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PubMed2002

Peer relations of youth with pediatric conditions and health risks: promoting social support and healthy lifestyles.

Peer relations and close friendships play important roles in youngsters' emotional development and take on special significance when a child or adolescent has a chronic disease. This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on (1) the role of peers and close friends as a source of support, (2) friends' influence on treatment adherence, and (3) peers' and friends' impact on health-promoting and health-risk behaviors. In general, youngsters with chronic conditions do not have more problems in their peer relations than other youth, although children with medical conditions that are stigmatizing or that involve the central nervous system (CNS) may encounter peer difficulties. Social support from friends and classmates appears to facilitate youngsters' disease adaptation and may help with the lifestyle aspects of treatment regimens. Adolescent peer-crowd affiliations (e.g., "brains," "jocks") that are linked with health-promoting behaviors may prove beneficial to youngsters' disease management and health. The findings underscore the need for helping children and adolescents disclose their medical condition to peers in positive ways and for including youngsters' close friends in the treatment process and in school-reentry programs after extended medical care. Additional research is needed to develop strategies for incorporating youngsters' peers and friends into the medical management of youth with chronic pediatric conditions.

Adaptation, Psychological↗
PubMed1980

Tardive dyskinesia and hospital discharge.

Two hundred ninety-three schizophrenic inpatients were rated for dyskinetic movements on the Abnormal Involuntary Movement Scale (AIMS). Two years later, discharge status on 265 of these patients was related to the AIMS ratings. Results indicated that the discharge group had significantly lower AIMS ratings than the nondischarged group. The effect was not an artifact of age but was evident across nearly all age groups. The groups were also different on length of current hospitalization, age at time of first psychiatric hospitalization, and time since first psychiatric hospitalization. Possible reasons for the results are discussed, including the development of functional deficits, stigmatization, and tardive psychosis, as well as the possible association between tardive dyskinesia, discharge, and treatment refractoriness.

Antipsychotic Agents↗
PubMed2001

The relationship between insight and social skill in persons with severe mental illness.

The relationship of insight with the social behaviors of outpatients with severe mental illness (SMI) was investigated. Participants' engaged in two social interactions (i.e., stigmatizing and nonstigmatizing), each with a different research confederate. The participant's behavior was later coded for the presence of various self-presentation and social skill variables. Results indicated that greater insight was associated with better overall social skill, less observed strangeness, and greater self-disclosure of one's mental illness. Furthermore, the three measures of insight, one based on self-report and two interview-based, were all highly intercorrelated, suggesting that they are measuring a similar construct. Finally, consistent with previous research in the area, greater insight was associated with less severe psychiatric symptoms. Implications of these findings for future research are discussed.

Adult↗
PubMed1976

Integrating mental health services into primary medical care.

Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in illness and in health. Federal efforts to encourage Health Maintenance Organization (HMO) development as part of a national health program prompts serious attention to organizational arrangements for developing such an integrated program for medical-mental health care. We have found a team collaborative model in which mental health providers are members of a primary care team to be useful and promising. Supportive services are provided on a continuing basis through patterned relationships. Shared responsibility for patient care between physicians, nurse practitioners, physician assistants, and mental health workers provides built-in peer review and encourages intrateam consultation.

Connecticut↗
PubMed1997

Satisfaction with inpatient acquired immunodeficiency syndrome care. A national comparison of dedicated and scattered-bed units.

OBJECTIVES: This study sought to determine whether there were differences in acquired immunodeficiency syndrome (AIDS) patients' satisfaction with inpatient nursing care on dedicated AIDS units compared with conventional, multidiagnosis medical units. METHODS: Interview data were collected from more than 600 consecutive AIDS admissions in 40 patient care units in 20 hospitals in 11 high AIDS incidence cities. Ten hospitals with dedicated AIDS units were matched with comparable hospitals treating AIDS patients on multidiagnosis medical units. AIDS patients' satisfaction with nursing care on dedicated AIDS units was compared with AIDS patients' satisfaction with care on scattered-bed units in the same hospital and with AIDS patients' satisfaction on scattered-bed units in different, matched hospitals without dedicated units. Interhospital differences that were not controlled by design were controlled statistically, as were differences in patient characteristics and illness severity. RESULTS: Acquired immunodeficiency syndrome patients receiving care on dedicated AIDS units were significantly more satisfied with their nursing care. In hospitals with units of both types, dedicated AIDS units had a higher proportion of white patients, men, and homosexuals, whereas scattered-bed units had more minority patients and intravenous drug users. Controlling for these factors as well as for differences in illness severity and interhospital differences in patient satisfaction did not diminish the positive AIDS unit effect on patient satisfaction. CONCLUSIONS: Dedicated AIDS units achieve higher levels of satisfaction among patients with AIDS than general medical units. There is no evidence that patients feel isolated or stigmatized on dedicated AIDS units compared with patients on general units, and many patients have a clear preference for dedicated units.

Acquired Immunodeficiency Syndrome↗
PubMed1999

When asked, patients tell: disclosure of sensitive health-risk behaviors.

OBJECTIVES: National health care organizations recommend routinely screening patients for behavioral health risks, the effectiveness of which depends on patients' willingness to disclose risky behaviors. This study aimed to determine if primary care patients' disclosures of potentially stigmatizing behaviors would be affected by (1) their expectation about whether or not their physician would see their disclosures and (2) the assessment method. METHODS: One thousand nine hundred fifty-two primary care patients completed a questionnaire assessing human immunodeficiency virus (HIV), alcohol, drug, domestic violence, tobacco, oral health, and seat belt risks; half were told their responses would be seen by the researcher and their physician and half were told that their responses would be seen by the researcher only. Patients were randomly assigned to one of five assessment methods: written, face-to-face, audio-based, computer-based, or video-based. RESULTS: Across all risk areas, patients did not disclose differently whether or not they believed their physician would see their disclosures. Technologically advanced assessment methods (audio, computer, and video) produced greater risk disclosure (4%-8% greater) than traditional methods in three of seven risk areas. CONCLUSIONS: These findings suggest patients are not less willing to disclose health risks to a research assistant knowing that this information would be shared with their physician and that a number of assessment methods can effectively elicit patient disclosure. Potentially small increases in risk disclosure must be weighed against other factors, such as cost and convenience, in determining which method(s) to use in different health care settings.

Adult↗
PubMedDate not supplied

The impact of epilepsy on the adolescent adolescent.

Epilepsy is the most common serious neurologic condition affecting adolescents, coinciding with a time of dramatic change in growth, hormones, psychology, and social situations. Adolescents with epilepsy are sensitive to peer norms and beliefs and may limit disclosure of their chronic illness to feel less different or stigmatized. They may also explore the world of alcohol and recreational drugs, like others in their peer group, as well as experiment with their own medications. The goal of treatment should be maintenance of a normal lifestyle with complete seizure control, minimal adverse effects, and achievement of normal adolescent milestones. Adolescents with epilepsy have an increased incidence of depression because of the combination of the unpredictable nature of epilepsy, a perceived lack of control, uncontrollable adverse events, and negative perceptions of themselves. The purpose of this article is to summarize the physical, developmental, emotional, and cognitive effects of epilepsy on adolescents. By increasing the awareness of healthcare providers, interventions designed to prevent further negative consequences can be considered for adolescents with epilepsy.

Adaptation, Psychological↗
PubMed2001

Comparing optical systems, and the concept of the converter system.

The purpose of this article was to present a complete and general method for comparing the first-order optical character of optical systems. The method provides a common basis for quantifying the difference between systems of all kinds including thin lenses, ophthalmic prisms, eyes before and after accommodation, eyes before and after refractive surgery, etc. Systems may be astigmatic or stigmatic, coaxial or noncoaxial. In special cases, the method reduces to being equivalent in essence to ostensibly incommensurate comparisons implicit or explicit in current optometric and ophthalmological usage (difference in power for refractions, corneas, and thin lenses, difference in prismatic power for prisms, ratio of magnifications for afocal telescopes, etc.). The method uses the concept of a converter system that when placed in front of or behind one system, converts its first-order optical character to the equivalent of a second system. Equations are presented for the ray transferences of the anterior and posterior converter systems for pair-wise comparisons in general. For any two systems, the transferences of the converter systems always exist and are unique. Numerical examples are presented; they illustrate converter systems that may be thin in special cases but thick otherwise. The transference of a converter system embodies and quantifies the optical difference between systems or characterizes the change from one state of a system (presurgical or preaccommodative, for example) to another (postsurgical or postaccommodative). The method provides a rational and uniform methodology for research and clinical applications in many areas of optometry and ophthalmology.

Accommodation, Ocular↗
PubMed2002

Tilted power of thin lenses.

Tilting changes the effective power of a thin lens. Blendowske has recently provided an elegant matrix expression for the tilted power in the case of tilt about a vertical axis (faceform tilt). He makes use of what can be called a tilt matrix. He shows that the same expression holds in the case of tilt about a horizontal axis (pantoscopic tilt) if one makes use of a different tilt matrix. The purpose of this note is to derive a general tilt matrix that makes Blendowske's equation valid for tilt about any axis. The general tilt matrix reduces to the particular tilt matrices in the case of rotation about the horizontal and vertical axes. The lens may be stigmatic or astigmatic and may be in air or in some other medium.

Eyeglasses↗
PubMed2002

Determining the power of a thin toric intraocular lens in an astigmatic eye.

Astigmatism poses a number of special difficulties when attempting to achieve a desirable refractive outcome during cataract surgery and intraocular lens implantation. One of the most pertinent difficulties is that traditional Gaussian theoretical formulas are simply unable to handle general astigmatic optical systems, that is, systems in which the principal meridians of the refracting interfaces do not lie in two mutually orthogonal planes. This means that the traditional approach falls short when the cornea is treated as bitoric or when other toric optical devices are already present in the eye. In this paper, the modified step-along procedure is utilized in a demonstration of the derivation of the traditional Gaussian theoretical formulas for the determination of intraocular lens power in a stigmatic eye. Matrices are then used to derive a general formula for the determination of the power of a thin toric intraocular lens in an astigmatic eye. This formula is then modified to allow the user to determine the power of the secondary intraocular lens required to compensate for any residual refraction in a phakic or pseudophakic astigmatic eye. The formulas hold under all conditions, including the case when the cornea is treated as thick and bitoric and when other toric optical devices are already present in the eye. Worked examples are provided.

Astigmatism↗
PubMedDate not supplied

Functional health illiteracy. Ethical concerns.

Functional health illiteracy is a silent disability demanding the attention of healthcare professionals because it affects millions of people in the United States. Patients are reluctant to disclose this problem because they fear discrimination and stigmatization. Inadequate health literacy raises ethical questions because it is a barrier to healthcare and results in poor health outcomes. The purposes of this article are to provide an overview of functional health illiteracy, identify related ethical concerns, and discuss selected, relevant nursing implications. Nurses are in a unique position to serve as advocates, mediators, and translators for their patients who are functionally health illiterate.

Adult↗
PubMedDate not supplied

Who speaks for the vulnerable?

Feeling vulnerable is a common human experience; everyone has probably felt powerless or unable to exert personal control in various situations. Lacking information, feeling stigmatized, being unable to control what is happening, or lacking access to services may lead people to have a heightened sense of vulnerability. They may wonder what rights they have, whether they have been stripped of their rights, or whether anyone cares about their situation. Although a more consumer-oriented approach is being used in many healthcare facilities, patients do not know how to get the help they need or to whom to turn for help. Therefore, the purposes of this article are to explore the concept of vulnerability, discuss advocacy as an ethical response for nurses, and offer recommendations for creating an ethical environment that supports efforts of nurses to act as advocates and uphold the rights of patients and families.

Attitude to Health↗
PubMed1987

Transconjunctival lateral canthopexy in Down's syndrome patients: a nonstigmatizing approach.

In Down's syndrome patients, surgical correction of the palpebral fissure obliquity through an external approach may produce a red, slightly hypertrophic scar. A transconjunctival approach for this repair was used for 15 Down's syndrome patients aged 3 to 17 years (mean 8.7 years), and the results were compared with those in two boys aged 6 and 17 years who underwent correction by the external approach. Palpebral fissure inclinations were recorded using anthropometric measurements preoperatively and 6 months postoperatively. Inclinations were reduced significantly by either technique; however, often the precise degree of the improvement was clear only from the measurements rather than from photographs. Complications of the transconjunctival approach were few, and there were no problems with wound healing and no ocular injury. Transconjunctival lateral canthopexy is a safe, effective method that avoids a potentially stigmatizing external scar.

Adolescent↗
PubMed1996

Is pharyngoplasty a risk in velocardiofacial syndrome? An assessment of medially displaced carotid arteries.

The association of medially positioned internal carotid arteries and velocardiofacial (Shprintzen) syndrome was first made in 1987. This is also the most common syndrome associated with facial clefting. The potentially dangerous implications in children with this syndrome requiring pharyngoplasty for velopharyngeal incompetence and stigmatized hypernasal speech involve potential damage to these vessels. This three-part study was undertaken to analyze this anatomic variant. First, a group of 25 children with velocardiofacial syndrome, velopharyngeal incompetence, and obvious posterior pharyngeal pulsations seen on nasendoscopy was studied by CT angiography to determine the degree of this abnormal vascular pattern. This technique, together with three-dimensional reconstructions, made it possible to determine the precise location of these abnormally positioned vessels. Second, our routine superiorly based pharyngeal flap was measured by lateral cervical x-ray to show the distal tip of the flap. The variance was minimal and demonstrated the tip of most flaps to be at the disk between the C2 and C3 vertebrae. By correlating this information with the CT angiography, the risk of surgery can be determined on strict anatomic grounds, allowing customized flap design in some unilateral cases. In this series of children, routine superiorly based pharyngoplasty would be safe in 52 percent, while in 28 percent a pharyngeal flap would be safe if custom designed, and in the remaining 20 percent surgery should not be attempted because the risk of damage to the carotid arteries is too great. Third, in a double-blind study, velocardiofacial children with obvious pulsations seen on nasendoscopy were grouped with other children with palatal dysfunction. When only endoral examination was performed by plastic surgeons and plastic surgical residents, no vascular pulsations were ever seen. This indicates another important role of nasendoscopy in the preoperative assessment of children for palatopharyngoplasty.

Carotid Arteries↗
PubMed1998

Cranioplasty in frontometaphyseal dysplasia.

Frontometaphyseal dysplasia is an extremely rare craniotubular bone disorder predominantly manifested by supraorbital bossing. Although recognizable with findings at birth, it is usually identified successfully before the onset of puberty. These patients often are stigmatized related to their appearance and may present to the plastic surgeon for intervention. We present a case of successful cranioplasty in correcting the fronto-orbital deformity in a 9-year-old child with frontometaphyseal dysplasia.

Child↗
PubMed1997

Sex, drugs, and infections among youth. Parenterally and sexually transmitted diseases in a high-risk neighborhood.

BACKGROUND AND OBJECTIVES: To determine the extent to which youth who reside in households in a neighborhood with large numbers of drug injectors 1) are infected with parenterally or sexually transmitted agents, and 2) engage in high-risk behaviors. STUDY DESIGN: A multistage probability household sample survey was conducted in Bushwick, Brooklyn from 1994 to 1995. All households in 12 randomly selected primary sampling units were screened for age-eligible youth. One hundred eleven English-speaking 18- to 21-year-olds were interviewed. One hundred three sera were tested for human immunodeficiency virus type 1 (HIV-1), Hepatitis B virus, hepatitis C virus (HCV), human T-cell lymphotrophic virus types I and II (HTLV-I/II), herpes simplex virus type 2 (HSV-2), or syphilis. Urines were tested for chlamydial infection, and for opiate and cocaine metabolites. RESULTS: Eighty-nine percent had sex in the past year, 45% with two or more partners. Only 19% of the sexually active always used condoms. Two (of 95) had had sex with a crack smoker. Thirty percent of women reported being coerced the first time they had sex, and 23% of women and 3% of men reported having been sexually abused. Only 3% reported ever using heroin, and 9% cocaine. Only one reported ever having injected drugs or smoked crack. Some underreporting of stigmatized behaviors occurred: two "nonreporters" had opiate-positive urines and two had cocaine-positive urines. Marijuana use was common, with 48% using it in the past year. No subjects tested positive for HIV-1, HIV-II, or syphilis; 2% tested positive for HTLV-I and 3% for hepatitis C; 3% had hepatitis B markers, 12% had chlamydial infection, and 50% serologic HSV-2 markers. CONCLUSIONS: Population-representative samples of high-risk communities can provide important knowledge. Although heroin and cocaine use, during drug injection, and rates of infection with parenterally transmitted infectious agents appear to be lower among these youth, sexual risk behaviors and chlamydial and HSV-2 infection are widespread. Sexually transmitted disease screening and outreach strategies are needed both to prevent sexually transmitted disease sequelae (including potential increased susceptibility to HIV infection) and to prevent transmission to partners.

Adolescent↗
PubMed2003

Risk factors for sexually transmitted diseases in northern Thai adolescents: an audio-computer-assisted self-interview with noninvasive specimen collection.

BACKGROUND: Previous studies of sexual behavior and sexually transmitted diseases (STDs) in Thai adolescents may have been limited by participation bias and underreporting of stigmatized behaviors. GOAL: The goal was to increase knowledge about risk behaviors and STDs among youths in Thailand. STUDY DESIGN: Students aged 15 to 21 years completed an audio-computer-assisted self-interview. Oral fluid was tested for HIV antibodies and urine was tested for Chlamydia trachomatis and Neisseria gonorrhoeae nucleic acids with polymerase chain reaction. RESULTS: Of 1736 invited students, 1725 (99.4%) agreed to participate. Overall, C trachomatis infection was detected in 49 (2.8%), and there were five cases (0.3%) each of infection with N gonorrhoeae and HIV. Among those who reported sexual intercourse, the prevalence of chlamydial infection was 3.7% among men and 6.1% among women. Logistic regression analysis showed age-adjusted factors associated with chlamydial infection among men to be parents' occupation in agriculture, having sold sex, having a sex partner who had been pregnant, and the number of casual sex partners during lifetime. Among women, age-adjusted factors were parents' occupation in agriculture, number of casual partners during lifetime, having an older sex partner, and perception of higher HIV infection risk. CONCLUSION: These adolescents had high rates of unprotected intercourse and are at risk for STDs. Prevention programs should emphasize use of effective contraceptive methods, including condom use; reducing the number of sex partners (stressing the risk a partner of older age may pose to female adolescents); and reducing engagement in commercial sex.

Adolescent↗
PubMed1998

Reactivation of hepatitis B after transplantation in patients with pre-existing anti-hepatitis B surface antigen antibodies: report on three cases and review of the literature.

BACKGROUND: Patients who have been exposed to the hepatitis B virus (HBV) and who were able to clear the hepatitis B surface antigen from the serum and to develop anti-hepatitis B surface antigen (anti-HBs) antibodies are not considered at risk for HBV reactivation after solid organ transplantation. METHODS AND RESULTS: We, however, observed three solid organ transplant recipients who demonstrated clinically significant HBV reactivation after transplantation. All patients presented normal liver enzymes and serological stigmates of healed HBV infection at the time of transplantation, as indicated by the absence of hepatitis B surface antigen and the presence of anti-HBs and anti-hepatitis B core antibodies in the serum. Patient 1, a renal transplant recipient, presented HBV reactivation 3 years after transplantation and developed chronic HBV hepatitis. Patient 2 developed HBV reactivation 7 months after a second cadaveric renal graft and died of cirrhosis four and a half years after transplantation. Patient 3, a heart-lung transplant recipient, developed HBV reactivation within months after transplantation, but died of unrelated causes. HBV reactivation in the presence of anti-HBs antibodies has been previously reported in other settings of immunosuppression, mainly in patients with acquired immunodeficiency syndrome and after bone marrow transplantation, and may lead to fatal liver disease. Data from our renal transplant recipients suggest that the incidence of HBV reactivation among patients with anti-HBs and anti-hepatitis B core antibodies is about 5%. CONCLUSIONS: Transplant physicians should be aware of the risk of HBV reactivation in patients presenting with healed HBV infection before transplantation.

Adult↗