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At least 1,315 records · Page 73Linked to original sources
PubMed1996

Air pollution and daily mortality in three Swiss urban areas.

Particulate air pollution, in association with other common urban air pollutants, has been associated with various measured health endpoints, including the incidence and duration of respiratory symptoms, lung function, absence from work or school due to respiratory illness, hospitalization for respiratory disease, and cardiopulmonary disease mortality. In this study, the association between daily mortality and air pollution was assessed in Zurich, Basle, and Geneva (Switzerland) for the time period 1984 through 1989. Various regression modeling techniques were used to estimate the effect of air pollution on mortality, to control for time trends, seasonal factors, and weather variables, and to assess the sensitivity of the results. A positive, statistically significant association between daily mortality counts and measures of ambient air pollution in all three cities was observed. Mortality was associated with total suspended particulate pollution, sulfur dioxide, and nitrogen dioxide. The strongest association was with a 3-day moving average (including the concurrent day and the preceding 2 days) of these pollutants. The estimated mortality-air pollution effects were not highly sensitive to regression modeling techniques used to control for seasonality, long-term trends, and weather variables.

Aged↗
PubMed2003

Factors affecting diabetes knowledge in Type 2 diabetic veterans.

AIMS/HYPOTHESIS: To describe the clinical, psychological and social factors affecting diabetes knowledge of veterans with established Type 2 diabetes. METHODS: We conducted an observational study of 284 insulin-treated veterans with stable Type 2 diabetes. All subjects completed the University of Michigan Diabetes Research and Training Centre Knowledge Test, the Diabetes Care Profile, the Mini-Mental State Examination, the Geriatric Depression Scale, and the Diabetes Family Behaviour Checklist. Stepwise multiple linear regression was used to develop a model for the diabetes knowledge score based upon clinical and psychosocial variables. RESULTS: One hundred eighty subjects were evaluated in a derivation set. The mean age +/- SD was 65.4+/-9.6 years, 94% were men, and 36% were members of a minority group. Performance on the diabetes knowledge test was poor (64.9+/-15.3% correct). Self-perceived understanding of all management objectives explained only 6% of the variance in the knowledge scores. Multivariate analysis showed that age, years of schooling, duration of treatment, cognitive function, sex, and level of depression were independent determinants of the knowledge score. When the model was applied to 104 subjects in a validation set, there was a strong correlation between observed and predicted scores (r=0.537; p<0.001). CONCLUSIONS/INTERPRETATION: Stable, insulin-treated veterans have major deficiencies in diabetes knowledge that could impair their ability to provide self-care. A multivariate model comprised of demographic variables and psychosocial profiling can identify patients who have limited diabetes knowledge and be used to assess individual barriers to ongoing diabetes education.

Body Weight↗
PubMed2005

Global consensus on ADHD/HKD.

A Global ADHD Working Group of experienced clinicians and researchers was gathered to review the latest evidence, discuss current best practice in the treatment of attention-deficit/hyperactivity disorder (ADHD), and make a statement based on consensus. The statement aims to re-affirm ADHD as a valid disorder that exists across different cultures, has a significant global impact, and should be diagnosed and effectively treated wherever it occurs. ADHD is one of the most common neurobehavioural disorders of childhood and impacts on many aspects of development, including social, emotional and cognitive functioning, in the home and school environment. Although these findings are from developed countries, the impact in developing countries is likely to be similar. There is strong supportive evidence for the validity of ADHD as a syndrome with neurobiological aspects, and complex genetic factors are primarily implicated in the aetiology. Accurate diagnosis and measurement of impairment is important to enable appropriate and successful management of symptoms. ADHD is a persistent condition that needs to be treated and monitored over time. The evidence supporting medication-based interventions (such as methylphenidate) is strong and consensus treatment algorithms to guide the multimodal treatment of ADHD, alone and in combination with common comorbidities, are suggested.

Adolescent↗
PubMed1991

The whys of patient education.

The rationale for patient education is that patients and families have the right to be informed; that professional standards describe appropriate patient education; that health care organizations and the law require patient education; and patients, health care organizations, and that society benefit from the process. Patients with cancer benefit in terms of knowledge acquisition, enhanced self-care, reduced anxiety, enhanced self-concept and self-esteem, increased satisfaction with care, improved pain control, improved oral status, and reduced disruption in daily functioning. Health care organizations benefit in terms of quality services, reduced costs, and reduction in malpractice suits. Society benefits as patients with knowledge and skills maintain or resume functional status and return to school, work, or service activities. Nurses are key professionals in the coordination and delivery of patient education programs. They too have the opportunity to benefit from patient education through therapeutic alliances with patients and families that foster both personal and professional satisfaction.

Economics, Hospital↗
PubMed1982

Transplantation of adult kidney into the very small child: long-term outcome.

Adult kidneys were transplanted into 12 children weighing between 5,400 and 8,800 gm. Ten received parental and two received cadaver grafts. Ten of the 12 children are alive 18 months to 9 years post transplant; eight have their original grafts and two required retransplantation-their original grafts were lost at 4 and 9 years because of chronic rejection. All but these two surviving children had normal or accelerated growth rates despite growth retardation prior to transplant. All children evidenced moderate to severe delay in psychomotor development prior to transplant. Seven of the ten survivors now have normal psychomotor function. Two are behind in school, and one with a degenerative central nervous system disease prior to transplant remains profoundly retarded. We conclude that because of donor availability, capacity for good donor-recipient matching, and minimization of time on dialysis, transplantation of adult kidneys into pediatric patients is preferable to awaiting the relatively uncommon pediatric cadaver donor. We further conclude that the procedure is warranted.

Age Factors↗
PubMed2002

Posterior approach for retroperitoneal laparoscopic bilateral nephrectomy in a child.

We report on a unique posterior approach for bilateral nephrectomy by retroperitoneoscopy that was conducted in a 13-year-old boy with end-stage renal disease managed by peritoneal dialysis. A posterior approach for bilateral nephrectomy by retroperitoneal laparoscopy provided adequate visualization and created enough working space for the manipulation. The procedure was performed during a short period, and the patient did not need to be repositioned. Retroperitoneal laparoscopic bilateral nephrectomy is a useful option in school-aged children with poorly functioning kidneys, particularly those children also undergoing peritoneal dialysis.

Adolescent↗
PubMed1998

The Pain Coping Questionnaire: preliminary validation.

A new measure of coping, the Pain Coping Questionnaire (PCQ), is presented and validated in two studies of children and adolescents. Factor analyses of data from healthy children and adolescents supported eight hypothesized subscales (information seeking, problem solving, seeking social support, positive self-statements, behavioral distraction, cognitive distraction, externalizing, internalizing/catastrophizing) and three higher-order scales (approach, problem-focused avoidance, emotion-focused avoidance). The subscales and higher-order scales were internally consistent. The pain coping scales were correlated in the expected directions with children's appraisals of pain controllability, self-rated coping effectiveness, emotional distress when in pain, and among high school students, pain thresholds and functional disability. The structure and internal consistency of the PCQ were replicated in a sample of children and adolescents experiencing recurrent pain (headache, arthritis), and their parents. Relations between child- and parent-ratings of children's coping were moderate (median r=0.34). Higher levels of emotion-focused avoidance were related to more emotional distress (both samples), less coping effectiveness (headache sample), and higher levels of pain (arthritis sample). Higher levels of approach coping were related to less disability (headache sample). Other relations between approach and distraction coping and the outcome variables were generally not significant. The PCQ is a promising instrument for assessing children's pain coping strategies. The items are simple and relatively few, making it useful for assessing coping across a wide age range. It can be administered to children as young as 8 years of age in approximately 15 min.

Adaptation, Psychological↗
PubMed1998

Efficacy of a self-management program for childhood asthma--a prospective controlled study.

Asthma training programs for parents and children have been developed to increase both the self-management skills of asthmatic children and compliance with medical regimes. In order to evaluate two training programs for asthmatic children aged 7-14, 81 patients were randomly assigned to three groups. Group 1 consisted of 27 patients and their parents who participated in a five-day standardized family-oriented clinical asthma training program. They had monthly follow-up meetings with the training team for a period of six months. Group 2 (n = 29) had the same clinical training without follow-up interventions; a control group (n = 25) received regular medical treatment according to the international guidelines at the asthma clinics without a training program and served as control group. Questionnaires regarding self-management aspects, coping and anxiety were filled out by patients, parents, family doctors and the training team prior to as well as twelve months after the training. The results indicate that Training group 1 benefitted most with respect to active asthma self-management, Training group 2 to some degree while the control group showed no significant effects. The differences after one year between the three groups regarding physical parameters such as lung-function and days missed in school did not reach the level of significance. Our results indicate that the long-term efficacy of self management courses for asthmatic children is enhanced by regular follow-up training sessions.

Adolescent↗
PubMed2003

[A national campaign for the prevention of hand accidents].

The objective of this article is to propose the launch of a prevention campaign against hand-related accidents. This effort is motivated by: epidemiological studies which, despite their disparate and inhomogeneous character, show that hand and wrist accidents are the primary cause of traumatic lesions. They occur two-third of the time during daily activities. For the work-related accidents, they are also the primary cause of work stoppages as well as permanent invalidities. current legal and regulatory prevention measures have reached their efficacy limits. These can not be applied to errors of individuals by inattention, negligence or a lack of information. Sensibilization efforts in public education, professional training programs or direct to the public are still much too limited in scope and are never included in a global strategy. The objective of the prevention campaign will be to increase public awarenesses as a function of one's milieu (school, workplace, leisure, household) to identify the risks of hand injuries and to provide advice on how to avoid them. In this context, the operationalization of the campaign will pass, at the level of each region, by the coordination of each traditional agencies (public health, local government, corporations), of new partners (insurers, renters or sellers of handiwork and gardening equipment, etc.), as well as FESUM centres.

Accident Prevention↗
PubMed2003

Long-term FEIBA prophylaxis does not prevent progression of existing joint disease.

Activated prothrombin complex concentrates have been used to treat bleeding episodes for patients who have developed an inhibitor to factor VIII (FVIII). FEIBA-Vh (FVIII bypassing activity, FEIBA) has been used since 1970 for this purpose and with FVIII for immune tolerance programmes. Studies have not been presented to show the safety and efficacy of FEIBA when given over a long period of time to prevent haemophilic arthropathy with bleeding into the joints of these patients. This study was undertaken to ascertain the outcome of haemophilic arthropathy with FEIBA prophylaxis. Data were collected on seven patients with known long-standing high-titre FVIII inhibitors given FEIBA prophylaxis for 3-6(1/2) years. Patients were given 50-100 units of FEIBA three to four times weekly. A functional joint evaluation revealed some degree of arthropathy already present in all patients at time of prophylaxis initiation. Safety was measured by medical status, evidence of thrombosis, life-threatening bleeding and inhibitor titre. Efficacy was measured for joint outcome by a functional physical therapeutic scale. At the conclusion of the study, efficacy was mixed as all of the joints for which the patients were placed on prophylaxis had progressed and developed synovitis. Two patients had a functional improvement in their arthropathy, and all were functional enough to attend regular school. The product was deemed safe for long-term use, as there were no complications of therapy with no thrombosis, no life-threatening bleeding episodes and no anamnesis caused by FEIBA alone. Inhibitor titres fell in all patients over the course of the study. Total product usage ranged from approximately 9373-15,571 U kg(-1) year(-1). FEIBA is safe for long-term prophylaxis when given in the recommended dosage for an extended period of time. Efficacy to prevent arthropathy could not be seen as all patients had some degree of arthropathy at time of prophylaxis initiation. An additional study needs to be performed using FEIBA before arthropathy has developed.

Blood Coagulation Factors↗
PubMed1996

Surgical reconstruction of a high cloacal anomaly with two short vaginas.

We treated a patient with a complex cloacal malformation: a high confluence cloaca and 2 separate short vaginas. At the age of 1 year and 2 months the rectocloacal fistula was closed because of frequent urinary infections, and the vaginas were separated from the wide urogenital sinus and anastomosed to the lower colon. At the age of 2 years and 4 months the lower colon, which had been anastomosed with the 2 vaginas, was pulled down to the perineum to serve as a lower vagina, and the sigmoid colon was pulled through to form a neorectum. She is now 7 years old and goes to school without problems of bowel function or urinary function except that catheterization is done twice a day.

Anus, Imperforate↗
PubMed1989

A randomized study of inpatient versus outpatient continuous intravenous infusion chemotherapy: psychosocial aspects.

This study was designed to test whether previously untreated patients with head and neck cancer could effectively manage home continuous infusion chemotherapy, and to compare their acceptance and adjustment to home versus inpatient treatment. Twenty-two patients received 3-4 cycles of induction chemotherapy and a 5-day continuous intravenous infusion (CVI). Patients were randomized to receive the CVI portion of cycle 1 either in the hospital via a standard chemotherapy delivery device or at home via the Travenol Infusor, a portable and disposable drug delivery system. For their second cycle of chemotherapy, patients crossed over to the alternate drug delivery method. Patients who did not want to receive their treatment at home received their chemotherapy as inpatients via the Infusor. Therefore, all patients received treatment with both drug delivery methods. Nineteen patients were evaluable for this study. Eleven patients received at least one cycle of home CVI chemotherapy, and adjusted well to this method of drug delivery. Levels of psychological distress decreased for this group of patients when receiving outpatient chemotherapy compared to their inpatient cycles. The eight patients who received all chemotherapy cycles as inpatients (refused home treatment) were found to be less educated and reported greater physical impairment prior to study entry than future home CVI acceptors. Levels of psychological distress in this group increased with each inpatient chemotherapy cycle. We conclude that home CVI chemotherapy may be an alternative to inpatient treatment for patients who have had at least one cycle of inpatient chemotherapy. The best candidates for home treatment are patients with unimpaired daily functioning and a minimum high school education.

Drug Therapy↗
PubMed2003

Dissociations of cerebral cortex, subcortical and cerebral white matter volumes in autistic boys.

High-functioning autistic and normal school-age boys were compared using a whole-brain morphometric profile that includes both total brain volume and volumes of all major brain regions. We performed MRI-based morphometric analysis on the brains of 17 autistic and 15 control subjects, all male with normal intelligence, aged 7-11 years. Clinical neuroradiologists judged the brains of all subjects to be clinically normal. The entire brain was segmented into cerebrum, cerebellum, brainstem and ventricles. The cerebrum was subdivided into cerebral cortex, cerebral white matter, hippocampus-amygdala, caudate nucleus, globus pallidus plus putamen, and diencephalon (thalamus plus ventral diencephalon). Volumes were derived for each region and compared between groups both before and after adjustment for variation in total brain volume. Factor analysis was then used to group brain regions based on their intercorrelations. Volumes were significantly different between groups overall; and diencephalon, cerebral white matter, cerebellum and globus pallidus-putamen were significantly larger in the autistic group. Brain volumes were not significantly different overall after adjustment for total brain size, but this analysis approached significance and effect sizes and univariate comparisons remained notable for three regions, although not all in the same direction: cerebral white matter showed a trend towards being disproportionately larger in autistic boys, while cerebral cortex and hippocampus-amygdala showed trends toward being disproportionately smaller. Factor analysis of all brain region volumes yielded three factors, with central white matter grouping alone, and with cerebral cortex and hippocampus-amygdala grouping separately from other grey matter regions. This morphometric profile of the autistic brain suggests that there is an overall increase in brain volumes compared with controls. Additionally, results suggest that there may be differential effects driving white matter to be larger and cerebral cortex and hippocampus-amygdala to be relatively smaller in the autistic than in the typically developing brain. The cause of this apparent dissociation of cerebral cortical regions from subcortical regions and of cortical white from grey matter is unknown, and merits further investigation.

Autistic Disorder↗
PubMed2003

Challenges and opportunities in recruiting and retaining underrepresented populations into health promotion research.

PURPOSE: To evaluate how recruitment strategies and program characteristics interact with participant characteristics to influence recruitment and retention in an exercise intervention study targeted to African American and White older adults with multiple chronic illnesses. DESIGN AND METHODS: Characteristics of 273 referrals and 103 enrollees were analyzed in conjunction with programmatic decisions about recruitment design and eligibility criteria. RESULTS: Eligible participants who did not enroll were younger and more likely to be under 60 and to self-report having diabetes. After 1 year, 70% of the enrolled participants remained in the program. Program attrition was not associated with randomization, race, or chronic illness but was associated with functional status, having a high school degree, and program site. IMPLICATIONS: Program design decisions can significantly influence the participation of underrepresented populations in exercise health promotion programs for older adults. In particular, group-specific efforts targeted to recruiting and retaining African Americans can be successful.

Black or African American↗
PubMed2005

Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia.

OBJECTIVE: To describe the development and test the efficacy of a cognitive-behavioral intervention (CBT) for juvenile fibromyalgia. METHOD: Sixty-seven children with fibromyalgia and their parents were recruited to participate in an 8-week intervention that included modules of pain management, psychoeducation, sleep hygiene, and activities of daily living. Children were taught techniques of cognitive restructuring, thought stopping, distraction, relaxation, and self-reward. Additionally, they kept daily pain and sleep diaries. Children completed questionnaires of pre- and post-treatment measuring physical status and psychological functioning. RESULTS: Following CBT, children reported significant reductions (p < .006) in pain, somatic symptoms, anxiety, and fatigue, as well as improvements in sleep quality. Additionally, children reported improved functional ability and had fewer school absences. CONCLUSION: Children with fibromyalgia can be taught CBT strategies that help them effectively manage this chronic and disabling musculoskeletal pain disorder.

Adolescent↗
PubMed1997

Impact of comorbid oppositional or conduct problems on attention-deficit hyperactivity disorder.

OBJECTIVE: To investigate whether the presence of comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) alters the correlates of attention-deficit hyperactivity disorder (ADHD). METHOD: Three groups of children (33 "pure" ADHD, 46 ADHD + ODD, and 12 ADHD + CD) were compared on measures of ADHD, aggression, anxiety, parental psychopathology, self-esteem, school, and social-emotional functioning. RESULTS: Findings indicated that the presence of comorbid oppositional or conduct problems in children with ADHD altered the correlates of ADHD across a number of areas, including greater ADHD symptom severity and social dysfunction. Nevertheless, some correlates were more closely linked with the comorbid condition of ADHD + CD (e.g., higher aggression, anxiety, and maternal pathology, as well as decreased self-esteem), while others appeared more closely linked with ADHD + ODD (e.g., social withdrawal, elevated academic achievement paired with higher perceived scholastic competence). CONCLUSIONS: Findings support the distinctive profiles of the disruptive behavior disorder groups and emphasize the deleterious effects on the quality of life experienced by the comorbid conditions. The need for syndrome-specific interventions is stressed.

Achievement↗
PubMed2002

Prevalence and description of selective mutism in a school-based sample.

OBJECTIVE: To examine the prevalence of selective mutism (SM) in a public school sample and compare the functioning and symptoms of children with SM to age- and gender-matched unaffected children. METHOD: Kindergarten, first, and second grade teachers in a large district were asked to identify pupils who met DSM-IV criteria for SM and to complete ratings of speaking behavior, social anxiety, other internalizing and externalizing symptoms, and overall functioning for these and comparison youngsters. Teachers completed the same ratings on the SM children 6 months later. RESULTS: A participation rate of 94% (125 of 133 teachers) was obtained, and the prevalence of SM was .71% (16/2,256). Measures were completed for 12 (75%) of 16 identified children. Compared with peers, children with SM were more symptomatic on measures of frequency of speech, social anxiety, and other internalizing symptoms. As a group, children with SM had improved 6 months later but remained impaired and symptomatic when compared with the comparison group. CONCLUSIONS: SM may not be as rare as previously thought. The functioning of children with SM is impaired, and although there is some improvement over time, notable impairment remains, suggesting that intervention is preferable to waiting for SM to remit spontaneously.

Child↗
PubMed2006

ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis.

Vaginal symptoms are common in the general population and are one of the most frequent reasons for patient visits to obstetrician-gynecologists. Vaginitis may have important consequences in terms of discomfort and pain, days lost from school or work, and sexual functioning and self image. Vaginitis is associated with sexually transmitted diseases and other infections of the female genital tract, including human immunodeficiency virus (HIV), as well as adverse reproductive outcomes in pregnant and nonpregnant women. Treatment usually is directed to the specific cause of vaginal symptoms, which most commonly include bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. The purpose of this document is to provide information about the diagnosis and treatment of vaginitis.

Anti-Infective Agents↗