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PubMedDate not supplied

The Chilean version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Chilean language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Chilean CHAQ-CHQ were derived from the European Spanish version with changing of the few words whose use is different in the 2 countries. A total of 126 subjects were enrolled: 72 patients with JIA (29% systemic onset, 39% polyarticular onset, 4% extended oligoarticular subtype, and 28% persistent oligoarticular subtype) and 54 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the JIA patients having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the JIA patients having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Chilean version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMedDate not supplied

The Dutch version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Dutch language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Dutch CHAQ was fully validated with 3 forward and 3 backward translations while the CHQ was already published and therefore it was revalidated. A total of 180 subjects were enrolled: 100 patients with JIA (17% systemic onset, 31% polyarticular onset, 18% extended oligoarticular subtype, and 34% persistent oligoarticular subtype) and 80 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Dutch version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMed2003

Motor and functional skills of children with developmental coordination disorder: a pilot investigation of measurement issues.

This paper reports on the motor and functional outcomes of 20 children with developmental coordination disorder (DCD) aged 4-8 years consecutively referred to a pediatric physiotherapy service. Children with a Movement ABC (M-ABC) score less than the 15th percentile, and with no concurrent medical, sensory, physical, intellectual or neurological impairments, were recruited. The Motor Assessment Outcomes Model (MAOM) [Coster and Haley, Infants and Young Children 4 (1992) 11] provided the theoretical base for measurement selection, and preliminary findings at the activities and participation levels of the model are reported in this article. Children with DCD performed at the lower end of the normal range on the Peabody Developmental Motor Scales (fine motor total score) (M=85.65, SD=12.23). Performance on the Visual Motor Integration Test (VMI) standard scores was within the average range (M=96.15, SD=10.69). Videotaped observations of the children's writing and cutting indicated that 29% were left-handed and that a large proportion of all children (31%) utilized unusual pencil grasp patterns and immature prehension of scissors. Measurement at the participation level involved use of the Pictorial Scale of Perceived Competence and Social Acceptance (PCSA) and Pediatric Evaluation of Disability Inventory (PEDI). Overall, these young children rated themselves towards the more competent and accepted end of the PCSA over the dimensions of physical and cognitive competence and peer and maternal acceptance. The PEDI revealed generally average performance on social (M=49.98, SD=16.62) and mobility function (M=54.71, SD=3.99), however, self-care function was below the average range for age (M=38.01, SD=12.19). The utility of the MAOM as a framework for comprehensive measurement of functional and motor outcomes of DCD in young children is discussed.

Child↗
PubMed2004

Adolescent alcohol initiation: a review of psychosocial risk factors.

Longitudinal research studies focused on alcohol use initiation in adolescence were reviewed to determine which variables function as antecedent predictors or risk factors. Only studies that focused on time-1 abstainers were included. Classes of risk factors examined include sociodemographic, family, peer, personality, and behavioral variables. The most consistent antecedent risk factors for starting to drink in adolescence were parental and peer approval and models for drinking and drug use as well as adolescents' own prior involvement in delinquent behavior. There was little evidence for gender differences in risk factors for alcohol use initiation. Secondary analyses of existing longitudinal data sets are encouraged to examine whether there are ethnic/racial differences in the risk factors for starting to drink and to establish those factors that serve a protective or buffering function, delaying onset of alcohol use in adolescence.

Adolescent↗
PubMed1997

Visual impairment in very low birthweight children.

AIMS: To compare the visual function of a cohort of very low birthweight (VLBW) children in early adolescence with that of their normal birthweight peers; to correlate visual impairment in this group with available perinatal data; and to examine the relation between the visual ability of VLBW children and their cognitive and motor skills. METHODS: As part of a long term neurodevelopmental study, 137 VLBW children and 163 normal birthweight controls were visually assessed between the ages of 11 and 13 years. Their eyes were examined for strabismus and movement disorders, and the use of visual correction for refractive errors was noted. Measures were made of visual acuity, stereopsis, and contrast sensitivity. All children had standardised tests of motor ability and cognitive skills. Perinatal data, including cranial ultrasonography results, had been obtained from the children's notes. No data were available however, regarding retinopathy of prematurity as screening was not established when these infants were born. RESULTS: On all measures, the visual function of the VLBW children was poorer than that of the controls. Reduced visual function was present in 63.5% of VLBW children compared with 36% of controls. Poor contrast sensitivity and strabismus were predictive of poor motor skills in the VLBW children. Poor contrast sensitivity and poor visual acuity (at 0.3 metres) were predictive of lower IQ. Low birthweight, intraventricular haemorrhage, intrauterine growth retardation and low 1 minute Apgar scores predicted reduced visual function. CONCLUSIONS: VLBW children have a high incidence of impaired vision. Stereopsis and contrast sensitivity are useful additions to the screening of this high risk group. They identified impaired vision that was not detected by normal screening and were related to impaired neurodevelopmental outcome.

Adolescent↗
PubMedDate not supplied

The Argentinian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Argentinian language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Argentinian CHAQ was already published and therefore it was revalidated while the Argentinian CHQ was derived from the European Spanish version by changing few words which use is different in the 2 countries. A total of 124 subjects were enrolled: 61 patients with JIA (29% systemic onset, 38% polyarticular onset, 7% extended oligoarticular subtype, and 26% persistent oligoarticular subtype) and 63 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, and polyarticular having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Argentinian version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMedDate not supplied

The Mexican version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Mexican language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Mexican CHAQ was already published and therefore it was revalidated while the Mexican CHQ was derived from the European Spanish version with changing of the few words whose use is different in the 2 countries. A total of 182 subjects were enrolled: 89 patients with JIA (26% systemic onset, 47% polyarticular onset, 13.5% extended oligoarticular subtype, and 13.5% persistent oligoarticular subtype) and 93 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, and polyarticular onset subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, and polyarticular onset having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Mexican version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMedDate not supplied

Children's social reasoning about inclusion and exclusion in gender and race peer group contexts.

This study investigated whether children's and adolescents' judgments about exclusion of peers from peer group activities on the basis of their gender and race would differ by both age level and the context in which the exclusion occurred. Individual interviews about exclusion in several different contexts were conducted with 130 middle-class, European American children and adolescents. Younger children were expected to reject exclusion, by using judgments based on moral reasoning, regardless of the potential cost to group functioning, whereas older children were expected to condone exclusion on the basis of group membership in cases in which the inclusion of these children might interrupt effective group functioning. On measures of judgments, justifications for those judgments, and ratings of the appropriateness of exclusion, the vast majority of children used moral reasoning and rejected exclusion in contexts in which only the presence of a stereotype justified it. As expected, however, older children (13 years) were more likely to allow exclusion than younger children (7 and 10 years) when group functioning was threatened, and they justified this exclusion by using appeals to effective group functioning.

Adolescent↗
PubMed1988

Psychological functioning of children who have recurrent migraine.

Thirty-two children experiencing recurrent migraine, aged 8-17, were compared to 32 non-headache peer controls matched for age, sex, and social class. Each child completed an extensive battery of psychological tests, which consisted of (1) the Children's Depression Inventory (for children aged 8-13) or the Beck Depression Inventory (for children 14 and above), (2) the State-Trait Anxiety Inventory for Children (ages 8-12) or the State-Trait Anxiety Inventory, Form X (ages 13 and above), (3) the Children's Depression Rating Scale, (4) the Personality Inventory for Children, (5) the Child Behavior Checklist, (6) the Psychosomatic Symptom Checklist, SUNYA Revision, (7) the Children's Social Readjustment Rating Questionnaire, (8) the Wide Range Achievement Test for Reading, and (9) the Peabody Picture Vocabulary Test, Form L. Children with migraine revealed higher scores on all scales measuring depression and somatic complaints; adolescent headache sufferers also revealed increased levels of trait anxiety. Older male headache sufferers revealed the poorest overall level of adjustment as reflected by scores on the Adjustment scale of the Personality Inventory for Children. It was argued that the psychological differences were most likely a consequence of the migraineurs having to live with frequent, unpredictable attacks of intense pain. However, the correlational nature of this study does not make it possible to rule out alternative explanations.

Adaptation, Psychological↗
PubMedDate not supplied

Psychophysiological and behavioral evidence for varying forms and functions of nonsocial behavior in preschoolers.

Four-year-old children showing low levels of social behavior in a laboratory play session with unfamiliar peers were classified as reticent (unoccupied or onlooking behaviors) or solitary-passive (solitary constructive or exploratory play). Compared with a group of more social children, the children in both low-social groups were rated high on maternal reports of shyness and displayed a pattern of right frontal EEG asymmetry. However, only the reticent group was elevated on measures indicative of a fearful temperament, both concurrently and retrospectively. A subset of children in the solitary-passive group showed increasing levels of reticent behavior over the course of the visit, suggesting that for some children solitary-passive behaviors provide a means for coping with feelings of unease.

Adaptation, Psychological↗
PubMed2005

Violence perpetration among urban american Indian youth: can protection offset risk?

OBJECTIVE: To predict the likelihood of violence perpetration given various combinations of the most statistically salient risk and protective factors related to violence perpetration. DESIGN: Urban Indian Youth Health Survey, conducted from October 9, 1995, to March 30, 1998, consisting of 200 forced-choice items exploring values, cultural identity, relationships, decision-making skills, and health and well-being. SETTING: Urban schools and an after-school youth development program at an urban American Indian center. PARTICIPANTS: Five hundred sixty-nine urban American Indian youth enrolled in grades 3 through 12. MAIN OUTCOME MEASURES: Violence perpetration dichotomized in 2 ways: (1) level of violence perpetration (ie, hitting someone 1-2 times in the past year vs picking fights, hitting repeatedly, participating in group fights, or shooting or stabbing someone in the past year) and (2) having shot and/or stabbed someone during the past year. RESULTS: In the final multivariate models with age as a covariate, most protective against violence perpetration were connections to school (odds ratio [OR], 0.17), positive affect (OR, 0.29), and peer prosocial behavior norms against violence (OR, 0.35). School connectedness (OR, 0.01) and positive affect (OR, 0.46) were also protective against shooting and/or stabbing someone, as was parental prosocial behavior norms against violence (OR, 0.23). The strongest risk factors for violence perpetration were substance use (OR, 2.60) and suicidal thoughts/behaviors (OR, 2.71); for shooting and/or stabbing, it was substance use (OR, 5.26). The likelihood of violence perpetration increased markedly (from 10% to 85%) as the exposure to risk factors increased and protective factors decreased. For shooting or stabbing someone, the probabilities ranged from 3% (0 risks and 3 protective factors) to 64% (1 risk and 0 protective factors). CONCLUSION: The dramatic reduction in the likelihood of violence involvement when risk was offset with protective factors in the probability profiles suggests the utility of a dual strategy of reducing risk while boosting protection.

Adolescent↗
PubMed2004

Neuropsychologists diagnose traumatic brain injury.

The case of John versus Im (2002) stands for the proposition that clinical neuropsychologists are not qualified to diagnose traumatic brain injury. This ruling by the Supreme Court of Virginia prohibits neuropsychologists from testifying about these professional conclusions in the courtroom. However, in clinical practice neuropsychologists are often asked to disentangle the relative contribution of brain dysfunction and psychological factors to presenting symptomology. In the proposed submission, the authors provide an analysis of the neuropsychological testimony at issue in John versus Im using the admissibility standards for expert testimony that were established and refined by a trilogy of cases from the Supreme Court of the United States. The paper provides support for the notion that neuropsychological method has an established scientific base of knowledge, standards for clinical competence, and evidence of peer-reviewed acceptance by medical related disciplines. No other scientific discipline has employed a more rigorous methodology for assessing cognitive function and disentangling the relative contributions of brain dysfunction and psychological factors to presenting symptomology. By limiting the testimony of neuropsychologists as to cause of an individual's cognitive impairment, courts will exclude opinions based on scientific research and specialized knowledge that would assist in the trier of fact.

Brain Injuries↗
PubMed1997

Outcome of multimodal day treatment for children with severe behavior problems: a five-year follow-up.

OBJECTIVE: To evaluate the long-term outcome of a multimodal day treatment program for children with severe behavior problems and to identify factors that may predict a positive outcome. METHOD: Thirty-three children who completed a day treatment program were assessed using a prospective, single-cohort design tested at intake, discharge, and 5-year follow-up. The child's functioning was assessed using the Revised Child Behavior Profile (RCBP), Hare Self-Esteem Scale, Depression Self-Rating Scale, Hopelessness Scale for Children, Index of Peer Relations, and a 5-point ordinal scale for scholastic reintegration. RESULTS: Repeated-measures analyses of variance showed that improvement was maintained on all measures between intake and 5-year follow-up. A stepwise multiple regression showed that 92% of the adjusted variance in the behavioral functioning of the children at 5-year follow-up, as assessed by the RCBP, was explained by parental cooperation, initial RCBP total and externalizing scores, and history of problem pregnancy. CONCLUSIONS: Children who were admitted to a day treatment setting appear to function well globally, even 5 years after discharge. Parental cooperation was the most important variable in predicting positive outcome.

Adolescent↗
PubMed1998

Low nitric oxide production in patients with chronic renal failure.

BACKGROUND: Rats with chronic renal failure have a low nitric oxide (NO) production and a diminished NO excretion. The supplementation of L-arginine has an inhibitory effect on the progression of renal insufficiency. METHODS: The present study was designed to determine whether chronic renal failure patients have a low NO production. Plasma and urine nitrate (NO3) and nitrite (NO2), stable metabolites of NO, were measured in 83 consecutive patients with chronic renal failure. The 83 chronic renal failure patients were divided into three groups: group 1, mild renal failure (creatinine clearance >60 ml/min/1.73 m2); group 2, moderate renal failure (creatinine clearance >30 <60 ml/min/1.73 m2), and group 3, severe renal failure (creatinine clearance <30 ml/min/1.73 m2). Thirty-three healthy volunteers served as controls. RESULTS: The daily urinary NO excretion was significantly lower in patients with moderate and severe renal failure as compared with those with mild renal failure and normal controls. The lowest values were found in the severe renal failure group. When the 24-hour urinary NO excretion or NO per milligram creatinine and the NO clearance were correlated with the renal function in all patients as a group, these parameters were directly correlated with the creatinine clearance and inversely correlated with the serum creatinine level. The plasma NO concentration was not different between the three chronic renal failure groups, but higher than in the controls. Plasma NO in renal failure patients was not correlated with the creatinine clearance or serum creatinine levels. CONCLUSIONS: Chronic renal failure is a state of NO deficiency. Treatment strategies to increase NO production (L-arginine supplementation or other NO compounds) may prove to be useful in maintaining the renal function and slow the progression of renal disease.

Aged↗
PubMed1977

Peer review: accountability and legal implications.

In summary, increasingly accountability implies the acceptance of peer review as an integral part of nursing practice. Peer review in turn presents a variety of ethical and legal implications and, beyond the scope of this discussion, educational, organizational and psychological implications as well. We must proceed to identify the components necessary to a sound peer review approach, starting with ethical issue and the necessary data base to measure outcomes of care right through the mechanisms of process and structural arrangements. Then, of course, we must ensure the application of rigorous examination of results. Whether QAPs as a whole or peer review as a specific, results are not dependent solely on the provider and client. Environmental and organizational factors must also be considered. Outcomes of care and performance are a function of the interaction of a variety of factors. In essence, the onus for assuring that the profession will meet its public accountability rests largely with each and every one of us. Every professional practitioner in the context of peer review will be compelled to be involved in assessment of the many dimensions of patient care. If professional self-requlation is to be effective, all professional nurses must be involved. In sum, we are the ones who must determine the what and the how of accountability for the nursing profession.

Ethics, Nursing↗
PubMed2001

Tamoxifen treatment and gynecologic side effects: a review.

OBJECTIVE: To review the literature on tamoxifen side effects on the female genital tract and psychosexual function in premenopausal and postmenopausal women. DATA SOURCES: We used the English-language literature in MEDLINE and reference lists from selected articles. Search terms included: "tamoxifen and estrogen receptor," "transcription activation," "premenopause," "postmenopause," "vaginal epithelium," "uterus," "endometrial hyperplasia," "polyps," "endometrial cancer," "sonography," "sonohysterography," "hysteroscopy," "myometrium," "myoma," "sarcoma," "endometriosis," "ovarian cysts," "hot flushes," "concentration problems," "sleep disturbance," "vaginal dryness," "sexual function," "libido," "dyspareunia," and "quality of life." No study-type restrictions were imposed. METHODS OF STUDY SELECTION: With respect to clinical studies we included case cohort studies, observational studies; if no trials were available on a subject, case reports published in peer-reviewed journals were selected. For the discussion on endometrial surveillance of tamoxifen users, letters and editorials published in peer-reviewed journals also were used. Subjects of interest were mechanism of action of tamoxifen, tamoxifen and the vaginal epithelium, endometrium, mesenchymal tumors of the uterus, ovaries, sexual function, and vasomotor instability. TABULATION, INTEGRATION, AND RESULTS: Eligible studies were analyzed to determine their usefulness in this review. Data from trials that evaluated tamoxifen side effects on specific genital tissues were combined, with special interest in differentiation of side effects in premenopausal and postmenopausal women. Weighted estimates of severity and extent of side effects were usually not possible because of lack of randomized trials. Only the risk of endometrial cancer in relation to tamoxifen treatment could be estimated. CONCLUSION: The gynecologic side effects of tamoxifen are diverse and reflect the complexity of its mechanism of action, with agonistic and antagonistic effects on various tissues, depending on the ambient estradiol concentration and hence menopausal status of the patient. The most frequently reported side effect was hot flushes, and the most worrisome gynecologic side effect was a two- to three-fold increased risk of endometrial cancer in postmenopausal women. Despite its side effects, the benefits of tamoxifen in controlling breast cancer or prevention of its relapse are still without debate.

Breast Neoplasms↗
PubMed1986

The relative influence of health beliefs, parental and peer behaviors and exercise program participation on smoking, alcohol use and physical activity.

This research specifies a model for lifestyle health behavior which includes socialization, social environmental and cognitive influences on smoking, alcohol use and exercise. Survey respondents were participants in university conditioning classes, academic health classes and a community fitness program. Of the socialization influences, drinking by both parents was directly related to drinking by females and drinking by the mother to that of males. Physical activity level of the father was associated with the activity of both genders. Parental smoking was not related to that of the respondents. Income was positively correlated with alcohol consumption in both genders and with smoking among women. In the immediate environment, drinking and smoking by male and female friends were directly associated with that of both male and female respondents with congruent gender relationships being strongest. Exercise by male friends was positively associated with activity level for both genders, as was exercise by female friends for women only. For college students, program participation was related to lower alcohol consumption among men only and higher activity level for women only. It was not related to the likelihood of smoking. For cognitive factors, belief in the efficacy of lifestyle change was inversely related to alcohol consumption for both genders and to smoking for women. Susceptibility to heart disease was associated with a low exercise frequency and smoking, while generalized susceptibility was directly related to activity level and to smoking. Self control over health was positively related to activity level. With one exception, the peer modeling variables had the strongest relationships of any of the model elements in the multivariate analyses. Gender specificity for modeling of behavior was found for peers, but not for parents. These findings suggest that prevention programs incorporate strategies to maximize peer support for healthful behavior and to counteract the effects of unhealthful behavior modeled by peers. Interventions to increase beliefs in the efficacy of lifestyle change to reduce risk are appropriate to encourage behavior change. When the change is underway, discussion of lowered susceptibility as a function of program compliance should reinforce the new behavior.

Adolescent↗
PubMed1996

Improving peer review: alternatives to unstructured judgments by a single reviewer.

BACKGROUND: Peer review, usually involving unstructured judgments by a single peer reviewing medical records, was the backbone of quality management in health care organizations until recent years. Although other approaches to quality management, such as continuous quality improvement, are now being widely adopted, peer review can still play a role in identifying dysfunctional organizational processes and individuals delivering poor care. Given the questionable reliability and validity of peer review as usually practiced, however, a more rigorous and thoughtful approach is needed-with consideration of issues such as the number of peers involved, the nature of their interaction while forming judgments, and the type of assessment instruments they use. MULTIPLE-REVIEWER PROCEDURES: Such procedures include the use of two or more reviewers making their assessments independently, discussion to consensus among reviewers, and committee review. STRUCTURED ASSESSMENT INSTRUMENTS: A number of studies suggest that instruments that carefully guide the reviewer have higher interrater reliability than less structured instruments. IDENTIFICATION OF SYSTEM ISSUES: The focus of peer review can be expanded beyond individual practitioner performance to include assessment of the operational environment in which the clinician functions. For example, one might ask whether any changes in hospital policies or procedures or in administrative or computerized support for clinicians might have improved the care received by a patient. CONCLUSION: The available data and the known limitations of unstructured judgments by a single reviewer justify serious consideration of multiple reviewer procedures and structured assessment instruments, particularly for reviews that have major consequences for patients and practitioners.

Humans↗