Resilient parenting of preschool children at developmental risk.

BACKGROUND: Given the great benefits of effective parenting to child development under normal circumstances, and the even greater benefits in the face of risk, it is important to understand why some parents manage to be effective in their interactions with their child despite facing formidable challenges. This study examined factors that promoted effective parenting in the presence of child developmental delay, high child behaviour problems, and low family income. METHOD: Data were obtained from 232 families at child age 3 and 5 years. Using an adapted ABCX model, we examined three risk domains (child developmental delay, child behaviour problems, and low family income) and three protective factors (mother's education, health, and optimism). The outcome of interest was positive parenting as coded from mother-child interactions. RESULTS: Levels of positive parenting differed across levels of risk. Education and optimism appeared to be protective factors for positive parenting at ages 3 and 5, and health appeared to be an additional protective factor at age 5. There was an interaction between risk and education at age 3; mothers with higher education engaged in more positive parenting at higher levels of risk than did mothers with less education. There was also an interaction between risk and optimism at age 3; mothers with higher optimism engaged in more positive parenting at lower levels of risk than did mothers with less optimism. The risk index did not predict change in positive parenting from age 3-5, but the protective factor of maternal health predicted positive changes. CONCLUSIONS: This study examined factors leading to positive parenting in the face of risk, a topic that has received less attention in the literature on disability. Limitations, future directions, and implications for intervention are discussed.

Parent-child problem solving in families of children with or without intellectual disability.

OBJECTIVE: To examine differences in child social competence and parent-child interactions involving children with intellectual disability (ID) or typical development (TD) during a Parent-Child Problem-Solving Task. DESIGN: Mothers and their 9-year-old children (n = 122) participated in a problem-solving task in which they discussed and tried to resolve an issue they disagreed about. The interactions were coded on child and mother problem solving and affect behaviours, as well as the dyad's problem resolution. RESULTS: Children with ID (n = 35) were rated lower on expression/negotiation skills and higher on resistance to the task than children with TD (n = 87). Mothers in the ID group (vs. TD group) were more likely to direct the conversation. However, there were no group differences on maternal feeling acknowledgement, engagement, warmth or antagonism. The ID dyads were less likely to come to a resolution and to compromise in doing so than the TD dyads. These group differences were not attributable to differences in children's behaviour problems. CONCLUSIONS: Children with ID and their mothers had more difficulty resolving problems, and this increased difficulty was not explained by greater behaviour problems. Additionally, with the exception of directiveness, mothers of children with ID displayed similar behaviours and affect towards their children during problem solving as mothers of children with TD. Results suggest that the Parent-Child Problem-Solving Task is a useful way to assess social skills and associated parental behaviours in middle childhood beyond self-report. Implications for future research and intervention are discussed.

Temporal variation in nasal and oral breathing in children.

The purpose of this study was to measure several variables associated with respiratory function at repeated intervals. The temporal variation of these variables was assessed within persons and within the sample population. Twenty-nine children, 18 boys and 11 girls, between the ages of 7 and 13 years of age, participated. Each subject attended three separate appointments. At each appointment, the percentage nasal breathing was measured three times with inductive plethysmography. The nasal resistance and smallest nasal cross-sectional area were measured once at each appointment with posterior rhinomanometry. The findings suggest a significant amount of variation in repeated measurements of respiratory variables. More variation was noted in measurements taken on different days than within 1 day. No correlation was present between either nasal resistance or nasal cross-sectional area in relation to percentage of nasal breathing. All subjects had a nasal component of respiration; no one was a 100% oral breather. No correlation was observed between age or gender of the subjects and any of the respiratory variables measured.

The organization of heart services. Part three: Building a cardiac PHO.

This article has examined some of the legal requirements for establishing a PHO or a SPHO. These guidelines have been presented in a generalized format. Legal counsel should be retained prior to developing a PHO to ensure that applicable legal statutes at the state, local and national level are met. Various organizational models have been presented for developing the PHO. The PHO entity allows the physicians and the hospital a single entity, representative of both parties, to locate, negotiate and enter into contracts on their behalf. The PHO can allocate revenues among the parties based on the amount of risk and services provided. There are some questions as to the long-term viability of PHOs given the regulatory changes occurring in the healthcare arena. Regardless of the regulatory changes that may occur, PHOs provide a vehicle for enhancing the relationship between a hospital and its physicians. PHOs are often a step in the process of developing a fully integrated healthcare organization. The PHO provides a forum for developing and enhancing trust and collaboration among the physicians and between the physicians and the hospital. Trust and collaboration will be key ingredients in the future as physicians and hospitals work more closely together in providing high-quality, cost-effective care that meets the patient market needs and expectations. Part Four of this series will discuss the fully integrated healthcare organization.

Pulpal response to orthognathic surgery: a long-term radiographic study.

The purpose of this study was to determine if the ischemia associated with orthognathic surgery causes long-term pathologic changes in the pulp similar to those documented after traumatic injuries. A total of 93 patients, 21.9 to 63.9 years of age (mean 38.5 years, SD 9.4), consented to participate in a follow-up study ranging from 4.7 to 15.3 years (mean 8.9 years, SD 2.9) after surgery. LeFort I osteotomy was performed on 42 patients and bilateral sagittal split osteotomies on 76 patients. Full-mouth series of periapical radiographs taken at the time of follow-up were compared with pretreatment and posttreatment panoramic radiographs. The development of pulp canal obliteration was observed more often in the maxillae of patients treated with LeFort I osteotomy than in those without (p < 0.001). No difference was seen in the frequency of maxillae with teeth developing radiographic signs of pulp necrosis between patients treated with and without LeFort I osteotomy. However, a higher proportion of the teeth were affected among the patients treated with osteotomy (p < 0.01). The presence of a restoration or caries was a risk factor for the development of necrosis (p < 0.01). Bilateral sagittal split osteotomies had no apparent effect on long-term pathologic pulpal changes. No internal resorption was seen. Only very few teeth were extracted during the follow-up period.

Photoradiation therapy of Lewis lung tumors in mice with low optical dose rat and high HpD-dose.

Lewis Lung carcinomas in B6D2 mice have been treated by photoradiation therapy (PRT). All irradiations were performed at 630 nm. The optical power levels were typically varied from 45-100 mW with a radiation duration of 60 min. This gave an optical energy of 160-360 J delivered through a centrally inserted optical fiber into the tumor during treatment. The optical power density and the temperature were monitored during exposure. After treatment the animals were observed for at least two days before sacrifice. Biopsies have been taken for the histological follow-up. The experimental series were composed of non-treated controls and treated cases with variations in the chemical and optical dose scheme. Only the high (50 mg/kg) Hematoporphyrin derivative (HpD)-dose gave curative response from the tumors. The low dose (5 mg/kg) gave no significantly different response from the control case by visual observation; however, histologically there was some difference.