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Biomedical subjects

F Oberklaid

Publications and source records attributed to F Oberklaid.

At least 19 recordsLinked to original sources
PubMed1995

Late diagnosis of congenital sensorineural hearing impairment: why are detection methods failing?

This study was designed to look in detail at the paths to diagnosis for a group of 197 children with congenital sensorineural hearing impairment (SNHI), who were diagnosed between 1989 and 1991 in the state of Victoria, Australia. Despite the existence of universal infant screening at 7-9 months by distraction test or questionnaire, the median age at diagnosis for the study group was 18.0 months, with median age at aid fitting of 20.8 months, and median age at commencement of specialised intervention programmes of 22.3 months. Parent questionnaires completed for 143 (73%) of these children showed that 49% had known risk factors for hearing loss yet only 20% of them had been referred for audiological assessment before the 7-9 month screen. Only 63% of those eligible for the 7-9 month screen had received it. Of those children who were screened by distraction test 46% passed as did 57% of those screened by questionnaire. Twenty four parents (17%) described how they had initially 'denied' their own observations of their infants' abnormal hearing behaviour. When concerns were raised with professionals, 10% of parents were falsely reassured without audiological assessment. Detection methods are failing through a combination of poor screen test efficacy, incomplete population coverage, and parental and professional denial.

Age Factors↗
PubMed1995

Is community screening for amblyopia possible, or appropriate?

Photoscreeners are becoming increasingly available and are being widely used to screen for visual abnormalities in young children. However, consideration of accepted criteria for screening programs indicates there is still much further research that needs to be carried out before amblyopia screening could be recommended as a routine component of a community health surveillance program--an adequate description of the potential consequences of an individual developing amblyopia has yet to be provided and the natural history of the condition and factors that determine the effectiveness of treatment have yet to be fully described. While there is the promise of technology that satisfies specific test requirements, this still needs to be trialed in community settings and community trials are required before it will be possible to determine whether the costs that will be incurred in carrying out routine screening and in providing the resources for treatment are warranted. In conclusion, the development of new and possibly more effective technology for screening is only part of the answer to the amblyopia question. While superficially this technology makes screening for amblyopia a possibility, we do not know at this stage whether or not it is appropriate.

Amblyopia↗
PubMed1992

Health screening of international adoptees. Evaluation of a hospital based clinic.

OBJECTIVE: To report the findings of health screening of 100 international adoptees. DESIGN: Retrospective case review. SETTING AND PATIENTS: The first 100 children to attend the Outpatient Inter-Country Adoption Clinic at the Royal Children's Hospital, Melbourne. INTERVENTIONS: A medical history was taken and a thorough physical examination and series of screening investigations were performed on all children. RESULTS: The children ranged in age from two months to 16 years (median, five months; mean, 2.8 years). The countries most represented were Korea, with 36 children, and India, with 21. Thirty children fell below the third Australian centile for both height and weight. Abnormalities on physical examination included hepatosplenomegaly (13 children), scabies (six) and severe dental caries (six). Parasitic infestation of the stools was found in 23 children, a positive Mantoux test result in nine (three had active tuberculosis), anaemia in 12, elevated hepatic transaminase levels in nine and positive hepatitis B surface antigen and e antigen in two. One child had acquired syphilis. Screening for human immunodeficiency virus antibody gave negative results in all children. CONCLUSION: International adoptees constitute a special paediatric subgroup requiring assessment and screening investigations as soon as possible after arrival in their adoptive country.

Adolescent↗
PubMed1992

Charting infant distress: an aid to defining colic.

The value of a 24-hour distress diary, previously validated against a voice-activated audiotape record, was investigated in 30 infants with colic and 30 control infants. The infants with colic had significantly more distress behavior (300.0 minutes vs 102.5 minutes; p < 0.001), although overlap of duration of distress was noted. On the basis of a clinical definition of colic--total distress lasting 180 minutes in a 24-hour period--the diary had a sensitivity of 77% and a specificity of 87%. The sensitivity of the chart was confirmed in a separate study of another 90 infants with colic.

Child Behavior↗
PubMed1992

Transient versus stable behavior problems in a normative sample: infancy to school age.

Identified 3 subgroups of children from a prospective longitudinal study of temperament and development: (a) those with stable, (b) transient, or (c) no-behavior problems, as rated by mothers across the toddler, preschool, and preparatory school grade periods. Children with stable behavior problems were particularly characterized by more difficult temperament, mothers' overall perception of the child as difficult, and aggressive behavior in the 2- to 4-year age period. Group differences were linear rather than categorical with transient behavior problem children showing a lesser degree of difficulty. In a second study where more comprehensive child and family measures were available, temperament was again an important discriminator, with Vineland Adaptive Behavior Composite Score, mothers' overall perception of the child's temperament, and maternal psychological health and stress factors also more adverse for the stable group. However, correct classification of the members of these groups using a combination of the above variables was not impressive.

Child↗
PubMed1992

The detection of developmental problems in children.

General practitioners are ideally placed to assist in the identification of children whose development is slower than expected for age. In this article various methods of detecting developmental delay are discussed, and an algorithm is proposed for application in a busy office.

Age Factors↗
PubMed1991

Can short hospital admissions be avoided? A review of admissions of less than 24 hours' duration in a paediatric teaching hospital.

OBJECTIVE: To review the records of children admitted to hospital for less than 24 hours to assess the appropriateness of the admission and subsequent discharge, and the suitability of these patients for admission to a short stay area rather than the hospital wards. DESIGN: Retrospective study consisting of a one in three sample of all children admitted to the hospital's general medical units over one year. All admissions were listed sequentially, and every third patient was included in the study. SETTING: Royal Children's Hospital, Melbourne; a tertiary paediatric hospital with a major primary care role. PARTICIPANTS: There were a total of 660 patients eligible for inclusion in the study; 220 were selected, and all records were reviewed. RESULTS: It was found that although 87.7% of admissions could be justified on medical grounds alone, the children quickly recovered with at least 65% being fit for discharge within 12 hours of admission. In spite of this the mean duration of admission was 17.0 hours. The majority of patients were suffering from easily diagnosed and treated disorders, with 78.9% falling into four diagnostic groups (asthma, ingestions, infections, and convulsions). Criteria for admission to a short stay observation area were satisfied in 65% of patients (at the time of the study no such area existed in the hospital). No patients were discharged inappropriately early. CONCLUSIONS: A significant number of children require brief hospitalisation for relatively minor illness, but unnecessary delays caused by administrative aspects of hospital admission and relatively infrequent inpatient review by medical staff often lengthen the period of admission. Significant cost savings are possible with the use of a short stay facility, and a large number of patients are suitable for this form of care.

Australia↗
PubMed1991

Randomised trial of laxatives in treatment of childhood encopresis.

Primary faecal incontinence (encopresis) in children is usually treated with laxative medication and a behaviour modification programme aimed at promoting regular toileting, but the effectiveness of laxatives has never been adequately investigated. 169 children with encopresis and evidence of stool on plain abdominal radiograph were randomly allocated to receive multimodal (MM) therapy (laxatives plus behaviour modification; n = 83) or behaviour modification alone (BM; n = 86). Mean (SD) follow-up was 55.1 (27.0) weeks and 56.7 (32.0) weeks, respectively. By 12 months' follow-up 42 (51%) of the MM group and 31 (36%) of the BM group (p = 0.079) had achieved remission (at least one 4 week period with no soiling episodes) and 52 (63%) vs 37 (43%) (p = 0.016) had achieved at least partial remission (soiling no more than once a week). MM subjects achieved remission significantly sooner than BM subjects, and the difference in the Kaplan-Meier remission curves was most striking in the first 30 weeks of follow-up (p = 0.012). The patterns of compliance with toileting in the treatment groups were almost identical, although about 1 in 8 children overall did not comply with the sitting programme. After exclusion of the 24 poor compliers, there was no significant difference between BM and MM groups. This study shows a clear advantage overall for the use of laxative medication, although the benefit may not be as great for children who are able to maintain regular toileting.

Adolescent↗
PubMed1991

Acute asthma in children: evaluation of management in a hospital emergency department.

To test the premise that asthma in children is treated erratically and often inappropriately, we studied the medical records of children with asthma presenting to the emergency department of a paediatric teaching hospital over a 12-month period. Four hundred and twenty-two patients (10% of those eligible) were selected; they ranged in age from 5 months to 17 years with a mean age of 5.4 years and a male to female ratio of 1.6:1. Eighty-six per cent of patients were self referred and 53% had a documented history of asthma. Thirty-seven per cent of patients were not taking medication at the time of presentation and 19% had been prescribed antibiotics. Documentation of physical findings in the medical record was generally inconsistent. For the vast majority of patients the treatment given was a nebulised beta-agonist, with 30% receiving oral corticosteroids. Seventy-six per cent of patients were able to be discharged from the emergency department, but 10% of these patients re-presented during the same attack. When discharged, 98% of patients were taking beta-agonists, 23.5% theophylline and 29% corticosteroids (usually a short oral course). For over one-third of patients attending the emergency department no documented follow-up arrangements were made. The poor documentation of severity and the variability of treatment of asthma among physicians, both in the community and in the emergency department, is cause for concern. There is a need for further education of health professionals in the appropriate assessment, documentation and treatment of asthma in children.

Adrenal Cortex Hormones↗
PubMed1991

Risk indicators: assessment of infancy predictors of pre-school behavioural maladjustment.

The prediction of later outcome from factors present in infancy has been an ongoing concern, with difficult temperament frequently being posited as one important risk factor. Using data from a longitudinal study of a large representative sample of children, and a categorical approach to analysis, a set of infancy risk factors covering within-child, environmental and relationship variables was related to behavioural and emotional adjustment at 4-5 years. Single risk factors, including difficult temperament, resulted in only modest increases in the prevalence of later maladjustment. However, certain combinations of risk factors were associated with markedly increased prevalence rates. The results indicate the cumulative effects of risk factors, and the need to consider temperament within a contextual framework.

Affective Symptoms↗
PubMed1991

Temperament and behavior of preterm infants: a six-year follow-up.

To test the commonly held premise that prematurity is a risk factor for problems of behavior and social interaction, as well as cognitive and physical development, temperament and behavior of children born preterm and full-term control subjects were compared at five separate time periods from infancy through early school age. All the preterm infants (n = 126) of a representative group of infants enrolled in a longitudinal study (n = 2443) were surveyed at 4 to 8 months corrected age. Subsamples of the group were studied further in successive years as young toddlers (n = 65), older toddlers (n = 60), preschoolers (n = 84), and at early school age (n = 81). At each period there were no differences between those studied and those not studied on socioeconomic status, gestational age, sex, or birth order. Parental ratings of temperament and behavior were used at appropriate ages: the Revised Infant Temperament Questionnaire, the Toddler Temperament Scale, the Childhood Temperament Questionnaire, Behaviour Checklist, Preschool Behaviour Questionnaire, and Rutter's Childhood Behaviour Questionnaire (CBQ), as well as mother's overall rating of temperament. In infancy there were no significant differences on temperament dimensions, clinical temperament categories, or parental ratings of individual or composite behaviors between the preterm and full-term groups. For toddlers, temperament scores were similar for the two groups but preterm subjects were significantly more likely (P less than .01) to have an easy temperament and less likely to have a difficult temperament. There were no differences on any of the other temperament or behavior ratings.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Behavior↗
PubMed1990

It's time: the future of school health in Australia.

School medical services in Australia have a long tradition of providing community-based services to school-aged children, and in some states to preschool children. Conceived as a public health measure early this century, doctors and nurses worked in schools to address the health issues of the time, which were largely to do with nutrition, hygiene, and infectious diseases. It was perceived that many children had poor access to medical care, and began school with unaddressed health problems which often had a deleterious effect on their learning. Doctors were often employed by education authorities and only transferred to health departments many years later. In some states the service was expanded subsequently to include preschool children, based on the concept that the earlier problems were detected the earlier they could be treated appropriately and the greater the benefits to the child. While social structures, community needs and paediatric morbidity patterns have changed dramatically over recent years, there is a widespread perception that in some states school medical services have not yet embraced fully the changing needs of the population of school children they are designed to serve. Hamstrung by political expediency (with decision-making driven by political rather than scientific considerations) and bureaucratic inertia, school nurses and doctors often operate in structures and systems that are urgently in need of review and reorganization. In this paper the rationale for current processes will be reviewed critically, a model of school health services focused on contemporary paediatric needs is proposed, and a set of factors which are considered essential to the development of the school health services of the future is outlined.

Australia↗
PubMed1990

Assessment of temperament in the toddler age group.

We used the Toddler Temperament Scale with large representative samples of younger (mean age = 20.5 months; N = 1188) and older (mean age = 35.4 months; N = 1360) Australian toddlers. There were significant sex differences on 6 of the temperament dimensions for the young group, and on 5 of the 9 dimensions for the older group. Older boys were also more likely to be categorized clinically as having a "difficult" temperament and less likely to have an "easy" temperament. Each group was divided into quartiles according to socioeconomic status. For the younger toddlers there were significant differences in 3 of 9 temperament dimensions, and for the older group there were significant differences in 7 of 9 dimensions. Groups with higher socioeconomic status had temperament ratings which were more likely to make them easier to manage, and to be categorized clinically as having an easy temperament, but toddlers with low socioeconomic status were more likely to have a difficult temperament. There were significant differences in temperament dimension scores between Australian toddlers and those studied in an American setting. These results indicate that toddler temperament ratings differ according to age, sex, social class, and cultural context. Great caution needs to be taken in interpreting individual temperament profiles utilizing comparison data obtained from different sociocultural settings. Future temperament "norms" may need to specify characteristics of the group of children from which they were derived to allow more valid comparisons.

Age Factors↗