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PubMed2005

[A comparison of special and traditional inpatient care of people with dementia].

Recent studies reveal that approximately two thirds of the residents in German nursing homes suffer from some type of moderate to severe dementia. In addition to cognitive impairments, other psychiatric symptoms and behavior problems frequently impact the quality of life of the affected residents, their fellow residents and the nursing staff. Novel concepts of nursing care for dementia patients with behavior problems have been developed against this backdrop, e. g. within the framework of the program of special care for dementia patients in Hamburg. A comprehensive course study (follow-up period: approximately six months) of a sample population of nursing home residents and consecutive admissions focused upon:the degree to which the quality of life and care for dementia patients in Hamburg differs according to the type of care given, i. e. segregative (domus philosophy), or partially segregative (integration philosophy), and the differences between the special care of dementia patients as provided in Hamburg, as opposed to the traditionally integrative care of dementia patients as practiced in the city of Mannheim. In order to gain the most complete picture possible-also for persons with severe cognitive impairments-information was collected primarily on the basis of the assessments made by qualified nursing staff. In the city of Hamburg there were advantages and disadvantages, respectively, between segregative care (domus philosophy) and partially segregative care (integration philosophy): the activity rates were higher for care in integrative than in domus environments, and could be maintained better over time. Moreover, the number of visits from relatives and their involvement in the nursing and social care was also higher for the integrative, as opposed to the domus setting. Among the residents of domus-care homes, however, significantly more biographical information was collected, and the proportion of dementia patients receiving gerontopsychiatric care also was higher. Dementia patients in these homes also received more psychotropic medication, with antidementia drugs and antidepressants being prescribed significantly more frequently and antipsychotic drugs less frequently.The comparison of the special dementia care available in Hamburg with the traditional, integrative care available to dementia patients in Mannheim revealed a number of visible indicators for the quality of life that point in favor of the model program in Hamburg. This is apparent in the more frequent expression of positive feelings, the greater number of activities fostering competency, the significant involvement of relatives and volunteers, the greater number of social contacts with the staff, fewer use of physical restraint, and better gerontopsychiatric care. Contradictory to our expectation, however, dementia patients cared for in the traditional setting exhibited fewer behavior problems over time than did their counterparts cared for within the framework of the Hamburg model.

Aged↗
PubMed2004

The performance of the screener to identify children with special health care needs in a European sample of children with chronic conditions.

In the field of paediatric health care, measures based on consequences of health conditions have been recently developed to screen for children with special health care needs. These tools have been primarily used in survey research. The aim of this cross-sectional clinical study is to test the performance of a screener for identifying children with special health care needs (CSHCN) in a population of children with chronic conditions diagnosed and treated in different European paediatric hospitals. In the current study, the screener was employed in a sample of children with different chronic conditions (asthma, arthritis, dermatitis, epilepsy, cystic fibrosis, diabetes and cerebral palsy) across seven European countries; 456 parents of children, aged 4-7, 8-12, and 13-16 years, responded to the screener items. The study included a range of clinical measures to assess the severity of the conditions as well measures on functional health status. The prevalence of children identified positively with the CSHCN screener was 80%, which was higher than in survey estimates in the United States. Considerable variation in the screener classification was found between chronic conditions with cystic fibrosis and epilepsy showing higher rates, and skin conditions lower rates. There was no significant relationship between the screener classification and functional limitation. Findings of this study support in general the validity of the children with special health care needs screener, which shows, however, a differential validity across specific conditions. Several clinical and theoretical explanations for the lack of identifying some children with chronic conditions and the considerable variation between the conditions are discussed.

Adolescent↗
PubMed2005

Dietary specialization influences the efficacy of larval tortoise beetle shield defenses.

Plant chemical defenses and escape from natural enemies have been postulated to select for dietary specialization in herbivorous insects. In field and laboratory bioassays, we evaluated the effectiveness of intact and chemically modified larval shield defenses of the generalist Chelymorpha alternans and the specialists Acromis sparsa and Stolas plagiata (Chrysomelidae: Cassidinae) against three natural predators, using larvae reared on two morning glory (Convolvulaceae) species. We assessed whether: (1) specialists were better defended than generalists when both were fed and assayed on the same plant; (2) larval shield defenses were chemical, physical, or both; and (3) specialists exploit chemistry better than generalists. Live specialist larvae survived at higher rates than did generalists in predator bioassays with the bug Montina nigripes (Reduviidae), but there were no differences among groups against two species of Azteca ants (Hymenoptera: Dolichoderinae). Solvent leaching by H(2)O or MeOH significantly reduced shield efficacy for all species compared to larvae with intact shields. In contrast, freshly killed specialist larvae exhibited significantly lower capture rates and frequencies than the generalists. Although solvent leaching significantly reduced overall shield efficacy for freshly killed larvae of all species, the pattern of leaching effects differed between specialists and generalists, with H(2)O-leaching having a greater impact on the specialists. The overall vulnerability of the generalists appears due to lower chemical protection, which is ameliorated by increased escape behaviors, suggesting a selective trade-off between these defensive components. These experiments indicate that shield defenses are essential for larval survival and that specialists are superior at exploiting plant compounds residing in the aqueous fraction. Our results support the hypothesis that diet-specialized herbivorous insects have more effective defenses than generalists when both feed on the same plant due to the differential ability to exploit defensive precursors obtained from the host. The evolution of dietary specialization may therefore confer the advantage of enhanced enemy-free space.

Adaptation, Biological↗
PubMed2006

Community-based interdisciplinary research: introduction to the special issue.

This special issue on community-based interdisciplinary research grew out of the work of the SCRA Interdisciplinary Task Force and an Interdisciplinary Working Conference held at Vanderbilt University in May, 2004. In this introduction to the special issue, the historical context for interdisciplinary underpinnings for community psychology theory, research, action and training is first depicted. This is followed by a brief description of the mission and work of the recent SCRA Interdisciplinary Task Force and the Interdisciplinary Working Conference. The introduction concludes with a brief summary of the papers in the two main sections of the special issue, Prospects and Perspectives (four scholarly papers and three commentaries) and Community-Based Interdisciplinary Action-Research (four interdisciplinary action-research projects).

Congresses as Topic↗
PubMed2005

School-based mental health programs and services: overview and introduction to the special issue.

School-based mental health (SBMH) programs and services have grown progressively in the United States in the past two decades, related in part to increased recognition of their advantages and heightened federal support. However, SBMH is an emerging field, with many issues needing attention. This introductory article provides a context for the special issue by highlighting the importance of increased conceptual clarity about SBMH, enhanced mental health-education systems integration, and advancement of the SBMH research base. Key elements for success of SBMH programs and services are discussed, as underscored recently by the report of the New Freedom Commission on Mental Health (2003) and other important initiatives. These elements include (a) school-family-community agency partnerships, (b) commitment to a full continuum of mental health education, mental health promotion, assessment, problem prevention, early intervention, and treatment, and (c) services for all youth, including those in general and special education. A synopsis of the articles in the special issue is provided, emphasizing their conceptual and empirical contributions to delivery and sustainability of effective mental health practices in schools.

Adolescent↗
PubMed2005

Comparing states on outcomes for children with special health care needs.

OBJECTIVES: To develop two alternative methods for comparing and ranking states on the health, health care, and well-being of children with special health care needs (CSHCN). METHODS: Fifteen key indicators of CSHCN's functional abilities, health insurance coverage, access to care, and the impact of their conditions on their families were identified from the 2001 National Survey of Children with Special Health Care Needs. An initial composite score for each state was created by averaging the state's standardized scores for each of these indicators. Using linear regression analyses and standardized residuals, an adjusted composite score for each state was then created that accounted for demographic variables that differed by state and were related to the initial composite score. States were ranked based on the initial and adjusted composite scores. RESULTS: The initial composite scores were related to population differences by poverty status, African-American race, and the prevalence of special health care needs. Compared to ranks based on the initial scores, ranks based on the adjusted scores shifted by 10 or more positions for half the states. Hawaii, Rhode Island, Arizona, Iowa, and North Dakota had the highest ("best") adjusted scores. CONCLUSION: Adjustment to the initial composite scores permits states with different demographic compositions to be compared. The adjusted scores may also help raise awareness of CSHCN's concerns in states where demographic compositions favorable to health outcomes mask the fact that these outcomes are only average (or worse) given the states' demographic compositions.

Adolescent↗
PubMed2005

The association of child condition severity with family functioning and relationship with health care providers among children and youth with special health care needs in Alabama.

OBJECTIVE: The purpose of the present study is to assess how the severity of a child's condition affects family functioning and the relationship with health care providers among children with special health care needs in Alabama. METHODS: Using the data from the National Survey of Children with Special Health Care Needs (CSHCN), three variables were used as measures of condition severity: responses to the CSHCN screener questions, whether condition affected the ability to do things for children and youth with special health care needs (CYSHCN), and the level of severity of CYSHCN's condition. The dependent variables included family functioning and provider relationship. RESULTS: CYSHCN who only take prescription medicine for their chronic condition (MO) had lower condition severity from those who have other needs (NMO). In NMO CYSHCN, higher condition severity was associated with increased strain on family functioning outcomes and higher unmet needs in provider relationship outcomes, adjusted for demographic and insurance variables. Families of NMO CYSHCN with a more severe condition spent more temporal and financial resources and had a higher need for professional care coordination, and were less likely to have sensitive providers. CONCLUSIONS: Severity of condition is an important factor increasing strain on family resources and relationship with the provider. Our results indicate the need for professional care coordination and family support, particularly among those families in which there is a NMO CYSHCN with a more severe condition. This finding supports the mandate that all CYSHCN should have their health care coordinated and provided in the context of a medical home.

Adolescent↗
PubMed2005

Factors associated with health care access for Mississippi children with special health care needs.

OBJECTIVES: This purpose of the study was to examine the factors associated with access to routine care and to specialty care for Mississippi children with special health care needs (CSHCN). METHODS: We analyzed data for Mississippi CSHCN from the 2001 National Survey of Children with Special Health Care Needs. Using a modified version of Andersen and Aday's Behavioral Model of Health Services Use, we explored the relationship of independent variables (e.g., demographics, insurance, severity of illness) to dependent variables (did not obtain routine care, did not obtain specialty care). We conducted bivariate and logistic regression analyses using SAS and SUDAAN. RESULTS: Based on self-reported data, with a 61% response rate, 66% of Mississippi CSHCN needed routine health care, and 52.8% needed specialty care. Of these children, 6.5% did not receive routine care and 9.3% did not receive specialty care. In a fully adjusted model, discontinuous insurance coverage was an important factor associated with not having obtained routine care (OR = 7.8; CI = 1.7-35.9) and specialty care (OR = 8.6; CI = 2.0-36.8). Children with a high illness severity rank were more likely to have not obtained routine care than children with a low rank (OR 1.4; CI = 1.1-1.9). CONCLUSIONS: It may be important to establish a health insurance safety net for families who lack insurance continuity since it appears that a lapse in insurance coverage impedes health care access. Further research is needed to understand the relationship between illness severity and lack of health care access, especially for children with special health care needs.

Adolescent↗
PubMed2005

Defining underinsurance among children with special health care needs: a Virginia sample.

OBJECTIVES: The study sought to: 1) examine the national Children with Special Health Care Needs (CSHCN) survey to determine whether there are items that can serve to operationalize alternative definitions of underinsurance; 2) construct definitions from the survey items that are consistent with Structural and Economic definitions of underinsurance and devise an algorithm for determining underinsurance for each; and 3) compare these two underinsurance definitions with the Maternal and Child Health definition of inadequate insurance, a definition that takes an Attitudinal approach to the construct. METHODS: Analyses included Virginia children who were insured throughout the survey period. Survey items from the national CSHCN survey were examined to identify items related to underinsurance. Items were divided into groups corresponding to three definitions of insurance (Attitudinal, Structural, and Economic). Algorithms were established, and underinsurance rates calculated for each definition. Logistic regression models were constructed to investigate demographic characteristics related to underinsurance. RESULTS: Different percentages of Virginia CSHCN were found to be underinsured based on the definitions of Attitudinal (28.9%), Economic (25.6%), and Structural (2.9%). Eight demographic characteristics and the pervasiveness of the child's special health care needs were examined in relation to underinsurance. For the Attitudinal definition, poverty level and pervasiveness were significant predictors in the model. In the model predicting Economic underinsurance status, pervasiveness and three of the demographic characteristics significantly predicted underinsurance status. In the multivariate logistic regression model for the Structural definition, none of the predictors was significantly related to underinsurance. CONCLUSIONS: These findings demonstrate that alternative definitions of underinsurance yield dramatically different underinsurance rates. Further, even when yielding similar rates, alternative definitions may identify substantially different sets of children. The likelihood of being underinsured has a strong association with low-income status and pervasiveness of the child's special health care needs. Understanding these factors and their implications will be important when planning accessible and comprehensive health plans and care systems for CSHCN.

Child↗
PubMed2004

What's so special about cholesterol?

Cholesterol (or other higher sterols such as ergosterol and phytosterols) is universally present in large amounts (20-40 mol%) in eukaryotic plasma membranes, whereas it is universally absent in the membranes of prokaryotes. Cholesterol has a unique ability to increase lipid order in fluid membranes while maintaining fluidity and diffusion rates. Cholesterol imparts low permeability barriers to lipid membranes and provides for large mechanical coherence. A short topical review is given of these special properties of cholesterol in relation to the structure of membranes, with results drawn from a variety of theoretical and experimental studies. Particular focus is put on cholesterol's ability to promote a special membrane phase, the liquid-ordered phase, which is unique for cholesterol (and other higher sterols like ergosterol) and absent in membranes containing the cholesterol precursor lanosterol. Cholesterol's role in the formation of special membrane domains and so-called rafts is discussed.

Animals↗
PubMed1985

Special mattresses: effectiveness in preventing decubitus ulcers in chronic neurologic patients.

Thirty-two chronic neurologic patients between 19 and 60 years of age were randomly assigned, for a period of three months, to either an alternating air mattress or a silicore mattress to test the preventive qualities of special mattresses in the occurrence of decubitus ulcers. The two groups were comparable on the variables of age, weight, diagnoses, history of disease process, history of being wheelchair bound, history of previous pressures, and mean scores on Norton's scale of risk, which is based on the subject's physical condition, mental alertness, ambulation, mobility and incontinence. No significant differences were observed in the preventive qualities of the two types of special mattresses in terms of the incidence, location, severity, or healing duration of the subjects' decubitus ulcers. Improved studies of common special mattresses are suggested.

Adult↗
PubMed1987

Pre-steady-state reduction kinetics of QH2:cytochrome c oxidoreductase and the Q-pool: evidence for a special quinone not in rapid equilibrium with the Q-pool.

The pre-steady-state kinetics of the reduction of the prosthetic groups of QH2:cytochrome c oxidoreductase in bovine heart submitochondrial particles were studied in relation to the kinetics of the Q-10 reduction, using duroquinol as substrate. The prosthetic groups, including semiquinone, were measured with EPR and low-temperature-diffuse reflectance spectroscopy, the samples being prepared with the rapid-freeze quench technique. For the determination of the redox state of ubiquinone in the pre-steady state the rapid chemical quench technique was used as an extension of the rapid-freeze quench technique, and Q-10 and QH2-10 were measured with reversed-phase HPLC after extraction with petroleum ether. Ubiquinone was reduced biphasically, 8% of total Q-10 (equal to 1 mol Q-10/mol cytochrome c1), being reduced within 5 ms, and the rest, the Q-pool, at a much lower rate. The initial rapid reduction of this special Q-10 was accompanied by rapid formation of Qi and rapid reduction of a large part of the cytochrome b-562. Both semiquinone formation and reduction of b-562 showed transient kinetics due to a contribution of the reaction pathway via centre o when the iron-sulphur cluster and cytochrome c1 were oxidised. The majority of the special quinol was located at centre i, probably bound, but also at centre o some bound quinol was formed. This was visible when antimycin was present, the antimycin-insensitive bound quinol being totally sensitive to myxothiazol. Myxothiazol alone accelerated the reduction of the Q-pool via centre i, but also the equilibration of cytochrome b-562 with the Q-pool. Antimycin drastically lowered the rate of reduction of the Q-pool and additionally seemed to block the rapid electron transfer from part of the Rieske iron-sulphur cluster to cytochrome c1. It is concluded that, during the pre-steady-state, cytochrome b-562 is not in equilibrium with the Q-pool and that the rate of equilibration is probably determined by the rate of dissociation of the special bound quinol from centre i.

Animals↗
PubMed1986

Epithelial cell specialization at a limb segment boundary in the grasshopper embryo.

Epithelial cells at the developing femur-trochanter limb segment boundary in the grasshopper embryo are specialized with respect to nonboundary cells. They are elongated, with the long axis oriented along the limb circumference. Some cells along the boundary preferentially bind an antibody (anti-HRP), and so are molecularly specialized as well. The specialized cells are the most proximal cells of the more distal segment.

Animals↗
PubMed1991

Inferring patterns of hemispheric specialization for individual subjects from laterality data: a two-task criterion.

Sixty-three subjects (31 dextrals and 32 sinistrals) were given two visual half-field laterality tasks (recognition of words and faces). Subjects were classified as having typical or atypical hemispheric specialization on the basis of the relative magnitude of their asymmetry scores on the two laterality tasks. Those subjects whose word asymmetry scores were larger than their face asymmetry scores (asymmetry scores computed as RVF-LVF for both tasks) were classified into Group Typical and those subjects whose word asymmetry scores were smaller than their face asymmetry scores were classified into Group Atypical. For both dextrals and sinistrals, the proportion of subjects classified into Groups Typical and Atypical was consistent with estimates of the incidence of typical and atypical hemispheric asymmetry patterns based on sodium amytal testing. These results support the hypothesis that the relative magnitude of asymmetry scores on left and right hemisphere specialized tasks index individual differences in patterns of hemispheric specialization.

Adolescent↗
PubMedDate not supplied

Special histochemical stains in ocular pathology: agnogenic myeloid metaplasia with leukemic transformation.

With the use of special immune and enzymatic histochemical techniques, ocular pathologists are able to detect and localize certain cytoplasmic antigens and proteins in tissue section. An immunoperoxidase stain and special enzyme histochemical technique were used to confirm leukemic ocular involvement in a patient who suffered from agnogenic myeloid metaplasia (AMM). Although the transformation of AMM to acute leukemia can be heralded by ocular symptoms, diffuse leukemic infiltration of the choroid may be difficult to detect clinically. Special stains to detect immature myeloid cells may be of particular importance in establishing the diagnosis of granulocytic sarcoma of the orbit in children and certain forms of leukemia having a predilection for cutaneous and conjunctival involvement in adults.

Choroid↗
PubMed1977

Observations on rat Sertoli ectoplasmic ('junctional') specializations in their association with germ cells of the rat testis.

The ectoplasmic ('junctional') specialization, a subsurface modification of the Sertoli cell that is often seen facing germ cells, was studied in relation to the development and maturation of these germ cells. This structure is composed of subsurface bundles of filaments and more deeply placed endoplasmic reticulum. The data indicate that these subsurface modifications of Sertoli cells are reutilized in a cyclic fashion, being transferred from their position facing late spermatids to one opposing less mature germ cells. Ectoplasmic specializations appeared to function mechanically in grasping the heads of the spermatids which are undergoing the elongation and maturation phases of spermiogenesis rather than in actually attaching Sertoli cells to these germ cells. It is postulated that the ectoplasmic specialization imparts rigidity to that area of the Sertoli cell that surrounds the head region of the germ cell, forming a recess and a mantle by which the germ cell may be moved toward the base or toward the surface of the seminiferous epithelium. The observed linkage of microtubules to the cisternae of the complex provided a morphological basis for the changes in the cytoarchietecture of the Sertoli cell, which must accompany these movements.

Animals↗
PubMed1996

Poor speed discrimination suggests that there is no specialized speed mechanism for cyclopean motion.

Luminance-defined and stereo-defined (cyclopean) motion share some common properties, suggesting that the two forms of motion may be detected by similar mechanisms. For luminance-defined motion there are at least two levels of processing: direction is detected and then speed is thought to be extracted by a specialized processing mechanism at a higher level. Here, we tested whether there is also a specialized speed processing mechanism for stereo-defined motion. Speed discrimination thresholds were compared for stimuli containing only stereo-defined motion, and stimuli that contained both stereo-defined and luminance-defined motion. When the stimulus contained luminance-defined motion, increment thresholds were around 0.05-0.1. For stereo-defined motion, increment thresholds were never better than 0.3. By careful analysis, it was possible to test what cues were being used to solve the speed discrimination task. Results were consistent with observers responding to distance cues rather than to speed for stereo-defined motion, suggesting that there is no specialized mechanism for processing the speed of stereo-defined motion.

Cues↗
PubMed1991

Hemispheric specialization for semantic and syntactic components of language in simultaneous interpreters.

Hemispheric specializations for semantic and syntactic components in Italian (L1) and English (L2) were studied with a dichotic listening test, simulating simultaneous interpretation tasks in 24 right-handed female interpretation students at the Scuola Superiore di Lingue Moderne per Interpreti e Traduttori (SSLM) of the University of Trieste and in 12 right-handed female professional interpreters at the European Communities (EEC). The test involved the recognition of correct translations, translations with semantic errors, and translations with syntactic errors from L1 to L2 and vice versa. As an overall result, both students and interpreters gave significantly more correct answers when sentences in L2 as the target language were sent to the left ear. Students recognized significantly more sentences containing syntactic errors than did professional interpreters, while professional interpreters recognized significantly more sentences with semantic errors than did interpreting students. In regard to hemispheric specialization in interpreting students, no significant asymmetries were revealed in the recognition of semantic and syntactic errors. Professional interpreters showed a significant right-ear superiority in recognizing semantic errors in L1 and a significant left-ear superiority in recognizing semantic errors in L2. In the recognition of syntactic errors, professional interpreters showed significant left-ear superiority for L1 and significant right-ear superiority for L2. The prolonged practice in simultaneous interpreting strategies in EEC professional interpreters may account for some of their peculiar hemispheric specializations for languages revealed by this study.

Adult↗