Lynette Keyes

Evaluation of a home-based intervention program to reduce infant passive smoking and lower respiratory illness

We conducted a randomized controlled trial to determine whether a home-based intervention program could reduce infant passive smoking and lower respiratory illness. The intervention consisted of four nurse home visits during the first 6 months of life, designed to assist families to reduce the infants exposure to tobacco smoke. Among the 121 infants of smoking mothers who completed the study, there was a significant difference in trend over the year between the intervention and the control groups in the amount of exposure to tobacco smoke; infants in the intervention group were exposed to 5.9 fewer cigarettes per day at 12 months. There was no group difference in infant urine cotinine excretion. The prevalence of persistent lower respiratory symptoms was lower among intervention-group infants of smoking mothers whose head of household had no education beyond high school: intervention group, 14.6%; and controls, 34.0%.

Implementing early childhood inclusion: Barrier and support factors

Abstract This study examined the underlying factor structure of a rating scale designed to assess perceived barriers and supports associated with early childhood inclusion. Participants were 201 administrators and direct service providers from the early intervention, early childhood, and special education fields and 287 parents (primarily mothers) of young children with disabilities (birth through 5 years) who received early intervention services. A four-factor solution for barriers that accounted for 41% of the total variance emerged from an exploratory factor analysis. Because one of the factors was found to have low internal consistency, a three-factor solution was used in subsequent analyses. The three factors consisted of barriers associated with early childhood program quality, community resources, and coordinating and integrating services for children with disabilities and their families. Items reflecting supports for early childhood inclusion produced a single supports factor. A confirmatory factor analysis revealed a barriers factor structure for parents that was consistent with that obtained for professionals. Background variables contributed to explaining ratings of barriers and supports among parents who differed with respect to race, education, employment status, and experience with inclusion, lending further support for the validity of the factor structure.

National Portrait of Sociodemographic Factors Associated with Underutilization of Services Relevance to Early Intervention

Under the Individuals with Disabilities Education Act, states are designing and implementing comprehensive multidisciplinary early intervention services for families with young children with disabilities. It is the intent of the legislation that early intervention services reach populations that have been typically underserved. To understand ways in which services may promote utilization among typically underserved populations, it is necessary to examine the factors that have been associated with underutilization and their prevalence in the population of families with young children. In addition to a conceptual model of underutilization, we present statistics generated from the March 1991 Current Population Survey on the sociodemographic characteristics of families with children under 5 years of age. We also suggest four types of policies that may facilitate the participation of families who are likely to underutilize services.

Lower respiratory illness in infants and low socioeconomic status.

OBJECTIVES Infants from families of low socioeconomic status are said to suffer higher rates of lower respiratory illness, but this assertion has not been carefully examined. METHODS We studied the frequency and determinants of lower respiratory illness in infants of different socioeconomic status (n = 393) by analyzing data from a community-based cohort study of respiratory illness during the first year of life in central North Carolina. RESULTS The incidence of lower respiratory illness was 1.41 in the low socioeconomic group, 1.26 in the middle group, and 0.67 in the high group. The prevalence of persistent respiratory symptoms was 39% in infants in the low socioeconomic group, 24% in infants in the middle group, and 14% in infants in the high group. The odds of persistent respiratory symptoms in infants of low and middle socioeconomic status were reduced after controlling for environmental risk factors for lower respiratory illness. Enrollment in day care was associated with an increased risk of persistent symptoms among infants of high but not low socioeconomic status. CONCLUSIONS Infants of low socioeconomic status are at increased risk of persistent respiratory symptoms. This risk can be partly attributed to environmental exposures, most of which could be changed.

An ecobehavioral analysis of early childhood classrooms.

The purpose of the study was to address the following questions: (1) what child and classroom characteristics typically accompany complex interactions with objects and peers? and (2) under what circumstances are children more likely to experience complex interactions from teachers in the classroom? The sample consisted of 3216 observations of 60 preschool children (M age = 53.72 months). General estimating equation (GEE) methods were used to model the log-odds of complex interactions with objects and peers, and complex interactions with teachers, as a function of child and classroom variables. Results revealed that complex interactions with objects were highly probable in dramatic play activities and, when a teacher was present, in art activities. Complex interaction with peers was rare over-all, but was most probable when children were with one child or with a group of children. Complex teacher behavior was more probable when children were alone with a teacher and in dramatic play activities. The data are discussed from an ecobehavioral and methodological framework.

Urinary cotinine and parent history (questionnaire) as indicators of passive smoking and predictors of lower respiratory illness in infants

Studies of the effects of passive smoking on lower respiratory illness (LRI) have relied on questionnaires to measure exposure. We studied the association between two measures of passive smoking and the incidence of acute LRI in infants. We analyzed data from a community‐based cohort study of respiratory illness during the first year of life in North Carolina. The incidence of LRI was determined by telephone calls at 2‐week intervals. Environmental, demographic, and psychosocial risk factors for LRI were measured during home interviews. Tobacco smoke exposure was measured as the mean number of cigarettes smoked per day in the infants presence. Smoke absorption by the infants was measured by the urinary cotinine/creatinine ratio.

Accuracy of the clinical examination in detecting hypoxemia in infants with respiratory illness

OBJECTIVES To evaluate the diagnostic accuracy of the clinical examination in detecting hypoxemia in infants with lower respiratory tract illness. DESIGN Cross-sectional study. SETTING Three university pediatric outpatient departments and one private pediatric practice. PATIENTS Healthy infants less than 1 year of age seen between December and March 1989 and 1990, with symptoms suggesting acute lower respiratory tract illness. MAIN OUTCOME MEASURES The test characteristics of 27 elements of the clinical examination, as well as the accuracy of the overall examination and the components of the examination in detecting oxygen saturation < 95% measured by pulse oximetry. Reliability of clinical examination findings. RESULTS None of the 27 clinical findings had sensitivities that would make them useful diagnostic tests for hypoxemia. By combining all the clinical findings, however, we found good diagnostic accuracy (area under the receiver operator characteristic curve 0.90). Three groups of clinical findings--social interactiveness, respiratory effort, and physical appearance--accounted for much of the diagnostic accuracy of the examination. Auscultatory findings contributed little. In these three groups, five clinical findings accounted for almost all the accuracy: attentiveness, consolability, respiratory effort, color, and movement. Together, these findings also had good accuracy (area under the receiver operator characteristic curve 0.95). CONCLUSIONS A small number of clinical observations may be mostly responsible for the diagnostic value of the clinical examination of infants with symptoms of LRI. Concentrating on a limited group of findings appears to enhance the accuracy of the examination in detecting hypoxemia.

INDIVIDUAL AND TEAM CONSENSUS RATINGS OF CHILD FUNCTIONING

The authors examined agreement between interdisciplinary teams of professionals in rating the functional abilities of children with disabilities. 129 children were rated on the ABILITIES index by 72 professionals working in nine developmental evaluation centers. Independent individual ratings were made first, followed by a consensus rating. Team members had a high degree of agreement on independent ratings of abilities and limitations, with nearly 90 per cent of the ratings within one point of each other. More disagreement was associated with rating areas of behavior and communication, team experience and increased severity of disability. The teams consensus ratings were more likely to defer to the ratings of the expert in particular areas. Implications for team assessment and team functioning are discussed.

Playmate Preferences and Perceptions of Individual Differences Among Typically Developing Preschoolers

The purpose of this study was to describe preschoolers’ playmate preferences and perceptions of classmates with and without disabilities using a peer rating task and a corresponding teacher rating scale. Participants consisted of 34 typically developing preschoolers ranging in age from 42 to 69 months and 5 classroom teachers. Although preschoolers with disabilities received lower sociometric ratings than their typically developing peers, the reasons children cited for selecting or rejecting their peers with disabilities were essentially the same as those given for nondisabled children. In dyads In which one child had disabilities and the other did not, teachers reported that approximately 50% preferred not to play with each other, whereas reciprocal nonpreference was reported to occur in only 21 % of dyads in which both partners were typically developing. The proportions of mutual playmate preferences in the two types of dyads were roughly equivalent, suggesting that children with disabilities are capabl...

Comfort Zone Revisited: Child Characteristics and Professional Comfort with Consultation

This study examined professional comfort of 84 early intervention professionals in providing consultation about children with varying types, severity levels, and combinations of disabilities. A replication of an earlier study with classroom teachers, the study involved a structured interview using the ABILITIES Index to assess professional comfort on the basis of child characteristics. Preliminary analyses suggested that discomfort was consistent with reported disability (behavioral, orthopedic, sensory, cognitive, or multiple disabilities). Significantly more discomfort was reported if the child had severe disabilities or difficulties in communication and behavior. Additionally, training in consultation and experience in early intervention predicted professional comfort in providing consultation. Findings have implications for professional development aimed at improving consultation practice to support early childhood inclusion.