The behavioral and emotional well-being of school-age children with different birth weights.

OBJECTIVE: To describe the mental and emotional well-being of children born at different birth weights assessed at school age and to identify neonatal, intervening health, and sociodemographic and environmental factors associated with mental and emotional well-being. METHODS: To address this issue, we used a prospective cohort study involving two previously studied cohorts, which were recontacted at 8 to 10 years of age to provide a multisite sample of 247 children weighing 1000 g or less at birth, 364 weighing 1001 to 1500 g, 724 weighing 1501 to 2500 g, and 533 weighing more than 2500 g. Maternal reports were obtained on three standardized measures of mental and emotional well-being (the Rand General Well-being Scale, the Behavior Problem Index, and the Harter Scale of Child Competence) and on intervening health, sociodemographic, and environmental variables. Neonatal variables were derived from records at birth. Statistical techniques included analysis of variance and ordinary least squares multiple regression. RESULTS: Lower birth weight children did not differ on the General Well-being Scale but were more likely to have behavior problems and to be considered less competent. Other important correlates of mental and emotional well-being included childhood illness, maternal mental health, home environment score, and exposure to household cigarette smoking. CONCLUSION: Although lower birth weight children have poorer mental and emotional well-being, a substantial portion of this adverse outcome reflects modifiable environmental factors.

Maternal rating of child health at school age: does the vulnerable child syndrome persist?

OBJECTIVES: To assess the extent to which parental ratings of child health, including perceived vulnerability to illness, are associated with current and past health events and sociodemographic characteristics of the family and the child. DESIGN: Prospective cohort study of children aged 8 to 10 years previously assessed in infancy in two multi-site studies. SETTING: Thirteen sites largely in eastern United States. PARTICIPANTS: 1877 children representing 65% of those originally selected for follow-up from the two previous studies. Participants were specifically selected on the basis of birth weight so that more than two-thirds were low birth weight. MEASUREMENT: Parental interviews at school age including measures of several dimensions of child health and sociodemographic characteristics of the family. The former included a six-item scale assessing parental perceptions of child health overall, and on subscales assessing child current health, previous health, and resistance or susceptibility to illness. Data on health problems at birth were derived from previously collected birth certificates, medical records, and interviews. MAIN RESULTS: Although overall parental perceptions of child health reflected both current and past health events, a clear distinction emerged. Parental rating of current child health and resistance or susceptibility were associated with current child health problems, not events in infancy including very low birth weight. Nonwhite race and maternal rating of her own health also influenced maternal rating of child health. CONCLUSION: The results do not support the persistence of a vulnerable child syndrome, as health in infancy does not affect maternal rating of current child health at school-age in the absence of current health problems.

When you're only a phone call away: a comparison of the information in telephone and face-to-face interviews.

Telephone interviews offer an economical method of obtaining information, but little published experience addresses the use of telephone interviews for the sometimes lengthy questionnaires composed of scales with multiple-category items often required in developmental and behavioral research. In a study of the outcomes of very low birth weight infants, circumstances required that we administer a questionnaire, including seven scales composed of several Likert-type items each, to a substantial portion of the study population. Those contacted by telephone (n = 1067) differed from those responding face-to-face (n = 822) in being less likely to have a very low birth weight child and more likely to be white and of higher maternal education. The length of the interview was only slightly shorter by telephone (60.7 +/- 27.9 vs 66.4 +/- 21.0 minutes, p < .001), but respondent fatigue, as indicated by lower completion rates for scales at the end of the interview (92.5%) compared with those near the beginning (99.5%) did not differ by mode. Internal consistency of parental response (Cronbach's alpha) was high for most scales and did not differ by mode. Because assignment to mode was not random, other factors may influence our findings. However, high completion rates and comparable consistency of response supports the use of telephone interviews.

Birth weight and illness severity: independent predictors of neonatal mortality.

BACKGROUND: Low birth weight is a major determinant of neonatal mortality. Yet birth weight, even in conjunction with other demographic markers, is inadequate to explain the large variations in neonatal mortality between intensive care units. This variation probably reflects differences in admission severity. The authors have recently developed the Score for Neonatal Acute Physiology (SNAP), an illness severity index specific for neonatal intensive care, and demonstrated illness severity to be a major determinant of neonatal mortality. OBJECTIVE: To define the relative contributions of birth weight and illness severity to the risk of neonatal mortality and to identify other significant independent risk factors. METHODS: Logistic regression was used to analyze data from a cohort of 1621 consecutive admissions to three neonatal intensive care units (92 deaths), to test six alternative predictive models. The best logistic model was then used to develop a simple additive clinical score, the SNAP Perinatal Extension (SNAP-PE). RESULTS: These analyses demonstrated that birth weight and illness severity are powerful independent predictors across a broad range of birth weights and that their effects are additive. Below 750 g, there is an interaction between birth weight and SNAP. Other factors that showed independent predictive power were low Apgar score at 5 minutes and small size for gestational age. Separate derivation and test samples were used to demonstrate that the SNAP-PE is comparable to the best logistic model and has a sensitivity and specificity superior to either birth weight or SNAP alone (receiver-operator characteristic area .92 +/- .02) as well as excellent goodness of fit. CONCLUSION: This simplified clinical score provides accurate mortality risk estimates for application in a broad array of clinical and research settings.

Hospitalization of very low birth weight children at school age.

OBJECTIVE: To assess whether very low birth weight (VLBW) increases the risk of hospitalization at school age. DESIGN: Prospective, multisite cohort study. PARTICIPANTS: Selected from a previous multisite, hospital-based trial, 611 VLBW children, and, from a prior representative sample, 724 children who weighed 1501 to 2500 gm and 533 who weighed > 2500 gm. All the children were re-contacted at 8 to 10 years of age for this study. METHODS: Maternal interview with the use of standardized questions. MAIN OUTCOME: Hospitalization in year before interview. RESULTS: The VLBW children were three or four times more likely to be rehospitalized than children of normal birth weight, both in the year before the interview (7% vs 2%) and since birth (50% to 60% vs 22%). Morbidity and Medicaid coverage increased the risk of hospitalization in the year before the interview; non-white race decreased it. After control for other factors, however, lower birth weight remained a significant risk factor for hospitalization. CONCLUSIONS: The VLBW children continue to have an increased risk of hospitalization; the risk is similar in magnitude to that seen in infancy.

Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index.

Severity-of-illness scales have proven valuable in assessing clinical outcomes and resource consumption in adult and pediatric intensive care, but they have been less extensively developed for neonatal care. The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS). From the 76 original TISS items, 42 were deleted and 28 added to form the NTISS. Like TISS, NTISS assigns score points from 1 to 4 for various intensive care therapies. Admission-day NTISS scores were calculated for 1643 newborns admitted to three neonatal intensive care units (NICUs) between November 1, 1989, and September 30, 1990. NTISS scores ranged from 0 to 47 with a mean of 12.3 +/- 8.7 (SD). There was little correlation with birth weight (r = -.11) or gestational age (r = -.17), but NTISS scores were highly correlated with expected markers of illness severity, including mortality risk estimates by neonatal attending physicians (r = .70, P < .0001), in-hospital mortality rates (P < .05), and a measure of nursing acuity (Medicus) (r = .69, P < .0001). In addition, admission-day NTISS scores were found to be predictive of both NICU length of stay (r = .37, P < .0001) and total hospital charges for survivors (r = .65, P < .0001). It is concluded that NTISS is a valid measure of therapeutic intensity that is independent of birth weight and can be used as an indicator of neonatal illness severity and resource utilization. Further validation in other NICUs is required.

The health and developmental status of very low-birth-weight children at school age.

OBJECTIVE: To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights. DESIGN: Inception cohort. SETTING/PARTICIPANTS: Participants were selected from two previously studied multisite cohorts: very low-birth-weight (less than or equal to 1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible. MAIN OUTCOME MEASURES: The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores. RESULTS: Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight. CONCLUSIONS: Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.

Cohort reconstruction: which infants can be restudied at school age?

Longer-term follow-up of infants with specific health concerns, such as low birthweight, is critical to assessing the effect of medical interventions. This report examines the approach of reconstructing previously studied cohorts in terms of the factors discriminating between respondents and non-respondents. Follow-up was attempted during 1987-1988 for 1875 children born during a 6-month period in 1978 in three geographically defined regions in the United States, for whom 1-year assessments of health and developmental status were obtained at 1 year of age as part of a previous study. For a 25% sample, participation involved a clinic visit for developmental assessments; for the remainder an interview by telephone or home visit. Follow-up was obtained for 72.5% of the cohort. Refusal rates were low (7%); most non-response was due to an inability to locate the families. Predictors of non-response reflected primarily low socio-economic status; completion rates were not influenced by mode of assessment. The role of a tracing agency is discussed. We conclude that cohort reconstruction is feasible with response rates comparable to some prospective studies with ongoing cohort maintenance.

How stressful is retirement? Findings from the Normative Aging Study.

The stressfulness of retirement both as a transitional event experienced during the past year and as a life stage was investigated. Transitional stress was assessed using a life events approach, and stage stress using a "hassles" approach. Respondents were 1,516 male participants in the Normative Aging Study, 45% of whom were retired. Among those retiring in the past year, respondents' own and spouse's retirement were rated the least stressful from a list of 31 possible events. Only 30% found retirement stressful. Retirement hassles were also less frequently reported and were rated less stressful than the work hassles of men still in the labor force. The only consistent predictors of both transitional and stage retirement stress were poor health and family finances; personality did not predict retirement stress.

The MAC scale in a normal population: the meaning of "false positives".

The MAC scale has been very successful in identifying alcoholics and, in studies of clinical populations, is often considered a test for predisposition to alcoholism. MacAndrew, however, holds that the MAC scale assesses a more general personality trait characterized by sociability, boldness, rebelliousness and pleasure seeking. The present study examines the distribution of MAC scale scores in a normal population and tests for correlates of high MAC scores other than alcohol-related problems (e.g., arrest history). The sample consisted of 1,117 men, participants in the Normative Aging Study (mean age = 61.6). As expected, heavier drinkers and problem drinkers reported significantly higher MAC scale scores than did lighter and nonproblem drinkers. However, arrestees without drinking problems had MAC scale scores nearly identical to those of problem drinkers without arrest histories (23.19 and 23.42, respectively). Further, 36% of the sample without problem drinking or arrest histories had MAC scale scores of 24 or above, the clinical indicator of alcoholism, and more than 32% of these had scores above 27. In the entire sample, of the 152 men who had MAC scores above 27, 71% had no problems, either with arrest or drinking. Results are interpreted as supporting MacAndrew's interpretation of the meaning of the MAC scale as a general personality measure rather than a specific alcoholism instrument.

Differences in social support among retirees and workers: findings from the Normative Aging Study.

Cross-sectional differences between retirees and workers in the importance of coworkers as a source of support, as well as in general quantitative support (social networks and frequency of interaction) and qualitative support (confidants and the perceived reliability of support) were examined. The sample consisted of 1,513 older men (mean age = 61), participants in the Normative Aging Study. Half (56%) were working, and the rest were retired. Slightly fewer retirees than workers reported coworker friends, especially among those who were long-term retirees or who did not work at all in retirement. Whereas similar findings were seen with quantitative support, workers and retirees reported nearly identical levels of qualitative support. However, retirees almost never discussed personal problems with former coworkers. The relevance of these findings for the convoy construct is discussed.

Childhood problem behavior and neuropsychological functioning in persons at risk for alcoholism.

The relationship of childhood hyperkinetic and minimal brain dysfunction (Hk-MBD) to neuropsychological functioning was examined in three groups of young adults. Nonalcoholic offspring of an alcoholic parent (N = 21) and of nonalcoholic parents (N = 21) were examined. A comparison group of similar age alcoholic patients (N = 21) was also studied. Each subject completed a battery of neuropsychological test measures and was administered a checklist on the presence of Hk-MBD symptoms in childhood. Offspring of an alcoholic parent and offspring of nonalcoholic parents could not be distinguished on the basis of their cognitive abilities or their frequency of reported Hk-MBD symptoms in childhood. Alcoholic subjects performed more poorly on measures of verbal and performance intelligence and reported a higher frequency of childhood Hk-MBD symptoms. Further, it was found that the frequency of childhood Hk-MBD symptoms was related to poor performance on certain types of cognitive tasks, regardless of group membership. These findings do not support the suggestion that certain cognitive deficits distinguish persons with a family history for alcoholism. However, poor neuropsychological performance in adulthood, at least on certain types of tasks, appears to be associated with the presence of childhood Hk-MBD.

Effect of major depression and antisocial personality on alcoholism: course and motivational patterns.

Major depression and antisocial personality are two diagnoses often associated with alcoholism. The relationship of these two diagnoses to the course of alcoholism and on the motivation for alcohol use was examined in a sample of 321 persons receiving inpatient treatment for alcoholism. Major depression did not alter the course of alcoholism in either men or women. However, patients with a history of major depression more frequently reported drinking to relieve symptoms related to depression than patients without a history of major depression. Patients with antisocial personality had an earlier onset of alcohol-related problems than patients without antisocial personality. The motivational patterns for drinking did not distinguish patients with antisocial personality from patients without antisocial personality. These findings indicate the etiological logical importance of antisocial personality for the development of alcoholism and highlight the patients' perception of depression as an explanation for their drinking.