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PubMed2004

Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model.

PURPOSE: The purpose of this article is to critically review the literature to examine factors that are most consistently related to employment outcome following traumatic brain injury (TBI), with a particular focus on metacognitive skills. It also aims to develop a conceptual model of factors related to employment outcome. METHOD: The first stage of the review considered 85 studies published between 1980 and December 2003 which investigated factors associated with employment outcome following TBI. English-language studies were identified through searches of Medline and PsycINFO, as well as manual searches of journals and reference lists. The studies were evaluated and rated by two independent raters (Kappa=0.835) according to the quality of their methodology based upon nine criteria. Fifty studies met the criteria for inclusion in the second stage of the review, which examined the relationship between a broad range of variables and employment outcome. RESULTS: The factors most consistently associated with employment outcome included pre-injury occupational status, functional status at discharge, global cognitive functioning, perceptual ability, executive functioning, involvement in vocational rehabilitation services and emotional status. CONCLUSIONS: A conceptual model is presented which emphasises the importance of metacognitive, emotional and social environment factors for improving employment outcome.

Brain Injuries↗
PubMed2006

Sources of payment for assistive technology: findings from a national survey of persons with disabilities.

This article provides an overview of who pays for the most commonly used assistive technology devices, special adaptations, and environmental accommodations by persons with disabilities in the United States. The latest findings from the 2001 survey of Use and Need of Assistive Technology and Information Technology by Persons With Disabilities in the United States conducted by the National Institute on Disability and Rehabilitation Research, Rehabilitation Engineering and Assistive Technology Society of North America, and the University of Michigan will be presented and compared to findings from earlier research and reviews of the literature. A modified discriminant function analysis was performed to determine the interaction between the source of payment for assistive technology used by persons with disabilities. In the sample of 1,414 such persons, 901 were found to use some form of assistive technology in their daily lives. Ten distinct sources of payment were specified. Respondents were able to mention up to three sources of payment for each example of assistive technology used. A total of 1,877 sources were mentioned. Overall, the most mentioned payment source was self or other family member in household, accounting for nearly 40% of all sources mentioned. The variables tested were found to have varying levels of interactive potency. Occupational status, education level, severity of impairment, opinion as to the effectiveness of assistive technology, and personal income were significant, whereas age, family income, opinion as to improvement over the past decade, and race were statistically unrelated to source of payment. From the perspective of relative discrimination on the basis of payment source, Medicare stands as the lone significant discriminant source of payment. The authors offer a summary and conclusion based on an integrated view of all available sources of information about payment.

Persons with Disabilities↗
PubMed2006

VEdeTTE, a longitudinal study on effectiveness of treatments for heroin addiction in Italy: study protocol and characteristics of study population.

The aim of this study was to provide a methodological overview of the study design of the national evaluation large-scale study VEdeTTE and a description of the VEdeTTE study population and to compare enrollments with refusals and the study population with the overall clients at the National Health System (NHS) treatment centers. VEdeTTE is a longitudinal study of heroin addicts recruited in 115 NHS treatment centers in Italy, 1998-2001; 11,903 people were enrolled, 3876 refused to participate; data were analysed on 10,454. Information from refusals was compared to enrollments. The characteristics of the cohort were compared to those of all patients treated in 1999 in Italy. Refusals had a lower educational level and less regular occupational status than those enrolled. Fourteen percent of enrolled patients were women; heroin users in the VEdeTTE study were older than patients attending all NHS treatment centers in Italy; incident cases were less represented. The majority of participants had more than 8 years of education, 33.5% were regularly employed, and only 2% did not have a fixed address. Injectors were 72.3%; 40.6% had a previous overdose, and 14.3% had been imprisoned for life; 15.7% shared injection equipment during the previous 6 months. The proportion of participants reporting heroin use approximately halved from the beginning of the current treatment to the time of the interview. The VEdeTTE study is the biggest cohort of heroin addicts attending treatment centers in Europe. The Italian heroin-addicted population under treatment seems to have low level of education but good social integration. Compared with men, women show a higher severity. Participants show a beneficial effect of treatment.

Adult↗
PubMed2002

Case study of circadian rhythm sleep disorder following haloperidol treatment: reversal by risperidone and melatonin.

A patient with Gilles de la Tourette syndrome treated with haloperidol, ingested once daily after awakening from sleep, exhibited an irregular sleep-wake pattern with a free-running component of approximately 48 h. Transfer to risperidone, ingested once daily after awakening from sleep, was beneficial resulting in a sleep-wake cycle more synchronized at the appropriate phase to the external zeitgebers, and fewer nocturnal disturbances. The circadian sleep-wake schedule was fully synchronized when the patient had been subsequently treated with melatonin at 21:00h, before intended nocturnal sleep, in addition to risperidone in the morning. Restoration of the sleep-wake circadian pattern was accompanied by the patient's subjective report of significant improvement in his quality of life, social interactions, and occupational status. This observation suggests that circadian rhythm sleep disorders can be related to the typical neuroleptic haloperidol and restored by the atypical neuroleptic risperidone. Similar findings reported in patients suffering from other disorders support the hypothesis that the described disruption of the sleep-wake schedule is medication rather than illness-related. Therefore, it is very important to realize that circadian rhythm sleep disorders may be a side effect of neuroleptics.

Adult↗
PubMed2001

Long-term effects of stimulant medications on the brain: possible relevance to the treatment of attention deficit hyperactivity disorder.

In spite of extensive data supporting the short-term efficacy and safety of stimulant medications in the treatment of children with attention deficit hyperactivity disorder (ADHD), only limited information is available on the long-term effects of these drugs. On one hand, it is unclear whether treatment of ADHD with amphetamine-like stimulant medications for extended periods of time during child development can carry negative consequences, as manifested by an increase in use of illicit drugs, higher incidence of mania, psychosis, or other manifestations of psychopathology. On the other hand, it is not known whether the beneficial effects of stimulants extend beyond acute symptomatic relief and affect important outcome variables, such as later psychopathology, educational achievement, antisocial behavior, and social or occupational status. Data from naturalistic follow-up of clinical samples are limited by lack of appropriate controls and self-selection biases that are difficult to determine and control. These studies have reached conflicting conclusions, although most of them found no lasting negative effects of chronic stimulant treatment. Studies in animals, mainly in rodents, indicate that repeated exposure to stimulants leads to behavioral sensitization to the psychomotor effects of these medications. Extrapolation of these data to therapeutic use in humans is difficult given interspecies differences and the relatively high doses and parenteral route of administration usually employed in animals. This report is based on the proceedings of a workshop organized by the National Institute of Mental Health in December 1999 to discuss possible research approaches to studying the long-term effects of stimulants in children with ADHD. Both clinical and basic neuroscience data are reviewed, and opportunities for future research are highlighted.

Animals↗
PubMed2003

Choice of unconventional treatment by patients with cancer.

OBJECTIVES: Previous studies conducted on the use of unconventional treatment by patients with cancer have focused on unconventional treatment as a joint group of therapies. The objective of this study is to gather preliminary information about the use of different modes of unconventional cancer treatment by patients with cancer and to describe user profiles of standardized and individualized treatments. DESIGN: Data originate from an ongoing explorative 5-year study of 441 consecutively registered cancer patients who have consulted medical doctors and alternative therapists practicing unconventional treatment in Denmark. This paper is based on data from the first and second of six questionnaires. The unconventional treatments included in this study are categorized into two forms of treatment: standardized and individualized treatment. SUBJECTS: Four hundred and forty-one (441) Danish patients with cancer who use unconventional cancer treatment. OUTCOMES MEASURES: The analysis shows significant correlations between type of treatment and the following variables: gender, education, occupational status, type of cancer, purpose of seeking unconventional treatment, metastatic spread, opinion regarding appropriate unconventional treatment, and simultaneous use of unconventional treatment. RESULTS: The study shows that there are significant differences between patients with cancer choosing standardized and those choosing individualized unconventional treatment. The probability of choosing standardized unconventional treatment is greatest among male participants, patients having shorter school education, and for patients who have recovery as the goal of seeking unconventional treatment. The probability of choosing individualized unconventional treatment is greatest among women, for patients with longer school education, and for patients wanting relief from symptoms, information, and improvement of general condition as the purpose of seeking unconventional cancer treatment. Patients with breast and gynecologic cancer are more inclined to seek individualized treatment than patients with all other cancer diseases. CONCLUSIONS: The study points to the fact that it might be essential to differentiate between different forms of unconventional treatment to understand the use by patients with cancer and the outcomes of these treatments.

Adult↗
PubMed2006

The role of low grade inflammation as measured by C-reactive protein levels in the explanation of socioeconomic differences in carotid atherosclerosis.

BACKGROUND: The role of inflammation as part of the explanation of socioeconomic differences in carotid atherosclerosis has not been specifically investigated. METHODS AND RESULTS: The associations between socioeconomic position (SEP), C-reactive protein (CRP), and preclinical carotid atherosclerosis were investigated in a general population sample of 3921 middle-aged Swedish men and women. Common carotid intima-media thickness (IMT) and presence of carotid plaque (focal IMT > 1.2 mm) were determined by B-mode ultrasound. The results showed that low SEP was associated with increased levels of CRP, independently of established risk factors. Furthermore, common carotid IMT increased with increasing CRP-levels. Presence of carotid plaque increased with increasing CRP-levels in men, but not in women. While the socioeconomic differences in carotid IMT were weak, there were associations between low educational level and carotid plaque prevalence with an age- and sex-adjusted odds ratio (OR) of 1.39 (95% CI: 1.21, 1.59). A similar association was seen for having a manual occupation, OR = 1.23 (95% CI: 1.07, 1.42). The age- and sex-adjusted absolute differences in carotid plaque prevalence were 9% with regard to educational level and 7% with regard to occupational status. Adjustment for CRP caused only a minor attenuation of the association between SEP and carotid atherosclerosis. CONCLUSIONS: The association between SEP and carotid atherosclerosis as measured by carotid IMT and carotid plaque could only to a minor extent be referred to differences in low grade inflammation as measured by CRP.

C-Reactive Protein↗
PubMed1984

Retirement preparation programs: differentials in opportunity and use.

Two issues rarely addressed in the retirement planning field are (a) the proportion of older workers who participate, or have the opportunity to participate, in retirement preparation programs; and (b) socioeconomic differentials in access to such programs. Data from the National Longitudinal Surveys of older men were used to investigate these two issues. The data indicate that fewer than 4% of this sample of men aged 60 to 74 in 1981 had participated in a retirement preparation program. Logistic multiple regression analysis indicated that level of education, occupational status, government employment, and private pension coverage were positively related to the likelihood of participation as well as the likelihood of opportunity to participate. Conclusions from this analysis are (a) very few older men are ever exposed to retirement preparation programs and (b) those who would seem to benefit most from preparation programs, low status and low income workers, are the least likely to have access to these programs.

Aged↗
PubMed1986

Characteristic depressive symptoms of bereaved elders.

Profiles of 21 self-reported depression symptoms from 196 recently bereaved elders (mean age = 67.70 years) were compared with those of 145 comparison control participants (mean age = 70.01). Responses from bereaved individuals were recorded approximately 2 months following the loss of their spouse. Comparison participants were married or, if single, had not lost a spouse to death or divorce in the previous 5 years. Results were consistent with the literature concerning normative bereavement reactions; that is, although bereaved people reported several features associated with depression, the likelihood of self-deprecatory cognitions was no greater among them than among control participants. Bereaved individuals were significantly more likely to report heightened dysphoria, dissatisfaction, and somatic disturbances typical of depression, even when variations in age, sex, number of years married, and educational and occupational status were taken into account. Differentiation of bereaved/control participants on some dysphoric features was dependent on the number of years married.

Aged↗
PubMed1992

Adjustment among different age and ethnic groups of Indochinese in the United States.

This study examines adjustment among different age and ethnic groups of Indochinese refugees in the United States. The data came from a nationwide probability sample of 3,414 respondents aged 20 or older. Respondents are divided into four age groups (20-29, 30-39, 40-54, and 55 and older). Ordinary least squares regression analysis revealed that education, occupational status, urban/rural location in the country of origin, English language ability, financial problems, gender, age, and length of residence in the U.S. had statistically significant relationships with adjustment in different age and ethnic groups.

Adaptation, Psychological↗
PubMed1992

Smoking habits in Denmark from 1953 to 1991: a comparative analysis of results from three nationwide health surveys among adult Danes in 1953-1954, 1986-1987 and 1990-1991.

Changes in smoking habits in Denmark from 1953 to 1991 are described on the basis of data from three nationwide population surveys on health and morbidity. The data on smoking habits were collected at personal interviews with 34,018, 4753 and 4818 subjects aged more than 15 years in 1953-1954, 1986-1987 and 1990-1991, respectively. Among men, the proportion of smokers has fallen from 78% to 47%, but among women it has remained constant at around 40%. The greatest decrease occurred among younger men. The proportion of heavy smokers (> or = 15 g tobacco a day) has remained constant at around 25% in men, but in women it has increased from 3% to 14%. There is a correlation between occupational status and smoking; the proportion of smokers being highest among the unemployed, early retirement pensioners and unskilled workers, and lowest among upper-level salaried employees. Today, more smokers started smoking before the age of 15 years. Possible explanations of the changes include public debate, campaigns concerning the health risks of tobacco, and a change in the roles of the sexes. Since today's smokers are characterized by smoking onset before age 15 years it is proposed that future initiatives to reduce smoking must focus on the psychosocial factors related to early onset of smoking.

Adolescent↗
PubMed1997

The association of modernization with dyslipidaemia and changes in lipid levels in the Polynesian population of Western Samoa.

BACKGROUND: Obesity and non-insulin-dependent diabetes mellitus (NIDDM) have increased in prevalence in Polynesian Western Samoans over the 13-year period 1978-1991, as the population undergoes an 'epidemiological transition'. METHODS: We therefore investigated changes in the frequency of dyslipidaemia over the same period in adults aged 25-74 years, and examined factors associated with dyslipidaemia in cross-sectional and longitudinal data. Subjects were drawn from three geographically defined locations representing different degrees of modernization. RESULTS: The age-standardized prevalence of dyslipidaemia increased in each location between 1978 (n = 1197) and 1991 (n = 1748) with the prevalence of hypercholesterolaemia (> or = 5.5 mmol/l) increasing from 18% to 36% (P < 0.001), and that of hypertriglyceridaemia (> or = 2.0 mmol/l) increasing from 9% to 15% (P < 0.001) in the capital city, Apia. In 1991 the highest serum concentrations of total, high density lipoprotein (HDL) and calculated low density lipoprotein (LDL) cholesterol were found in Poutasi (intermediate level of modernization), and the highest triglyceride levels in urbanized Apia. Higher levels of body mass index (BMI), waist-hip ratio (WHR), glucose intolerance, fasting insulin concentration, physical inactivity, educational level, and occupational status were all associated with adverse lipid levels in univariate data. Obesity (BMI in women, WHR in men) and survey location were the most important correlates of abnormal lipid levels in logistic regression models. Fasting insulin was also independently associated with high triglyceride levels in men, while in women the increasing levels of fasting insulin were associated with adverse levels of total, LDL and HDL cholesterol, and triglycerides. In longitudinal data (n = 311), lower baseline levels of cholesterol and triglycerides were associated with greater increases in either parameter at follow-up. Elevated fasting insulin and female gender also predicted increasing cholesterol concentrations, and urban residence predicted an increase in triglyceride levels. CONCLUSIONS: Current levels of dyslipidaemia in Western Samoa are similar to those observed in developed Western populations, and are increasing rapidly. These findings, considered along with the high prevalence of other cardiovascular disease risk factors in Samoans, including smoking, obesity and NIDDM, suggest that cardiovascular disease will be a major health concern in the future.

Adult↗
PubMed1999

Effects of husbands' smoking on the incidence of lung cancer in Korean women.

BACKGROUND: Although smoking remains uncommon among Korean women, lung cancer mortality is rapidly escalating. METHODS: We investigated the effects of spousal smoking in 160130 Korean women, aged 40-88, who received health insurance from the Korea Medical Insurance Corporation (KMIC). Exposure data were collected during medical examinations conducted between April 1992 and June 1994. The primary outcome variable was the incidence of lung cancer defined by hospital admissions between July 1994 and December 1997. Standardized rates for the incidence of lung cancer were assessed according to the smoking habits of their husbands. RESULTS: At baseline (n = 160 130), 53.9% of husbands were smokers and 23.3% were ex-smokers, while 1.1% of wives (n = 1756) were current smokers and 0.6% (n = 938) were ex-smokers. During follow-up, 79 cases of lung cancer occurred among non-smoking wives (n = 157436). Wives of heavy smokers were found to have a higher risk of developing lung cancer. The husbands' smoking habits did not affect their wives' risk of developing other cancers such as those of the stomach, liver and cervix, but they did affect breast cancer, which has a significantly higher risk in relation to the longer duration of husbands' smoking. In Poission regression models, adjusting for the age of both husband and wife, socioeconomic status, occupation, residency and vegetable intake, the rate ratio (RR) of lung cancer in non-smoking wives was 1.9 (95% CI: 1.0-3.5) in current smokers and 1.3 (95% CI: 0.6-2.7) in ex-smokers. The RR of lung cancer was 3.1 (95% CI: 1.4-6.6) in wives of husbands who had smoked for 30 years or more compared with wives of non-smoking husbands. CONCLUSION: In Korea, the incidence of lung cancer is higher among non-smoking women whose husbands smoke, and a dose-response relationship seems to exist.

Adolescent↗
PubMed2004

Family, socioeconomic and prenatal factors associated with failure to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC).

BACKGROUND: The epidemiological profile of infants failing to thrive is unclear. The aim of this study is to investigate the prenatal and socioeconomic factors associated with these infants using standardized weight gain conditional on previous weight. METHODS: In a large UK population cohort study, 11 718 infants born at term in 1991-1992 with no major congenital abnormalities were identified. Using a weight gain criterion conditional on initial weight from birth to 6-8 weeks, 6-8 weeks to 9 months, and birth to 9 months, the slowest gaining 5% were identified. RESULTS: None of the prenatal factors was associated with failure to thrive in the multivariable analysis nor were traditional markers of socioeconomic deprivation such as poor parental education or low occupational status. Parental height was significantly correlated with slow infant weight gain in both separate periods and from birth to 9 months (Pearson's r = +0.20, P < 0.001). Eight times as many infants born to shorter parents (8.7%, 95% CI: 6.6, 11.3) showed slow weight gain as infants born to taller parents (1.1%, 95% CI: 0.5, 2.5). Higher parity was also related to slow infant weight gain; infants born in the fourth or subsequent pregnancy were twice as likely to fail to thrive from birth to 9 months (8.3%, 95% CI: 6.4, 10.6) as first-born infants (3.4%, 95% CI: 2.9, 10.6). CONCLUSIONS: Future studies need to take account of parental height when calculating growth standards and look at why failure to thrive is more common, not in poorer families but in larger families.

Adult↗
PubMed1993

Parents' contributions to knowledge and attitudes regarding AIDS.

Examined, in a sample of 170 students in Grades 1-12, relationships between parental background and socialization variables and children's knowledge of AIDS risk factors and willingness to interact with people who have AIDS. Most parents had talked to their children about AIDS and supported early AIDS education, but were susceptible to common transmission myths. Age was the strongest predictor of a child's knowledge and attitudes, but parent ethnicity, education, and occupational status also contributed. Moreover, consistent with a "potentiation" model of socialization, parent knowledge of common transmission myths predicted child knowledge of those same myths only when parent-child communication about AIDS was relatively frequent.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Increase of physical activity level after successful renal transplantation: a 5 year follow-up study.

BACKGROUND: Physical activity (PA) level of end-stage renal disease (ESRD) patients after renal transplantation (TP) is a largely unexplored field, although it is an important component of quality of life. METHODS: Using the Baecke self-administered and the Five-City Project 7-day PA recall questionnaires, PA level was estimated in 32 consecutive ESRD patients (12 males, 20 females; mean age 45.9+/-13.1 years; mean dialysis duration 23.5+/-21.8 months) admitted for renal TP and to whom no exercise programme of any kind was proposed. PA were recorded 1, 3, 6, 12 and 60 months after TP. RESULTS: Immediate pre-TP PA level of renal transplant candidates was between 18 and 35% less than that of age-matched healthy subjects (P < 0.05), depending on gender and questionnaire. After an immediate decrease in PA level 1 month post-TP, mean PA level increased and reached a plateau 1 year after TP. This gain in PA capacity reached 30%, as compared with pre-TP values (P = 0.06 to P < 0.01). During the fifth year after TP, the mean level of PA was unchanged. A more qualitative analysis, allowed by the sub-score comparisons, showed that although the occupational status of the patients remained the same, they participated significantly more in moderate and even high intensity PA (leisure, sports, household chores) after TP. CONCLUSIONS: Most renal graft recipients are spontaneously more active after TP, an observation consistent with a better quality of life. Therefore, they should be advised precisely about how to resume more strenuous activities such as sports in order to avoid cardiac or musculoskeletal disorders in relation to their weakened pre-TP condition.

Adult↗
PubMed1980

A case-control study of Hodgkin's disease in Brazil. I. Epidemiogic aspects.

A number of epidemiologic variables were investigated in a case-control interview study, conducted in São Paulo, Brazil, of 70 Hodgkin's disease (HD) patients, 70 tumor control subjects matched for age and sex, and 128 siblings of the patients. The major epidemiologic findings were a high percentage of total cases among children, with a high sex ratio, a relative predominance of the mixed cellularity histologic subtype, and a bimodal age-specific incidence curve with the highest rates among young adults and the elderly. When the matched controls were used as the comparison group, high socioeconomic status (SES) was found to be associated with an increased risk for HD (p = 0.001). On the basis of the case-sibling comparison, an association between prior tonsillectomy and risk for HD was found (p = 0.04), and the relative risk for HD among tonsillectomized persons as compared to individuals who had not had the operation was 2.5. Other variables, including sibship size, birth order, marital status, occupational exposure, prior use of amphetamines or diphenylhydantoin, intensity of exposure to children and history of viral illnesses were not found to be determinants of risk for HD in this study.

Adolescent↗
PubMed1986

Stress and acute respiratory infection.

To examine the relationship between stress and upper respiratory tract infection, 235 adults aged 14-57 years, from 94 families affiliated with three suburban family physicians in Adelaide, South Australia, participated in a six-month prospective study. High and low stress groups were identified by median splits of data collected from the Life Events Inventory, the Daily Hassles Scale, and the General Health Questionnaire, which were administered both before and during the six months of respiratory diary data collection. Using intra-study stress data, the high stress group experienced significantly more episodes (mean of 2.71 vs. 1.56, p less than 0.0005) and symptom days (mean of 29.43 vs. 15.42, p = 0.005) of respiratory illness. The two groups were almost identical with respect to age, sex, occupational status, smoking, passive smoking, exposure to air pollution, family size, and proneness to acute respiratory infection in childhood. In a multivariate model with total respiratory episodes as the dependent variable, 21% of the variance was explained, and two stress variables accounted for 9% of the explained variance. Significant, but less strong relationships were also identified between intra-study stress variables and clinically "definite" episodes and symptom days in both clinically definite and total respiratory episodes. Pre-study measures of stress emphasized chronic stresses and were less strongly related to measures of respiratory illness than those collected during the study. However, significantly more episodes (mean of 2.50 vs. 1.75, p less than 0.02) and symptom days (mean of 28.00 vs. 17.06, p less than 0.03) were experienced in the high stress group. In the multivariate analyses, pre-study stress remained significantly associated with total respiratory episodes and symptom days in total and "definite" respiratory episodes. In all of the multivariate analyses performed, sex (female) and age also appeared as important correlates of respiratory illness.

Adolescent↗