A pilot study was undertaken to assess the validity of two new tests for predicting the immune response of Toronto schoolchildren with no acceptable evidence of prior administration of diphtheria or tetanus toxoid to a routine booster injection of diphtheria and tetanus (DT) toxoid. The tests, an inexpensive enzyme-linked immunosorbent assay (ELISA) fingerprick test for tetanus antibodies and a modification of the Schick skin test for susceptibility to diphtheria, were administered before the booster injection. One week later the ELISA test was repeated and the result of the modified Schick test read. On both occasions a diphtheria microneutralization assay was done for "gold standard" evidence of prior exposure to diphtheria toxoid or toxin. The results were used to determine the sensitivity and specificity of a single prebooster tetanus ELISA test or a modified Schick test for predicting which children with no records could be safely protected with only one DT booster dose instead of the primary series of three or four doses usually given to such children. Only 6 of the 34 subjects (18%) were totally without prior exposure to tetanus toxoid. Two of the six (6% of 33 subjects) appeared to mount a primary immune response to diphtheria toxoid as well. An initial ELISA titre of 0.01 IU/ml or lower correctly identified all six children needing a full series of tetanus toxoid (sensitivity for a primary immune response 100%) and falsely identified only 3 of 28 immune children as needing the series (specificity for immunity 89.3%). The modified Schick test appeared to have even greater accuracy for identifying children needing a full series of diphtheria toxoid. However, its use, entailing the costs of an extra nurse visit, would have prevented only seven more children from receiving an unnecessary full series of diphtheria toxoid than use of the baseline tetanus ELISA test alone.
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This study evaluates initial validity and reliability of the "Galker test of speech reception in noise" developed for Danish preschool children suspected to have problems with hearing or understanding speech against strict psychometric standards and assesses acceptance by the children.
The Galker test is an audio-visual, computerised, word discrimination test in background noise, originally comprised of 50 word pairs. Three hundred and eighty eight children attending ordinary day care centres and aged 3-5 years were included. With multiple regression and the Rasch item response model it was examined whether the total score of the Galker test validly reflected item responses across subgroups defined by sex, age, bilingualism, tympanometry, audiometry and verbal comprehension.
A total of 370 children (95%) accepted testing and 339 (87%) completed all 50 items. The analysis showed that 35 items fitted the Rasch model. Reliability was 0.75 before and after exclusion of the 15 non-fitting items. In the stepwise linear regression model age group of children could explain 20% of the variation in Galker-35-score, sex 1%, second language at home 4%, tympanometry in best ear 2%, and parental education another 2%. Other variable did not reach significance.
The Galker-35 was well accepted by children down to the age of 3 years and results indicate that the scale represents construct valid and reliable measurement.
In Finland, the Finnish Association for Swimming Instruction and Life Saving (SUH) and Statistics Finland (SF) both provide nationwide data on unintentional drowning. The SUH database relies on rapid reporting from a newspaper clipping service and additional local police information, whereas the SF database relies on the later release of the death certificate information, which is based on extensive medico-legal investigation. The aim of the study was to explore the main differences between the SUH and SF databases for drowning and to evaluate the capacity of the former to characterize drowning events in Finland from 1998 to 2000. Computerized files of death certificates tabulated by SF were linked with the SUH database by deterministic methods. SF and SUH databases allowed the identification of 704 and 567 unintentional drownings, respectively, giving an unintentional drowning rate of 4.5 and 3.6/100?000 per year. Of the 704 drownings described by SF, 418 (59.4%) were also found in the SUH database. The SUH database markedly underreported drowning fatalities in certain settings, such as bath, ditch and swimming pool drownings; fall- and land-traffic-related drownings; and drownings occurring in South Finland. The narrative text of SUH drownings contributed limited information to characterize the drowning events. It was concluded that the newspaper-based SUH data provide more timely data on individual drownings but are not representative of all drownings. Conversely, the SF vital statistics data are more accurate but may take up to 2 years to become available. Both SUH and SF data provide little detailed information on drowning events. A multidisciplinary national surveillance system for drowning is necessary to provide more accurate and timely drowning data, analyse risk factors and design follow-up studies for developing and monitoring prevention strategies.
To investigate relations between children's attachment and sleep, using objective and subjective sleep measures. Secondarily, to identify the most accurate actigraphy algorithm for toddlers.
55 mother-child dyads took part in the Strange Situation Procedure (18 months) to assess attachment. At 2 years, children wore an Actiwatch for a 72-hr period, and their mothers completed a sleep diary.
The high sensitivity (80) and smoothed actigraphy algorithms provided the most plausible sleep data. Maternal diaries yielded longer estimated sleep duration and shorter wake duration at night and showed poor agreement with actigraphy. More resistant attachment behavior was not associated with actigraphy-assessed sleep, but was associated with longer nocturnal wake duration as estimated by mothers, and with a reduced actigraphy-diary discrepancy.
Mothers of children with resistant attachment are more aware of their child's nocturnal awakenings. Researchers and clinicians should select the best sleep measurement method for their specific needs.
Previous growth references for Norwegian children were based on measurements from the 1970s and 1980s. New reference data, collected through the Bergen Growth Study and the Medical Birth Registry of Norway, are presented as LMS values.
A cross-sectional sample of children aged 0-19 years in stratified randomized design measured in 2003-2006 as a part of the Bergen Growth Study (n = 7291) and birth data of children born in 1999-2003 from the Medical Birth Registry of Norway (n = 12 576) was used to estimate the new references by the means of the LMS method. Measurement reliability was assessed by test-rest studies.
New references were constructed for length/height, weight, body mass index (BMI) and head circumference. Length/height and weight for children aged 0-4 years were similar to previous Norwegian references, but mean height increased up to a maximum of 3.4 cm in boys and 2.5 cm in girls during the pubertal years. Mean height was similar to (or slightly higher) in comparison with other recent European references. Reliability of the measurements compared well with published estimates.
Because of the observed secular trends in growth, it is advised to use the new references, which have been endorsed by the Norwegian Department of Health.
Although a great variety of pediatric tests of visual acuity exist, few have been compared directly within the same patients or have been evaluated directly against an adult gold standard.
Right eyes from 80 3- to 5-year-old preschoolers were tested at 3 m with the two current pediatric optotype tests-the Patti Pics and the Lea Symbols (Mass VAT versions)-that best adhere to the international standard for early eye and vision screening. For comparison, right eyes from 52 adults were tested under the same conditions with both pediatric tests and with a gold standard Mass VAT Sloan letter test.
Compared with the Patti Pics, both children and adults showed relatively better and finer levels of visual acuity with Lea Symbols (0.07-0.11 logMAR better). Compared with Sloan letters, adults' acuity was also 0.09 logMAR better with the Lea Symbols but was virtually identical and also showed good statistical agreement with Patti Pics acuity.
Although both pediatric tests show excellent testability, our data suggest that acuity values obtained with the Patti Pics optotypes are more consistent with those obtained with a gold standard visual acuity test used for older children and adults.
The authors examine the metrological qualities of a French version of the Parenting Stress Index (Abidin, 1983; Loyd and Abidin, 1985) based on a sampling of 122 Québec mothers with a preschool child. Results show that the Parental Stress Inventory presents internal consistency indices that are equivalent to those obtained in the U.S. sampling. However, the samplings differ on seven out of 13 subscales, as well as concerning the scores obtained for the child's realm and the overall stress, Québec mothers show higher scores. The factorial analysis of the subscales supports the existence of a hierarchical structure composed of a general factor of parental stress and two specific factors: the realm of the child and the realm of the parent. The score relative to the realm of the parent varies according to the socioeconomic level and the marital status of the mother. The mother's age is negatively correlated with the score of the child's realm. The child's aggressiveness/hyperactivity level, as perceived by the teacher in a class situation, is positively correlated with the score of the subscale Difficulty to accept the child's characteristics and the subscale Distraction and hyperactivity of the child. The authors present benchmarks that were developed in order to take into account the noted differences between the Québec and U.S. samplings.
Erratum In: Sante Ment Que 1993 Spring;18(1):321-2
Anatomic injury, physiological derangement, age, and injury mechanism are well-founded predictors of trauma outcome. We aimed to develop and validate the first Scandinavian survival prediction model for trauma.
Eligible were patients admitted to Oslo University Hospital Ullevål within 24?h after injury with Injury Severity Score =?10, proximal penetrating injuries or received by a trauma team. The derivation dataset comprised 5363 patients (August 2000 to July 2006); the validation dataset comprised 2517 patients (August 2006 to July 2008). Exclusion because of missing data was
To provide X-ray characteristics of mediastinal lymph nodes revealed by computed tomography (CT) in children and adolescents with uninfected Mycobacterium tuberculosis.
The basis of the study was the results of CT in 105 children and adolescents with uninfected with Mycobacterium tuberculosis. All the children and adolescents from a follow-up group underwent X-ray study using a two-slice spiral Somatom Emotion Duo CT scanner (Siemens). The study used a conventional procedure for chest scanning in children, by applying the Thorax Routine program.
The study ascertained that Groups 1-3 intrathoracic lymph nodes were visualized in 73.3% of the children in normalcy and were not in 22.8%. In children, the normal size of the lymph nodes did not exceed 0.8 cm in diameter; they had a homogeneous structure and clearly defined, even outlines; their perinodular fat was unchanged. CT data showed that the sizes and number of visible groups of lymph nodes were unrelated to age.
The upper diameter limit for normal mediastinal lymph nodes may be established to be 8 mm if there were no abnormal changes in the structure of lymph nodes and perinodular fat.
We present the validation of a translation into Danish of the Oxford ankle foot questionnaire (OxAFQ). We followed the Isis Pros guidelines for translation and pilot-tested the questionnaire on ten children and their parents. Following modifications we tested the validity of the final questionnaire on 82 children (36 boys and 45 girls) with a mean age of 11.7 years (5.5 to 16.0) and their parents. We tested the reliability (repeatability (test-retest), child-parent agreement, internal consistency), feasibility (response rate, time to completion, floor and ceiling effects) and construct validity. The generic child health questionnaire was used for comparison. We found good internal consistency for the physical and the school and play domains, but lower internal consistency for the emotional domain. Overall, good repeatability was found within children and parents as well as agreement between children and parents. The OxAFQ was fast and easy to complete, but we observed a tendency towards ceiling effects in the school and play and emotional domains. To our knowledge this is the first independent validation of the OxAFQ in any language. We found it valid and feasible for use in the clinic to assess the impact on children's lives of foot and/or ankle disorders. It is a valuable research tool.