<p>The purposes of the thesis were to study associations between size at birth, short adult stature and risks of subnormal intellectual performance, high blood pressure, and overweight among males, and to study associations between size at birth, short adult stature and risk of overweight and giving birth to small for gestational age (SGA) infants among females.</p><p>The effect of short adult stature on intellectual performance among males was analyzed in two population-based cohort studies. Data were obtained from the Swedish Birth Register which was individually linked to the Swedish Conscript Register. Being born SGA was associated with increased risks of subnormal intellectual performance in all four dimensions included in the test, and lack of catch-up growth leading to short adult stature further increased this risk. If anything, logical performance was found to be most affected.</p><p>To estimate the risk of high blood pressure in males born SGA we used the Birth Register linked to the Conscript Register. Being born SGA was associated with a slightly increased risk of high systolic blood pressure, and being born light and ending up with short adult stature further increased this risk.</p><p>Association between short adult stature and overweight was analyzed in both males and females born SGA, in two different studies. In the male cohort data from the Birth Register was linked to the Conscript Register. In females the Birth Register was used twice, when the females were born and when they gave birth to their first child. In both the male and female cohort, there was an increased risk of becoming overweight among those born SGA who also ended up with short adult stature.</p><p>Finally, an intergeneration study was performed using the Birth Register to analyze associations between being born short for gestational age and giving birth to short infants. Catch-up growth to normal adult stature among women born short-for-gestational age was associated with reduced risk of giving birth to a short-for-gestational age infant.</p><p>Conclusions. Among males born SGA, short adult stature is associated with increased risk of subnormal intellectual performance, high blood pressure and overweight compared to those with normal adult stature. Similarly, among females born SGA, there is an increased risk of becoming overweight in those with short adult stature, compared with those not short as adult. Females born short for gestational age, with short adult stature are at increased risk of giving birth to a short infant.</p>

Thèse (Ph.D.)--Université de Montréal, 1999. / Comprend des réf. bibliogr.

The purposes of the thesis were to study associations between size at birth, short adult stature and risks of subnormal intellectual performance, high blood pressure, and overweight among males, and to study associations between size at birth, short adult stature and risk of overweight and giving birth to small for gestational age (SGA) infants among females. The effect of short adult stature on intellectual performance among males was analyzed in two population-based cohort studies. Data were obtained from the Swedish Birth Register which was individually linked to the Swedish Conscript Register. Being born SGA was associated with increased risks of subnormal intellectual performance in all four dimensions included in the test, and lack of catch-up growth leading to short adult stature further increased this risk. If anything, logical performance was found to be most affected. To estimate the risk of high blood pressure in males born SGA we used the Birth Register linked to the Conscript Register. Being born SGA was associated with a slightly increased risk of high systolic blood pressure, and being born light and ending up with short adult stature further increased this risk. Association between short adult stature and overweight was analyzed in both males and females born SGA, in two different studies. In the male cohort data from the Birth Register was linked to the Conscript Register. In females the Birth Register was used twice, when the females were born and when they gave birth to their first child. In both the male and female cohort, there was an increased risk of becoming overweight among those born SGA who also ended up with short adult stature. Finally, an intergeneration study was performed using the Birth Register to analyze associations between being born short for gestational age and giving birth to short infants. Catch-up growth to normal adult stature among women born short-for-gestational age was associated with reduced risk of giving birth to a short-for-gestational age infant. Conclusions. Among males born SGA, short adult stature is associated with increased risk of subnormal intellectual performance, high blood pressure and overweight compared to those with normal adult stature. Similarly, among females born SGA, there is an increased risk of becoming overweight in those with short adult stature, compared with those not short as adult. Females born short for gestational age, with short adult stature are at increased risk of giving birth to a short infant.

Occupational therapists assess and make recommendations for modifying home environments to facilitate caregiving of children in their homes. Children who are profoundly and permanently physically disabled remain dependent for their care throughout their lifespan. As they mature, the physical demands on family members to provide care become more challenging requiring major modifications to ease caregiving. Qualitative interview data of ten educationally influential occupational therapists (EIOTs) were collected to examine what information the EIOTs collect and how they prioritize and organize these data to make modification recommendations. The data were analyzed using grounded theory methodology. The findings detail myriad information required by the EIOT to make recommendations for modifications. Findings suggest a future oriented and highly contextualized information gathering process. The themes were integrated into a process model that suggests how therapists may be developing recommendations. The findings highlight important implications for research, education, clinical practice and service delivery policy.

Occupational therapists assess and make recommendations for modifying home environments to facilitate caregiving of children in their homes. Children who are profoundly and permanently physically disabled remain dependent for their care throughout their lifespan. As they mature, the physical demands on family members to provide care become more challenging requiring major modifications to ease caregiving. Qualitative interview data of ten educationally influential occupational therapists (EIOTs) were collected to examine what information the EIOTs collect and how they prioritize and organize these data to make modification recommendations. The data were analyzed using grounded theory methodology. The findings detail myriad information required by the EIOT to make recommendations for modifications. Findings suggest a future oriented and highly contextualized information gathering process. The themes were integrated into a process model that suggests how therapists may be developing recommendations. The findings highlight important implications for research, education, clinical practice and service delivery policy.

Pediatric overweight is of paramount importance in Kentucky, as studies show prevalence rates are higher in the state than the national average. Research suggests that comprehensive treatments involving diet training, exercise training, and psychological counseling are most effective at reducing overweight in children. Little research has been done, however, to compare parents' and physicians' perceptions of obesity, its treatment, or barriers to weight management. The purpose of this study is to examine differences in attitudes toward pediatric obesity and weight management among parents and physicians, specifically related to the importance of diet training, exercise training, and psychological counseling. Surveys were sent to a population of pediatricians and family practitioners serving pediatric patients in the ten-county Barren River Area Development District of south-central Kentucky and to a convenience sample of 160 parents, identified when they brought their child(ren) to a physician for an office visit. Data were analyzed 1) descriptively and 2) inferentially to test hypotheses. Frequencies and measures of central tendency were conducted on categorical and continuous data. A series of t-tests were conducted at a 95% confidence interval to determine if differences existed between parents and physicians concerning the importance of 1) diet training, 2) exercise training, or 3) psychological counseling to pediatric weight control. Results showed a 42.9% prevalence of overweight among the children of sampled parents. Results also showed that physicians rated the three treatment modalities under study as significantly more important than did parents. Additionally, parents and physicians identified different barriers to the successful treatment of child overweight. While physicians felt child and family adherence issues presented the largest barriers, parents cited cost and self-esteem concerns as larger barriers to pediatric weight management. This study has many public health implications, including potential benefits from awareness efforts and educational training related to the identification of child overweight and the importance of a comprehensive treatment strategy. Additionally, physicians who are aware of parents' concerns related to finances and their child's self-esteem might be able to tailor their educational efforts to address those concerns, thus increasing treatment adherence.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent chronic disorders in childhood. The measurement of health-related quality of life (HRQOL) can compliment ADHD behavior rating scales and provide a more comprehensive understanding of the impact of ADHD and its treatment on the child's overall daily functioning and well-being. The purpose of the current study was to assess HRQOL from the perspective of pediatric patient self-report and parent proxy-report and family impact from the perspective of parents in children with ADHD ages 5 to 18 years being seen at a Pediatric Psychiatric Clinic utilizing the PedsQL(TM) 4.0 Generic Core Scales and Family Impact Module. For all PedsQL(TM) 4.0 Generic Core Scales, pediatric patients with ADHD and their parents reported statistically significant worse HRQOL than healthy children, with large effect sizes across all domains. More impaired generic HRQOL was significantly correlated with more severe ADHD symptoms as measured by the NICHQ Vanderbilt Total ADHD Symptom Score for parent proxy-report but not child self-report. More impaired family functioning was significantly correlated with more severe ADHD symptoms. Intraclass Correlations (ICC) between pediatric patient self-report and parent proxy-report across the PedsQL(TM) 4.0 Generic Core Scales were in the poor to fair agreement range. These findings have implications for future research and clinical practice with pediatric patients with ADHD and co-morbid psychiatric conditions and their families. Given the large effect sizes reported between the present sample and healthy children across all HRQOL domains, it is important that interventions designed for children with ADHD and co-morbid psychiatric conditions not only address psychosocial difficulties, but also the physical impairments that may result from medications and/or co-morbid psychiatric diagnoses such as anxiety or depression. Given our finding that greater ADHD symptomatology was significantly associated with greater negative family impact, interventions for this population should focus on mitigating the negative impact of ADHD and co-morbid psychiatric conditions on families, particularly related to the areas of parental worry, family relationships, and daily family activities.

Abstract Traditionally, doctors and patients are based on different cognitions and ways of thinking to communicate with each other. Doctors are often holding dominated role in the process. The knowledge of doctors is coming from the curricula that they have learned at medical school and their clinical experience, whereas the knowledge of patients is coming from their health experience and the information which was reported in the common medical magazines and journals. Because of the different cognitive modes of medicine between doctors and patients, the efficiency of doctor-patient communication is usually unsatisfied. With the popularity of medical information, the rise of consumers¡¦ consciousness, and the change of health insurance system, patients are asking better quality of medical treatment now. Thus, the quality of doctor-patient communication seems to be more important. This research was employed by case study. The doctors and outpatients of the pediatrics department were selected as the research sample. Totally, the sample included six senior doctors with three different levels of hospital and 30 outpatients. The dialogs of interrogation enquiry between these doctors and patients were collected. The analytic framework was derived from Brown and Levinson¡¦s politeness theory, Grice¡¦s conversational maxims, and Roter¡¦s analytical system of doctor-patient communication behavior. This study analyzed the politeness strategies used during doctor-patient communication, and also found the communication modes that were frequently emerging in the diagnostic processes. The research results show that the maximum politeness strategies used in pediatrics clinics is the bald on record. This reveals a kind of consensus on the importance of communication efficiency for doctors and patients. Most of patients adopt more polite strategies to communicate with doctors for medical knowledge. The results also suggest several commonly-seen dialog modes providing the further self-awareness and self-observation for doctors and patients. Indirect communication, the off-record politeness strategies are also appeared in the dialogues of doctors and patients. This study contributed toward gaining the efficiency of doctor-patient communication, thus may be helpful in the saving of medical resources. Keywords: doctor-patient communication, politeness theory, therapeutic behavior, pediatrics clinics

Infancy is a time of rapid physiological (e.g. anthropometric, immunological and neurological) development. Hence, during this period of life nutritional requirements are at their highest in relation to body mass. There is a paucity of data with respect to the nutritional quality of complementary foods manufactured in the UK for infants and young children. The primary objective of this study was to examine the nutritional value of ‘ready to feed‘ complementary infant foods on the UK market in order to ascertain their suitability, relative to dietary guidelines, for the target group. Quantitative analysis was conducted on eight different products representing four popular commercial brands (meat and vegetable based) currently on sale in the UK for infants aged between 6-12 months. The chemical analyses conducted included Kjeldhal for protein, acid hydrolysis and extraction for fat, phenol sulphuric acid for carbohydrate and AOAC 985.29 for fibre. The results of these studies were referenced to the Recommended Nutrient Intake (RNI) values for 6 to 9 months old children, and a listing of the entire daily intake of nutrients was composed taking into consideration the nutrient and energy intake from milk consumption in order to (1) accurately estimate the daily intake of these nutrients derived from commercial infant food consumption, and (2) ascertain their nutritional suitability relative to dietary guidelines for the 6-9 month age group. The only significant difference found between different product varieties (meat and vegetable-based) was with respect to the protein content (p = 0.04) per 100 g of food. The experimentally determined concentrations of macronutrients (g/100 kcal) were compared to the declared values provided by the manufacturers on the product labels and, despite some variations, the values obtained comply with regulatory requirements (Commission Directive 2006/125/EC). The total daily intake of fat (27.0 g/day), based on the menu composed from commercial complementary food, is suggested to exceed the Dietary Reference Values (DRVs) for fat (31%), if the intake of snacks and desserts are incorporated. The aforementioned results imply that the formulations of the recipes, based on a standard commercial menu, are of significant importance in relation to the nutritional quality of the diet of infants. In terms of elemental analysis, the concentrations of up to twenty (essential and non-essential) elements in a selected range of sixteen different products representing meat, poultry, fish and vegetable base varieties were established by ICP-OES and ICP-MS. Six major essential elements, namely: calcium, iron, magnesium, potassium, sodium and zinc were measured by ICP-OES. The concentrations of six essential trace elements (selenium, molybdenum, cobalt, copper, chromium, manganese) and eight non-essential, potentially toxic, elements (arsenic, barium, nickel, cadmium, antimony, lead, mercury, aluminium) in chicken and fish-based varieties were determined by ICP-MS due to the higher sensitivity required. Based on the results of elemental analysis, there was also some evidence of a lack of attention to micro-nutrient interactions in food. With reference to the guidelines, the RNI values for 6 to 9 month olds, all samples provided less than 20% of RNI values except for potassium (20%). In terms of the risk of exposure to toxicity, the concentration of non-essential elements in ready to feed products analysed were not considered to be of concern. With regard to the analyses of vitamins, a novel assay for the simultaneous quantitative determination of riboflavin (B2) and pyridoxine (B6) has been developed. The method involves a mild hydrolysis step, extraction of the supernatant by centrifugation followed by quantitative analysis using UHPLC. Separation of the two water soluble vitamins achieved is excellent and rapid - within one minute whilst the resultant sample is also LC-MS compatible. With respect to vitamin B analyses, despite wide individual differences between brands (p = 6.5e-12), no significant differences were observed in the levels of vitamin B6 between the meat and vegetable-based varieties (p = 0.7) per 100 g of commercial infant food. Vitamin B2 was not detected in any of the samples, where the detection limit was below 0.07μg/mL. In terms of the RNI of vitamin B6 for 6 - 9 month old infants, the complementary infant meal products analysed herein provided less than 15% of the RNI values with mean (SD) values of 12.87 (±4.46) % and 13.88 (±4.97) % for the meat- and vegetable-based recipes, respectively. The estimated total daily intake of vitamins B2 and B6 from the consumption of commercial complementary food was found to be satisfactory and in accordance with the DRVs. The intake of both vitamin B2 and B6 was estimated to be mainly derived from the consumption of formula milk which could be a cause of concern if the quality of an infant‘s milk diet is compromised by an inadequate or lack of supplemented milk intake. All the foregoing results suggest that commercial complementary infant foods on the UK market may not contain minimum levels of micronutrients required for labelling declaration of micronutrient content (Commission Directive 2006/125/EC). An attempt, therefore, was made to optimise the formulated version of the meat based infant food as a baseline and measure the post-process retention of its nutrient content after being subjected to different processing condition in terms of a combination of temperature and time. This was achieved by quantitative analysis of the post-process values of the nutrients in the optimised formula using the aforementioned analytical techniques. The results of this study indicates that careful formulation of the recipes, in the context of new product development, is important; the selection of high quality ingredients and the ratios in which they are used have a direct effect on the nutrient content of the final product. It also indicates that a carefully controlled temperature-time combination, pH, pressure and macroscopic conditions of processing (e.g. controlled leaching) are very important in reducing heat loss and improving the nutritional quality of the food product. This provides opportunities and scope for product optimisation, of ready to eat to eat infant foods, in order to improve their nutritional value.

Although the psychomotor vigilance task (PVT) is commonly used in adult sleep research, normative data for PVT performance in children have not been published and performance in children with sleep disordered breathing (SDB) has not been explored. This report describes PVT performance among children participating in the Tucson Children's Assessment of Sleep Apnea (TuCASA). A community-based sample of 360 Caucasian and Hispanic children completed a standard PVT trial. Participants were 48% female and 36% Hispanic; mean age was 8.9 years. Children with respiratory disturbance index (RDI) &gt;1 event/hour and those with parent-reported sleep problems were excluded from the normative analysis. Among normal sleepers, performance on several measures improved with increasing age and differed between boys and girls. No ethnic differences were detected. Among children with SDB, no differences in performance were identified. Age and gender differences in PVT performance must be considered when the PVT is utilized in pediatric populations.