Evolutionary developmental psychology: introduction to the special issue.
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Biological Evolution↗
Biomedical subjects
Peter K Smith
Publications and source records attributed to Peter K Smith.
The use of coping strategies by Danish children classed as bullies, victims, bully/victims, and not involved, in response to different (hypothetical) types of bullying.
The coping strategies employed in response to different types of bullying, by 305 Danish children (142 boys, 163 girls) in school years four to nine (aged 10-15 years), were investigated. Children were classed into four bully-victim status types. A revised version of the Olweus Bully/Victim Questionnaire was used for the classification of children, and a Self-Report Coping Measure for the investigation of coping strategies. The coping strategy of Externalizing was used significantly more by children classed as bully/victims compared with victims and not involved children: Seeking Social Support and Internalizing were preferred significantly more by girls, whereas Externalizing was preferred significantly more by boys; Distancing, Seeking Social Support, and Internalizing were favored significantly more by children in years four to six compared with children in years seven to nine. Looking at coping strategies in response to different types of bullying, Seeking Social Support was used significantly more in response to attack on property relative to verbal bullying, social exclusion, and indirect bullying, and Distancing was used significantly less in response to attack on property compared with any of the other types of bullying. The results are discussed in relation to implications for educational practice.
Adaptation, Psychological↗
Interventions to reduce school bullying.
In the last 2 decades, school bullying has become a topic of public concern and research around the world. This has led to action to reduce the problem. We review interventions targeted at the school level (for example, whole school policy, classroom climate, peer support, school tribunal, and playground improvement), at the class level (for example, curriculum work), and at the individual level (for example, working with specific pupils). Effectiveness of interventions has been sporadically assessed. We review several systematically evaluated, large-scale, school-based intervention programs. Their effectiveness has varied, and we consider reasons for this. We suggest ways to improve the evaluation and comparability of studies, as well as the effectiveness of future interventions.
Adolescent↗
Postcardiac surgery complications: association of acute renal dysfunction and atrial fibrillation.
UNLABELLED: Postoperative creatinine increase is associated with adverse outcome after cardiac surgery. Although postoperative stroke and renal dysfunction are associated after cardiac surgery, suggesting a common systemic insult, a similar assessment of atrial fibrillation and renal dysfunction has not been performed. Therefore, we tested the hypothesis that patients with new-onset atrial fibrillation complicating coronary bypass surgery have a greater postoperative creatinine increase. Data were obtained for 453 elective coronary bypass surgery patients with no history of atrial fibrillation. Multivariate regression analyses of factors associated with peak fractional change in creatinine demonstrated a two-way interaction between age and atrial fibrillation (variable estimate, -1.1; P = 0.002). Similar results were obtained in a secondary multivariate model analyzing factors associated with peak postoperative creatinine (variable estimate, -0.01; P = 0.04). We confirmed our hypothesis that patients with new-onset atrial fibrillation are more likely to have acute renal dysfunction after cardiac surgery. The association of atrial fibrillation and creatinine increase diminishes with advancing age. These data are consistent with a common pathophysiology that contributes in an age-dependent fashion to the etiology of both acute renal dysfunction and atrial fibrillation after coronary bypass surgery. IMPLICATIONS: We found an independent association between new-onset atrial fibrillation and postoperative creatinine increase that is influenced by age. The degree to which atrial fibrillation is associated with postoperative creatinine increase diminishes with advancing age. This interaction suggests that a common etiology for these two complications may be more important in younger patients.
Acute Kidney Injury↗
Victimization in the school and the workplace: are there any links?
We examine whether reported roles in school bullying, and victimization in the workplace, are connected; the influence of victim coping strategies at school; and sex differences. A questionnaire was completed by 5,288 adults from various workplace venues in Great Britain. We analysed two questions on school experiences (participant role; coping strategies if bullied) and questions on workplace bullying (experiences of being bullied). We found a significant relationship between reported roles in school bullying, and experience of workplace victimization. The highest risk of workplace victimization was for those who were both bullies and victims at school (bully/victims), followed by those who were only victims. An analysis of relative risk of workplace bullying, given being a victim at school plus using various coping strategies, revealed an increased risk for the strategies 'tried to make fun of it', and 'did not really cope'. Women were at slightly higher risk of getting bullied at work, but there were no interactions with roles at school, and only one interaction with coping strategies. This is the first study to report an association between school and workplace bullying. Victims at school are more at risk of workplace victimization, but the especial risk for 'bully/victims' supports other indications that this particular category of school pupils should be a focus of concern. The findings also suggest that school pupils who consistently cannot cope with bullying, or try to make fun of the bullying, are more at risk for later problems in the workplace. However, associations are modest; many victims of school bullying are not being victimized in later life, and the results also suggest important contextual or environmental effects on risks of victimization.
Adaptation, Psychological↗
Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank).
In this observational treatment comparison in a single center over 25 years, we sought to assess long-term outcomes of coronary artery bypass surgery (CABG) or medical therapy in patients with heart failure, coronary artery disease, and left ventricular systolic dysfunction. The benefit of CABG compared with medical therapy alone in these patients is a source of continuing clinical debate. This analysis considered all patients with New York Heart Association class II or greater symptoms, 1 or more epicardial coronary vessels with a > or = 75% stenosis, and a left ventricular ejection fraction <40% who underwent an initial cardiac catheterization at Duke University Medical Center from 1969 to 1994. Patients were classified into the medical therapy group (n = 1,052) or CABG group (n = 339) depending on which therapy they received within 30 days of catheterization. Cardiovascular event and mortality follow-up commenced on the day of CABG, or at catheterization plus 8 days (the mean time to CABG) for the medical therapy arm. A Cox proportional-hazards model was employed to adjust for differences in baseline characteristics. In the first 30 days from baseline, there was an interaction between treatment strategy and number of diseased vessels. Unadjusted, event-free, and adjusted survival strongly favored CABG over medical therapy after 30 days to >10 years regardless of the extent of coronary disease (p <0.001). Thus, regardless of the severity of coronary disease, heart failure symptoms, or ventricular dysfunction, CABG provides extended event-free and survival advantage over medical therapy alone in patients with an ischemic cardiomyopathy.
Aged↗
Basic fibroblast growth factor is upregulated in hibernating myocardium.
BACKGROUND: Ischemia is known to be a potent stimulus for the upregulation of angiogenic growth factors, such as basic fibroblast growth factor (bFGF). While previous investigations have shown that many angiogenic growth factors are upregulated in animal models of myocardial ischemia, the models used are limited in their ability to produce stable ischemia beyond a few weeks. Our laboratory uses a stable model of hibernating myocardium where later time points may be examined. Therefore, the goal of this study was to examine bFGF protein levels in the myocardium at baseline and 3 or 6 months following the onset of myocardial ischemia. METHODS: A total of 18 miniswine were studied. Basal endogenous levels of bFGF were measured in control animals (n = 6) immediately following sacrifice, while 12 other pigs underwent a 90% left circumflex artery occlusion with documented hibernating myocardium by positron emission tomography ((13)N-ammonia) and dobutamine stress echocardiography. These animals were studied at 3 (n = 7) and 6 months (n = 5) postoperatively. At sacrifice, six 3 x 3 mm samples were harvested from the left circumflex (hibernating) myocardium. Basic FGF levels (picograms per microgram of protein) were determined using ELISA kits. RESULTS: Basic FGF protein levels 3 months after the creation of hibernating myocardium were three times greater than in nonischemic control animals (P < 0.05), while levels at 6 months were increased sixfold compared to control animals (P < 0.05 versus both control and 3-month groups). CONCLUSIONS: Endogenous bFGF production is upregulated at 3 and 6 months in hibernating porcine myocardium. The angiogenic effects of exogenous bFGF delivered into ischemic myocardium with varying levels of endogenous growth factors must be determined.
Animals↗
Risk of anaphylaxis from aprotinin re-exposure during LVAD removal and heart transplantation.
Aprotinin has been shown to reduce transfusion requirements in re-operative cardiac surgery and in implantation of long-term left ventricular assist devices (LVAD). However, it is an antigenic polypeptide and re-exposure is associated with a small incidence of anaphylaxis. This report describes 2 cases of anaphylactic response to aprotinin when the agent was employed for both the LVAD implant and for the subsequent explant and cardiac transplant. Early re-exposure to just the test dose was associated with a significant incidence of anaphylaxis.
Adult↗
Neuroprotection is associated with beta-adrenergic receptor antagonists during cardiac surgery: evidence from 2,575 patients.
OBJECTIVE: To determine the impact of perioperative beta-adrenergic receptor (betaAR) antagonist administration on neurologic complications. DESIGN: Observational database analysis. SETTING: A clinical investigation at a single tertiary academic medical center. PARTICIPANTS: Elective coronary artery bypass graft surgical patients operated on in the period 1994-1996. INTERVENTIONS: Patients were divided into 2 groups: (1) patients given betaAR antagonist-blocking drugs in the perioperative period, including during operation, and (2) patients not given betaAR antagonists. MEASUREMENTS AND MAIN RESULTS: betaAR antagonist use in 2,575 consecutive patients undergoing coronary artery bypass graft surgery (1994-1996) was determined using the Cardiovascular Database and Anesthesia Information System Database. Outcome variables were postoperative stroke, coma, and transient ischemic attack. Of patients, 113 (4.4%) had postoperative neurologic complications, including stroke (n = 44), coma (n = 12), and transient ischemic attack (n = 3). Of patients, 2,296 (89%) received perioperative betaAR antagonist therapy, and 279 (11%) did not. Adverse neurologic events occurred in 3.9% (n = 90) of patients who received perioperative betaAR antagonists and 8.2% (n = 23) of patients who did not receive betaAR antagonists (odds ratio, 0.45; 95% confidence interval, 0.28 to 0.73; p = 0.003, unadjusted.) Severe neurologic outcomes (stroke and coma) occurred in 1.9% (n = 44) of patients who received betaAR antagonists and 4.3% (n = 12) of patients who did not receive betaAR antagonists (odds ratio, 0.43; 95% confidence interval, 0.23 to 0.83; p = 0.016). CONCLUSION: Use of beta-adrenergic antagonists was associated with a substantial reduction in the incidence of postoperative neurologic complications. A prospective randomized trial is needed to verify this potentially important neuroprotective strategy in cardiac surgery.
Adrenergic beta-Antagonists↗
Association of leukocyte-depleted blood transfusions with infectious complications after cardiac surgery.
BACKGROUND: To test the hypothesis that leukocyte-mediated immunosuppression may contribute to postoperative infections after blood transfusions, we compared the incidence of postoperative infections in patients undergoing elective coronary artery bypass graft (CABG) surgery who received either leukocyte-depleted (LD-RBCC) or non-LD transfusions of red blood cell concentrates (RBCC) within 48 h of surgery. MATERIALS AND METHODS: Data for all primary elective CABG patients between 1995 and 1998 who received allogeneic RBCC transfusions in the first 48 h after surgery were collected. Patients were divided into two groups (group LD: LD-RBCC transfusions only; group non-LD: non-LD-RBCC transfusions only were excluded). Patients who received a combination of LD and non-LD-RBCC transfusions, or any blood products other than RBCC were excluded. Infectious complications recorded included pneumonia, acute respiratory distress syndrome, mediastinitis, leg wound/sternal wound infection, nosocomial infection, catheter-related infection, urinary tract infection, decubitus ulcers, and bacteremia/fungemia. RESULTS: One hundred forty-two patients received only LD-RBCC transfusions, and 1,765 patients received only non-LD-RBCC transfusions. Power analysis demonstrated that the sample size attained 80% power to detect an odds ratio of 2.1 at a significance level of p < 0.05. Infection rates were not significantly different between the non-LD and LD groups (7.57% vs. 9.52%, p = 0.40). Leukocyte depletion status of RBCC transfusions was not a predictor of infectious complications (p = 0.73). However, total units of RBCC received was highly associated with increased infection (p = 0.0001). CONCLUSIONS: No association between postoperative infections and the use of leukocyte-depleted blood was identified. However, an increased incidence of postoperative infections was observed to be associated with blood transfusions in general.
Aged↗
The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass.
UNLABELLED: Outcome after cardiac surgery varies depending on complication type. We therefore sought to determine the association between complication type, mortality, and length of stay in a large series of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Multivariate logistic regression was used to test for differences between complication types in mortality and prolonged length of stay (>10 days) while controlling for preoperative and intraoperative risk factors. In 2609 consecutive cardiac surgical patients requiring CPB, the mortality rate was 3.6%; 36.5% had one or more complications, and 15.7% experienced an adverse outcome (death or prolonged length of stay). Multivariate logistic regression demonstrated that complication type was significantly associated with adverse outcome (P < 0.001) independent of Parsonnet score and CPB time (c-index = 0.80). The development of noncardiac complications only (Group NC) and cardiac complications with other organ involvement (Group B) significantly increased mortality and hospital and intensive care unit length of stay (P < 0.001) when compared with cardiac complications only (Group C). The incidences of adverse outcome in Groups C, NC, and B were 15%, 43%, and 67%, respectively; the mortality rates were 3%, 7%, and 20%, respectively. All these intergroup comparisons were significantly different (adjusted P < 0.05). Complications involving organs other than the heart appear to be more deleterious than cardiac complications alone, underscoring the need for strategies to reduce noncardiac complications. IMPLICATIONS: Complications, particularly when they involve organs other than just the heart, increase mortality and prolong the length of hospital stay after heart surgery, independent of a patient's preoperative risk factors and the duration of cardiopulmonary bypass. Strategies aimed at preventing damage to other organs during cardiac surgery need to be improved.
Adult↗
Serum creatinine patterns in coronary bypass surgery patients with and without postoperative cognitive dysfunction.
UNLABELLED: Renal dysfunction is common after coronary artery bypass graft (CABG) surgery. We have previously shown that CABG procedures complicated by stroke have a threefold greater peak serum creatinine level relative to uncomplicated surgery. However, postoperative creatinine patterns for procedures complicated by cognitive dysfunction are unknown. Therefore, we tested the hypothesis that postoperative cognitive dysfunction is associated with acute perioperative renal injury after CABG surgery. Data were prospectively gathered for 282 elective CABG surgery patients. Psychometric tests were performed at baseline and 6 wk after surgery. Cognitive dysfunction was defined both as a dichotomous variable (cognitive deficit [CD]) and as a continuous variable (cognitive index). Forty percent of patients had CD at 6 wk. However, the association between peak percentage change in postoperative creatinine and CD (parameter estimate = -0.41; P = 0.91) or cognitive index (parameter estimate = -1.29; P = 0.46) was not significant. These data indicate that postcardiac surgery cognitive dysfunction, unlike stroke, is not associated with major increases in postoperative renal dysfunction. IMPLICATIONS: We previously noted that patients with postcardiac surgery stroke also have greater acute renal injury than unaffected patients. However, in the same setting, we found no difference in renal injury between patients with and without cognitive dysfunction. Factors responsible for subtle postoperative cognitive dysfunction do not appear to be associated with clinically important renal effects.
Aged↗
Postoperative hyperthermia is associated with cognitive dysfunction after coronary artery bypass graft surgery.
BACKGROUND AND PURPOSE: Temperature is a well-known modulator of experimental cerebral injury. We hypothesized that hyperthermia would be associated with a worsened cognitive outcome after coronary artery bypass graft surgery (CABG). METHODS: Three hundred consenting patients undergoing cardiopulmonary bypass for CABG had hourly postoperative temperatures recorded. The degree of postoperative hyperthermia was determined by using the maximum temperature within the first 24 hours as well as by calculating the area under the curve for temperatures >37 degrees C. Patients underwent a battery of cognitive testing both before surgery and 6 weeks after surgery. By use of factor analysis, 4 cognitive domains (scores) were identified, and the mean of the 4 scores was used to calculate the cognitive index (CI). Cognitive change was calculated as the 6-week CI minus the baseline CI. Multivariable linear regression (controlling for age, baseline cognitive function, and temperature during cardiopulmonary bypass) was used to compare postoperative hyperthermia with the postoperative cognitive change. RESULTS: The maximum temperature within the first 24 hours after CABG ranged from 37.2 degrees C to 39.3 degrees C. There was no relationship between area under the curve for temperatures >37 degrees C and cognitive dysfunction (P=0.45). However, the maximum postoperative temperature was associated with a greater amount of cognitive dysfunction at 6 weeks (P=0.05). CONCLUSIONS: This is the first report relating postoperative hyperthermia to cognitive dysfunction after cardiac surgery. Whether the hyperthermia caused the worsened outcome or whether processes that resulted in the worsened cognitive outcome also produced hyperthermia requires further investigation. In addition, interventions to avoid postoperative hyperthermia may be warranted to improve cerebral outcome after cardiac surgery.
Area Under Curve↗
Knowledge and attitudes about school bullying in trainee teachers.
BACKGROUND: Recent research has highlighted the issue of bullying in schools. However, little attention has been paid to the knowledge and beliefs of trainee teachers, who will hold a key position in reducing the problem of bullying in schools. AIMS: To determine (i) trainee teachers' beliefs about some aspects of school bullying; (ii) their recommended strategies for pupils to cope; (iii) their confidence in dealing with bullying issues as future teachers; (iv) the value of specific aspects of training; (v) the importance for these of sex, and primary/secondary training. SAMPLE: This comprised 270 students enrolled on either a one-year postgraduate Certificate in Education (PGCE) course (N =197) or a four-year degree in education (BEd) course (N =73). Age ranged from 18-51 years (mean=28 years). METHODS: Questionnaire completed and returned within a 2-week period. RESULTS: Bullying was seen as an important issue. Some aspects of trainee teachers' knowledge of bullying were accurate, others less so. Telling teachers, and parents, were the strategies most highly recommended to pupils. The great majority were in favour of teacher training courses incorporating information regarding ways of combating bullying. However, they had less confidence about their ability to deal with bullying. Respondents expressed more confidence when dealing with victims rather than bullies and working with the parents of victims rather than the parents of bullies. CONCLUSION: It is important that teacher-training programmes incorporate information about school bullying, and are designed to take account of existing knowledge, and areas in which trainee teachers may feel less confident.
Adaptation, Psychological↗
Definitions of bullying: a comparison of terms used, and age and gender differences, in a fourteen-country international comparison.
The study of school bullying has recently assumed an international dimension, but is faced with difficulties in finding terms in different languages to correspond to the English word bullying. To investigate the meanings given to various terms, a set of 25 stick-figure cartoons was devised, covering a range of social situations between peers. These cartoons were shown to samples of 8- and 14-year-old pupils (N = 1,245; n = 604 at 8 years, n = 641 at 14 years) in schools in 14 different countries, who judged whether various native terms cognate to bullying, applied to them. Terms from 10 Indo-European languages and three Asian languages were sampled. Multidimensional scaling showed that 8-year-olds primarily discriminated nonaggressive and aggressive cartoon situations; however, 14-year-olds discriminated fighting from physical bullying, and also discriminated verbal bullying and social exclusion. Gender differences were less appreciable than age differences. Based on the 14-year-old data, profiles of 67 words were then constructed across the five major cartoon clusters. The main types of terms used fell into six groups: bullying (of all kinds), verbal plus physical bullying, solely verbal bullying, social exclusion, solely physical aggression, and mainly physical aggression. The findings are discussed in relation to developmental trends in how children understand bullying, the inferences that can be made from cross-national studies, and the design of such studies.
Adolescent↗
Predicting and preventing adverse neurologic outcomes with cardiac surgery.
Adverse neurologic outcomes after cardiac surgery can have devastating consequences, among them increased mortality risk and, among survivors, loss of independence and a diminished quality of life. They also represent a burden on the health-care system, requiring prolonged hospitalizations and additional aftercare and, therefore, greater costs. Adverse outcomes are classified by their severity. Frank stroke is the most serious. This complication is associated with patient age; however, the presence of significant ascending aortic disease represents the greatest hazard. Multivariable analysis also indicates that prior neurologic events, diabetes, chronic obstructive pulmonary disease, preoperative status, and diffuse vascular disease are predictive. The second type of adverse cerebral outcome includes neurocognitive abnormalities such as memory loss and diminished emotional health. The strongest predictors of these abnormalities are hypertension and a history of alcohol use, as well as age. These predictive factors have been incorporated into the Multicenter Study of Perioperative Ischemia stroke-risk index, which clinicians can use to better assess the risk of adverse neurologic events. Clinical research examining the relationship between the predictive variables for neurologic adverse events and cerebral blood flow has suggested some surgical strategies for minimizing risk, such as limiting manipulation of the ascending aorta. The benefits of strategies such as using low or high mean arterial pressures and manipulating pump flow remain unclear. Off-pump coronary bypass surgery has been proposed as a means of reducing neurologic risk, but its effectiveness is unproved in this area. One pharmacologic strategy, the administration of aprotinin, has been shown to reduce the incidence of stroke in high-risk patients.
Aprotinin↗
Implantable left ventricular assist devices: new hope for patients with end-stage heart failure.
INTRODUCTION: Recently, the Food and Drug Administration approved implantable left ventricular assist devices (LVAD) as destination therapy (DT) for end-stage heart failure patients who are ineligible for cardiac transplantation. OBJECTIVE AND STUDY DESIGN: This is a case series that describes the early results with DT LVAD at Duke University Medical Center (DUMC). An additional objective is to provide general information to a broad group of caregivers on this LVAD therapy, which is a new and developing treatment option. DATA SOURCE/COLLECTION METHODS: Pretreatment clinical condition and outcomes data were collected retrospectively on this cohort of patients through chart review. Outcomes in our patients are compared to data from prior studies and established databases. PRINCIPAL FINDINGS: Since approval of this therapy two years ago, 18 patients have been treated with implantable LVAD as DT at DUMC. The primary reason for ineligibility for transplant was advanced age (median age was 66). Nearly all of the patients (89%) were confined to the hospital requiring continuous inotropic infusions or temporary mechanical support (e.g., intra-aortic balloon pump) prior to LVAD. The 30-day survival following LVAD implantation was 94.5%; one-year survival was 60%. Eighty-nine percent of patients were successfully discharged to independent living. Operative mortality is similar to that of other cardiac surgery procedures performed on patients with advanced heart failure, while duration of intensive care stay and hospitalization remain considerably longer. PRINCIPAL LIMITATIONS: The principal limitation of this review is the absence of a control group of patients with end-stage heart failure who received conventional therapies. For this reason, the DT LVAD outcomes are compared to prior studies and database results. CONCLUSION: Implantable LVAD therapy provides new hope for end-stage heart failure patients who do not qualify for cardiac transplantation.
Adult↗
Cyberchondriacs.
Over 110 million Americans have accessed the internet for healthcare information. This information is often used in medical consultations and possibly contributing to increasing health care burdens. Although well informed patients are an advantage in disease management, the quality and reliability of information online is variable. Adolescents today have grown up with the Internet as a primary knowledge source, but still lack the skills to effectively filter credible information. Voluntary standards on health information have been attempted by Health on the Net Foundation; however their success has been limited, mainly due to the fact that most people searching for health information on line use a search engine rather than a specific site. This makes regulations almost impossible. Cyberchondriacs, a term used to describe anyone who seeks health-related information on the Internet, are not only at risk of acquiring unreliable information on line and therefore potential unnecessary anxiety, but they could also be financially exploited, for example, by e-health organisations and pharmaceutical companies. Moreover, the vulnerable e-health seeker, such as the inexperienced adolescent, is able to buy any quantity of nearly any medication on-line. Reasons for patients seeking information on line are varied, but include not having enough time at consultations. To try to address these issues, organisations such as NHS direct have been set up but their success is difficult to measure due to a lack of data. However, potential exploitation of a vulnerable population and the motivations behind their search for information on the internet merit further study.
Adolescent↗