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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↗
PubMed2002

Summary of the National Toxicology Program's report of the endocrine disruptors low-dose peer review.

At the request of the U.S. Environmental Protection Agency (U.S. EPA), the National Toxicology Program organized an independent and open peer review to evaluate the scientific evidence on low-dose effects and nonmonotonic dose-response relationships for endocrine-disrupting chemicals in mammalian species. For this peer review, "low-dose effects" referred to biologic changes that occur in the range of human exposures or at doses lower than those typically used in the standard testing paradigm of the U.S. EPA for evaluating reproductive and developmental toxicity. The demonstration that an effect is adverse was not required because in many cases the long-term health consequences of altered endocrine function during development have not been fully characterized. A unique aspect of this peer review was the willing submission of individual animal data by principal investigators of primary research groups active in this field and the independent statistical reanalyses of selected parameters prior to the peer review meeting by a subpanel of statisticians. The expert peer-review panel (the panel) also considered mechanistic data that might influence the plausibility of low-dose effects and identified study design issues or other biologic factors that might account for differences in reported outcomes among studies. The panel found that low-dose effects, as defined for this review, have been demonstrated in laboratory animals exposed to certain endocrine-active agents. In some cases where low-dose effects have been reported, the findings have not been replicated. The shape of the dose-response curves for reported effects varied with the end point and dosing regimen and were low-dose linear, threshold-appearing, or nonmonotonic. The findings of the panel indicate that the current testing paradigm used for assessments of reproductive and developmental toxicity should be revisited to see whether changes are needed regarding dose selection, animal-model selection, age when animals are evaluated, and the end points being measured following exposure to endocrine-active agents.

Androgens↗
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↗
PubMed2000

Impact of recurrent and chronic pain on child and family daily functioning: a critical review of the literature.

The author reviewed the current status of research on the impact of recurrent and chronic pain on everyday functioning of children and families and organized the research findings around the specific life contexts (e.g., school, peers) that may be affected by pain. Although findings demonstrate that many different aspects of child and family life are affected by pain, the prevalence and severity of children's functional limitations associated with pain remain unknown. Few treatment studies for pediatric recurrent and chronic pain have focused on enhancing children's functioning. It has been shown, however, that functional outcomes can be improved by cognitive-behavioral interventions. Recommendations for research on functional outcomes and implications for clinical practice are discussed.

Activities of Daily Living↗
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↗
PubMed1996

An orientation to vision loss program: meeting the needs of newly visually impaired older adults.

An Orientation to Vision Loss program was developed to meet the needs of individuals, and their families, new to the difficult experience of vision loss. Program components address: education regarding services and resources, issues around the emotional response to vision loss and adjustment, tips and ideas for daily functioning, and enhancing families' awareness of how the vision loss "looks." Peer counselors co-facilitate the experience. Evaluations have been overwhelmingly positive, with participants expressing satisfaction and recognizing value in their participation.

Activities of Daily Living↗
PubMedDate not supplied

Creating an effective clinical engineering team.

Creating an effective clinical engineering team is critical to: coordinating the functions of a multi-staffed CE department; working on a peer level with other departments of the hospital; and presenting a professional image within the hospital. This feature article defines the characteristics of an effective team, presents ways to create a CE team, and discusses the payoffs of a team approach.

Biomedical Engineering↗
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↗
PubMed1998

Hypothalamic-pituitary-adrenal function in children with asthma and rhinitis treated with topical glucocorticosteroids.

BACKGROUND: The risk of suppression of hypothalamic-pituitary-adrenal (HPA) function in children on topical glucocorticosteroids is currently much debated. OBJECTIVE: To review data on HPA function in children with asthma and rhinitis on topical glucocorticosteroids, and to discuss the value of HPA function measures in clinical practice and research. METHOD: A review of peer refereed data. RESULTS/CONCLUSIONS: There is no evidence that insufflated or inhaled glucocorticosteroids in recommended doses have ever caused clinically significant HPA insufficiency in any child. Using sensitive measures of basal adrenal activity, however, several studies have found suppressive effects with specific drugs, high doses and application systems. These observations may represent homeostatic diminution in endogenous cortisol. Such measures have no place in the management of children on topical glucocorticosteroids, but may be useful in clinical trials assessing systemic activity of administration regimens and application devices. In children growth suppression seems to the most important adverse effect of topical glucocorticosteroids.

Administration, Topical↗
PubMed2001

The aging cardiovascular system: changes in autonomic function at rest and in response to exercise.

Tonic vagal modulation of cardiac period (R-R interval) decreases with advancing age, but is greater in middle-aged and older adults who habitually perform aerobic exercise compared with their sedentary peers. Cardiovagal baroreflex sensitivity also declines markedly with age in sedentary adults but only 50% as much in regularly exercising adults. In previously sedentary middle-aged and older adults, a 3-month program of moderate aerobic exercise increases cardiovagal baroreflex sensitivity by 25%. Tonic (basal) sympathetic nervous system (SNS) activity increases with advancing age in both sedentary and habitually exercising adults. Despite this, SNS beta-adrenergic support of energy metabolism (resting metabolic rate--RMR) declines with age in sedentary individuals. However, SNS beta-adrenergic support of RMR is maintained with age in endurance exercise-trained adults and therefore is much greater in middle-aged and older individuals who exercise regularly compared with their sedentary peers. Thus, regular aerobic (endurance) exercise modulates selective age-associated impairments in autonomic nervous system-physiological function.

Aging↗
PubMedDate not supplied

The effects of tibolone on mood and libido.

OBJECTIVE: To review published data pertaining to the effects of tibolone on sexual parameters, mood, and cognitive function in postmenopausal women. DESIGN: A review of all relevant published, peer-reviewed studies. RESULTS: Tibolone is a compound that can be selectively metabolized by individual tissues to its estrogenic, progestogenic, or androgenic metabolites and hence exhibits tissue-specific hormonal effects. Tibolone also lowers sex hormone binding globulin, thus increasing free estradiol and testosterone levels. Tibolone alleviates climacteric vasomotor symptoms and displays a dominant progestogenic effect on the endometrium. Tibolone normalizes the vaginal karyopyknotic and maturation indexes and alleviates symptomatic atrophic vaginitis. Women treated with tibolone report significant reductions in vaginal dryness and dyspareunia, effects that may be secondary to both estrogenic and androgenic actions. Randomized studies indicate tibolone has positive effects on mood compared with placebo and alleviates several adverse mood parameters to a similar extent as conventional hormone replacement therapy. Improved mood is associated with increased plasma beta-endorphin. With respect to cognition, tibolone seems to improve semantic memory but does not significantly improve recognition memory. Tibolone is associated with improvements in sexual function that seem to be greater than those achieved with standard hormone replacement therapy. CONCLUSION: Published studies indicate beneficial effects of tibolone on both libido and mood, which otherwise significantly compromise physical, psychological, and social well-being. Hence, tibolone provides another option for menopausal women experiencing loss of libido as part of their symptomatology or who have persistent low libido despite adequate estrogen/progestin replacement therapy.

Affect↗
PubMed2001

Linking cardiovascular theory to practice in an undergraduate medical curriculum.

Case-based teaching (CBT) tutorials were introduced by the Physiology Department at Adelaide University to bridge the gap between theory and practice in the early years of undergraduate medical education. With the use of a clinical case-based environment, CBT aimed to achieve integration of structure-function relationships and an increase in students' capacity to apply a physiological understanding to clinical observations/symptoms and data. With peer-peer interactions in small groups, students could trial history taking and examination skills, interpret common investigations, and relate their findings to an understanding of structure and function. Here, the cardiovascular tutorials highlight the centrality of an understanding of structure and function in the evaluation of a case of syncope. An independent evaluation of the students' learning experience demonstrated that CBT tutorials were successful in their aims. The "hands-on" experience was highly rated, with students reporting that the CBT approach gave relevance to structure and function. Whatever the curriculum learning style, underpinning practice with an understanding of theory remains a desirable feature of medical education.

Cardiovascular Physiological Phenomena↗
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↗
PubMed1999

Childhood peer relationship problems and young people's involvement with deviant peers in adolescence.

Using prospective longitudinal data from the Christchurch Health and Development Study, this article examined the relationship between children's peer relationship problems in middle childhood and their subsequent risk of forming deviant peer affiliations in adolescence. The analysis proceeded in three steps. First, a structural equation model demonstrated a moderate association between early peer relationship problems and later deviant peer affiliations (r = .27). Second, the model was extended to include a latent variable measure of early conduct problems. This analysis revealed that when the confounding effects of concurrently measured conduct problems were taken into account, peer relationship problems in middle childhood were no longer significantly related to young people's choice of deviant peers in adolescence. Third, the model was further extended to include lagged variables, permitting an examination of possible reciprocal relationships between early conduct problems and peer relationship problems. Results suggested that both early peer relationship problems and adolescent deviant peer involvement are symptomatic of early child behavioral adjustment. The implications of these findings for explanations of deviant peer selection are discussed.

Adolescent↗
PubMed2000

Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care.

BACKGROUND: Primary care treatment of depression needs improvement. OBJECTIVE: To evaluate the efficacy of 2 augmentations to antidepressant drug treatment. DESIGN: Randomized trial comparing usual care, telehealth care, and telehealth care plus peer support; assessments were conducted at baseline, 6 weeks, and 6 months. SETTING: Two managed care adult primary care clinics. PARTICIPANTS: A total of 302 patients starting antidepressant drug therapy. INTERVENTIONS: For telehealth care: emotional support and focused behavioral interventions in ten 6-minute calls during 4 months by primary care nurses; and for peer support: telephone and in-person supportive contacts by trained health plan members recovered from depression. MAIN OUTCOME MEASURES: For depression: the Hamilton Depression Rating Scale and the Beck Depression Inventory; and for mental and physical functioning: the SF-12 Mental and Physical Composite Scales and treatment satisfaction. RESULTS: Nurse-based telehealth patients with or without peer support more often experienced 50% improvement on the Hamilton Depression Rating Scale at 6 weeks (50% vs 37%; P =.01) and 6 months (57% vs 38%; P =.003) and on the Beck Depression Inventory at 6 months (48% vs 37%; P =. 05) and greater quantitative reduction in symptom scores on the Hamilton scale at 6 months (10.38 vs 8.12; P =.006). Telehealth care improved mental functioning at 6 weeks (47.07 vs 42.64; P =.004) and treatment satisfaction at 6 weeks (4.41 vs 4.17; P =.004) and 6 months (4.20 vs 3.94; P =.001). Adding peer support to telehealth care did not improve the primary outcomes. CONCLUSION: Nurse telehealth care improves clinical outcomes of antidepressant drug treatment and patient satisfaction and fits well within busy primary care settings.

Adult↗