Case report: clonidine withdrawal after atypically high-dose maintenance treatment.
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Adolescent↗
Biomedical subjects
C A McDonald
Publications and source records attributed to C A McDonald.
Intentions to quit smoking in substance-abusing teens exposed to a tobacco program.
In 1993-94, fifty-five clients at an adolescent residential drug treatment facility with an innovative tobacco prevention, education and cessation program reported their tobacco attitudes, intentions, and behavior at admission and discharge. Of entering clients, 93% were current smokers and 93% felt the facility should help clients quit smoking. Clients interested in quitting increased from 61% at admission to 87% at discharge, as measured by the precontemplation/contemplation ladder of Rustin and Tate (1993). Clients who wanted to immediately quit smoking increased from 15% to 29%. Sixty-five percent of the teens studied said the tobacco-free activities were extremely helpful. At discharge, 16% of the smokers reported having quit tobacco and all four nonsmokers remained smoke-free. During the preceding year there was a naturally occurring quit rate of 1%. As a result of this work, the facility required residential clients to be nicotine-free as of July 1996.
Adolescent↗
Genetics of early cancer detection behaviours in Australian female twins.
Early detection of cervical and breast cancers is an important component of women's health strategy. Screening programmes, health professional interventions and preventive behaviours such as breast self-examination provide the means to this end. Our twin study sought to identify the relative influence of environmental and genetic factors on liability to early cancer detection behaviours, including use of cervical smear tests, mammograms, and breast examination. Additive genetic and random environmental effects models gave the best, most parsimonious fit to the data for each early cancer detection behaviour. The heritability of liability to Pap smear use was 66%, mammogram use 50%, breast examination by a doctor or nurse 38% and breast self-examination 37%. Genetic influences were behaviour-specific; there was no evidence for a common genetic influence on the four behaviours. Potential covariates investigated included age, amount of contact between co-twins, educational level and personality traits such as harm avoidance, novelty seeking, reward dependence, neuroticism, anxiety, depression, self-esteem, perceived control, interpersonal dependency and ways of coping. None were significant. The study was carried out before the implementation of national screening programmes with media campaigns to increase participation rates. Hence follow-up investigation, including data on regularity of behaviours, would be informative.
Adaptation, Psychological↗
American Academy of Pediatrics. Committee on Substance Abuse. Marijuana: A continuing concern for pediatricians.
Marijuana, the common name for products derived from the plant Cannabis sativa, is the most common illicit drug used by children and adolescents in the United States.(1) Despite growing concerns by the medical profession about the physical and psychological effects of its active ingredient, Delta-9-tetrahydrocannabinol, survey data continue to show that increasing numbers of young people are using the drug as they become less concerned about its dangers.(1)
Adolescent↗
Paediatric assessment in a residential child and adolescent psychiatry unit.
OBJECTIVE: To document the health status, comorbidity and functional impairments experienced by a group of psychiatrically disturbed children and adolescents. METHODOLOGY: A detailed study of consecutive admissions to a residential unit over a two-year period was undertaken. All admissions had a comprehensive paediatric, speech pathology and psychiatric assessment. RESULTS: Compared to the general population, there was a significant history of developmental delay and low birthweight, but only a slightly greater prevalence of antenatal problems. Clumsiness (37%), severe speech and language disorder (32%), and hearing loss (15%) were prominent. Only 25% had no history of comorbid medical or neurological disorders. CONCLUSION: Children and adolescents presenting with moderate to severe mental health morbidity may have pre-existing comorbid medical problems, as well as unrecognised difficulties and impairments in other skills areas. Multidisciplinary assessment and intervention should be an integral part of the residential programme.
Adolescent↗
A profile of children and adolescents in a psychiatric unit: multidomain impairment and research implications.
OBJECTIVE: The scientific literature has not kept pace with the evolution of child and adolescent psychiatric inpatient units, including their nature, patient profile, philosophical orientation and efficacy. This study aims to establish a comprehensive, multimodal description of the population served by an inpatient psychiatric treatment facility for children and adolescents. METHOD: A multidisciplinary assessment regime including psychiatric, medical, speech and language examination, observer rating and patient self-report of psychopathology was used to assess 58 consecutive patients over a 20-month period. RESULTS: In addition to a prevalence of disruptive behaviour disorders of 67% and a high rate of comorbidity with other psychiatric conditions, a breadth of impairment was demonstrated in many areas. Significantly decreased measures of socialisation, communication, daily living skills, self-esteem, intelligence and physical health are reported. Moderate to severe language handicap was found in 40% of patients. CONCLUSIONS: The inpatient population of children and adolescents exhibited not only a high rate of disruptive behaviour disorders, frequently comorbid with other psychiatric conditions, but also high levels of physical, speech, language and living skills impairment. This finding supports the need for multimodal, multidisciplinary evaluation and treatment in this population. Outcome research evaluating treatment effectiveness must also account for the wide-ranging disabilities of these children and adolescents.
Activities of Daily Living↗
Patient characteristics and pathology in colorectal adenomas removed by colonoscopic polypectomy.
Between September 1981 and August 1987 420 patients with 565 adenomas underwent colonoscopic polypectomy to produce a 'clean colon'. Data from these patients were analysed to identify associations between patient characteristics (age and sex), polyp characteristics (site, size, shape, multiplicity and villous content) and the degree of dysplasia in the index adenoma. In univariate analysis, severe dysplasia in the index adenoma was significantly but weakly associated with size (> or = 10 mm), peduncular shape and villous architecture. Logistic regression confirmed an independent effect only from villous architecture. These findings suggest that it is unlikely that strong predictors of a patient developing a metachronous adenoma or colorectal cancer can be identified on the basis of an index adenoma found at initial colonoscopy. These patients will continue to be followed to investigate this question.
Adenomatous Polyps↗
Live animal measurement of carcass traits: estimation of genetic parameters for beef cattle.
Ultrasound measurements by trained and accredited sonographers on 9,232 Angus, Hereford, and Polled Hereford cattle at an average age of 450 d were used to estimate genetic and environmental (co)variances for weight at scanning (Wt), longissimus muscle area (LMA), longissimus muscle area adjusted to a constant weight of 400 kg (LMAawt), and fat depths at the rump and 12/13 rib sites. Estimated kilograms (ESMkg) and percentage of saleable meat yield (ESM%) were also calculated and analyzed. Subjective muscle scores, available for 2,488 animals, were also included in the analysis. Estimated heritabilities were 46% for Wt, 21% for LMA and LMAawt, 37% for rump fat, 30% for rib fat, 15% for muscle score, 44% for ESMkg, and 36% for ESM%. The two measurements, LMA and LMAawt, had high genetic (.82) and environmental (.91) correlations. The two fat depths were also highly correlated (.86 genetic; .67 environmental). Weight at scanning was moderately correlated with LMA (.45 genetic; .41 environmental). Differences between breeds could not be detected, but some variation in parameter estimates between data sets of the same breed was observed. Environmental correlations between fat depths or muscle score and Wt were approximately .3; genetic correlations were .07 to .12. Subjective muscle score had marginally higher genetic correlations with LMA than with LMAawt (.22 vs .08) but similar environmental correlations (.31 vs .27). Results show that carcass traits measured by ultrasound and predictions of meat yield have genetic variability, are moderately heritable, and that genetic progress based on genetic evaluation by mixed-model analysis can be made.
Adipose Tissue↗
Live animal measurement of carcass traits by ultrasound: assessment and accuracy of sonographers.
The establishment and evaluation of an assessment system to accredit sonographers for measuring the carcass traits of subcutaneous fat depths and longissimus muscle area (LMA) on potential breeding animals by real-time ultrasound is described. Repeatability of operators, variation between the animal's left and right sides, and variations in technique were assessed from measurements and repeat measurements of 30 cattle by up to eight operators at three testing sessions. Accuracy of carcass data was determined by repeatability of measurements, variability between measurers, between left and right sides of the carcass, and variation due to handling and dressing procedures. Correlations with carcass data averaged .92 for rump fat, .90 for rib fat, and .87 for LMA. Residual SD averaged .81 mm, .88 mm, and 5.1 cm2. A very experienced sonographer can measure LMA only marginally less accurately than it can be measured on the carcass. In Session 3, the SE between repeat fat measurements for accredited sonographers averaged .43 mm, indicating that fat depths can be measured more accurately, but when comparing measurements from different operators, adjustments may be required for differences in technique, otherwise overall accuracy will be about the same, approximately 1 mm. Scanned rump fat measurements were consistently approximately 20% higher than on the chilled, hanging carcass 24 h after slaughter; after applying the standard correction factor of 1.17, LMA measurements were similar. Scan and carcass rib fat measurements were similar for animals with less than or equal to 10 mm of fat cover, above which carcass measurements tended to be higher.
Accreditation↗
Chlamydia trachomatis Fitz-Hugh-Curtis syndrome without salpingitis in female adolescents.
We encountered seven female adolescents with the Fitz-Hugh-Curtis syndrome and no signs or symptoms of salpingitis. Six of the patients had cervical cultures positive for Chlamydia trachomatis. The Fitz-Hugh-Curtis syndrome should be included in the differential diagnosis of right-sided abdominal pain in the sexually active female adolescent to avoid unnecessary diagnostic procedures and to reduce the prevalence of chlamydial infection and its complications.
Abdomen↗
Immunochemical detection of fecal occult blood.
An immunochemical test for fecal occult blood has been evaluated. It has been found to be specific for human hemoglobin and to be reproducible, accurate and four times more sensitive than chemical occult blood tests. Storage of prepared slides at -20 degrees C prevented reduction in sensitivity. To determine the effect of blood from the upper gastrointestinal tract, six volunteers ingested 100 ml of their own blood. Positive chemical, but no positive immunochemical tests were produced. In 20 healthy subjects, challenge with red meat and vegetables with high peroxidase content increased the positivity rate of chemical tests but had no effect on the positivity rate of the immunochemical test. The immunochemical method for fecal occult blood has advantages over chemical testing in that it is specific for human blood and for lower gut bleeding. Its increased sensitivity should result in a high detection rate of colorectal neoplastic lesions. However, this same increased sensitivity may also reduce its effectiveness in bowel cancer screening because of positive results in patients with trivial blood loss from non-neoplastic colonic sources.
Adult↗
Allergens in hymenoptera venom. VIII. Immunologic comparison of venoms from six species of Vespula (yellow jackets).
Venoms from six species of ground dwelling yellow jackets of the genus Vespula were studied by direct and inhibition of RAST. Significant differences were found among the various species. Reactivity of patients showed significant correlation with insect distribution with the exception of some patients from the far west. The immunologic relationships observed among the venoms correlated well with the current phylogeny, which is based upon morphologic, behavioral and ecologic studies. The correlation with isoenzyme studies that have recently been reported was less complete. Individual patients exhibit highly significant differences in their reactivity to the various species, in many cases comparable to the differences seen in reactivity to yellow jackets and aerial hornets (Dolichovespula).
Allergens↗
Allergens in hymenoptera venom. IX. Species specificity to Polistes (paper wasp) venoms.
Sera from 62 patients allergic to Polistes venom were used to study the allergenic relationships among four individual species of Polistes by both direct and inhibition RAST. Both direct and inhibition results showed that the four species' venoms were closely related. The species within the same subgenus were more closely related than those in different subgenera. The Polistes species were more closely related to each other than various yellow jacket (Vespula) species are to each other. The commercial Polistes venom mix appears to contain all of the relevant allergens.
Allergens↗
Political-economic structures-approaches to traditional and modern medical systems.
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American Medical Association↗
Allergens in hymenoptera venom. VII. Species specific reactivity to yellow jacket venoms.
Venom from three species of yellow jacket, Vespula maculifrons, V. squamosa and Vespa crabro, was tested in direct and inhibition of RAST with a panel of 39 sera from three regions of the U.S. V. squamosa venom was found to be missing at least one allergen present in V. maculifrons. Patterns of reactivity were highly correlated with geography; reactivity with V. squamosa correlated with distribution of the species. Sera fron California recognized Vespa crabro; however, the insect is not found west of Indiana. This suggests that there are also some differences in the venom from the western species, V. pennsylvanica. No correlations were found with reactivity to hornet, wasp or bee venoms.
Allergens↗
An alternative model in geriatric care.
An analysis is presented of one long-term care facility's attempt to develop a comprehensive geriatric program including care of the patient in a hospital, a skilled nursing home, a day hospital, or a clinic for care of the ambulatory aged. The goal was to raise issues for debate and discussion, especially in terms of the evolving role of medical directors in long-term care. The need for group professionalism in cooperation with the Board of citizens in community geriatric practice is emphasized.
Aged↗
Career ladder: tool for recruitment, retention, and recognition.
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Aged↗