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PubMed1999

Development of bladder and bowel control: significance of prematurity, perinatal risk factors, psychomotor development and gender.

UNLABELLED: Development of bladder and bowel control from 6 months to 6 years was investigated in 140 preterm children and a control group of 349 healthy term children. Structured parental interviews and neurodevelopmental assessments were carried out when the child was 1, 3, 6, 9, 12, 18 and 24 months, and at yearly intervals thereafter. Even though preterm children were put on the potty at significantly earlier ages and significantly more frequently than term children, they expressed their need for evacuation and attained day and night bladder and bowel control at the same corrected age as term children. Initiation and intensity of toilet-training were not significantly correlated with the development of bladder and bowel control. Gestational age, being too small for gestational age, adverse perinatal conditions and mild to moderate neurological impairment did not affect the occurrence of the child's initiative and the development of bladder and bowel control. Neither developmental and intelligence quotients at the age of 1 to 3 years nor the socioeconomic status of the families influenced the age at which the child became clean and dry. Girls were significantly more advanced in expressing their needs and gaining bladder and bowel control than boys in both the preterm and term groups. CONCLUSION: Development of bladder and bowel control is largely a maturational process which cannot be accelerated by an early onset or a high intensity of training. It is not affected by prematurity, adverse perinatal events or mild to moderate neurological impairment, nor is it related to psychomotor development or actual Swiss socioeconomic conditions.

Child Development↗

PubMed1996

Development of striatal dopaminergic function. I. Pre- and postnatal development of mRNAs and binding sites for striatal D1 (D1a) and D2 (D2a) receptors.

Quantitative receptor autoradiography with iodinated ligands, quantitative in situ hybridization histochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) were used to describe the prenatal and early postnatal ontogeny (embryonic day 14 to postnatal day 7, or E14 to P7) of striatal D1 and D2 dopamine receptor binding sites and mRNA levels, respectively, in relation to the development of dopaminergic nigrostriatal innervation D1 dopamine receptor, measured by [125I]SCH23982 binding, and dopamine transporter binding sites, measured by [125I]RTI-55 binding, were present in low amounts beginning on E14 (2-3% and 0.3-0.6% of adult values, respectively) and increased slowly during the prenatal period. D2 receptor binding sites, measured with [125I]spiperone, were also detected on E14 but in higher relative quantities (17% of adult values) than D1 receptor and dopamine transporter binding sites at the same age. Other than abrupt declines in the late prenatal period for D1 and D2 receptor binding sites, all three binding sites increased throughout development and increased maximally between P7 and adulthood. On P5, both D1 and D2 receptors were functionally coupled to their respective G proteins, based on GTP-induced decreases in affinity of dopamine for [125I]SCH23982 and [125I]spiperone binding. D1 receptor mRNA was present in E14 striatal anlage, increased prenatally, declined on P0, then increased to a peak on P5, after which it declined to its lowest levels (20% of peak values) in the adult. In contrast, D2 receptor mRNA levels were presented also on E14, increased to a peak on P0, declined until P5, and increased thereafter to adulthood. Anatomically, nigrostriatal innervation and D1 and D2 receptor mRNA levels increased from the medial to lateral striatal quadrants. In contrast, D1 and D2 receptor binding site ontogency exhibited fairly homogenous distributions from E18 to P7. D1 and D2 receptor mRNAs appear to be expressed early in prenatal development before there is any significant dopaminergic innervation. In contrast, the majority of D1 and D2 receptor binding activity, representing expressed receptor proteins, develops in the postnatal period and correlates well with the increase in dopaminergic innervation. Intrinsic genetic programming is more likely to be responsible for D1 and D2 receptor gene transcription in striatal neuroblasts and newly born neurons, while factors derived from ingrowing dopaminergic afferents may direct post-transcriptional dopamine receptor development. The dissociation between the ontogeny of dopamine receptor binding sites and mRNAs suggests that the developmental regulation of D1 and D2 receptor synthesis is independent of D1 and D2 receptor gene transcription.

Animals↗

PubMed1994

Teaching and learning clinical skills, Part 2--Development of a teaching model and schedule of skills development.

In Part 1 of this paper the development of a multidisciplinary Skills Centre in a London teaching hospital, and the Clinical Skills Matrix, a composite list of skills required by nurses and doctors was described. Part 2 describes how a model for skills teaching, the Integrated Skills Teaching Model, was developed in order to provide a framework for teaching within the centre. This work and that of Alavi et al (1991) led to the development of a Schedule of Skills Development. This identifies the skills to be acquired and indicates the level of performance at specific stages throughout the Project 2000 programme. The schedule provides a comprehensive overview of skill development for teachers, students and clinical staff.

Clinical Competence↗

PubMed2005

Development of a hamster superovulation program and adverse effects of gonadotropins on microfilament formation during oocyte development.

OBJECTIVE: To establish a superovulation procedure for the golden hamster (Mesocricetus auratus) by elucidating gonadotropin effects on oocyte development. DESIGN: Randomized, prospective study. SETTING: University laboratory of embryology and gamete biotechnology. ANIMAL(S): Twelve- to 15-week-old female and sexually mature male hamsters. INTERVENTION(S): Different doses of pregnant mare serum gonadotropin (PMSG) were injected into female hamsters in metestrus, diestrus, or proestrus. The same dose of hCG was injected 56 hours later. MAIN OUTCOME MEASURE(S): Embryo development and oocyte morphology after treatment. RESULT(S): First, 10 IU or 15 IU each of PMSG and hCG was injected into 10 hamsters weighing <110 or 110-130 g, respectively. All hamsters were mated, but none delivered live young after injection. Second, the doses of 15 IU, 7.5 IU, 5 IU, or 0 IU of each gonadotropin were injected into each hamster (regardless of body weight, 5 per each group). Increasing numbers of embryos were retrieved as the dosage was increased (11.2 to 46.6 embryos per hamster), whereas the percentage of two-cell embryos at retrieval was significantly decreased (100% to 3%, P<.05). In subsequent culture, none developed to blastocysts after 15-IU injection, whereas 47%, 55%, and 70% of two-cell embryos developed after 7.5-IU, 5-IU, and 0-IU treatments, respectively. As a result, females injected with 5 IU yielded more blastocysts than did females without injection (67 vs. 39). The number of inner cell mass cells per blastocyst was greatly increased in the control groups compared with the 5-IU and 7.5-IU treatment groups (22 vs. 14.3-14.7 cells per blastocyst). Third, the ultrastructure of oocytes was examined after injecting 5 IU each of PMSG and hCG (regardless of body weight). Superovulation did not affect oocyte maturation, but different patterns in microfilament formation were detected after the treatment. CONCLUSION(S): Female hamsters can be superovulated effectively by injecting equal amounts of PMSG and hCG, 56 hours apart. However, embryo development was adversely affected in a dose-dependent manner at all doses of gonadotropins, and microfilament distribution was affected by such treatment.

Actin Cytoskeleton↗

PubMed2005

Learning needs analysis: the development of a tool to support the on-going professional development of multiple sclerosis specialist nurses.

Continuous professional development (CPD) is essential in modern day nursing. Learning needs analysis (LNA) is an important element of CPD. This paper describes the development of a LNA tool for multiple sclerosis specialist nurses. The tool contains an empirically developed LNA schedule and uses a blend of both subjective and objective exercises to help the nurse formulate a comprehensive learning plan. The tool is organised into four phases: phase 1, focuses on the knowledge and skills necessary to the fulfillment of work-based objectives; phase 2, involves a more in-depth assessment of particular areas of professional knowledge; phase 3, examines learning strategies; and phase 4, involves the development of a learning plan. The tool has been implemented throughout the UK via local trainers. While the tool was developed for a specialist nurse population the principles upon which it is based are likely to be transferable to other nursing contexts.

Attitude of Health Personnel↗

PubMed2006

Prenatal methyl mercury exposure from fish consumption and child development: a review of evidence and perspectives from the Seychelles Child Development Study.

Evidence from an outbreak of methyl mercury (MeHg) poisoning in Iraq suggested that adverse effects of prenatal exposure on child development begin to appear at or above 10ppm measured in maternal hair. To test this hypothesis in a fish-eating population, we enrolled a cohort of 779 children (the main cohort) in the Seychelles Child Development Study (SCDS). The cohort was prenatally exposed to MeHg from maternal fish consumption, and the children started consuming fish products at about 1 year of age. Prenatal exposure was measured in maternal hair and recent postnatal exposure in the child's hair. The cohort has been examined six times over 11 years using extensive batteries of age-appropriate developmental tests. Analyses of a large number of developmental outcomes have identified frequent significant associations in the appropriate direction with numerous covariates known to affect child development, but only one adverse association between prenatal MeHg exposure and a developmental endpoint. Because such results could be ascribed to chance, there is no convincing evidence for an association between prenatal exposure and child development in this fish-eating population. Secondary analyses have generally supported the primary analyses, but more recently have suggested that latent or delayed adverse effects might be emerging at exposure above 10-12ppm as the children mature. This suggests that the association between prenatal exposure and child development may be more complex than originally believed. This paper reviews the SCDS main cohort study results and presents our current interpretations.

Animals↗

PubMed2006

Immune systems in developed and developing countries; implications for the design of vaccines that will work where BCG does not.

New vaccine candidates for tuberculosis are beginning to enter clinical trials. In this review we discuss issues surrounding the design of these candidates, and the way they were screened in animal models. First, screening vaccines for their ability to attenuate inevitably fatal tuberculosis in immunologically naïve mice might be leading to the selection of inappropriate candidates. We need to screen vaccines for their ability to stop the development of progressive disease, since this is what they must achieve in man. A solution to this problem is proposed. Secondly, we point out that some mouse models of tuberculosis in laboratories in developing countries, where exposure to environmental mycobacteria is large, mimic neglected aspects of human disease more closely than do low-dose infections in hyper-susceptible immunologically naïve mice in the USA or Europe. We need to think more about geographical differences in immunological experience, and these mouse models can help us. Thirdly, we conclude that in developing countries where BCG fails this is not because there is too little Th1 response, but rather because the Th1 response is rendered ineffective and immunopathological by other subversive mechanisms, including IL-4 responses and inappropriate regulatory T cell function. Therefore, we suggest that vaccines that will work in those countries might need to have immunoregulatory properties that can switch off pre-existing subversive mechanisms, and block their development in the future. The development of such vaccines, that might work where BCG does not, will require a greater understanding of the roles of the many types of regulatory T cell in tuberculosis.

Animals↗

PubMed2005

Transcript profiling during mouse oocyte development and the effect of gonadotropin priming and development in vitro.

The molecular basis for acquisition of meiotic and developmental competence, the two main outcomes of oocyte development and essential for producing an egg capable of being fertilized and supporting development to term, is largely unknown. Using microarrays, we characterized global changes in gene expression in oocytes derived from primordial, primary, secondary, small antral, and large antral follicles and used Expression Analysis Systematic Explorer (EASE) to identify biological and molecular processes that accompany these transitions and likely underpin acquisition of meiotic and developmental competence. The greatest degree of change in gene expression occurs during the primordial to primary follicle transition. Of particular interest is that specific chromosomes display significant changes in their overall transcriptional activity and that in some cases these changes are largely confined to specific regions on these chromosomes. We also examined the transcript profile of oocytes that developed in vitro, as well as following eCG priming. Remarkably, the expression profiles only differed by 4% and 2% from oocytes that developed in vivo when compared to oocytes that developed in vitro from either primordial or secondary follicles, respectively. About 1% of the genes were commonly mis-expressed, and EASE analysis revealed there is an over-representation of genes involved in transcription. Developmental competence of oocytes obtained from eCG-primed mice was substantially improved when compared to oocytes obtained from unprimed mice, and this correlated with decreased expression of genes implicated in basal transcription.

Animals↗

PubMed2005

Genome-wide expression dynamics during mouse embryonic development reveal similarities to Drosophila development.

Gene transcription mediates many vital aspects of mammalian embryonic development. A comprehensive characterization and analysis of the dynamics of gene transcription in the embryo is therefore likely to provide significant insights into the basic mechanisms of this process. We used microarrays to map transcription in the mouse embryo in the important period from embryonic day 8 (e8.0) to postnatal day 1 (p1) during which the bulk of the differentiation and development of organ systems takes place. Analysis of these expression profiles revealed distinct patterns of gene expression which correlate with the differentiation of organs including the nervous system, liver, skin, lungs, and digestive system, among others. Statistical analysis of the data based on Gene Ontology (GO) group annotation showed that specific temporal sequence patterns in gene class utilization across development are very similar to patterns seen during the embryonic development of Drosophila, suggesting conservation of the temporal progression of these processes across 550 million years of evolution. The temporal profiles of gene expression and activation of processes revealed here provide intriguing insights into the mechanisms of mammalian development, embryogenesis, and organogenesis, as well as into the evolution of developmental processes.

Animals↗

PubMed2002

Gross motor development and reach on sound as critical tools for the development of the blind child.

The aim of the study was to assess early neuromotor development in 20 congenitally blind or severely visually impaired children, nine without (B) and 11 with associated handicaps (B + H), in order to develop a strategy for early intervention in these subjects. The mean age at first observation was 11.4 months (range: 4-30 months). The mean follow-up duration was 16.9 months (range: 3-36 months). Assessment included developmental history, neurological examination, video-recording of spontaneous activity and administration of the Reynell-Zinkin Scales and neuroradiological and neurophysiological investigations. All B children walked independently (mean age 19.8 months) and 55.5% crawled (mean age 15 months); the B + H subjects displayed absence of almost all neuromotor functions, except one who walked at 20 months. All the B and just one (9%) of the B + H children developed satisfactory fine motor abilities. 'Reach on sound' at distance was achieved by all the B children by the age of 14.2 months while in the B + H group it was achieved by only two subjects at a median age of 19.5 months. We conclude that it is possible to describe the profile of neuromotor development in B and B + H children; strategies to help postural-motor development and 'reach on sound' appear to be fundamental in early intervention in these subjects.

Blindness↗

PubMed1983

Visual, kinaesthetic and cross-modal development: relationships to motor skill development.

The ability of children between the ages of 5 and 10 years to match the length of lines within and between the modalities of vision and kinaesthesis was studied. No evidence was found for specific increases in cross-modal skill which could not be explained in terms of within-modal development. Performance in the perceptual task was related to measures of developing motor skill in the children. Substantial relationships were found between performance on the within-modal tasks and motor skill, but no significant relationships were found between cross-modal measures and motor skill development. It is concluded that the development of cross-modal integration is not a major determinant of motor skill development.

Child↗

PubMed2005

Development and construct validation of an inventory for assessing the home environment for motor development.

A contemporary view of early childhood motor development considers environmental influences as critical factors in optimal growth and behavior, with the home being the primary agent. However, there has been minimal research examining the relationship between motor development and the home. The present study addresses this gap with the goal of creating an innovative parental self-report instrument to assess the quality and quantity of factors (affordances and events) in the home that are conducive to enhancing motor development in children ages 18-42 months. Following initial face validity determination, expert opinion feedback and selective pilot testing, construct validity was examined using 321 Portuguese families. Factor analysis techniques were used to: (a) compare competingf actorial models according to previous theoretical assumptions, and (b) analyze the fit of the preferred model. Of the five plausible models tested, the five-factor solution provided the best fit to the data. Reliability was established through the scale reliability coefficient with a value of .85. The findings of this study suggest that the Affordances in the Home Environment for Motor Development Self-Report is a valid and reliable instrument to assess how well home environments afford movement and potentially promote motor development.

Child Development↗

PubMed2005

Early childhood development interventions and cognitive development of young children in rural Vietnam.

Little is known about the long-term benefits of interventions that aim to promote early childhood development programs. The goal of this research was to determine whether an early childhood development intervention added to a nutrition intervention during preschool ages had lasting effects on the cognitive development of school-age children in communes of Thanh Hoa province in rural Vietnam. The study focused on a total of 313 children aged 6.5-8.5 y (grades 1 and 2 in primary school) in 2 communes that were exposed to nutrition intervention or nutrition and early childhood development (ECD) intervention from 1999 to 2003. Measurements of height and cognitive test scores (Raven's Progressive Matrices Test) were collected from the children; household characteristics were determined by interviews with mothers. Longitudinal analysis was performed by integrating the data with that collected from the same children in past surveys. Significant effects of the ECD intervention compared with the nutrition intervention were detected. The beneficial effect of ECD intervention on the cognitive test scores was large for the most nutritionally challenged children whose height-for-age Z-scores declined or remained in the stunted range. The findings help provide useful insights into the development of an effective integrated model of ECD and nutrition intervention for children in rural Vietnam.

Body Height↗

PubMed2000

The patient care development programme: organisational development through user and staff involvement.

A number of approaches have been developed in recent years to try effectively to engage service users in the process of planning and delivering health-care services. The consumerist methodology for the strategy described in this paper was designed to maximise staff involvement in capturing user views, in order to develop services at a district general hospital. This strategy--the Patient Care Development Programme (PCDP)--provides a framework for both staff and patient involvement in shaping and influencing the development of health-care services. Uses the findings from applying the strategy to modify care packages, roles, skills, layouts, protocols and procedures, in response to both the "shortfalls" and the service strengths that the patient's view uncovers. Discusses the results of an evaluation of the programme which has been replicated in another part of the UK. The PCDP now forms part of a clinical governance framework and is being used to develop multi-agency integrated care pathways.

Community Participation↗

PubMed2006

Appraisal, assessment and career development for doctors in training: the Mersey Deanery personal development portfolio.

OBJECTIVES: To develop a robust valid and exportable appraisal and assessment process for doctors in training which is portfolio based and works at all hospitals within the deanery. It is called the personal development portfolio. DESIGN: For every senior house officer, there was a recorded meeting with his or her supervisor, at the beginning, midterm and at the end of the post. An outside assessor witnessed the exit assessment meeting. SETTING: The Wirral Hospital, a District General Hospital with 72 senior house officers in 10 different specialties was used as a pilot site to develop the process. Then the process was exported and implemented at the other 12 trusts of the deanery. MAIN OUTCOME MEASURES: Records were kept of the induction, midterm and exit assessment meetings. A record was kept of the number of senior house officers succeeding and failing at their exit assessments. Also, the number promoted to the specialist registrar grade was recorded. RESULTS: The process was performed every 6 months on 11 occasions between 2000 and 2005. It involved 72 senior house officers in 10 different specialties. On each occasion, participation usually exceeded 70%: 623 were appraised and assessed and 609 of them (97.8%) had satisfactory exit assessments. For 14 doctors (2.2%), the process identified a cause for concern, which was usually accepted by the doctor and sometimes allowed remedial action to be taken. Twenty-six (4.2%) were promoted to the specialist registrar grade in this period. The process also identified the strengths and weaknesses of the senior house officer posts in the 10 different specialties that had such posts, and was used to encourage good medical teaching practice in them. Over 4 years, we exported the process to all the other 12 Trusts in the Mersey Deanery. Once established, the process was easy to use for both trainees and trainers, although it was time consuming. CONCLUSIONS: It was possible to develop and implement a portfolio based appraisal and assessment process, which was accepted by senior house officers and their trainers in all specialties at all hospitals within the deanery. Now that the senior house officer grade has been superseded by the Foundation and the training grade years, the principles of the personal development portfolio are being used to appraise and assess doctors in these grades too.

Career Mobility↗

PubMed1993

Estrogen receptors, estradiol, and diethylstilbestrol in early development: the mouse as a model for the study of estrogen receptors and estrogen sensitivity in embryonic development of male and female reproductive tracts.

To date, there is no conclusive evidence that ERs are present in preimplantation embryos. There are reports that estrogen is made by the rabbit blastocyst (61), and estrogens have been used to induce implantation in mice (62), but whether estrogens act through ERs in the embryo or in the maternal uterus is not known. ERs may be present in early embryos, but if so, levels are below the methods of detection used thus far. Perhaps with more sensitive immunodetection methods, it may be possible to detect ERs in embryos if they are present. Using PCR, messenger RNA for ER has been detected as early as the oocyte stage in mouse embryos (Q. Hou and J. Gorski, unpublished results). This was confirmed recently by Wu et al. (83a). Figure 7 shows a model for the pattern of ER expression in the developing mouse fetus based on the various reports discussed in this review. ERs are present in the 10-day mouse fetus, possibly in the developing ambisexual reproductive tract. Analysis of seven individual 10-day-old fetuses taken from the same litter showed similar levels of an immunostained protein the size of the ER in each fetus (57). The pattern of expression of ER between implantation and the development of the reproductive tract may be the same in male and female mice. Estrogen, acting through ERs, may be one factor (of many) that determines which cells are destined to be part of the indifferent reproductive tract. We were not able to isolate fetal mouse reproductive tracts at an indifferent stage (day 10) due to their very small size. One way to study ER in the indifferent reproductive tract would be to examine these tissues in a larger animal, such as the bovine, using similar immunodetection methods. The distribution of ER in the fetal mouse reproductive tract on fetal days 13 (before sexual differentiation) and 15 (initiation of sexual differentiation) is similar in males and females (71, 72). Thus, estrogen does not appear to be responsible for the initiation of sexual differentiation. Early experiments by Jost (41) showed that removal of the gonad from male or female rabbit fetuses resulted in the female phenotype, which lent weight to the hypothesis that ovarian hormones are not critical in the development of the female phenotype, whereas testicular hormones are essential for the development of the male phenotype.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1992

Insulin and insulinlike growth factors in embryonic development. Effects of a biologically inert insulin (guinea pig) on rat embryonic growth and development in vitro.

Congenital anomalies occur up to four times more frequently in diabetic pregnancy than in the nondiabetic population. Although past work has shown that maternal hyperglycemia and hyperketonemia may increase embryonic abnormalities, recent experimental evidence suggests that low insulin levels may also contribute to diabetic embryopathy. This study investigated the effects of guinea pig serum (whose insulin is inactive in rat systems) on rat embryonic growth and development in culture. Supplementation of guinea pig serum with pork insulin at low (1 ng/ml) and high (5 ng/ml) physiological concentrations and insulinlike growth factors (IGF) I and II were also studied. Culture of rat embryos from the early headfold stage in guinea pig serum resulted in poor embryonic growth and development with a 92% rate of anomalies. Supplementation of guinea pig serum with zinc-binding pork insulin significantly improved rat embryonic growth and development (46% anomaly rate) especially between the first 5 and 21 h of the period of organogenesis. This evidence supports our most recent findings that low insulin levels, as encountered in untreated diabetic pregnancy, may contribute to the increased risk of congenital abnormality. Insulin at low physiological concentrations improved growth, whereas higher physiological concentrations were required to increase growth and development. IGF-I or IGF-II supplementation improved rat embryonic growth and development but failed to match that of the controls, indicating that other growth factors including insulin may also be required.

Abnormalities, Drug-Induced↗

PubMedDate not supplied

The important role of international exchange in the development of medical informatics in developing countries: a report from China.

China is a developing country, and so is inferior to the developed countries in many aspects of science and technology. It is similarly a new member in the world ranking of the application of computers in biomedicine. However, since implementing the policy of reform and opening to the outside world in 1976, China has achieved greater success in biomedical signal and image processing, biomedical data processing, computer-aided diagnosis, computerized hospital management, etc. China's development shows that international exchange and cooperation are very important for the development of medical informatics in developing countries, and the application of computers in biomedicine has progressively spread all over the world and is increasingly taking root in the hearts of the people.

China↗