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PubMed2005

Behavioral aspects of nutrition in children with cystic fibrosis.

PURPOSE OF REVIEW: Nutritional status in cystic fibrosis is important to the health and long-term survival of patients; however, children with cystic fibrosis are not achieving the dietary recommendations or achieving normal growth. This paper reviews current knowledge about behavioral and environmental barriers to dietary adherence in this population. RECENT FINDINGS: Children with cystic fibrosis do not have the same appreciation of the need to gain weight as their parents. Parents of children with cystic fibrosis describe meal times as 'battling' with the child. Direct observation studies of meal times demonstrate that school-aged children with cystic fibrosis do not differ from children without cystic fibrosis on the frequency of behaviors incompatible with eating, as was seen in younger age groups, but parents of school-aged children with cystic fibrosis continue to engage in ineffective management styles at a greater frequency than parents of children without cystic fibrosis. Assessment of family functioning during mealtime demonstrates that these interaction patterns have a negative effect on family functioning in families of children with cystic fibrosis compared with families of same-age peers in all age groups: infancy/toddler, preschool, and school age. SUMMARY: Achieving the cystic fibrosis dietary recommendations is challenging, and typical parenting strategies to encourage eating not only are ineffective but may have a negative impact on family functioning. To improve dietary adherence and decrease conflict at meals, children with cystic fibrosis and their parents need to be taught more effective management strategies as part of dietary counseling.

Child↗

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↗

PubMed2006

The relationship between viewing US-produced television programs and intentions to drink alcohol among a group of Norwegian adolescents.

The aim of this study was to examine the influence of exposure to US-produced television programs and family rules prohibiting alcohol use on the development of normative beliefs, expectancies, and intentions to drink alcohol in the next 12 months among a group of Norwegian adolescents who reported that they had not previously consumed alcohol. Data were collected via a survey administered to 622 eighth and ninth graders enrolled at ten junior highs in southeastern Norway. To examine these relationships we tested the fit of a structural equation model which was based on the Theory of Planned Behavior (Ajzen, 1988). Data from the non-drinkers (n= 392, 63% of the respondents) were used. To control for the influence of peer drinking on behavioral intentions, our model was tested under two group conditions: (1) those subjects reporting that they have no friends who drink alcohol and (2) those subjects reporting that they have one or more friends who drink. The findings indicate that the influence of TV exposure was a significant predictor (directly) of normative beliefs, expectancies (indirectly) and intentions to drink (both directly and indirectly) only for those subjects who reported having no friends who drink. For the group with non-drinking friends, family rules constrain intentions only indirectly by influencing normative beliefs. For those with friends who drink, however, family rules have a direct (inverse) effect on intentions. It is concluded that exposure to US-produced television programs functions as a limited knowledge source only for those subjects who had little or no personal experience with alcohol while the presence of family rules have limited impact on behavioral intentions.

Adolescent↗

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↗

PubMed2007

Involvement or isolation? The social networks of children with autism in regular classrooms.

Including children with autism in regular classrooms has become prevalent; yet some evidence suggests such placements could increase the risk of isolation and rejection. In this study, we used social network methods to explore the involvement of children with autism in typical classrooms. Participants were 398 children (196 boys) in regular 2nd through 5th grade classes, including 17 children (14 boys) with high functioning autism or Asperger's syndrome. Children reported on friendship qualities, peer acceptance, loneliness, and classroom social networks. Despite involvement in networks, children with autism experienced lower centrality, acceptance, companionship, and reciprocity; yet they did not report greater loneliness. Future research is needed to help children with autism move from the periphery to more effective engagement with peers.

Autistic Disorder↗

PubMed2003

Cognitive development in children born preterm: implications for theories of brain plasticity following early injury.

The human brain is functionally altered through experience, a phenomenon known as plasticity. Relevant experiences may be negative, as in brain injury. Adult brain injury results in permanent impairment. However, it has been assumed that early injury leads to substantial functional recovery. Animal studies suggest several predictions regarding whether this principle generally holds true. These studies indicate that the timing of brain injury, relative to the expected course of neurodevelopment, impacts the extent of recovery. Injuries occurring during the period of cell migration are particularly detrimental. However, outcome must be assessed longitudinally because apparent recovery in childhood may reverse as the brain matures. Moreover, recovery of one function may come at the expense of others. Whether these findings characterize outcome following preterm birth is the focus of this review. Preterm birth is associated with high rates of neurodevelopmental disability, primarily due to hypoxic-ischemic events. Periventricular brain structures and white matter tracts are particularly vulnerable to damage. Through school age, preterm children exhibit diminished levels of global intellectual function, attention, memory, and reasoning skills relative to full-term peers. It is questionable whether these deficits persist. Because few studies have followed recent cohorts into young adulthood, it is argued that outcome cannot be reliably described based on the available literature. Moreover, important contributors to later development have been neglected, including both genetic and experiential factors. With improved assessment, it may be possible to develop interventions based on the individual child's constellation of genetic, biological, and sociodemographic risks.

Adolescent↗

PubMed2005

Late adolescent identity development: narrative meaning making and memory telling.

Personally important autobiographical memories are the smallest unit of the life story, which begins to emerge in adolescence. This study examined 2 features of self-defining memories in late adolescence, the meaning made of the memories to garner an understanding of the narrative construction of identity as a life story and how those memories were told with an emphasis on the functions for telling and audiences to understand the social component of narrative identity development. For late adolescents (N = 185), meaning was infrequently reported for the entertainment function in comparison with the self-explanation function. At later ages, adolescents' audiences were more likely to be peers, and at earlier ages, adolescents' audiences were more likely to be parents. Discussion focuses on the individual and social levels of identity construction that are apparent in personally important autobiographical memory narratives.

Adaptation, Psychological↗

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↗

PubMed2005

American Indian/Alaskan Native grandparents raising grandchildren: findings from the Census 2000 Supplementary Survey.

This article documents the prevalence and national profile of American Indian/Alaskan Native (AI/AN) grandparents who are raising their grandchildren, based on data from the American Community Survey/Census 2000 Supplementary Survey. In 2000 there were estimated to be nearly 53,000 AI/AN grandparent caregivers age 45 and older in the United States. Almost half of the caregiving grandparents had been raising a grandchild for five years or longer. The findings reveal a portrait of grandparents committed to raising their grandchildren despite the fact that many were living in extreme poverty, with ill health, and with limited resources and services. One-third of grandparent caregivers were living below the poverty line, and only one-quarter of these were receiving public assistance. Even when compared with their noncaregiving AI/AN peers, grandparents raising grandchildren were disproportionately female, poor, living with a functional disability, and living in overcrowded conditions. Implications for social work practice are presented and recommendations for policy and research are discussed.

Aged↗

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↗