bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Hemangiomatosis and Atrial Septal Defect: A Rare Cause of Right Heart Failure in Infancy
Authors: Sidwell Rachel U. , Daubeney Piers E. F. , Porter William , Roberts Nerys M.
Published: February 2004

Abstract:  Neonatal hemangiomatosis is a well‐recognized cause of left ventricular failure. We describe an infant with neonatal hemangiomatosis and an ostium secundum atrial septal defect who developed severe right heart failure. This was due to the combination of increased flow through the right heart as a result of the atrial septal defect, and the background high cardiac output from the massive arteriovenous shunting and multiple hemangiomas. In addition, the multiple hepatic hemangiomas may exert a vasoactive influence on the pulmonary vasculature.
Unilateral Linear Psoriasis with Palmoplantar, Nail, and Scalp Involvement
Authors: Saraswat Abir , Sandhu Kamaldeep , Shukla Rajeev , Handa Sanjeev
Published: February 2004

Abstract:  Linear psoriasis is a rare entity. It is commonly confused clinically and histopathologically with verrucous epidermal nevus. We report a child who had linear psoriasis in a unilateral distribution with palmoplantar, nail, and scalp involvement.
Onychomycosis in Children: A Brief Overview with Treatment Strategies
Authors: Gupta Aditya K. , Skinner Alayne R.
Published: February 2004

Abstract:  Onychomycosis in children is uncommon. In those children that are affected, a family history of onychomycosis is not uncommon, giving importance to the examination of the entire family for fungal nail infections. In the United States, the newer oral antifungal agents itraconazole, fluconazole, and terbinafine, and the topical nail lacquers ciclopirox and amorolfine are not approved for this indication. More data are needed on the use of these antifungal agents for the treatment of onychomycosis in children.
SUCCESSFUL TREATMENT OF PEDIATRIC PSORIASIS WITH INFLIXIMAB
Authors: Menter M. Alan , Cush John. M.
Published: February 2004

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, typewritten double spaced, and must not exceed two pages of text including references. Two copies of all letters should be submitted along with one copy on disk. Letters ahould not duplicate material submitted or published in other journals. Prepublication proofs with not be provided.
“Men of Influence”– The Ontology of Leadership in the 1914 Boer Rebellion
Authors: Swart Sandra
Published: February 2004

Abstract  This paper raises questions about the ontology of the Afrikaner leadership in the 1914 Boer Rebellion – and the tendency to portray the rebel leadership in terms of monolithic Republicans, followed by those who shared their dedication to returning the state to the old Boer republics. Discussions of the Rebellion have not focused on the interaction between leadership and rank and file, which in part has been obscured by Republican mythology based on the egalitarianism of the Boer commando. This paper attempts to establish the ambitions of the leaders for going into rebellion and the motivations of those who followed them. It traces the political and economic changes that came with union and industrialization, and asks why some influential men felt increasingly alienated from the new form of state structure while others adapted to it. To ascertain the nature of the support for the leaders, the discussion looks at Republican hierarchy and the ideology of patriarchy. The paper further discusses the circumscribed but significant role of women in the Rebellion. This article seeks to contribute to a wider understanding of the history of leadership in South Africa, entangled in the identity dynamics of masculinity, class and race interests.
Against Time: Scheduling, Momentum, and Moral Order at Wartime Los Alamos
Authors: Thorpe Charles
Published: February 2004

Abstract  This article examines scheduling as a source of institutional momentum in the Los Alamos atomic weapons laboratory during World War Two. As well as allowing coordination of the large and geographically dispersed sites of the atomic bomb project, the scheduling regime operated as a system of social control, suppressing opposition to the use of the weapon. The analysis suggests the importance of historical and ethnographic attention to how schedules inscribe instrumental rationality in the quotidian life of modern organizations.
Differences in cancer incidence between men and women in the province of Québec, Canada, 1984–1993
Authors: Gangbè Marcellin , Thouez Jean‐Pierre , Ghadirian Parviz
Published: February 2004

This research concerns variation in incidence rates of cancer for males and females aged 35 to 69 in Québec for the period 1984 to 1993. In analysing the data, the Island of Montréal (health region 06) was distinguished from the rest of the province of Québec (excluding Nunavik and the James Bay regions). Relative rate index and the ratio of standardised incidence rates of cancer for males and females showed similar tendencies in all regions studied, with the risk of non–sex‐specific cancer higher in men than in women (excess ranged from 5 or 20 to 240 percent according to the study region). However, this higher risk was not consistent across lifespan and cancer site in the Montréal area. We suggest some general points that could explain the differences in cancer incidence between males and females.
A multi‐criteria analysis of Canadian electricity supply futures
Authors: Noble Bram F.
Published: February 2004

This paper presents a multi‐criteria analysis of Canadian electricity supply futures. Based on the results of Natural Resources Canada's Energy Technology Futures Project, a panel of energy and environmental experts was selected to evaluate alternative electricity supply futures according to several competing environmental, social and economic criteria. Electricity supply futures are explored from both sectoral and regional perspectives and the sensitivity of supply preferences examined in regard to changing electricity environment conditions. The results indicate a demonstrated preference for national electricity supply diversification, including improvements in fossil‐fueled electrical generation technologies and significant increases in the integration of renewable electricity sources. At the regional level, however, the analysis suggests significant dissent amongst provinces with regard to the nature of electricity diversification and future growth opportunities based on regional electricity resource siting.
The changing landscapes of Southwest Montréal: a visual account
Authors: DeVerteuil Geoffrey
Published: February 2004

The Canadian inner city is currently marked by diversity and dynamism. One way to approach this diversity is through photography. A visual approach was used to capture the simultaneous upgrading, decline/revitalization, decline and stability within the changing landscapes of Southwest Montréal, Canada's original industrial heartland.
The influence of the ‘spaces of everyday life’ on pregnancy health
Authors: Lindsay Sally
Published: February 2004

Given the recent focus of medical geography on the social influences of health and illness, this paper draws upon a socio‐theoretical framework to show the link between pregnancy health and the spaces of everyday life. The health of pregnant women is becoming increasingly important given that 85 percent of women work during their pregnancy. Employment during pregnancy is consistently linked with good health for infants; however, large discrepancies exist on the effects for employed mothers. This study estimates the health effect of women's employment during pregnancy with data from the National Longitudinal Survey of Children and Youth. Findings show that women's involvement in paid employment has a beneficial impact for infants compared to women not involved in paid labour. Women who work one job or more per week experience more health problems than women who work less than one job per week. Finally, women who work in male‐dominated and gender‐neutral workspaces experience significantly more prenatal problems than women in female‐dominated workspaces. In conclusion, there is evidence to support that differences in employment status, number of workplaces involved in and gendered workspaces influence the experience of health and illness that are negotiated in the spaces of everyday life.
‘Safe space’ as counter‐space: women, environmental illness and ‘corporeal chaos’
Authors: Coyle Fiona
Published: February 2004

Women constitute a disproportionate 80 percent of people diagnosed with environmental illness (EI), a contentious condition in which patients react adversely to everyday chemicals in the environment at levels politically conceived to be ‘safe’. Whilst the diverse range of somatic symptoms constitutes a biomedical anomaly, in this paper I present an alternative means of conceiving environmentally ill bodies. Women (and environmental health practitioners at the Environmental Health Centre, Nova Scotia) have begun to view their bodies as complex systems that have been nudged into a state of ‘corporeal chaos’, in which minute quantities of chemicals trigger disproportionate somatic symptoms. This chaos extends into ‘corporeal space’[Moss and Dyck (1999a)] as the diagnosis of environmental illness is experienced simultaneously through both material and discursive bodies. This diagnosis also carries with it a means to mitigate corporeal chaos through a series of body‐ and environment‐based modifications that replace risky bodies with ‘safe space’. As a discursive construct, safe space is associated with an absence of chemicals, and in order to mitigate chaos, should ideally be stable, predictable, controllable and communicative. I finalise this paper with some examples of body modifications and illustrate how safe space materialises in the home environment.
Observations on weathering forms at the Caniapiscau Reservoir, North‐Central Québec, Canada
Authors: Jansson Krister N. , Lidmar‐Bergström Karna
Published: February 2004

Weathering forms were encountered during field work in a formerly glaciated shield area in Canada that lies within the Labrador‐Ungava sector of the former Laurentide Ice Sheet. The granite and gneissic granite in the study area display features of surface weathering, such as weathering pits, and of deep weathering, such as an exposed weathering front with associated gravelly saprolite and core stones. Most observations were made along the shoreline of the Caniapiscau reservoir, where wave abrasion since the construction of a hydropower dam has lead to recent exposure of bedrock over extensive areas. The saprolite remnants emphasise the importance of weathering processes in shaping of bedrock relief in the area and together with the other weathering forms indicate restricted glacial erosion. The weathering forms are discussed in the context of glacial erosion and preservation mechanisms.
The role of growth factors in diabetic peripheral neuropathy
Authors: Leinninger Gina M. , Vincent Andrea M. , Feldman Eva L.
Published: February 2004

Abstract Peripheral neuropathy afflicts 60% of all diabetic patients. Underlying the clinical disorder is the loss or degeneration of neurons, Schwann cells, and neuronal fibers. This degenerative pathology has prompted interest in the potential of growth factors as a therapy in diabetic neuropathy. Three lines of evidence support the theory that growth factors may be important in this disorder: (1) endogenous growth factors promote survival and health of neurons, (2) expression levels of growth factors are altered in diabetic neuropathy and peripheral neuron injury, and (3) growth factors induce neuronal regeneration inin vitroandin vivomodels of diabetic injury. This review surveys the roles of several growth factors in diabetic neuropathy, including the neurotrophins, insulin‐like growth factors, cytokine‐like growth factors, and vascular endothelial growth factor. These growth factors are examined in terms of their expression during peripheral nerve injury and their protective and regenerative effects on peripheral neurons. Growth factor‐mediated neuroprotective signaling is discussed, particularly in relation to the recent research, suggesting that diabetic neuropathy‐induced degeneration stems from oxidative stress. Finally, the potential of growth factors as therapeutic agents is addressed, including an assessment of past growth factor clinical trials and other potential avenues of growth factor therapy.
Bed footboard peroneal and tibial neuropathy. A further unusual type of Saturday night palsy
Authors: Tacconi Paolo , Manca Davide , Tamburini Giorgio , Cannas Antonino , Giagheddu Marcello
Published: February 2004

Abstract  An uncommon cause of bilateral tibial and peroneal compression neuropathy is reported. After taking alcohol and drugs, a young heroin‐addicted man lay unconscious overnight in supine position, with both legs crossing the wooden board at the end of the bed, the posterior aspect of the flexed knees pressing against its edge. The following day, he had weakness of foot flexion and extension and a sensory loss consistent with a bilateral tibial and peroneal neuropathy. Symptoms resolved rapidly in the left side; in the right side, a conduction block was still demonstrable 3 weeks later.
Hepatic stem cells: from inside and outside the liver?
Authors: Alison M. R. , Vig P. , Russo F. , Bigger B. W. , Amofah E. , Themis M. , Forbes S.
Published: February 2004

Abstract.   The liver is normally proliferatively quiescent, but hepatocyte loss through partial hepatectomy, uncomplicated by virus infection or inflammation, invokes a rapid regenerative response from all cell types in the liver to perfectly restore liver mass. Moreover, hepatocyte transplants in animals have shown that a certain proportion of hepatocytes in foetal and adult liver can clonally expand, suggesting that hepatoblasts/hepatocytes are themselves the functional stem cells of the liver. More severe liver injury can activate a potential stem cell compartment located within the intrahepatic biliary tree, giving rise to cords of bipotential transit amplifying cells (oval cells), that can ultimately differentiate into hepatocytes and biliary epithelial cells. A third population of stem cells with hepatic potential resides in the bone marrow; these haematopoietic stem cells may contribute to the albeit low renewal rate of hepatocytes, but can make a more significant contribution to regeneration under a very strong positive selection pressure. In such instances, cell fusion rather than transdifferentiation appears to be the underlying mechanism by which the haematopoietic genome becomes reprogrammed.
Embryonic stem cells
Authors: Rippon H. J. , Bishop A. E.
Published: February 2004

Abstract.  Embryonic stem cells have huge potential in the field of tissue engineering and regenerative medicine as they hold the capacity to produce every type of cell and tissue in the body. In theory, the treatment of human disease could be revolutionized by the ability to generate any cell, tissue, or even organ, ‘on demand’ in the laboratory. This work reviews the history of murine and human ES cell lines, including practical and ethical aspects of ES cell isolation from pre‐implantation embryos, maintenance of undifferentiated ES cell lines in the cell culture environment, and differentiation of ES cells in vitro and in vivo into mature somatic cell types. Finally, we discuss advances towards the clinical application of ES cell technology, and some of the obstacles which must be overcome before large scale clinical trials can be considered.
The gastrointestinal stem cell
Authors: Brittan M. , Wright N. A.
Published: February 2004

Abstract.   The longevity of adult stem cells, and their potential for vast tissue regeneration, makes them a focal point of current research and debate, with future aspirations for the use of stem cells in the treatment of a number of human pathological conditions. Due to the rapid rate of cell turnover in the gastrointestinal tract, the stem cells of this tissue are amongst the most assiduous in the body, although they remain unidentified to this day due to their immature, undifferentiated phenotype. However, our knowledge of the mechanisms regulating gastrointestinal stem cell function is evolving, with the identification of putative cellular markers and the elucidation of signalling pathways which regulate cell behaviour in the normal and neoplastic gastrointestinal tract. This review describes the fundamental properties of the gastrointestinal stem cell including: (i) their number, location and origins, (ii) their primary function of deriving gastrointestinal cell lineages and maintaining tissue homeostasis, (iii) the acquisition of gastrointestinal cell lineages from adult stem cells of extraneous tissues and the consequences of this in a therapeutic context, and (iv) the genetic and morphological phenomena surrounding neoplastic transformation in the gastrointestinal tract.
Stem cell plasticity: from transdifferentiation to macrophage fusion
Authors: Camargo F. D. , Chambers S. M. , Goodell M. A.
Published: February 2004

Abstract.   The past 5 years have witnessed an explosion of interest in using adult‐derived stem cells for cell and gene therapy. This has been driven by a number of findings, in particular, the possibility that some adult stem cells can differentiate into non‐autologous cell types, and also the discovery of multipotential stem cells in adult bone marrow. These discoveries suggested a quasi‐alchemical nature of cells derived from adult organs, thus raising new and exciting therapeutic possibilities. Recent data, however, argue against the whole idea of stem cell ‘plasticity’, and bring into question the therapeutic strategies based upon this concept. Here, we will review the current state of knowledge in the field and discuss some of the clinical implications.
The role of stem cells for treatment of cardiovascular disease
Authors: Lovell M. J. , Mathur A.
Published: February 2004

Abstract. Cardiovascular disease is a global cause of mortality and morbidity. Current treatments fail to address the underlying scarring and cell loss, which are the causes of ischaemic heart failure. Cellular transplantation can overcome these problems and new impetus has been injected into this field following the isolation of human embryonic and adult stem cells. These cells have shown remarkable ability to produce cardiomyocytes and vascular cells in vitro and in vivo. Initial transplantation studies have demonstrated functional benefits and it is hoped further randomised clinical trials will concur with initial findings. Much basic science remains to be unearthed, such as the signals for homing, differentiation and engraftment of transplanted cells. Further matters of concern are the role of cell fusion and the mechanisms by which transplanted cells improve cardiac function. In spite of initial progress made in stem cell therapy there is still much to be done and we are some way off from achieving the goal of effective cellular regeneration.
Pulmonary epithelial stem cells
Authors: Bishop A. E.
Published: February 2004

Abstract.  Classically, the stem/progenitor cells of the pulmonary epithelium are considered to be the basal and mucous cells of the proximal airways, Clara cells in the bronchioles and type II pneumocytes in the alveoli. Recent data suggest that there is a variant of Clara cells, lying in pulmonary neuroendocrine bodies, that meets several stem cell criteria and that type II pneumocytes exist in at least two populations, one of which is more resistant to injury. However, a complete revision of our understanding of pulmonary stem cell biology is underway as a result of the discovery of pulmonary epithelium derived from blood‐borne cells. In addition, the existence in the lung of a ‘universal’ pluripotent cell has long been speculated upon and now some initial evidence has emerged with the identification of a spore‐like cell that can differentiatein vitroto bronchiolar tissue.
Tomorrow's skeleton staff: mesenchymal stem cells and the repair of bone and cartilage
Authors: Otto W. R. , Rao J.
Published: February 2004

Abstract.  Stem cells are regenerating medicine. Advances in stem cell biology, and bone marrow‐derived mesenchymal stem cells in particular, are demonstrating that many clinical options once thought to be science fiction may be attainable as fact. The extra‐ and intra‐cellular signalling used by stem cells as they differentiate into lineages appropriate to their destination are becoming understood. Thus, the growth stimuli afforded by LIF, FGF‐2 and HGF, as well as the complementary roles of Wnt and Dickkopf‐1 in stem cell proliferation are evident. The ability to direct multi‐lineage mesenchymal stem sell (MSC) potential towards an osteogenic phenotype by stimulation with Menin and Shh are important, as are the modulatory roles of Notch‐1 and PPARγ. Control of chondrocytic differentiation is effected by interplay of Brachyury, BMP‐4 and TGFβ3. Smads 1, 4 and 5 also play a role in these phenotypic expressions. The ability to culture MSC has led to their use in tissue repair, both as precursor and differentiated cell substitutes, and with successful animal models of bone and cartilage repair using MSC, their clinical use is accelerating. However, MSC also suppress some T‐cell functions in transplanted hosts, and could facilitate tumour growth, so a cautious approach is needed.
The role of emotional social support in the psychological adjustment of siblings of children with cancer
Authors: Barrera M. , Fleming C. F. , Khan F. S.
Published: February 2004

Background  Siblings of children with cancer are at risk for reduced emotional support. The role of emotional social support in the psychological adjustment of siblings of paediatric cancer patients was examined, in the context of age and gender.

Methods  The sample consisted of two groups of siblings of children being treated for cancer: siblings referred for behaviour problems (n = 47) and a comparison group of non‐referred siblings (n = 25). Forty‐two were female, and 30 were male. The mean age was 10.31 years (SD = 2.71). Siblings completed measures of depression, anxiety, behaviour, and emotional social support. One parent of each sibling completed measures of sibling's behaviour and anxiety.

Results  Siblings who reported more social support endorsed significantly fewer symptoms of depression, anxiety, and fewer behaviour problems, and their parents reported less anxiety and fewer behaviour problems than siblings who reported lower social support. Parents of referred siblings reported significantly more behaviour problems than parents of non‐referred siblings. Referred adolescent females reported significantly higher depression scores and were perceived as more anxious than referred adolescent males and non‐referred adolescent females. Non‐referred younger siblings with high social support were perceived by their parents as having the fewest behaviour problems.

Conclusions  High level of social support appears to play a protective role in psychological adjustment of siblings of paediatric cancer patients, with age and gender as modifying factors. Although not all siblings develop behaviour or emotional problems, it is critical to identify those who do in order to intervene accordingly.
Motor co‐ordination in a South Indian population of children
Authors: Hackett R. J. , Hackett L. , Bhakta P.
Published: February 2004

Aims  To examine the associations of motor co‐ordination in Kerala, South India.

Methods  The Modified Oseretsky Test of motor co‐ordination was administered to 1155 representative children during a door‐to‐door survey of 8–12 year olds. Reading, vocabulary and visuospatial reasoning were measured, as were height and weight. Information on medical history, socio‐demographic background and behaviour was systematically collected.

Results  Age was the major association of motor incoordination indicating the importance of maturation. Behaviour, vocabulary, visuospatial reasoning, material deprivation, perinatal complications, chronic physical symptoms and occupational status of the father were also independently associated with motor co‐ordination. Using sibling pairs, evidence of familial aggregation of motor co‐ordination was found.

Abstract  An explanatory model based on an interaction between social and physical factors was discussed.
Achieving early surgery for undescended testes: quality improvement through a multifaceted approach to guideline implementation
Authors: Brown J. J. , Wacogne I. , Fleckney S. , Jones L. , Ni Bhrolchain C.
Published: February 2004

Background  Surgery for undescended testes is recommended before the age of 2 years. However, boys are still undergoing surgery for undescended testes at a much later age than recommended.

Methods  An initial audit reviewed all orchidopexies performed at Northampton General Hospital between 1992 and 1994. This demonstrated that only 19% of boys had surgery by the age of 2 years, and the key reason for late surgery was late referral. Guidelines for referral of undescended testes were established in which referral to a surgeon was advised following the 8‐month child health surveillance check if undescended testis was suspected. This would enable surgery before the age of 2 years. Audit results were disseminated and we implemented a package of measures based on evidence based change management techniques. These included written advice to general practitioners (GPs), a parent information leaflet and an amended personal child health record advising timing of referral. A reminder to the GP to refer following the 8‐month check was generated using computer recall from the Child Health System records. Guideline implementation was monitored by annual audit and feedback.

Results  The baseline audit for the years 1992–94 found a median age at surgery of 4 years. Implementation of the new policies in 1998 resulted in a reduction in median age at surgery to 2.0 years in the 12 months ending September 2001.

Conclusions  While concern about the age at orchidopexy has been highlighted in many previous studies, this is the first to show that improvement in the age at orchidopexy can be achieved. Implementing locally agreed guidelines with written information to GPs and parents combined with computerized recall from Child Health System records achieved the target within 3 years. Similar systems could be implemented nationally at minimal cost.
What influences physiotherapy use by children with cerebral palsy?
Authors: Parkes J. , Hill N. , Dolk H. , Donnelly M.
Published: February 2004

Aim To investigate factors that influence the frequency of physiotherapy currently used by a population of children with moderate to severe cerebral palsy (CP).

Methods A survey using a postal questionnaire was sent to 212 parents of children with moderate to severe CP. The families were identified from a geographically defined case register of children with CP in Northern Ireland (the Northern Ireland Cerebral Palsy Register). Eighty‐five per cent of parents responded. One‐third of parent responses regarding their child's use of physiotherapy were validated with their child's physiotherapist and the level of agreement was high.

Results Ninety‐four per cent (169/180) of children received conventional physiotherapy from a statutory source during the school term. Of these, 61% (104/169) used ‘intense’ levels of physiotherapy (defined as at least twice a week). A higher proportion of intense users were children with severe CP compared with moderate CP (69% vs. 47%;P < 0.01); with moderate intellectual impairment (IQ ≤ 70 > 50) compared with severe (IQ ≤ 50) or no intellectual impairment (IQ > 70) (81% vs. 64% vs. 39% respectively;P < 0.01) and at schools for physical disability (PD) compared with severe learning disability (SLD) or mainstream (MS) schools (82% vs. 66% vs. none respectively;P < 0.001). After controlling for severity of motor impairment and the presence and severity of intellectual impairment, children with CP at MS schools used on average significantly less physiotherapy compared with children with similar levels of motor impairment at PD schools (P < 0.001).

Conclusions Children with CP in MS schools use less physiotherapy compared with children with similar levels of disability in special schools. Organizing services around special schools may limit the degree to which children with CP and other disabilities are successfully integrated into MS education.
The potential of emergency department injury surveillance data: an illustration using descriptive analysis of data in 0–4 year olds from the Bath injury surveillance system
Authors: Brownscombe J. , Simpson N. , Lenton S. , Davis R. , Barby T.
Published: February 2004

Objectives  To illustrate the potential of injury surveillance data from an emergency department surveillance system.

Setting  Bath clinical area.

Methods  Data for children (0–4 years old) resident in Bath city in UK were recoded and analysed.

Results  There were a total of 3144 attendances and 2300 unintentional injuries – equivalent to an attendance rate of 131/1000. There were 91 thermal injuries and 162 poisoning/ingestions. Descriptive information is presented on the circumstances and consequences.

Conclusion  The majority of unintentional injuries in 0–4 year olds occur in the home, which is a modifiable environment. Detailed information around the circumstances available from the Bath injury surveillance system allows better focus for prevention messages and priority setting.
Measure of Processes of Care (MPOC) applied to measure parent's perception of the habilitation process in Sweden
Authors: Bjerre I. M. , Larsson M. , Franzon A.‐M. , Nilsson M. S. , Strömberg G. , Westbom L. M.
Published: February 2004

Aim  To evaluate the instrument Measure of Processes of Care (MPOC) in a Swedish context.

Methods  The MPOC consists of 56 questions in the five scales: enabling and partnership; providing general information; providing specific information about the child; co‐ordinated and comprehensive care; and respectful and supportive care. The questionnaire was translated into Swedish and distributed to 850 families, served by four habilitation centres. After two reminders, a response rate of 74.9% was obtained, and about 60% of the questionnaires qualified for further statistical analysis. Reliability, calculated as Cronbach's alpha, was high for four of the five scales and acceptable for the fifth (scale no. 3).

Results  Significant differences were shown between centres as well as between age groups. These differences were reasonable as judged through background knowledge, indicating that the instrument was able to discriminate between actual differences in services. Commenting on the practical use of the questionaire, staff, as well as responding parents, found the questionnaire rather long and some parents reported difficulties in giving answers as specific as the questionnaire asked them to.

Conclusion  The MPOC shows sufficient sensitivity to be used as an evaluation tool for services at a centre or program level, and can be recommended for research and practical use.
‘I was running away from death’– the pre‐flight experiences of unaccompanied asylum seeking children in the UK
Authors: Thomas S. , Thomas S. , Nafees B. , Bhugra D.
Published: February 2004

Objective  To collect information about the pre‐flight experiences of unaccompanied asylum seeking children (UASC) in the UK to increase the understanding of support needed on arrival in the UK.

Methods  Retrospective social services case file and legal statement review and semi‐structured in‐depth interviews with 100 UASC.

Results  Nearly half of all UASC have experienced separation from or loss of parents and/or family members (47%), and a further 41% had personally experienced or witnessed violence. Sexual violence (such as rape) was reported by 24% of African girls. Many children reported complex journeys to the UK.

Conclusions  UASC arrive in the UK with a variety of potentially traumatic experiences. Whilst research is starting to identify some of the experiences of UASC, further culturally appropriate research is needed to identify their health and social needs after arrival. Further research will help to identify the specific experiences of UASC, indicating where services should be improved to deal with their complex and diverse needs.
Comparing specialist early years provision for speech and language impaired children with mainstream nursery provision in the UK – an application of the Early Childhood Environment Rating Scale (ECERS)
Authors: Law J. , Dockrell J. , Williams K. , Seeff B.
Published: February 2004

Background  This study examines the application of the Early Childhood Environment Rating Scale (ECERS) to specialist early years provision for children with developmental speech and language impairment. The scale, which has been used in the national Effective Provision of Pre‐school Education (EPPE) study in the UK comprises seven subscales describing the quality of provision along a continuum centred on the following areas: ‘space and furnishings’, ‘personal care routines’, ‘language reasoning’, ‘activities’, ‘interaction’, ‘program structure’, and ‘parents and staff’.

Methods  The ECERS was applied to two nurseries funded by the UK charity I CAN by two researchers with inter‐rater‐reliability coefficients ranging from 0.91 to 0.96.

Results  There were notable differences between the specialist early years provision and ‘average’ nursery provision in the UK. On 7/8 measures the early years centre scores are markedly higher than average pre‐school provisions. The standard of education and care for the pre‐school provisions included in the EPPE project ranged from below minimal (for the diversity subscale, ECERS‐E) to approaching good (for the space and furnishings subscale). In contrast, the early years centres were rated as between minimal to good on areas such as space and furnishings and good to excellent on all other areas.

Conclusions  Clearly specialist services such as those described offer something different from the average. Given results which suggest the positive effects on the children's language abilities of such services it is quite possible that the distinctive characteristics of the nursery environment are responsible for the positive impact. There is a good case for extending the application of the ECERS as a way of helping those providing specialist services start to detect the active ingredients of the provision.
Are foster parents reliable informants of children's behaviour problems?
Authors: Tarren‐Sweeney M. J. , Hazell P. L. , Carr V. J.
Published: February 2004

Background  Clinicians and researchers primarily measure behavioural and emotional problems of children in foster care from carer‐report checklists. Yet the reliability of these reports is not adequately established. The present study examines one indicator of reliability for foster parent checklist reports: interrater agreement between foster parents and teachers.

Methods  Estimates of interrater agreement of foster parent and teacher responses on the cross‐informant scales of the Child Behaviour Checklist (CBCL) and the Teacher Report Form (TRF) were obtained for 47 children in long‐term foster care, aged 5–11 years. The estimates included calculations of agreement for continuous measures of problem behaviour, as well as for categorical determinations of clinically significant behaviour.

Results  Correlations of CBCL and TRF mean raw scores for the total problems (r = 0.71) and externalizing (r = 0.78) scales exceeded those described in prior studies of parent–teacher agreement, while correlation for internalizing scores (r = 0.23) was similar to that found previously. Teachers and foster parents demonstrated moderate to good agreement (kappa = 0.70–0.79) in identifying clinically significant total problems and externalizing problems, but poor agreement in identifying internalizing problems.

Conclusions  Discrepancies between these and prior findings are discussed. For children in long‐term foster care, foster parents or teachers may be used as informants for total problems, externalizing problems, and social‐attention‐thought problems. The reliability of data on internalizing symptoms is less certain.
Sleep problems in children with an intellectual disability: parental perceptions of sleep problems, and views of treatment effectiveness
Authors: Robinson A. M. , Richdale A. L.
Published: February 2004

Background  Sleep problems are common in children with an intellectual disability (ID), often lasting for many years. Many parents do not perceive their child to have a sleep problem, do not believe treatment is possible and do not seek treatment. This paper examined prevalence and duration of sleep problems in children with an ID and considered parental perceptions of sleep problems and views towards treatment.

Method  The paper reports on two studies (n = 149 and 243 respectively) of children between 3 and 18 years, with a range of disabilities. Parents in each study completed a questionnaire about their child's sleep problems, and the type and effectiveness of any treatment used to address their child's sleep problems.

Results  Prevalence rates ranged between 25.5% and 36.2% for sleep problems with an average duration of between 6 and 9 years. Around half of parents had sought treatment for their child's sleep problem in Study 1, while 76% had done so in Study 2. Parental ratings regarding treatment effectiveness were higher in Study 1 than in Study 2. Contrary to expectations, behavioural treatment was not rated as significantly more effective than other treatments in either study.

Conclusions  While sleep problems are common and chronic in children with an ID, parents may not recognize a sleep problem as present, often do not seek treatment for their child's sleep problems, and treatment advice and effectiveness is very variable. Thus, further research and parent and professional education regarding the identification and treatment of sleep problems in these children is required.
Severe traffic injuries to children, Trent, 1992–7: time trend analysis
Authors: Arai Lisa
Published: February 2004

Objective  To examine trends in hospital admission rates and socio‐economic gradients for traffic injuries in children, 1992–97.

Design and location  Analysis of hospital admission data, Trent, UK.

Participants  Children aged 0–14 years admitted to hospital for pedal, pedestrian or other transport‐related injury.

Results  Admission rates for severe injuries among cyclists and pedestrians significantly increased during the study period. In 1992–93, admission rates (per 100 000) for severe injuries among child cyclists were 22.5. By 1996–97, these had increased to 28.3. The rates for pedestrians were 9.2 and 11.3, respectively. Other transport‐related injuries decreased during the study period. Socio‐economic gradients in admission rates did not change significantly.

Conclusions  Hospital admission rates for severe injuries to child cyclists and pedestrians increased in 1992–97, but not the rates for other transport‐related injuries.
Cerebral palsy and intrauterine growth in single births: European collaborative study
Authors: Reading Richard
Published: February 2004

Background  Cerebral palsy seems to be more common in term babies whose birthweight is low for their gestational age at delivery, but past analyses have been hampered by small datasets and Z‐score calculation methods.

Methods  We compared data from 10 European registers for 4503 singleton children with cerebral palsy born between 1976 and 1990 with the number of births in each study population. Weight and gestation of these children were compared with reference standards for the normal spread of gestation and weight‐for‐gestational age at birth.

Findings  Babies of 32–42 weeks’ gestation with a birthweight for gestational age below the 10th percentile (using fetal growth standards) were 4–6 times more likely to have cerebral palsy than were children in a reference band between the 25th and 75th percentiles. In children with a weight above the 97th percentile, the increased risk was smaller (from 1.6 to 3.1), but still significant. Those with a birthweight about 1 SD above average always had the lowest risk of cerebral palsy. A similar pattern was seen in those with unilateral or bilateral spasticity, as in those with a dyskinetic or ataxic disability. In babies of less than 32 weeks’ gestation, the relation between weight and risk was less clear.

Interpretation  The risk of cerebral palsy, like the risk of perinatal death, is lowest in babies who are of above average weight‐for‐gestation at birth, but risk rises when weight is well above normal as well as when it is well below normal. Whether deviant growth is the cause or a consequence of the disability remains to be determined.
Psychosocial correlates of depressive symptoms among 12–14‐year‐old Norwegian adolescents
Authors: McConachie Helen
Published: February 2004

Background  The aim of the study was to examine the relationships between various psychosocial factors and depressive symptoms in early adolescence.

Methods  A representative sample of 2465 12–14‐year‐old adolescents comprising 50.8% girls and 49.2% boys, with a mean age of 13.7 years, was recruited in two counties in Norway. The participation rate was 88.3%. Depressive symptoms were measured by the Mood and Feelings Questionnaire (MFQ).

Results  Correlations between the total sum of stressful events/daily hassles and the total sum of MFQ were moderately high, rs = 0.49 and rs = 0.53, respectively. Depressive symptoms were more strongly correlated with school‐related stress among boys than girls, whereas the correlation between daily hassles and depressive symptoms was higher for girls than boys. The results of univariate analyses showed significantly higher mean total MFQ scores among adolescents not living with both natural parents, those who had moved more than twice and those with more than 3 siblings or having fewer than 2 close friends. Further, adolescents from Third World societies and adopted adolescents, those from lower socio‐economic status (SES) groups, having unemployed parents or living in coastal areas had higher mean depressive symptom scores. The results of multiple regression analyses yielded the following six significant predictors of total MFQ scores in order of importance: Sum of daily hassles and sum of stressful life events, gender, number of friends, ethnicity and mother's employment status. Altogether, these variables accounted for 43% of the total variance in MFQ scores.

Conclusions  It is concluded that these psychosocial predictors should be addressed when assessing depressive symptoms in early adolescence. The findings of the study are discussed in view of previous research in the field and their clinical significance.
Randomized controlled trial of treatment of unilateral visual impairment detected at preschool vision screening
Authors: Reading Richard
Published: February 2004

Objectives  To test the efficacy of treatment for unilateral visual loss detected by preschool vision screening and the extent to which effectiveness varies with initial severity.

Design  Randomized controlled trial of full treatment with glasses and patching, if required, compared with glasses only or no treatment. Masked assessment of best corrected acuity after 1 year of follow‐up.

Setting  Eight UK eye departments.

Participants  One hundred and seventy‐seven children aged 3–5 years with mild to moderate unilateral impairment of acuity (6/9–6/36) detected by screening.

Results  Children in the full and glasses treatment groups had incrementally better visual acuity at follow‐up than children who received no treatment, but the mean treatment effect between full and no treatment was equivalent to only one line on a Snellen chart (0.11 log units; 95% confidence interval 0.050–0.171; P < 0.0001). The effects of treatment depended on initial acuity: full treatment showed a substantial effect in the moderate acuity group (6/36–6/18 at recruitment) and no significant effect in the mild acuity group (6/9–6/12 at recruitment) (P = 0.006 for linear regression interaction term). For 64 children with moderate acuity loss the treatment effect was 0.20 log units, equivalent to one to two lines on a Snellen chart. When all children had received treatment, 6 months after the end of the trial, there was no significant difference in acuity between the groups.

Conclusions  Treatment is worthwhile in children with the poorest acuity, but in children with mild (6/9–6/12) unilateral acuity loss there was little benefit. Delay in treatment until the age of 5 did not seem to influence effectiveness.
Monitoring poverty and social exclusion 2003
Authors: Reading Richard
Published: February 2004

The New Policy Institute has produced its sixth annual report of indicators of poverty and social exclusion. This year's report focuses on regional variations across England, Scotland and Wales. With 5 years of data now available to measure progress since Labour came to office in 1997, it is becoming much clearer where the Government's strategy for combating poverty and social exclusion is being successful – and where it is not. With the number of people living in low‐income households now on a steady downward trend, the latest figures (for 2001/2002) passed the notable milestone of taking income poverty lower than at any time in the 1990s. The main reason why the number of people in low‐income households fell in the 5 years to 2001/2002 is that there were fewer people in workless households. But, over the same period, the number of people in low‐income, working households did not fall. Out‐of‐work benefits to both working‐age families with dependent children and to pensioners have risen by around 30% in real terms since 1998, faster than earnings. This, plus the rise in tax credits, will have had a significant impact on the severity of poverty suffered by some low‐income households even when it has not taken them above the low‐income threshold. In education, earlier progress in increasing the numbers of those with an adequate minimum level of qualification has stalled, with no further advance since 2000, compared with rapid progress during the second half of the 1990s. Around a quarter of young people at each of the ages of 11, 16 and 19 are still failing to reach a basic level of attainment. There is no sign of any reduction since 1997 in the health inequalities which leave people with low incomes more likely to suffer serious health‐related problems. Across the range of indicators, problems of poverty and social exclusion are generally more prevalent in the North‐east than in other areas of the country. London has particular problems centred on low income and work and Scotland has particular problems centred on health.