School Choice and Vocational Guidance for Schoolchildren with Chronic Diseases and Other Health Problems

Osim praćenja rasta, razvoja i zdravstvenog stanja učenika tijekom školovanja, liječnik školske medicine razmišlja i o njihovu profesionalnom razvoju. Posebnu pozornost zahtijevaju učenici s kroničnim bolestima, kojih je prema istraživanjima 10 % do 15 %. Prije izbora zanimanja potrebno je upoznati roditelje i učenike s ograničenjima koja proizlaze iz prirode bolesti ili stanja. To omogućuje učenicima da razviju interes za zanimanja za koja nemaju kontraindikaciju. Sistematski pregled u osmom razredu osnovne škole procjena je učenikovih psihofi zičkih sposobnosti za nastavak srednjoškolskog obrazovanja. Tijekom pregleda provodi se profesionalno informiranje za sve učenike. Učenici s kroničnim bolestima, teškoćama u razvoju i drugim poremećajima zdravlja upućuju se na profesionalno usmjeravanje. Cilj ovog rada bio je prikaz razloga upućivanja na školsko i profesionalno usmjeravanje učenika osmih razreda, deset osnovnih škola iz Varaždinske županije, u razdoblju od školske godine 1998./99. do 2007./08. Od ukupno 4939 pregledanih učenika, na profesionalno usmjeravanje bilo je upućeno njih 458 (9,3 %). Najčešći razlozi upućivanja bili su bolesti i stanja iz skupine duševnih poremećaja i poremećaja ponašanja, sa zastupljenošću od 41,3 %. Preporuke stručnog tima za profesionalno usmjeravanje za daljnje školovanje nije slijedilo 10,5 % učenika. Za učenike s kroničnim bolestima i drugim poremećajima zdravlja bilo bi potrebno osigurati dovoljan broj upisnih mjesta u srednjim školama te kontinuirano pratiti njihov profesionalni razvoj radi intervencije u slučaju potrebe promjene škole i uvida u ishod obrazovanja. To bi se postiglo koordiniranim radom školskih liječnika, timova za profesionalno usmjeravanje, srednjih škola i županijskih upravnih odjela za prosvjetu, kulturu i šport.By following a child’s growth, development, and health, school medicine specialist can see opportunities for career choice. Special attention is needed for schoolchildren with chronic diseases and developmental difficulties, because of limited occupation choices. Studies report 10 % to 15 % prevalence of chronic diseases among schoolchildren. Parents and children should be informed about child’s limitations before career choice. It would be helpful for the students to develop interests for occupations that are not contraindicated for their condition. Physical examination gives an insight into the psycho-physical abilities of an eighth-grade primary school student for further education. During examination, counselling and vocational guidance is provided for all students with chronic diseases and other health problems. All procedures are oriented to personal abilities and preferences. The aim of this study was to analyse the reasons for vocational guidance in the Varaždin County of Croatia. It included eighth-grade students from ten primary schools from 1998/99 to 2007/08. Of 4939 students, 458 (9.3 %) with chronic diseases and health difficulties were referred to vocational guidance. Of these, 41.3 % were referred due to mental and behavioural disorders. These students were assessed and received a recommendation for at least two occupations. Forty-eight students (10.5 %) did not follow the recommendation. In a coordinated effort, school physicians, vocational guidance experts, and school and local authorities should secure enrollment of students with chronic diseases and health difficulties in secondary schools and follow their development and education to provide them the best available career opportunities

Coping strategies of economically (partially) inactive households: the case of Croatia

How do households with inactive or unemployed members face growing risks and uncertainty? The present study tackles this problem with a case study on Croatia, a country at the bottom of the European Union’s (EU) scale of economic activity rate. The low level of activity that has characterized Croatia for more than twenty years has been accompanied by a continuously high unemployment rate, which has further increased since 2009. In this context, households with (long-term) inactive or unemployed members have had to develop alternative coping strategies. In order to identify and examine these strategies, in 2014 we conducted a mixed-method study, including a quantitative survey of 453 households and 37 semi-structured interviews. We identified six household strategies, more or less ‘successful’ in terms of the household’s material position. In this essay we further examine these strategies’ characteristics and implications, with a focus on the profiles of households employing specific strategies

An Emerging Screening Method for Interrogating Human Brain Function: Tutorial

Cognitive decline can be observed due to a myriad of causes. Clinicians would benefit from a noninvasive quantitative tool to screen and monitor brain function based on direct measures of neural features. In this study, we used neuroimaging data from magnetoencephalography (with a whole-head Elekta Neuromag 306 sensor system) to derive a set of features that strongly correlate with brain function. We propose that simple signal characteristics related to peak variability, timing, and abundance can be used by clinicians as a screening tool to investigate cognitive function in at-risk individuals. Using a minimalistic set of features, we were able to perfectly distinguish between participants with normative and nonnormative brain function, and we were also able to successfully predict participants’ Mini-Mental Test score (r=0.99; P<.001; mean absolute error=0.413). This set of features can be easily visualized in an analog fashion, providing clinicians with several graded measurements (in comparison to a single binary diagnostic tool) that can be used for screening and monitoring cognitive decline

Epilepsy center characteristics and geographic region influence presurgical testing in the United States

Objective: Persons with drug-resistant epilepsy may benefit from epilepsy surgery and should undergo presurgical testing to determine potential candidacy and appropriate intervention. Institutional expertise can influence use and availability of evaluations and epilepsy surgery candidacy. This census survey study aims to examine the influence of geographic region and other center characteristics on presurgical testing for medically intractable epilepsy. Methods: We analyzed annual report and supplemental survey data reported in 2020 from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Test utilization data were compiled with annual center volumes, available resources, and US Census regional data. We used Wilcoxon rank-sum, Kruskal–Wallis, and chi-squared tests for univariate analysis of procedure utilization. Multivariable modeling was also performed to assign odds ratios (ORs) of significant variables. Results: The response rate was 100% with individual element missingness \u3c 11% across 342 observations undergoing univariate analysis. A total of 278 complete observations were included in the multivariable models, and significant regional differences were present. For instance, compared to centers in the South, those in the Midwest used neuropsychological testing (OR = 2.87, 95% confidence interval [CI] = 1.2–6.86; p =.018) and fluorodeoxyglucose–positron emission tomography (OR = 2.74, 95% CI = = 1.14–6.61; p =.025) more commonly. For centers in the Northeast (OR =.46, 95% CI =.23–.93; p =.031) and West (OR =.41, 95% CI =.19–.87; p =.022), odds of performing single-photon emission computerized tomography were lower by nearly 50% compared to those in the South. Center accreditation level, demographics, volume, and resources were also associated with varying individual testing rates. Significance: Presurgical testing for drug-resistant epilepsy is influenced by US geographic region and other center characteristics. These findings have potential implications for comparing outcomes between US epilepsy centers and may inject disparities in access to surgical treatment

Association between Characteristics of National Association of Epilepsy Centers and Reported Utilization of Specific Surgical Techniques

Background and Objective Nearly one-third of persons with epilepsy will continue having seizures despite trialing multiple antiseizure medications. Epilepsy surgery may be beneficial in these cases, and evaluation at a comprehensive epilepsy center is recommended. Numerous palliative and potentially curative approaches exist, and types of surgery performed may be influenced by center characteristics. This article describes epilepsy center characteristics associated with epilepsy surgery access and volumes in the United States. Methods We analyzed National Association of Epilepsy Centers 2019 annual report and supplemental survey data obtained with responses from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Surgical treatment volumes were compiled with center characteristics, including US Census region. We used multivariable modeling with zero-inflated Poisson regression models to present ORs and incidence rate ratios of receiving a given surgery type based on center characteristics. Results The response rate was 100% with individual element missingness less than 4% across 352 observations undergoing univariate analysis. Multivariable models included 319 complete observations. Significant regional differences were present. The rates of laser interstitial thermal therapy (LITT) were lower at centers in the Midwest (incidence rate ratio [IRR] 0.74, 95% CI 0.59–0.92; p = 0.006) and Northeast (IRR 0.77, 95% CI 0.61–0.96; p = 0.022) compared with those in the South. Conversely, responsive neurostimulation implantation rates were higher in the Midwest (IRR 1.45, 95% CI 1.1–1.91; p = 0.008) and West (IRR 1.91, 95% CI 1.49–2.44; p \u3c 0.001) compared with the South. Center accreditation level, institution type, demographics, and resources were also associated with variations in access and rates of potentially curative and palliative surgical interventions. Discussion Epilepsy surgery procedure volumes are influenced by US epilepsy center region and other characteristics. These variations may affect access to specific surgical treatments for persons with drug resistant epilepsy across the United States

Associations between testing and treatment pathways in lesional temporal or extratemporal epilepsy: A census survey of NAEC center directors

Objective: The evaluation to determine candidacy and treatment for epilepsy surgery in persons with drug-resistant epilepsy (DRE) is not uniform. Many non-invasive and invasive tests are available to ascertain an appropriate treatment strategy. This study examines expert response to clinical vignettes of magnetic resonance imaging (MRI)–positive lesional focal cortical dysplasia in both temporal and extratemporal epilepsy to identify associations in evaluations and treatment choice. Methods: We analyzed annual report data and a supplemental epilepsy practice survey reported in 2020 from 206 adult and 136 pediatric epilepsy center directors in the United States. Non-invasive and invasive testing and surgical treatment strategies were compiled for the two scenarios. We used chi-square tests to compare testing utilization between the two scenarios. Multivariable logistic regression modeling was performed to assess associations between variables. Results: The supplemental survey response rate was 100% with 342 responses included in the analyses. Differing testing and treatment approaches were noted between the temporal and extratemporal scenarios such as chronic invasive monitoring selected in 60% of the temporal scenario versus 93% of the extratemporal scenario. Open resection was the most common treatment choice; however, overall treatment choices varied significantly (p \u3c.001). Associations between non-invasive testing, invasive testing, and treatment choices were present in both scenarios. For example, in the temporal scenario stereo-electroencephalography (SEEG) was more commonly associated with fluorodeoxyglucose–positron emission tomography (FDG-PET) (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.06–3.29; p =.033), magnetoencephalography (MEG) (OR 2.90; 95% CI 1.60–5.28; p = \u3c.001), high density (HD) EEG (OR 2.80; 95% CI 1.27–6.24; p =.011), functional MRI (fMRI) (OR 2.17; 95% CI 1.19–4.10; p =.014), and Wada (OR 2.16; 95% CI 1.28–3.66; p =.004). In the extratemporal scenario, choosing SEEG was associated with increased odds of neuromodulation over open resection (OR 3.13; 95% CI 1.24–7.89; p =.016). Significance: In clinical vignettes of temporal and extratemporal lesional DRE, epilepsy center directors displayed varying patterns of non-invasive testing, invasive testing, and treatment choices. Differences in practice underscore the need for comparative trials for the surgical management of DRE

Visual field defects after radiosurgery versus temporal lobectomy for mesial temporal lobe epilepsy: Findings of the ROSE trial.

PurposeStereotactic radiosurgery (SRS) may be an alternative to anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE). Visual field defects (VFD) occur in 9-100% of patients following open surgery for MTLE. Postoperative VFD after minimally invasive versus open surgery may differ.MethodsThis prospective trial randomized patients with unilateral hippocampal sclerosis and concordant video-EEG findings to SRS versus ATL. Humphries perimetry was obtained at 24 m after surgery. VFD ratios (VFDR = proportion of missing homonymous hemifield with 0 = no VFD, 0.5 = complete superior quadrantanopsia) quantified VFD. Regressions of VFDR were evaluated against treatment arm and covariates. MRI evaluated effects of volume changes on VFDR. The relationships of VFDR with seizure remission and driving status 3 years after surgery were evaluated.ResultsNo patients reported visual changes or had abnormal bedside examinations, but 49 of 54 (91%) of patients experienced VFD on formal perimetry. Neither incidence nor severity of VFDR differed significantly by treatment arm. VFDR severity was not associated with seizure remission or driving status.ConclusionThe nature of VFD was consistent with lesions of the optic radiations. Effective surgery (defined by seizure remission) of the mesial temporal lobe results in about a 90% incidence of typical VFD regardless of method