Impairment In School-age Children Research Articles

Speech Sounds Production, Narrative Skills, and Verbal Memory of Children with 22q11.2 Microdeletion.

22q11.2 deletion syndrome (22q11.2DS), the most frequent microdeletion syndrome in humans, is related to a high risk of developing neurodevelopmental disorders. About 95% of patients with 22q11.2DS have speech and language impairments. Global articulation, story generation, and verbal memory tests were applied to compare articulatory characteristics of speech sounds, spontaneous language abilities, and immediate verbal memory between four groups of Serbian-speaking children: patients with 22q11.2DS, children with clinical presentation of 22q11.2DS that do not have the microdeletion, children with non-syndromic congenital heart defects, and their peers with typical speech-sound development. The obtained results showed that children with this microdeletion have impaired articulation skills and expressive language abilities. However, we did not observe weaker receptive language skills and immediate verbal memory compared to healthy controls. Children with 22q11.2DS should be considered a risk category for the development of speech-sound pathology and expressive language abilities. Since speech intelligibility is an instrument of cognition and adequate peer socialization, and language impairment in school-aged children with 22q11DS might be an indicator of increased risk for later psychotic symptoms, patients with 22q11.2 microdeletion should be included in a program of early stimulation of speech-language development immediately after diagnosis is established.

Screening for Hearing Impairment in School-Age Children and Adolescents With Developmental Disabilities in an Ethnically Diverse Community.

Screening for Hearing Impairment in School-Age Children and Adolescents With Developmental Disabilities in an Ethnically Diverse Community.

Structural brain abnormalities and their association with language impairment in school-aged children with Autism Spectrum Disorder

Language impairment is comorbid in most children with Autism Spectrum Disorder (ASD) but its neural basis is poorly understood. Using structural magnetic resonance imaging (MRI), the present study provides the whole-brain comparison of both volume- and surface-based characteristics between groups of children with and without ASD and investigates the relationships between these characteristics in language-related areas and the language abilities of children with ASD measured with standardized tools. A total of 36 school-aged children participated in the study: 18 children with ASD and 18 age- and sex-matched typically developing controls. The results revealed that multiple regions differed between groups of children in gray matter volume, gray matter thickness, gyrification, and cortical complexity (fractal dimension). White matter volume and sulcus depth did not differ between groups of children in any region. Importantly, gray matter thickness and gyrification of language-related areas were related to language functioning in children with ASD. Thus, the results of the present study shed some light on the structural brain abnormalities associated with language impairment in ASD.

The Prevalence and Causes of Low Vision and Visual Impairment in School-Aged Children: The Shiraz Pediatric Eye Study.

To determine the prevalence and causes of visual impairment (VI) in Shiraz schoolchildren aged between 6 and 12 years. In the present population-based study, stratified random sampling was used to select 2400 schoolchildren aged 6-12 years from all four educational districts of Shiraz, Iran. Using the definitions of the World Health Organization, VI was defined as best-corrected visual acuity (BCVA) ≤0.5 logMAR (20/60) in the better eye, and blindness as BCVA worse than 1.3 logMAR (20/400) in the better eye. The low vision was defined as BCVA equal to or worse than 0.5 logMAR (20/60) in either eye. Data were recorded from a detailed interview and ocular examination of each eligible student. The mean age of the students was 9.1 ± 1.6 years. The prevalence of VI was 3/2001 (0.14%). The cause of VI in all these three patients (100%) was amblyopia due to high refractive errors (high ametropia and astigmatism). Regarding the main refractive errors leading to VI among these three patients, one patient had bilateral high hyperopia (compound hyperopic astigmatism), one of them had bilateral high astigmatism, and the other one had compound myopic astigmatism. According to a visual acuity of less than or equal to 20/60 in at least one eye, 9/2001 (0.4%) of children had low vision. This study revealed a low prevalence of VI in a sample of 6- to 12-year-old school-aged children. Amblyopia in the setting of high ametropia and astigmatism were the most common causes of VI.

Fetal alcohol spectrum disorders: current state of diagnosis and treatment.

The purpose of this review is to describe recent findings on the clinical presentation, pathogenesis, and management of fetal alcohol spectrum disorders (FASDs). Alcohol causes a range of physical, developmental, and cognitive impairments on the developing fetus. Individuals exposed to alcohol prenatally have a wide variability in dysmorphic and neurologic features. Hence, a greater understanding of the mechanisms through which alcohol induces defects in the developing fetus is imperative in developing therapies that prevent alcohol-induced effects. Current research has focused on leveraging technology to developing tools that can aid in the diagnostic process, defining patterns of neurocognition and neuroimaging specific to FASD, developing neurobehavioral and pharmacologic interventions, and expanding access to care. FASDs are a common cause of neurodevelopmental impairment in school-age children, and their recognition is essential to provide early interventions in order to optimize the outcome for these individuals when they reach adulthood. Although previously thought to be the result of irreversible neurologic injury from prenatal alcohol exposure, recent evidence points to the benefits of applying principles regarding neuroplasticity in improving the lives for patients and their families.

An Error Analysis of Nonword Repetition Performance in Toddlers and Young Children: Theoretical Implications and Clinical Utility.

Purpose Nonword repetition has been cited as a measure of phonological working memory and continues to gain status as a clinical tool used to identify language impairment in school-age children. Less is known about nonword repetition skills in the toddler population. Method The current study presents a detailed analysis of errors by segmenting nonwords into word, syllable, and phoneme levels. Errors were also analyzed for type (e.g., addition, substitution, deletion). The Test of Early Nonword Repetition was used to measure performance in a sample of 36 typically developing children, aged 24-48 months. Clinical assessments including parent report, language sampling procedures, and standardized assessments were also administered. Results As a group, participants produced significantly more syllable errors compared to word-level errors; however, most errors were made at the phoneme level. Errors of addition were the least common error type, and no differences between substitutions or deletions were present for the entire sample. Toddlers (aged 2 years) produced more syllable-level errors compared to older children (aged 3 years). Substitution errors were positively correlated with performance on clinical measures of language, whereas deletion errors were negatively correlated with performance. Conclusion Nonword repetition performance patterns in young children may be associated with language delay or language impairment and have both clinical and theoretical relevance.

Prevalence of hearing loss in school aged Nepalese children

ObjectivesThe main objective of this study is to identify the prevalence of hearing loss in school aged children of Nepal. MethodsThis cross-sectional study was carried out on school aged children attending the government run schools of Nepal. A total of 79,340 children from grades 1 through 10 were included in the study. After taking brief history about ear diseases and hearing loss, children were screened for ear diseases in their respective classroom by otoscope. Hearing evaluation was carried out by pure tone audiometer and hearing threshold was obtained at 0.5–4 kHz. The results were then documented and analyzed. ResultsThe prevalence of hearing impairment in school aged children in Nepal is found to be 5.73% (4551 of 79,340). Conductive hearing loss was the most common type of hearing loss and was observed in 70.47% (n = 3207) of the children. ConclusionsThis study shows that hearing loss is a common problem in children of Nepal. With the main cause of hearing loss due to preventable conditions such as chronic otitis media, it is believed that early standardized screening, detection and timely management of chronic otitis media in these children can prevent hearing loss and its impact on their educational, social and language development. School based ear health programs are a useful community-oriented solution for prevention of deafness. It shows how important it is to introduce hearing screening for primary school aged children to prevent hearing loss.

Unique Associations Between Specific Attention-Deficit Hyperactivity Disorder Symptoms and Related Functional Impairments.

The purpose of this study was to explore the unique relationships between specific attention-deficit hyperactivity disorder (ADHD) symptoms and functional impairment in school-age children using parent and teacher ratings. Parents and teachers rated ADHD symptoms and comorbidities (internalizing and oppositional behaviors) as well as impairments (academic, relationship, and classroom behavior) for 8689 children using the Vanderbilt ADHD Diagnostic Rating Scales. Stepwise regression was used to determine which of the 18 ADHD symptom items were most associated with specific domains of impairment with relevant demographic and clinical characteristics used as covariates (e.g., sex, comorbidities, medication status, and age). "Careless mistakes" and "avoids tasks" significantly predicted academic impairment across content areas and across parent- and teacher-rating models. ADHD symptoms accounted for limited variance in impairment in the family and peer relationship domains or in organized activities when oppositional symptoms were entered as a covariate. Regarding teacher-rated classroom behavior, the strongest predictor of impairment was "talks too much." The findings indicate that the symptoms that were most predictive of impairment varied by domain of impairment.

Vision screening in school children from low-income areas of Sao Paulo city: Frequency and causes of visual impairment and blindness

Objective: The purpose of this study was to investigate frequency and causes of visual impairment in school-aged children from low-income areas of Sao Paulo evaluated by the “Ver na Escola” project, an initiative from São Paulo city government in partnership with a local non-governmental organization, launched aiming to offer free-of-charge visual screening and treatment to children enrolled in public schools. Methods: Vision screening included presenting VA, ocular motility, and automated dynamic refraction assessment. Children referred for the ophthalmologist were submitted to automated and subjective static refraction, best-corrected VA, slit lamp, and fundus examination. Results: A total of 17972 children were included in the study. Our findings show a frequency of visual impairment and blindness of 14.6% considering presenting VA decreasing to 1.3% after appropriate refractive correction. The main causes of visual impairment and blindness were uncorrected refractive errors (96.77%), amblyopia (0.88%), and retinal abnormalities (0.37%). Conclusion: The frequency of visual impairment and blindness in the population under study was 14.6% mainly due to uncorrected refractive errors. These results support the need for expanded and perennial refractive services through school-based programs associated with provision of spectacles. These initiatives should be sustainable and pursued by health and school authorities to provision of screening and eye care for those in need.

Ouvrier’s Modified Mini Mental State Examination as a screening test for cognitive impairment in school-aged children with epilepsy

Background Epilepsy may affect children's development, including their cognitive function. The prevalence of cognitive impairment in epilepsy patients is quite high. Weschler Intelligence Scale for Children (WISC) takes a long time to administer and is expensive, so a simpler screening tool for cognitive evaluation is needed in pediatric epilepsy patients.
 Objective To assess the diagnostic value of Ouvrier’s Modified Mini Mental State Examination (MMSE) for detecting cognitive impairment in children aged 8-11 years with epilepsy.
 Methods This diagnostic study was conducted in December 2018 to February 2019 at Cipto Mangunkusumo and Fatmawati Hospitals in Jakarta. Data were collected with purposive sampling of children with epilepsy aged 8 to 11 years. Cognitive function was assessed by Ouvrier’s Modified MMSE and WISC. Ouvrier’s Modified MMSE was compared to WISC as and the gold standard. Results were analyzed using a 2x2 table.
 Results The prevalence of cognitive impairment in 8-11-year-old epilepsy patients was 72.9%. Ouvrier’s Modified MMSE had 83% sensitivity, 85% specificity, 94% positive predictive value, 65% negative predictive value, and 83% accuracy.
 Conclusions Ouvrier’s Modified MMSE has good diagnostic value, thus it may be useful for early detection of cognitive impairment in pediatric epilepsy.

Ouvrier’s Modified Mini Mental State Examination as a screening test for cognitive impairment in school-aged children with epilepsy

Background Epilepsy may affect children's development, including their cognitive function. The prevalence of cognitive impairment in epilepsy patients is quite high. Weschler Intelligence Scale for Children (WISC) takes a long time to administer and is expensive, so a simpler screening tool for cognitive evaluation is needed in pediatric epilepsy patients.
 Objective To assess the diagnostic value of Ouvrier’s Modified Mini Mental State Examination (MMSE) for detecting cognitive impairment in children aged 8-11 years with epilepsy.
 Methods This diagnostic study was conducted in December 2018 to February 2019 at Cipto Mangunkusumo and Fatmawati Hospitals in Jakarta. Data were collected with purposive sampling of children with epilepsy aged 8 to 11 years. Cognitive function was assessed by Ouvrier’s Modified MMSE and WISC. Ouvrier’s Modified MMSE was compared to WISC as and the gold standard. Results were analyzed using a 2x2 table.
 Results The prevalence of cognitive impairment in 8-11-year-old epilepsy patients was 72.9%. Ouvrier’s Modified MMSE had 83% sensitivity, 85% specificity, 94% positive predictive value, 65% negative predictive value, and 83% accuracy.
 Conclusions Ouvrier’s Modified MMSE has good diagnostic value, thus it may be useful for early detection of cognitive impairment in pediatric epilepsy.

Prevalence and determinants of visual impairment amongst school-aged children in Southern Nigeria

Background: Visual impairment among school children is relatively common and research provides evidence for integration of comprehensive eye care into school health programmes. Aim: To determine the prevalence and determinants of visual impairment in school-aged children in Southern Nigeria. Setting: School aged children from 10 public and private-owned schools in Cross River State, Southern Nigeria. Methods: This cross-sectional analytic study used a multistage random sampling technique to select 2418 school children aged 6–17 years. Comprehensive eye examinations were performed on the study. The logistic regression analysis with 95% confidence interval (CI) was used to test hypotheses. Results: Of the 2418 school children selected, 2110 (87%) were assessed. The prevalence ‘of uncorrected, presenting and best corrected visual acuity of 0.3 (20/40) or worse in the better eye’ was 7.3%, 7.2% and 0.19%, respectively. Errors of refraction were the cause of the impairment in 198 (70.7%; 63.5–76.0) eyes with reduced vision, followed by glaucoma suspects 38 (19.2%; 13.8–24.8), amblyopia (3.0%; 1.1–6.4) and corneal opacity 3 (1.5%; 0.3–4.3). The major and independent predictors of visual impairment were age (adjusted odds ratio [AOR] 1.97, 95% 1.45–2.67), high socio-economic status (adjusted odds ratio [AOR] 1.68, 95% 1.36–2.09) and female gender (AOR 1.35, 95% 1.00–1.88). Conclusion: The common causes of visual impairment in school-aged children are avoidable, and are mostly because of uncorrected refractive error, which could reflect inadequate refractive error services in the area.

P122 SEX DIFFERENCES IN STATURAL GROWTH IMPAIRMENT IN PEDIATRIC CROHN’S DISEASE: EARLY FINDINGS FROM THE GROWTH STUDY

Abstract Background Statural growth impairment is both a marker and complication of poorly controlled Crohn’s disease (CD), and occurs more commonly in males than females. The specific molecular mechanisms responsible for this sex difference in growth impairment in CD remain poorly characterized. Methods We are conducting a prospective multicenter longitudinal study (Growth Study) examining sex differences in statural growth impairment in school-age children with CD with growth potential based on bone age (BA) [females (BA 4 yrs, 2 mos to 12 years, 0 months) and males (BA 5 years, 0 months to 14 yrs, 0 mos)]. We have enrolled 118 (65% male) patients. Variable Z scores calculated based on BA are denoted as Variable BA-Z scores; those calculated based on chronological age (CA) are denoted as Variable CA-Z scores. Height Z score difference was calculated as Height CA-Z score minus Height BA-Z score. We analyzed the concentration of selected cytokines in serum in 54 patients (56% male), using a V-Plex kit (Meso Scale Discovery, Rockville, MD). Serum hormone levels were analyzed at Esoterix Endocrinology (Calabasas Hills, CA). We used t-test and Chi-squared test to examine the sex difference for continuous variables and categorical variables respectively. We assessed the association between cytokines and hormones via linear regression. Results The mean height Z score difference was -0.4 ± 1.0 (SD) [range: -3.9 to 2.0] in males and -1.1 ± 1.1 [-3.9 to 0.9] in females (Figure). The absolute value of the mean height Z score difference was significantly lower in males (P= 0.021). The mean BA Z score was (0.0 ± .04 [-0.7 to 0.9]) in males and (0.0 ± 0.2 [-0.4 to 0.5]) in females (P= 0.952). Race/ethnicity [76% White], Tanner stage [63% pre/early puberty; 37% mid/late puberty], mean disease duration [2.3 ± 1.9 (SD) (range: 0.1 to 8.3) years], medication use [65% infliximab; 39% methotrexate; 13% azathioprine/6-mercaptopurine; 9% adalimumab], and mean disease activity indices (indicated remission) did not differ by sex (P= NS for all). TNF-α, IL-4, IL-6, IL-10, and IL-12 were significantly negatively associated with hormones important in growth in males, while IL-13 was significantly negatively associated with hormones important in growth in females (Table). Conclusions Statural growth remains compromised in males compared with females in a novel contemporary cohort of children with CD. Our early data suggest that the higher frequency of growth impairment in males appears to be due to less standardized height gain with skeletal maturation, rather than advanced BA progression. BA does not appear to be significantly delayed in this cohort. Furthermore, our preliminary data suggest that systemic inflammation exerts a greater negative impact on hormone levels important in growth in males, and that different molecular pathways lead to growth impairment in males versus females. We are further investigating these preliminary findings in the ongoing prospective multicenter longitudinal Growth Study.

Visual problems: a review of prevalence studies on visual impairment in school-age children.

Childhood visual impairment (VI) have a significant impact on the educational achievement, career choices and social life of affected individual, and in children, is mainly due to either preventable or treatable causes. Reliable data on the prevalence and causes of VI in children will guide the development of a systematic vision screening program for its early detection and successful treatment of possible causes. The purpose of this literature review is to summarize the available data on prevalence and causes of VI in school-age children from various regions globally. A discussion on the major findings highlighting the definition criteria, classifications and limitations for further studies is also presented.

Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: A systematic review and meta-analysis.

BackgroundEvidence of an adverse influence of soil transmitted helminth (STH) infections on cognitive function and educational loss is equivocal. Prior meta-analyses have focused on randomized controlled trials only and have not sufficiently explored the potential for disparate influence of STH infection by cognitive domain. We re-examine the hypothesis that STH infection is associated with cognitive deficit and educational loss using data from all primary epidemiologic studies published between 1992 and 2016.MethodsMedline, Biosis and Web of Science were searched for original studies published in the English language. Cognitive function was defined in four domains (learning, memory, reaction time and innate intelligence) and educational loss in two domains (attendance and scholastic achievement). Pooled effect across studies were calculated as standardized mean differences (SMD) to compare cognitive and educational measures for STH infected/non-dewormed children versus STH uninfected /dewormed children using Review Manager 5.3. Sub-group analyses were implemented by study design, risk of bias (ROB) and co-prevalence of Schistosoma species infection. Influential studies were excluded in sensitivity analysis to examine stability of pooled estimates.FindingsWe included 36 studies of 12,920 children. STH infected/non-dewormed children had small to moderate deficits in three domains—learning, memory and intelligence (SMD: -0.44 to -0.27, P<0.01–0.03) compared to STH-uninfected/dewormed children. There were no differences by infection/treatment status for reaction time, school attendance and scholastic achievement (SMD: -0.26 to -0.16, P = 0.06–0.19). Heterogeneity of the pooled effects in all six domains was high (P<0.01; I2 = 66–99%). Application of outlier treatment reduced heterogeneity in learning domain (P = 0.12; I2 = 33%) and strengthened STH-related associations in all domains but intelligence (SMD: -0.20, P = 0.09). Results varied by study design and ROB. Among experimental intervention studies, there was no association between STH treatment and educational loss/performance in tests of memory, reaction time and innate intelligence (SMD: -0.27 to 0.17, P = 0.18–0.69). Infection-related deficits in learning persisted within design/ROB levels (SMD: -0.37 to -52, P<0.01) except for pre-vs post intervention design (n = 3 studies, SMD = -0.43, P = 0.47). Deficits in memory, reaction time and innate intelligence persisted within observational studies (SMD: -0.23 to -0.38, all P<0.01) and high ROB strata (SMD:-0.37 to -0.83, P = 0.07 to <0.01). Further, in Schistosoma infection co-prevalent settings, associations were generally stronger and statistically robust for STH-related deficits in learning, memory and reaction time tests(SMD:-0.36 to -0.55, P = 0.003–0.02). STH-related deficits in school attendance and scholastic achievement was noted in low (SMD:-0.57, P = 0.05) and high ROB strata respectively.InterpretationWe provide evidence of superior performance in five of six educational and cognitive domains assessed for STH uninfected/dewormed versus STH infected/not-dewormed school-aged children from helminth endemic regions. Cautious interpretation is warranted due to high ROB in some of the primary literature and high between study variability in most domains. Notwithstanding, this synthesis provides empirical support for a cognitive and educational benefit of deworming. The benefit of deworming will be enhanced by strategically employing, integrated interventions. Thus, multi-pronged inter-sectoral strategies that holistically address the environmental and structural roots of child cognitive impairment and educational loss in the developing world may be needed to fully realize the benefit of mass deworming programs.

The Potential of Past Tense Marking in Oral Reading as a Clinical Marker of Specific Language Impairment in School-Age Children.

The purpose of this study was twofold. The first aim was to explore differences in profiles of past tense marking in oral reading of school-age children with specific language impairment (SLI). The second aim was to explore the potential of past tense marking in oral reading as a clinical marker of SLI in school-age children. This study examined oral readings of connected text to describe the frequency and type of reading errors on regular and irregular past tense verbs for 21 children with SLI as compared to 30 children with typical language in Grades 2 and 3. Each past tense verb token was categorized into 1 of 6 mutually exclusive response types: (a) correctly marked past tense, (b) overmarked past tense, (c) bare stem, (d) other verb inflection, (e) nonverb, or (f) no response. Performance across groups was compared. Additionally, classification statistics were calculated at several cutoffs for regular past tense accuracy and regular past tense finiteness marking. For regular past tense, there was a significant group difference on accuracy. Children with SLI were less accurate at marking past tense when in oral reading than typical language peers; other response types did not differ. For irregular past tense, there were no group differences. In addition, there was a significant group difference on finiteness marking; this difference was driven by regular but not irregular verbs. A cutoff of 90% for regular past tense accuracy yielded moderate sensitivity and specificity; no cutoff for regular past tense finiteness marking yielded sensitivity above 70%. Regular past tense accuracy in oral reading provides promise as a clinical marker for diagnosing SLI in school-age children.

Theory of mind and specific language impairment in school-age children

Research on the relationship between aspects of language development and Theory of Mind (ToM) in children with language impairments suggests that children with language impairment show a delay in ToM development. This study aimed to examine the relationships of the syntactic, semantic, and pragmatic skills with ToM in school-age children. Twenty children with Specific Language Impairment (SLI) aged 9–12 years and two control groups, one matched for chronological age (CA) and one for language ability (LA) (aged 8–10 years) were compared on a set of language tasks tapping syntactic, semantic, and pragmatic skills and on an advanced test of ToM. Results showed that children with SLI performed poorly on the ToM task compared to the CA matches. Also, analysis showed that language skills and ToM are related and that syntactic and pragmatic abilities contributed significantly to the prediction of ToM performance in the SLI group. It is concluded that the syntax/pragmatic aspects of the language impact on ToM understanding in children with SLI.

Prenatal anti-Ro antibody exposure, congenital complete atrioventricular heart block, and high-dose steroid therapy: impact on neurocognitive outcome in school-age children.

To determine the impact of prenatal exposure to maternal anti-Ro antibodies, slow fetal heart rate, and/or prolonged dexamethasone therapy for immune-mediated congenital atrioventricular heart block (CAVB) on the cognitive and academic performance of these children at school age. We performed a prospective, blinded assessment of the cognitive functioning of 3 cohorts of children ages 6-16 years with in utero exposure to maternal anti-Ro antibodies in the following groups: no CAVB and no prenatal dexamethasone treatment (n = 14), CAVB without prenatal treatment (n = 10), and CAVB with prenatal dexamethasone treatment (n = 16). Domains assessed included intelligence, visual perceptual and visual motor skills, auditory and visual attention, verbal learning and memory, visual memory, executive function, and behavior. All cohorts scored within the normal range and were not significantly different in terms of intelligence scores, verbal comprehension, perceptional reasoning, working memory, and processing speed. For children with CAVB who were treated prenatally, there were no significant associations between the neurocognitive function scores, the minimal fetal heart rate (range 47-80 beats per minute), and either the duration (range 2-15 weeks) or dosage (range 56-824 mg) of dexamethasone therapy. CAVB and transplacental treatment with dexamethasone was not associated with neurocognitive impairment in school-age children. Larger numbers of children are needed to validate our observation, and assessment of other cognitive abilities is warranted.

Listening to voices of children with a visual impairment: A focus group study

The purpose of the study was to identify the educational, social and leisure activities and issues that matter to school children and young people with a visual impairment and to compare their lifestyle with fully sighted counterparts. Thirteen focus groups were conducted and the groups were stratified by age, gender, visual status and school location (urban and non-urban). The sessions were audio taped, transcribed verbatim, coded using NVivo software and a qualitative data analysis was carried out to identify the main themes. Eighty-one children and young people aged between 5–18 years participated in the focus groups; 34 were visually impaired (22 boys) and 47 were fully sighted (24 boys). In total, 121 different daily living activities important to children and young people were discussed in the focus groups. Results suggested that children and young people with a visual impairment have similar lifestyles to their fully sighted counterparts but are more restricted in some specific activities. The children and young people also reported that sometimes these restrictions were imposed by those supporting them rather than their own abilities. This information provided an in-depth understanding of the impact of visual impairment in school-aged children and young people.

Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model

The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.