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Four models (and an emergent fifth model) of parent partnership are described and their relevance to UK child development centres is explored. Clinical, management and service development issues are drawn out.
The literature remains unclear about the effects of prenatal cocaine exposure on child development. Meanwhile, the implications for public policy and treatment and for our scientific understanding of the toxicity of cocaine are substantial. In this article we describe; (1) our current understanding of the effects of prenatal cocaine use and child outcome, (2) the issues that need to be investigated, and (3) implications for treatment of cocaine exposed children. Findings from our database of the published literature shows that our knowledge is still limited, scattered, and compromised by methodological problems that mitigate any conclusions about whether or not or how prenatal cocaine exposure affects child outcome. The cocaine problem is more complicated than first envisioned--it is a multifactorial problem including the use of other drugs, parenting, and environmental lifestyle issues. However, we also show that, even though the effects may be more subtle than initially anticipated, prenatal cocaine exposure will substantially increase in the number of school age children who will need special education services. Clinicians working with these children and families need to be prepared to address psychosocial and environmental issues, as well as developmental performance, in order to optimize their assessment and intervention.
Smoking among greenlandic schoolchildren is considered a major health hazard. Greenland is a modern society susceptible to social changes, including changes in family structure. The objective was to investigate if changes in the family, as a child development context, were affecting schoolchildren's smoking behaviour. The survey was carried out in February 1998 in all schools in Greenland in the context of the WHO Health Behaviour in School-Aged Children study. 3081 questionnaires were received, which gave a response rate of 68% of the total study population. The present sample from the HBSC study consists of 1648 students, 826 boys and 822 girls in the age groups 11, 13 and 15 years old. Descriptive statistics and a logistic regression model were applied. The results were that smoking prevalence among Greenlandic schoolchildren increased with age and was lower in boys than in girls. Daily smoking prevalence among 15 year olds was high, namely 50% among boys and 56% among girls. With regard to family structure, it was found that the odds ratio for smoking was higher when the child was living in an broken/restructured family versus living in a biological family. The influence of socio-economic class on smoking behaviour was weak and statistically insignificant, and age proved to be the strongest predictor of prevalence in smoking behaviour.
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OBJECTIVES: To compare the early employment careers of people with disabilities and their non-disabled contemporaries. STUDY DESIGN: The employment of 436 people with disabilities was investigated between the ages of 23 and 33. The sample were part of a continuing longitudinal study, the National Child Development Study (NCDS), of some 17,000 people born during one week in 1958 and living in England, Wales and Scotland. Cross-tabulations were carried out comparing the employment of people with disabilities and that of their non-disabled counterparts using SPSS for Windows. RESULTS: Despite the majority of the sample not having difficulties with everyday activities people with disabilities were disadvantaged in terms of educational and vocational qualifications, employment rates and earnings. Those with physical disabilities fared better than the other disability groups in terms of employment and earnings, among this group men with 'below average' educational and vocational qualifications differing most from their non-disabled counterparts and women with 'above average' qualifications differing least. CONCLUSIONS: Findings indicate the importance of educational and vocational qualifications for those with disabilities, for more emphasis on job retention, for measures against wage discrimination, and for job placement assistance for some groups of those with a disability.
Several birth cohort studies have shown adverse effects of perinatal exposures to methylmercury (MeHg) and environmentally persistent organic pollutants (POPs). These chemicals are ingested mainly through fish consumption, but little is known about the hazardous effects in Japanese, whose fish consumption is high. The present study, the Tohoku Study of Child Development, was designed to examine the effects of perinatal exposures to MeHg, polychlorinated biphenyls (PCB), dioxins, pesticides, and other chemicals in Japanese children. Six hundred eighty-seven pregnant women were participated in this study with their written informed consent. Maternal peripheral blood, cord blood, cord tissue, placenta, and breast milk samples were collected for chemical analysis. Maternal hair was also taken for MeHg analysis. Infants born at full term were assessed by neurobehavioral tests: the Brazelton Neonatal Behavioral Assessment Scale at three days old, the Kyoto Scale of Psychological Development and the Bayley Scales of Infant Development at 7 and 18 months old, and the Fagan Test of Infant Intelligence at 7 months old. The children will be continuously followed up to ages 6-7 years. Maternal food intake frequency, maternal IQ, socioeconomic status, and home environment were assessed as covariates. The results of this cohort study will allow us to evaluate associations between the neurobehavioral development of children and perinatal exposures to MeHg and environmentally POPs in Japan.
Developmental disabilities result from complex interactions of genetic, toxicologic (chemical), and social factors. Among these various causes, toxicologic exposures deserve special scrutiny because they are readily preventable. This article provides an introduction to some of the literature addressing the effects of these toxicologic exposures on the developing brain. This body of research demonstrates cause for serious concern that commonly encountered household and environmental chemicals contribute to developmental disabilities. The developing brain is uniquely susceptible to permanent impairment by exposure to environmental substances during time windows of vulnerability. Lead, mercury, and polychlorinated biphenyls (PCBs) have been extensively studied and found to impair development at levels of exposure currently experienced by significant portions of the general population. High-dose exposures to each of these chemicals cause catastrophic developmental effects. More recent research has revealed toxicity at progressively lower exposures, illustrating a "declining threshold of harm" commonly observed with improved understanding of developmental toxicants. For lead, mercury, and PCBs, recent studies reveal that background-population exposures contribute to a wide variety of problems, including impairments in attention, memory, learning, social behavior, and IQ. Unfortunately, for most chemicals there is little data with which to evaluate potential risks to neurodevelopment. Among the 3000 chemicals produced in highest volume (over 1 million lbs/yr), only 12 have been adequately tested for their effects on the developing brain. This is a matter of concern because the fetus and child are exposed to untold numbers, quantities, and combinations of substances whose safety has not been established. Child development can be better protected by more precautionary regulation of household and environmental chemicals. Meanwhile, health care providers and parents can play an important role in reducing exposures to a wide variety of known and suspected neurodevelopmental toxicants that are widely present in consumer products, food, the home, and wider community.
PURPOSE: To explore the best approach to identify and adjust for confounders in epidemiologic practice. METHODS: In the Port Pirie cohort study, the selection of covariates was based on both a priori and an empirical consideration. In an assessment of the relationship between exposure to environmental lead and child development, change-in-estimate (CE) and significance testing (ST) criteria were compared in identifying potential confounders. The Pearson correlation coefficients were used to evaluate the potential for collinearity between pairs of major quantitative covariates. In multivariate analyses, the effects of confounding factors were assessed with multiple linear regression models. RESULTS: The nature and number of covariates selected varied with different confounder selection criteria and different cutoffs. Four covariates (i.e., quality of home environment, socioeconomic status (SES), maternal intelligence, and parental smoking behaviour) met the conventional CE criterion (> or =10%), whereas 14 variables met the ST criterion (p < or = 0.25). However, the magnitude of the relationship between blood lead concentration and children's IQ differed slightly after adjustment for confounding, using either the CE (partial regression coefficient: -4.4; 95% confidence interval (CI): -0.5 to -8.3) or ST criterion (-4.3; 95% CI: -0.2 to -8.4). CONCLUSIONS: Identification and selection of confounding factors need to be viewed cautiously in epidemiologic studies. Either the CE (e.g., > or = 10%) or ST (e.g., p < or = 0.25) criterion may be implemented in identification of a potential confounder if a study sample is sufficiently large, and both the methods are subject to arbitrariness of selecting a cut-off point. In this study, the CE criterion (i.e., > or = 10%) appears to be more stringent than the ST method (i.e., p < or = 0.25) in the identification of confounders. However, the ST rule cannot be used to determine the trueness of confounding because it cannot reflect the causal relationship between the confounder and outcome. This study shows the complexities one can expect to encounter in the identification of and adjustment for confounders.
BACKGROUND: A quarter of US children are at increased risk of obesity-related health problems because of excess weight. The few national studies of child overweight and inadequate household resources available to purchase healthy foods, or food insecurity, have shown inconsistent results. We hypothesized that the inconsistency in these results may be attributed to a differential effect of participation in food assistance programs in food secure and food insecure households. METHODS: Using the 1997 Panel Study of Income Dynamics Child Development Supplement, we compared the risk of a child aged 5 to 12 years being at or above the 85th percentile of body mass index for age in food insecure and food secure, low-income households when controlling for participation in the Food Stamp Program and the national school lunch and breakfast programs as well as other covariates. RESULTS: We found that food insecure girls who participated in all 3 programs had a 68% reduced odds (odds ratio, 0.32; 95% confidence interval, 0.12-0.77) of being at risk of overweight when compared with food insecure girls in nonparticipating households and controlling for other factors. Girls in food secure households generally had no greater or less risk of overweight if they participated in any or all programs. Boys in both food insecure and food secure households had no greater or less risk of overweight by if they participated in any or all of the programs. CONCLUSIONS: These results support our hypothesis that food assistance programs play a protective role for low-income children's health, particularly in girls in food insecure households.
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