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PubMed2004

[Ten years after German unification--current behavioural and emotional problems of adolescents in Germany].

Internalizing and externalizing problems based on Youth Self-Report (YSR) were investigated in an empirical sample of 371 students at the age of 13 until 18 years from common secondary and vocational schools in Rostock (Mecklenburg-Western Pomerania) in 2000/2001. Considering syndromes in comparison with other german and international empirical studies, internalizing and externalizing problems show high prevalence for both girls and boys. Nearly every fifth student judges themselves as within clinical range for psychiatric problems. Girls reported significant more internalizing problems (social withdrawal, somatic complaints, anxious/depressed). An interaction effect by age and sex for aggressive and delinquent behaviour was found with highest prevalence for boys at age 15/16. The frequency of internalizing problems and attention problems increases with adolescent's age. Low adolescent's education level, parental divorce and big size of siblings were associated with externalizing problems, whereas unemployment of the father was associated with depressive and social problems. Delinquent behaviour and attention problems are the most important predictors for negative school outcome like comparatively bad school achievement and low reading ability. The results suppose a possible increase in psychosocial problems of juvenile persons in eastern Germany one decade after German Unification, indicated the necessity of higher supply for preventive and therapeutic programs.

Adolescent↗
PubMed2002

Treatment of ADHD in neurofibromatosis type 1.

Forty-six of 93 children with neurofibromatosis type 1 (NF1) were found to satisfy the diagnostic criteria for attention-deficit-hyperactivity disorder (ADHD). Detailed comparisons were made among 20 children with NF1 and ADHD (12 males, 8 females; mean age 10.7 years, SD 2.2), 26 control children with NF1 (15 males, 11 females; mean age 11.3 years, SD 2.3), 14 control children with ADHD (7 males; mean age 9.9 years, SD 1.9), and 14 normally developing control children (7 males; mean age 11.2 years, SD 2.8). Children with NF1 and ADHD had the lowest IQ scores among the four groups. Test of Variables of Attention (TOVA) scores were poorer in the NF1-ADHD and ADHD control groups than in the two non-ADHD groups. Those with NF1 and ADHD were rated significantly poorer on the Child Behavior Checklist (CBCL) than were the NF1 control group. By administrating low doses (5 to 15 mg) of methylphenidate to the NF1-ADHD group, significantly improved TOVA scores were obtained. One-year follow-up yielded significantly improved CBCL scores. Our results show a high incidence of ADHD in NF1 and support an association between ADHD and learning and social problems in children with NF1. It was demonstrated that stimulant medication can lead to improvement in cognitive, academic, and social problems of children with NF1 and ADHD.

Attention↗
PubMed2004

To have but one true friend: implications for practice of research on alcohol use disorders and social network.

Although social networks play an integral role in the recognition and resolution of drinking problems, social network influences may be positive, negative, or mixed. The author reviewed empirical literature on positive and negative aspects of the structure of problem drinkers' social networks, the impact of the social network on problem recognition, social network predictors of treatment outcomes, treatments that involve the social network in treatment, and posttreatment changes in social network structure and functioning. Future directions for research and clinical implications of research findings are discussed.

Alcohol-Related Disorders↗
PubMed2001

Dopamine agonists for cocaine dependence.

BACKGROUND: Cocaine is a major drug of abuse. Cocaine dependence is a common and serious condition, which has become nowadays a substantial public health problem. There is a wide and well documented range of consequences associated to chronic use of this drug, such as medical, psychological and social problems, including the spread of infectious diseases (e.g. AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. Therapeutic management of the cocaine addicts includes an initial period of abstinence from the drug. During this phase the subjects may experience, besides the intense craving for cocaine, symptoms such as depression, fatigue, irritability, anorexia, and sleep disturbances. It was demonstrated that the acute use of cocaine may enhance dopamine transmission and chronically it decreases dopamine concentrations in the brain. Pharmacological treatment that affects dopamine could theoretically reduce these symptoms and contribute to a more successful therapeutic approach. OBJECTIVES: To evaluate the efficacy and acceptability of dopamine agonists for treating cocaine dependence. SEARCH STRATEGY: We searched: The Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (from 1966 - 2000), EMBASE (from 1980 - 2000), LILACS (from 1982 - 2000), PsycLIT (from 1974 - 2000), Biological Abstracts (1982 to 2000). Reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of cocaine dependence. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of dopamine agonists on the treatment of cocaine dependence. Trials including patients with additional diagnosis such as opiate dependence were also eligible. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated. The reviewers assumed that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. MAIN RESULTS: Twelve studies were included, with 587 participants randomised. Amantadine and Bromocriptine were compared to placebo in most of trials. In two studies amantadine was directly compared to bromocriptine, while amantadine was compared to desipramine, an antidepressant in three. The main efficacy outcome presented was positive urine sample for cocaine metabolites, with no significant differences between interventions. When retention in treatment was assessed as an acceptability measure, it was found a similar rate of patients remaining in treatment in both placebo and active drugs. There were no significant differences in trials where participants had primary cocaine dependence or had additional diagnosis of opioid dependence and/or were in methadone maintenance treatment. REVIEWER'S CONCLUSIONS: Current evidence does not support the clinical use of dopamine agonists in the treatment of cocaine dependence. Given the high rate of dropouts in this population, clinicians may consider adding psychotherapeutic supportive measures aiming to keep patients in treatment.

Amantadine↗
PubMed2003

A controlled longitudinal study of the social functioning of children who completed treatment of cancer.

BACKGROUND: A follow-up assessment of social functioning was performed for children with cancer after completion of treatment. It was hypothesized that children who completed cancer treatment (CCT) would have more social problems than their peers who were not chronically ill (COMP) and that greater treatment intensity would be predictive of increasing social difficulties over time. PATIENTS AND METHODS: Peer, teacher, and self-reports of social functioning were obtained from 69 CCTs and 77 COMPs. Social reputation and social acceptance were evaluated cross-sectionally and longitudinally. RESULTS: Relative to COMPs, CCTs described themselves as more prosocial, were perceived by teachers as less aggressive, and were seen by peers as more sick, more tired, and as missing more school. Longitudinal analyses indicated that self-reported prosocial scores were significantly more stable over time for CCTs relative to COMPs. Children who received more intense treatment were perceived by peers as more prosocial and less aggressive, but as having fewer best friends 2 years after treatment ended. CONCLUSIONS: CCTs had minimal impact on their social functioning as a result of their experience with cancer for those children who have returned to school. These results suggest that routine interventions with regard to social functioning after treatment ends may not be warranted for most CCTs when an integrated program of psychosocial services coordinated by mental health professionals has been provided during treatment. However, children who have undergone especially intense treatment may be at some risk for social problems.

Adolescent↗
PubMedDate not supplied

Effects of treatment history and centralized intake on drug treatment outcomes.

This study assesses differences between first-time treatment clients (n=90) and repeat treatment clients (n=361), including whether entering treatment through a central intake unit affects outcomes differently for the two groups. Interview data were collected at baseline, one-month and 12-month follow-up. Study groups were similar in gender, race and age, but repeat treatment participants were more educated, more likely to primarily use heroin and more likely to have ever injected drugs. First-time treatment clients were more likely to have been required to enter treatment, but less likely to have applied to another program or to be in the program they desired. First-time treatment clients were also more likely to be in outpatient or day treatment, and less likely to be in residential treatment. Problem severity decreased for both groups over time, with no significant differences between groups. There was one significant interaction effect of study group and length of stay on social problem severity, such that longer stays in treatment led to a greater reduction in social problems for repeat treatment clients. Route of treatment entry (CIU/non-CIU) was not associated with problem severity nor change in problem severity over time for either study group.

Adult↗
PubMed1980

[The treatment of Dupuytren's contracture. A social medical problem (author's transl)].

After a brief description of the characteristics of Dupuytren's disease the operative and conservative therapeutic measures are examined from both clinical and social medical aspects. It is shown in 154 patients with Dupuytren's contracture of the hands in various stages that an advance of this disease could usually be prevented by treatment with soft X-rays. A comparison of costs shows that this therapy is at least 11 times cheaper than a good operative procedure without follow-up treatment. For the patient it is highly important that only little time is lost in the outpatient compared with inpatient treatment. Loss of work-place, professional incapacity or inability to work because of Dupuytren's disease can be prevented with a probability bordering on certainty.

Disability Evaluation↗
PubMed1998

A comprehensive approach to premenstrual complaints.

BACKGROUND: General practice is characterised by its person-centred approach. It crosses the boundaries of all the medical disciplines as well as the boundary between medical and social problems. Family physicians are committed to dealing with whatever problem the patient presents. This is particularly relevant when women present with premenstrual complaints, since most do not have PMS as defined by researchers. Many have problems external to the menstrual cycle contributing to symptoms. Detection of these external factors, be they intercurrent medical, psychiatric or social problems, frequently determines treatment. OBJECTIVE: To describe a simple model of premenstrual complaints which includes all women who present in this way, in order ot inform GPs of the common patterns of illness in this group and provide them with a systematic approach to management. DISCUSSION: The model contains up to four levels of activity which may contribute to the complaint. These are: 1. menstrual cycle physiology--resulting in cyclical changes in mood, breast and bloating 2. intercurrent pathology (comorbidity)--gynaecological, psychiatric and medical 3. the social context of marital, family and work relationships, cultural influences 4. interpretation (attribution)--the meaning attached to the experience of the first 3 factors.

Adult↗
PubMed1986

Legislative and educational alternatives to a judicial remedy for the transfer trauma dilemma.

Transfer trauma is alleged to be an increase in morbidity and mortality in institutionally relocated chronically ill elderly. Efforts by the legal profession to persuade courts that transfer trauma should be a legally recognized phenomenon invoking judicial protections against transfer (the "transfer trauma argument") have been unproductive. In O'Bannon v. Town Court Nursing Center, Inc., the United States Supreme Court denied standing to elderly persons claiming a property interest in remaining in alleged substandard facilities. The Court rejected the argument that the possibility of transfer trauma constituted a deprivation of life or liberty that would have required due process protections of notice and hearing. Despite the Court's preclusion of transfer trauma litigation in a constitutional context and the general unwillingness of lower courts to recognize the phenomenon, attorneys continue to burden the judicial system with frivolous transfer trauma arguments. The unfruitful pursuit of a judicial remedy for the ethical and social problems that arise with relocation of the elderly continues, in part, because of a misguided belief that this distressing social phenomenon is best remedied by the courts. Judicial unwillingness to recognize the transfer trauma argument, however, does not preclude legislative consideration of the humanitarian issues concerning the institutional relocation of elderly persons. This Article examines gerontological research in order to understand the judicial rejection of the transfer trauma argument and argues in support of legislative and educational solutions for the ethical and social problems attending transfer.

Aged↗