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PubMedDate not supplied

Where does primary care begin? The health facilitator as a central figure in primary care.

The role of lay advisors (health facilitators) in primary care is described. Health facilitators are people to whom others naturally turn for advice, counsel and support. The majority of illnesses reported by patients are never presented to a doctor. Because primary care is center in the family or other close social support system within the community social structure, all professional care is in fact external to that natural structure and may be considered secondary in function. In the United States, the recent trend toward self-care shows that professional care does not meet the needs of even the middle class and that people actively seek and receive support from peer groups. A pilot program in North Carolina is described, in which 39 health facilitators were identified and given training in the recognition of common illnesses, disease prevention, health promotion, and community resources. The implications of such programs and their effects on primary health care are discussed.

Adolescent↗
PubMed1993

The development of sex typing in middle childhood.

The present study examined the development of sex typing during middle childhood, using a sample of 558 children aged 5-12 years. The purpose of the study was to provide information about the developmental course and stability of various aspects of sex typing during this period and to examine the relative contributions of cognitive and environmental factors to sex-role development. Multiple measures of sex typing were obtained, including indices of personal preference, knowledge of stereotypes, and flexibility in the domains of activities, occupations, and traits. We also collected information about the child's cognitive maturity, exposure to sex-typed models at home, and socioeconomic status. Results supported the need for an integrative theory of sex-role development, incorporating factors emphasized by cognitive-developmental, schematic-processing, and social learning theories. Knowledge of stereotypes, flexibility, and sex-typed personal preferences all increased with age during middle childhood. There were also individual differences in sex typing that were stable over a 1-year period. Distinct "cognitive" and "affective" aspects of sex typing were identified using a principal components analysis. Cognitive elements (flexibility and knowledge of stereotypes) were largely a function of the child's cognitive maturity level, although social-environmental factors such as father's presence in the home also had some effect. Affective elements (sex-typed preferences for activities, occupations, and peers), on the other hand, were related more consistently to sex typing of the home environment. Children whose mothers frequently modeled "reversed" sex-role behaviors (i.e., traditionally "masculine" household and child-care tasks) were less sex typed in their own preferences. However, cognitive factors were also important, in that children who believed gender stereotypes to be flexible were less sex typed in their choices of activities, occupations, and peers. In sum, both cognitive maturation and socialization experiences contribute to the development of sex typing during middle childhood. Potential practical implications of these findings, as well as implications for stereotyping in other social domains such as race and ethnicity, are discussed.

Child↗
PubMed2006

Young people with intellectual disabilities attending mainstream and segregated schooling: perceived stigma, social comparison and future aspirations.

BACKGROUND: Mainstream schooling is a key policy in the promotion of social inclusion of young people with learning disabilities. Yet there is limited evidence about the school experience of young people about to leave mainstream as compared with segregated education, and how it impacts on their relative view of self and future aspirations. METHODS: Sixty young people with mild to moderate intellectual disabilities in their final year of secondary school participated in this study. Twenty-eight individuals came from mainstream schools and 32 attended segregated school. They completed a series of self-report measures on perceptions of stigma, social comparison to a more disabled and non-disabled peer and the likelihood involved in attaining their future goals. RESULTS: The majority of participants from both groups reported experiencing stigmatized treatment in the local area where they lived. The mainstream group reported significant additional stigma at school. In terms of social comparisons, both groups compared themselves positively with a more disabled peer and with a non-disabled peer. While the mainstream pupils had more ambitious work-related aspirations, both groups felt it equally likely that they would attain their future goals. Although the participants from segregated schools came from significantly more deprived areas and had lower scores on tests of cognitive functioning, neither of these factors appeared to have an impact on their experience of stigma, social comparisons or future aspirations. CONCLUSIONS: Irrespective of schooling environment, the young people appeared to be able to cope with the threats to their identities and retained a sense of optimism about their future. Nevertheless, negative treatment reported by the children was a serious source of concern and there is a need for schools to promote the emotional well-being of pupils with intellectual disabilities.

Adaptation, Psychological↗
PubMed1997

Protective and risk effects of peer relations and social support on antisocial behaviour in adolescents from multi-problem milieus.

This article addresses the relation between antisocial behaviour and social resources in a 2-year longitudinal study of 100 high-risk adolescents in residential care. Problem behaviour was measured with the Externalizing Scale of the Youth Self Report. Social resources were recorded using semi-structured methods. Hierarchical regression analyses showed interactions suggesting that the same variables can fulfil risk as well as protective functions: clique membership and satisfaction with social support fostered behavioural continuity. In contrast, a lack of social embeddedness had a risk effect for well-adapted adolescents and a protective effect for the deviant ones. Social resources were more influential in girls. Theoretical implications and methodological problems are discussed.

Adolescent↗
PubMed1988

Pulmonary function in young and older athletes and untrained men.

This study compared the lung volumes and pulmonary functions of older endurance-trained athletes with those of healthy sedentary age-matched controls, young athletes, and young untrained men to determine whether training affects the age-associated changes in these variables. Despite large differences in maximal 02 consumption (VO2max), the older athletes and their sedentary peers had similar values for all pulmonary variables when expressed as absolute values. However, because the older athletes were shorter than the older sedentary men, their vital capacity, total lung capacity (TLC), and forced expiratory volume in 1 s were significantly larger than those of the older sedentary men when normalized for age and height; the average values for maximal voluntary ventilation and residual volume (RV) were also larger in the older athletes when normalized for age and height, but the differences were not significant. The young trained and untrained men did not differ in any of these measures. TLC was the only pulmonary variable that was the same in the young and older men; RV and the RV-to-TLC ratio were larger, whereas all other pulmonary function and volume measures were lower in the older men compared with the younger men. The older athletes were the only group whose lung volumes and pulmonary function measures were all, except for RV, substantially greater than expected based on their age and height. Thus prolonged strenuous endurance training in these older highly trained endurance athletes appears to have altered the decline in pulmonary function and volumes associated with aging.

Adult↗
PubMed1990

The acculturation of Chinese immigrants: perceived effects on family functioning of length of residence in two cultural contexts.

In two studies, conducted in Australia and the United States, first- and second-generation adolescents of Chinese descent, together with adolescents from the host culture (Anglo-Australian or Euro-American) and from Hong Kong, were asked about their family environment. In both studies, an autonomy-promoting family style differentiated the host culture from the Hong Kong Chinese, with the Chinese immigrants occupying an intermediate position. Chinese immigrants of both generations reported more structured, controlling family environments than did the nonimmigrant groups. First-generation Chinese-Australians reported a more organized family pattern than that of their second-generation peers, whereas second-generation Chinese-Americans perceived more family regulation of adolescents than did the first-generation respondents. The two studies yielded remarkably similar results in spite of differences in the Chinese communities' positions in the host culture. There was evidence of somewhat rapid change in the first-generation families toward individualistic norms but little shift in family environment as a function of length of residence.

Acculturation↗
PubMed1996

Health-care technology assessment of surgical procedures: the case of reduction pneumoplasty for emphysema.

End-stage chronic obstructive pulmonary disease (COPD) is frequent in the practice of pulmonology. The recent report that reduction pneumoplasty results in lung function improvement in a high proportion of patients with emphysema has raised the question of how effectively the medical profession assesses the efficacy of new surgical procedures. Unlike drugs and devices, the introduction of new surgical procedures is not regulated. Technique changes rapidly for a period of time after new procedures are introduced. Peer review is done mainly by quality-improvement activities in the surgeon's hospital and by publication in peer-reviewed journals. Randomized clinical trials (RCT) are procedurally and ethically difficult to do and few have been done for new surgical procedures. Some trials have been problematic. For example, a controlled cooperative trial of radial keratotomy resulted in unsuccessful antitrust suits brought by physicians and patients alleging that third-party payers would not reimburse them for surgery. RCTs that have been done have tended to be reported long after the procedure has been incorporated into surgical practice. A RCT of reduction pneumoplasty would be impossible at this time because of rapid flux in surgical techniques. There might also be ethical problems because of the substantial improvement in lung function of many patients in the existing case series, a level of improvement seen with no other treatment than lung transplantation. It is proposed that a prospective, cooperative, consecutive-case, observational study (registry) of reduction pneumoplasty for emphysema could greatly speed the acquisition of information about the efficacy of this new procedure.

Humans↗
PubMed2001

Attachment at school age and academic performance.

The association between attachment and school-related cognitive functioning was longitudinally examined for a French Canadian sample of 108 school-age children. The affective quality of mother-child interaction patterns, child cognitive engagement, and quality of child attachment to mother were evaluated during a laboratory visit that included a separation-reunion procedure occurring when the children were approximately 6 years of age. Children's mastery motivation and academic performance were assessed 2 years later (at age 8). Analyses indicated that secure children had higher scores than their insecure peers on communication, cognitive engagement, and mastery motivation. Controlling children were at greatest risk for school underachievement, with the poorest performance on all measures except mastery motivation. Avoidant and ambivalent children were lowest on mastery motivation. Results of mediational analyses support the salience of mother-child interactional processes and child cognitive engagement at school age in explaining relations between attachment and cognitive functioning in school.

Child↗
PubMed2002

The facilitation of social-emotional understanding and social interaction in high-functioning children with autism: intervention outcomes.

This study evaluated the effectiveness of a 7-month cognitive behavioral intervention for the facilitation of the social-emotional understanding and social interaction of 15 high-functioning children (8 to 17 years old) with autism. Intervention focused on teaching interpersonal problem solving, affective knowledge, and social interaction. Preintervention and postintervention measures included observations of social interaction, measures of problem solving and of emotion understanding, and teacher-rated social skills. Results demonstrated progress in three areas of intervention. Children were more likely to initiate positive social interaction with peers after treatment; in particular, they improved eye contact and their ability to share experiences with peers and to show interest in peers. In problem solving after treatment, children provided more relevant solutions and fewer nonsocial solutions to different social situations. In emotional knowledge, after treatment, children provided more examples of complex emotions, supplied more specific rather then general examples, and included an audience more often in the different emotions. Children also obtained higher teacher-rated social skills scores in assertion and cooperation after treatment. The implications of these findings are discussed in terms of the effectiveness of the current model of intervention for high-functioning children with autism.

Affect↗
PubMed2005

From 2R to 3R: evidence for a fish-specific genome duplication (FSGD).

An important mechanism for the evolution of phenotypic complexity, diversity and innovation, and the origin of novel gene functions is the duplication of genes and entire genomes. Recent phylogenomic studies suggest that, during the evolution of vertebrates, the entire genome was duplicated in two rounds (2R) of duplication. Later, approximately 350 mya, in the stem lineage of ray-finned (actinopterygian) fishes, but not in that of the land vertebrates, a third genome duplication occurred-the fish-specific genome duplication (FSGD or 3R), leading, at least initially, to up to eight copies of the ancestral deuterostome genome. Therefore, the sarcopterygian (lobe-finned fishes and tetrapods) genome possessed originally only half as many genes compared to the derived fishes, just like the most-basal and species-poor lineages of extant fishes that diverged from the fish stem lineage before the 3R duplication. Most duplicated genes were secondarily lost, yet some evolved new functions. The genomic complexity of the teleosts might be the reason for their evolutionary success and astounding biological diversity.

Animals↗
PubMed2002

Health-related quality of life of preterm children and their caregivers.

As advances in medical science have extended the limit of viability downward to 23 or 24 weeks gestation, interest has turned from long-term health outcomes to quality of life for survivors. During the last decade, the first studies of the health-related quality of life (HRQOL) of children and young adults who were born extremely preterm were published. Taken from the fields of anthropology, economics, sociology, and psychology, the foundation of HRQOL is formed by theories of functionalism, positive well-being, and utility. HRQOL can be defined as the physical, psychological, and social domains of health, which can be influenced by an individual's experiences and perception. HRQOL instruments are generally composed of multiple domains and measure physical functioning, mental health, and social role functioning in some form. Utilities, or preferences for health outcomes under conditions of uncertainty, are also used. Studies of HRQOL to-date indicate that preterm children have, on average, poorer health than their normal birthweight peers, but the majority do not perceive their quality of life as significantly different than others of their own age. Measures of HRQOL should not replace the traditional measures of morbidity, but should become part of the standard battery of tools used to assess a preterm child's health and well-being. Ultimately, studies of the HRQOL of preterm children should identify aspects of life, physical, psychological, or social, that could be improved with intervention.

Adult↗
PubMed2003

And then there were many: MADS goes genomic.

During the past decade, MADS-box genes have become known as key regulators in both reproductive and vegetative plant development. Traditional genetics and functional genomics tools are now available to elucidate the expression and function of this complex gene family on a much larger scale. Moreover, comparative analysis of the MADS-box genes in diverse flowering and non-flowering plants, boosted by bioinformatics, contributes to our understanding of how this important gene family has expanded during the evolution of land plants. Therefore, the recent advances in comparative and functional genomics should enable researchers to identify the full range of MADS-box gene functions, which should help us significantly in developing a better understanding of plant development and evolution.

Evolution, Molecular↗
PubMed1998

The scarring processes in mucosal tissues after immune injury.

OBJECTIVES: An important feature of the healing processes is scar formation which may be necessary for organism survival. If it proceeds to the pathological state, it may impair normal function. The purpose of this review is to focus on some of the factors that may influence this process after immune injury, comparing it in the skin and mucosa. METHODS: A detailed literature search of peer-reviewed journals was conducted. Studies reported in all languages considered relevant and important were used, including humans, animals, and tissue culture. RESULTS: Analysis of the data indicate that the scarring process is mainly dependent on (1) the type of the lesion, (2) the cause and duration of injury, and (3) the tissue involved and its microenvironment. Equally important is the large spectrum and heterogenicity in the biological activity of fibroblasts and their role in scar formation. CONCLUSIONS: The process of scar formation is complex and multistep process and is affected and influenced by local and systemic factors. Although it appears irreversible, there are pharmacological agents available, and under investigation, that may minimize its detrimental effects.

Animals↗
PubMed2000

Longitudinal risk of std acquisition in adolescent girls using a generalized estimating equations model

Background: To date, few studies have used a longitudinal approach in examining risk factors for STD acquisition in teenage girls. In the present study, we examined risk of STD acquisition in adolescent girls over a three-year period using longitudinal analyses.Methods: One hundred and seventy-four girls between the ages of 12 and 16 (mean age = 14.5) participated in a longitudinal study of adolescent romantic relationships. The racial composition of the subject pool was 80% African-American and 20% Caucasian. These girls were followed for three years at six-month intervals. By the end of the study, 127 of the girls were sexually experienced, and thus, were included in the analyses regarding risk for STDs. The risk for history of STD was evaluated using a generalized estimating equations (GEE) model, which allows for the inclusion of data from subjects with missing visits. The following independent variables were entered into the model: age, race, screening IQ score, qualitative cognitive functioning, perceptions of STD prevalence among female friends, and whether a condom was used at last intercourse. Additional independent variables included number of lifetime partners (4 or more lifetime partners, 2 to 3 lifetime partners, only one partner) and age of sexual debut (less than 14 years, 14-16 years, and 17 years and older), five factors from the Family Environment Scale, and three types of parental monitoring (direct, direct when with peers, and indirect).Results: The results of the longitudinal (GEE) model indicated that having a history of an STD was significantly related to a younger age of sexual debut (p <.01), having more partners (p <.0001), being African-American (p =. 01), and having a lower screening IQ score (p <.01).Conclusions: These results suggest that risk of STD is associated with both modifiable and non-modifiable variables. Race and intellectual functioning independently contributed to STD risk, stressing the importance of utilizing prevention programs that are culturally and developmentally specific. For example, less intelligent girls may need to have information presented in a more concrete manner, with a focus on the present rather than the future. The targets of these prevention programs should continue to emphasize delaying initiation, as well as partner selection. Finally, the fact that variables for STD acquisition in this longitudinal model are comparable to previous cross-sectional studies of STD acquisition suggests that these are potent predictors of risk.

Journal Article↗
PubMed1991

Ability, achievement, and adjustment in homeless children.

Homeless 3-12-year-old children residing in city shelters were compared with a matched control group of 45 inner city children in terms of cognitive functioning and emotional-behavioral adjustment. School-age children in both groups did not differ significantly on most measures. Preschool homeless children exhibited slower development and more emotional-behavioral problems than did their domiciled peers, and significantly fewer were enrolled in early childhood programs. The feasibility of evaluating this population on standardized instruments is demonstrated, and implications of the study for social policy are discussed.

Achievement↗
PubMed2007

Identification of tightly regulated groups of genes during Drosophila melanogaster embryogenesis.

Time-series analysis of whole-genome expression data during Drosophila melanogaster development indicates that up to 86% of its genes change their relative transcript level during embryogenesis. By applying conservative filtering criteria and requiring 'sharp' transcript changes, we identified 1534 maternal genes, 792 transient zygotic genes, and 1053 genes whose transcript levels increase during embryogenesis. Each of these three categories is dominated by groups of genes where all transcript levels increase and/or decrease at similar times, suggesting a common mode of regulation. For example, 34% of the transiently expressed genes fall into three groups, with increased transcript levels between 2.5-12, 11-20, and 15-20 h of development, respectively. We highlight common and distinctive functional features of these expression groups and identify a coupling between downregulation of transcript levels and targeted protein degradation. By mapping the groups to the protein network, we also predict and experimentally confirm new functional associations.

Analysis of Variance↗
PubMed1994

Subject pronoun and article omissions in the speech of children with specific language impairment: a phonological interpretation.

Children with specific language impairment (SLI) and their MLU-matched normally developing (ND) peers imitated proper nouns, the pronouns he and you, and the article the in subject phrases. Although all of these word types were phonological phrase-initial syllables, the proper nouns received strong stress, but the function words received weak stress. Both groups of children showed significantly more omissions of the function words than the proper nouns. There was no significant difference amongst the imitations of the two pronouns or the article; all were omitted frequently by both groups. This suggests that the status of subject articles and pronouns as weak syllables in the initial position of phonological phrases may in some cases constitute a more important factor than the distinctive grammatical roles they play. A phonological explanation of subject article and pronoun omissions is explored.

Child Language↗
PubMed2003

Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy.

OBJECTIVE: To compare the outcome of chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. DESIGN: Cross-sectional outcome analysis. SETTING: University Hospital Pellenberg, Leuven, Belgium. PATIENTS AND INTERVENTIONS: Of a total of 27 patients (28 knees) with chronic patellar tendinopathy, 13 were treated surgically, and 14 (15 knees) received extracorporeal shock wave therapy. MAIN OUTCOME MEASUREMENTS: Functional outcome questionnaire: Victorian Institute of Sport Assessment score, Visual Analog Scale, and Roles and Maudsley classification. RESULTS: At an average of 6 months of follow-up, the mean Victorian Institute of Sport Assessment and Visual Analog Scale scores for the extracorporeal shock wave therapy group were 78.8 +/- 28.7 and 9 +/- 2, respectively, which improved to 83.9 +/- 28.6 and 9 +/- 2, respectively, at 22.1 months. The surgery group scored 70.7 +/- 22.2 points on the Victorian Institute of Sport Assessment at an average of 26.3 months of follow-up (p = 0.41 and p = 0.18) and 8 +/- 3 on the Visual Analog Scale (p = 0.14). In the extracorporeal shock wave therapy group, 5 (33%) patients rated their pain status at 22.1 months as excellent, 5 (33%) as good, 2 (13%) as fair, and 2 (13%) as poor. In the surgery group, 4 (33%) evaluated the result as excellent, 3 (25%) as good, 3 (25%) as fair, and 2 as poor (17%). CONCLUSIONS: Extracorporeal shock wave therapy shows a comparable functional outcome to surgery in a cross-sectional analysis of patients with chronic proximal patellar tendinopathy resistant to conservative treatment.

Adult↗