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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↗
PubMed1993

Cognitive, psychosocial, and reported sexual behavior differences between pregnant and nonpregnant adolescents.

A wide variety of variables have been related to the occurrence of adolescent pregnancy. However, many previous studies have produced conflicting results and are univariate in nature. The purpose of this study was to assess differences in pregnant and nonpregnant adolescents on variables from three domains: cognitive, psychosocial, and reported sexual behavior. Sixty-nine pregnant adolescents and 58 comparison adolescents filled out nine questionnaires presented on microcomputers. Significant differences were found on 10 of 24 univariate tests. The strongest differences concerned areas of scholastic functioning and reported sexual behavior; pregnant teenagers were more likely than nonpregnant peers to be doing poorly in school and less likely to use contraceptives. In addition, pregnant teenagers were more likely to have a relative or friend who was an adolescent mother and to expect child rearing to be easier than did the nonpregnant adolescents. A discriminant analysis was computed which correctly classified 83% of the sample, based on variables from each of the three domains. This study has served to replicate, refute, and expand on previous findings concerning the antecedents of teenage pregnancy. More importantly, this study has empirically demonstrated the multivariate and interrelated nature of variables associated with teenage pregnancy.

Adolescent↗
PubMed1993

Tourette syndrome: a psychoeducational presentation.

Tourette Syndrome (TS) is a neurological disorder with onset prior to age 21. The wide range of difficulties associated with TS present significant barriers to both the positive school functioning of students with TS and the ability of their teachers and peers to cope with the sometimes difficult classroom behavior which results from this syndrome. Since TS children with teachers knowledgeable about TS and its effects on learning fare better than those whose teachers are not knowledgeable, dissemination of this information to school personnel is crucial. Health teaching is a significant contribution within the nursing role. In order to ameliorate some of the stressors and academic problems experienced by children and adolescents with TS, the TS Clinic of St. Boniface General Hospital is composed of a multidisciplinary team whose mandate includes the provision of educational awareness audiovisual presentations to schools and the general community throughout Manitoba. This presentation will include the historical, psychosocial, educational, symptomatological, and treatment aspects of TS.

Humans↗
PubMed1993

Quality assurance in graduate medical education: a peer review process.

The Accreditation Council for Graduate Medical Education in the United States has recently required institutions with residency and fellowship training programmes to develop an Institutional Policy Review Document outlining how the educational quality of these programmes is monitored. Whereas departments may have assumed this responsibility in the past, this is clearly a function of the institution. The purpose of this paper is to describe a long-standing, effective, internal peer review process to assure quality education in an institution.

Education, Medical, Graduate↗
PubMed1996

[Functional evaluation by treadmill in children and adolescent following correction of Tetralogy of Fallot].

AIM OF THE STUDY: The Authors have examined 22 children (16m and 6f), mean age 9.64 +/- 2.63 years, range 5-15, after total correction for Tetralogy of Fallot, to evaluate the response of their cardiovascular apparatus during an exercise testing on treadmill (Bruce protocol). METHODS: Parameters examined: exercise duration, maximal heart rate (HR), maximal systolic blood pressure (max BP), non invasive cardiac output at rest and at the peak of exercise (CO), arterial oxygen saturation; lung function test at rest, echocardiogram and 24 hours Holter monitoring. CONTROL GROUP: 22 healthy peers, same gender, height and weight, not practising competitive sports. RESULTS: The exercise duration was significantly lower in the first group (77.8 +/- 11.8%; 86.5 +/- 8.2%; P = 0.006). Also max HR and max BP were significantly lower (max HR: 162 +/- 12 b/m'; 187 +/- 8 b/m'; P = 0.000), (max BP: 119 +/- 9 mm Hg; 126 +/- 12 mm Hg; P = 0.042). There were no differences for CO at rest (3.70 +/- 1.09 l/m'; 3.95 +/- 1.07 l/m'). In the first group, CO at peak of exercise was lower but not significantly (6.51 +/- 2.56 l/m'; 7.95 +/- 2.77 l/m'; NS). CONCLUSIONS: These results make more complete the not invasive functional evaluation for a better follow-up of these patients and a better choice for their physical activity.

Adolescent↗
PubMed1976

A component analysis of attentional problems of educationally handicapped boys.

Seventy-three educationally handicapped (EH) and 78 regular class, normally achieving (NA) boys grades 3-8 were tested with a series of measures selected to test three components of attention: coming to attention, decision making, and maintaining attention over time. EH and NA samples were subdivided into three gropus by grade level (grades 3-4, 5-6, and 7-8). Based on a teacher-completed behavioral check list, the EH group was further subdivided according to pupils perceived by teachers as hyperactive or nonhyperactive. With the exception of the youngest group, EH and NA samples did not differ from each other on CA, but regular class boys had slightly higher IQs and better reading scores than did their EH peers; EH hyperactives and EH nonhyperactives differed significantly on reading scores, the difference favoring the nonhyperactives. All pupils were individually administered the Children's Embedded Figures Test (CEFT), the Matching Familiar Figures Test (MFFT), and the Children's Checking Task (CCT), the last designed specifically to assess ability to maintain attention over time. EH pupils did not function as efficiently or as accurately on the attentional tasks as did their normally achieving age peers. Significant differences between EH and NA samples were found for CEFT and MFFT errors, as well as for CCT errors of omission and commission. Analyses of the EH group according to hyperactive--nonhyperactive status were for the most part nonsignificant. Correlational analyses yielded low but statistically significant relationships among the attentional measures, but nonsignificant relationships between IQ and the attentional test scores. Findings were consistent with the interpretation that the three hypothesized components of attention are partially independent and thus may have differential influence on pupils performance in school.

Attention↗
PubMed1996

The role of adolescent peer affiliations in the continuity between childhood behavioral adjustment and juvenile offending.

This research reports on a structural equation model analysis of the relationships between childhood behavioral adjustment, adolescent peer affiliations, and adolescent offending using data gathered during the course of a 16-year longitudinal study of a birth cohort of New Zealand children. The model developed contained parameters that estimated (a) the continuities between early behavior and later offending, (b) the associations between early behavior and adolescent peer affiliations, and (c) the potentially reciprocal relationship between adolescent peer affiliations and adolescent offending behaviors. This analysis suggested that, when due allowance was made for reporting error, there was evidence of relatively strong continuity (r = .50) between early behavior and later offending. The model estimates suggested that these continuities arose from both direct continuities in behavior over time and from the effects of adolescent peer affiliations in reinforcing and sustaining earlier behavioral tendencies. The implications of the analysis for the understanding of the role of adolescent peer affiliations in behavioral continuities and discontinuities are discussed.

Adolescent↗
PubMed1996

Teaching preschool age autistic children to make spontaneous initiations to peers using priming.

Children with autism rarely initiate social interactions with their peers. Currently available interventions have not increased autistic children' spontaneous initiations in natural settings without extensive teacher involvement. A "priming" strategy consisting of a low demand, high reinforcement session prior to the regular school activity was used to increase the spontaneous social initiations of 2 preschool age autistic boys to typically developing peers in a regular preschool classroom. Peers were also trained to independently respond to initiations. Implications for developing practical ways to improve autistic children's social functioning in regular school settings are discussed.

Autistic Disorder↗
PubMed1990

Biomedical information, peer review, and conflict of interest as they influence public health.

The peer review process serves a vital role in the publication of biomedical information. When properly functioning, review should focus exclusively on questions of scientific validity and should avoid becoming enmeshed in questions such as "authorization" and "data ownership." We present a case in which the dissenting views of a coinvestigator were suppressed because the principal investigator and grantee institution informed a medical journal that the coinvestigator was not "authorized" to use the data generated by a publicly funded grant and because the editor of a scholarly journal refused to review the dissenting manuscript and to submit that dissent to external reviewers for peer review. The current peer review system, as shown by this case, is unable to embrace dissent within the peer review process and to use dissent to serve scientific truth and the public interest.

Biomedical Research↗
PubMed2026

Effectiveness of peer recovery support services for substance use disorders: A systematic review of healthcare utilization, behavioral health, and engagement outcomes.

BACKGROUND: Peer recovery support services (PRS) delivered by individuals with lived experience of substance use, are increasingly incorporated into substance use disorder (SUD) care systems to improve care engagement, reduce acute care use, and support recovery. However, existing systematic reviews have focused on substance use outcomes, with limited attention to healthcare utilization, psychosocial functioning, and outcomes across settings, and populations. METHODS: This systematic review, registered in PROSPERO (CRD42023469279), synthesized peer-reviewed studies from 2003 to 2026 evaluating PRS for individuals with alcohol or drug-related SUD. Using MEDLINE, Embase, PsycINFO, and CINAHL, the review included 53 studies primarily conducted in high-income countries that reported quantitative outcomes across substance use, healthcare utilization, behavioral health, and treatment engagement. Risk of bias was assessed using Cochrane RoB 2, ROBINS-I, and ROBINS-E tools. RESULTS: Overall, evidence was most favorable for selected treatment-linkage and engagement outcomes, whereas findings for substance use, emergency department use, hospitalization, overdose, and mortality were inconsistent. Uncontrolled longitudinal studies frequently reported improvements in depression and anxiety, but no randomized trials evaluated these outcomes, limiting causal inference. Exploratory cross-study patterns suggested that sustained navigation, practical assistance, and repeated peer contact were more often present in programs reporting favorable outcomes; however, these components were not independently evaluated. Substantial heterogeneity, frequent multicomponent interventions, high risk of bias in many nonrandomized studies, and limited long-term and economic data constrain conclusions. CONCLUSIONS: Findings support the promise of PRS while underscoring the need for more rigorous comparative studies, cost-effectiveness data, and further research in low- and middle-income countries.

Humans↗
PubMed1992

[The effects of early manual instruction on the oral language development of two deaf children].

The speech and language training for deaf children at our clinic is performed using a multisensory method, which consists of reception and expression training for sign language and fingerspelling as well as auditory training, lip reading, and written language training (the Kanazawa Method). We have already reported that acquisition of written language is not dependent on oral language, and that written language is easier to learn than oral language for deaf children. In the present investigation, we analyzed the acquisition of comprehensible and expressive vocabulary in sign language and fingerspelling. The subjects were two children congenitally deaf at levels higher than 105dB. Recorded language samples by the age of 48 months were analyzed. Acquisition of sign language was found to be significantly easier than acquisition of oral language. The development of expressive noun words, function words, and Wh-question words in sign language at the early period was almost equivalent to that of hearing peers, and then the sign language appeared transfer to the oral language. These results suggest that early presentation of sign language with written and oral language is effective in the acquisition of communicative attitudes, function words and interrogative sentences which are most difficult for the hearing-impaired. It was shown that early presentation of sign language with written and oral language serves to promote acquisition of oral language.

Child↗
PubMed1982

Symptoms associated with menstruation.

Symptoms associated with menstruation during the teenage and young adult years may represent a spectrum of possibilities varying from a relatively benign deviation from normal to a serious life-threatening disease. Nevertheless, even for the young woman found to be without serious disease, menstrual problems have special meaning associated with the fear of being different from peers, concern about being less than complete or wholesome, and anxiety regarding future functioning as a normal woman. The physician must be aware of the adolescent's sensitivity in this area. Her apprehension should influence the manner in which the various abnormalities of menstruation are evaluated and managed. The physician must understand and appreciate the potential for profound emotional effects and psychological implications of menstrual conditions. The manner in which we care for the adolescent with menstrual symptoms will determine to a significant degree how successfully the patient will cope with abnormalities of menstruation.

Adolescent↗