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PubMed1996

Respiratory health in a total very low birthweight cohort and their classroom controls.

AIMS: To compare the respiratory health and function at 8 to 9 years of age of a total population based cohort of 300 very low birthweight (VLBW) children with that of two classroom controls (n = 590) matched for age and sex. STUDY DESIGN: Cohort study with controls. SETTING: Schools throughout Scotland. RESULTS: The VLBW children were more likely than their peers to use an inhaler, to be absent from school, and to be admitted to hospital because of respiratory illness. They were significantly shorter than their classroom controls, but even after adjusting for differences in height, the VLBW children had reduced forced vital capacity (FVC); this was associated with a history of prolonged ventilation (> 28 days) and pneumothorax in the neonatal period. There were no significant differences between the groups in forced expiratory volume in one second (FEV1)/FVC but twice as many (7.9% v 3.7%) of the VLBW children had ratios < 70%, denoting obstructive airways disease. Poor expiratory function was associated with neonatal respiratory distress syndrome, prolonged ventilation, and the need for > 40% oxygen. Exercise induced airway narrowing was increased in VLBW children (odds ratio = 2.0; 95% confidence interval 1.2 to 3.4) and was very little changed by adjustment for inhaler use and exposure to cigarette smoke. CONCLUSIONS: As in other low birthweight cohorts, respiratory morbidity was increased. Unlike previous studies, FVC was more affected than expiratory function in this VLBW population. Our findings support the hypothesis that poorer lung function is associated with very low birth weight, but not with intrauterine growth retardation.

Asthma, Exercise-Induced↗
PubMedDate not supplied

Sedentary habits, health, and function in older women and men.

PURPOSE: To evaluate the relation of physical activity and cardiorespiratory fitness to morbidity, mortality, and functional limitations in older persons. DATA SOURCES: We reviewed published reports related to the review's purpose. Sources were identified from recent major reports and position statements from scientific and public health organizations, our files, and reference lists of published papers. STUDY INCLUSION AND EXCLUSION CRITERIA: We included prospective epidemiological studies and clinical trials published in the peer-reviewed literature that included data from age groups of people 60 years and older. We evaluated study methods and included studies that used valid measures of exposures, clearly specified outcomes, and controlled for confounders. DATA EXTRACTION METHODS: We extracted by detailed review data on sample characteristics, outcomes, and rates and relative risks. DATA SYNTHESIS: Extracted data were included in tables, figures, or the text and were synthesized by nonquantitative methods. MAJOR CONCLUSIONS: Active and fit individuals were at much lower risk for morbidity, mortality, and loss of function when compared with sedentary and unfit persons. Data from the studies generally conformed to a steep inverse dose-response gradient across activity or fitness categories. Results were consistent, temporally appropriate, strong, and graded, and therefore support a causal hypothesis that a fit and active way of life improves health and function in older individuals.

Activities of Daily Living↗
PubMed1983

Inclusive fitness, altruism and family adaptation.

An integrative model of family functioning is put forward using a sociobiological framework. Three key sociobiological concepts that have a relevance to family interaction are inclusive fitness, altruism, and a struggle for status. The term 'inclusive fitness' encompasses the parents' own fitness and that of their kith and kin. Altruism refers to how parents promote the survival of their progeny and extended family. The struggle for status refers to a struggle for power and prestige. According to the author's hypothesis 'inclusive fitness' exerts its influence through the struggle for status which in turn influences the degree of altruism and the level of 'family adaptation'. The parents' level of inclusive fitness largely determines the level of family adaptation which in turn influences the growth and individuation of the next generation. A common negative outcome of failure in the struggle for status and power is a displacement of the struggle for power into a family context. Failure in a struggle for status between peer group members would in a pretechnological society probably have reflected a relative lack of fitness. Failure in the struggle for status is likely to generate maladaptive cycles in the family which will lower the inclusive fitness of the parents. A concept of ideal family functioning is derived from sociobiology and specifically related to a high inclusive fitness in the parents. The author argues that sociobiological concepts can contribute to the development of an integrative theory of family behaviour. The clinical implications of this model are explored.

Adaptation, Psychological↗
PubMed2005

The "lost boys of Sudan": functional and behavioral health of unaccompanied refugee minors re-settled in the United States.

OBJECTIVE: To assess the functional and behavioral health of unaccompanied Sudanese refugee minors approximately 1 year after resettlement in the United States. DESIGN: A descriptive survey. SETTING: Local refugee foster care programs affiliated with the US Unaccompanied Refugee Minors Program. PARTICIPANTS: A total of 304 Sudanese refugee minors enrolled in the US Unaccompanied Refugee Minors Program. MAIN OUTCOME MEASURES: Health outcomes were assessed using the Harvard Trauma Questionnaire and the Child Health Questionnaire. Outcomes included the diagnosis of posttraumatic stress disorder and scores on all Child Health Questionnaire subscales and global single-item assessments. RESULTS: Twenty percent of the minors had a diagnosis of posttraumatic stress disorder and were more likely to have lower (worse) scores on all the Child Health Questionnaire subscales. Low functional and behavioral health scores were seen mainly in functioning in the home and in subjective health ratings. Social isolation and history of personal injury were associated with posttraumatic stress disorder. CONCLUSIONS: Unaccompanied Sudanese minors have done well in general. The minors function well in school and in activities; however, behavioral and emotional problems manifest in their home lives and emotional states. The subset of children with traumatic symptoms had characteristics that may distinguish them from their peers and that may inform future resettlement services for unaccompanied minors in the United States.

Adolescent↗
PubMed1975

Differentiating criteria for acute-chronic distinction in schizophrenia.

Type of onset, presence of precipitating events, mental status, and premorbid instrumental functioning, commonly associated with prognosis in schizophrenia, were studied in relation to the acute-chronic distinction and short-term outcome in 641 schizophrenic patients. Contrary to the general position held by some researchers, none of the clinical predictors (type of onset, precipitating crises, and mental status) appeared to distinguish the two types of schizophrenics, or to contribute substantially to the prediction of readmission. Preadmission social functioning of the two patient groups was more similar than generally indicated by previous reserach. As regards prediction of short-term rehospitalization, the study identified poor relationships with parents, friends, and opposite-sexed peers as important factors for acute patients and antisocial behavior and inability to relate to the opposite sex and others in the community as important variables for chronic patients.

Acute Disease↗
PubMed2007

Osteophytes: relevance and biology.

OBJECTIVE: Osteophytes are common features of osteoarthritis. This review summarizes the current understanding of the clinical relevance and biology of osteophytes. METHOD: This review summarizes peer-reviewed articles published in the PubMed database before May 2006. In addition this review is supplemented with own data and theoretical considerations with regard to osteophyte formation. RESULTS: Osteophytes can contribute both to the functional properties of affected joints and to clinical relevant symptoms. Osteophyte formation is highly associated with cartilage damage but osteophytes can develop without explicit cartilage damage. Osteophytes are mainly derived from precursor cells in the periosteum and growth factors of the TGFbeta superfamily appear to play a crucial role in their induction. CONCLUSION: Osteophyte formation is an integral component of OA pathogenesis and understanding the biology of osteophyte formation can give insights in the disturbed homeostasis in OA joints.

Animals↗
PubMed1987

Interviewing guidelines for the clinical evaluation of adolescent substance abuse.

Pediatricians can learn to assess adolescent patients' use of drugs and alcohol. Their most important task is to determine whether use of chemicals is causing behavioral impairment. A general psychosocial assessment of an adolescent's functioning is the most important component of an evaluation for substance abuse. It provides the foundation for determining whether behavioral dysfunction exists. The pediatrician should address several topical areas: family relationships, school performance and attendance, peer relationships, legal difficulties, leisure activities and employment, and self-perception. The chemical use history helps the pediatrician in two ways. In general, it helps to provide focus to the pediatrician's educational counseling about the risks of chemical use. It also helps the pediatrician to determine whether substance abuse is the cause of any behavioral dysfunction that the pediatrician may have discovered during the general psychosocial assessment. Strategies to enhance more accurate disclosure of substance use by adolescents include postponing this section of the interview until rapport has been developed with the teenager, ordering questions so that illicit substances are addressed later, exploring peer involvement with chemicals as an antecedent to discussing the adolescent's personal use, and using an historical perspective, so that the teenager is asked to describe his or her initial experience with each substance class prior to addressing current use patterns. Dysfunctional consequences of chemical use may present an opportunity for adolescents and their families to accept intervention. If the pediatrician believes that an adolescent patient would benefit from a formal treatment program, the following steps help to ensure successful completion of the referral. The pediatrician should first summarize information learned during the evaluation that is relevant to the problem behaviors. Try to outline the dysfunctional behavior in the context of chemical use. Communicate concern for the teenager's well-being. Provide information without moralizing or lecturing. Clarify your role as pediatrician. Try to personalize the referral process to prevent feelings of rejection by the adolescent and family. If necessary, provide concrete assistance to the family to facilitate the referral process.

Adolescent↗
PubMed2000

The recovery from alcohol problems over the life course: the Lundby longitudinal study, Sweden.

The aim of this paper is to 'look behind the statistics' and to study alcohol-related problems over time and to portray the recovery (treated and untreated) from these problems over the life course in a subset of 41 males, defined as DSM-IV alcoholics from the Lundby general population project. The subjects were interviewed with semi-structured interviews by a psychiatrist. There was only minimal attrition. An analysis was made of the distribution of alcohol-related problems among the current alcoholic group compared to the recovered one at follow-up. Due to the limited number of subjects the calculations were mainly descriptive. The dominant problems were medical (64% vs. 25%), mental (45% vs. 17%), family (27% vs. 0%) and work (18% vs. 8%). The overall functioning assessed by the GAF scale implied a change from continuous to transient symptoms and problems in the recovered group. The subjects' attributions of reasons for recovery were social stabilization (84%), treatment (58%), family and peer pressure (58%) and medical complications (33%). It is argued that the qualitative findings might be used to complement the large statistical investigations in order to understand how to link alcohol-related problems and social consequences to the life course studies.

Adult↗
PubMed2006

Language play in children with autism spectrum disorders: implications for practice.

The purpose of this article is to present evidence for the use of language play by children with autism spectrum disorders (ASD) within the context of play with peers. A conceptual framework for the development of language play is described. This framework, which is supported by the literature on language play in typically developing children, is used to assess patterns of language play in children with ASD. The findings of a descriptive study are used to provide evidence for language play in the speech of children with ASD during interactions with typical peers and show that children with ASD use language play in a similar way as their typically developing peers with the exception of age of occurrence. Implications for clinicians in their work with children with ASD are discussed as they relate to the existence of language play in children with ASD and the function of language play as a tool for language learning.

Autistic Disorder↗
PubMed1977

Verbal communication between students in multidisciplinary health teams.

The study reported here was connected with the influence of two variables--the context in which communication occurs, and the concept availability of various health professionals--upon the verbal interaction of various health professionals. Specifically, the verbal output of health professionals in groups consisting entirely of their own professional peers (i.e. all nurses, or all medical students) was compared with that of professionals in multidisciplinary health teams. The study, in attempting to delineate possible barriers to effective verbal interaction, has important implications for the functioning of multidisciplinary health teams.

Australia↗
PubMed1995

Cooperative conversations. The effect of cooperative learning on conversational interaction.

An ongoing challenge for educators of deaf and hard-of-hearing students is to find opportunities for students to use their language skills in a functional way, that is, through conversation. This study was initiated to determine whether cooperative learning is a viable means of encouraging mainstreamed hard-of-hearing students to engage in conversational interaction with their hearing peers and teachers. A single-subject design utilizing three mainstreamed hard-of-hearing subjects attending middle school was used to examine this question. Results of the study indicated that cooperative learning positively influenced the conversational turns, initiations, moves, and mean length of turn in these hard-of-hearing subjects.

Adolescent↗
PubMed2003

"I speak a different dialect": teen explanatory models of difference and disability.

What do teens with disabilities believe about their conditions, and what do they understand to be the causes, correlates, and consequences of disability? We elicited a cultural explanatory model (EM) of disability from a longitudinal sample of 23 European American adolescents with varied cognitive disabilities and delay. We asked teens how they were similar to or different from others; the name of this difference; its causes, severity, course, effects, associated problems and benefits; and need for treatment. IQ and type of disability strongly affected quality of responses only from the lowest functioning teens. A majority of teens had a reasonably rich and coherent EM, blending typical and disability themes of cultural knowledge and identity. The EM is a window into social context (schools, services, parents, and peers) as well as personal experience. Eliciting explanatory models from teens with disabilities is not only possible but also can enhance understanding of identity, family influence, and appropriate services.

Adolescent↗
PubMed1996

Pragmatic difficulties and socio-emotional problems: a case study.

Dialogue structures, use of utterance functions and dialogue coherence were analysed in a 5-year-old boy with socio-emotional problems in a kindergarten. His communicative performance, understood in these terms, was compared with those of his normal peers. Observations were taken from natural free play in peer groups. The utterances and communication of the children were written down, scored and analysed. Analysis indicated that the boy differed significantly from his peers in communicative performance. This varied, however, depending on the play group constellation. When the boy played with one particular peer, his communicative performance seemed to improve. Contrary to the others, this peer tried to take the perspective of the subject, adjusting his play and conversation to that of the boy and keeping up a dialogue with him. Pragmatic difficulties may explain some of the socio-emotional problems of the boy, with implications for practice in kindergarten.

Affective Symptoms↗
PubMed1999

The familial and developmental context of obsessive-compulsive disorder.

This article discusses developmental and familial factors in childhood obsessive-compulsive disorder (OCD) highlighting the spectrum of normative to pathologic obsessions and rituals. In addition, it explores the possible role of family functioning in the emergence and maintenance of OCD in childhood and adolescence. Finally, it posits a developmental model that integrates genetic and neurobiologic vulnerability, cognitive models of information processing, behavioral coping strategies, and familial and peer relationships.

Child↗
PubMed1975

[Alcoholism in school-age children].

Curiosity motivated consumption of illegal drugs by young people decreased during the last 5 years. At the same time the problem of school-children abusing alcohol increased. This has to be seen against the background of more general epidemiological data of alcohol consumption in the Federal Republic of Germany: --between 1961 and 1974 the expenditure for alcoholic beverages more than doubled; --according to serious estimations there are between 700,000 and 1 million of alcoholics in this country (from these about 8-10% being minors); --the average age of inmates of clinics for alcoholics dropped considerably during the last decade. Main findings of a follow-up survey conducted (size of sample: about 10,000 school-children in Hamburg, age 13-20, representative of a total of 110,000) are: --more than 25% of the above mentioned 110,000 school-children showed a rather excessive drinking behaviour (i.e. having been drunk 1-5 or more than 5 times during a period of 2 months prior to the interviews); --positive correlations were found to exist between excessive drinking habits and certain psycho-social variables (i.e. broken home, suicide-attempts, excessive consumption of alcohol by the parents, etc.); --the subgroup of those school-children who were users of illegal drugs: about 60% of them belong also to the category of "excessive alcohol user". Reasons for the general increase of alcohol consumption in Western Germany are for instance: --a change of drinking habits (more frequently, drinking at home and alone); --a shift of preferances (from relatively low percentage-beverages like beer and wine to so-called hard liquors); --an increase of alcohol consumption among those societal groups--the young and women--who formerly were almost abstinent. Some reasons and causes for the increase of alcohol consumption among school-children are: --being exposed to negative model-behaviour of adults and especially of parents; --peer-group pressure; --the discovery of school-children by the industry as an important consumer group, i.e. shape of images through advertisement (for example "drinking makes you appear strong" etc.); --the increasing loss of functions of traditional agents of socialization (i.e. family, school and religion).

Adolescent↗
PubMed2005

[Rehabilitation of spinal cord injury patients].

The life expectancy of patients with spinal cord injury has increased linearly in the past five decades, but continues to be below that of their non disabled peers. This improvement was achieved through better knowledge of the pathophysiology of the multisystem impairments caused by spinal cord injury. The main treatment goals in spinal cord injury are to prevent complications, to obtain optimal function (depending on the affected neurological level), to facilitate social re-integration, and to provide specialized follow-up throughout life. This comprehensive management must be provided in spinal units, using a multidisciplinary approach.

Disability Evaluation↗
PubMedDate not supplied

Organizational support of the clinical nurse specialist role: a nursing research and professional development directorate.

Administrative support is essential for optimal utilization of the Clinical Nurse Specialist (CNS) resource. It has been linked to successful role implementation, role efficacy and job satisfaction. The article addresses how a Nursing Research and Professional Development Directorate (NRPD) provides administrative support of the CNS role. The impact of the directorate on the role functions of practitioner, consultant, educator and researcher is delineated. Specific challenges to the CNS role and organizational benefits are described. A model of organizational support of the CNS, based on the concepts of collaboration and peer mentorship, is proposed. The model emphasizes mutual goal setting to achieve both organizational and professional objectives.

Humans↗