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PubMed1999

Cardiovascular effects of mechanical ventilation.

OBJECTIVE: To review the cardiovascular effects of spontaneous breathing and mechanical ventilation in healthy and pathological states. DATA SOURCES: A review of articles published in peer-reviewed journals from 1966 to 1998 and identified through a MEDLINE search on cardiopulmonary interaction. SUMMARY OF REVIEW: Respiration has a hydraulic influence upon cardiovascular function. Pulmonary and cardiac pathology alter this interaction. Spontaneous inspiration increases right ventricular (RV) preload and left ventricular (LV) afterload. Mechanical ventilation with positive pressure (MV) reduces LV preload and afterload. The influence of MV upon the cardiovascular system (CVS), particularly in critically ill patients, depends upon the mode of ventilation and the pre-existing cardiac and respiratory status. The influence of these factors is reviewed. Consideration of these parameters will enable the clinician to predict the likely effect of MV and develop strategies to minimise adverse events. CONCLUSIONS: Mechanical ventilation has an adverse effect upon the CVS in healthy subjects and in patients with pulmonary pathology, particularly in the presence of preload-dependent LV dysfunction or afterload-induced RV dysfunction. Mechanical ventilation may benefit cardiac function in patients with respiratory failure and afterload-dependent or exercise-induced LV dysfunction.

Journal Article↗
PubMed2003

Deliberate self-harm in a nonclinical population: prevalence and psychological correlates.

OBJECTIVE: Research on deliberate self-harm (intentionally injuring oneself without suicidal intent) has focused on clinical and forensic populations. Studying only these populations, which typically have serious psychopathology, may lead to inflated estimates of the association between self-harm and psychiatric disorder, as well as of the prevalence of deliberate self-harm. The present study investigated the prevalence and correlates of deliberate self-harm in a large group of nonclinical subjects. METHOD: Participants were 1,986 military recruits, 62% of whom were men, who were participating in a study of peer assessment of personality traits and pathology. Individuals who did and did not report a history of self-harm were compared on measures of personality and psychopathology. RESULTS: Approximately 4% of the participants reported a history of deliberate self-harm. Compared with participants without a history of deliberate self-harm, self-harmers scored higher on self- and peer-report measures of borderline, schizotypal, dependent, and avoidant personality disorder symptoms and reported more symptoms of anxiety and depression. Item-level analyses indicated that peers viewed self-harmers as having strange and intense emotions and a heightened sensitivity to interpersonal rejection. CONCLUSIONS: About one of every 25 members of a large group of relatively high-functioning nonclinical subjects reported a history of self-harm. Self-harmers had more symptoms of several personality disorders than non-self-harmers, and their performance across measures suggested that anxiety plays a prominent role in their psychopathology. Future research should investigate whether psychotherapies or psychiatric medications known to reduce symptoms of anxiety can be effective in treating deliberate self-harm.

Adult↗
PubMed2006

Relationship between renal function and left ventricular assist device use.

BACKGROUND: Poor renal function may affect outcomes after left ventricular assist device (LVAD) placement. Conversely, LVADs may optimize circulation and improve renal function. METHODS: To assess the relationship between renal function and LVAD use, changes in creatinine clearances (CrCl, in mL/min) were assessed retrospectively in 220 patients who underwent LVAD placement. These patients were also divided into four groups based on CrCl quartiles (< 47, 48-68, 69-95, and > 95) and compared for outcomes post-LVAD placement. RESULTS: Eighty-four patients died on LVAD support. Survival on LVAD was worse for patients with the worst baseline CrCl (42%, 52%, 63%, and 79% for 6 month and 26%, 34%, 47%, and 66% for 12 month survival for quartiles 1-4; both p < 0.01 for trend). Adjusting for other covariates, patients in the lowest CrCl quartile were at a higher risk of dying postimplant (odds ratio 1.95, 95% confidence interval 1.14-3.63). Paired sample analysis showed the following changes in CrCl: preoperative to week 1, 77.0 +/- 46.6 to 92.1 +/- 51.1 (p < 0.01; n = 202), week 1 to 2, 89.4 +/- 49.2 to 95.2 +/- 52.4 (p = 0.01, n = 171), week 2 to 3, 107.5 +/- 58.1 to 113.7 +/- 66.1 (p = 0.16, n = 74), and week 3 to 4, 111.1 +/- 56.6 to 110.5 +/- 56.8 (p = 0.87, n = 60). For the 60 patients with baseline CrCl less than 50, CrCl increased from 36.7 +/- 9.2 to 60.1 +/- 35.5 (p < 0.01; n = 55 pairs) from preimplant to week 1. In 37 of these patients (62%) on intraaortic balloon pump support preimplant, CrCl increased from 38.4 +/- 8.2 to 67.9 +/- 40.3 mL/minute (p < 0.01) during week 1 postimplant. Recovery of renal function to CrCl greater than 50 was associated with a trend towards better 30-day survival (84% vs 66%, p = 0.09). CONCLUSIONS: Baseline poor renal function is associated with worse outcomes after LVAD implantation. However, renal function improves substantially and rapidly in post-LVAD survivors and is associated with improved outcomes. These data underscore the importance of careful patient selection for LVAD therapy.

Adult↗
PubMed2004

Peer support groups in multiple sclerosis: current effectiveness and future directions.

Peer support programs have become a common method of providing support for patients with chronic illness. Utilizing peers as resources has been proposed as an effective means for coping with a stressful life experience and for gaining support from others who share a common factor, although data are somewhat mixed on the efficacy of peer support. The aim of the present study was to evaluate the effectiveness of eight weeks of a standard form of peer support in improving quality of life and reducing depressive symptoms in 44 patients with multiple sclerosis (MS). One person from each of six groups participated in a training course in order to learn basic principles of peer support. Eight weekly sessions were held and patients completed self-administered questionnaires pre- and post-treatment assessing quality of life and depression. Results showed that support groups do not provide consistent improvement in quality of life or depression in patients with MS and suggest that patients who have better mental health functioning could be at risk for deterioration in support groups.

Depression↗
PubMed1999

Syme amputation for the treatment of fibular deficiency. An evaluation of long-term physical and psychological functional status.

BACKGROUND: Syme amputation is an accepted treatment for fibular deficiency. With improvement in limb-lengthening procedures, there has been renewed interest in limb salvage for these patients. The purpose of the present study was to evaluate the physical and psychological results in ten young adults who had had a Syme amputation for the treatment of fibular deficiency when they were children. METHODS: The evaluation consisted of physical examination, prosthetic assessment, psychological testing, and physical performance testing of knee extension and flexion with use of a Cybex-II dynamometer. RESULTS: Five patients reported no difficulty with the involved limb since the Syme amputation, four had had minor secondary procedures (three medial distal femoral or proximal tibial hemiepiphyseodeses, one reconstruction with an autologous patellar ligament graft, one revision of the stump, and one tibial osteotomy) on the affected extremity, and one had mild instability of the knee that had been treated nonoperatively. All ten patients had an appropriate, functional Syme prosthesis, and none reported difficulty with walking or running. On psychological testing, this group generally did not differ from the norm with regard to occupational satisfaction, personal growth, relationships with family members and peers, and recreational behavior. The patients' overall assessment of self-reported quality of life and self-esteem was similar to that of normative adult samples. In general, these patients were leading active, productive lives and had always done so. CONCLUSIONS: On the basis of the results of this study, we concluded that young adults who have had a Syme amputation apparently are not limited in their ability to pursue and achieve personal goals. In order to justify recommending limb salvage rather than early Syme amputation for the treatment of fibular deficiency, the results of multistaged lengthening and reconstruction would have to match the functional, psychological, and cost-effective results for the patients whom we studied, who had had a Syme amputation.

Adolescent↗
PubMed2001

In utero exposure to coumarins and cognition at 8 to 14 years old.

OBJECTIVE: To assess the cognitive abilities in school-aged children who have been exposed to coumarins in utero. BACKGROUND: Coumarin derivatives are an effective option for anticoagulant therapy in pregnant women. However, case reports describe anomalies of the fetal central nervous system after in utero exposure to coumarins. It is unclear whether prenatal exposure has an effect on cognitive functioning later in childhood. METHODS: The exposed cohort consisted of 291 children from mothers who were prospectively registered because of coumarin treatment during pregnancy. The nonexposed cohort included 253 age-matched peers. An IQ was estimated using subtests of the Weschler Intelligence Scale for Children-Revised. Educational achievement was examined with tests for reading, spelling, and arithmetic. In addition, schoolteachers were asked to judge performance on language and arithmetic. The observers were not aware of the exposure status of the child. RESULTS: No differences in mean IQ were found between the exposed and nonexposed cohort (mean difference: -1.1; 95% confidence interval [CI]: -3.2-1.1), but an IQ score below 80 was found in 11 children in the exposed compared with 3 children in the nonexposed cohort (odds ratio [OR] = 3.1; CI: 0.8-11.6). Regarding the tests for educational achievement, exposed children as a group performed as well as nonexposed controls. Exposed boys, in comparison with nonexposed boys, showed a higher frequency of poor performance on reading (OR = 2.9; CI: 1.1-7.4) and spelling (OR = 2.5; CI: 1.0-6.0). CONCLUSION: Cognitive functioning in coumarin-exposed children does not differ from nonexposed controls, but a minority of children seem to be prone to the potential negative effects of coumarins during pregnancy.

Adolescent↗
PubMed2003

Major depression and conduct disorder in a twin sample: gender, functioning, and risk for future psychopathology.

OBJECTIVE: Major depression (MDD) and conduct disorder (CD) co-occur in adolescents at rates higher than would be expected by chance. This study described the functioning of adolescents with histories of these disorders and examined whether these patterns of association differed by gender. METHOD: Subjects with a lifetime diagnosis of MDD and/or CD were selected from a sample of 17-year-old twins; control subjects had no history of either disorder. The domains of school success, substance dependence, peer relationships, and age of first sexual intercourse were examined. RESULTS: Overall, each disorder separately and especially both disorders together related to increased maladjustment in the domains of school success and substance dependence. For school behavior problems, nicotine dependence, and drug dependence, the combination of MDD and CD related to particularly problematic functioning. Results were similar for males and females. Longitudinal data indicated that the occurrence of these disorders by late adolescence was predictive of subsequent depression and antisocial behavior in early adulthood. CONCLUSIONS: The combination of CD and MDD relates to more serious maladjustment, especially relating to school success and substance dependence, than would be expected given the adjustment associated with each disorder alone.

Adolescent↗
PubMed2002

Risk and protective factors as predictors of outcome in adolescents with psychiatric disorder and aggression.

OBJECTIVE: To identify predictors of behavioral outcomes in high-risk adolescents with aggression and serious emotional disturbance (SED). METHOD: Three hundred thirty-seven adolescents from a statewide North Carolina treatment program for aggressive youths with SED were followed between July 1995 and June 1999 from program entry (T1) to approximately 1 year later (T2). Historical and current psychosocial risk and protective factors as well as psychiatric symptom severity at T1 were tested as predictors of high and low behavioral functioning at T2. Behavioral functioning was a composite based on the frequency of risk-taking, self-injurious, threatening, and assaultive behavior. RESULTS: Eleven risk and protective factors were predictive of T2 behavioral functioning, while none of the measured T1 psychiatric symptoms was predictive. A history of aggression and negative parent-child relationships in childhood was predictive of worse T2 behavior, as was lower IQ. Better T2 behavioral outcomes were predicted by a history of consistent parental employment and positive parent-child relations, higher levels of current family support, contact with prosocial peers, higher reading level, good problem-solving abilities, and superior interpersonal skills. CONCLUSIONS: Among high-risk adolescents with aggression and SED, psychiatric symptom severity may be a less important predictor of behavioral outcomes than certain risk and protective factors. Several factors predictive of good behavioral functioning represent feasible intervention targets.

Adolescent↗
PubMed2006

The associations among childhood headaches, emotional and behavioral difficulties, and health care use.

BACKGROUND: Headaches are common among children and adolescents, particularly migraine and tension-type headaches. They contribute to missed school days, affect children's peer and family relationships, and significantly impact children's quality of life, often times into adulthood. OBJECTIVES: This study, based on responses to the Strengths and Difficulties Questionnaire, was designed to examine difficulties and impairments related to emotions, concentration, behavior, and social functioning among children with frequent or severe headaches (FSH). METHODS: We used a cross-sectional study of 9264 children aged 4-17 years from the 2003 National Health Interview Survey, an ongoing, computer-assisted personal interview survey of the noninstitutionalized US population. RESULTS: Approximately 6.7% of children experienced FSH during the previous 12 months. Overall, children with FSH were 3.2 times more likely than children without FSH to have a high level of difficulties and 2.7 times more likely to have a high level of impairment, suggesting potential mental health issues. More specifically, analyses revealed that children with FSH were significantly more likely than those without FSH to exhibit high levels of emotional, conduct, inattention-hyperactivity, and peer problems and were significantly more likely than children without FSH to be upset or distressed by their difficulties and to have their difficulties interfere with home life, friendships, classroom learning, and leisure activities. CONCLUSION: Because children with FSH experience notable pain, mental health issues, and functional limitations, integrated care using a biopsychosocial approach is warranted.

Adolescent↗
PubMed2006

A Web-based systematic review on traumatic spinal cord injury comparing the "citation classics" with the consumers' perspectives.

Although the citation index of an article is not a direct measure of its quality or importance, it is a measure of recognition that may suggest its impact on the scientific community. This study was undertaken to examine the characteristics of the top 100 most frequently cited articles (so-called "citation classics") on traumatic spinal cord injury (SCI) that were published between 1986 and 2003, and to compare this selected professional literature with the consumers' perspective on the key issues in SCI research. The 100 top-cited articles on traumatic SCI were identified using the Internet database of the Science Citation Index Expanded and the Web of Science with the terms "spinal cord injury" and "spinal cord injuries." Meeting abstracts, letters, and editorials were excluded. No language restriction was applied. From a consumers' perspective, the areas of greatest interest for people with SCI as reported in two previous large-scale surveys include motor function, bowel and bladder control, sexual function, and pain. The final list of citation classics on traumatic SCI included 82 original articles and 18 article reviews, which were cited 146 times on average. Topics on basic science (63%) were more frequent than clinical studies (37%). The years of publication were distributed in a bell-shape curve with a peak between 1992 and 1994. North American and European centers (99%) led the list of the citation classics. Most of the top 100 most frequently cited articles on traumatic SCI (63%) explicitly focused on at least one of the topics of greatest interest to individuals with SCI. Motor function was the leading topic in the matching list between professional literature and consumers' perspective. This bibliometric analysis, for the first time, identifies the key features of the citation classics on traumatic SCI between 1986 and 2003, a period that represents one of an unprecedented increase in knowledge in this field. The 100 top-cited peer-reviewed articles have been predominantly focused on basic science SCI research indicating a need for greater bench-to-bedside translational studies in SCI research. Although the body of this top-cited professional literature mostly matches with the consumers' perspective, most of this research has been focused on motor function assessment and recovery following SCI.

Bibliometrics↗
PubMed1991

Childhood asthma in interaction with family, school, and peer systems: a developmental model for primary care.

The developmental/biopsychosocial approach to primary care of childhood asthma offered in the above model emphasizes four interlocking features: 1. Consideration of the biologic, psychologic, and social aspects of asthma which interact with one another and influence disease management and psychosocial functioning and development of the asthmatic child 2. The importance of balance between disease management and quality of life and developmental needs of the patients and their families 3. Appreciation and facilitation of a developmentally synchronized shift toward self care of the asthma and its social and emotional aspects; 4. Central role played by the primary care provider (or health care team) in integrating developmental/biopsychosocial aspects of comprehensive treatment for childhood asthma.

Adaptation, Psychological↗
PubMed2006

Children enrolled in public pre-K: the relation of family life, neighborhood quality, and socioeconomic resources to early competence.

This article presents data on the family and social environments of 501 children enrolled in public sponsored pre-K in 5 states and tests the relation of these resources to child competence. Structured interviews and questionnaires provide information from parents about the family's social and economic status. Direct assessments and teacher reports provide data on children's literacy, numeracy, and behavioral problems. A majority of the children served in public pre-K lived in poverty and showed decrements in language but not in other domains. A socioeconomic resource factor consisting of parental education, household income, and material need predicted all domains of children's functioning. Children from households high in socioeconomic resources entered pre-K with more well developed language and math skill but fewer behavioral problems than their disadvantaged peers. Neighborhood quality status was related to language competence and mother's marital status to math competence. Neighborhood quality and income level may have their impact on child competence through their relation to dyadic quality and the health and the psychological well-being of the parents.

Aptitude↗
PubMed1991

Responses to requests for conversational repair by adults with mental retardation.

This study focused on adjustments made in conversation in response to listener feedback. Subjects consisted of 22 community-based and 22 institutionalized adults with mental retardation individually matched for full-scale IQ. For each subject, data were collected in a dyadic conversation with an investigator. During the course of the conversation, the investigator introduced stacked sequences of three requests for clarification of the same message ("Huh?" "What?" "What?"). Each subject's responses to these requests were analyzed. Results indicated that community-based subjects used certain sophisticated repair strategies more often than did their institutionalized peers. However, neither group of subjects was as responsive to the requests for clarification as would have been predicted considering their general levels of intellectual and linguistic functioning.

Adult↗
PubMed2000

Emotional and behavioural problems and family functioning in children with haemophilia: a cross-sectional survey.

A comparative study is presented about emotional and behavioural problems in haemophilia and family functioning. This cross-sectional survey looked at boys, aged between 4 and 15 years, with haemophilia and compared them with a group of their healthy school peers. A basic demographic questionnaire was used for both groups along with the Child Behaviour Checklist (CBCL) and the Family Assessment Measure (FAM). Seventeen of 24 families of boys with haemophilia participated (70.8% response). The comparison group consisted of 12 boys, i.e. 70.6% of the haemophilia sample. The groups did not differ in terms of the children's ages and family sizes but significantly fewer of the mothers of the boys with haemophilia worked outside the home. The two groups were compared for scores on the CBCL and FAM. More problems were identified in the haemophilia group on both measures, i.e. there were more emotional, behavioural and family difficulties compared with the healthy group; however, because of the small sample sizes, the differences between the groups did not reach statistical significance. A larger study would be indicated in order to explore these differences further.

Adolescent↗
PubMed2003

The computational analysis of scientific literature to define and recognize gene expression clusters.

A limitation of many gene expression analytic approaches is that they do not incorporate comprehensive background knowledge about the genes into the analysis. We present a computational method that leverages the peer-reviewed literature in the automatic analysis of gene expression data sets. Including the literature in the analysis of gene expression data offers an opportunity to incorporate functional information about the genes when defining expression clusters. We have created a method that associates gene expression profiles with known biological functions. Our method has two steps. First, we apply hierarchical clustering to the given gene expression data set. Secondly, we use text from abstracts about genes to (i) resolve hierarchical cluster boundaries to optimize the functional coherence of the clusters and (ii) recognize those clusters that are most functionally coherent. In the case where a gene has not been investigated and therefore lacks primary literature, articles about well-studied homologous genes are added as references. We apply our method to two large gene expression data sets with different properties. The first contains measurements for a subset of well-studied Saccharomyces cerevisiae genes with multiple literature references, and the second contains newly discovered genes in Drosophila melanogaster; many have no literature references at all. In both cases, we are able to rapidly define and identify the biologically relevant gene expression profiles without manual intervention. In both cases, we identified novel clusters that were not noted by the original investigators.

Animals↗
PubMed1986

Minor neurological indicators and developmental function in preschool children.

An attempt was made to determine whether neuromaturational indicators (soft neurological signs) were associated consistently with specific areas of developmental function in 5-year-old children. Fifty-eight children were assessed over two diagnostic sessions. One involved administration of the Pediatric Exam of Educational Readiness (PEER) by pediatric fellows; the other consisted of administration of the McCarthy Scales of Children's Abilities (MSCA) by trained psychoeducational specialists. Data indicate that children who exhibited a greater number of minor neurological indicators had a high likelihood of experiencing difficulty with visual-perceptual, fine motor, and gross motor tasks of the PEER and the MSCA. What is more important, no relationship was found between aggregates of minor neurological indicators and performance on linguistic, memory, sequencing, quantitative, verbal, or preacademic sections of these diagnostic instruments. This information suggests that physicians should limit their interpretation of such signs when evaluating young children with academic difficulties. Additional data must be accumulated before the role of neuromaturational signs can be fully understood.

Child, Preschool↗