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PubMed1997

The transition to adulthood for youth who have serious emotional disturbance: developmental transition and young adult outcomes.

This article reviews studies that depict the developmental transition from adolescence to young adulthood of persons who have experienced serious emotional disturbance (SED) as children or adolescents. The literature demonstrates that their plight in young adulthood is grave. Youth with SED enter the transition phase delayed in their developmental maturation and face additional challenges relative to their nondisabled peers. As a group, they are undereducated, underemployed, and have limited social supports. Homelessness, criminal activity, and drug use are prevalent. This article defines the transitional youth population, describes the developmental tasks of transition, and summarizes the results of longitudinal studies that have tracked functional outcomes of transitional youth into young adulthood. The discussion focuses on the relevance of these findings to service provision.

Adolescent↗
PubMed2005

How do adolescent girls evaluate body dissatisfaction prevention messages?

PURPOSE: This research examined responses of adolescent girls to messages typically used in eating disorder and body image prevention programs and 2 new messages promoting a positive body image and persuading against body comparison with the media and peers. METHODS: Girls in the 7th, 8th, and 10th grades completed a questionnaire assessing comparison tendency, internalization of the thin body ideal, body image concerns, psychological functioning, and risk factors for eating disorders. Two weeks later, participants viewed on videotape 9 persuasive messages and 1 nonpersuasive control message and rated them on relevance, believability, emotional response to body, intention to compare, and intention to diet. RESULTS: Two message themes frequently used in prevention programs (1. media images are not real, and 2. the ideal body changes through history and between cultures) and 1 new message (don't fall into the comparison trap) were rated most strongly. Relevance ratings consistently were associated positively with body comparison, internalization of the thin ideal, body dissatisfaction, and dieting measures. CONCLUSIONS: Body dissatisfaction prevention messages vary in their persuasiveness and this research identifies messages that potentially are of particular value for inclusion in intervention programs.

Adolescent↗
PubMed2004

Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a well-recognized clinical sleep disorder that results in chronically fragmented sleep and recurrent hypoxemia. The primary daytime sequelae of the disorder include patient reports of excessive daytime sleepiness, depression, and attention and concentration problems. It has been well established that OSAHS negatively impacts certain aspects of cognitive functioning. The primary goals of this article are to (1) clarify the pattern of cognitive deficits that are specific to OSAHS; (2) identify the specific cognitive domains that improve with treatment; and (3) elucidate the possible mechanisms of cognitive dysfunction in OSAHS. At the conclusion of the paper, we propose a potential neurofunctional theory to account for the etiology of cognitive deficits in OSAHS. Thirty-seven peer-reviewed articles were selected for this review. In general, findings were equivocal for most cognitive domains. Treatment, however, was noted to improve attention/vigilance in most studies and consistently did not improve constructional abilities or psychomotor functioning. The results are discussed in the context of a neurofunctional theory for the effects of OSAHS on the brain.

Attention↗
PubMed2005

Comparison of measured and estimated cognitive ability in older adolescents with and without ADHD.

Premorbid intellectual function estimation is a crucial part of patient evaluation following a traumatic brain injury (TBI), especially in individuals with ADHD who are at higher risk for TBI compared to their non-ADHD peers. This study investigates the value of using regression-based estimates of intelligence for concurrently predicting measured intelligence in a sample of older adolescents with and without a childhood history of ADHD. Correlations between measured and estimated intelligence are highly significant in the full sample and in the individual groups. Adding reading performance to the regression equation increases the accounted-for variance in both groups. Results indicate that regression equations based on demographic characteristics constitute a valid method for estimating premorbid functioning in adolescents with ADHD and that they can play an essential role in the assessment of individuals with ADHD who sustain TBI, especially when measures of word reading are used to augment demographic estimates.

Adolescent↗
PubMed2002

The young and the clueless.

It's natural to promote your best and brightest, especially when you think they may leave for greener pastures if you don't continually offer them new challenges and rewards. But promoting smart, ambitious young managers too quickly often robs them of the chance to develop the emotional competencies that come with time and experience--competencies like the ability to negotiate with peers, regulate emotions in times of crisis, and win support for change. Indeed, at some point in a manager's career--usually at the vice president level--raw talent and ambition become less important than the ability to influence and persuade, and that's the point at which the emotionally immature manager will lose his effectiveness. This article argues that delaying a promotion can sometimes be the best thing a senior executive can do for a junior manager. The inexperienced manager who is given time to develop his emotional competencies may be better prepared for the interpersonal demands of top-level leadership. The authors recommend that senior executives employ these strategies to help boost their protégés' people skills: sharpen the 360-degree feedback process, give managers cross-functional assignments to improve their negotiation skills, make the development of emotional competencies mandatory, make emotional competencies a performance measure, and encourage managers to develop informal learning partnerships with peers and mentors. Delaying a promotion can be difficult given the steadfast ambitions of many junior executives and the hectic pace of organizational life. It may mean going against the norm of promoting people almost exclusively on smarts and business results. It may also mean contending with the disappointment of an esteemed subordinate. But taking the time to build people's emotional competencies isn't an extravagance; it's critical to developing effective leaders.

Administrative Personnel↗
PubMed1997

Peer review of the quality of care. Reliability and sources of variability for outcome and process assessments.

CONTEXT: Peer assessments have traditionally been used to judge the quality of care, but a major drawback has been poor interrater reliability. OBJECTIVES: To compare the interrater reliability for outcome and process assessments in a population of frail older adults and to identify systematic sources of variability that contribute to poor reliability. SETTING: Eight sites participating in a managed care program that integrates acute and long-term care for frail older adults. PATIENTS: A total of 313 frail older adults. DESIGN: Retrospective review of the medical record with 180 charts randomly assigned to 2 geriatricians, 2 geriatric nurse practitioners, or 1 geriatrician and 1 geriatric nurse practitioner and 133 charts randomly assigned to either a geriatrician or a geriatric nurse practitioner. MAIN OUTCOME MEASURES: Interrater reliabilities for structured implicit judgments about process and outcomes for overall care and care for each of 8 tracer conditions (eg, arthritis). RESULTS: Outcome measures had higher interrater reliability than process measures. Five outcome measures achieved fair to good reliability (more than 0.40), while none of the process measures achieved reliabilities more than 0.40. Three factors contributed to poorer reliabilities for process measures: (1) an inability of reviewers to differentiate among cases with respect to the quality of management, (2) systematic bias from individual reviewers, and (3) systematic bias related to the professional training of the reviewer (ie, physician or nurse practitioner). CONCLUSIONS: Peer assessments can play an important role in characterizing the quality of care for complex patients with multiple interrelated chronic conditions, but reliability can be poor. Strategies to achieve adequate reliability for these assessments should be applied. These strategies include emphasizing outcomes measurement, providing more structured assessments to identify true differences in patient management, adjusting systematic bias resulting from the individual reviewer and their professional background, and averaging scores from multiple reviewers. Future research on the reliability of peer assessments should focus on improving the ability of process measures to differentiate among cases with respect to the quality of management and on identifying additional sources of systematic bias for both process and outcome measures. Explicit recognition of factors influencing reliability will strengthen efforts to develop sound measures for quality assurance.

Aged↗
PubMed1995

The self-image of adolescents with cystic fibrosis.

PURPOSE: The changing expectations, therapies and outcomes for young people with cystic fibrosis (CF) necessitate a re-evaluation of the impact of this chronic illness on adolescent development. The aim of this study was to assess the psychological well-being and adjustment of contemporary adolescents with CF. METHODS: Forty-nine adolescents with CF (24 males, 25 females) aged 14-18 years were enrolled from the Royal Children's Hospital CF Clinic, Melbourne, Australia. The Offer Self-Image Questionnaire was administered to participating subjects whose growth and pubertal developmental and pulmonary function was assessed. RESULTS: The mean (SD) FEV1% was 82 (21), and mean (SD) National Institute of Health clinical score was 81 (12). There were no significant differences between males and females in pulmonary function or clinical scores, but growth and pubertal development were delayed in both sexes. Females, but not males, with CF were less well-adjusted than their healthy peers. Two-way analysis of variance was performed and showed significant sex differences in sub-scales of the Offer questionnaire numbers I, II, III, VI, VIII, IX, as well as in the total score. Age was significant only for scales II and VIII, and only scale II displayed an interaction between sex and age. CONCLUSIONS: This study suggests that adjustment and self-esteem are less than ideal in young people with CF, especially females.

Adaptation, Psychological↗
PubMed2002

Exercise training and the cardiovascular consequences of type 2 diabetes and hypertension: plausible mechanisms for improving cardiovascular health.

The coexistence of type 2 diabetes and hypertension is especially damaging to cardiovascular health. Most trials of exercise training for these conditions have focused on glycemic control and blood pressure reduction. Less is known about the effects of exercise on the cardiovascular consequences of diabetes and hypertension. This article reviews the available evidence and plausible mechanisms by which exercise training may improve the cardiovascular health of persons with type 2 diabetes and hypertension and provides practical guidelines for exercise prescription. A MEDLINE search was performed for January 1985 to June 2002. Bibliographies from relevant articles, professional society clinical practice guidelines, and books were also reviewed. Because few large, randomized trials exist on these topics, meta-analyses, smaller trials, nonrandomized trials, and animal studies were also considered. Data quality was determined by publication in peer-reviewed journals or professional society literature. Type 2 diabetes and hypertension result in abnormalities in central and peripheral parameters of cardiovascular structure and function. Evidence for an exercise training benefit is strongest for improvements in endothelial vasodilator function and left ventricular diastolic function. The data for exercise training's improvement of arterial stiffness and system inflammation and reduction of left ventricular mass are less robust. However, this assertion is based more on a lack of randomized controlled trials rather than data to the contrary. Exercise training also reduces total and abdominal fat. These changes in body composition mediate improvements in insulin sensitivity and blood pressure and may improve endothelial vasodilator function. The current evidence, albeit not fully confirmed in randomized trials, suggests that the benefits of exercise training go beyond the recognized benefits of glycemic control and blood pressure reduction.

Adipose Tissue↗
PubMed1981

The mutagenic effect of cis-diamminedichloroplatinum (II) and its degradation products in the Ames microbial assay.

cis-Diamminedichloroplatinum (II), an antitumor compound which exhibits mutagenic activity, and its degradation products platin B salt, magnus red, and magnus red anion salt were tested in the Ames microbial mutagenicity assay. The purpose of this investigation was to determine if the positive mutagenic response of the platinum compound could be due to, or enhanced by, the presence of degradation products. Results indicate that platinum degradation complexes are weak mutagens which are capable of inducing both base pair and frameshift-type mutations.

Animals↗
PubMed2001

The quality of adolescents' friendships: associations with mothers' interpersonal relationships, attachments to parents and friends, and prosocial behaviors.

Adolescents' friendship quality and observed emotional expression with their best friends were predicted from reports of their mother's interpersonal relationships-specifically the quality of her marriage and social network. Two models explaining these relationships received support. Consistent with an Attachment Theory model, adolescents' perceptions of marital quality predicted attachment security with mother, father and friends. Security of attachment to friends in turn predicted best friendship quality, but not affective behavior with the friend. A Social Learning Theory model was also supported, in which perceptions of both marital quality and mother's social network quality predicted adolescents' prosocial behavior. Prosocial behavior in turn predicted both best friendship quality and affective behavior with the friend.

Adolescent↗
PubMed1993

Parent reports of child behavior problems: bias in participation.

This paper compares the characteristics of 274 children whose parents agreed to provide information about their children's functioning in research with children whose parents did not. Parents had provided permission for child participation in school-approved research. Measures included self-, peer, teacher, and parent ratings. Parents of minority children were less likely to participate than parents of nonminority children. Among nonminorities, children of parent participants were viewed as more socially skilled and liked by their peers; teachers rated them as having less attention problems, less depression, and better academic skills than children of nonparticipating parents. Among minorities, no differences emerged. Implications for research involving the use of parent ratings are discussed.

Achievement↗
PubMed1991

CSF monoamine metabolite concentrations vary according to age, rearing, and sex, and are influenced by the stressor of social separation in rhesus monkeys.

In humans, CSF monoamine metabolite concentrations have been shown to vary as a complex function of age, sex, psychiatric diagnosis, and stress. To test for such relationships in rhesus monkeys, 28 subjects, reared either in anxiety producing peer-only groups or in mother-infant dyads, were studied at 6, 18 or 50 months of age. Each monkey underwent a series of four 4-day social separations, each followed by 3 days of reunion. Prior to and during the first and fourth separations, CSF was obtained from the cisterna magna and assayed for the serotonin metabolite 5-HIAA, the dopamine metabolite HVA, and the norepinephrine metabolite MHPG. CSF 5-HIAA showed an age-related decline which was greater in the mother-reared subjects. Peer-only-reared males had an increased 5-HIAA concentration relative to females, and higher 5-HIAA levels than mother-reared males. MHPG was also higher in peer-only-reared monkeys than in mother-reared subjects at all ages. In both groups HVA declined across the three ages, and MHPG increased from the 18- to the 50-month measurements. Both MHPG and 5-HIAA concentrations increased during the initial social separation, although only MHPG remained elevated across the repeated separations; HVA, on the other hand declined during social separation. These results are discussed in terms of established anxiety and aggression differences between peer-only and mother-reared monkeys.

Aging↗
PubMedDate not supplied

Ion channel regulation by chronic hypoxia in models of acute oxygen sensing.

Several potentially life-threatening cardiovascular and respiratory disorders result in prolonged deprivation of oxygen, which in turn results in significant cellular adaptation, or remodelling. An important component of this functional adaptation arises as a direct consequence of altered ion channel expression by chronic hypoxia. In this review, we discuss current understanding of this hypoxic remodelling process, with particular reference to regulation of L-type Ca2+ channels and high-conductance, Ca2+-sensitive K+ (BK) channels. In systems where this remodelling occurs, changes in functional expression of these particular channels evokes marked alteration in, or responses to, Ca2+-dependent events. Evidence to date indicates that channel expression can be modulated at the transcriptional level but, additionally, that crucial post-transcriptional events are also regulated by chronic hypoxia. Importantly, such remodelling is, in some cases, strongly associated with production of amyloid peptides of Alzheimer's disease, implicating chronic hypoxia as a causative factor in the progression of specific pathology. Moreover, subtle changes in functional expression of BK channels implicates chronic hypoxia as an important regulator of cell excitability.

Animals↗
PubMed1994

A computerized system for reviewing medical records from physicians' offices.

BACKGROUND: Review of clinical performance in office-based care is increasing in importance as more medical care shifts to outpatient settings. Decisions made in primary care settings can save lives and limit disability through prevention and early intervention in disease. Information is needed to assess quality of care by answering such questions as whether drugs are prescribed and monitored appropriately, follow-up on serious health threats is carried out promptly, or procedures are performed for appropriate indications. Moreover, data from medical records are essential to provide important clinical information not found in the more widely used administrative data sets. Managed care organizations, too, face the need to respond to requests for objective information about the quality of primary care that they provide. Those organizations now planning assessments of primary care will need to consider the cost of obtaining information from medical record review. METHODS: The DEMPAQ Record Review System (DRRS) is a tool for peer review organizations (PROs) to use to review ambulatory care given to Medicare beneficiaries in physicians' offices. The system is described in terms of functions (activities commonly performed in the course of an office visit, such as drug prescribing), indicators (summary measures of quality for each key function of clinical care), and clinical items (for example, specific drugs or tests for each function and indicator)--a total of 263 indicators in all. A framework is provided for measuring the operational costs of a review system based on medical records. RESULTS: The costs directly associated with a fully operational review system were less than $48 per case in Iowa and Alabama and $72 per case in Maryland. On average, reviewers spent about an hour per case signed on to DRRS; average review times declined over time with practice. About half the cost of the review process is accounted for by administrative costs. Therefore, once the effort has been made to obtain records, the additional cost of abstracting more data items is relatively low. Since samples of 300-500 records suffice to measure average performance for a region or state, costs per region/state approximate $15,000 to $25,000 per measurement cycle for assessment of a wide array of clinical areas. SUMMARY: The cost of collecting information on quality of care from medical records using the review system falls within current budgets for PRO review. However, organizations planning to implement a quality improvement campaign should also consider the costs of analyzing the data, reporting information to physicians, and continuing to monitor changes in performance.

Aged↗
PubMed1987

Language of hydrocephalic children and adolescents.

How adequate a substrate for the development of language is the young hydrocephalic brain? To answer this question, the development of five language domains (word finding, fluency and automaticity, immediate sentence memory, understanding of grammar, and metalinguistic awareness) was studied in children and adolescents, 75 with hydrocephalus in the first year of life, and 50 normal controls. The results revealed a limited resilience of language to the effects of early hydrocephalus. Resilience was indicated by the finding that, for several language skills, hydrocephalics scored at comparable levels to normals and improved their test performances as they matured. The limits to resilience were also apparent. Language development was not uniform after early hydrocephalus, and, within particular language domains, hydrocephalics were either less skilled or less able to maintain age-appropriate skill mastery than normal peers. Early hydrocephalus had diverse effects on language development: Of the variables measuring its forms, manifestations, and treatments, some were indicative of preserved language functioning while others were predictive of language deficit. The young hydrocephalic brain mediates language development in a manner that is adequate, but far from ideal.

Adolescent↗
PubMed2002

Wanda: a database of duplicated fish genes.

Comparative genomics has shown that ray-finned fish (Actinopterygii) contain more copies of many genes than other vertebrates. A large number of these additional genes appear to have been produced during a genome duplication event that occurred early during the evolution of Actinopterygii (i.e. before the teleost radiation). In addition to this ancient genome duplication event, many lineages within Actinopterygii have experienced more recent genome duplications. Here we introduce a curated database named Wanda that lists groups of orthologous genes with one copy from man, mouse and chicken, one or two from tetraploid Xenopus and two or more ancient copies (i.e. paralogs) from ray-finned fish. The database also contains the sequence alignments and phylogenetic trees that were necessary for determining the correct orthologous and paralogous relationships among genes. Where available, map positions and functional data are also reported. The Wanda database should be of particular use to evolutionary and developmental biologists who are interested in the evolutionary and functional divergence of genes after duplication. Wanda is available at http://www.evolutionsbiologie.uni-konstanz.de/Wanda/.

Animals↗
PubMed2001

The effects of poverty on childrens socioemotional development: an ecological systems analysis.

Bronfenbrenner's process-person-context-time model is used to examine theories that explain the adverse effects of economic deprivation on children's socioemotional development. In his model, each of five structures of the ecological environment-microsystems, mesosystems, exosystems, macrosystems, and chronosystems-is subsumed within the next higher level. Theories of the effects of poverty on proximal processes in the microsystem of the family have the most research support, but processes in other microsystems such as the peer group and school and in other levels of the ecological environment may also explain the relation between economic deprivation and children's socioemotional functioning. Social work practice and policy implications are drawn from the analysis.

Adaptation, Psychological↗
PubMed2006

Pediatric breast deformity.

Congenital breast anomalies represent a relatively common set of disorders encountered by pediatric plastic surgeons with a spectrum of severity that ranges widely from the relatively benign polythelia to the very complex disorders such as Poland's syndrome and tuberous breast deformities. While the former can be treated in a single surgical setting with minimal morbidity, the more complicated disorders often require a staged reconstructive algorithm. Some disorders also require a multidisciplinary management for both workup and management. Although rarely a source of functional morbidity, these physical deformities are often a significant source of psychological stress for the adolescent male or female who feels alienated from their peers. The purpose of this article is to review the most common congenital breast disorders including the diagnosis, workup, and management especially the timing of surgical intervention as guided by normal developmental milestones.

Adolescent↗