小学学习不良儿童家庭功能研究

我们运用访谈法研究了小学学习不良儿童家庭功能,结果发现学习不良儿童家庭功能比一般儿童家庭在问题解决、沟通、情感反应、行为控制四个维度以及家庭功能总分上显着低下;并进一步分析了学习不良儿童家庭功能中存在的问题.     

学习障碍儿童情绪理解特点比较研究

本研究以90名学习障碍儿童和90名一般儿童为对象,采用表情图片和情境故事法, 探讨学习障碍儿童情绪理解特点.研究发现,学习障碍儿童在情绪理解方面存在一定缺陷,具体表现为:(1)表情识别能力差;(2)自我意识情绪识别水平低下;(3)混合情绪识别较差;(4)情绪原因理解落后;(5)情绪隐藏理解较差;(6)情绪改变理解水平低下.     

MRI对儿童难治性、局灶性癫痫的临床诊断及预后判断

癫痫外科的临床病理研究表明,儿童局灶性皮质发育不良(FCD)及海马硬化是儿童难治性局灶性癫痫常见的致病因素。但在术前的常规的MRI检查中,这些结构上的异常经常被忽视,从而造成延误诊断。临床医生在阅片判断上的失误可能是一个原因,但癫痫的影像专业知识的不全面是重要因素。本文结合MRI技术在癫痫临床诊断领域的应用进展,阐述了儿童难治性、局灶性癫痫患者MRI影像中可能出现的结构性病变;重点阐述了临床易于忽视的局灶性皮质发育不良(FCD)及海马硬化的MRI研究、应用进展。     

小儿重症肺炎的诊治策略

肺炎是儿童常见的呼吸道疾病,小儿重症肺炎及其导致的并发症特别全身炎症反应综合征和多脏器功能衰竭是严重威胁儿童健康和生命的重要原因.随着基础医学和临床医学的发展,人们的认识逐渐深入,防治水平也取得重要进展.但病原学的变迁,不恰当的临床监测和干预仍然影响着人们对该病的正确认识和处理.运用哲学的辩证思维来探讨小儿重症肺炎诊治中的若干问题,将为儿科临床工作提供新的指导.     

小儿重症肺炎的诊治策略

肺炎是儿童常见的呼吸道疾病,小儿重症肺炎及其导致的并发症特别全身炎症反应综合征和多脏器功能衰竭是严重威胁儿童健康和生命的重要原因。随着基础医学和临床医学的发展,人们的认识逐渐深入,防治水平也取得重要进展。但病原学的变迁,不恰当的临床监测和干预仍然影响着人们对该病的正确认识和处理。运用哲学的辩证思维来探讨小儿重症肺炎诊治中的若干问题,将为儿科临床工作提供新的指导。     

哮喘控制与医疗改革

达到并维持哮喘控制和减少未来风险是哮喘的管理目标,绝大多数患者通过药物治疗可以实现这一目标。但目前哮喘控制率很低,除与GINA和我国哮喘诊治规范实施不足有关外,还与传统医疗结构、医疗体制和医疗观念有关,加速医疗改革,人人享有基本医疗卫生服务是提高哮喘控制率的重要环节。     

学习不良儿童的策略研究

策略作为目标指向的旨在解决问题的心理操作,负责对基本信息加工的执行和控制,影响着个体的学习效果,因而被引入到学习不良领域。对学习不良儿童的策略研究具有重要价值。文章分析和综合了已有研究,阐述了学习不良与策略的关系、学习不良儿童的策略表现以及学习不良儿童策略低下的原因,提出了当前研究中存在的问题以及今后的发展趋势。     

哮喘控制与医疗改革

达到并维持哮喘控制和减少未来风险是哮喘的管理目标,绝大多数患者通过药物治疗可以实现这一目标.但目前哮喘控制率很低,除与GINA和我国哮喘诊治规范实施不足有关外,还与传统医疗结构、医疗体制和医疗观念有关,加速医疗改革,人人享有基本医疗卫生服务是提高哮喘控制率的重要环节.     

被“爱心”迷乱的心灵

做了二十多年的心理医生，诊治过不少患精神疾病的儿童少年，虽然他们的临床表现各有所异、发病原因多种多样，但其中有一类原因，却难以为人们所预料和理解，这类原因就是父母的“爱心”。     

基于中央执行功能的儿童工作记忆可塑性机制

近期的研究发现儿童的工作记忆能力具有一定的可塑性。研究者采用双盲对照实验设计, 通过改编的工作记忆广度、N-back、活动记忆和GO-NOGO等任务对15岁以下的正常儿童和特殊儿童(多动症、智力低下等)的工作记忆能力进行训练, 训练的周期一般为15~30天不等, 每天训练时长约15~25分钟。研究结果发现, 工作记忆训练不仅可以提高儿童的工作记忆能力, 而且还可以迁移至其它高级认知功能(流体智力、数学能力等), 甚至可以改善多动症儿童的临床症状。研究者还发现这种训练效应可以保持3~6个月。通过工作记忆中央执行功能的训练, 是否可以促进儿童认知功能的发展？儿童认知功能的可塑性表现为短暂的提高还是促进认知发展？中央执行功能的训练如何影响儿童认知加工过程的发展？这些问题的回答对于近一步探索认知活动和认知神经的可塑性具有一定的理论意义。可以为工作记忆缺陷儿童的临床干预和治疗提供有效的工具, 具有实践意义。     

Temperamental Differences Between Healthy,Asthmatic, and Allergic Children Before Onset of Illness: A Longitudinal Prospective Study of Asthma Development

The authors investigated the link between children's temperament and the development of asthma and allergies. Prospective longitudinal data on children at the ages of 3-5 months, 3-5 years, and 7-9 years were collected. At age 7-9 years, analyses were performed on data for 3 groups of children (n = 42): those with asthma (no allergies), those with allergies (no asthma), and those with neither asthma nor allergies (the control group). Data for children who developed asthma or allergies prior to age 7-9 years were not analyzed. Differences were found in the premorbid period between the control group and the children who later developed asthma or allergies as well as between the asthma and allergy groups. After onset of illness, no temperamental differences were observed between the 3 groups. The study shows the importance of longitudinal design for asthma research.     

Temperamental differences between healthy,asthmatic, and allergic children before onset of illness: a longitudinal prospective study of asthma development

The authors investigated the link between children's temperament and the development of asthma and allergies. Prospective longitudinal data on children at the ages of 3-5 months, 3-5 years, and 7-9 years were collected. At age 7-9 years, analyses were performed on data for 3 groups of children (n = 42): those with asthma (no allergies), those with allergies (no asthma), and those with neither asthma nor allergies (the control group). Data for children who developed asthma or allergies prior to age 7-9 years were not analyzed. Differences were found in the premorbid period between the control group and the children who later developed asthma or allergies as well as between the asthma and allergy groups. After onset of illness, no temperamental differences were observed between the 3 groups. The study shows the importance of longitudinal design for asthma research.     

Symptom perception in childhood asthma: the role of anxiety and asthma severity.

This study tested the relationship of anxiety and asthma severity to symptom perception. Eighty-six children diagnosed with mild or moderate asthma had symptom perception and pulmonary function measured throughout methacholine challenge (to induce bronchoconstriction). Higher trait anxiety was associated with heightened symptom perception (controlling for pulmonary function) at baseline. Greater asthma severity was associated with blunted symptom perception (controlling for pulmonary function) at the end of methacholine challenge and with a slower rate of increase in symptom perception across methacholine challenge. These results suggest that anxiety plays a role when children's symptoms are mild, whereas medical variables such as severity play a role in perception of changes in asthma symptomatology as bronchoconstriction worsens.     

Transactional Paths Between Children and Parents in Pediatric Asthma: Associations Between Family Relationships and Adaptation

The particular challenges posed by pediatric asthma may have a negative impact on the adaptation of children and their parents. From a transactional approach it is important to examine how reciprocal links between children and parents contribute to explain their adaptation and under which conditions these associations occur. This cross-sectional study aimed at examining the direct and indirect links between children’s and parents’ perceptions of family relationships and adaptation, separately (within-subjects) and across participants (cross-lagged effects), and the role of asthma severity in moderating these associations. The sample comprised 257 children with asthma, aged between 8 and 18 years-old, and one of their parents. Both family members completed self-reported questionnaires on family relationships (cohesion and expressiveness) and adaptation indicators (quality of life and psychological functioning). Physicians assessed asthma severity. Structural Equation Modeling was used to test within-subjects and cross-lagged paths between children’s and parents’ family relationships and adaptation. The model explained 47 % of children’s and 30 % of parents’ adaptation: family relationships were positively associated with adaptation, directly for children and parents, and indirectly across family members. Asthma severity moderated the association between family relationships and health-related quality of life for children: stronger associations were observed in the presence of persistent asthma. These results highlight the need of including psychological interventions in pediatric healthcare focused on family relationships as potential targets for improving children’s and parents’ quality of life and psychological functioning, and identified the children with persistent asthma as a group that would most benefit from family-based interventions.     

Association of Hypothalamic-Pituitary-Adrenal Axis Function with Neuropsychological Performance in Children with Mild/Moderate Asthma

The present study examines the relationship between hypothalamic-pituitary-adrenal (HPA) axis function and child psychological/neuropsychological function in a group of children with mild to moderate asthma. The goal of the study was to determine whether child neuropsychological functioning and psychological functioning were associated with cortisol production in response to adrenocorticotropic hormone(ACTH) stimulation when assessed as area under the curve. Data for this study were gathered from 63 children who participated in an ancillary study within the Childhood Asthma Management Program (CAMP) during the pre-randomization phase of the CAMP trial. At 2 of the 8 CAMP clinical centers participants completed an ACTH stimulation test after an overnight stay in the General Clinical Research Center. Gender differences on baseline cortisol and change in cortisol 30 minutes after infusion of ACTH were present. Results further indicated significant associations between cortisol production and measures of child neuropsychological function. Stepwise multiple regression analysis revealed that cortisol change could be predicted by measures of gender, working memory, and arousal maintenance, providing support for the hypothesis that cortisol plays a modest role in the neuropsychological function of children with mild and moderate asthma. In contrast, cortisol production was not associated with child reports of psychological functioning. Limitations to the methods employed in this study are discussed.     

Association of hypothalamic-pituitary-adrenal axis function with neuropsychological performance in children with mild/moderate asthma.

The present study examines the relationship between hypothalamic-pituitary-adrenal (HPA) axis function and child psychological/neuropsychological function in a group of children with mild to moderate asthma. The goal of the study was to determine whether child neuropsychological functioning and psychological functioning were associated with cortisol production in response to adrenocorticotropic hormone(ACTH) stimulation when assessed as area under the curve. Data for this study were gathered from 63 children who participated in an ancillary study within the Childhood Asthma Management Program (CAMP) during the pre-randomization phase of the CAMP trial. At 2 of the 8 CAMP clinical centers participants completed an ACTH stimulation test after an overnight stay in the General Clinical Research Center. Gender differences on baseline cortisol and change in cortisol 30 minutes after infusion of ACTH were present. Results further indicated significant associations between cortisol production and measures of child neuropsychological function. Stepwise multiple regression analysis revealed that cortisol change could be predicted by measures of gender, working memory, and arousal maintenance, providing support for the hypothesis that cortisol plays a modest role in the neuropsychological function of children with mild and moderate asthma. In contrast, cortisol production was not associated with child reports of psychological functioning. Limitations to the methods employed in this study are discussed.     

Asthma in children of Caribbean descent living in the inner-city: comparing Puerto Rican and Afro-Caribbean children

Ethnic minority children bear a disproportionate amount of the US asthma burden. We compared asthma morbidity and pulmonary function (%FEV₁) in two Caribbean groups living in the Bronx, NY: Puerto Rican and Afro-Caribbean children. Caregiver-child dyads (Puerto Rican: n = 113, M age = 9.89 ± 2.05; Afro-Caribbean: n = 47, Mage = 10.35 ± 2.08) responded to sociodemographic and asthma-related questions, and children’s %FEV₁ was measured. Puerto Rican children had significantly greater (past year) asthma morbidity, yet there were no significant differences in %FEV₁. This discrepancy between objective pulmonary function and asthma morbidity suggests the importance of considering sociocultural factors in pediatric asthma care.     

肺功能检查对婴幼儿哮喘诊断的价值

如何对婴幼儿哮喘进行早期诊断和进行早期干预已成为目前儿童哮喘防治的主要话题。随着肺功能检测技术的进步,临床上已有多项肺功能检测技术可应用于婴幼儿。正确地理解和掌握这些检测技术可为婴幼儿哮喘的诊断和鉴别诊断提供重要依据。本文对这些不同检测技术的原理、参数及其临床意义进行了阐述。     

Attentional bias to respiratory- and anxiety-related threat in children with asthma

This study investigated attentional biases in children with asthma. The study aimed at testing whether children with asthma are vigilant to asthma and/or anxiety cues. Thirty-six children (18 with asthma and 18 healthy controls) aged 9–12 completed a computerised dot probe task designed to measure attentional bias to three different categories of words: asthma, anxiety symptom and general negative emotion. Main caregiver anxiety was also assessed, as was frequency of inhaler use for those with asthma. Children with asthma showed an attentional bias towards asthma words but not anxiety or general negative emotion words. Children without asthma showed no significant attentional biases to any word categories. Caregiver anxiety was correlated with asthma word attentional bias in the asthma group. The findings indicate that attentional bias is present in children with asthma. Further research is required to ascertain if this exacerbates or maintains health-related problems.     

Home-based family intervention for low-income children with asthma: a randomized controlled pilot study

Low-income African American children have disproportionately higher asthma morbidity and mortality. Education alone may not address barriers to asthma management due to psychosocial stress. This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model. Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp. Caregivers with elevated scores on a stress measure were enrolled. Forty-three families were randomized to the 4- to 6-session Home Based Family Intervention (HBFI) or the single session of Enhanced Treatment as Usual (ETAU). All families received an asthma action plan and dust mite covers; children performed spirometry and demonstrated MDI/spacer technique at each home visit. The HBFI addressed family-selected goals targeting asthma management and stressors. Asthma management, morbidity, family functioning, and caregiver stress were assessed at baseline, postintervention, and 6 months after the intervention. ED visits and hospitalizations were ascertained by medical record review for a year after intervention completion. Only one child (5%) in HBFI had an asthma-related hospitalization compared to 7 patients (35%) in ETAU in the year following intervention. Participants in both groups demonstrated improved asthma management and family functioning, and reduced ED visits, symptom days, missed school days, and caregiver stress, but there were no differential treatment effects. The results suggest that a home-based intervention addressing medical and psychosocial needs may prevent hospitalizations for children with poorly controlled asthma and caregivers under stress.