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PubMed1993

Item and relational processing in young and older adults.

The item and relational information framework of memory provided a methodology for an analytical approach to age differences in encoding and retrieval processes. Subjects were given related or unrelated words to sort or rate for pleasantness. Young adults performed better than older adults in free recall, but older adults were able to use both item and relational information as well as young adults. In a second experiment, subjects also sorted or rated a list composed of different numbers of category items. The pattern of free recall and cued recall scores indicated that item and relational information affected the memory performance of both age groups in a similar fashion. By examining memory in terms of item and relational information, it appears that older adults do not have difficulty combining two types of target information during encoding and that the information assists in recall of target items.

Adolescent↗
PubMed2026

Are Adverse Childhood Experiences Associated with Metabolic Syndrome in Patients with Severe Mental Illness?

BACKGROUND: Patients with severe mental disorders (SMD) are at substantially elevated risk for metabolic syndrome (MetS), contributing to excess cardiovascular morbidity and premature mortality. Adverse childhood experiences (ACEs) have been associated with dysregulation of metabolic pathways, yet their contribution to MetS risk in SMD remains poorly understood. OBJECTIVE: This study aimed to investigate the association between ACEs and MetS in outpatients with bipolar disorder (BD) and schizophrenia (SZ) in clinical remission and to identify independent and incremental predictors of MetS using a hierarchical analytical framework. METHODS: This cross-sectional study included 140 outpatients with SMD (96 with BD and 44 with SZ) in clinical remission, recruited from a university hospital in Eastern Turkey. MetS was defined according to NCEP-ATP III criteria, and ACEs were assessed using the Turkish version of the Adverse Childhood Experiences Scale (ACE-TR). Hierarchical and multivariable logistic regression analyses were performed to examine factors associated with MetS. RESULTS: MetS was highly prevalent in this sample (46.4%). ACE-TR total score was independently and consistently associated with MetS across all hierarchical models (odds ratio [OR] range: 1.68-1.77), with each one-unit increase conferring approximately 71% higher odds in the fully adjusted model (OR = 1.71; 95% confidence interval [CI] 1.26-2.32; P = 0.001). The number of hospitalizations was the only other independently associated variable (OR = 1.19; 95% CI 1.02-1.39). Sexual abuse (16.9% vs. 2.7%; P = 0.004), emotional neglect (63.1% vs. 30.7%; P < 0.001), and physical neglect (30.8% vs. 14.7%; P = 0.022) were significantly more prevalent in the MetS group. ACE-TR total score was positively correlated with waist circumference and triglyceride levels. CONCLUSION: The strong and consistent association between ACEs and MetS underscores the importance of trauma-informed care models in psychiatric practice, where metabolic comorbidity remains a leading cause of premature mortality.

Humans↗
PubMed2005

Recursive partitioning models for linkage in COGA data.

We have developed a recursive-partitioning (RP) algorithm for identifying phenotype and covariate groupings that interact with the evidence for linkage. This data-mining approach for detecting gene x environment interactions uses genotype and covariate data on affected relative pairs to find evidence for linkage heterogeneity across covariate-defined subgroups. We adapted a likelihood-ratio based test of linkage parameterized with relative risks to a recursive partitioning framework, including a cross-validation based deviance measurement for choosing optimal tree size and a bootstrap sampling procedure for choosing robust tree structure. ALDX2 category 5 individuals were considered affected, categories 1 and 3 unaffected, and all others unknown. We sampled non-overlapping affected relative pairs from each family; therefore, we used 144 affected pairs in the RP model. Twenty pair-level covariates were defined from smoking status, maximum drinks, ethnicity, sex, and age at onset. Using the all-pairs score in GENEHUNTER, the nonparametric linkage tests showed no regions with suggestive linkage evidence. However, using the RP model, several suggestive regions were found on chromosomes 2, 4, 6, 14, and 20, with detection of associated covariates such as sex and age at onset.

Alcoholism↗
PubMed2006

Assessment of the relational factor in male patients consulting for sexual dysfunction: the concept of couple sexual dysfunction.

In a consecutive series of 1140 male subjects reporting a stable couple relationship and different degrees of sexual dysfunction, we evaluated the impact of relational factors, as assessed by the Structured Interview on Erectile Dysfunction (SIEDY) Scale 2 (exploring, as reported by the patient, menopausal symptoms, partner's medical illness interfering with sexual activity, and reduced partner desire and climax). We found that the SIEDY Scale 2 is significantly and independently associated with erectile dysfunction (ED), delayed ejaculation, hypoactive sexual desire, and decreased frequency of intercourse. SIEDY Scale 2 scores are associated with an advanced age of the partner and a long couple relationship, independently from patient's age. In addition, an increased relational factor correlates with increased extramarital affairs, conflicts in the couple, alcohol abuse, and presence of depressive symptoms, as assessed by the Middlesex Hospital Questionnaire. Our results should encourage the andrologist to consider the context in which sexual symptoms develop, analyzing the relationship and partner's behaviors and diseases. Resolving, or at least ameliorating, the relational background and the sexual framework might help in treating male sexual dysfunction.

Erectile Dysfunction↗
PubMedDate not supplied

[Computer analysis of face and skull size by "quantitative verbal portrait" method].

The aim of this study was to develop a "quantitative verbal portrait" method on the basis of universal measured signs of the face and skull. The database includes 90 cases with expert evaluation of photocompatibility with proven identity. Four groups of signs were investigated: DX and DY--the width and height between accurately fixed concrete craniometrical (facial) points and the so-called RX and RY indices--the ratio between distances within the framework of the same direction. The proposed scheme of evaluation helps compare the photograph of a live human and the skull. For evaluating the degree of identity, one should have a summary characterization of all selected signs for the skull and compare it with the sum on the photograph; sometimes it is possible to rule out the identity of the photograph and the skull by the absolute size, e.g., a very large skull cannot belong to a human with a very little face. The score for each group of signs is used for analysis of the information for detecting the similarities. Accumulation and comparative analysis of two information flows are possible: database on portraits of lost subjects and database on graphic images of the skulls of unidentified corpses.

Face↗
PubMed1984

Ego development in female-to-male transsexual couples.

The ego development of 22 postoperative female-to-male transsexuals and their spouses or lovers with whom they had been living for a year or more was investigated. The transsexuals, their spouses, and a control group of 22 couples were administered the Washington University Sentence Completion Test of Ego Development, a projective measure of ego functioning. Ego development refers to the framework of meaning that the individual brings to an experience. The construct of ego development incorporates a series of sequential stages that integrate various frames of reference including cognitive style, interpersonal style, conscious preoccupation, and impulse control. These processes have received little attention in studies on female-to-male transsexuals who have successfully negotiated the social barrier of cross-living to the extent that they are living the male role in a heterosexual relationship. No significant differences in the distribution of ego development scores were found between the transsexuals and the control males, or between the transsexuals' spouses and the control spouses. Over 93% of the transsexuals and their spouses scored above the conformist level of ego development. These findings are discussed in terms of some of the previous literature on conformist thinking by transsexuals.

Adult↗
PubMed1986

Sexual experience and drinking among women in a U.S. national survey.

A 1981 national survey of 917 women provided rates of major sexual experiences and dysfunctions for the entire sample and across alcohol abstention/consumption categories. Most women drinkers (heavier drinkers most often) reported that drinking lessens sexual inhibition and helps them feel close to others; only 8% reported becoming less particular in sexual partner choice, 22% more sexually assertive, but over half (60%) had been targets of other drinkers' sexual aggression. On a sexual dysfunction index combining lifetime lack of sexual interest, lifetime lack or low frequency of orgasm with a partner, and vaginismus, moderate drinkers scored significantly lower than lighter and heavier drinkers. The heaviest drinking women had the highest rates of lifetime sexual disinterest and lack of orgasm with a partner. "Temporary abstainers" (who drank in the past 12 months but not the last 30 days) also had elevated sexual dysfunction rates, particularly those with substantial drinking histories. Several nontraditional sexual behaviors were correlated with heavier drinking, which was also related to morally liberal sexual attitudes. The study's findings may show the effects of a generalized moral value framework in which one large portion of the nation's population, especially females, is subject to pervasive proscriptions of behavioral, including their drinking and sexuality, while others vary in the freedom they find to drink and be sexual. More suppressed traditional sexuality occurs more frequently with lighter drinking and abstention, as is also true of sexual dysfunction. At heavier drinking levels suppressed and dysfunctional sexuality and heavy drinking may be both cause and consequence in a vicious circle, sometimes escaped by temporary or lasting abstention.

Alcohol Drinking↗
PubMed2004

The cognitive orientation of patients with type 2 diabetes in Israel.

The purpose was to explore the beliefs of patients with type 2 diabetes, in the framework of the Cognitive Orientation model which assumes that cognitions could promote disease. The major hypotheses were that there is a cluster of beliefs characteristic for type 2 diabetes and that it does not differ with disease duration. The participants were 112 individuals with type 2 diabetes and 103 matched healthy controls. They were administered a questionnaire that included items representing beliefs about goals, self, rules and norms, and general, referring to relevant themes. The results supported the main hypotheses and showed that the questionnaire scores identified correctly patients and controls in 85%. The themes supported by the patients focus on maintaining the status quo, formal relations, authority, following rules, and relying on powerful others. A major conclusion is that there is a unique cluster of beliefs characteristic for patients with type 2 diabetes. The findings can aid in helping these patients to apply self-care procedures and cope with particular stresses.

Adaptation, Psychological↗
PubMed1998

Cost of extracorporeal life support in pediatric patients with acute respiratory failure.

OBJECTIVES: To determine the impact of extracorporeal life support (ECLS) on mortality in pediatric patients with acute hypoxemic respiratory failure (AHRF) at our institution; and to calculate the hospital charges associated with the use of ECLS. DESIGN: Retrospective review of medical records and hospital charges. SETTING: Pediatric intensive care unit (ICU) of a university-affiliated children's hospital. PATIENTS: Twenty patients admitted to the pediatric ICU between 1991 and 1995 for AHRF who received ECLS as a part of their hospital course. INTERVENTIONS: Predicted mortality was calculated using the Pediatric Respiratory Failure score and was compared with survival at the time of hospital discharge. Hospital charges were used as a proxy for resource utilization. Cost-per-life-year-saved calculations were performed based on a normal life expectancy for survivors. MEASUREMENTS AND MAIN RESULTS: Twenty patients were identified. The median age was 4.83 yrs. The median duration of ECLS was 9 days, with 19.5 days in the pediatric ICU and 23.5 days for the entire hospital length of stay. The observed mortality rate for these patients was 20%. Median predicted mortality rate based on the Pediatric Respiratory Failure score calculation was 83%. The hospital charges incurred by these patients was a median of $199,096. Based on a normal life expectancy for survivors, this results in a cost of $4,190/life-year. CONCLUSIONS: ECLS for the pediatric patient with AHRF is done at a considerable cost. However, ECLS affects survival favorably, and compares favorably when considering cost/life-year calculations. The data presented in this study may serve as a benchmark for comparison with newer therapies (i.e., liquid ventilation, nitric oxide). These data also provide a framework for cost-based analyses at other ECLS institutions.

Adolescent↗
PubMed2005

National audit of continence care for older people: results of a pilot study*.

INTRODUCTION AND AIM: Bladder and bowel problems are common in the elderly and are associated with a considerable morbidity and impact on quality of life. Inequalities in service provision and access to services have been recognized but there has been no systematic approach to measuring the quality of continence care for older people. This study aimed to develop quality standards, to assess the reliability and utility of the resulting audit package and to report on the standards of care provided in primary care, secondary care and care home setting. METHOD: Fifteen sites in secondary care, primary care and in long-term care settings were randomly selected to pilot the audit package. Data collectors completed audit questionnaires relating to the structure [organization] of care, the outcomes of care, and the process of care for 20 subjects with urinary incontinence and 10 subjects with faecal or double incontinence. RESULTS: The audit tool was reliable (median kappa score of 0.7). Access to integrated continence services, as defined by Good Practice in Continence Services was inadequate. Eighty-five per cent of hospitals had no written policy for continence care. There were deficiencies in obtaining information, in carrying out basic and specialist examinations and investigations and in determining the cause of incontinence. There was a high prevalence of catheter use in secondary care settings. CONCLUSION: The pilot has indicated significant inadequacies in continence care and demonstrates that in many sites the National Service Framework milestone for integrated continence services has not been met. A national audit of continence care is required to determine the extent of inadequate continence care.

Aged↗
PubMedDate not supplied

Reliability and validity of critical care orientation tests.

The purpose of this study was to establish the reliability and validity of the multiple choice orientation tests used in one critical care unit. A criterion-referenced measurement framework was used to develop 10 orientation tests covering five content areas, two tests for each content area. A sample of 40 critical care nurses (CCNS) and 31 medical-surgical nurses completed the tests. Standard reliability and validity measures were performed including: test-retest, parallel forms, construct and decision validity and item analysis. Parallel form correlations ranged from .46 to .90 (P < .05). Test-retest correlations ranged from .56 to .93 (P < .01). A significant (P < .01) difference was found between the scores of the critical care nurses and medical-surgical nurses for nine of the tests. Reliability and validity were supported for the tests. This study identifies one process that can be used in test development.

Critical Care↗
PubMed1994

Determinants of health-promoting lifestyles in adolescent females.

The relationship between health-promoting lifestyle and definition of health, perceived health status, self-efficacy, maternal and paternal health-promoting lifestyle, and selected demographics in adolescent females was investigated. Included in the study were 184 adolescents and their parents. A modification of Pender's (1982, 1987) Health Promotion Model provided the conceptual framework for the study. Two research questions evolving from the conceptual model guided the study. Results indicated that mothers' and fathers' health-promoting lifestyles were significantly correlated with their daughters' health-promoting lifestyles. A strong relationship existed between the predictor variables of definition of health (clinical, functional, and eudaemonistic subscales), self-efficacy, perceived health status, and ethnicity, and the criterion variable of adolescents' health-promoting lifestyles. Together these variables accounted for 41% of the variance in adolescent health-promoting lifestyle scores. Implications for nursing research and practice are discussed.

Adolescent↗
PubMed1996

Learning temporal probabilistic causal models from longitudinal data.

Medical problems often require the analysis and interpretation of large collections of longitudinal data in terms of a structural model of the underlying physiological behavior. A suitable way to deal with this problem is to identify a temporal causal model that may effectively explain the patterns observed in the data. Here we will concentrate on probabilistic models, that provide a convenient framework to represent and manage underspecified information; in particular, we will consider the class of Causal Probabilistic Networks (CPN). We propose a method to perform structural learning of CPNs representing time-series through model selection. Starting from a set of plausible causal structures and a collection of possibly incomplete longitudinal data, we apply a learning algorithm to extract from the data the conditional probabilities describing each model. The models are then ranked according to their performance in reconstructing the original time-series, using several scoring functions, based on one-step ahead predictions. In this paper we describe the proposed methodology through an example taken from the diabetes monitoring domain. The selection process is applied to a set of input-output models that generalize the class of ARX models, where the inputs are the insulin and meal intakes and the outputs are the blood glucose levels. Although the physiological process underlying this particular application is characterized by strong non-linearities and low data reliability, we show that it is possible to obtain meaningful results, in terms of conditional probability learning and model ranking power.

Algorithms↗
PubMedDate not supplied

Correlates of fatigue in Koreans with chronic lung disease.

OBJECTIVES: The purpose of this study is to explain the multidimensional characteristics of fatigue in Korean persons with chronic lung disease. FRAMEWORK: The Unpleasant Symptom Theory by Lenz et al (1995) provided the theoretical framework for the study. DESIGN: A descriptive correlational study design was used. SAMPLE: A convenience sample of 128 subjects (age = 64.2 +/- 11.3; forced expiratory volume in 1 second percent predicted value = 64.5 +/- 28.8%) was recruited from the outpatient respiratory clinic at a large university hospital in Korea. INSTRUMENTS: Fatigue was measured with the Multidimensional Fatigue Inventory. To identify the factors influencing fatigue, demographic variables, physiological variables, psychological variables, and a situational variable were measured. RESULTS: Subjects had a moderate degree of fatigue in general. The mean score for physical fatigue was relatively higher than that of mental fatigue. Using regression analysis, 48.4% of the variance in overall fatigue was explained by dyspnea and negative mood state. CONCLUSION: This study provides an understanding of multidimensional characteristics of fatigue experienced by Korean persons with chronic lung disease. It suggests that nurses need to include fatigue in their assessments and develop interventions to decrease dyspnea and negative mood in the management of fatigue.

Affect↗
PubMed2005

Evaluating the efficacy of an integrated curriculum on adolescent health and development for pre-service nursing education in Hong Kong.

BACKGROUND: An integrated adolescent curriculum on health and development (ADH) was implemented in a pre-service nursing programme in a university. AIM: This study examined the efficacy of an ADH curricular framework in improving the competency variables of student nurses in delivering ADH services. METHOD: The design of the study was quasi-experimental with the systematically designed ADH training curriculum as an intervention. Pre- and post-tests incorporating an experimental group and a control group for a sample of 101 student nurses were used. FINDINGS: Reports from 50 student nurses in the experimental group indicated that there was a significant increase from the pre-test to the post-test phase in the total score for the variables in the ADH Competency Checklist (Z=-5.71, p<0.001) and its four subscales: the professional development subscale (Z=-5.37, p<0.001), the psychosocial and physical well-being subscale (Z=-5.66, p<0.001), the health behaviours and lifestyles subscale (Z=-5.07, p<0.001), and the identity and reproductive health subscale (Z=-4.86, p<0.001). Significant changes were detected in the ADH competency variables for the control group in the post-test phase. CONCLUSION: The findings reveal that the systematic integration of ADH in the nursing curriculum had the positive impact of increasing the competency of student nurses for the examined variables.

Adolescent↗
PubMed2003

Assessment of the impact of disease on the individual.

From the medical or disease perspective, patients' functioning, disability and health are seen primarily as the consequences or the impact of a disease or condition. In this perspective, self-administered health status instruments are used primarily to evaluate the effects of drug treatments or surgical interventions. The interpretation of these measures is generally based on scales and scores and not on individual items. Currently used instruments are reviewed and an algorithm for the selection of instruments is provided. In the rehabilitation or disability perspective, patients' functioning and health is associated with and not merely a consequence of, a condition or disease. The basis for the understanding of functioning, disability and health--in association with the condition but also the personal and contextual factors--is WHO's International Classification of Functioning, Disability and Health or ICF. This chapter illustrates the use of the ICF framework for structuring patients' problems, and the use of condition-specific ICF-Core-Sets to check for problems typically encountered in patients with a given condition.

Disability Evaluation↗
PubMed2003

Using the ISMP Medication Safety Self-Assessment to improve medication use processes.

BACKGROUND: The 194-item Institute for Safe Medication Practices (ISMP) Medication Safety Self-Assessment for hospitals is being used by a 21-hospital collaborative as a framework for understanding, evaluating, and systematically implementing medication use system safety improvements. METHODS: The results of the self-assessment were used to prioritize and organize the review of medication use processes, in which each self-assessment-defined "representative characteristic" is reviewed in detail, and "best implementation practices" for the characteristic are established. The collaborative concurrently identifies educational needs and develops tools to assist organizations in implementing improvements. RESULTS: By December 2002 participating organizations had implemented a wide variety of medication safety improvements. Collaborative member scores for the self-assessment increased approximately 20% during the initial assessment when the self-assessment was repeated by members in the second quarter of 2002. SUMMARY: Participant progress in improving medication safety practices is supportive of collaborative methods and the value of completing the ISMP self-assessment, expanding on the knowledge gained, developing effective implementation tools, and systematically applying lessons learned.

Benchmarking↗
PubMed2001

Wellness perception in persons with traumatic brain injury and its relation to functional independence.

OBJECTIVES: To test the reliability and validity of a perceptual wellness measure in persons after traumatic brain injury (TBI) and to determine whether a relation exists between functional independence and wellness perceptions in the same population. DESIGN: Survey research. SETTING: A private, residential brain injury program. PARTICIPANTS: A convenience sample of 49 patients (43 men, 6 women) with TBI whose mean age was 32.1 years (range, 18-61yr) and mean time since injury was 10.47 years (range, 1-21yr). MAIN OUTCOME MEASURES: The Perceived Wellness Survey (PWS) assessed wellness. The PWS has 6 subscales measuring physical, psychologic, emotional, intellectual, spiritual, and social wellness. The FIM instrument was used to measure functional status. RESULTS: The mean PWS score (15.99) for the sample was comparable to published samples of adults (mean, 15.31-16.51); however, the reliability of the composite score (alpha = .58) and the subscales (alpha = .32-.64) was less than that obtained in previous samples (composite alpha = 0.91; subscale alpha = .64-.81). The correlations between the PWS and the FIM scores were not significant. CONCLUSIONS: The PWS in its composite form is a reliable measure for use with persons with TBI. The finding that perceived wellness and functional independence were not related suggests that these constructs are unique and thus should both be measured. The measurement of perceptions will enable the provider to consider a client holistically and to develop programs that address quality of life issues. Further, because perceptions influence behaviors, understanding a person's perceptions in multiple dimensions may provide a useful and necessary framework for developing intervention programs that address behavioral and cognitive issues that are important to that person.

Activities of Daily Living↗