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PubMed1998

Relationships among respiratory infections, triggers of attacks, and asthma severity in children.

The present study of asthmatic children examined relationships among the frequencies of prior respiratory infections (i.e., those prior to the development of asthma) and recent (past year) respiratory infections, asthma severity, and the impacts of 12 common asthma triggers: air pollution, allergy problems, anger, cigarette smoke, excitement, high humidity, high or low environmental temperature, laughter, nighttime hours, physical activity, respiratory infection, and stress or worry. Data on these variables were obtained through a survey in which 325 families completed questionnaires; 121 families had asthmatic children who were 2-20 years of age. Pearson correlational analyses revealed many significant positive correlations: The frequencies of prior and recent infections were correlated. The frequency of prior infections was correlated with the impacts of all asthma triggers except allergy problems, but the frequency of recent infections was correlated only with the impacts of air pollution, cigarette smoke, respiratory infection, and nighttime hours as triggers of asthma attacks. Asthma severity was correlated with the frequencies of prior and recent respiratory infections and with the impact of respiratory infection as an asthma trigger.

Adolescent↗

PubMed2003

Complications of chronic vagus nerve stimulation for epilepsy in children.

OBJECT: The aim of this study was to define better the incidence of surgical complications and untoward side effects of chronic vagus nerve stimulation (VNS) in a population of children with medically refractory epilepsy. METHODS: The authors retrospectively reviewed the cases of 74 consecutive patients (41 male and 33 female) 18 years of age or younger (mean age 8.8 years, range 11 months-18 years) who had undergone implantation of a vagal stimulator between 1998 and 2001 with a minimum follow up of 1 year (mean 2.2 years). Of the 74 patients treated, seven (9.4%) had a complication ultimately resulting in removal of the stimulator. The rate of deep infections necessitating device removal was 3.5% (three of 74 patients who had undergone 85 implantation and/or revision procedures). An additional three superficial infections occurred in patients in whom the stimulators were not removed: one was treated with superficial operative debridement and antibiotic agents and the other two with oral antibiotics only. Another four stimulators (5.4%) were removed because of the absence of clinical benefit and device intolerance. Two devices were revised because of lead fracture (2.7%). Among the cohort, 11 battery changes have been performed thus far, although none less than 33 months after initial implantation. Several patients experienced stimulation-induced symptoms (hoarseness, cough, drooling, outbursts of laughter, shoulder abduction, dysphagia, or urinary retention) that did not require device removal. Ipsilateral vocal cord paralysis was identified in one patient. One patient died of aspiration pneumonia more than 30 days after device implantation. CONCLUSIONS: Vagus nerve stimulation remains a viable option for improving seizure control in difficult to treat pediatric patients with epilepsy. Surgical complications such as hardware failure (2.7%) or deep infection (3.5%) occurred, resulting in device removal or revision. Occasional stimulation-induced symptoms such as hoarseness, dysphagia, or torticollis may be expected (5.4%).

Adolescent↗

PubMed1989

Getting the joke: interpreting humor in group therapy.

1. Jokes, humor and laughter imply a defense against other feelings or a relief with palliative effects. 2. Jokes are vehicles of humor and may be placed on a negative-positive continuum. Placement on the continuum depends on the content and context elements such as timing, place, and the individuals involved (teller and receiver). 3. If the joke surfaces before the content and process have been presented or made clear, the joke may be the first key to the exploration of underlying issues. 4. Viewing humor and jokes as another form of emotional expression with motivation can supply a clue to group psychopathology and the group process.

Communication↗

PubMedDate not supplied

Our journey together.

These three challenges of political activism, public awareness, and patient advocacy were met through a broad range of activities by many committed AOTA members. During the past 3 years, our membership has grown, our number of educational programs at the professional, technical, and postprofessional levels has dramatically increased, and our visibility as a profession has bloomed. Promotion of the benefits of occupational therapy to society is in evidence throughout the land and throughout the world. My heartfelt thanks go to all the Executive Board members, the state presidents, the representatives and National Office staff for their active partnership with our members, making these achievements for the profession possible. As our journey together takes on a new relationship, Nikolai Gogol provides us with a final thought: And for a long time yet, led by some wondrous power, I am fated to journey hand in hand with my strange heroes and to survey the surging immensity of life, to survey it through the laughter all can see and through the tears unseen and unknown by anyone (1842/1961 no page number available).

Occupational Therapy↗

PubMed1999

What's funny about nursing?

The authors examine the topic of humour and argue that humour is needed as one of many skills within the nurse patient relationship. We advance the view that humour has been well researched as an agent of therapeutic value and as a communication tool which helps to relieve stress, but, to date is not used to its fullest potential and tends therefore to be underestimated in both general and psychiatric nursing areas. Humour has benefits for both the nurse and the patient having psychological benefits and a vast array of physiological advantages and is regarded by those who use it as a social lubricant acting as a positive in nurse patient relationships. We also argue that it is essential that nurses know when to use humour as timing and appropriateness is imperative in order for it to be most effective. Humour can be used in all areas of clinical nursing practice and may prove useful in being a reliable predictor over the course of a patient's illness. The use of humour can help improve the nurse-patient relationship by initially breaking the ice between nurse and patient. This alternative mode of delivery can then be foundational to other areas of the nurse patient relationship such as self-disclosure, the enhancement of learning and relieving stress. Furthermore, it helps to facilitate and promote mutual health and well being for both the patient and the nurse. The usage of humour in psychiatric nurse settings is discussed and the benefits to both the patients and their staff are outlined as being of immense therapeutic value. The literature perhaps tends to skirt around these benefits somewhat, as psychiatry and laughter in partnership are not really considered important discursive topics.

Humans↗

PubMedDate not supplied

A study of storytelling, humour and learning in medicine.

Story telling is a fundamental part of clinical practice. It provides the mechanism by which doctors and patients communicate and understand the meaning of illness and possible ways of dealing with it. Humour is a particular aspect of story telling and, while there are some negative aspects, generally does have a therapeutic benefit. The physiological effects of laughter are considerable. Both story telling and humour are important for learning and are complementary to the more formal learning from text books and lectures. Stories assist in the development of emotional knowledge. The hypothesis of the contagious theory of behaviour change is presented as a way in which ideas are transmitted from one person to another.

Aphorisms and Proverbs as Topic↗

PubMed1995

Was that really funny? The politics of humor.

Everybody loves a comic--or do they? A Human Resources Department picked up a pattern when several departing employees, all excellent performers, said they liked their jobs but felt "excluded" from the camaraderie. One said he'd found the humor "barbed." Another said she's never seen anything funny in jokes that seemed to convulse everyone else. The past five years have been so gloomy, economically speaking, that, in many hospitals and health care organizations, laughter is a mega-event. But lately I've been listening to what employees joke about and watching how their humor affects others. Physician executives need to be alert to some kinds of humor that are weapons used by employees against other employees, their managers, and the company generally.

Economic Competition↗

PubMed1991

Dignity--the cornerstone of care.

At the Alzheimer's Day Center in Columbia, South Carolina, staff, families, and volunteers comprise the A-team. The team offers persons with Alzheimer's disease a homelike environment full of laughter and love, while providing respite for family caregivers.

Aged↗

PubMedDate not supplied

Healing with humor. Clowns on call bring hugs and happiness.

Each year tens of thousands of children visit The Detroit Medical Center's Children's Hospital of Michigan as patients. Hundreds of thousands of orders are processed and even more prescriptions are written. This year rare and different kinds of orders and prescriptions are being written ... orders for Clowns-on-Call and prescriptions for laughter.

Child↗

PubMed1976

Observations of a health and healing system in a Papago community.

The Papago people in the Tohono village have a repertoire of culturally stylized patterns of behavior to help them maintain their health. The use of foods and ceremonies for preventing illness and maintaning health are emphasized in the styles of the people as well as the concept of taking care of self and others. Comfort and discomfort, fatigue, aches, thirst, hunger, and sadness are daily experiences of the people. Laughter, crying, "taking care of self and others", walking slowly, eating beans and tortillas, maintaining calm thoughts, and so on, are all culturally defined patterns for coping with alterations in feeling. When professional healers are needed, they will be consulted according to how helpful people perceive these healers to be by their sensitive attitudes and actions. The medicine man, nurses, medicine ladies, the ladies-who-pray, physicians, and St. Francis are perceived to be members of the health care team for the Papago people. The meaningful patterning of culturally defined behavior must be understood within the context of the Papago cultural system. As illustrated by the Tohono, "taking care of self and others" is highly valued, but it is only meaningful as we understand the rules of the Papago society, particularly the religious and kinship systems. These systems tell us that family members are important in taking care of themselves and others. Thus, the description in this paper of culturally patterned health practices with their rituals, ceremonies, and ways to help maintain health and heal the sick help the reader to understand the importance of health and healing behaviors within a designated cultural context. In this study, it is the Papago community and their specialty life ways of maintaining health and preventing illnesses.

Adolescent↗

PubMed1999

Four legs or two: up front with you--preventing tragedies by keeping children and pets out of the cargo areas of pickup trucks.

Dogs and children riding in the cargo area of pickup trucks are common sights on our nation's highways, country roads, and small town streets. This scene brings to mind idyllic childhoods filled with summer days spent bouncing down roads in the back of grandpa's pickup truck, wind catching the laughter from children's throats. For hundreds of families each year, this activity is the cause of heartache, traumatic injuries, and senseless deaths. More than 200 people die each year, half of whom are younger than 18 years of age, as a direct result of falls from cargo areas of pickup trucks. Injuries and deaths resulting from riding in cargo areas of pickup trucks are not limited to humans. In a recent survey, 71% of veterinarians reported treating dogs for injuries sustained by falling or jumping from cargo areas of pickup trucks. This percentage does not take into account countless dogs that were killed and not treated. Injuries and deaths resulting from riding in cargo areas of pickup trucks are preventable. Whereas it may take millions of dollars and many years to cure diseases such as cancer, heart disease, and AIDS, pickup truck-associated deaths can be prevented simply by educating the public to not allow children and pets to ride in cargo areas. The primary objective of "Four legs or two: Up front with you" is to educate the public on the risks involved with travel in the cargo areas of pickup trucks. Making people aware that children and pets are not cargo is the first step toward decreasing senseless injuries and deaths.

Accidents, Traffic↗

PubMed1999

Genetic analyses of focal aspects of infant temperament.

The authors explored the genetic and environmental underpinnings of individual differences in temperament with a sample of 604 3- to 16-month-old infant twins and their parents. Mothers completed Rothbart's Infant Behavior Questionnaire (IBQ), and a subsample of 140 9-month-old twins participated in behavioral assessment of temperament in the laboratory as well. For IBQ Smiling and Laughter and Duration of Orienting, both additive genetic and shared environmental effects were needed to best represent the data. Shared environmental effects fully accounted for cotwin similarity for IBQ Soothability, and conversely, additive genetic effects fully accounted for cotwin similarity for the IBQ Distress to Limitations, Distress to Novelty, and Activity Level scales. With the subsample, the authors fit a multivariate model to mother report, father report, and lab measures of stranger distress and found that genetic influences were most important for the covariation among these measures.

Arousal↗

PubMed1999

Overcome terminal seriousness: let go, laugh, and lighten up!

This article examines physiological and psychological benefits of laughter and humor. These are essential tools that can successfully combat the stress and pressure of the perioperative environment. Used in tandem with "life balancing skills," they can enrich the work arena and help nurses rekindle passion and meaning in their lives.

Adaptation, Psychological↗

PubMed1999

Parental imprinting and Angelman syndrome.

Angelman syndrome is an inherited disorder that includes severe mental retardation and epilepsy. Patients have no speech, puppet-like gait with jerky movements, hyperactivity, disturbed sleep, bouts of inappropriate laughter, a pronounced jaw, and widely spaced teeth. The syndrome results from deletion or mutation within maternal chromosome 15q11-q13. Considerable evidence suggests that the gene or genes responsible for Angelman syndrome are expressed only from the maternal chromosome 15, a situation known as parental imprinting. This epigenetic marking of certain regions of the parental genomes is characterized by parent-of-origin-specific allelic DNA methylation, allele-specific DNA replication timing, and physical pairing of the two chromosome 15 homologues. Imprinting is important for normal development, and its disregulation causes several human disorders. The epilepsy of Angelman syndrome has been studied and indicates a rather typical electroencephalographic abnormality with slowing and notched wave and spikes. Various types of seizures occur, usually including myoclonus and atypical absence. Variable severity among patients suggests potential molecular diversity in the genetic mechanism, possibly the involvement of more than one gene. Angelman syndrome can arise from the following molecular genetic defects: a deletion in 15q11-q13 that covers the Angelman gene or genes, mutations that alter imprinting, and paternal uni-parental disomy for the region. Another 20% or so of patients with clinical symptoms of Angelman syndrome have none of these three defects but are believed to have mutations in one or more genes in the region, and this may be familial. The UBE3A gene, which codes for the enzyme ubiquitin protein ligase involved in protein degradation and processing, has been found to be mutated in many but not all of patients with Angelman syndrome and can be considered a major Angelman candidate gene. Other potential candidate genes in the region include a cluster of three GABAA receptor subunits, which are involved in inhibitory synaptic transmission in the brain. The GABRB3 gene, which codes for the beta 3 subunit, is deleted in most persons with Angelman syndrome. The absence of this gene in mice causes craniofacial abnormalities and neurologic impairment with seizures. The exact role of UBE3A and GABRB3 in the syndrome and their imprinting status are under investigation.

Alleles↗

PubMed2000

[The modiolus. Comparative anatomy, embryological and physiological review, surgical importance].

Monkeys, imitators of man's gesture never shared smile with him and their facial expressions only result in grimaces. Study of animal anatomy may explain why subtle expressions of the lips are a more man's special gift than laughter. These fine movements are related to a subcutaneous muscular structure termed modiolus, which is the meeting point of muscles involved in the motion of mouth and comparative anatomy shows this structure to be better defined in Man than in other primates. Embryologically, muscles that form the modiolus derive from a cellular concentration in the region of the second branchial arch. It is then logical to see these muscles converge to the corner of the mouth to form the modiolus, as they emerge from a common area. Functioning of the modiolus is complex, as its position may change many times in a minute to allow the orbicularis oris muscle to take any position and do any movement as if it was inserted on bone. With its complex physiology, the modiolus is of critical importance in the subtle expressions of the lips and must be preserved or reconstructed when performing repair of full-thickness tissue defects of lips.

Animals↗

PubMedDate not supplied

EEG--a valuable tool in early diagnosis of Angelman syndrome.

Angelman Syndrome (happy puppet syndrome) is one of the genetic diseases causing developmental delay in children. Late diagnosis used to be the rule because of delayed appearance of disease markers such as craniofacial dysmorphism, ataxia, unprovoked laughter and seizure. However, reports have described characteristic EEG changes such as 2-3 Hz large amplitude slow wave paroxysms which appear early and are quite specific to the syndrome. With EEG aid, we made very early diagnosis in a 9 month-old young infant. And we would like to advocate the use of EEG study in cryptogenic psychomotor retardation in children.

Angelman Syndrome↗

PubMed1999

Narcolepsy-cataplexy syndrome associated with DRB10806-DQB0602 haplotype in a Caucasian patient.

Narcolepsy-Cataplexy (NC) is a neurological disorder associated with the human leukocyte antigen HLA DR2. This is a prerequisite for the disease in 95 to 98% of Caucasian patients. It has been demonstrated that the HLA DQB1*0602 allele is a better marker for narcolepsy than DRB1*1501 (DR2). We present a DR-negative and DQB1*0602-positive Caucasian Spanish patient with a very unusual genotype. A 20-year-old male presented with a 12-year history of excessive daytime sleepiness and sudden muscle weakness caused by laughter and disturbed nocturnal sleep. He had never presented hypnagogic hallucinations or sleep paralysis. The family history was negative. Physical and neurological examinations were normal. The Epworth Sleepiness Scale score was 21/24, The Ullanlinna Scale score was 20/40. The polysomnographic recording showed short sleep latency, increased percentage of stage 1 (St 1), increased number of body movements and decreased sleep efficiency index. MSLT data: mean sleep latency of 1 minute and three sleep onset rapid eye movement (REM) periods (SOREMPs). HLA phenotype: A1, A11; Cw5, Cw7; B44, B39; Bw4, Bw6; DR4, DR8; DR53; DQ6, DQ8 and at the gene level: DRB1*0402, DQB1*0302; DRB1*0806, DQB1*0602. The DRB1*0806 and DQB1*0602 genotype is very infrequent in NC and identical to one African-American case in the series by Mignot et al. (1997a), and to a Caucasian case in another series by Mignot et al. (1997b). This indicates the genetic heterogeneity of the NC.

Adult↗

PubMed2000

[Hypocretin (orexin) deficiency in narcolepsy-cataplexy].

A mutation in the HCRT locus was proved in 18-yrs old male suffering from narcolepsy-cataplexy. He has demonstrated cataplectic attacks (brief spells of head dropping provoked by laughter) as well as imperative sleep in spells of several minutes up to one hour since the age of six months. He has suffered from severe bulimia since five years; later hypnagogic hallucinations, sleep paralysis and unquiet nocturnal sleep accompanied by periodic limb movements appeared. Symptoms are partially controlled with methylphenidate and either imipramine, clomipramine or fluoxetine. Periodic leg movements poorly responded to L-DOPA and clonazepam treatment. He is HLA-DQB1*0602 negative. Repeated MSLT (over 16 years followed-up period) showed extremely short latency with predominant SOREMPs and also nocturnal PSG recordings revealed fragmented sleep with SOREMPs. This case report demonstrates that hypocretin (orexin) mutations in human can produce the full narcolepsy phenotype and validates data recently reported in dog and mouse models suggesting a role for hypocretin (orexin) in the pathophysiology of narcolepsy and the regulation of REM sleep.

Adolescent↗