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PubMed1995

Development of a measure to assess the perceived illness experience after treatment for cancer.

The development of a scale to measure perceived illness experience in young people with cancer is described. Areas of concern were first identified through semistructured interviews conducted with children and adolescents. As a result, 78 items were generated to cover the main areas identified (physical appearance, interference with activity, peer rejection, integration in school, manipulation, parental behaviour, disclosure, preoccupation with illness, and impact of treatment). These items were rated (on five point scales) by 41 patients (mean age 14.6 years) and 35 of their parents. Measures of physical functioning (symptoms, functional disability, and restrictions) and psychological functioning (symptoms) were included for validation purposes. Test-retest reliability was calculated on the basis of ratings made by a subsample of parents on two separate occasions. A 34 item scale was constructed with four items in each of the areas identified above, except for physical appearance (n = 2). The scale has adequate internal reliability and validity. There were significant correlations between parents and their children on all subscales except for illness disclosure and impact of treatment, suggesting that parents may be less reliable informants for their children in these contexts. The scale has potential use in clinical contexts, in evaluating the psychosocial impact of different treatment regimens, and as an outcome measure in intervention work.

Adolescent↗
PubMed2006

Signs of resilience in sexually abused adolescent girls in the foster care system.

In a sample of 99 sexually abused adolescent girls in the foster care system (64% in congregate living situations and 36% in family/foster care homes), nearly half were psychologically functioning well despite having experienced moderate-to-severe emotional, physical, and sexual abuse. It was hypothesized that these girls with resilient trajectories would differ from the currently symptomatic girls on several protective factors: education, future orientation, family support, peer influence, and religion. The results revealed that the girls with resilient trajectories were significantly more certain of their educational plans and optimistic about their future and had more positive peer influences.

Adaptation, Psychological↗
PubMed1998

The role of veterinary research laboratories in the provision of veterinary services.

Veterinary research laboratories play an essential role in the provision of veterinary services in most countries. These laboratories are the source of new knowledge, innovative ideas and improved technology for the surveillance, prevention and control of animal diseases. In addition, many laboratories provide diagnostic and other services. To ensure the optimal integration of various veterinary activities, administrators must understand the functions and constraints of research laboratories. Therefore, a brief discussion is presented of the following: organisational structures methods for developing research programmes outputs of research scientists and how these are measured the management of quality assurance funding of research. Optimal collaboration can only be attained by understanding the environment in which a research scientist functions and the motivational issues at stake.

Animals↗
PubMed2003

The role of peroxisome proliferator-activated receptor gamma in colon cancer and inflammatory bowel disease.

OBJECTIVE: Review the role and therapeutic potential of peroxisome proliferator-activated receptor (PPAR) gamma in colonic disorders. DATA SOURCES: Recent peer-reviewed scientific literature focusing on PPAR gamma in the colon. STUDY SELECTION: Research reports using animal models, cultured cell lines, and clinical material were examined for content related to the role of PPAR gamma in normal colon cell function, colon cancer, and inflammatory bowel disease. Issues concerned with potential therapeutic use were also considered. DATA SYNTHESIS: Key points pertaining to PPAR function and involvement in colon pathology were extracted and noted. Potential compromises to therapeutic utility are identified. CONCLUSIONS: The emerging important role of PPAR gamma in normal tissue homeostasis and pathologic outcomes suggests this receptor is a good candidate as a drug target. Several potential problems with this approach will require further investigation prior to widespread recommendations for modulation of PPAR as an efficacious therapy for cancer, chemoprevention of colon cancer, or treatment of inflammatory bowel disease. The widespread use of PPAR gamma ligands for management of type 2 diabetes (such as the glitazone class of drugs including rosiglitazone and pioglitazone) may provide a fortuitous assessment of the efficacy of long-term PPAR modulation.

Animals↗
PubMed2001

Social roles as mechanisms for psychological need satisfaction within social groups.

The authors explored ways in which needs for autonomy and relatedness can be simultaneously met within the context of group life. Specifically, it was hypothesized that social role performances provide means of both expressing the self and connecting with group members. Consistent with the assumption that autonomy and relatedness are complementary rather than conflictual, these needs were positively correlated in all 5 studies. Consistent with the authors' assumption that these needs are both important, feelings of autonomy and relatedness in social roles independently predicted subjective well-being, as measured by concurrent (Studies I and 3), peer-report (Study 2). and longitudinal (Studies 4 and 5) methodologies. Study 5 showed that participants whose characteristics matched an assigned role experienced more autonomy and relatedness and thus more positive mood during a group task. Implications for optimal functioning in group contexts are discussed.

Adult↗
PubMed1976

Evaluation of the normal range of values for uptake of radioactive iodine by the thyroid gland.

Uptake of radioactive iodine by the thyroid gland after oral administration of 75 muCi was determined in 1971-72 in 60 euthyroid female volunteers from the North Shore of Vancouver. Values were as low as 3% at 4 hours and 7% at 24 hours in subjects otherwise proven to be euthyroid. The highest values found were 13 and 26% at 4 and 24 hours. The effective thyroxine ratios were all within the accepted normal range. However, more than half of the volunteers showed some enlargement of the thyroid gland. These results suggest an increased iodine pool in the subjects, the likley source being iodine in mild, dairy products and erythrosine, a colouring agent in foods and pharmaceutical products. Potassium iodate, used sometimes in bread baking, contributed little to this pool in our sample. Subjects were, on the average, 9 to 25% heavier than their peers 20 years ago.

Adult↗
PubMed2006

Social adjustment of children with cerebral palsy in mainstream classes: peer perception.

The aim of this study was to describe the social experience of children with cerebral palsy (CP) in mainstream classes in Canada and compare it with that of their classmates without disability. The CP group included 25 females and 35 males (mean age 10 y 5 mo [SD 0.95], range 10 y 4 mo-10 y 10 mo) diagnosed as having hemiplegia (n=44) or diplegia (n=16) and classified as Level I on the Gross Motor Function Classification System (GMFCS). Fifty-seven comparison children, born at term and without any motor and/or sensory impairment, were recruited from the classes of the children with CP during a school visit (mean age 10 y 3 mo, [SD 1.0], range 10 y-10 y 6 mo). They were matched to children with CP for sex, age, parents' education level, and family income. Social adjustment measures (social status, reciprocated friendships, social isolation, aggression, sociability/leadership, and verbal and/or physical victimization) were obtained by conducting a class-wide sociometric interview (n=943) in the classes of the children with CP. Findings showed that children with CP (specifically females with CP and irrespective of their type of disability) had fewer reciprocated friendships, exhibited fewer sociable/leadership behaviours, and were more isolated and victimized by their peers than their classmates without a disability. This seems to suggest that females and males with CP are perceived differently from their peers in a mainstreaming context. The discussion addresses the issue of age- and sex-related differences and provides avenues of intervention relating to personal and environmental factors that could facilitate or interfere with the social experience of children with CP in a mainstream environment.

Cerebral Palsy↗
PubMed1988

Dyadic peer interaction and task orientation in attention-deficit-disordered children.

A sequential observational approach was used to compare peer interactions in 10 mixed dyads of ADD-H and non-Add-H boys and 10 dyads of non-ADD-H boys in laboratory cooperative and school classroom task analogue activities. Mixed dyads were found to have a greater frequency of aggression and less joint activity than control dyads in specific situations. No differences were found for measures of functional attention as measured by frequency, duration, and mean duration of task-oriented behavior. Lag sequential analyses revealed two major sequences that differentiated mixed from normal dyads. These were Verbal Reciprocity (a measure of reciprocal verbal interaction) and Retreat (a measure of social withdrawal following aggression).

Aggression↗
PubMed2001

Patterns of intellectual development among survivors of pediatric medulloblastoma: a longitudinal analysis.

PURPOSE: To examine two competing hypotheses relating to intellectual loss among children treated for medulloblastoma (MB): Children with MB either: (1) lose previously learned skills and information; or (2) acquire new skills and information but at a rate slower than expected compared with healthy same-age peers. PATIENTS AND METHODS: Forty-four pediatric MB patients were evaluated who were treated with postoperative radiation therapy (XRT) with or without chemotherapy. After completion of XRT, a total of 150 examinations were conducted by use of the child version of the Wechsler Intelligence SCALES: These evaluations provided a measure of intellectual functioning called the estimated full-scale intelligence quotient (FSIQ). Changes in patient performance corrected for age (scaled scores) as well as the uncorrected performance (raw scores) were analyzed. RESULTS: At the time of the most recent examination, the obtained mean estimated FSIQ of 83.57 was more than one SD below expected population norms. A significant decline in cognitive performance during the time since XRT was demonstrated, with a mean loss of 2.55 estimated FSIQ points per year (P =.0001). An analysis for the basis of the intelligence quotient (IQ) loss revealed that subtest raw score values increased significantly over time since XRT, but the rate of increase was less than normally expected, which resulted in decreased IQ scores. CONCLUSION: These results support the hypothesis that MB patients demonstrate a decline in IQ values because of an inability to acquire new skills and information at a rate comparable to their healthy same-age peers, as opposed to a loss of previously acquired information and skills.

Adolescent↗
PubMed1999

Helping others helps oneself: response shift effects in peer support.

The present work explores the impact of helping others on the physical and psychosocial well-being of the provider. Lay people were trained to listen actively and to provide compassionate, unconditional positive regard to others with the same chronic disease. The recipients of the peer support intervention were participants of a psychosocial randomized trial, whereas the peer supporters were study personnel and were therefore not randomized. We describe a secondary analysis of a randomized trial to explore the impact of being a peer supporter on these lay people. Subjects were 132 people with multiple sclerosis, all of whom completed quality-of-life questionnaires 3 times over 2 years. A focus group was also implemented with the peer telephone supporters 3 years after completion of the randomized trial. Effect size was computed for each quality-of-life outcome, and the focus group discussion was content analyzed. We found that compared to supported patients, the peer telephone supporters: (1) reported more change in both positive and negative outcomes as compared to the supported patients and that the effect size of these changes tended to be larger (chi2 = 9.6, df = 4, p < 0.05) and (2) showed pronounced improvement on confidence, self-awareness, self-esteem, depression and role functioning. Content analysis revealed that the participants articulated a sense of dramatic change in their lives in terms of how they thought of themselves and in how they related to others. We conclude with a discussion of response shift, a mediator of adaptation to illness which involves shifting internal standards, values, and concept definitions of health and well-being. We suggest that a response shift may be induced by a therapeutic strategy involving the externalization and re-internalization of concern among physically ill patients.

Adaptation, Psychological↗
PubMedDate not supplied

The European Spanish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation of 2 health related quality of life instruments into the European Spanish language. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with Juvenile Idiopathic Arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from an underlying disease. The Spanish CHQ was fully validated with 3 forward and 3 backward translations, while the Spanish CHAQ, already published, was revalidated. A total of 149 subjects were enrolled: 80 patients with JIA (28% systemic arthritis, 34% polyarthritis, 17% extended oligoarthritis, and 21% persistent oligoarthritis) and 69 healthy children. The CHAQ appropriately distinguished healthy subjects from JIA patients, with those classified in the systemic arthritis, polyarthritis and extended oligoarthritis categories having a higher degree of disability and pain, as well as a lower overall well-being than their healthy peers. The CHQ was also able to discriminate healthy subjects from JIA patients, with those allocated in the systemic arthritis, polyarthritis and extended oligoarthritis categories having a lower physical and psychosocial well-being than their healthy counterparts. In conclusion, the European Spanish version of the CHAQ-CHQ is a reliable and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Adolescent↗
PubMedDate not supplied

Biomedicine's electronic publishing paradigm shift: copyright policy and PubMed Central.

Biomedical publishing stands at a crossroads. The traditional print, peer-reviewed, subscription journal has served science well but is now being called into question. Because of spiraling print journal costs and the worldwide acceptance of the Internet as a valid publication medium, there is a compelling opportunity to re-examine our current paradigm and future options. This report illustrates the conflicts and restrictions inherent in the current publishing model and examines how the single act of permitting authors to retain copyright of their scholarly manuscripts may preserve the quality-control function of the current journal system while allowing PubMed Central, the Internet archiving system recently proposed by the director of the National Institutes of Health, to simplify and liberate access to the world's biomedical literature.

Authorship↗
PubMed1996

Youth with chronic conditions and their transition to adulthood. Findings from a Finnish cohort study.

OBJECTIVE: To explore the effect of chronic health conditions in adolescence on eventual transitional paths and young adult functioning in a cohort of Finnish youths. DESIGN: Survey in school at age 16 years followed by postal questionnaire at age 22 years. METHODS: Youths who had reported persistent chronic conditions at ages 16 and 22 years were compared with peers without chronic health conditions, using two-way analysis of variance for continuous outcomes and logistic regression models for dichotomous outcomes, adjusting for socioeconomic differences. MAIN OUTCOME MEASURES: Health status, chronic conditions, personal characteristics (including self-esteem), health behavior, education, family background, personal relations, and depression. RESULTS: Adolescents with chronic health conditions attained levels of psychosocial well-being, education, and marriage or dating as young adults similar to their peers without chronic conditions. Most of them experienced a successful transition to adulthood. Females with chronic conditions were more likely than women without chronic conditions to have moved away from their family of origin and to be living with a spouse or steady partner. Our findings also suggest that males with chronic conditions from white-collar family backgrounds may be at increased risk for symptoms of depression in early adulthood. Youths with chronic conditions had similar rates of nicotine and alcohol consumption as their healthy peers. CONCLUSION: Our findings suggest that in this cohort, most adolescents with common chronic conditions had a successful transition to adulthood.

Adolescent↗
PubMed1988

Competence and stress in school children: the moderating effects of individual and family qualities.

This study examined the associations of stress exposure to various aspects of school-based competence in a normative sample of 205 children aged 8-13. Potential moderators of these relations, including child attributes of sex and IQ and environmental attributes of socioeconomic status (SES) and family qualities, were also studied. Stress exposure was indexed by a life event questionnaire. Competence was assessed by teacher ratings, peer assessments and school record data. Family attributes were derived from a set of rating scales completed by interviewers after 6 hours of interviews with a parent. Results suggest that the relations of stress exposure to competence vary as a function of individual differences as well as the competence criterion. Disadvantaged children, with lower IQ and SES, and less positive family qualities, were generally less competent and more likely to be disruptive at high stress levels. Advantaged children were more competent, and with stress positively engaged in school, but were not likely to be disruptive. Boys were less socially competent than girls and, when stress was high, appeared to be less protected by positive family qualities. Causal hypotheses for future research in this area are discussed.

Achievement↗
PubMed1988

Evaluation of the contribution of clinical pharmacists: inpatient care and cost reduction.

Clinical pharmacists in this study hospital reported 1027 interventions in patient drug therapy over two time periods of three and two weeks, respectively. These interventions were subjected to self and peer reviews and to cost-avoidance evaluation. The most frequent type of intervention was recommendations related to drug selection (29.6 percent). Recommendations were not implemented by physicians in only 10.2 percent of the cases. The perceived impact of these interventions on the quality, cost, or both was found by the peer reviewers to occur in 58.5, 16.1 and 25.6 percent of the cases, respectively. Also, when peer reviewed for clinical significance, 983 of these interventions were judged to improve drug therapy to an acceptable level based on the professional literature, and 36 were deemed very significant in terms of saving patients' lives or preserving major organ functions. Of the 983 interventions rendering drug therapy to an appropriate level, 398 were deemed to have cost-avoidance impact; of this number a 25 percent random sample was subjected to cost-avoidance evaluation. Realized cost-avoidance averaged $242 for each intervention implemented. When extrapolated annually, $364,900 was the net realized cost-avoidance after discounting for the cost of providing clinical pharmacy services. An average cost-avoidance of $860.50 was calculated for each intervention made by pharmacists, but not followed by physicians, for an annual potential cost-avoidance of $532,650. In all, clinical pharmacists had the potential to save $897,550 annually in hospital resources if all their interventions had been accepted and implemented.

Cost Control↗
PubMedDate not supplied

[Profile and specialization of the chief of emergency medical services].

The specific task of emergency medicine consists of the limitation of mortality and morbidity caused by the repercussion on vital system functioning of acute illness and trauma. This task has to be realized within a structure including the mobile emergency care system and the emergency department. The chief of such a structure has to be a medical doctor. It will be a full-time job, since continuity of service is essential. Emergency medicine is closely related to intensive care, together indicated in the USA as 'critical care medicine'. Nevertheless important differences are obvious, due to the fact that in emergency medicine diagnosis is as important as supportive therapy, while it functions within a specific structure and is handling an as well qualitatively as quantitatively uncontrollable workload. As far, chiefs of emergency departments became experts through self-study and attending postgraduate teaching sessions, as well as through learning from their peers, but the expertise required by the chief of emergency medicine will in the future make a specific curriculum indispensable.

Curriculum↗
PubMed2005

Antenatal glucocorticoids increase early total thyroxine levels in premature infants.

BACKGROUND: Hypothyroxinemia is associated with adverse neonatal outcomes including white matter damage, cerebral palsy, poor neurodevelopment and death. It has become increasingly important to understand the natural history and modifiers of thyroid function in the premature infant. It is standard obstetrical practice to offer antenatal glucocorticoids to pregnant women with threatened preterm delivery. Few studies have investigated the effect of antenatal glucocorticoids on neonatal thyroid function. OBJECTIVE: To examine the association between antenatal exposure to glucocorticoids and early total thyroxine (T4) levels among extremely premature infants. METHODS: We studied 521 infants born at 4 medical centers. Entry criteria included a gestational age of 23-28 weeks and a serum thyroxine level obtained in the first postnatal week. Receipt of antenatal glucocorticoids was recorded as none, partial, or complete. A complete course consisted of two doses of betamethasone or four doses of dexamethasone within a 48-hour period between 2 and 7 days of delivery. Early total T4 levels were obtained from state-mandated newborn screening programs. RESULTS: Controlling for potential maternal, perinatal and neonatal confounding variables, infants exposed to a complete course of antenatal glucocorticoids had total T4 levels 0.8 microg/dl higher than their peers who were not exposed to a complete course of antenatal glucocorticoids (p = 0.03). CONCLUSIONS: Extremely premature infants who received a complete course of antenatal glucocorticoids had significantly higher total thyroxine levels in the first postnatal week. Maternal, perinatal, and early neonatal variables did not completely explain this association. We speculate that antenatal glucocorticoids influence early neonatal thyroid function.

Adult↗