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PubMed2026

Genome-Wide Association Analyses Identify Distinct Genetic Architectures for Extreme Early-Onset and Late-Onset T2D.

AIMS: Type 2 diabetes (T2D) is a heterogeneous disorder with substantial variation in age at onset (AAO). This study aimed to characterize the distinct genetic architectures and biological mechanisms underlying extreme AAO-defined T2D subtypes. MATERIALS AND METHODS: Using 74 795 European-ancestry participants from the UK Biobank, we performed genome-wide association studies (GWAS) of relatively early-onset T2D (eoT2D; AAO < 55 years) and late-onset T2D (loT2D; AAO ≥ 70 years). We investigated subtype-specific genetic loci, SNP-based heritability, genetic correlations, Mendelian randomization (MR)-based relationships, polygenic risk scores (PRS) and phenome-wide association studies (PheWAS). Single-cell transcriptomic data from human pancreatic tissues were further used to evaluate cell-type-specific expression patterns of candidate genes. RESULTS: SNP-based heritability was substantially higher for eoT2D than loT2D (11.2% vs. 6.4%), with eoT2D displaying distinct genetic loci related to β-cell function and insulin regulation, including SLC30A8 and IRS1. By contrast, loT2D showed a comparatively lipid-related genetic profile, featuring APOE-associated signals and expression patterns in immune-related cell populations. Linkage disequilibrium score regression (LDSC) and MR analyses further underscored this divergence: eoT2D exhibited broader genetic overlap with cardiometabolic traits, whereas loT2D showed stronger relationships with traditional metabolic risk factors. Finally, subtype-specific PRSs improved risk discrimination beyond conventional covariates, although their clinical utility warrants further evaluation. CONCLUSIONS: Extreme AAO-defined T2D subtypes exhibit partially distinct genetic architectures, highlighting AAO as an important dimension of T2D heterogeneity and providing a framework for future age-stratified genetic risk assessment.

Type 2 diabetes↗

PubMedDate not supplied

Critical thinking skills and dispositions of baccalaureate nursing students--a conceptual model for evaluation.

To date, little has been written on specifically what critical thinking is and what the scores reported on critical thinking instruments actually represent. This lack of specificity provided the impetus to examine critical thinking skills and dispositions of baccalaureate nursing students, to ascertain whether or not a significant difference exists between academic levels, and to ascertain, using the California Critical Thinking Skills Test (CCTST) and the California Critical Thinking Disposition Inventory (CCTDI), whether a relationship exists between nursing students' critical thinking skills and their critical thinking dispositions. The conceptualization of critical thinking consisting of two dimensions, cognitive skills and affective dispositions, developed by a panel of experts comprised the conceptual framework for this study. A cross-sectional, descriptive, comparative, and correlational study was undertaken in which two instruments, CCTST, Form A, and the CCTDI were administered to a convenience sample of nursing students representing five academic levels. The sample in the statistical analyses comprised 328 students. Results indicated that the total critical thinking mean score for students at each level reflected percentile ranking ranging between 48 and 65 per cent. The mean score for the critical thinking subscale, inference, had the lowest percentile rankings, ranging between 37 and 55 per cent. The analysis of variance (ANOVA) statistical analysis indicated that students at the junior I level had the highest critical thinking mean scores, and students at the sophomore II level attained the lowest scores, reflecting a significant difference (P < or = .05). ANOVA also indicated a significant difference in the total critical thinking disposition mean scores between students at the junior I and senior I and II levels and those at the sophomore II level (P < or = .0000). Results indicated weak truth-seeking disposition scores among students at all levels. Pearson Product Moment Correlation Coefficient yielded a significant positive relationship between critical thinking skills and critical thinking dispositions (P < or = .01). The conceptual model, as well as its relevancy to the professional standards of Essentials for College and University Education for Professional Nursing (AACN, 1986), is presented. Recommendations are discussed in regard to nursing education, curriculum, and research.

Analysis of Variance↗

PubMed1991

Causes and correlates of death after unsupported coronary angioplasty: implications for use of angioplasty and advanced support techniques in high-risk settings.

To better understand the factors predisposing a patient to death after elective percutaneous transluminal coronary angioplasty (PTCA) and to gain insight into indications for high-risk PTCA both with and without adjunctive use of support devices, the outcomes of 8,052 consecutive procedures were reviewed. Death occurred after 32 procedures (0.4%) and was directly related to coronary artery closure in 26 (81%) of these cases. Left ventricular failure due to vessel closure at the dilated site, the most common cause of death, was independently correlated with female sex (p less than 0.001), "jeopardy score" (p less than 0.001) and PTCA of a proximal right coronary artery site (p = 0.002), but not with left ventricular ejection fraction or presence of multivessel disease. Right ventricular failure after closure of the proximal right coronary artery, and left main coronary dissection accounted for the majority of the remaining deaths. Systolic blood pressure immediately after coronary artery closure was also closely correlated with jeopardy score, and cardiogenic shock was frequent in women with scores greater than or equal to 3.5 and in men with scores greater than or equal to 5.0. These data highlight the superiority of the jeopardy score versus ejection fraction in the determination of risk, stress the importance of gender in determining outcome and point to the need for better means of right ventricular protection from severe ischemia. Therefore, an initial framework for rational use of PTCA and support devices in the high-risk setting is established.

Aged↗

PubMed1993

Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines.

Clinicians and researchers without a suitable health-related quality of life (HRQOL) measure in their own language have two choices: (1) to develop a new measure, or (2) to modify a measure previously validated in another language, known as a cross-cultural adaptation process. We propose a set of standardized guidelines for this process based on previous research in psychology and sociology and on published methodological frameworks. These guidelines include recommendations for obtaining semantic, idiomatic, experiential and conceptual equivalence in translation by using back-translation techniques and committee review, pre-testing techniques and re-examining the weight of scores. We applied these guidelines to 17 cross-cultural adaptation of HRQOL measures identified through a comprehensive literature review. The reporting standards varied across studies but agreement between raters in their ratings of the studies was substantial to almost perfect (weighted kappa = 0.66-0.93) suggesting that the guidelines are easy to apply. Further research is necessary in order to delineate essential versus optional steps in the adaptation process.

Cross-Cultural Comparison↗

PubMedDate not supplied

Motivation and job satisfaction of deans of schools of nursing.

Factors influencing the job satisfaction of deans of schools of nursing were analyzed using the motivational theory of expectancy. A questionnaire was sent to 595 deans/directors of baccalaureate and higher degree schools of nursing accredited by the National League for Nursing. The three part questionnaire consisted of (1) Demographic data, (2) Motivation and Reward Scales, and (3) The Job Description Index. Significant relationships were found within each job satisfaction variable (P less than or equal to .05). The most significant and numerous relationships were found within the variable of pay or salary. Deans who had long tenure in their administrative positions and were associated with large universities and schools of nursing were also found to be statistically significant (P less than or equal to .05). A direct relationship between the scores on the Motivation and Reward Scale and the scores on the Job Description Index was supported. The individual and collective facets of job satisfaction were positively and significantly correlated (P less than or equal to .05) with motivation, providing support for the theoretical framework that proposes an interdependent relationship. Additional findings from regression analyses suggested that motivation is a significant predictor of job satisfaction.

Adult↗

PubMed2004

Assessing the clinical significance of change scores recorded on subjective outcome measures.

BACKGROUND: To date, clinical trials have relied almost exclusively on the statistical significance of changes in scores from outcome measures in interpreting the effectiveness of treatment interventions. It is becoming increasingly important, however, to determine the clinical rather than statistical significance of these change scores. OBJECTIVE: To determine cutoff values for change scores that distinguish patients who have clinically improved from those who have not. METHOD: Data were obtained from 165 back and 100 neck patients undergoing chiropractic treatment. Patients completed the Bournemouth Questionnaire (BQ) before treatment and the BQ and Patient's Global Impression of Change (PGIC) scale after treatment. Three statistical methods were applied to individual change scores on the BQ. These were (1) the Reliable Change Index (RCI); (2) the effect size (ES); and (3) the raw and percentage change scores. The PGIC scale was used as the "gold standard" of clinically significant change. RESULTS: The RCI, using the cutoff value of >1.96, appropriately identified clinical improvement in back patients but not in neck patients. An individual ES of approximately 0.5 had the highest sensitivity and specificity in distinguishing back and neck patients who had undergone clinically significant improvement from those who had not. In terms of raw score changes, percentage BQ change scores [(raw change score/baseline score) x 100] of 47% and 34% were identified as having the highest sensitivity and specificity in distinguishing clinically significant improvement from nonimprovement in back and neck patients, respectively. CONCLUSION: This study provides a methodological framework for identifying clinically significant change in patients. This approach has important implications in providing clinically relevant information about the effect of a treatment intervention in an individual patient.

Adult↗

PubMedDate not supplied

The eating disorders as addiction: a psychobiological perspective.

A number of theories have been proposed to explain the substantial comorbidity between the eating disorders and the substance-related disorders. Among them is the claim that self-starvation--exacerbated by excessive exercising--is itself an addiction to the body's endogenous opioids. While efforts have also been made to identify an "addictive personality," attempts to establish whether eating-disordered patients share these characteristics have met with mixed success. The present study was designed to determine the degree to which anorexic and bulimic patients display addictive personality characteristics, and whether these traits are useful in predicting the severity of the patient's weight preoccupation and their degree of excessive exercising. Results confirmed that both anorexic and bulimic patients had high scores on the Addiction Scale of the Eysenck Personality Questionnaire, and that addictiveness and obsessive-compulsiveness were related simultaneously to weight preoccupation and excessive exercising in both patient groups. Findings are discussed within the framework of the auto-addiction opioid theory, and they highlight the similarities and differences in the personality structure of the eating-disorder subtypes.

Adaptation, Psychological↗

PubMed2001

Couples' adjustment to breast disease during the first year following diagnosis.

The objectives were to determine (a) the extent to which psychosocial, demographic, and medical variables predict women's and husbands' adjustment to breast disease during the first year following diagnosis; (b) the degree of autocorrelation among and intercorrelation between partners' adjustment scores; (c) the extent to which baseline levels of adjustment predict adjustment 1 year later; and (d) the extent to which one partner's adjustment affects the other partner's adjustment. A stress-coping framework guided this study. The sample consisted of 131 couples, 58 couples received a cancer diagnosis and 73 received a benign diagnosis. Couples were interviewed at 1 week, 2 months, and 1 year postdiagnosis. Structural equation modeling was used to analyze the data. The strongest predictors of adjustment for women were severity of the illness and hopelessness and for husbands, their own baseline level of adjustment. Husbands' and wives' levels of adjustment at 1 year had a significant direct effect on each other's adjustment.

Adaptation, Psychological↗

PubMed1980

Methodological issues in short-term motor memory research.

Four methodological issues identified and studied by short-term motor memory researchers were examined in this paper: (a) the distributions of three commonly used measures of error (AE, CE, and VE); (b) statistical analysis of these scores as dependent measures in an experiment; (c) within-cell and experiment-wise estimates of the reliability of CE; and (d) the power of the statistical test with CE as the dependent measure. The first two sub-problems were explored theoretically, while the latter two were subjected to empirical examination using four data sets from previously published experiments. The distributions of AE and VE scores were described as non-normal under certain conditions, while the CE score distribution was shown to be normal. Therefore analyses of these three dependent measures may require different statistical procedures. In light of this information, the assumptions affecting estimates of reliability and power in an experimental framework were examined. Based on an analysis of the four data sets, a strategy was proposed in which a relatively small number of subjects could be utilized in an experiment without sacrificing desired experimental controls.

Journal Article↗

PubMed2005

Neglect assessment in urban emergency departments and confirmation by an expert clinical team.

BACKGROUND: Elder neglect accounts for over 70% of all adult protective services reports in the nation annually, and it has been estimated that there are over 70,000 new cases each year. The purpose of this study was to conduct elder neglect research in the emergency department (ED), using a dyadic vulnerability/risk-profiling framework for elder neglect. METHODS: Patients were recruited through four EDs in New York and Tampa from the beginning of February 2001 through the end of September 2003. Demographics, a Mini-Mental Status Examination score, and an initial elder assessment screen were collected. The diagnosis of neglect was then made by a Neglect Assessment Team (NAT) comprising a nurse, physician, and social worker, with extensive clinical experience in elder neglect. RESULTS: Of the 3664 ED screens of adults 70 years and older, 405 (11%) met the inclusion criteria and agreed to participate. Neglect was diagnosed by the NAT in 86 of the 405 cases reviewed. Demographic differences between neglect versus no neglect cases were examined using Fisher's exact test, and differences emerged between the 2 groups. CONCLUSION: This study documents the underreporting of cases of neglect as evidenced by differences in diagnoses by screeners versus experts. The research assistants screened positive for neglect in 5% (N=22) of the 405 cases. The NAT made the diagnosis of neglect in 22% (86/389) of the cases. This markedly different rate of neglect may mean that ED screens are important but may underestimate the true number of cases. Conversely, an NAT may make the diagnosis of neglect in an older adult more often given a higher sensitivity and a more robust knowledge base of the problem.

Aged↗

PubMed1989

Application of health status assessment measures in policy research.

The application of health status measures in policy research relies considerably on patterns of mortality, life expectancy, and health status indicators, such as hospital readmission and institutionalization rates. In recent years the state of the art in health status measurement has advanced substantially with the development of multidimensional measures with established reliability and validity. These newer measures have not found wide application in policy research. This may reflect many factors, including the complexity of these measures, the cost of data collection, and the perception that the health status scores are not easily interpreted. It also may reflect the perceived value of simpler and unidimensional measures of health that can be translated more readily into estimates of the need for health care services. A framework is proposed for the application of health status measures in policy research. This framework emphasizes the relationship between health status and the need for care, the measurement of unmet needs for care, and the role of health policy in assuring that services are available and appropriate to meet the needs for care. A case study is used to illustrate some of the issues in using health status indicators to measure needs for care and outcomes.

Aftercare↗

PubMed2005

Development of the Childhood Atopic Dermatitis Impact Scale: initial validation of a quality-of-life measure for young children with atopic dermatitis and their families.

To measure the effects of atopic dermatitis (AD) on the quality of life of affected young children and their families, we developed a prototype 62-item instrument, the Childhood Atopic Dermatitis Impact Scale (CADIS). The prototype CADIS was developed from a comprehensive conceptual framework based on data from parents and clinicians. The instrument had eight subscales (four each for child and parent): physical health, emotional health, physical functioning, and social functioning. The goal of this work was to test the validity of and to refine the prototype of CADIS. Two hundred seventy parents of children under the age of 6 y with AD responded to the instrument. Content validity was demonstrated by expert and parent reviews of the drafted and refined instrument, and by analyzing parents' responses to open-ended questions about their children's skin disease. Construct validity was assessed in exploratory factor analyses which supported a refinement in the conceptual framework to consist of two dimensions with five domains: child dimensions (symptoms and activity limitation/behavior), and parent dimensions (family/social function, sleep, and emotions). Seventeen items were eliminated, yielding a 45-item refined version of CADIS (score 0-180) with evidence of content and construct validity and suggested use in clinical research.

Adolescent↗

PubMedDate not supplied

Sufficiently important difference: expanding the framework of clinical significance.

BACKGROUND: It is generally agreed that randomized controlled trials should be powered to detect small but clinically significant treatment effects. Toward these ends, minimal important difference (MID) was proposed as a benchmark for designing trials and for interpreting health-related quality-of-life instrument scores. MID was defined in 1989 as "the smallest difference in score in the domain of interest which patients perceive as beneficial and which would mandate, in the absence of troubling side effects and excessive cost, a change in the patient's management." OBJECTIVE: 1) To expand the idea of minimal clinically important difference so as to take into account harms as well as benefits. 2) To propose concepts and methods with which to do so. SUMMARY: The authors define sufficiently important difference (SID) as the smallest amount of patient-valued benefit that an intervention would require to justify associated costs, risks, and other harms. As a means toward estimation of SID, the authors propose benefit-harm tradeoff methods, in which domains of benefit and harm are systematically traded off against each other and assessed in relation to the global decision of whether a treatment choice is worthwhile. Specific SID estimates can be used to power and interpret clinical trials or to inform health services research and/or public health policy. This article briefly describes the evolution of the important difference concept and outlines similarities and differences between MID and SID.

Attitude to Health↗

PubMed2004

Mapping child molester treatment progress with the FoSOD: denial and explanations of accountability.

A continuing challenge in the treatment of sexual offenders involves the identification of measurement instruments that can be used to monitor treatment progress. This paper provides evidence that the Facets of Sexual Offender Denial (FoSOD; pronounced "façade") Scale maps critical aspects of treatment progress, yet avoids problems typically associated with self-report measures. Fifty-three child molesters completed the FoSOD twice with an 18-month interval between administrations. The Time 1 and Time 2 FoSOD scores were analyzed as a function of advancement through a court-sanctioned sexual offender treatment program. Results demonstrated not only that advancement in treatment corresponded with predictable changes in FoSOD scores, but also that FoSOD component scores, representing denial associated with refutation, minimization and depersonalization of the offense, revealed critical patterns indicative of the issues with which offenders contend at various points within treatment. These results are discussed within a conceptual framework that recognizes the relationships between denial in its various forms and the explanations that offenders develop to limit their accountability for alleged offenses, associated thoughts or behaviors, and deviant predispositions.

Adult↗

PubMed2002

Living with Huntington's disease: Illness perceptions, coping mechanisms, and patients' well-being.

OBJECTIVES: To describe the illness perceptions and coping mechanisms of patients with Huntington's disease (HD), and to assess their role in the well-being of these individuals. DESIGN: A single group, cross-sectional study. METHODS: In 77 individuals with a clinically confirmed diagnosis of HD, illness perceptions, coping mechanisms, motor and cognitive performance, and well-being were assessed by means of questionnaire-guided interviews, and subjected to correlational analyses, t-tests and two-stage regression analyses. RESULTS: HD patients' illness perceptions were characterized by a strong illness identity, combined with beliefs about a long duration of HD, perceived negative consequences for their daily lives, and little hope for cure or improvement of their symptoms. In turn, the coping strategies that HD patients reported adopting to deal with their disease were comparable with those adopted by reference individuals dealing with everyday life stressful situations. Where the well-being of HD patients is concerned, compared with Dutch community sample, HD patients scored significantly lower on measures of physical well-being and general health. Both illness perceptions and coping mechanisms were significant predictors of patients' well-being. CONCLUSIONS: More systematic research within a health psychology framework is justified in order to assess the role of illness perceptions and coping mechanisms in the well-being of HD patients.

Journal Article↗

PubMed1986

Predictors of benefit from art, movement, and poetry therapy: a pilot study.

No validated criteria exist for assigning patients to the creative arts therapies. This paper reports on a pilot study attempting to identify predictors of benefit from art, movement, and poetry therapy. Based on a priori hypotheses, selected psychological tests were administered to 31 patients who each received all three modalities of treatment. The relationships of these test scores and therapist prediction of benefit ratings to outcome were then evaluated statistically; outcome was measured by patient ratings and figure drawings. Results showed few significant predictors, though several findings requiring confirmation may provide a framework for future research. Implications and possible explanations of these results, as well as design and other research issues relevant to further work in this area, are discussed.

Art Therapy↗

PubMed1999

A general conditional-logistic model for affected-relative-pair linkage studies.

Model-free LOD-score methods are often employed to detect linkage between marker loci and common diseases, with samples of affected sib pairs. Although extensions of the basic one-disease-locus model have been proposed that allow separate inclusion of other types of affected relative pairs, discordant relative pairs, covariates, or additional disease loci, a unified framework that can handle all of these features has been lacking. In this report, I propose a conditional-logistic parameterization that generalizes easily to include all of these features. Two data examples, one using simulated data and one using type 1 diabetes, illustrate applications of the models.

Alleles↗

PubMed2006

The nonlinear dynamical hypothesis in science education problem solving: a catastrophe theory approach.

The current study tests the nonlinear dynamical hypothesis in science education problem solving by applying catastrophe theory. Within the neo-Piagetian framework a cusp catastrophe model is proposed, which accounts for discontinuities in students' performance as a function of two controls: the functional M-capacity as asymmetry and the degree of field dependence/independence as bifurcation. The two controls have functional relation with two opponent processes, the processing of relevant information and the inhibitory process of dis-embedding irrelevant information respectively. Data from achievement scores of freshmen at a technological college were measured at two points in time, and were analyzed using dynamic difference equations and statistical regression techniques. The cusp catastrophe model proved superior (R(2)=0.77) comparing to the pre-post linear counterpart (R(2)=0.46). Besides the empirical evidence, theoretical analyses are provided, which attempt to build bridges between NDS-theory concepts and science education problem solving and to neo-Piagetian theories as well. This study sets a framework for the application of catastrophe theory in education.

Humans↗