Orientation Items Research Articles

Diagnosing dementia. Univariate and multivariate analyses of the mental status examination.

Investigators have reported poor recognition of dementia by primary physicians. For this reason, mental status examinations were performed on 72 demented and 144 nondemented medical inpatients to assess the sensitivity, specificity, and predictive value of components of this examination in the diagnosis of dementia. Sensitivity of individual level-of-orientation items was low (15.3 to 56.9%), though specificity was high (91.7 to 100%). Sensitivity of several nonorientation items was high (80.6 to 100%), though specificity was low. A multivariate discriminant equation using both orientation and nonorientation items achieved high sensitivity (89.6% test cases, 87.5% validation cases) and specificity (78.1% test cases, 87.5% validation cases). Adding the easily obtained patient characteristic of age to the equation further increased sensitivity (95.8%, 91.3%), while maintaining specificity (82.3%, 85.4%). From these results, it is concluded that the level-of-orientation screening examination used by clinicians to detect dementia is unacceptably insensitive. In contrast, a composite decision rule including nonorientation items achieves high sensitivity with relatively high specificity.

Temperament ratings in infancy: The saliency of perceived difficulty

The behavioral capabilities of neonatal chimpanzees are not well known. A major goal of this study was to document their ability to orient to social and nonsocial objects and to compare their performance with that of human infants. The Brazelton Neonatal Behavioral Assessment Scale (NBAS) was administered to 13 nursery-reared chimpanzees, every other day during their first month of life, and to 42 humans, twice, on the third and thirtieth day of life. The orientation items included social stimuli (a human face and both human and chimpanzee sounds) and nonsocial stimuli (a red ball and a red rattle). Repeated-measures analysis of variance on the orientation cluster of the NBAS revealed that chimpanzee neonates have the capacity for sustained attention to all stimuli, both social and nonsocial, indistinguishable from that of human neonotes. Significant improvements in orientation performance from Day 2 to Day 30 were found for both species. These striking similarities in early orientation ability are viewed as a challenge to notions of unique human propensities.

The behavior of jaundiced infants treated with phototherapy.

This study was performed in order to evaluate possible changes in behavior in jaundiced infants without perinatal complications other than hyperbilirubinemia treated with phototherapy. Thirty jaundiced infants (mean bilirubinemia 13.3 mg/100 ml, range 8.4-17.5) born spontaneously at term and undergoing phototherapy for 6 h or more, and 30 comparison subjects similar for sex, birthweight, gestational age, Apgar score, obstetrical history and father's profession were examined during the 3rd day of life according to Brazelton Neonatal Behavior Assessment Scale (BNBAS). For 6 of 26 items we found higher values for comparison group (Wilcoxon's Test): inanimate visual median (m.) 5 vs. 3 (P less than 0.05); animate visual m. 5 vs. 3.5 (P less than 0.01); visual and auditory 5.5 vs. 4 (P less than 0.005); pull-to-sit m. 6 vs. 5 (P less than 0.01); cuddliness m. 5 vs. 4 (P less than 0.01); alertness m. 5 vs. 4 (P less than 0.005). Visual orientation responses were the most compromised. On the 4th day of life, 14 infants who had terminated phototherapy at least 2 h before (mean 9.9 h) were compared with their matched comparison group subjects and the same significantly poorer performances, mainly in visual orientation, were found. At one month of age, 12 of these infants treated with phototherapy still showed a significantly poorer performance in 2 items of orientation: inanimate visual m. 6 vs. 4.5 (P less than 0.05); visual and auditory m. 6.5 vs. 4 (P less than 0.05). Whether these results depend on the jaundice or on the phototherapy remain to be established.

An evaluation of reality orientation therapy

An evaluation was made of reality orientation therapy utilizing 14 male patients with dementias of various types. The therapy is designed to improve memory and reduce confusion in elderly and demented individuals. Utilizing a group comparison with crossover design, it was found that the patients improved significantly over sessions on orientation items actually taught during those sessions. However, no significant improvement was found on a series of “generalization items” consisting of orientation-related questions that were not asked during sessions. Furthermore, there was no generalization to ward activities. It was noted that individual responses to the treatment were quite varied, and so three cases reflecting highly different responses are presented.

651 GROWTH & DEVELOPMENT OF INFANTS < 1500 g FED BANKED HUMAN MILK (BHM) OR PREMATURE FORMULA (F)

BHM composition and nutritional adequacy for infants < 1500g has not been established. We have randomized 65 infants < 1500g to ad lib feeds of F (Similae Special Care, a protein and mineral enriched formula designed to sustain intrauterine-like growth) or frozen BHM until infants weighed 2000g. BHM was low in fat (2.3%) and calories (bomb analysis 58 cal/100g), a finding also recently noted by Carroll. BHM infants ingested more milk (192 vs 162 ml/kg/d) but fewer calories (121 vs 142 cal/kg/d); grew less in weight (14 vs 30 g/d), length (0.7 vs 1.1 cm/wk), and FOC (0.8 vs 1.2 cm/wk); and at 37 wks post-conception were less responsive to visual & auditory stimuli (Brazelton orientation items, mean score = 2.4 vs 3.6; p < 0.05). Amino acids, BUN, and pH values were similar. Findings at blind evaluation 92 wks post-conception: Bayley developmental scores were higher for F than BHM infants at 92 wks (PDI:92 vs 78; p<0.05; MDI:89 vs 76, p=0.13). Birthweight, gest. age, and need for ventilation were similar for BHM and F infants seen at 92 wks. F supports near intrauterine growth rates and may confer short and long term advantages over BHM for infants < 1500g. *Actual age minus age at which measurements equal 50th percentile.

Behavioral dimensions and cry sounds of infants of differential fetal growth

This report describes behavioral dimensions and spectrographic cry features of underweight-, average weight- and overweight-for-length newborn infants. Analyzed for this study were the four a priori dimensions of the Neonatal Behavioral Assessment Scale (NBAS), a dimension of the mean modal scores of the orientation items from the NBAS, and the highest dominant frequency of the cries occurring during the administration of the NBAS. Results indicate that both underweight-for-length and overweight-for-length infants showed less optimal performances on all dimensions of the NBAS than average weight-for-length infants, and also showed a high-pitched cry sound which has been used to indicate an impaired functioning of the central nervous system. No differences were found on any of these measures between the underweight- and overweight-for-length infants. These results suggest that, at a group level of analysis, a deviation from average fetal growth in either direction on the distribution of neonatal anthropometry is associated with similar changes in the behavioral functioning of infants in the normal newborn nursery. This differential behavioral functioning may be manifested in the daily activity of the infants and may alter the functional relationship between the infant and environment.

Individual Differences in Infant-Mother Attachment Relationships at Age One: Antecedents in Neonatal Behavior in an Urban, Economically Disadvantaged Sample

Neonatal Behavioral Assessment Scales (NBAS) were administered to 100 neonates at 7 and 10 days after birth. The infants and their mothers were subsequently observed in the Ainsworth and Wittig strange-situation procedure at age 1. Infants were classified as secure, anxious/avoidant, or anxious/resistant. When compared with the secure attachment group, anxious/resistant infants scored lower on orientation, motor maturity, and regulation items at day 7. The secure and anxious/avoidant subjects did not differ at day 7. The anxious/resistant group improved from day 7 to day 10, and neither anxious group differed from the secure group on the second examination. The results suggest that early neonatal difficulties may reflect probelms in integrative and adaptive mechanisms which continue to influence behavior, interaction, and eventually attachment relationships, despite the tendency of all normal infants eventually to meet the demands of the neonatal period. In view of the resiliency of neonatal behavior, it is assumed that neonatal difficulties must interact with difficult environments to produce anxious attachments.

68 BRAZELTON BEHAVIOR TESTING IN THE HIGH RISK NEWBORN

The Brazelton Scale was administered to 204 high risk infants; 366 tests were given. 88% were <2500g and 90% were <36 weeks gestation. 42% had assisted ventilation, and 19% were small for gestational age. Gestational age at test time was 35-43 weeks in 92%. Deviant reflexes (scored as 0, 1 or 3 except for passive movements) were: crawling (20%), standing (39%), placing (23%) Moro (27%), walking (79%), and passive movements of arms (77%) & legs (82%). Mean scores on decrement and orientation items wereSignificant correlations were: 1) Infants with ventilatory support were less able to self quiet or to be consoled; 2) The longer the ventilatory support the poorer the self quieting, consolability and response to animate stimuli, but the better the use of postural changes to self quiet; 3) Gestational age at birth and/or test time influenced dominant states, alertness, consolability, pull to sit, activity, and response to inanimate auditory stimulus.Conclusion: gestational age and perinatal events influence high risk infant responses to the Brazelton test so that their behavior is not accurately described by term newborn standards.

THE STABILITY OF BEHAVIORAL ASSESSMENT IN THE FIRST DAYS OF LIFE

As part of a research program designed to assess the Brazelton Neonatal Assessment Scale as a predictor of styles of later infant sociability, we examined 12 normal infants daily to determine the stability of the scale over the first 4 days of life. Each day, every infant was assigned a “typology score” of 1, 2 or 3 (high, average, low) for each of 3 dimensions (Interactive, Motor and State Control) according to Brazelton's criteria. Scores for State Control and Motor processes were remarkably stable across the 4 days; most infants scored 2. The interactive process (response to social stimuli including items of visual and auditory orientation, cuddliness and consolability) was less stable across the first 4 days as a result of significantly (p<.025) increased variability on Day 2. Variability was further assessed by comparing mean scores across 4 days for behaviors comprising the Interactive cluster. Scores on Days 1, 3 and 4 were highly correlated (p<.05) while scores on Day 2 did not correlate with other days. These data suggest that as yet unidentified factors related to the infant's second day alter his pattern of interaction with his environment. Perhaps the interactive process is more sensitive than other dimensions to any form of disruption. For predictive purposes, it may be inadvisable to perform behavioral exams on infants on the second day of life, particularly if one includes assessment of interactions with the social (e.g., maternal) environment.

NEUROLOGIC DEVELOPMENT OF PREMATURES TREATED FOR NEONATAL HYPOCALCEMIA(HC)

During the first 72 hrs of life, 30% of premature (≤37wks) develop HC. Possible sequelae of early HC have not been examined. Twelve well AGA prematures were studied in matched pairs (gestation and Apgar) and given prophylactic doses of 1, 25 dihydroxyvit 03 (l,25(OH)2D3 - the active D metabolite), or vit D2 400 IU(controls) during the first 3 days. Infants were studied prospectively for degree of tremors on day 1, 2, 3; Brazelton Behavior Assessment (BBA) at 40wks postconception; and Gesell Developmental Exam at 3 & 6 mos. Exams were blinded to ionized Ca (ICa, Orion SS-20) and treatment group. All prestudy iCa were <3.5mg%. By 48hrs, the 1,25(OH)2D3 group had significantly higher iCa, 3.6±0.1mg% (mean±SEM) vs 3.2±0.1 at 12 hrs (paired t, p<.05); controls did not change. Degree of tremors was not related to iCa. Controls were less responsive to BBA orientation (visual, auditory and combined) items than 1, 25(OH)2D3 group, 4.1±.16vs 5.0±.21(t test, p<.01). The 3 mo Gesell was lower for controls vs 1, 25(OH)2D3, 89±3 vs 99±4 (p<.06) and was 110±1 vs 116±1 at 6 mo (p<.01). Eight of the 12 infants were rematched blindly in pairs for Apgar, gestation and HC at 48 hrs vs normocalcemia (NC). HC infants appeared less responsive than NC in the BBA visual-auditory item, 5±0.6 vs 6±.4 (Wilcoxon-Mann, p<.07), to need more consoling (6.6±0.3 vs 7.6±.4, p<.10) and to be more excitable (5.6±.3 vs 6.3±.4, p<.10). No differences were found between HC and NC in 386 mo Gesell. Early neonatal hypocalcemia appears to have an effect on the newborn's ability to respond to social(orientation) stimuli; long term sequelae are uncertain.

The occupation of funeral director: A research note on work orientations

Factor analysis of responses of funeral directors to work orientation items is interpreted first as specifying major orientational themes and second as to how well the theoretical value components of professionalism and a business orientation hold together empirically. The analysis revealed that the professionalism model as operationalized in this study has no single underlying dimension which would define this orientation. It is thus suggested that the meaning of professionalism be altered to refer only to involvement in the occupational structure and not include service and autonomy. The business orientation model, however, appears to be fairly well supported by the data.

Sociological Concomitants of Health Orientations: A Partial Replication of Suchman

The present paper is a partial replication of the late Edward Suchman's study of health orientations in Washington Heights. Data were collected for a representative sample of Los Angeles County, and Suchman's medical orientation, health knowledge, and preventative behavior items were asked. In addition, several community orientation items that difler from Suchman's, but partake of the same theoretical domain as those he used were asked. The data are analyed for Mexican-Americans, Blacks, and Whites-Anglos, and within categories of income. The results difler from those Suchman found in Washington Heights in a number of important respects. Several diflerences of time and place are suggested as variables that might account for the diflerences observed between the two samples.