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Children with mild learning difficulties in an integrated and in a special school: comparisons of behaviour, teasing and teachers' attitudes.

Comparisons were made between children and teachers in two schools, one a mainstream school with an integrated resource unit for children with mild learning difficulties, the other a special school. Seventeen children with mild learning difficulties from the special school and ten children with mild learning difficulties from the mainstream school, matched with ten mainstream children for age and sex, took part in the study. Observations were made on children in the playground and their social proximity and positive and negative behaviours were categorised. Self-reports on teasing, bullying and friendships were also collected from children in the mainstream school. Teachers from both schools completed a questionnaire on their attitudes to integration. There was no difference in amount of social contact children with mild learning difficulties had in the mainstream and special school nor were there significant differences in total positive and negative behaviours. Mainstream children, however, played significantly less frequently with children with mild learning difficulties and this was more marked in the older than the younger children. Self-reports from children in the integrated school indicated that the children with mild learning difficulties were teased/bullied more and made fewer friends than the mainstream children. Teachers in the mainstream were more positive and teachers in the special school were more negative towards integration. The special school teachers' expectations fitted more with the findings of the study than did those of the mainstream teachers.

Adaptation, Psychological↗

School level at 10 years of age in children who required neonatal intensive care in 1980-1989.

UNLABELLED: School level at age 10 was studied in two cohorts of children who had required neonatal intensive care (NIC): cohort 1, children born 1980-1985 (n=310); and cohort 2, children born 1986-1989 (n=245); and two control groups. More than 80% of all NIC children of both cohorts attended the appropriate mainstream grade 3 or 4; 12.9% of cohort 1 and 6.8% of cohort 2 were in mainstream grade 2. Six per cent of both cohorts received special education. Among very preterm children (23-31 gestational weeks), 73.5% of cohort 1 and 80.3% of cohort 2 attended grades 3 and 4, while 22.9% and 12.1%, respectively, were in grade 2. Assistance (remedial teaching, personal assistant or special teaching group) was given to 42.4% of cohort 1 in the mainstream (grades 2, 3 and 4) and to 38.2% of cohort 2 in the mainstream. In cohort 2, more very preterm girls than matched controls received assistance (p<0.05); no corresponding difference was found in very preterm boys. Most children with congenital malformations received assistance in mainstream education or received special education. CONCLUSION: Most NIC children are in mainstream school classes at age 10. Twelve to 23% of very preterm children are 1 y behind. Many NIC children in the school mainstream need assistance at school, but the proportion of children in mainstream education increases markedly with time.

Child↗

Tobacco-specific nitrosamines in Canadian cigarettes.

Twenty-five brands of Canadian commercial cigarettes were analyzed for tobacco-specific nitrosamines (TSNA) in tobacco and in mainstream smoke as well as for nitrate in tobacco. Preformed N'-nitrosonor-nicotine (NNN) in the tobacco ranged from 265 ng to 979 ng/cigarette, preformed 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) ranged from 465 ng to 878 ng/cigarette. The mainstream smoke concentration for NNN was between 5 ng and 39 ng/cigarette and for NNK between 5 ng and 97 Ng/cigarette. The nitrate levels were between 0.3 mg and 3.4 mg/cigarette. The NNK levels in tobacco and in mainstream smoke were higher than the NNN levels, which is typical for Virginia-type cigarettes. Based upon the average mainstream smoke concentration of the three most popular Canadian cigarette brands, an average TSNA delivery for 20 cigarettes of 0.7 micrograms NNN and 1.7 micrograms NNK can be calculated, which is less than the average for West German cigarettes. The results of this investigation demonstrate that there seems to be a good correlation between the TSNA and tar deliveries in mainstream smoke. However, no correlation between the level of preformed TSNA in tobacco and the tar delivery in mainstream smoke could be observed. It is demonstrated that the good correlation between the tar and TSNA deliveries in mainstream smoke can only be attributed to the unusual good correlation between the tar delivery and the ventilation ratio. For the cigarettes investigated, which seemed to be Virginia-type cigarettes, with few exceptions, the ventilation ratio had a much higher influence on the mainstream smoke concentration than the level of preformed TSNA in tobacco.

Canada↗

Changes in educational placement and speech perception ability after cochlear implantation in children.

OBJECTIVE: The purpose of this study was to evaluate the effect and relationship of paediatric cochlear implantation on educational placement and speech perception ability and to determine the effect of a multilingual background on educational placement and speech perception ability after cochlear implantation. DESIGN: This study consisted of a retrospective chart review of 83 implanted patients and a questionnaire sent to parents of 80 implanted children. SETTING: This study was conducted in a cochlear implant program at a tertiary care centre. METHODS AND OUTCOME MEASURES: From the chart review, the educational placements and speech perception scores of implanted children were determined before and after implantation. In the questionnaire, parents were asked about their preferred educational placement for their child, the language spoken at home, and their impressions of the chosen school program for their child. RESULTS: Of the children who were in nonmainstream school programs at implantation (n = 30), 50% moved toward mainstream with 9 (30%) reaching mainstream placement. Of the children who were preschool at implantation (n = 34), 24 (70%) were placed or planned to be placed in mainstream after implantation. The rate of improvement in speech perception ability was significantly higher in those children who moved toward or remained in mainstream than those who stayed at the same nonmainstream educational placement or moved away from mainstream. Children from a multilingual background were able to achieve similar educational placements and similar rates of progress of speech perception outcome as the only English-speaking children. CONCLUSIONS: Children with cochlear implants have increased educational opportunities, with those children in mainstream and those who have moved toward mainstream demonstrating improved progress in speech perception ability.

Child↗

[Speciation and distribution characters of rare earth elements in the Baotou Section of the Yellow River].

As a whole of water column, suspended matter and surface sediment in the mainstream and the branch taking up industry wastewater, speciation and distribution characters of rare earth elements (REEs) were investigated systemically in the Baotou section of the Yellow River. This study shows that rare earth elements in the mainstream of the Baotou section of the Yellow River mainly exist in suspended particles, and the dissolved contents are in extremely minute quantities. REEs mainly exist in dissolved particles in the branch taking up industry wastewater, and suspended sigma REE and dissolved sigma REE are obviously higher than those in the mainstream. The change of sigma REE of dissolved particles in water phase along the Baotou section of the Yellow River is very similar to that of sigma REE of suspended particles, and consistent along the main river, it is that sigma REE increase appreciably from the control profile to the keystone discharged section, come to a head in the D site and reduce in the E site. This distribution pattern indicates pile industry wastewater of Baotou to rare earth elements in the mainstream of the Yellow River, particularly LREE. The REE distribution in the mainstream of the Baotou section of the Yellow River is the same, with LREE enrichment and Eu depletion. But LREE origin of D site is different from the other sites by excursion of LREE distribution curve and other geochemical parameters, they are origin of industry wastewater piled, otherwise the other four sites are origin of loess altiplano. And HREE are origin of loess altiplano in all the sites. The speciation characteristics of REE in the sediments and suspended matter are quite similar with the amount in as follows: residual >> bound to carbonates, bound to Fe-Mn oxides > bound to organic matter >> exchangeable. REEs exchangeable in surface sediment and suspended matter in the branch taking up industry wastewater are higher than those in the mainstream, it confirms that REEs in the mainstream mainly exist in suspended particles, and mainly exist in dissolved particles in the branch.

Geologic Sediments↗

Educational placement of deaf children following cochlear implantation.

This study examined the educational placements, before cochlear implantation, of 121 deaf children, and the educational placements, two years after implantation, of the 48 children who had reached that stage, looking at the influence of age at implantation and duration of deafness on the placement of these children. In addition, it compared the educational placements of those given implants prior to schooling, and those given implants when already in an educational setting. Categories used were pre-school, school for the deaf, unit or resource base within a mainstream school and full-time mainstream provision. Age at implantation and duration of deafness were found to be significant predictors of placement two years after implantation. The duration of deafness of children in schools for the deaf or units was twice that of children in mainstream education. Fifty-three per cent of children who were in pre-school at the time of implantation were in mainstream schools two years after implantation, whereas only 6% of those who were already in educational placements at the time of implantation were in mainstream education. This difference was statistically significant. The results indicate that children who are given implants early, before an educational decision has been made, are more likely to go to mainstream schools than those given implants when already in an educational setting.

Adolescent↗

The educational settings of profoundly deaf children with cochlear implants compared with age-matched peers with hearing aids: implications for management.

The educational settings of 42 implanted profoundly deaf children 3 years after implantation were compared with the respective settings of 635 age-matched severely deaf and 511 profoundly deaf children with hearing aids. All implanted children received their implants before beginning school. The results revealed that 3 years after implantation. 38% (16 children) of the implanted profoundly deaf children attended mainstream schools, whereas 57% (24 children) were in a unit, or special class, in a mainstream school, and 5% (two children) were in schools for the deaf. With regard to the age-matched profoundly deaf children with hearing aids, 12% (63 children) attended mainstream schools, whereas 55% (281 children) were in a unit of a mainstream school, and 33% (167 children) were in schools for the deaf. In the group of age-matched severely deaf children, 38% (239 children) attended mainstream schools, whereas 51% (326 children) were in a unit of a mainstream school, and 11% (70 children) were in schools for the deaf. Statistical analysis revealed a highly significant difference between the educational placement of implanted children and hearing-aided profoundly deaf children (p<0.00001), whereas there was no statistically significant difference between implanted children and hearing-aided severely deaf children. In conclusion, implanted profoundly deaf children who have received their implants before beginning school have the same profile of educational placement as aided severely deaf children rather than aided profoundly deaf children of the same age in the UK. This is likely to have significant implications for the future management of profoundly deaf children and to influence future planning of educational support services.

Child↗

Safety assessment of high fructose corn syrup (HFCS) as an ingredient added to cigarette tobacco.

A tiered testing strategy has been developed to evaluate the potential for new ingredients, tobacco processes, and technological developments to alter the biological activity that results from burning tobacco. A series of studies was initially conducted with cigarettes containing 3% high fructose corn syrup (HFCS) as an alternate tobacco casing material to corn syrup/invert sugar, including determination of selected mainstream cigarette smoke (MS) constituent yields, Ames assay, sister chromatid exchange (SCE) assay in Chinese hamster ovary (CHO) cells, a 30-week dermal tumor-promotion evaluation of cigarette smoke condensate (CSC) in SENCAR mice, and a 13-week subchronic inhalation study of MS in Sprague-Dawley rats. A second series of studies was conducted with cigarettes containing 3%, 4% and 5% HFCS including MS chemistry, Ames assay, SCE assay in CHO cells, and a neutral red cytotoxicity assays. Collectively, mainstream smoke chemistry, genotoxicity, dermal tumor-promotion, and inhalation toxicity studies demonstrated no differences between cigarettes with 3% HFCS and cigarettes with 3% corn syrup/invert sugar. Also, mainstream smoke chemistry and genotoxicity of cigarettes with 4% and 5% HFCS were not different from cigarettes with 3% HFCS. In conclusion, the addition of up to 5% HFCS to cigarette does not alter the mainstream smoke chemistry or biological activity of mainstream smoke or mainstream smoke condensate as compared to cigarettes with 3% corn syrup/invert sugar with regard to the parameters investigated and presented.

Administration, Inhalation↗

Toxicologic evaluation of licorice extract as a cigarette ingredient.

Licorice extract (block, powder or liquid) may be applied to cigarette tobacco at levels of about 1-4% to enhance and harmonize the flavor characteristics of smoke, improve moisture holding characteristics of tobacco, and act as a surface active agent for ingredient application. Neat material pyrolysis studies, and smoke chemistry and biological activity studies (bacterial mutagenicity, cytotoxicity, micronucleus, and sub-chronic inhalation) with mainstream smoke, or mainstream smoke preparations from cigarettes containing various target levels (1.5-12%) of the licorice extracts were performed to provide data for an assessment of the use of licorice extract as a cigarette tobacco ingredient. At simulated tobacco burning temperatures up to 900 degrees C all forms of neat licorice extract pyrolyzed extensively, yielding small amounts of benzene, toluene, phenol and acetaldehyde with no indication that licorice extracts would transfer intact to mainstream smoke. As a single ingredient added to cigarette tobacco, block licorice extract at a target level of 12.5% increased smoke constituents including selected PAH, arsenic, lead, phenol and formaldehyde (on a TPM basis), while licorice extract powder (target level of 8% tobacco) increased select PAH, phenol and formaldehyde (on a TPM basis). Lower target application levels (including typical application levels) of block, powder or liquid licorice extract did not significantly alter the smoke chemistry profile. Biological tests indicated no relevant difference in the genotoxic or cytotoxic potential of either mainstream smoke (or smoke preparations) from cigarettes with added licorice extracts compared to control cigarettes. In sub-chronic 90-day rat inhalation studies, the mainstream smoke from cigarettes with 12.5% added block and 8% added powder licorice extract contained higher formaldehyde concentrations compared to control cigarette smoke. Female rats in the 12.5% block licorice extract exposure group displayed an increased incidence and severity of epithelial hyperplasia in the nose (level 2), with no relevant respiratory tract changes in the 8% powder licorice extract exposed rats. At the lower licorice extract application levels (1.25-5%), there was no indication of increased formaldehyde concentration in the smoke atmosphere and no relevant changes in respiratory tract tissues. Mineralcorticoid-like effects which have been associated with excess licorice ingestion were not found in any of the smoke inhalation studies. The results of these studies with various forms of licorice extract applied to cigarette tobacco suggest that adding licorice extract to cigarette tobacco at levels of < or =5% does not discernibly alter the smoke chemistry or biological effects normally associated with mainstream cigarette smoke.

Animals↗

The generation of formaldehyde in cigarettes--Overview and recent experiments.

In recent years much effort has been devoted to assessing the influence of tobacco ingredients on the chemistry and toxicity of cigarette mainstream smoke. All of the studies have indicated that commonly used tobacco ingredients do not change the toxicity of smoke as measured in specified assays. Also, the ingredients have little effect on the levels of most smoke constituents that may be relevant to smoking-related diseases. One exception to this generalisation is formaldehyde, which is generated from saccharides used as tobacco ingredients. However, the past studies have generally used mixtures of ingredients added to the tobacco so that the exact effect of each saccharide in turn could not be precisely determined. This is addressed in the present study. Many diverse studies over the last 30 years have examined particular aspects of formaldehyde in smoke and its generation although no attempt has been made to draw the various aspects together. This has also been addressed in the present paper and an overview is developed on the subject. The experimental results of the present study are rationalised within the framework of this previous knowledge. In the present experimental study, several individual saccharides commonly used as tobacco ingredients have been added to cigarettes, the cigarettes have been machine-smoked and the yields of formaldehyde in the resultant smoke have been compared to those from a control (no ingredient) cigarette. Using four series of cigarettes made on different occasions, the results indicate that all tested sugars added to tobacco increase the yield of formaldehyde in mainstream cigarette smoke under ISO standard smoking machine conditions. Increases up to 60% are observed at maximum sugar levels used on cigarettes. The increases are mostly statistically significant although their magnitudes are variable. These results with formaldehyde are consistent with all previously published studies on the subject. The increases in mainstream formaldehyde are also observed using smoking machine conditions that are more intense than the standard ISO conditions. Different sugars increase mainstream formaldehyde to different extents, which may be due at least partially to the presence of varying amounts of amino compounds in some of the sugars, such as honey and maple syrup. The presence of such compounds has been shown to inhibit the generation of formaldehyde from sugars. In general, the first puff of the cigarette generates abnormally high yields of formaldehyde, and this effect has been shown to persist in the presence of added sugars. In contrast to the situation with mainstream smoke, the levels of formaldehyde in sidestream smoke are not affected by the presence of sugars. The addition of the various saccharides to tobacco also produced some statistically significant effects in the cigarette mainstream yields of six other carbonyl smoke constituents that were analysed at the same time as formaldehyde. These effects were generally small, less than 16%, were not consistent amongst the various cigarette series and lost their significance when the long-term analytical variability was taken into account.

Flavoring Agents↗

The effect of a 2-h exposure to cigarette smoke on the metabolic activation of the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone in A/J mice.

4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), a tobacco-specific nitrosamine, induces lung adenomas in A/J mice following a single intraperitoneal (i.p.) injection. However, inhalation of mainstream cigarette smoke does not induce or promote NNK-induced lung tumors in this mouse strain purported to be sensitive to chemically-induced lung tumorigenesis. The critical events for NNK-induced lung tumorigenesis in A/J mice is thought to involve O(6)-methylguanine (O(6)MeG) adduct formation, GC-->AT transitional mispairing, and activation of the K-ras proto-oncogene. The objective of this study was to test the hypothesis that a smoke-induced shift in NNK metabolism led to the observed decrease in O(6)MeG adducts in the lung and liver of A/J mice co-administered NNK with a concomitant 2-h exposure to cigarette smoke as observed in previous studies. Following 2 h nose-only exposure to mainstream cigarette smoke (600 mg total suspended particulates/m(3) of air), mice (n=12) were administered 7.5 micromol NNK (10 microCi [5-3H]NNK) by i.p. injection. A control group of 12 mice was sham-exposed to HEPA-filtered air for 2 h prior to i.p. administration of 7.5 micromol NNK (10 microCi [5-3H]NNK). Exposure to mainstream cigarette smoke had no effect on total excretion of NNK metabolites in 24 h urine; however, the metabolite pattern was significantly changed. Mice exposed to mainstream cigarette smoke excreted 25% more 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) than control mice, a statistically significant increase (P<0.0001). Cigarette smoke exposure significantly reduced alpha-hydroxylation of NNK to potential methylating species; this is based on the 15% reduction in excretion of the 4-(3-pyridyl)-4-hydroxybutanoic acid and 42% reduction in excretion of 4-(3-pyridyl)-4-oxobutanoic acid versus control. Detoxication of NNK and NNAL by pyridine-N-oxidation, and glucuronidation of NNAL were not significantly different in the two groups of mice. The observed reduction in alpha-hydroxylation of NNK to potential methylating species in mainstream cigarette smoke-exposed A/J mice provides further mechanistic support for earlier studies demonstrating that concurrent inhalation of mainstream cigarette smoke results in a significant reduction of NNK-induced O(6)MeG adduct formation in lung and liver of A/J mice compared to mice treated only with NNK.

Animals↗

Comparison of three sampling and analytical methods for measuring m-xylene in expired air of exposed humans.

Three breath sampling and analytical methods were tested following exposure of 12 subjects for 4 hr to 75 ppm m-xylene in a controlled environmental chamber. Mixed-expired breath was sampled for m-xylene from all 12 subjects with a new stainless steel device that permits continuous mainstream or sidestream sampling of the solvents present. The m-xylene was sampled from the mainstream using charcoal cloth and from the sidestream using Tenax TA. Alveolar breath also was sampled for m-xylene from 6 of these subjects using bags. The carbon dioxide concentrations of the mixed and alveolar samples, obtained from these 6 subjects, were also determined and used to assess the accuracy of the mixed-expired sampling and analytical procedures. Breath sampling was conducted over the immediate 240-min postexposure period. All m-xylene samples were analyzed using gas chromatography with flame ionization detection. Carbon dioxide concentrations were determined with an infrared analyzer. Nonlinear regression analysis was used to model the desaturation of m-xylene via the breath. Overall, the desaturation of m-xylene from all subjects by all methods was best described using three-compartment pharmacokinetic models. The precision of each sampling and analytical method, estimated from the residual variabilities of the desaturation curves were 0.13 for alveolar sampling, 0.14 for mainstream-mixed sampling (12 subjects), and 0.23 for sidestream-mixed sampling (12 subjects). For all 12 subjects, the breath m-xylene concentrations determined by sidestream-mixed sampling averaged 83% of those determined by mainstream-mixed sampling; this bias was significant. For the 6 subjects from whom both mixed-expired and alveolar breath samples were obtained, the average m-xylene desaturation rates determined by both mainstream-mixed and alveolar sampling were comparable but substantially different from those determined by sidestream-mixed sampling. For these subjects, comparison of the average and individual mixed to alveolar ratios of m-xylene and carbon dioxide showed that mainstream-mixed sampling was accurate and that sidestream-mixed sampling was not.

Air Pollutants, Occupational↗

Health and school performance of teenagers born before 29 weeks gestation.

OBJECTIVE: To ascertain the health and school performance of teenagers born before 29 weeks gestation (extremely low gestational age (ELGA)) and to compare those in mainstream school with classroom controls. METHODS: Three geographically defined cohorts of babies born in 1983 and 1984 were traced at the age of 15-16 years. Their health, abilities, and educational performance were ascertained using postal questionnaires to the teenagers themselves, their parents, their general practitioners, and the teachers of those in mainstream school. Identical questionnaires were sent to classroom controls. RESULTS: Of the 218 teenagers surviving to the age of 16 years, information was obtained on 179. Of these, 29 were in special schools and 150 in mainstream school, 10 of whom had severe motor or sensory impairment. Using the Child Health Questionnaire, parents of teenagers in mainstream school reported a higher incidence of problems than controls in physical functioning (difference in mean scores 9.0 (95% confidence interval (CI) 4.9 to 13.1)) and family life (difference in mean scores for family cohesion 7.0 (95% CI 1.6 to 12.4)). In all areas of learning, teachers rated the ability of the ELGA teenagers in mainstream school lower than the control group. Parents of teenagers in special schools reported a higher rate of problems in most areas. CONCLUSIONS: One in six ELGA survivors at age 16 years have severe disabilities and are in special schools. Most ELGA survivors are in mainstream school and are coping well as they enter adult life, although some will continue to need additional health, educational, and social services.

Adolescent↗

Screening for syphilis among men who have sex with men in various clinical settings.

OBJECTIVES: To assess the prevalence of syphilis infections among men who have sex with men (MSM) accessing the Brisbane Sexual Health Clinic during the period 1997 up to May 2003, data were collated through three clinical programmes conducted by the service-a large inner city mainstream sexual health clinic and two small outreach sessional clinics conducted on the site of male sex on premises venues (SOPV). Data analysis also provided the opportunity to evaluate the effectiveness of the smaller outreach clinics to access populations of MSM less likely to attend or identify at the larger mainstream clinic, and therefore enhance the detection of previously undiagnosed sexually transmissible infections. METHODS: Computerised records from 1997-2003 were collated for a statistical analysis of syphilis and other STI pathology results for all MSM accessing the mainstream clinic, and two outreach clinics. RESULTS: A review of client charts showed that 16 new syphilis diagnoses were made over the previous 5 years, but only two of these infections (both through the mainstream clinic) were early syphilis and therefore transmissible. All other cases were latent infections. A higher proportion of bisexual men was identified with positive syphilis serology but this was just below significance (p=0.06). Significantly, almost a third of syphilis diagnoses (all latent) were made at SOPV outreach clinics, despite the much lower proportion of clients seen overall through the SOPV clinics. For other sexually transmissible infections, the mainstream clinic demonstrated greater efficiency at case detection. CONCLUSION: Outreach clinics located in male saunas may serve an effective function in syphilis screening by facilitating access for a particular subpopulation of MSM (bisexual, married men). These outreach clinics may provide important outlets for education and opportunistic screening of asymptomatic MSM and foster a greater willingness for men to honestly self identify. However, larger, mainstream clinics serve a more anonymous venue for the testing of symptomatic men.

Adolescent↗

Factors affecting the school placement of children with spina bifida.

Integrating children with disabilities into mainstream schools has been an active policy in Britain since the 1981 Education Act. 26 children with spina bifida, 13 of whom were educated in mainstream schools, and 13 in special schools were assessed to clarify the relative importance of the following factors 1) IQ, 2) Mobility, 3) Hand function, 4) Bladder and bowel function, and 5) Behaviour. A marked difference was found between those attending mainstream and special schools. 11/13 of the former attained scores within the normal range as compared to only 2/13 of the latter. Neither mobility nor hand function alone were found to influence school placement and a marked correlation was found between the two. Whilst those educated in special schools had more marked problems, all children functioned poorly compared with the norms for able-bodied peers. Neither bladder nor bowel incontinence hindered attendance at mainstream school, but faecal soiling was considered the more serious problem. The frequency of behavioural problems showed a similar distribution amongst the two groups. Comments from parents highlighted their reservations about both special and mainstream schooling which indicates the policy for integration needs considerably more commitment from Government and Education Authorities in order to succeed.

Activities of Daily Living↗

Prevalence study of cerebral palsy in Hong Kong children.

OBJECTIVES: To investigate the prevalence of cerebral palsy in local children aged 6 to 12 years and to evaluate service utilisation by those children who attend mainstream schools. DESIGN: Cross-sectional survey. SETTING: Mainstream primary schools and special needs schools in Hong Kong. PARTICIPANTS: Headmasters or headmistresses of special needs schools, and various organisations that provide services to children with cerebral palsy in the school year September 2003 to June 2004. MAIN OUTCOME MEASURES: Prevalence of cerebral palsy and support services used by children with cerebral palsy who attend a mainstream school. RESULTS: Of 435 572 children, 578 with cerebral palsy were identified. The overall point prevalence was 1.3 per 1000 children. The age-specific prevalence rate varied from 1.04 to 1.50 per 1000 children. Approximately 38% of children with cerebral palsy attended a mainstream school. Among those studying in special needs schools, 96% attended a school for the physically handicapped or a school for the severely mentally handicapped. Among 219 children with cerebral palsy in mainstream schools, 57 (26%) received educational support, and 134 (61%) received out-patient therapy support. Only 12% received both supporting services. No educational or therapeutic support was received by 26% of children. CONCLUSIONS: Compared with overseas data, the low prevalence of cerebral palsy detected in local children in this investigation may be due to the differences in study design or a genuinely low prevalence. Setting up a cerebral palsy registry could help monitor the local prevalence of this childhood disability more accurately, thereby providing more reliable information for planning support services for this subgroup of children.

Cerebral Palsy↗

Toxicological evaluation of an electrically heated cigarette. Part 4: Subchronic inhalation toxicology.

The biological activity of mainstream smoke from an electrically heated cigarette (EHC) with controlled combustion and from the University of Kentucky Reference Cigarette 1R4F was determined in Sprague Dawley rats exposed nose-only for 90 days, 6 h a day, 7 days per week. For an equivalent response comparison between the two cigarette types, two doses were chosen for the EHC where the anticipated results were in the dynamic range of the 1R4F dose-response curve (four concentrations) for most end points. The number of cigarettes smoked per m(3) of diluted smoke resulted in total particulate matter concentrations of 40 and 90 microg l (-1) for the EHC and 40-170 microg l (-1) for the 1R4F. Biomonitoring indicated achievement of target doses. Mainstream smoke yields were lower for the EHC, with the exception of formaldehyde. No smoke-related mortality, remarkable in-life observations or abnormal gross pathological findings were observed. Smoke- and dose-related clinical pathology and organ weight changes included: increases in segmented neutrophils, some liver parameters and lung and adrenal weight relative to body weight; and decreases in lymphocytes, glucose concentration and spleen weight. Smoke-related histopathological findings in the respiratory tract included epithelial cell hyperplasia, squamous metaplasia, atrophy and accumulation of pigmented alveolar macrophages; they were mostly dose-dependent, more pronounced in the upper than lower respiratory tract and completely or partially reversed by 6 weeks post-inhalation. Qualitatively, the biological effects seen for the EHC and the 1R4F were comparable and similar to those observed in other mainstream smoke inhalation studies. Quantitatively, the biological activity of the EHC mainstream smoke was, on average, 65% lower than that of the 1R4F mainstream smoke on an equal cigarette basis and equivalent activity on an equal TPM basis.

Administration, Inhalation↗

Sidestream tobacco smoke as the main predictor of exposure to polycyclic aromatic hydrocarbons.

Polycyclic aromatic hydrocarbons (PAHs) were measured in mainstream and sidestream tobacco smoke from 14 commercial brands of cigarettes purchased in Italy during 2001-2002. The PAHs detected in smoke and analysed with HPLC and a fluorimetric detector were: fluoranthene, pyrene, benzo[a]anthracene, chrysene, benzo[a]pyrene, benzo[b] fluoranthene, benzo[k] fluoranthene, benzo[g,h,i]perylene and dibenzo[a,h]anthracene. The PAH levels in mainstream smoke from different cigarette brands obtained using an official smoking machine varied by about threefold (from 118 to 374 ng per cigarette for total PAHs and from 23.5 to 100 ng per cigarette for carcinogenic PAHs). Total PAH levels in mainstream smoke were correlated with tar content (r = 0.615, P < 0.05, n = 14). Total PAH content in sidestream smoke, measured by collection of all the smoke produced by a lit cigarette in a glass chamber, was about tenfold higher compared with mainstream smoke. The PAH content in sidestream smoke was relatively uniform (2.3-3.9 and 0.49-1.21 micro g per cigarette for total and carcinogenic PAHs, respectively) and was not correlated with tar content. These results indicate that cigarette manufacturing and filter characteristics influence the PAH composition of mainstream smoke, but have no effect on the PAH content in sidestream smoke, which is the main determinant of smokers' and non-smokers' exposure to PAHs in environmental tobacco smoke.

Chromatography, High Pressure Liquid↗