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Biomedical subjects

J Stevenson

Publications and source records attributed to J Stevenson.

At least 55 records · Page 3Linked to original sources
PubMed2000

Frozen chips: an unusual cause of severe frostbite injury.

A case of severe frostbite injury to the right foot is presented. This was caused by the inappropriate application of a bag of frozen chips to the foot in an attempt to ease non-specific pain. No specific acute traumatic injury was identified. As the patient was a teacher of physical education, the pain had initially been assumed to originate from a minor musculoskeletal injury. Full recovery ensued after surgical excision of necrotic tissue and split skin grafting. The danger of inappropriate overenthusiastic use of ice packs or other frozen material to treat soft tissue injuries is emphasised. The need for education to prevent similar future injuries is discussed.

Adult↗
PubMed2000

Parents' and teachers' ratings of problem behaviours in children: genetic and contrast effects.

We obtained ratings on the Conners' scales from teachers (CTRS-28) and parents (CPRS-48) for 61 monozygotic and 64 dizygotic twin pairs, aged between 7 and 11 years. Model-fitting analyses were carried out to estimate the extent of genetic and environmental influences on problem behaviours, and to explore possible contrast effects in ratings by parents and teachers. Confirming previous findings with other measures, there was evidence of moderate to strong genetic effects on a range of problem behaviours. Parents' ratings on the Anxiety, Impulsive-Hyperactive and Learning Problem sub-scales showed significant evidence of contrast effects. There was no evidence of such rater bias or competitive sibling interaction effects in ratings by teachers, or in parents' ratings on the Conduct Problem and Psychosomatic sub-scales.

Analysis of Variance↗
PubMed1999

Changes in clinic vaccination coverage after institution of measurement and feedback in 4 states and 2 cities.

BACKGROUND: Since 1995, states and jurisdictions receiving federal immunization funds have been required to perform annual measurements of vaccination coverage in their public clinics, based on data from Georgia where clinic coverage increased after the institution of a measurement and feedback intervention. OBJECTIVE: To determine if clinic vaccination coverage improved in localities that used the Georgia intervention model. DESIGN: Retrospective examination of clinic vaccination coverage data. PARTICIPANTS: Children aged 19 to 35 months enrolled in clinics in localities that had applied the intervention for 4 years or longer. INTERVENTION: The Georgia intervention model: assessment of clinic vaccination coverage, feedback of the information to the clinic, incentives to clinics, and promotion of exchange of information among clinics (AFIX). MAIN OUTCOME MEASURE: Change in median clinic coverage rates, based on the primary (4-3-1) vaccine series, with comparison to results of the National Immunization Survey. RESULTS: Four states and 2 cities that had applied the AFIX intervention for 4 years or longer were identified. The number of clinic records reviewed annually was 4639 to 18000 in 73 to 116 clinics for states, and 714 to 5276 in 8 to 25 clinics for cities. Median clinic coverage rose in all localities: Missouri, 44% (1992) to 93% (1997); Louisiana, 61% (1992) to 83% (1997); Colorado, 55% (1993) to 75% (1997); Iowa, 71% (1994) to 89% (1997); Boston, Mass, 41% (1994) to 79% (1997); and Houston, Tex, 28% (1994) to 84% (1997). The increase in clinic coverage exceeded that of the general population in 5 localities and was identical in the sixth. The average annual coverage rise attributable to the intervention was +5 percentage points per year (Georgia, +6 per year). The average crude direct program cost was $49533 per locality per year. CONCLUSION: The Georgia intervention model (AFIX) can be reproduced elsewhere and is associated with improvements in clinic vaccination coverage.

Child, Preschool↗
PubMed1999

Oral-motor dysfunction in children who fail to thrive: organic or non-organic?

Forty-seven children with non-organic failure to thrive (NOFT) were identified from a whole-population survey of children's growth and development. A significant proportion (N=17) of these 47 children were found to have oral-motor dysfunction (OMD) identified using a previously validated assessment tool. NOFT children with OMD and those with normal oral-motor function (N=30) were compared in order to ascertain whether there were any neurodevelopmental differences which might explain this finding. We hypothesized that children with OMD might have a subtle neurodevelopmental disorder. Few psychosocial variables discriminated the two groups. However, cognitive stimulation within the home and cognitive-growth fostering during mealtimes was much poorer for children with OMD. Some evidence has suggested that NOFT children with OMD may be 'biologically' more vulnerable from birth. We suggest that the continued use of the term 'non-organic' to describe failure to thrive in such children is questionable and requires redefining.

Brain Damage, Chronic↗
PubMed1999

Using genetic analyses to clarify the distinction between depressive and anxious symptoms in children.

Self-report measures of depression and anxiety in children are highly correlated and distinguishing between shared and independent factors in their etiologies is therefore problematic. The aim of this article was to test whether less correlated measures of depression and anxiety could be produced and, if so, what genetic and environmental factors would account for the variance in these symptoms. Second-order factor analysis of the items from two standardized self-report questionnaires of depression and anxiety collected from 395 pairs of same-sex twins aged 8 to 16 years resulted in purer dimensions of depression and anxiety. Behavioral genetic analyses confirmed the distinction between these two dimensions, and bivariate analyses revealed that the association between the two was primarily accounted for by shared genetic factors.

Adolescent↗
PubMed1999

The structure of genetic influences on general cognitive, language, phonological, and reading abilities.

The etiology of individual differences in literacy, phonological awareness, and language ability is reported in 126 pairs of monozygotic and dizygotic twins. At age 6 and 7 years, more than 60% of the variance in literacy was heritable. Heritabilities for 6- and 7-year-olds were .52 and .62, respectively, for phonological awareness and .43 and .50, respectively, for language ability. After genetic effects on IQ were controlled, a separate genetic influence was identified that acted on literacy, phonological awareness, and language. No genetic link between phonological awareness and literacy independent of general language ability was found; such covariance was mediated through environmental influences. Individual differences in literacy ability are substantially influenced by genetic factors, some of which also act on phonological awareness and general language ability.

Child↗
PubMed1999

Genetic and environmental origins of verbal and performance components of cognitive delay in 2-year-olds.

The authors investigated the etiology of several measures of cognitive delay. Verbal (V) and performance (P) abilities were assessed in over 3,000 pairs of 2-year-old twins. Group-differences heritability for general delay (the lowest 5% of the V and P composite) was 35%. However, V and P delays considered independently showed large differences in group heritability (77% for V vs. 40% for P). Specific delays with comorbid cases eliminated showed an even greater difference in group heritability (78% vs. 22%, respectively). The small sample comorbid for both V and P delay also yielded high group heritability for both V (77%) and P (93%) scores. Shared environmental factors also differed in magnitude for V (20%) and P (41%) delays. Because the genetic and environmental origins of V and P delays in infancy differ, they are better considered separately rather than combined into a composite measure of general cognitive delay.

Child, Preschool↗
PubMed1999

Comparative study of the in vitro behavior of cord blood subpopulations after short-term cytokine exposure.

We investigated the effect of short-term cytokine exposure on defined cord blood subpopulations. CD34+Thy1+, CD34+Thy1-, CD34+38-, CD34+38+, CD34+DR+, CD34+DR-, CD34+Rhodamine123 (Rh123)- and CD34+Rh123+ cells were incubated for 7 days in IMDM + 10% FCS + IL3 + IL6 + G-CSF + SCF (36GS) + flt3L. We evaluated LTHC-IC, immunophenotype and nucleated cell count for each cell population before and after cytokine exposure. Short-term exposure of CD34+38+, CD34+Thy1-, CD34+DR+, CD34+DR- and CD34+Rh123+ cells to 36GS causes a significant increase in cell number, whereas CD34+38-, CD34+Thy1+, and CD34+Rh123- cells show only a limited increase. CD34 status post cytokine incubation shows that CD34+38+, CD34+Thy1-, CD34+DR+, and CD34+Rh123+ fractions have a lower proportion of cells remaining CD34+ than CD34+38- CD34+Thy1+, CD34+DR- and CD34+Rh123- fractions. LTHC-IC analyses among input subpopulations show a higher frequency among CD34+38+, CD34+Thy1-, CD34+DR+, CD34+DR- and CD34+Rh123+ cells as compared with CD34+38-, CD34+Thy1+ and CD34+Rh123- cells. However, when LTHC-IC were evaluated after cytokine exposure, CD34+38-, CD34+Thy1+, and CD34+Rh123- cells showed a higher frequency of LTHC-IC as compared with other subpopulations. Addition of flt3L to 36GS doubled the numbers in all subpopulations without altering the proportion of CD34+ cells. Results suggest that CD34+38-, CD34+Thy1+ and CD34+Rh123- cells have a limited proliferative response to cytokines, the stem cell component of these populations is largely maintained and that expansion is derived from mature cell populations.

Cell Culture Techniques↗
PubMed1999

A Jacksonian and biopsychosocial hypothesis concerning borderline and related phenomena.

OBJECTIVE: The aim of this paper is to develop an aetiological model for borderline personality disorder. METHOD: The postulates of Hughlings Jackson are used to provide a preliminary explanatory framework for borderline phenomena. As a necessary background to this discussion, the findings concerning abuse in the early history of borderline personality disorder (BPD) and other conditions, notably somatisation disorder and dissociative states, are briefly reviewed. Other data, including family studies, which might have significance in the aetiology of BPD are also reviewed. RESULTS: The hypothesis is put forward that the symptoms of BPD are due to the failure of 'experience-dependent' maturation of a cascade of neural networks, with prefrontal connections, which become active relatively late in development and which coordinate disparate elements of central nervous system function. These networks subserve higher psychological functions, including attentional focus and affect regulation. They also underpin the reflective function necessary to the emergence of self as the stream of consciousness, which appears at about the age of 4 years. CONCLUSION: Adverse developmental circumstances may produce an interrelated set of symptom clusters, with associated neural network disturbances that are amenable to investigation with psychometric and brain imaging techniques. Since these disturbances are seen as 'experience-dependent', they are considered reversible, at least in part.

Adolescent↗
PubMed1999

Psychotherapy with borderline patients: I. A comparison between treated and untreated cohorts.

OBJECTIVE: The aim of this study is to compare the clinical outcome of patients with borderline personality disorder (BPD) who had received outpatient psychotherapy for 1 year with BPD patients who received no formal psychotherapy for the same period. METHOD: Thirty patients with BPD were treated by trainee psychotherapists working according to clearly described therapeutic principles. They received intensive audiotaped supervision. Patients were seen twice weekly for 1 year. They were compared with 30 patients subsequently referred to the clinic, for whom no therapist was available and who remained on a waiting list for 1 year, receiving their usual treatment. The outcome measure was a score derived from DSM criteria. It was taken at the beginning and end of the year's treatment, in the former case, and after at least 1 year on the waiting list in the latter. (The average waiting period was 17.1 months.) RESULTS AND CONCLUSIONS: Patients who received psychotherapy were significantly improved in terms of the DSM score. Thirty percent of treated patients no longer fulfilled DSM-III criteria for BPD. The untreated patients were unchanged.

Adult↗
PubMed1999

Psychotherapy with borderline patients: II. A preliminary cost benefit study.

OBJECTIVE: The aim of this study was to conduct a preliminary cost benefit study of the effect of outpatient psychotherapy, twice a week for 1 year, in 30 borderline patients. METHOD: Costs to the health system in terms of inpatient care for the year before treatment were compared with the costs for the year following treatment. RESULTS: The cost of hospital admissions for the 30 patients for the year before treatment was $684 346 (range = $0-$143 756/patient). The cost of hospital admissions for the year after treatment was $41 424 (range = $0-$12 333/patient). These figures represent an average decrease in costs per patient of $21 431. By using the schedule fee as the basis, the estimated cost of therapy per patient was approximately $13 000, representing a saving/patient of $8431 or approximately $250 000 over the total cohort in the first year after treatment. CONCLUSION: This study suggests that there is a significant cost benefit in the appropriate treatment of borderline patients.

Adult↗
PubMed1999

A randomised comparison of the effects of oral versus transdermal 17beta-oestradiol, each combined with sequential oral norethisterone acetate, on serum lipoprotein levels.

OBJECTIVE: To investigate the effects of oral versus transdermal 17beta-oestradiol, given in both cases with sequential addition of oral norethisterone acetate, on serum lipid and lipoprotein levels in postmenopausal women. DESIGN: Open, randomised, parallel groups study. SETTING: University Clinical Research Group. POPULATION: Sixty-four postmenopausal women with climacteric complaints who were otherwise healthy were screened. Of these, 58 fulfilled the entry criteria. METHODS: Fifty-eight postmenopausal women were randomised to receive either oral 17beta-oestradiol/oestriol (Trisequens) or transdermal 17beta-oestradiol (Estrapak) together with cyclical addition of norethisterone acetate for 48 weeks. MAIN OUTCOME MEASURES: Serum levels of total cholesterol, triglycerides, high density lipoproteins (HDL), low density lipoproteins (LDL), very low density lipoproteins (VLDL), apolipoproteins, and lipoprotein(a) at baseline, and after 46 weeks (oestrogen-alone phase), and 48 weeks (oestrogen-progestogen phase) of treatment. RESULTS: Oral oestradiol therapy did not affect serum total cholesterol levels during the oestrogen-alone phase, but during the combined phase there was a 5% fall (P < 0.05) due to a 7% decrease in LDL cholesterol levels (P < 0.01). Oral therapy also increased serum triglyceride levels by 9.4% during the oestrogen-alone phase (P < 0.05). During the combined phase of transdermal therapy, there was a 19% fall in serum triglyceride levels (P < 0.05) and a 6% fall in HDL levels (P < 0.05). Oral oestradiol reduced lipoprotein(a) levels by 31% during the oestrogen-alone phase and by 37% with norethisterone acetate addition (P < 0.05). Transdermal therapy had no significant effect on lipoprotein(a). CONCLUSIONS: Other than a minor fall in HDL3 in women receiving transdermal 17beta-oestradiol, coadministration of oral progestogen in general improved, rather than worsened, this serum lipoprotein profile.

Administration, Cutaneous↗
PubMed1999

Assessing immunization performance of private practitioners in Maine: impact of the assessment, feedback, incentives, and exchange strategy.

INTRODUCTION: A provider-based vaccination strategy that has strong supportive evidence of efficacy at raising immunization coverage level is known as Assessment, Feedback, Incentives, and Exchange. The Maine Immunization Program, and the Maine Chapter of the American Academy of Pediatrics collaborated on the implementation and evaluation of this strategy among private providers. METHODS: Between November 1994 and June 1996, the Maine Immunization Program conducted baseline immunization assessments of all private practices administering childhood vaccines to children 24 to 35 months of age. Coverage level assessments were conducted using the Clinic Assessment Software Application. Follow-up assessments were among the largest practices, delivering 80% of all vaccines. RESULTS: Of the 231 practices, 58 were pediatric and 149 were family practices. The median up-to-date vaccination coverages among all providers for 3 doses of diphtheria-tetanus-pertussis vaccine and 2 doses of oral polio vaccine, and 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of oral polio vaccine, and 1 dose of measles-mumps-rubella vaccine at age 12 and 24 months were 90% and 78%, respectively, and did not vary by number of providers in a practice or by specialty. Urban practices had higher coverage than rural practices at 12 months (92% vs 88%). The median up-to-date coverage for 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of oral polio vaccine, and 1 dose of measles-mumps-rubella vaccine at 24 months of age improved significantly among those practices assessed 1 year later (from 78% at baseline to 87% at the second assessment). On average, the assessments required 21/2 person-days of effort. CONCLUSIONS: We document the feasibility and impact of a public/private partnership to improve immunization delivery on a statewide basis. IMPLICATIONS: Other states should consider using public/private partnerships to conduct private practice assessments. More cost-effective methods of assessing immunization coverage levels in private practices are needed.

Child↗
PubMed1999

The treatment of the long-term sequelae of child abuse.

The literature on the long-term sequelae of sexual and physical abuse is reviewed. Abused children are at risk of long-term adverse psychological sequelae related to the abuse per se and not just as a consequence of other associated background factors. There is some specificity relating the type of psychological outcome to the type of abuse experienced. Physical abuse is just as traumagenic as sexual abuse in the long-term. Whatever the efficacy of specific psychological treatments, there are broad general service measures that will prevent both abuse and re-abuse and therefore impact on long-term sequelae. The studies on the effectiveness of intervention to prevent psychological sequelae of abuse are systematically appraised. There are few well-conducted and adequately controlled studies of the efficacy of treatment for abused children. Where a corpus of studies does exist, e.g. group therapy for sexually abused children, treatment for abused children appears to be as effective for children whose problems arise from other causes. Studies have also shown that abusive parenting can be changed by training.

Adolescent↗
PubMed1999

Immunization performance measurement in a changing immunization environment.

OBJECTIVE: The measurement of performance in the delivery of recommended vaccinations for children is used frequently as a marker for quality of care and as an outcome for studies of interventions to improve immunization coverage levels. The critical element of immunization performance measurement is the determination of immunization status. This methodologic review 1) discusses immunization status as a measure of quality of primary care for children, 2) describes immunization status measures used in immunization intervention studies, and 3) examines selected technical issues of immunization status measurement. METHODS AND TOPICS: 1) Description of the characteristics of immunization status measurements obtained by a systematic review of studies published between 1980 and 1997 on interventions to raise immunization coverage, and 2) illustration of technical considerations for immunization status measurement using one local database and one national database of immunization histories. Technical issues for immunization status measurement include 1) the need to use documented immunization histories rather than parental recall to determine immunization status, 2) the need to link records across providers to obtain complete records, 3) the sensitivity of immunization status to missing immunization data, and 4) the potential of measures incorporating combinations of immunizations to underestimate the degree of vaccination in a population. CONCLUSIONS: Immunization performance measurement has many characteristics of a robust quality of care measure, including high acceptance by primary care providers of routine vaccination, association of immunization status with the conduct of other clinical preventive services, agreed-on technical and programmatic standards of care, and legislative requirements for medical record documentation. However, it is not without challenges. Careful attention to technical issues has potential to improve immunization delivery health services research.

Child↗
PubMed1999

Exploring the covariation between anxiety and depression symptoms: a genetic analysis of the effects of age and sex.

Self-reported anxiety and depression symptoms in children and adolescents have been shown to be heritable, and are also highly correlated. Furthermore, there have been indications in the literature of sex and age differences in the aetiologies of these two types of symptoms. This study set out to ascertain to what extent the genetic and environmental factors that influence anxiety symptoms also influence depression symptoms, and whether these are the same in children and adolescents, and males and females. Four hundred and ninety pairs of twins aged 8 to 16 years completed the Children's Depression Inventory and the Trait scale of the State-Trait Anxiety Inventory for Children. There were significant effects of age and sex on the variance in and covariance between these two types of symptom. Bivariate genetic analyses of the measures indicated that the genetic influences on anxiety and depression were shared for all four groups, a finding that has been consistently demonstrated for adults.

Adolescent↗
PubMed1998

Risk factors for development of sexually abusive behaviour in sexually victimised adolescent boys: cross sectional study.

OBJECTIVE: To identify factors that may increase the risk of a sexually victimised adolescent boy developing sexually abusive behaviour. DESIGN: Sexually victimised boys who had sexually abused other children were compared with sexually victimised boys who had not done so. SETTING: Social services departments in south east England were invited to refer sexually abused and sexually abusing boys to a London postgraduate teaching hospital. SUBJECTS: 25 adolescent boys aged between 11 years and 15 years and 11 months. MAIN OUTCOME MEASURES: Adjusted odds ratios estimated from unconditional logistic regression. RESULTS: Unadjusted odds rations for witnessing (8.1) as well as experiencing (18.0) intrafamilial violence and discontinuity of care (7.2) discriminated boys who had sexually abused from others who were solely victims of sexual abuse. Only the adjusted odds ratios for witnessing intrafamilial violence (39.7) discriminated the two groups. CONCLUSIONS: The risk of adolescent boys who have been victims of sexual abuse engaging in sexually abusive behaviour towards other children is increased by life circumstances which may be unrelated directly to the original abusive experience, in particular exposure to a climate of intrafamilial violence. Our findings have implications for the management of boys found to have been sexually abused and raise important questions about the possibility of secondary prevention of subsequent abusive behaviour in those at greatest risk.

Adolescent↗