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PubMed2002

Independent practice associations in New Zealand: a study of governance structures and process.

AIMS: To describe the governance structures and processes of four primary care organisations (PCOs) and to evaluate member general practitioners' (GPs) perceptions of the effectiveness of these structures and processes. METHODS: A sample of four PCOs was chosen in 1999, including three independent practitioner associations (IPAs), and a member organisation of CareNet. The chief executive officer of each PCO was interviewed, and the 245 member practitioners were surveyed with a written questionnaire. RESULTS: The response rate to the GP survey was 78.4%. A two tier governance structure was identifiable for all four PCOs: policy board or steering committee, and working committees. In addition each utilised a peer group review process to provide input to some administrative functions. The CareNet PCO emphasised reduced bureaucracy and a loose administrative structure and process. There was a high level of respondent satisfaction (>90%) with their PCO governance processes. CONCLUSIONS: Governance structures and processes have developed within the four PCOs that reflect the needs of member practitioners and according to the requirements of each district and PCO membership. A high level of member satisfaction with their PCO, its governance and processes, was evident.

Attitude of Health Personnel↗
PubMed2002

Aging and spinal cord injury: medical, functional, and psychosocial changes.

Fifty years ago, people who had a spinal cord injury had very limited life expectancies. Today, these individuals can expect to live into their 60s, 70s, and beyond. Advances in rehabilitation, technology, surgery, and medicines have been chiefly responsible for this change. Recent research in both Europe and the United States now indicates that as these people age, they often develop medical and functional problems that are not as common in their nondisabled peers until much later in life. The importance of these "premature" age-related problems has led the National Institute on Disability and Rehabilitation Research to fund the Rehabilitation Research and Training Center (RRTC) on Aging With a Spinal Cord Injury at Rancho Los Amigos National Rehabilitation Center in Downey, California. This article summarizes some of the important findings from this RRTC and from other sources.

Activities of Daily Living↗
PubMed1989

The sexual differentiation of social play.

Sex differences in social play are quantitative and not qualitative, referring to frequency and not the form of the behaviors. Whereas increased perinatal exposure to exogenous testosterone masculinizes social play, experimental manipulations of androgen levels after this period (i.e. following critical periods for neuronal differentiation) apparently have no effect on the expression of social play. This effect appears to involve, at least in part, androgen receptor occupancy in the amygdala. In the rat, there is a prominent sex difference in nuclear-bound androgen receptors in the amygdala during the sensitive period for the masculinization of play-fighting. Moreover, testosterone implants directly into the amygdala during this period masculinize social play in females. Progesterone exposure reduces play-fighting in male rats, as does corticosterone. This latter effect may be mediated by corticosteroid receptors in the limibic brain. Perinatal androgen exposure may also be important in humans, since girls born with congenital adrenal hyperplasia diagnosed and treated at birth still show male-like patterns of play. Theories concerning the function of sex differences in social play emphasize either the social or motor learning functions. Juvenile male primate social rank correlates with number of peer social interactions, which predominantly take the form of play-fighting. Females on the other hand appear to spend less time play-fighting and spend more time waiting and competing for interactions with infants, i.e. play-mothering, whereby they acquire the motor skills necessary for handling infants. Such differences may reflect socio-biological and developmental cascades that are, in some way, initiated by perinatal hormonal events.

Animals↗
PubMed1994

How sick is the West of Scotland? Age specific comparisons with national datasets on a range of health measures.

The Central Clydeside Conurbation (CCC) has relatively high mortality rates. This paper examines whether it also has relatively high rates of ill health, using data from three cohorts (aged 15, 35 and 55 in 1987/88) in the West of Scotland. Comparisons on a range of self-reported physical and mental health indicators, anthropometric measures, blood pressure, and respiratory function were made with comparable age groups in ten British or Scottish national studies. The older two cohorts in the CCC exhibited relatively high rates of longstanding and limiting longstanding illness and the youngest cohort had relatively poor psychosocial health, compared to their age peers elsewhere. Fewer differences were found in blood pressure, anthropometric measures or respiratory function although older CCC residents were slightly shorter than in Britain as a whole and had slightly poorer respiratory function. Central Clydesiders in the late 1980s were generally in poorer health than those of the same sex and similar age elsewhere in the UK, but the extent of the disadvantage varied across different dimensions of health, and was not as marked as some stereotypes of the West of Scotland would suggest.

Adaptation, Psychological↗
PubMed1996

Premorbid and postmorbid school functioning in bipolar adolescents: description and suggested academic interventions.

OBJECTIVE: This study was designed to describe and evaluate the manner in which changes in school functioning are associated with bipolar affective disorder (BAD) in adolescence. METHOD: Pre- and post-illness onset school functioning data were collected from a sample of 44 adolescents with a DSM-III-R diagnosis of BAD. A variety of assessment measures were used, including personal interview, a review of school history and formal academic testing. RESULTS: Our findings reveal an overall profile of generally good to excellent premorbid school functioning in most adolescent onset bipolar patients, which subsequently shows marked deterioration along several dimensions (work effort, academic achievement, peer relationships and extracurricular involvement) following BAD onset. CONCLUSIONS: Onset of bipolar illness in adolescence negatively impacts on the teenager's ability to function effectively in the school environment. Specific program modifications are required in order to optimize the bipolar teenager's success at school. These are identified and discussed.

Adolescent↗
PubMed2001

'Peer review' culture.

A relatively high incidence of unsatisfactory review decisions is widely recognised and acknowledged as 'the peer review problem'. Factors contributing to this problem are identified and examined. Specific examples of unreasonable rejection are considered. It is concluded that weaknesses of the 'peer review' system are significant and that they are well known or readily recognisable but that necessary counter-measures are not always enforced. Careful management is necessary to discount hollow opinion or error in review comment. Review and referee functions should be quite separate.

Ethics↗
PubMed1982

The effects of peer and parental smoking and age on the smoking careers of college women: a sex-related phenomenon.

In the United States, smoking for women has followed a different pattern for women than for men, and the literature suggests that it, as a 'masculine' behavior, may serve as a role-delineating function for women. This research examines the relationship between sex of smoking parents and peers and the smoking behavior of college women. Having a mother who smokes was significantly related to whether or not the daughter smokes, the age of onset, and the frequency of the daughter's smoking; the proportion of female friends who smoke, to the frequency and amount of the woman's smoking and to the degree of difficulty of quitting. Smoking by the father and male friends was not important. Also, the age of the woman was significantly to whether or not she ever smoked and to the age of onset of smoking. This likely reflects her experience of social norms regarding smoking by women and the publication of the first surgeon general's report on smoking and health. These findings support the notion of smoking as a role-related behavior for women. Further research is needed to extend these findings to men and other health behaviors.

Adult↗
PubMed1991

Shared governance for nursing. Part I: Creating the new organization.

In Part I, the concept of shared governance is presented. I have discussed what it means to move toward a shared governance model and the way of thinking and reorganizing that supports it. Basic principles that drive the concept are discussed, and the underpinnings necessary to make it work are identified. Clearly, the move toward shared governance is not simply an organizational transition. It is a method for transforming the way we work and make decisions. Part II will examine how roles are changed. The management function, the impact of shared governance on its function, and changes in the manager's behavior will be identified. In Part II, the importance of peer processes and supports for ensuring that changes are carried out by staff leadership are discussed. A new way of composing and exercising the executive function in a professional organization also will be discussed.

Hospital Administration↗
PubMed2000

The relationship of social support to physically abused children's adjustment.

OBJECTIVE: This study had three main objectives: First, to assess physically abused children's perceptions of teacher, peer, and family support; second, to determine whether the levels of perceived support differ according to the person's social role; and third to assess which sources of social support show stronger associations with adjustment in a physically abused sample. METHOD: Perceived social support from teachers, families and peers was assessed in a sample of 37 physically abused children using a shortened version of the Survey of Children's Social Support (Dubow & Ullman, 1989). Child adjustment was indexed by child and parent reports of child depression, anxiety, and anger. RESULTS: Analyses indicated that the children rated their families, peers, and teachers highly as sources of social support, with families being rated as the most important source. Hierarchical multiple regression analyses indicated that perceived peer support was significantly negatively related to children's and parent's reports of children's depression and anxiety. Furthermore, perceived family support was significantly negatively associated with child reported depression. No significant relationships were found between perceived teacher support and symptomatology. CONCLUSIONS: Overall, the results suggest that peer and family support are particularly important for physically abused children's psychological functioning, particularly for internalizing problems.

Adaptation, Psychological↗
PubMed1993

Factors related to integrating persons with chronic mental illness into a peer social milieu.

Client characteristics and their perceptions of the milieu in a psychosocial rehabilitation program were used to predict the clients' level of involvement in the peer-based social network. 81 clients in a psychosocial rehabilitation program participated in the study. The results indicated that client perceptions of higher support and clarity in the staff-client milieu, and being female, were strongly related to higher peer social involvement. Milieu factors were generally more important than client characteristics in predicting client social functioning. The implications of these findings for psychosocial intervention and for research on the social functioning of this population are discussed.

Adult↗
PubMed2004

Muscle activation and force production in Parkinson's patients during sit to stand transfers.

OBJECTIVE: The purpose of this study was to compare the kinematics, muscle activation, and force production between Parkinson's patients and healthy, age-matched participants during sit-to-stand transfers. DESIGN: This cross-sectional study employed a 2x2x3 multivariate analysis of variance to test for significant differences between and within groups. BACKGROUND: The underlying mechanisms that predispose an individual to lose strength during the clinical progression of Parkinson's disease have proved to be elusive, especially during performance of functional tasks such as the sit to stand transfer. METHODS: Twenty-four men (mean age: 71.5 years) categorized as Parkinson's patients (n = 13) and healthy adults (n = 11) participated in this study. Two force platforms measured antero-posterior and vertical force components as well as peak torque. Muscle activation was measured by a six channel, bilateral electromyography system. A lower-body kinematic assessment was conducted utilizing a high-speed motion analysis system. RESULTS: No statistically significant differences were found between groups for the outcome variables measured. However, Parkinson's patients did exhibit significant within-group bilateral differences for the variables of knee angle at seat-off, peak vertical force and peak torque. CONCLUSION: Data from this study reveal that persons with mild to moderate Parkinson's disease exhibit moderately altered bilateral mechanics when performing a sit to stand transfer compared to their healthy peers. RELEVANCE: The inability to produce constant equilateral force when performing functional tasks could be an indicator for the increased propensity of falls or other instabilities in this population.

Aged↗
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↗
PubMed1983

An ecological assessment inventory to facilitate community recreation participation by severely disabled individuals.

Severely disabled individuals have long been systematically excluded from actively participating in normalized recreation/leisure activities in integrated community settings. Severely disabled individuals should be taught functional and age appropriate skills, based upon the performance characteristics of nonhandicapped peers. In order to present this position, typical assumptions of leisure skill instruction for severely disabled individuals are discussed and opposing points of view are presented. Finally, the article presents a concrete strategy, or inventory, that is divided into three interrelated areas including: skill selection and skill/facility description, component skills and adaptations for full/partial participation, and supportive skills. The inventory can be used by therapeutic recreation specialists and other educators to develop functional, age appropriate leisure skill instructional content. It is expected that this approach, coupled with longitudinal planning, will facilitate the provision of opportunities for severely disabled individuals to actively participate in normalized recreation/leisure skills in integrated community settings.

Community Health Services↗
PubMed2003

The adjustment to diabetes of school-age children with psychological adjustment problems.

OBJECTIVE: To determine whether diabetic children with psychological adjustment problems have greater difficulties in specific areas of disease adaptation than their well-adjusted diabetic peers by comparing their diabetes-related adjustments in the family, school and peer environments. METHOD: Mothers of 47 school-age preadolescent children with diabetes completed a standardized assessment of general psychological functioning. Children with psychological adjustment problems were then compared with children who did not exhibit problems along the following dimensions: their demographic and medical profiles, maternal diabetes knowledge, associations between general psychological functioning and diabetes control, and the quality of their diabetes adjustment. RESULTS: No differences were found between children with psychological adjustment problems and their better-adjusted peers along any of the demographic or health status variables tested or in maternal diabetes knowledge. However, children with adjustment problems were more likely to receive visits from the hospital's home-care team and to be absent from school. Also, for children with psychological difficulty, indices of diabetes control and general psychological functioning were related, and the nature of this relation differed across the school and family environments. In addition, poorer psychological adjustment was associated with diabetes-specific problems in both mother and child. These included individual adjustment problems such as feeling different, relationship difficulties with family and peers, and difficulties with the treatment protocol, in particular, with the dietary regime. CONCLUSION: These findings are considered in relation to (1). the importance of multi-method techniques in research which concerns adjustment to diabetes, in particular the need to use both psychological and disease-specific instruments, and (2). clinical evaluations and interventions for children with diabetes and their families.

Adaptation, Psychological↗
PubMed1999

Adolescent individuation and alcohol use.

OBJECTIVE: This study evaluates a developmental psychosocial model of adolescent drinking. Specifically, the role of two aspects of adolescent individuation-separation and intergenerational individuation-is examined within the context of family dynamics, stress and peer associations. These measures parallel an ongoing debate regarding the nature of individuation. The separation measure captures aspects of individuation related to detachment or rebelliousness. Intergenerational individuation measures increasing self-reliance and control with maintenance of supportive family bonds. METHOD: A structural equation model describing adolescent alcohol use as a function of two measures of individuation, family conflict, communication with mother, stress and peer use of alcohol was tested in two independent samples. The first included 6th- through 12th-grade adolescents and the second was composed of 6th- through 8th-grade students. RESULTS: In both studies, significant direct and indirect paths were found from individuation measures and family, peer use and stress constructs to adolescent alcohol use. Separation had a stronger relationship to alcohol use than did intergenerational individuation and was associated with higher levels of stress and alcohol use by peers. CONCLUSIONS: The findings support the role of individuation as a contributing factor in adolescent alcohol use. They indicate the importance of family and parent-adolescent relationships in adolescent alcohol use and suggest directions for both family-based and school-based preventive interventions.

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↗
PubMed1998

Smokeless tobacco and cigarettes: differential attitudes and behavioral intentions of young adolescents toward a hypothetical new peer.

Examined adolescents' perceptions of cigarette smokers and smokeless tobacco users. Participants were 562 middle school students in rural Florida who viewed 1 of 6 videotapes of a hypothetical peer (i.e., actor) who would soon be attending their school. The videotapes differed only as a function of sex (boy or girl) and tobacco condition (no tobacco, cigarette, smokeless tobacco). After viewing the videotape, participants completed 2 measures designed to assess attitudes and behavioral intentions toward the peer. Results indicated that (a) the actor in the no-tobacco condition was rated more favorably than actors in the other two conditions, although the actor in the smokeless-tobacco condition was rated more favorably than the actor in the cigarette condition; (b) girls viewed the actor in smokeless-tobacco condition more favorably than did boys; (c) compared to nonsmokers, adolescents with a cigarette use history provided more favorable ratings for the actor in the cigarette condition. Taken together, results suggest that different types of tobacco use may have a different impact on social image within the young adolescent population.

Adolescent↗