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PubMed1993

The middle-Norway eye-screening study. III. The prevalence of capsular glaucoma is influenced by blood-group antigens.

The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p < or = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.

Aged↗
PubMed2005

Risk factors for peripheral arterial disease incidence in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study.

BACKGROUND: Some risk factors for peripheral arterial disease (PAD) have been identified, but little information is available on PAD risk factors in individuals with diabetes. METHODS: Using data from the Atherosclerosis Risk in Communities (ARIC) Study, we assessed the relation of traditional and non-traditional risk factors with the risk of PAD in 1651 participants with diabetes, but not PAD, at baseline. Incident PAD was defined as an ankle-brachial index (ABI)<0.9 assessed at regular examinations; hospital discharge codes for PAD, amputation, or leg revascularization; or claudication assessed by annual questionnaire. RESULTS: Over a mean of 10.3 years of follow-up, 238 persons developed incident PAD identified, yielding a PAD event rate of 13.9 per 1000 person years. Adjusted for sex, age, race, and center, the risk of developing PAD was increased 1.87-fold (95% confidence interval (95% CI): 1.36-2.57) in persons who were current smokers versus non-smokers, 2.27-fold (95% CI: 1.57-3.26) for baseline coronary heart disease (CHD) versus no baseline CHD, and 1.75-fold (95% CI: 1.18-2.60) for the highest quartile versus lowest quartile of triglycerides. We found no evidence of an association with other blood lipids or hypertension. Compared with the lowest quartiles, comparably-adjusted relative risks for the highest quartiles were 1.60 (95% CI: 1.10-2.33) for waist-to-hip ratio, 2.52 (95% CI: 1.70-3.73) for fibrinogen, 1.70 (95% CI: 1.17-2.47) for factor VIII, 1.73 (95% CI: 1.18-2.54) for von Willebrand factor, 2.15 (95% CI: 1.43-3.24) for white blood cell count, 1.81 (95% CI: 1.19-2.74) for serum creatinine, 0.55 (95% CI: 0.37-0.83) for serum albumin, and 2.73 (95% CI: 1.77-4.22) for carotid intima-media thickness. Persons who had a prior history of diabetes and were taking insulin had a relative risk of 1.97 (95% CI: 1.35-2.87) for future PAD events, compared with those with newly identified diabetes at baseline. In our final multivariable model, current smoking, prevalent CHD, elevated fibrinogen and carotid IMT, and a prior history of diabetes with insulin treatment were independently associated with greater PAD incidence. CONCLUSION: These markers might be useful to identify individuals with diabetes at particular risk for PAD.

Arteriosclerosis↗
PubMed1990

Can first-year medical students contribute to better care for patients with a chronic disease?

First-year medical students at the University of Western Australia are attached to a patient with a chronic illness in order to begin to understand the world of the chronically ill and their families. The patients are recruited by general practitioner preceptors who have been reticent in accepting first-year students because of their perceived immaturity and lack of medical knowledge. Not only have the preceptors' reservations proven groundless, but the teaching exercise has produced an unintended and positive side in that 35% of students discovered new information which was judged by the patients' general practitioners to be of significant help in the total management of patients' illness. Since these were only first-year medical students, the effect should be much greater with more mature students. Doctors often have incomplete records and act on incomplete information. Medical students are a means of correcting some of these deficits. In return they develop better psychosocial and communication skills and achieve considerable personal development by demonstrating to patients, their preceptors and themselves that they can be useful in contributing to more effective patient care.

Chronic Disease↗
PubMed2006

Application of attachment theory for psychological support in palliative medicine during the terminal phase.

BACKGROUND AND PURPOSE: The situation leading to the death of a close relative is a unique and irrevocable experience of separation which evokes a state of emotional strain for the patient and the family. This situation therefore is an especially effective trigger of the so-called 'attachment system'. Attachment research in recent decades has shown that already in early infancy every person develops special attachment strategies activated in cases whenever a person cannot cope on its own with dangers. Only four such patterns of attachment have been specified, namely 'secure', 'insecure-avoidant', 'insecure-ambivalent/enmeshed' and 'disoriented/disorganized'. Since the dying are usually brought to the hospital by members of the family, the doctor responsible for treatment can perceive with unusual clarity the patterns of attachment within the family system, and can integrate such observation into her treatment strategy. This article suggests an attachment-informed therapy in the field of palliative medicine. It seems apparent that such approaches provided by the attachment theory for relief during the terminal phase are not only relevant in a palliative context but also applicable within the overall field of medicine and care-giving relating to terminal patients and their families. METHODS: To the doctor familiar with the attachment patterns and the conditions of their formation, clinical observation easily reveals which pattern is active among the dying and the accompanying members of the family. Here, cases are used to show how these insights can be realized in the psychotherapeutic care of patients and their families on a palliative ward. For example, in a case of 'avoidant' attachment, denied emotions can be addressed carefully and still existent hopes for protection and support can be reinforced; in a case of so-called 'ambivalent-enmeshed' attachment, overly intense relationships can be disentangled, and in a case of 'disorganized' attachment, emotion regulation can be supported and clarity in the relationships can be promoted. RESULTS: The clinical results show that psychotherapeutic intervention based on insights imparted by the attachment theory are of special benefit in relieving the psychological strain for the dying and their families.

Aged↗
PubMed2005

Mentoring, clinical supervision and preceptoring: clarifying the conceptual definitions for Australian rural nurses. A review of the literature.

In Australia, mentoring is beginning to emerge on the rural and remote nursing landscape as a strategy to improve the recruitment and retention of nurses. However, the terminology used to discuss this and other supportive relationships in nursing is often unclear and can be confusing. The main aim of this article is to locate mentoring, clinical supervision and preceptoring in the nursing literature, and thus provide a guide for Australian rural nurse clinicians, managers and policy-makers in general. It is through better understanding of the possibilities of each type of relationship that they can be factored into the development of supportive work settings, and that will encourage the retention of existing staff and possibly the recruitment of new staff. Each type of supportive relationship discussed in the literature has a different focus. Mentoring is broadly based and concentrates on developing areas such as career progression, scholarly achievements and personal development. Clinical supervision focuses on progressing clinical practice through reflection and the provision of professional guidance and support. Preceptorship focuses on clinical skill acquisition and socialisation. Each support relationship also differs in context and intensity. Mentoring relationships are based around developing reciprocity and accountability between each partner. They are normally conducted outside the work environment and in the participants' own time. Clinical supervisory relationships are similar to mentoring in that they are reliant on developing a strong sense of reciprocity and accountability, and take place over a long period of time. They differ, though, in that they are conducted during working hours, although preferably away from the work setting. They are also commonly facilitated through the use of small groups. Preceptoring relationships are short term, exist in the clinical context and concentrate on clinical skill acquisition and assessment.

Australia↗
PubMed1978

Personality characteristics of physically impaired adolescents.

Investigated MMPI profile differences between disabled and nondisabled (normals). Comparison of mean raw scores on the MMPI was made by t-tests. A preliminary analysis that compared adolescents with congenital versus traumatic impairment yielded only one significant finding: Scale O (Si) (p is less than .05) for females with congenital impairment. Subsequently, after the congenital and traumatic groups for each sex were combined, t-tests were computed on mean raw scores of the MMPI for each scale between the disabled and nondisabled adolescent groups. The profile patterns of the disabled groups for both sexes were similar; however, the male disabled adolescents had significantly higher scores on Scales 1, 2, 5, 8 and 9, while the disabled female adolescents had significantly higher scores on Scales F, 1, 6, 7, 8 and 9. Inspection of the profiles revealed minimal sex differences among the disabled groups. It was suggested that the common factor of moderate to severe chronic physical impairment may serve to reduce normative sex differences in personality development at least as reflected by the MMPI.

Adaptation, Psychological↗
PubMed1992

Care for AIDS patients in developing countries: a review.

As an ever increasing number of HIV-infected persons develop AIDS, treating the manifestations associated with HIV infection has become a new challenge to health sectors in developing countries. Given resource constraints of health systems before the AIDS epidemic, there is an urgent need to start examining ways in which health care can be delivered to the large number of AIDS patients, without infringing on other primary health care activities. This paper reviews current experience with AIDS patient care management in developing countries and determines some of the areas where further research is crucial. The main issues identified are: (1) that reliable data on standardized treatment schemes for AIDS patients are scarce; (2) that there is an urgent need for research on low-cost supportive treatment of AIDS patients, comparing costs and outcomes; (3) that outpatient and home-based care can be a valuable alternative to hospital-based care, but that cost-efficiency of these alternative treatment strategies should be examined more closely; and finally, that (4) the potential benefit of using HIV/AIDS patients to promote prevention of HIV transmission should be acknowledged.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Family Violence and Development during Adolescence.

Adolescence is a time of major physical, emotional, social, and personal development. This chapter focuses on how these developmental issues are related to the types, causes, outcomes, prevention, and treatment of family violence involving adolescents. As adolescents are not well represented in the family violence literature, the authors conclude the chapter with a section on the need for further research in this area.

Journal Article↗
PubMed1986

The timing of psychosocial transitions and changes in women's lives: an examination of women aged 45 to 60.

Sixty-four middle-class women from four cohorts aged 45, 50, 55, and 60 participated in a retrospective interview concerning psychosocial changes in their adult lives. Their responses provided self-report data relating to specific psychosocial changes, and judges who read the interview protocols provided independent ratings of major psychosocial transitions. The results indicated that major psychosocial transitions were more likely to be associated with phases of the family cycle than with chronological age; within the family cycle, transitions were more likely to occur during the preschool (28% of the women), launching (42% of the women), and postparental (33% of the women) phases than during the no children, school-age, or adolescent phases; transitions associated with the preschool and launching phases were characterized by dissatisfaction, personal disruption, marital unhappiness, and decreased personal development, whereas transitions associated with the postparental phase were characterized by personal mellowing and improved marital relations; and finally, numerous self-reported psychosocial changes were associated with family cycle phase, and a small number of changes was associated with chronological age.

Age Factors↗
PubMed1995

[A prospective epidemiological investigation on the effect of China-mode attenuated live vaccine against hepatitis A in the population of Liu Zhou].

An 24-month prospective epidemiological investigation on the results of China-mode Hepatitis A attenuated live vaccine against hepatitis A by random group sampling was carried out. The incidence of case group was 15.91/10(5) (5/31421), the incidence of control group was 95.92/10(5) (30/ 31277) which showed a significant difference. In case group 2081 persons who missed vaccination, there was one person developed hepatitis A, making the incidence 48.05/10(5). In control group 760 persons were vaccinated by mistake and there was no case developed in this sub-population. There were 644 cases of hepatitis A in the external control group, the incidence was 90.14/10(5). Data showed that there was no significant difference among external control group, control group and persons from case group who missed vaccination. Comparing the data from case group and from the above 3 groups, the protective rates were 82.35%, 83.41% and 66.89%. respectively. When conparing the data from persons who had been mistakenly vaccinated in control group, there was no significant difference being noticed.

Adolescent↗
PubMed1997

Attachment and psychotherapy: an overview.

Attachment theory has an important role in clarifying personality development, and attachment style is increasingly recognised as a key intervening variable between personality and the response to psychotherapeutic interventions. Recent developments in attachment theory and its relationship to practice are reviewed as an introduction to a series of papers on Attachment and Psychotherapy.

Adult↗
PubMed1998

Summary of the II International Symposium on Cytomegalovirus.

Human cytomegalovirus (HCMV) is a highly species-specific DNA virus belonging to the Betaherpesvirinae subfamily of the herpesviridae family. Like other herpesviruses, primary infection with HCMV is followed by persistence of the virus in a latent form. The sites of latency are still largely undefined, but they probably include bone marrow progenitor cells and peripheral blood monocytes. From these sites, the virus can reactivate, resulting in renewed shedding of the virus, or, in immunocompromized persons, development of disease. Humans are the only reservoir of HCMV and transmission occurs by person-to-person contact. Infection with HCMV is common. In most developed countries, HCMV seroprevalence steadily increases after infancy and 10-20% of children are infected before puberty. In adults, the prevalence of antibodies ranges from 40 to 100%. Although HCMV has a world-wide distribution, infection with HCMV is more common in the developing countries and in areas of low socioeconomic conditions, which is predominantly related to the closeness of contacts within these populations. Except for a mononucleosis-like illness in some persons, infection with HCMV rarely causes disease in immunocompetent individuals. However, HCMV can cause severe morbidity and mortality in congenitally infected newborns and immunocompromized patients, most notably transplant-recipients and HIV-infected persons. This article provides a review of the information presented at the Second International Symposium on Cytomegalovirus organized and convened by The Macrae Group (New York City, NY) in Acapulco, Mexico on 24-28 April 1998. During this symposium, the state-of-the-art knowledge on diagnosis, treatment and prophylaxis of HCMV infections were discussed, and, based on this information, attempts to highlight the future directions in basic and clinical research areas that need to be stimulated to facilitate advancement in prevention and treatment of CMV disease.

AIDS-Related Opportunistic Infections↗
PubMed1987

The expectation and parentage of twins. A study on the language development of twin infants.

This is a follow-up study aiming to describe personality development of twins and possible differences at different ages. The investigation was conducted at the Mother Clinic in the Karolinska Hospital in Stockholm. This report describes the language development of 35 twin pairs at 9 months of age. The development values show that no greater differences exist for girls between twins and singletons. The language result is however lower. The boys, on the other hand, have considerably lower results both on total development scale and on the language scale.

Birth Weight↗
PubMed2003

[Interconnection of stress and physical development processes in young persons].

The physical development (PD) rates, constitutional peculiarities and an integral level of different manifestations of stress-reactivity (SR) were evaluated in 201 students of Medical Academy (73 males and 138 females), aged 17-21; the above parameters were tested by the color method of Luscher, by Teylor's anxiety assessment, by "Individual Minute" measurements, by the iridoscopic count of iris nervous rings, by the "Mathematical Count" technique and by calculating the index of regulatory systems' tension according to the heart rate variability. The highest total SR index, including the SR cardiac manifestations was found in youth to correlate with the lowest PD index. The integral SR level correlated, in youth, inversely with the PD parameters. Such relations are more pronounced in individuals of the abdominal somatic type. The mechanisms and biological significance of SR correlations with the processes of growth and development are under discussion.

Adolescent↗
PubMed1997

Role of personality self-organization in development of mental order and disorder.

Normal and abnormal personality development can be quantified in terms of 15 specific steps in the self-organization of character as a complex adaptive system. Character is measured as three dimensions of Self-directedness, Cooperativeness, and Self-transcendence, each with five components corresponding to steps in personality development. Each of these steps is differentially influenced by heritable temperament dimensions, antecedent steps in character development, and life experiences. Predictions about the nonlinear dynamics of personality development, such as equifinality and multifinality, are confirmed in longitudinal data about individuals representative of the general population. The stepwise development of character determines large differences between individuals in their risk of psychopathology, as well as varying degrees of maturity and health.

Child↗
PubMed1989

Comparison of anamnestic history, alcohol intake and smoking, nutritional status, and liver dysfunction between thorotrast patients who developed primary liver cancer and those who did not.

In order to clarify the differences in past history, nutritional condition and, consumption of alcohol and tobacco, and liver dysfunction between the thorotrast patients who developed primary liver cancer and those who did not, 103 persons who had no primary liver cancer in January 1980 were studied. All subjects were military men who had undergone angiography with thorotrast between 1943 and 1946. Twenty persons developed hepatocellular carcinoma and 16 developed intrahepatic bile duct carcinoma by April 1987, whereas 67 are still alive without any cancer. There was no difference in age or period after thorotrast infusion between those two groups of patients in January 1980. A difference in history of hepatitis and/or jaundice and presence of hepatic dysfunction was found between the subjects who developed primary liver cancers and those who did not. These findings suggest that an anamnestic history of hepatitis and liver dysfunction are risks for development of thorotrast-induced liver cancer. On the basis of the above findings, early detection of liver dysfunction offers a possibility of early diagnosis of primary liver cancer.

Aged↗
PubMed1976

[Drug therapy of early-childhood minimal brain damage].

Drug therapy in a child with juvenile psychoorganic syndrome is only one part of a comprehensive therapeutic program in which the main emphasis is on training and education, which are sometimes accompanied by psychotherapy. In many cases drug therapy is totally unnecessary. It may however provide essential support for the efforts of educators and therapists and is sometimes the factor which renders these possible at all. Not all symptoms respond equally well: the best results are obtained in disorders of drive and often in psychogenic disorders which have developed on the basis of the psychoorganic syndrome. Promotion of personality development, which is virtually always retarded in the child with psychoorganic syndrome, remains the exclusive preserve of training. Drug administration has psychogenic as well as chemical effects. It depends to a large extent on the reaction of the environment to the fact that drugs are being given at all, and to the behavioral changes exhibited by the treated child. Drug effects are thus modified, and, with time, determined by the environment, and thus in many cases treatment is possible only on a short-term or (sometimes) periodic basis. Where treatment is on a long-term basis the danger of drug dependency must be borne in mind, since patients with psychoorganic syndrome are particularly exposed to the risk of addiction. For this reason care is necessary in administering amphetamine-type substances. These drug should not be prescribed from puberty onwards; previously initiated treatment with them should be terminated before purberty. It should however be pointed out that the results registered with amphetamines and drugs with similar effect can usually be obtained equally with drugs involving fewer risks in this respect.

Age Factors↗
PubMedDate not supplied

[Validation study of the Depressive Experience Questionnaire].

Sidney Blatt, considering as being insufficient the categorical-symptomatic approach of depression, has worked out a theory of depression and psychopathology that integrates the contributions of psychoanalysis as well as cognitive and developmental psychology. Within a broad psychoanalytic framework, Blatt's formulation focus on the quality of interpersonal relationship, the nature of object representation and early life experiences. Personality development is viewed as the consequence of the interaction of 2 basic developmental tasks: the establishment of the capacity to form stable, enduring, mutually satisfying interpersonal relationships and the achievement of a differentiated, realistic, essentially positive identity. The relationship between these 2 developmental lines involves a complex dialectical process during which progress in each line is essential for progress in the other and which contributes to the development of both a sense of identity and the capacity for interpersonal relatedness. These developmental lines permit not only to define an during individual's primary personality configuration but also enable to identify cognitive structures that are inherent in various forms of psychopathology, including depression. Disruptions at different developmental stages create vulnerability to different subsequent psychological disturbances. Blatt characterised as anaclitic or dependent the axis concerned with interpersonal relationship and as introjective or self-critical the axis concerned with development of the sense of self and identity. Depressive Experience Questionnaire was developed by Blatt et al. to determine the validity of this model of psychopathology which emphazises continuities between normal and pathological forms of depression. The instrument was developed by Blatt et al. by assembling a pool of items describing experiences frequently reported by depressed individual. Sixty-six items were selected and administered to a large nonclinical sample (500 female and 160 male undergraduates). Principal component analysis within sex performed on the answers to DEQ confirmed his assumption in identifying two principal depressive dimensions. The first factor involved items that are primarily externally directed and refer to a disturbance of interpersonal relationships (anaclitism); the second factor consists of items that are more internally directed and reflect concerns about self-identity (self-criticism). A third factor emerged, assessing the good functioning of subject and confidence in his resources and capacities (efficacy). Scales derived from these factors have high internal consistency and substantial test-retest reliability. The solutions for men and women were highly congruent. Factor structure has been replicated in several nonclinical and clinical samples, supporting considerable evidence to the construct validity of the DEQ Dependency and Self-criticism scales. An adolescent form of DEQ (DEQ-A) has successively been developed. Factor analysis revealed three factors that were highly congruent in female and male students and with the three factors of the original DEQ. The reliability, internal consistency and validity of DEQ-A indicate that the DEQ-A closely parallels the DEQ, especially in the articulation of Dependency and Self-criticism as two factors in depression. These formulations and clinical observations about the importance of differentiating a depression focused on issues of self-criticism from issues of dependency are consistent with the formulations of others theorists which, from very different theoretical perspectives, posit 2 types of depression, one in which either perceived loss or rejection in social relationships is central and the other in which perceived failure in achievement, guilt or lack of control serves as the precipitant of depression. These 2 types of experiences have been characterized as dominant other and dominant goal , as anxiously attached and compulsively self-reliant and as sociotropic and autonomous . Our work presents the results of a validation study of both forms of Blatt's questionnaire (for adults--DEQ--and for adolescents--DEQA) translated in French in a large population of normal subjects, aged 15 to 45 years. DEQ and DEQ-A were compared by inspection of items loading strongly on each factor and by correlation of the three factors of adults and adolescents. The exploratory factor analysis of DEQ and DEQA revealed three orthogonal factors, corresponding with Blatt's original dimensions. Consistency and external validity were adequate for all 3 factors of DEQ and DEQ-A. Anaclitism and self-criticism dimensions of DEQ and DEQ-A correlate positively with measures of depression (DSM-IV, Beck Depression Inventory), consistently with the results obtained by Blatt. Differently from this author, anaclitism appears to be less differentiated in males than in females, suggesting that the concept of dependence could assume different relevance for men and women.

Adult↗