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PubMed2004

Childhood-onset multiple sclerosis and mood disorders: a case study.

Multiple Sclerosis (MS) is rare in children. Little research exists regarding emotional and behavioral disorders in childhood-onset MS, despite the occurrence of such problems in adults with MS. This paper describes the cognitive and behavioral characteristics of a boy diagnosed with MS at age 9 and mood disorder at age 10. He displayed no cognitive or behavioral problems prior to the onset of physical symptoms of MS. Three years after diagnosis, this child showed persistent problems with speed of processing, visual-motor skills, and parent and teacher-reported executive functioning. In addition, he had difficulties with emotional lability, behavioral disinhibition, depression, and social interaction. As with adults, children with MS may be at increased risk for mood disorder compared to their peers. Mood disorders in children with MS are likely to be multiply determined, although the specific causal mechanisms are unknown.

Age of Onset↗
PubMedDate not supplied

Effect of sentence length and complexity on working memory performance in Hungarian children with specific language impairment (SLI): A cross-linguistic comparison.

BACKGROUND: English-speaking children with specific language impairment (SLI) perform more poorly than their typically developing peers in verbal working memory tasks where processing and storage are simultaneously required. Hungarian is a language with a relatively free word order and a rich agglutinative morphology. AIMS: To examine the effect of linguistic structure on working memory performance. It was examined whether syntactic complexity has a larger impact on working memory performance than sentence length in Hungarian-speaking children, similar to the findings in English speaking children. METHODS & PROCEDURES: In Experiment 1, performance accuracy was measured with two linguistic span tasks that included stimuli with varying sentence length and syntactic complexity. Experiment 2 examined the impact of sentence length and morphological complexity on working memory performance. OUTCOMES & RESULTS: Children with SLI performed more poorly than their age-matched peers in all working memory tasks. Their error patterns differed from those of children with typical language development. Children with SLI produced a high number of interference errors that indicate poor executive functions. The findings were compared with previous results of English-speaking children. Complexity affected working memory performance accuracy differently across languages. In English, it was the increase of syntactic complexity that resulted in a decrease in performance accuracy, whereas in Hungarian, it was the morphological complexity that had a large impact on working memory performance. CONCLUSIONS: Working memory performance depends on the linguistic characteristics of the language tested. In both English- and Hungarian-speaking children, complexity has a larger effect on verbal working memory performance than the length of the stimuli. However, complexity affects working memory performance accuracy differently across languages.

Analysis of Variance↗
PubMed1986

Change in smoking status among a cohort of late adolescents: prediction and explanation of initiation, maintenance and cessation.

This study examined the degree and type of changes in adolescent smoking status that occurred over an eight-year period, when the group was in grades four to six, to late adolescence and early adulthood. Where changes in smoking occurred, they were more likely to be in the direction of increased (57.7%), as compared to decreased (4.1%) involvement with smoking, particularly among females. Discriminant function models were developed and resulted in 60% accuracy of classification. Variables measured in 1975 found to be related to change in status (from 1975 to 1983) were early smoking, sex, age, peer and parental smoking, prediction of future smoking, attitude and knowledge. Changes in some of the independent variables were examined and found to be related to changes in smoking. Implications for prevention and cessation programmes are discussed.

Adolescent↗
PubMed2006

Psychosocial needs of African American youth presenting to a pediatric emergency department with assault-related injuries.

OBJECTIVE: The purpose of this study was to identify the psychosocial needs confronting African American youth assaulted in their community. METHODS: A convenience sample of 36 African American youth (mean age, 14.8 years; range, 10-18 years) who presented to a pediatric emergency department with violent interpersonal injuries was interviewed to identify the psychosocial issues they were facing. Participants also completed self-report measures of violence exposure and trauma symptoms, and their parents completed a screening measure of the youths' emotional and behavioral functioning. RESULTS: During the interview, the youth reported 178 different concerns that were content-analyzed and placed into 10 thematic categories labeled anger/aggressive behavior (78% of respondents), general internalizing symptoms (61%), peer difficulties (53%), parent/family conflict (50%), posttraumatic stress symptoms (47%), academic concerns (42%), physical health concerns (39%), safety concerns (39%), and public service concerns (17%). Elevated rates of historical violence exposure and trauma symptoms were observed on the self-report measures, and one third of the youths' parents reported levels of emotional and behavioral problems that would warrant further clinical attention. CONCLUSION: African American assault victims are experiencing a broad range of psychosocial needs. To bolster youth recovery and reduce the risk of future injury, researchers and practitioners need to identify effective methods of assessing these needs in the emergency department so that youth victims of interpersonal violence can be referred for appropriate follow-up services.

Adolescent↗
PubMed2002

Development and validation of a questionnaire for the assessment of bowel and lower urinary tract symptoms in women.

OBJECTIVE: To develop a simple but sensitive instrument to evaluate and document symptoms of both bowel and urinary dysfunction in women. DESIGN: A 22-item questionnaire covering a range of bowel and urinary symptoms was developed and underwent rigorous psychometric testing. SETTING: The gynaecology departments of three hospitals, a urogynaecology clinic, a functional bowel clinic and a general practice. POPULATION: Six hundred and thirty women, comprising four groups: 1. women awaiting hysterectomy (n = 379), 2. women following hysterectomy (n = 45), 3. women referred with functional bowel and/or urinary symptoms (n = 65), 4. asymptomatic controls (n = 141). MAIN OUTCOME MEASURES: The content, construct and criterion validity, internal consistency, reliability and responsiveness of the questionnaire were measured. RESULTS Peer and patient reports and missing data patterns supported face and content validity. Factor analysis showed a clinically relevant four-factor structure with low content replication able to distinguish between patient groups, indicating good internal structure. Comparison with clinical, anorectal physiological, videoproctographic, transit time and urodynamic test results provide provisional indication of criterion validity. Key domain question analysis and Cronbach's alphas showed internal consistency. Kappa values demonstrated good test-retest reliability and key question correlation over time proved responsiveness. CONCLUSIONS: Our findings support the suitability, clinical validity, reliability and responsiveness of a simple questionnaire, which is sensitive to the constraints of clinical practice. The authors recommend its use in health care evaluation research assessing the effects of pelvic surgery and as a useful tool in comparing treatment efficacy.

Adult↗
PubMed2006

Considerations for increasing the competences and capacities of the public health workforce: assessing the training needs of public health workers in Texas.

BACKGROUND: Over the last two decades, concern has been expressed about the readiness of the public health workforce to adequately address the scientific, technological, social, political and economic challenges facing the field. A 1988 report from the Institute of Medicine (IOM) served as a catalyst for the re-examination of the public health workforce. The IOM's call to increase the relevance of public health education and training prompted a renewed effort to identify competences needed by public health personnel and the organizations that employ them. METHODS: A recent evaluation sought to address the role of the 10 essential public health services in job services among the Texas public health workforce. Additionally, the evaluation examined the Texas public health workforce's need for training in the 10 essential public health services. RESULTS AND CONCLUSION: Overall, the level of perceived training needs varied dramatically by job category and health department type. When comparing aggregate training needs, public health workers with greater day-to-day contact (nurses, health educators) indicated a greater need for training than their peers who did not, such as those working in administrative positions. When prioritizing and designing future training modules regarding the 10 essential public health services, trainers should consider the effects of job function, location and contact with the public.

Journal Article↗
PubMed2006

The role of CYP2A6 in the emergence of nicotine dependence in adolescents.

OBJECTIVES: The objectives of our study were to evaluate whether genetic variation in nicotine metabolic inactivation accounted for the emergence of nicotine dependence from mid- to late adolescence and whether initial smoking experiences mediated this effect. METHODS: Participants were 222 adolescents of European ancestry who participated in a longitudinal cohort study of the biobehavioral determinants of adolescent smoking. Survey data were collected annually from grade 9 to the end of grade 12. Self-report measures included nicotine dependence, smoking, age first smoked, initial smoking experiences, peer and household member smoking, and alcohol and marijuana use. DNA collected via buccal swabs was assessed for CYP2A6 alleles that are common in white people and are demonstrated to decrease enzymatic function (CYP2A6*2, *4, *9, *12). RESULTS: Latent growth-curve modeling indicated that normal metabolizers (individuals with no detected CYP2A6 variants) progressed in nicotine dependence at a faster rate and that these increases in nicotine dependence leveled off more slowly compared with slower metabolizers (individuals with CYP2A6 variants). Initial smoking experiences did not account for how CYP2A6 genetic variation impacts nicotine dependence. CONCLUSIONS: These findings may help to promote a better understanding of the biology of smoking behavior and the emergence of nicotine dependence in adolescents and inform future work aimed at understanding the complex interplay between genetic, social, and psychological factors in adolescent smoking behavior.

Adolescent↗
PubMedDate not supplied

A collective case study of nursing students with learning disabilities.

This collective case study described the meaning of being a nursing student with a learning disability and examined how baccalaureate nursing students with learning disabilities experienced various aspects of the nursing program. It also examined how their disabilities and previous educational and personal experiences influenced the meaning that they gave to their educational experiences. Seven nursing students were interviewed, completed a demographic data form, and submitted various artifacts (test scores, evaluation reports, and curriculum-based material) for document analysis. The researcher used Stake's model for collective case study research and analysis (1). Data analysis revealed five themes: 1) struggle, 2) learning how to learn with LD, 3) issues concerning time, 4) social support, and 5) personal stories. Theme clusters and individual variations were identified for each theme. Document analysis revealed that participants had average to above average intellectual functioning with an ability-achievement discrepancy among standardized test scores. Participants noted that direct instruction, structure, consistency, clear directions, organization, and a positive instructor attitude assisted learning. Anxiety, social isolation from peers, and limited time to process and complete work were problems faced by the participants.

Adaptation, Psychological↗
PubMed1995

Free radicals in health and disease: implications for primary health care providers.

Free radicals (FRs) are reactive chemical species that can damage or destroy biological molecules and have the potential for causing serious tissue and organ damage. Because of evidence suggesting that they are involved in the pathophysiology of a wide spectrum of human disorders. FRs have recently been the subject of considerable interest. While some popularized accounts depict FRs as always being destructive, essential physiological functions, including prostaglandin biosynthesis and phagocyte activity, depend upon them. It is only when FR reactions are uncontrolled that they are likely to be destructive. This article, based on citations from peer-reviewed biomedical literature, discusses some of the roles FRs play in essential physiological processes and their potential for inducing pathological changes. Also discussed are factors that add to body burdens of FRs and various antioxidant control mechanisms. The relationship of diet to FR pathology is emphasized because of evidence suggesting its importance in the prevention of chronic degenerative disorders including cardiovascular disease and cancer. The health benefits accruing from appropriate application of FR research are likely to be substantial. Accordingly, it is important for all health care practitioners to be aware of new developments in this area.

Adult↗
PubMed1998

The development of internal forensic review boards in the management of hospitalized insanity acquittees.

When working well, internal forensic review boards generally: (1) have the support of the courts and communities; (2) consider and review effective individual treatment and public safety; (3) permit direct care treatment teams the opportunity to advocate for the patient; (4) focus clinical and security considerations on the individual patient rather than dwelling on system issues; (5) identify resource needs for inpatient and community care; (6) provide a foundation for monitoring patient adjustment to various levels of stressors, both in the hospital and the community; (7) provide a mechanism for timely crisis intervention for individual patients; (8) afford administrative and clinical staff a mechanism for peer review; (9) are cost effective compared with external review boards; (10) provide data and a tracking mechanism for quality improvement for the forensic system of care; and (11) provide an education/training function for direct care and professional staff.

Community Mental Health Services↗
PubMed2006

Stem cell mobilization induced by subcutaneous granulocyte-colony stimulating factor to improve cardiac regeneration after acute ST-elevation myocardial infarction: result of the double-blind, randomized, placebo-controlled stem cells in myocardial infarction (STEMMI) trial.

BACKGROUND: Phase 1 clinical trials of granulocyte-colony stimulating factor (G-CSF) treatment after myocardial infarction have indicated that G-CSF treatment is safe and may improve left ventricular function. This randomized, double-blind, placebo-controlled trial aimed to assess the efficacy of subcutaneous G-CSF injections on left ventricular function in patients with ST-elevation myocardial infarction. METHODS AND RESULTS: Seventy-eight patients (62 men; average age, 56 years) with ST-elevation myocardial infarction were included after successful primary percutaneous coronary stent intervention <12 hours after symptom onset. Patients were randomized to double-blind treatment with G-CSF (10 microg/kg of body weight) or placebo for 6 days. The primary end point was change in systolic wall thickening from baseline to 6 months determined by cardiac magnetic resonance imaging (MRI). An independent core laboratory analyzed all MRI examinations. Systolic wall thickening improved 17% in the infarct area in the G-CSF group and 17% in the placebo group (P=1.0). Comparable results were found in infarct border and noninfarcted myocardium. Left ventricular ejection fraction improved similarly in the 2 groups measured by both MRI (8.5 versus 8.0; P=0.9) and echocardiography (5.7 versus 3.7; P=0.7). The risk of severe clinical adverse events was not increased by G-CSF. In addition, in-stent late lumen loss and target vessel revascularization rate in the follow-up period were similar in the 2 groups. CONCLUSIONS: Bone marrow stem cell mobilization with subcutaneous G-CSF is safe but did not lead to further improvement in ventricular function after acute myocardial infarction compared with the recovery observed in the placebo group.

Adult↗
PubMed1994

Psychosocial functioning of young adults with cystic fibrosis and their families.

BACKGROUND: The psychosocial functioning of adolescents and young adults with cystic fibrosis still living in the parental home was investigated. With its proven genetic aetiology cystic fibrosis is an ideal model with which to assess the impact of a chronic and life threatening disorder on family and individual psychological and social functioning. METHODS: Twenty nine patients with cystic fibrosis and their families were compared with those of 27 patients with anorexia nervosa and 31 well controls. Assessments were made using self reporting, interview, and observational methods. RESULTS: Most patients with cystic fibrosis were in robust psychological health and only differed from their healthy peers in that they were much less likely to be in employment. Mothers of patients with cystic fibrosis or anorexia nervosa were more likely than the mothers of the well group to be emotionally distressed, although this was not so for fathers. Young people in both illness groups were more likely to have parents with high levels of expressed emotion. Most families of patients with cystic fibrosis had good problem solving abilities. CONCLUSIONS: In spite of the burden of illness in cystic fibrosis psychological functioning in many respects matches that of well young people.

Adolescent↗
PubMed2005

Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs.

We outline and evaluate competing explanations of three relationships that have consistently been found between cannabis use and the use of other illicit drugs, namely, (1) that cannabis use typically precedes the use of other illicit drugs; and that (2) the earlier cannabis is used, and (3) the more regularly it is used, the more likely a young person is to use other illicit drugs. We consider three major competing explanations of these patterns: (1) that the relationship is due to the fact that there is a shared illicit market for cannabis and other drugs which makes it more likely that other illicit drugs will be used if cannabis is used; (2) that they are explained by the characteristics of those who use cannabis; and (3) that they reflect a causal relationship in which the pharmacological effects of cannabis on brain function increase the likelihood of using other illicit drugs. These explanations are evaluated in the light of evidence from longitudinal epidemiological studies, simulation studies, discordant twin studies and animal studies. The available evidence indicates that the association reflects in part but is not wholly explained by: (1) the selective recruitment to heavy cannabis use of persons with pre-existing traits (that may be in part genetic) that predispose to the use of a variety of different drugs; (2) the affiliation of cannabis users with drug using peers in settings that provide more opportunities to use other illicit drugs at an earlier age; (3) supported by socialisation into an illicit drug subculture with favourable attitudes towards the use of other illicit drugs. Animal studies have raised the possibility that regular cannabis use may have pharmacological effects on brain function that increase the likelihood of using other drugs. We conclude with suggestions for the type of research studies that will enable a decision to be made about the relative contributions that social context, individual characteristics, and drug effects make to the relationship between cannabis use and the use of other drugs.

Adolescent↗
PubMed2002

Activity, participation, and quality of life 6 months poststroke.

OBJECTIVES: To estimate the extent of activity and participation of individuals 6 months poststroke and their influence on health-related quality of life (QOL) and overall QOL, information that would be useful in identifying services that stroke patients would need in the community. DESIGN: Inception cohort study. SETTING: Ten acute care hospitals in metropolitan areas of the province of Quebec. PARTICIPANTS: Persons with first-ever stroke, either ischemic or hemorrhagic. In parallel, a population-based sample of community-dwelling individuals without stroke, frequency matched in age and city district, were also recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Stroke subjects were interviewed by telephone at 6-month intervals for 2 years of follow-up. The community-dwelling individuals without stroke were also followed. RESULTS: A total of 434 persons were interviewed approximately 6 months poststroke. Their average age +/- standard deviation was 68.4+/-12.5 years; the average age of the 486 controls was 61.7+/-12.4 years. The stroke group scored on average 90.6/100 on the Barthel Index; 39% reported a limitation in functional activities, 54% reported limitations with higher-level activities of daily living such as housework and shopping, and 65% reported restrictions in reintegration into community activities. By using the Medical Outcomes 36-Item Short-Form Health Survey (SF-36), persons with stroke rated their physical health 7 points lower than healthy peers; also, 7 of the 8 subscales of the SF-36 were affected by stroke. CONCLUSION: Almost 50% of the community-dwelling stroke population lived with sequelae of stroke such that, unless there was a full-time and able-bodied caregiver at home, they needed some form of home help. A large proportion also reported lack of meaningful activity, indicating a need for organized support groups for people with stroke; otherwise, boredom will lead to depression and worsening of function, affect, health status, and QOL.

Activities of Daily Living↗
PubMed2000

Nocturnal polyuria in older people: pathophysiology and clinical implications.

OBJECTIVES: To review the physiological changes of aging which affect the systems involved in urine formation and to consider how these changes interact with changes in bladder function, thereby leading to the onset of nocturnal polyuria with associated urinary frequency, nocturia, and incontinence. Based on this information, data are presented on the effectiveness of pharmacological interventions which reduce the rate of urine formation and, thus, can be of benefit in reducing symptoms, especially during the nighttime. METHODS: Peer-reviewed journal articles were identified by MEDLINE Search and by review of the literature. CONCLUSIONS: As a consequence of age-associated diminished renal concentrating capacity, diminished sodium conserving ability, loss of the circadian rhythm of antidiuretic hormone secretion, decreased secretion of renin-angiotensin-aldosterone, and increased secretion of atrial natriuretic hormone, there is an age-related alteration in the circadian rhythm of water excretion leading to increased nighttime urine production in older people. The interaction of nocturnal polyuria with age-related diminution in functional bladder volume and detrusor instability results in the symptoms of urinary frequency, nocturia and, in some persons, incontinence. The additional impact of Alzheimer's disease on these physiological and aging changes, as well as on a diminished perception of bladder fullness, leads to an even greater risk of urinary incontinence in these patients. Treatment of nocturnal polyuria with the antidiuretic hormone analog, DDAVP (desmopressin), can result in decreased nocturnal urine production with improvement in symptoms of frequency, nocturia, and incontinence.

Age Factors↗
PubMed1991

Combined treatment modality for medulloblastoma in childhood: effects on neuropsychological functioning.

8 long-surviving children, treated for medulloblastoma with combination radiotherapy and chemotherapy after surgery were examined in order to assess general intelligence, immediate attention and prolonged attention. Their siblings or first cousins were selected as controls. The children with medulloblastoma performed significantly worse than their peers, both in intelligence tests and attention tests. A trend towards a positive correlation between age at the start of treatment and IQs was confirmed in our study, while there was no evidence of a correlation between IQs and time elapsed from therapy. The role of chemotherapy, radiotherapy and their combination effect in producing neuropsychological sequelae is discussed.

Adolescent↗
PubMed1990

Peer Nomination Inventory of Depression: characteristics in a Spanish sample.

The Peer Nomination Inventory of Depression (PNID) was answered by 1,121 children from Barcelona in the fourth year of grammar school and by their teachers (n = 36) to analyze this questionnaire in a Spanish sample. The results indicated (1) high internal consistency; (2) discriminative power between depressed and nondepressed; (3) low concurrent validity; (4) convergent and discriminant validity; (5) a two-factor structure; and (6) that two discriminant functions could differentiate between depressed, dysthymic, and nondepressed subjects. The teacher's responses showed (1) moderate internal consistency; (2) discriminative power between depressed and nondepressed groups; (3) moderate concurrent validity; (4) and that two discriminant functions could differentiate between the diagnostic groups. The importance of the information given by the teacher to help detect severe depressive problems was pointed out.

Child↗