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Health-related quality of life and coping strategies of children after treatment of a malignant bone tumor: a 5-year follow-up study.

PURPOSE: This study was designed to evaluate the development of health-related quality of life (HRQoL) and coping strategies of children and young adults, who have undergone surgery for a malignant bone tumor in childhood. PATIENTS AND INSTRUMENTS: In this single center follow-up study 20 patients were included. The patients were tested 3 and 8 years after treatment. At the 3-year mark the parents participated as well. To measure the HRQoL and coping strategies the TACQOL and the TAAQOL questionnaires and the Utrecht Coping List for Adolescents (UCLA) were used. All measurements were compared to a control group of healthy peers (n = 1,122 and n = 272, respectively). RESULTS: At the first measurement (3 years after treatment) both the study patients and their parents reported significantly lower HRQoL scores on two domains: motor functioning and autonomy (P < 0.05). In addition parents reported their children to have significantly lower HRQoL scores on cognitive functioning and experiencing positive emotions. Five years later (8 years after treatment) the young adults reported comparable HRQoL on motor functioning and autonomy, and significantly higher HRQoL scores on cognitive functioning, social contacts and negative emotions (less depressive moods). With regard to coping strategies no significant differences between the two measurements in the study population and the reference group were found. CONCLUSIONS: Three years after surgery for a malignant bone tumor, patients and their parents reported lower HRQoL scores on different domains compared with a reference group. Eight years after surgery the young adults surprisingly reported comparable or higher HRQoL scores. These patients treated for bone cancer were able to adapt well after treatment and showed no long-term emotional or social problems.

Adaptation, Psychological↗

Intensity of CNS treatment for pediatric cancer: prediction of social outcomes in survivors.

PURPOSE: To evaluate the association of central nervous system (CNS) treatment intensity and the social functioning of children who have completed treatment for leukemia, lymphoma, and solid tumors outside the CNS. Furthermore, we expected that these associations would be moderated by child age at diagnosis and gender. METHOD: Peer, teacher, and self-report data were obtained for 82 cancer survivors (age 9-17 years) using classroom rating and nomination procedures that are widely used in research on social development. Information regarding cranial radiation therapy (CRT), intrathecal chemotherapy (ITC), and systemic methotrexate were obtained from medical records and used to create a composite index of CNS treatment intensity. RESULTS: Higher scores on the index of CNS treatment intensity were associated with poorer peer acceptance, fewer friendships, greater social sensitivity-isolation, and diminished leadership-popularity based on peer-report. These associations were stronger for boys and children who were younger (<10 years old) at diagnosis. In contrast, CNS treatment intensity was only predictive of teacher-perceptions of aggressive-disruptive behavior and it was unrelated to social self-perceptions. CONCLUSION: These results suggest that children who receive CRT and ITC are at risk for problematic peer relations, particularly if they are male or younger at diagnosis. Given the stability of poor peer relationships and documented linkages between peer problems and subsequent academic and psychiatric difficulties, clinical services should address these issues. Research is needed to identify mechanisms that account for these outcomes and provide direction for prevention and treatment efforts.

Adolescent↗

Correlation between power Doppler ultrasonography and clinical severity in Achilles tendinopathy.

Twenty-five patients with chronic Achilles tendinopathy were clinically and ultrasonographically evaluated. A positive correlation existed between power Doppler ultrasonography (PDU) and tendon thickness (r=0.63, p<0.001) and patient's age (r=0.40, p<0.05). A negative correlation existed between PDU and a functional test (number of toe raises to pain) (r=-0.57, p<0.005) and one recorded item of the Victorian Institute of Sport Assessment Achilles score (VISA-A questionnaire, item 6: jumping capability) (r=-0.46, p<0.05). Three patients had no detectable blood flow on PDU. PDU of Achilles tendons does not seem to be strictly related to symptoms but rather to functionality and chronicity of tendinopathy as indicated by toe-raises testing, jumping capability, patient age and tendon thickening.

Achilles Tendon↗

The influence of hearing and age on speech recognition scores in noise in audiological patients and in the general population.

OBJECTIVE: To describe the influence of pure-tone audiometry and age on the speech recognition score in noise, both in audiological patients and also in a random population sample. DESIGN: In a cross-sectional study, speech recognition scores (SRS) using monosyllabic words presented in a fixed background noise were evaluated on 1895 audiological patients of both genders with normal hearing or sensorineural hearing losses. The background noise was speech weighted and presented with a signal to noise ratio of +4 dB. In 291 participants, SRS in quiet was estimated as well. A female random population sample also was tested (N = 513). RESULTS: The major predictor for the SRS-noise was high-frequency hearing thresholds. If hearing was normal, age had no effect on speech recognition. Young persons with hearing loss had higher SRS-noise than older persons with the same degree of hearing loss. The difference between young and old persons became larger the greater the hearing loss. Predictive SRS-noise with consideration taken to hearing function and age are presented. SRS-noise correlated stronger with pure-tone audiometry and age than SRS-quiet. Controls performed better (by 10 to 20%) than their same-aged peers with similar hearing loss. CONCLUSION: It is recommended that speech recognition tests be performed in background noise. SRS-noise is a valuable tool for audiologists and audiological physicians to identify patients in need of pedagogic rehabilitation programs or further diagnostic investigations.

Adult↗

Biocompatibility of intraocular lenses.

PURPOSE: The choice of intraocular lens (IOL) implanted by cataract surgeons has significant implications for the effectiveness of the operation and the subsequent need for capsulotomy. METHODS: Comparison of pertinent peer-reviewed literature published from 1996 through 2001 obtained from a MEDLINE literature search on biocompatibility indicators and IOLs. This review pertains to routine, uncomplicated cataract surgery, and thus, the findings may not be relative to complicated surgeries. Currently available IOLs were not included in this review if no published data on the IOL were available. However, representative lenses from all the major biomaterial classes were included. RESULTS: Overall results of a comparison of published accounts of posterior capsular opacification, Nd:YAG capsulotomies, anterior capsular opacification, aqueous flare, cellular reaction, capsular adhesion, and capsular stability show a polyacrylic elastomer to be the most highly biointegrated IOLs by the human eye. CONCLUSIONS: Most evidence published in peer-reviewed journals suggests a clear IOL choice for cataract surgeons. In the field of implantable medical devices, one device in a category does not usually provide consistently superior performance of its intended function. The ability of the biomaterial to maintain a clear optical axis not only by suppressing the proliferation of lens epithelial cells, and thus inhibiting posterior capsular opacification formation and obviating the need for an Nd:YAG capsulotomy, but also by adhering to and stabilizing the capsular bag is, to date, unmatched by any other IOL available.

Biocompatible Materials↗

An intervention program for adolescents with behavior problems.

Adolescents with behavior problems (aged 12 to 14) attending a regular public high school were in need of an intervention program. The purpose was to enhance their personal and interpersonal functioning as well as to structure a stimulating learning environment. In order to improve their social, educational, and psychological functioning, program objectives were established to help students develop the ability to listen to one another, respect others as well as their opinions, become aware of their own emotions and those of their peers, and recognize and minimize derogatory remarks toward one another. To attain these objectives, relaxation sessions, magic circle activities, art sessions, future planning groups, and decision-making groups were used. Meetings with teachers enabled them to examine and improve their attitudes and relationship with students. Upon completion of the program, the adolescents manifested less disruptive classroom behavior, increased their class participation, and displayed a more positive attitude toward school. The achievement of these behavioral changes indicates that a psychologically oriented intervention program is a feasible addition to a conventional curriculum. Teachers learned the basic skills of program formation, implementation, and evaluation, and most importantly, revitalized their attitude toward troubled students and their profession.

Adolescent↗

Predictors of participation in a peer-led exercise program for senior women.

This study explored variables selected using the Interaction Model of Client Health Behavior (Cox, 1982) and their relationship to exercise group participation in seniors. Seventy-five women were surveyed from from two similar senior apartment buildings. Subjects' ages ranged from 65 to 88 years (M = 75.91, SD = 6.12). Discriminant function analysis was used to test the relationship of seven demographic and motivational variables to choice of exercise group participation. As hypothesized, significant predictors for all the women in both buildings were: a measure of competence, education, number of medications, building, and age. Two variables, income and marital status, did not emerge as significant predictors. Women more likely to attend an exercise group had greater competence in health matters, higher education, a lower number of medications, were living in building B, and were lower in age. Nurses who facilitate exercise groups for seniors in the community should be aware of the impact these variables could have on attendance.

Aged↗

Genes and/or jeans?: Genetic and socio-cultural contributions to risk for eating disorders.

Eating disorders are prevalent among young adult females and pose serious psychological and medical risks. Notwithstanding important advances, efforts to develop effective means of preventing and treating eating disorders have been limited by an incomplete understanding of their multifactorial etiology. Whereas epidemiologic data strongly suggest the influence of socio-cultural context in moderating risk, many hypotheses about how these effects are exerted have remained empirically unevaluated. Specifically, experimental and observational data suggest that social transition (e.g., transnational migration, urbanization, modernization), Western media exposure, and certain peer environments (involving social comparison and teasing) may all contribute to risk. With respect to genetic influences on etiology, family and twin studies have supported a genetic diathesis to eating disorders. Whereas, molecular genetic studies have generated interesting leads- with the most promising findings emerging for genes related to the function of serotonin-they have yet to identify well-replicated susceptibility loci. This paper reviews the data supporting both socio-cultural and genetic contributions for eating disorders and suggests productive future strategies for continuing to unravel their likely multiple and complex interactions.

Adult↗

Young adolescents' perception of their peers who wear hearing aids.

In order to evaluate the perceptions of young adolescents of their peers who wear hearing aids, observers were selected from four types of schools: rural, suburban, inner city, and a self-contained classroom for the hearing impaired. Observers made semantic differential ratings of two teen-aged peers, one of whom had normal hearing and one of whom had a moderately severe sensorineural hearing loss. Both boys spoke under three conditions: wearing a postauricular hearing aid, wearing a body aid, and wearing no aid at all. Results indicated at least partial support for the "hearing aid effect" (Blood and Blood, 1977) as evidenced by the differential perceptions of the observers as a function of the school they attended, differential reactions to the hearing impaired speaker and the one with normal hearing, and the absence, presence, and type of hearing aid worn. This study reports the perceptual similarities and differences among observer groups and between the two speakers. Further, it is suggested that the overall speech quality, in addition to the absence, presence, and type of hearing aid, is important to peer perceptions.

Adaptation, Psychological↗

Assessment of prose recall performance in chronic alcoholics: recall of essential versus detail propositions.

Evidence for impaired psychological functions mediated by the left hemisphere in sober alcoholics is inconsistent. We predicted that sober alcoholics have deficits in immediate and delayed memory similar to deficits found in left hemisphere damaged patients. Four prose stories were administered to 24 alcoholics and 24 nonalcoholic peers and were scored according to Webster et al's criteria for essential and detail propositions. These investigators found that right hemisphere stroke patients performed significantly worse than controls on recall of detail propositions, but left hemisphere damaged stroke patients performed worse on recall of both detail and essential propositions. Similar to their left hemisphere group, our alcoholics were impaired on both proposition types supporting the hypothesis of a residual mild generalized brain dysfunction state in sober alcoholics.

Adult↗

Interleukin-18/interferon-gamma-inducing factor, a novel cytokine, up-regulates ICAM-1 (CD54) expression in KG-1 cells.

Intercellular adhesion molecule-1 (ICAM-1, CD54) is a membrane glycoprotein and a member of the immunoglobulin superfamily. It plays a central role in cell to cell-mediated immune responses and is a ligand for leukocyte function-associated antigen-1 (LFA-1). We report here that a newly discovered cytokine, interferon-gamma-inducing factor (IGIF) [H. Okamura et al. (1995) Nature 378, 88] recently proposed to be designated as IL-18, selectively up-regulates ICAM-1 expression in KG-1 cells, a human myelomonocytic cell line, in which IL-18 also enhances interferon-gamma production. IL-18 induced heterotypic aggregation between KG-1 and Peer T cells, which was blocked by anti-ICAM-1 and/or LFA-1 antibodies. Anti-interferon-gamma antibody did not block the IL-18-induced up-regulation of ICAM-1 on KG-1 cells. These results thus show that IGIF/IL-18, enhances ICAM-1 expression in KG-1 cells in an interferon-gamma-independent pathway, up-regulates ICAM-1 functions, and that IL-18 might play a potential role in immunoregulation by mediating immune cell infiltration into the tissues.

Cell Line↗

The mentally handicapped person with epilepsy: a comparative study investigating psychosocial functioning.

A sample of institutionalized, mentally handicapped adults who suffered from epilepsy was compared with a matched control group without epilepsy in order to investigate profiles of adaptive skills and of behavioural disturbance. Results suggested that mentally handicapped people with epilepsy have consistently poorer life skills than their peers with no epilepsy but behavioural disturbance was not significantly elevated, except for a small sub-group whose epilepsy was resistant to pharmacological control. These results are discussed with reference to past research and management implications are considered.

Activities of Daily Living↗

Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) affects 3% to 7% of school-aged children and has been associated with a variety of comorbid mental illnesses and functional impairments, largely in clinical samples. However, little is known about the spectrum of emotional and behavioral problems and areas of impairment among children with a history of ADHD in nonclinical, nationally representative samples. METHODS: Data were analyzed from the 2003 National Health Interview Survey, an ongoing, computer-assisted, random-sample, personal-interview survey of the noninstitutionalized U.S. population. We examined the associations between history of parent-reported ADHD diagnosis and levels of parent-reported emotional and behavioral difficulties and related impairments among a nationally representative sample of U.S. children aged 4 to 17 years (n = 8681). The extended version of the Strengths and Difficulties Questionnaire was used to measure and score levels of difficulty and impairment. RESULTS: Approximately 5.9% of children had a history of ADHD diagnosis. Children with a history of ADHD were 6 times as likely as those without ADHD to have a high level of overall difficulties including emotional, conduct, and peer problems and were 9 times as likely to manifest a high level of impairment including interference with home life, friendships, classroom learning, and leisure activities. CONCLUSION: This study documents the significant level of current emotional and behavioral difficulties and impairments in everyday functioning experienced by children with a history of ADHD diagnosis, suggesting that people involved with the care of children--parents, health care providers, and teachers--need to be informed about the signs, symptoms, and appropriate treatment of ADHD and other comorbid disorders.

Adolescent↗

Heart failure with normal systolic function: a common disorder in older people.

OBJECTIVE: To review the incidence, pathophysiology, significance, diagnosis, and treatment of heart failure with normal systolic function in older patients. DATA SOURCE: Scientific reports of diastolic ventricular dysfunction in both the general population and the geriatric population were identified from repeated searches of the MEDLINE database and citations from appropriate articles. STUDY SELECTION: Studies were included only if they demonstrated proper methodology, were from a reputable source, and were published in a peer-reviewed journal. DATA EXTRACTION AND SYNTHESIS: Relevant data were obtained from the articles, with special importance placed on studies designed to examine older patients exclusively or as part of a subgroup in a larger study. Emphasis was placed on data pertaining to the pathophysiology, prognosis, and diagnosis of patients with diastolic dysfunction compared with normals and patients with systolic dysfunction as an etiology of heart failure. Therapeutic interventions were selected for the presence of prospective data with concrete end points such as mortality, functional class, exercise capacity, and regression of left ventricular hypertrophy. CONCLUSION: Diastolic ventricular dysfunction is a significant problem in older people, with at least 40% of older heart failure patients having diastolic dysfunction as the etiology of their heart failure. The pathophysiology of diastolic dysfunction is varied but usually involves impaired left ventricular relaxation and/or increased ventricular stiffness, each partially related to normal aging changes, as well as underlying cardiovascular diseases. The significance of heart failure caused by diastolic dysfunction is great, with increased morbidity and mortality compared with other cardiac diseases that have the same preserved systolic function. Diagnosis of diastolic dysfunction can be clinically difficult and often requires further testing to determine if diastolic dysfunction is present. At this time, no therapy specifically treats diastolic dysfunction, but several medications, such as diuretics, calcium channel blockers, beta blockers, and angiotension-converting enzyme inhibitors, offer symptomatic relief and may prevent progression of the disorder.

Aging↗

Health status and life satisfaction among breast cancer survivor peer support volunteers.

Two measures of health-related quality of life (HRQOL), the Medical Outcomes Survey Short Form 36 (SF-36) and the Satisfaction with Life Domains Scale for Cancer (SLDS-C), were compared to examine the relationship between health status and life satisfaction among breast cancer survivors (BCSs). A total of 586 BCSs, all of whom were volunteers in peer support programs, met inclusion criteria and completed the self-report measures. Significant correlation coefficients were shown between life satisfaction and measures of health status. SF-36 scores were significantly higher for physical functioning, emotional well-being, and vitality subscales compared to population norms. BCSs expressed greatest dissatisfaction with their sexual ability, physical strength, and bodies in general. Small age differences were found. Results suggest that incorporating multiple measures of HRQOL contribute to the understanding and measurement of the effects of cancer on perceived health status and life satisfaction.

Adult↗

Early cavopulmonary anastomosis after Norwood procedure results in excellent Fontan outcome.

BACKGROUND: Children with univentricular hearts and aortic arch obstruction are treated sequentially with Norwood procedure, superior cavopulmonary anastomosis (SCPA), and Fontan operation. Early SCPA results in lower initial O2 saturation and longer hospitalization, but not increased mortality. We sought to determine the impact of early SCPA on Fontan candidacy and outcomes. METHODS: Eighty-five consecutive patients undergoing Norwood operation between January 1998 and February 2003 were divided into group 1 (SCPA at less than 4 months, n = 33) and group 2 (SCPA at more than 4 months, n = 52). Of the original cohort, 69 have undergone Fontan operation, 7 await Fontan, 1 was transplanted, 3 are not Fontan candidates, and 5 died late after SCPA. Group 1 (n = 25) and group 2 (n = 44) patients who have completed Fontan operation were compared for preoperative and perioperative variables: age, size, O2 saturation, pulmonary artery pressure and size, prevalence of tricuspid regurgitation and ventricular dysfunction, extubation rate in operating room, duration of pleural drainage, hospital stay, and discharge O2 saturation. Late functional status and ventricular function were also compared. Survival was compared for original groups 1 and 2. RESULTS: There were no differences for any preoperative or perioperative variable, or late functional assessment. Actuarial survival at 6 years was also not different (88% +/- 5% for group 1 and 94% +/- 4% for group 2, p = 0.72). CONCLUSIONS: Although initially more cyanotic and hospitalized longer than older peers, younger SCPA patients achieve clinical equivalence by the time of Fontan operation and afterward. We conclude that both short- and long-term outcomes support performance of early SCPA.

Anastomosis, Surgical↗