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Journal Club/September 24, 2010. Swing et al. Television and video game exposure and the development of attention problems. Pediatrics 2010;126:214-221.David H. Rubin, MDDavid H. Rubin, MDChairman and Program Director, PediatricsChairman and Program Director, PediatricsSt Barnabas HospitalSt Barnabas HospitalProfessor of Clinical Pediatrics, Albert Professor of Clinical Pediatrics, Albert Einstein College of MedicineEinstein College of Medicine
OBJECTIVES OBJECTIVES
AimAim
Hypothesis Hypothesis
Methods/statisticsMethods/statistics
ConclusionConclusion
Competency based Competency based evaluationevaluation
COMPETENCY BASED EVALUATION
Review of competencies (pre-review of article)
Review of competencies (post-review of article)
Application of specific issues from article to each competency• Attempt to match issues from article
with specific competency
COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES
Medical KnowledgeMedical Knowledge • knowledge about the established knowledge about the established
and evolving biomedical, clinical, and evolving biomedical, clinical, and cognate (epidemiological and and cognate (epidemiological and social-behavioral) sciences and social-behavioral) sciences and their application to patient caretheir application to patient care
COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES
Patient CarePatient Care • family centered patient care family centered patient care
developmentally and age developmentally and age appropriate compassionate and appropriate compassionate and effective for treatment of health effective for treatment of health care problems and promotion of care problems and promotion of healthhealth
COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES
Practice Based LearningPractice Based Learning • investigation and evaluation of investigation and evaluation of
patient care, and the assimilation patient care, and the assimilation of scientific evidenceof scientific evidence
Communication SkillsCommunication Skills • interpersonal and communication interpersonal and communication
skills resulting in effective skills resulting in effective information exchange and learning information exchange and learning with patients, families and with patients, families and professional associatesprofessional associates
COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES
System Based PracticeSystem Based Practice • understanding systems of health understanding systems of health
care organization, financing, and care organization, financing, and delivery, and the relationship of delivery, and the relationship of one’s local practice and these one’s local practice and these larger systemslarger systems
ProfessionalismProfessionalism • carrying out professional carrying out professional
responsibilities, adherence to responsibilities, adherence to ethical principles, and sensitivity ethical principles, and sensitivity to diverse patient populationsto diverse patient populations
INTRODUCTIONINTRODUCTION Attention problems are associated Attention problems are associated
with with poorer school poorer school performance performance and and increased increased aggressionaggression
Is TV a risk factor for attention Is TV a risk factor for attention problems? Literature suggests:problems? Literature suggests:• TV is so exciting that children would TV is so exciting that children would
be bored with anything elsebe bored with anything else• TV may harm ability to sustain focusTV may harm ability to sustain focus
INTRODUCTIONINTRODUCTION Video games have a lot in Video games have a lot in
common with TVcommon with TV• High excitementHigh excitement• Rapid changes in focusRapid changes in focus
Cross sectional and longitudinal Cross sectional and longitudinal studies have found TV associated studies have found TV associated with attention problemswith attention problems
Few studies have examined Few studies have examined whether video games could have whether video games could have similar effectsimilar effect
INTRODUCTIONINTRODUCTION
At what age is the effect of TV and At what age is the effect of TV and attention problems?attention problems?• Prior studies have found effect in first 3 Prior studies have found effect in first 3
years of life and in adolescenceyears of life and in adolescence Current study addresses 3 Current study addresses 3
questionsquestions• Are both TV and video associated with Are both TV and video associated with
significant attention problems?significant attention problems?• Are both TV and video associated with Are both TV and video associated with
attention problems in middle childhood?attention problems in middle childhood?• Are both TV and video associated with Are both TV and video associated with
attention problems in late attention problems in late adolescence/early adulthood?adolescence/early adulthood?
METHODSMETHODS 2 age samples of males and 2 age samples of males and
femalesfemales• Middle childhood Middle childhood (10 schools in 2 (10 schools in 2
midwestern states; part of SWITCH midwestern states; part of SWITCH obesity prevention project; reports obesity prevention project; reports collected from parents, teachers, and collected from parents, teachers, and children at 4 points in 13 months)children at 4 points in 13 months)
• Late adolescence Late adolescence (undergraduate (undergraduate students from large school in midwest, students from large school in midwest, single lab session; self report at single lab session; self report at similar time periods)similar time periods)
METHODSMETHODS
TV and video game exposureTV and video game exposure• Both groups (TV and video) Both groups (TV and video)
completed similar questionscompleted similar questions• Middle childhood completed questions Middle childhood completed questions
with parentswith parents• Late adolescence completed self Late adolescence completed self
reportsreports
• TV and video exposure: average TV and video exposure: average time during 4 time periods during time during 4 time periods during weekdays and separately during weekdays and separately during same time periods on weekendssame time periods on weekends
METHODS METHODS
Attention problemsAttention problems• Childhood sampleChildhood sample by by
teacher reportteacher report• Good internal reliability; Good internal reliability;
= .91, .92= .91, .92
• Adolescent sample Adolescent sample self self report: Adult ADHD Self Report report: Adult ADHD Self Report Scale, Brief Self-Control Scale, Scale, Brief Self-Control Scale, Barratt Impulsive Scale Barratt Impulsive Scale
• Good internal reliability; Good internal reliability; = .89, .85, .84= .89, .85, .84
RESULTS
See Table 1 for sample characteristics
See Table 2: Correlation coefficients and odds ratios computed for• Weekly TV exposure• Weekly video game exposure• Weekly total screen exposure• Attention problems in 2 age groups
RESULTS
Logistic regression model comparing risk of being above median for attention problems and above and below the 2 hour AAP exposure recommendation• If exceeded AAP recommendations
above average in attention problems (OR: 1.67 (1.27, 2.21) and 2.23 (1.13, 4.391) (young and older groups)
RESULTS
General linear models- see Tables 3 and 4
DISCUSSION
Study demonstrates that risk of attention problems could be reduced if parents followed AAP recommendation of exposure to < 2 hours/day
Non violent, slower based educational content is less likely to cause attention problems
DISCUSSION/LIMITATIONS
Groups equivalent? Evaluation equivalent Comparison valid? Analysis correct? Conclusions based on data?
1. What is the major finding in this study (medical knowledge)?
2. What is the design of the study; what are the limitations and advantages of this methodology in the study (PBLI)?
3. What is the statistical analysis used in the study; is it appropriate? (PBLI).
4. Do you agree with the author’s methodology used in this study? Provide an explanation for your answer (PBLI).
5. Will the findings in this study alter your clinical practice? Provide an explanation for your answer (patient care).
COMPETENCY BASED QUESTIONS FOR
DISCUSSION
COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES
Medical KnowledgeMedical Knowledge • knowledge about the established knowledge about the established
and evolving biomedical, clinical, and evolving biomedical, clinical, and cognate (epidemiological and and cognate (epidemiological and social-behavioral) sciences and social-behavioral) sciences and their application to patient caretheir application to patient care
• Effect of prolonged TV and video Effect of prolonged TV and video exposure by ageexposure by age
COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES
Patient CarePatient Care • family centered patient care family centered patient care
developmentally and age appropriate developmentally and age appropriate compassionate and effective for compassionate and effective for treatment of health care problems treatment of health care problems and promotion of healthand promotion of health
• Presentation and management of disease Presentation and management of disease by ageby age
• Importance of information for family Importance of information for family regarding signs and symptoms of problemregarding signs and symptoms of problem
COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES
Practice Based LearningPractice Based Learning • investigation and evaluation of patient investigation and evaluation of patient
care, and the assimilation of scientific care, and the assimilation of scientific evidenceevidence
• Scientific evaluation of hypothesis, methods, Scientific evaluation of hypothesis, methods, and conclusion of articleand conclusion of article
Communication SkillsCommunication Skills • interpersonal and communication skills interpersonal and communication skills
resulting in effective information resulting in effective information exchange and learning with patients, exchange and learning with patients, families and professional associatesfamilies and professional associates
COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES
System Based PracticeSystem Based Practice • understanding systems of health care understanding systems of health care
organization, financing, and delivery, organization, financing, and delivery, and the relationship of one’s local and the relationship of one’s local practice and these larger systemspractice and these larger systems
• Referral systems, consultation Referral systems, consultation
ProfessionalismProfessionalism • carrying out professional responsibilities, carrying out professional responsibilities,
adherence to ethical principles, and adherence to ethical principles, and sensitivity to diverse patient populationssensitivity to diverse patient populations
• Patient education in diverse culturesPatient education in diverse cultures