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PubMed1996

Escalated substance use: a longitudinal grouping analysis from early to middle adolescence.

The authors surveyed a cohort of 1,184 adolescents in the 7th, 8th, and 9th grades. Measures of tobacco, alcohol, and marijuana use and of constructs from 3 theoretical models of substance use were obtained at each point. Clustering analysis for 3-wave substance use data indicated subgroups of nonusers, minimal experimenters, late starters, and escalators. Discriminant function analyses tested whether study variables differentiated the subgroups. One discriminant function accounted for the majority of between-group association; it had loadings for (high) life stress, nonadaptive coping, deviance-prone attitudes, and parental and peer substance use, and (low) parental support, academic competence, and behavioral control. Escalators were high on this function; late starters and experimenters had intermediate values; and nonusers were low on the function. Implications for theories of vulnerability to substance abuse are discussed.

Adolescent↗
PubMed1985

Professional self-regulation: peer review.

Dentistry, in fulfilling its responsibility for self-regulation, has established a highly specific and formalized method of peer review. Its primary purpose is to mediate problems between patients, dentists, and third parties relative to the quality of treatment and appropriateness of care. It is a confidential service provided to the public and profession at no cost and accomplished with the voluntary cooperation of all parties involved. Decisions of peer review committees are advisory in nature but offer an alternative to legal resolution of misunderstandings and problems in patient care. The profession, by continually refining peer review and by educating its members and the public to its function, is providing a unique and valuable service to patients, dentists, and third parties. The objective and consistent application of this self-monitoring process is but one mechanism by which dentistry seeks to serve the public and perpetuate its high standard of care.

Dentists↗
PubMed1990

Whole-cell K+ currents in type II pneumocytes freshly isolated from rat lung: pharmacological evidence for two subpopulations of cells.

The patch clamp technique was used to record whole cell K+ currents in type II pneumocytes freshly isolated from adult rats. Depolarizing voltage steps evoked outward K+ currents which were distinguished into low and high threshold types, only one type being apparent in any one cell. Low-threshold (LT) currents were activated at test potentials of -40 mV to -20 mV and were reduced in amplitude by 20 mM tetraethylammonium (TEA). High-threshold (HT) currents were activated only at test potentials positive to -20 mV and current noise was always greater than for LT currents. HT currents were also significantly more sensitive than were LT currents to block by TEA. Quinine (1 mM) blocked LT currents reversibly at all activating test potentials. HT currents were also reversibly blocked by 1 mM quinine, but in a voltage-dependent manner, the degree of block increasing with increasing test potential. 4-Aminopyridine (2 mM) further distinguished the two current types: it was virtually without effect on HT currents but caused large reductions in LT current amplitudes, apparently by acting on the open channels underlying this current. These data clearly distinguish type II pneumocytes into two subpopulations and suggest that they may play separate roles in the functioning of the intact alveolar epithelium.

4-Aminopyridine↗
PubMed1994

Peer-directed communicative interactions of augmented language learners with mental retardation.

Naturally occurring peer-directed communicative interactions of 13 youth with mental retardation and little or no functional speech who used the System for Augmenting Language (SAL) as their primary means of communication were described. Findings suggest that this system was an integral component of both successful and effective conversations and may be one important means of enhancing social interactions with peer communicative partners who have and do not have mental retardation.

Adolescent↗
PubMed1995

Manuscript peer review at the AJR: facts, figures, and quality assessment.

Concern by the government, funding institutions, and the public for quality assurance in all aspects of medical endeavors mandates critical examination of various professional activities. Although peer review is generally regarded as the best system for selecting and improving scientific papers for publication, the efficacy of this process has never been proved. Moreover, the administrative functions of the editorial staff are often poorly understood. The purpose of this article is to make peer review a the AJR less esoteric and more understandable by quantifying some of its activities. This information is then assessed as it relates to the quality of this important step in scientific publication.

Peer Review, Research↗
PubMed1992

The overtures of preschool social skill intervention agents. Differential rates, forms, and functions.

The purpose of this study was to examine the differential topographies and functions of social behaviors directed by normally developing preschoolers to their playmates with autism. Social interaction data from intervention phases of a study by Kohler, Strain, Hoyson, DeCesare, Donina, and Rapp were analyzed in three different ways. First, the frequency of four behaviors commonly included in social interaction training or assessment procedures (i.e., play organizer suggestions, share offers or requests, assistance offers or requests, and general statements) was examined. Second, the effects of each peer behavior on the immediate response of 3 children with autism were examined. Finally, the impact of each behavior that led to a positive response on the duration of subsequent target child-peer social interactions was examined. The four social behaviors had differential topographical and functional properties. Shares and play organizers occurred most frequently and generated the highest proportion of positive responses from all 3 children with autism. Conversely, assistance offers or requests occurred less often and received a lower percentage of positive responses. However, assistance behaviors consistently led to the longest social interactions. Implications of these results for future social skills training and research are discussed.

Autistic Disorder↗
PubMed1996

Exercise participation in a frail elderly population.

A low-intensity exercise demonstration project was developed jointly by researchers, social service practitioners, and program participants to actively involve frail older people in their own health maintenance. This article describes this collaborative process and its impact on the success of the health promotion program, which was conducted at three senior centers serving a low-income, urban elderly population. Participants were predominantly sedentary women over age 70 with multiple chronic conditions. The program was conducted with peer leaders to facilitate its continuation after the research demonstration phase. In addition to positive health outcomes related to functional mobility, blood pressure maintenance, and overall well-being, this intervention was successful in sustaining active participation in regular physical activity through the use of peer leaders selected by the program participants. The planning, implementation, and outcomes of this project illustrate the benefits and challenges of combining research and practice perspectives in conducting health promotion interventions with older populations.

Black or African American↗
PubMed1992

The case conference approach to teaching clinical pharmacology.

This article analyzes the development of the small group case conference format, historically, elsewhere, and at the authors' institution, as a way of introducing second-year medical students enrolled in a basic pharmacology course to the practicalities, nuances, and challenges of contemporary drug therapy. A number of goals and purposes for these conferences have been identified and incorporated into the development and execution of a plan carried out over the past 14 years. Two examples of the conferences were presented, including an analysis of their teaching features. A listing of the general topics of 40 individual conferences used by the authors was provided. The authors reviewed evidence based on several methods of evaluation that the conferences are enthusiastically accepted by second-year medical students as an adjunctive approach to teaching both basic and applied clinical pharmacology. In addition, the authors find that the conferences subserve a number of other teaching functions such as problem-solving, information retrieval and presentation, and peer co-instruction. The conferences provide a mechanism for faculty-student interaction and an additional way to evaluate student knowledge and performance beyond the more conventional examination approaches.

Diabetes Mellitus↗
PubMed1992

Communications and aging. A case for understanding African Americans who are elderly.

It is important to recognize that the samples drawn of African American elders in the preceding studies were drawn from nationally represented populations as well as from smaller groups of subjects drawn from specific cities. However, these samples, despite their intragroup regional heterogeneity, share similar cultural experiences that are expressed in the differences found in four significant areas from their white peers. These culturally related differences should not be overlooked in either functional assessment or in rehabilitation strategies nor should these differences remain unrecognized in future research. Wallace and Freeman (1991) go further to say that culturally sensitive approaches to clinical and academic preparation of clinicians, through an infusion approach, are needed to provide information about cultural diversity in adults including health/environmental issues that determine health status and consequences on communication competence in multicultural communities, such as poverty, access to health care, genetics, stress, living environments, and diet. One clear approach to sharpening clinician cultural sensitivity to diversity among people who are elderly is to include aging cultural differences in the speech-language pathology curricula of colleges and universities and to begin to explore these issues more fully in our research and professional forums.

Black or African American↗
PubMed1995

Interpersonal relations during simulated space missions.

The present article derives from two isolation studies performed for the European Space Agency (ESA) as simulations of space travels, lasting for 4 and 9 weeks. The aim was to study how interpersonal relations were affected by time, and how individual characteristics related to conflicts and tension among crewmembers. A broad battery of methods was used, including video-recording, peer-ratings and self-reports. In both studies, group-functioning declined in the middle of the isolation and towards the end of the stay. Dominance and task motivation seemed to be important characteristics for compatibility between crewmembers, and negative relations established early in the isolation remained stable over time. These findings have implications for composition, training, and support of crews for extended spaceflights.

Adult↗
PubMed1993

Pre- and postnatal low-level lead exposure and children's dysfunction in school.

The contributions of pre- and postnatal low-level lead exposures to the risk of learning problems were evaluated among 1923 children who were born in one Boston hospital in 1979-1980 and followed to age 8 years. In this relatively privileged group, more than 20% of the children had a mother with some formal postgraduate education. Prenatal lead exposure was estimated with a measurement of umbilical cord blood lead content, and postnatal lead exposure was approximated with measurement of lead in the dentin of an exfoliated deciduous tooth. Information about potential confounders and effect modifiers was obtained from maternal interview shortly after delivery and from a mailed questionnaire completed and returned when the child was approximately 6 years old. An assessment of each child's function in school was provided by the teacher, who completed a questionnaire near the end of the school year in which the child reached the age of 8 years. We considered a learning problem to be related to lead exposure if its adjusted prevalence increased with each loge increase in lead, and if the adjusted prevalence was elevated among children with high levels (i.e., approximating the highest decile) of umbilical cord blood lead (i.e., > or = 10 micrograms/dl) or dentin lead (i.e., > or = 5 micrograms/g). Girls with elevated umbilical cord blood lead levels were more likely than their peers to be dependent and inpersistent and to display an inflexible and inappropriate approach to tasks (defined as the "tasks" cluster). Boys with elevated umbilical cord blood lead levels were more likely than others to have difficulty with both simple directions and sequences of directions. Among girls, elevated deciduous tooth dentin lead content was associated with reading and spelling difficulties, the tasks cluster, and with "not functioning as well as peers." Elevated dentin lead levels were not overrepresented among boys with any of the assessed learning clusters. These findings are consistent with the inference that lead levels still prevalent among children (i.e., blood < 15 micrograms/dl) are associated with some learning problems in girls.

Child↗
PubMed1991

Long-term quality of life after kidney transplantation in childhood.

Transplantation is the treatment of choice for children with end-stage renal disease. However, the long-term quality of life and socioprofessional outcome for those with successful transplants have not previously been reported. We studied these factors in patients transplanted when less than 18 years old who currently have greater than or equal to 10 years of graft function. A total of 57 questionnaires were sent out; 57 (100%) responded [24 female and 33 male patients; average (+/- SD) age at tx = 10 +/- 5 years (0.9-17.7); average f/u = 15.6 +/- 3 years (10-26); current age = 26 +/- 5 years (12-38); 26 had greater than 1 transplant]. Of the 57 respondents, 9 are less than 18 (all are in school); 48 are greater than or equal to 18 (7 in school, 37 employed, 4 unemployed); 12 are married, 1 engaged, and 2 divorced; and 9 have children. While in school, 43 (75%) had participated in sports, 37 (65%) in other extracurricular activities; 7 (12%) were A and 33 (58%) B students; 15 (26%) received awards or scholarships. For those working, the range of occupations is broad (average work week = 41 +/- 5 hr). Health-related absence from work has been nonexistent for 93%. Health is rated as good to excellent by 91% and fair by 9%. The future is regarded as hopeful or promising by 80%. Similarly, 89% are satisfied with life in general; 95% said health never or seldom interferes with family life; 95% feel health and drug side effects are of no or minor concern in sexual relationships. Only 3% feel health is a problem in maintaining a sexual relationship (41% are not sexually active). Only 4% stated that health often interferes with social life; 98% meet with friends on a regular basis; 76% are satisfied with personal relationships and 8% dissatisfied; 91% are satisfied with their ability to perform at work or school and 5% dissatisfied. Of note, 32% are dissatisfied with body appearance. Major concerns are short stature and brittle bones. Major suggestions include education/support groups to deal with teasing at school and peer problems. We conclude that transplanted children with long-term graft function have a favorable social and professional outcome. Overall, quality of life seems excellent.

Adolescent↗
PubMed1989

Effects of early alcohol use on adolescents' relations with peers and self-esteem: patterns over time.

Strain or problem-solving models posit that deviance persists because it enhances youths' psychosocial properties and is therefore functional for adolescents. However, empirical tests of this assumption have been limited to determining whether a moderately social activity like delinquency produces time-ordered changes in self-esteem. This research examines whether a highly social activity like alcohol use improves adolescents' relations with peers and self-esteem over time. The results of a four-year panel study show that the effects of early alcohol use are limited to enhancing peer relations only among adolescents who use alcohol in order to be part of the group. Early alcohol consumption also has a delayed effect on boosting self-esteem, but this effect is restricted to youths who equate drinking with sophistication. The lack of generality of these findings and how the psychological functions of drinking might cancel these effects are discussed.

Adolescent↗
PubMed1996

Moral valuation: a third domain of conscience functioning.

OBJECTIVE: To assess development of moral valuation in normal children and adolescents, that is, how moral rules for living are derived and justified, and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. METHOD: Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed. All moral valuation responses were examined within three aspects of social reference: authority-derived, self-derived, and peer-derived. Each aspect was scaled for complexity into six anchored levels. RESULTS: The levels of all three aspects correlated positively with conceptualization stages as well as with each other. When the covariate, age, was taken into consideration, peer-derived valuation was significantly correlated with both age and stage. CONCLUSIONS: Moral valuation is a domain of conscience functioning in which moral rules and their justifications are socially referenced in relationship to authority, self, and peers. Anchored levels of these three aspects of moral valuation provide developmental guidelines for mental status examinations in patients between 5 and 17 years of age as well as providing criteria for future comparative studies in various diagnostic categories of psychopathology.

Adolescent↗
PubMed1995

[Consensus noninvasive diagnosis of peripheral arterial vascular diseases. Central Guidance Organization for Peer Review].

The outcome is described of a 1993 consensus meeting regarding the role and value of functional non-invasive vascular investigations in the assessment of severity and localization of arterial obstructions and in the selection of a therapeutic strategy in patients with arterial obstructive disease of the lower extremities. Since symptoms and clinical investigation alone are unreliable in assessing the severity of peripheral arterial disease, complementary functional vascular examinations are needed. Measurement of the systolic blood pressures at ankle level by means of a sphygmomanometric method and a Doppler flowmeter allows reliable determination of the presence or absence of haemodynamically significant arterial obstructions. In the case of minor obstructions the sensitivity of ankle pressure measurements can be increased by examination during a period of hyperaemia, preferably induced by a treadmill walking test. In the case of unreliable ankle pressure measurements due to non-compressible arteries determination of the toe blood pressure is indicated. Segmental blood pressure measurements as well as Doppler analysis of the blood flow at various levels of the leg were not considered reliable enough for the localization of arterial obstructions, unless the obstructive disease is restricted to one single arterial segment. Accurate non-invasive localization of arterial obstructions and the determination of their haemodynamic severity are only possible by means of a combined echo-Doppler (duplex) examination of the arteries. Duplex examination can also be helpful in choosing between surgery and percutaneous transluminal angioplasty of localised stenoses and short occlusions.

Arterial Occlusive Diseases↗
PubMed1994

Factors influencing self-esteem and self-consciousness in adolescents with spina bifida.

PURPOSE: To identify the demographic, personal, familial, attitudinal, and social factors that influence the self-esteem of adolescents with spina bifida. METHODS: A structured face-to-face interview, that included the Rosenberg Self-Esteem Inventory, was conducted with 107 adolescents with spina bifida. Discriminant analyses were performed to identify the factors that discriminate between adolescents with spina bifida who have low vs. high self-esteem and low vs. high self-consciousness. The discriminant functions included variables from the following domains: sociodemographics, personal biography, family interaction, peer relationships and activities, school and work experiences, attitudes toward spina bifida, sexuality and sexual education, and future aspirations. RESULTS: The factors contributing most positively to adolescents' self-esteem were age-appropriate treatments by parents and parental permissiveness in social participation, as perceived by the adolescents. Factors negatively associated with self-esteem included school problems, a perception of disability by others, and living in a medium-sized town (i.e., population 10,000-49,999). The discriminant models correctly identified 57.8% of adolescents who had low self-esteem and 50.4% of those with high self-consciousness, and accurately classified 92.6% and 88.4% of those who had high self-esteem and low self-consciousness, respectively. CONCLUSION: Parents' relationships with their adolescents have important associations with the self-image of the youth.

Adolescent↗
PubMed1994

Impact of parental substance use on adolescents: a test of a mediational model.

Tested a mediational model of the relationship between parental substance use and adolescents' substance (tobacco, alcohol, marijuana) use with data from a sample of 1,775 adolescents, mean age 13.3 years, who completed a questionnaire including constructs from three theories of substance use. Mediational analyses identified five constructs involved in the relationship of parental and adolescent use. A structural model with latent constructs for substance use showed indirect effects of parental substance use through greater tolerance for deviance, lower behavioral control, greater perceived coping function of substance use, more negative life events, and more affiliation with peer users, plus a direct effect. Implications for the theory of transmission of risk are considered.

Adaptation, Psychological↗
PubMed1991

The middle schooling process: influences on science and mathematics achievement from the longitudinal study of American youth.

The purpose of this longitudinal study was to develop and test a model of middle school science and mathematics achievement with a national probability sample of 3,116 seventh-grade public school students. Eighth-grade achievement was viewed as a function of readiness attributes on entry into seventh grade and intervening parent, peer, self, and classroom affective and behavioral measures. Data were collected from students and parents over three time periods in seventh and eighth grade. Results of a revised structural model showed that prior achievement in science and math was a strong mediator of effects in the process of schooling. Grades in sixth grade, parental expectations, parent educational attainment, and motivation had moderately strong indirect effects on eighth-grade achievements. Also notable was the positive direct influence of perceptions of classroom context on science and math achievement growth and the negative direct influence of sex (in favor of girls) on science achievement growth. Cross-validation on a split-half sample did not disconfirm the model. It was concluded that while prior achievement had a dominant influence in the schooling process, other variables including parental expectations, motivation, and classroom context do contribute to the schooling process and can be a focal point for improving school success. These and other factors, though helpful, may be most effective well before the middle school years.

Achievement↗