equation modeling was guided by hypotheses that assumed children's later independence is facilitated by specialized parental support in early social interactions. To address the importance of variability in early development for understanding children's later independence, we included 104 term and 185 preterm children, as they are known to differ in early skills. As predicted, mothers' maintaining of children's interests indirectly supported 4 1/2-year cognitive and social independence through a direct, positive influence on 2- and 3 1/2-year skills. Directiveness positively supported children's early cognitive and responsiveness skills but by 3 1/2 years, high levels of this behavior had a direct, negative influence on their cognitive and social independence at 4 1/2 years. Whereas high levels of maintaining interests across these ages support later independence, directiveness needs to decrease in relation to children's increasing competencies. Results support a theoretical framework that emphasizes the importance of the social context for understanding the origins of children's later independent functioning.

Effects of early middle ear effusion on child intelligence at three, five, and seven years of age.

OBJECTIVE: This study tested the hypothesis that children with prolonged middle ear effusion (MEE) during the first 3 years of life are at risk for cognitive delays or deficits. METHOD: A prospective study enrolled 698 children from diverse backgrounds and controlled for eight demographic and environmental factors. Participants were recruited at birth and monitored for ear status frequently in the home; 379 children were assessed for cognition with the Stanford-Binet, 4th ed., at 3 years of age, 294 at 5 years, and 198 at 7 years. RESULTS: Using the SAS General Linear Models (GLM) procedure, we found a significant direct relation between duration of bilateral MEE and Stanford-Binet Composite and Nonverbal Reasoning/Visualization Factor scores at age 3, but not at age 5 or age 7. Statistical clustering analysis revealed four groups with different temporal patterns of MEE: Low MEE, Early MEE (peaking at 0-6 months), Later MEE (peaking at 6-12 months), and High MEE. GLM analyses revealed no direct effects, but several moderated effects, of MEE cluster on cognitive development at 3 years, but none at 5 or 7 years. In general, children in the Later MEE and High MEE groups appeared to be more adversely affected by bilateral MEE at 3 years, but effects were moderated in complex ways by socioeconomic status or home stimulation. Growth curve modeling across the three assessment periods showed no effects of total duration of MEE but did indicate that children in the Later MEE cluster had low scores at age 3 but caught up at ages 5 and 7. CONCLUSIONS: Prolonged MEE, especially between 6 and 12 months, may put children at risk for cognitive delays at 3 years, but the risk effect is not strong and effects are no longer detectable at 5 or 7 years.

Relation of mothers' affective developmental history and parenting behavior: effects on infant medical risk.

Mothers of infants with varying degrees of medical risk were grouped according to their perception of acceptance or rejection in childhood. Those who recalled the highest degree of acceptance showed greater warmth and flexibility as parents, regardless of their infants' degree of medical risk. However, infant medical risk was an important moderator in relations between maternal perceptions of childhood rejection and parental behavior.

Patterns of adjustment among children of battered women.

Children exposed to interparental violence have been characterized by an array of psychological problems, but findings regarding the precise nature of these problems have been inconsistent. This study used cluster analysis to determine whether distinct patterns of adjustment could be identified in 228 8- to 14-year-old children residing in battered women's shelters. Five such patterns emerged: multiproblem-externalizing, multiproblem-internalizing, externalizing, mild distress, and no problems reported. This solution was cross-validated in independent halves of the sample and was similar for boys and girls. Differences among the clusters on relevant family and demographic variables were examined, and it was found that the clusters could be distinguished on the basis of the frequency of children's exposure to interparental violence, parent-child aggression, and children's appraisals of interparental conflict.

Electroglottographic tracking of phonatory response to Botox.

Botox injection into the thyroarytenoid muscle is thought to alter the glottal competence and laryngeal adduction of patients with adductor spasmodic dysphonia (ADSD). Hypofunctional responses to treatment have been rated subjectively and inferred from postinjection breathy voice, aphonia, midline glottal gap, or subclinical aspiration. Clinical experience suggests that temporary hypofunction varies in duration and severity among patients. This study used electroglottographic measures to examine changes over time in glottal competence during the relatively stable phonation produced by 5 patients with ADSD. Hierarchical linear modeling was used to test 3 hypotheses: (a) that reduced laryngeal adduction would occur during the first 3 weeks postinjection, followed by a reversal; (b) that patients' hypofunctional response curves would differ one from another; and (c) that changes in adduction, if present, would be related to changes in severity ratings of ADSD symptoms. For 3 participants, significant hypoadduction occurred after injection and reversed toward preinjection level over an 8-week period. Two participants demonstrated a flat or increasing vocal fold contact response curve during the early postinjection period. Observations were consistent with the previously reported differences and possibly complex relation between the resolution of breathy hypofunction and ultimate return of ADSD symptoms.

Feeding, medical factors, and developmental outcome in premature infants.

This is a prospective, longitudinal study of premature infants investigating whether the length of time needed to reach full enteral feedings (FEF) or full nipple feedings (FNF) is related to medical complications and/or developmental outcome at 24 months corrected age. Premature infants (n = 161) from three institutions with birth weights less than 1,600 grams were followed up from birth to 24 months corrected age. The infants were stratified into groups by the severity of medical complications. Bayley Scales of Infant Development were performed at 24 months corrected age. Multiple linear regression was used to analyze the association between feeding milestones, medical complications, and developmental outcomes. Our results show that when controlling for birth weight and gestational age (GA), the severity of respiratory complications was significantly related to reaching FEF (p = 0.024) and FNF (p = 0.0014). Furthermore, when controlling for the severity of respiratory complications, GA, and socioeconomic status, an increased length of time to FEF was significantly associated with a poorer mental outcome (p = 0.0013). We conclude that there is an association between the length of time to reach FEF and mental developmental outcome at 24 months corrected age. Infants who reach full enteral feedings at an earlier age appear to have a better developmental outcome despite their GA and severity of respiratory complications.

Adult smoking in the home environment and children's IQ.

In a sample of 3- and 5-yr.-old children, smoking in the home was found to be significantly and inversely related to IQ. Children of normal birth weight and without neurological impairment had been enrolled in a longitudinal study of child development. Analyses were conducted with sex, ethnicity, socioeconomic status, educational stimulation in the home, day care, and mother's intelligence controlled. Significant results were obtained for scores on the Peabody Picture Vocabulary Test-Revised at age three years and on the major Stanford-Binet Fourth Edition scales at ages three and five years. All effects were for the mother, not the father, smoking in the home.

The predictive validity of the Diet Readiness Test in a clinical population.

OBJECTIVE: To evaluate the psychometric properties, including the factorial and predictive validity, of the Diet Readiness Test (DRT) in a clinical population. METHOD: The DRT was administered to 132 women who participated in an obesity and binge eating treatment study. RESULTS: The DRT demonstrated adequate internal consistency. The DRT's proposed factor structure was not supported. Neither the DRT subscales nor the derived factors predicted changes in weight, binge eating, or exercise. DISCUSSION: The DRT did not demonstrate factorial or predictive validity in this study. Based on the DRT's cutoff criteria, 100% of the sample was considered not ready to begin a weight loss program, suggesting that the DRT may have limited utility with clinical populations.

The relation of change in maternal interactive styles to the developing social competence of full-term and preterm children.

This study evaluated the changing nature of mothers' interactive behaviors to understand alterations in children's social development across 6, 12, 24, and 40 months of age. Social skills were observed during daily activities and toy play in the home for medically high risk (HR; n = 73) and low risk (LR; n = 114) very low birthweight (VLBW) preterm and full-term (FT; n = 112) children. Variations in mothers' responses to children's changing capabilities predicted rates of change in children's social skills. For example, mothers who showed higher levels of maintaining measured across 6 to 40 months had children who displayed greater increases in initiating, but this was more apparent in daily activities than toy play and for the VLBW children compared to the FT children. Those VLBW children at the highest degrees of biological risk displayed faster gains in initiating than the other groups when their mothers provided even greater levels of support. Results demonstrate the importance of using methodologies that test more complex models of growth when evaluating parent-child relations.