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PubMed1992

Smoking education and prevention: a developmental model.

A developmental approach to smoking education and prevention for children and adolescents is proposed. Literature is reviewed concerning the most appropriate agent, content, and presentation, of anti-smoking education for each of three age groups: children to age ten, pre/early adolescents eleven to fifteen, and adolescents fifteen to eighteen. For children to age ten, it is suggested that parents are the best agents of education, with teachers, peers, and the mass media, also playing some role. For pre/early adolescents, peers are suggested as the best agents of education, building onto the earlier and ongoing work of the agents mentioned above. For adolescents, the role of the media hero-figure is discussed. It is emphasized that sources of influence may function additively in affecting the child or adolescent's decisions about smoking, and that education in each stage must build on the stage before.

Adolescent↗
PubMed2005

A review of pharmacologic strategies for switching to atypical antipsychotics.

BACKGROUND: In daily clinical practice, frequent switching of antipsychotic medications is widespread. There are various reasons for switching, including a partial or complete lack of efficacy, adverse side effects, and partial or noncompliance with medication. Patients switched from conventional drugs to oral atypical antipsychotic drugs have been shown to benefit from significant improvements in clinical response and tolerability. This review examines the strategies for switching patients from conventional antipsychotic drugs to both oral and long-acting formulations of atypical antipsychotic drugs that are the recommended treatment in the majority of patients with schizophrenia. DATA SOURCES AND STUDY SELECTION: An electronic literature search of relevant studies using MEDLINE (January 1994-June 2004) was performed using the search terms antipsychotic, atypical, conventional, schizophrenia, and switching. English-language articles, references from bibliographies of reviews, original research articles, and other articles of interest were reviewed. DATA EXTRACTION AND SYNTHESIS: Data quality was determined by publication in the peer-reviewed literature and the most important information identified. Data from clinical trials suggest that switching to an atypical antipsychotic drug is beneficial for the patient with schizophrenia. CONCLUSIONS: If initiated appropriately, switching to atypical antipsychotic medications should not compromise patient functioning; indeed, individualized strategies have been shown to provide continuous treatment efficacy. Switching to atypical antipsychotic therapy should, therefore, be employed as a pharmacologic strategy to maximize patient outcomes.

Journal Article↗
PubMed2000

Interventions to enhance social competence.

Social Impairment associated with attention deficit/hyperactivity disorder (ADHD) is difficult to treat. Stimulant treatment often improves social functioning, but rarely results in normalization. Behavioral approaches to improving social skills have progressed from unimodal techniques (contingency management) to packages that may combine multiple cognitive and behavioral techniques targeted directly to children and mediated by parents, teachers, other adults, and peers. Medication and behavioral treatment may improve different aspects of social impairment and may complement each other when used together. Much of the progress of treating social problems can be attributed to efforts to increase generalization across settings and durability of effects. A promising multimodal psychosocial approach is presented in detail.

Adult↗
PubMed1987

Short stature and pubertal delay in cystic fibrosis.

Survival of the patient with cystic fibrosis has been considerably extended in the last two decades due to improved therapy of pulmonary infection, nutritional management, and an organized system of centralized care. Psychological and social aspects of cystic fibrosis may be intensified during adolescence: developing independence in the face of required daily care; developing self-esteem in the face of illness-associated problems such as discolored teeth, malabsorption, short stature, and cough; and participating in group activities despite physical limitations and the disruption in peer relationships when recurrent acute illness is interposed. Pubertal delay is more common in the cystic fibrosis population than the general population, and attendant psychologic dysfunction may be particularly common in males. Comparative studies suggest that this pubertal delay is a function of malnutrition rather than intrinsic to the disease. Normal growth potential may be postulated from somatomedin studies and has been demonstrated in patients treated with long-term aggressive nutritional management. Intervention utilizing testosterone enanthate in males with cystic fibrosis and pubertal delay has resulted in improved rate of growth, progression through puberty, and self-image.

Adolescent↗
PubMed1980

Infant amputees: early growth and care.

Limb-deficient children are more like their physically normal peers than like children with other kinds of physical differences or adult amputees. The therapist working with these children should foster their normal development, and be guided by the child's needs and interests when intervention is necessary. Children who have functional upper extremities can and should lead virtually normal lives. Those who have severe upper limb deficiencies may always be dependent on others for help in certain activities. Prosthetic restoration usually, but not alway, effective in improving the amputee's functional abilities. Prostheses are not actual replacements for real limbs, but usually restore considerable function to the amputee. The amputee is the best judge of whether prosthetic restoration is beneficial to him. In working with limb-deficient children, the author has discovered that for them, less (treatment) is more. The author would also suggest that the practice of minimal intervention has more applications in rehabilitation medicine, and desrves further exploration.

Amputees↗
PubMed2003

[Evaluation of health-related quality of life in dialysis patients. Personal experience using questionnaire SF-36].

INTRODUCTION: Patients' perception of health is an important outcome measure in the assessment of influence of chronic disease and received treatment. The purpose of this study was: 1) to investigate the relation between selected demographic and clinical characteristics and Health-related Quality of Life (HRQoL) scores in patients with end-stage renal disease (ESRD) who receive dialysis, 2) to compare HRQoL in dialysis patients with their peers from the control group, 3) to evaluate the usefulness of SF-36 questionnaire. MATERIAL AND METHODS: We evaluated Health-Realated Quality of Life (HRQoL) of dialysis patients by the Polish version of the Short Form 36 Items Health Survey (SF-36). The SF-36 consists of eight scales: physical functioning (PF), social functioning (SF), role limitation attributable to physical problems (RP), role limitation attributable to emotional problems (RE), mental health (MH), vitality (VT), bodily pain (BP) and general health perception (GH). This study included 97 patients (44 men and 53 women), aged 28-86 years (mean age: 57.2) treated with HD (n = 77) and CAPD (n = 20) for 3-245 months (mean: 61 months). We compared the results with the data obtained from 217 healthy control subjects (105 men and 112 women), aged 20-92 years (mean age 51.1). The patients were divided into four age-groups and compared with the appropriate groups of controls. RESULTS: The perception of health of dialysis patients was worse than that of controls. We have found, that in the group aged over 65 years patients' scores were quite close to those of the control population. Our results show the following patient-connected factors to be independently associated with quality of life (QoL): age, sex, occupation, level of education, family situation and comorbidities. On average, females reported lower scores; the impact of ageing was more evident in physical scales. CONCLUSIONS: 1) age, sex, occupation, level of education, family situation as well as comorbidities are independent factors of HRQoL, 2) subjective QoL of elderly patients seems acceptable in comparison with healthier peers, 3) the SF-36 questionnaire is applicable in dialysis patients and SF-36 scores are related to important clinical aspects.

Adult↗
PubMed1998

Cognitive functioning and the inhibition of alcohol-induced aggression.

OBJECTIVE: A highly replicable research finding is that alcohol intoxication tends to induce aggressive responding. Recent research investigating the role of cognitive function in this relationship has shown that individuals who perform poorly on certain cognitive tasks have difficulty responding to contingencies to inhibit aggression, while high performers do not. High performers, however, do show increased aggression while intoxicated. This study investigated whether subjects with above average cognitive functioning would, when intoxicated, inhibit aggression in order to attain monetary reward. METHOD: Men (N = 43), aged 18-30, selected on the basis of high performance on a neuropsychological test putatively assessing function of dorsolateral prefrontal cortex, the spatial conditional associative learning task, participated in a modified version of the Taylor Aggression Task. Half the subjects were acutely alcohol intoxicated, the other half were sober. Furthermore, half the subjects in each of these groups received contingent monetary reward for choosing lower shocks. Aggression was defined as shock intensity delivered to a sham opponent. RESULTS: Contrary to the hypothesis, intoxicated subjects, even though significantly impaired cognitively relative to their nonintoxicated peers (F = 4.29, 1/41 df, p < .05), appeared to have no difficulty inhibiting their aggression in order to gain monetary reward. That is, there was no difference between intoxicated and nonintoxicated subjects on the dependent variable, shock intensity, when contingent money was available (F = .01, 1/20 df, p = .935). CONCLUSION: This finding provides further evidence that alcohol-induced aggression is not a uniform phenomenon, and it suggests a neuropsychological mechanism that may mediate the relationship. It may be that individuals with above average cognitive abilities retain sufficient residual functioning to inhibit aggressive responding, even when acutely alcohol intoxicated.

Adult↗
PubMed1998

A retrospective study of two-stage treatment outcomes assessed with two modified PAR indices.

This retrospective study was undertaken to evaluate the long-term outcome of two-stage (functional/fixed) Class II treatment. A modified peer assessment rating (PAR) was applied to the records of 27 patients who had been recalled an average of 9 years after the completion of the second phase of treatment. UK and US weightings were applied. Analysis of variance identified significant differences among treatment stages. The greatest change in PAR score occurred during the first (functional) phase of treatment. By the end of the second phase, there had been an 83% reduction in PAR score. At recall, however, the PAR scores had increased significantly, due largely to relapse in overjet and in the lower labial segment. These results call into question the ultimate utility of early, two-stage treatment regimens. Although the differences between the UK and USA weightings were smaller than anticipated, the nature of the relapse seen here argues against the American exclusion of the lower labial segment.

Adult↗
PubMed2002

Heart rate and walking velocity during independent walking in children with low and midlumbar myelomeningocele.

PURPOSE: The purpose of this study was to examine the heart rate and walking velocity of children with low and midlumbar myelomeningocele (MMC) using two types of orthoses. METHODS: Eight children with low and midlumbar myelomeningocele (mean age = 10.7 years) participated in the study. A clinical examination of muscle strength in the lower limbs was performed, and level of functional ambulation was defined. Weight and height were documented, and body mass index was calculated. Heart rate was recorded by a transmitter detecting heart beats, and walking time was registered as the children walked as far as possible along a straight corridor of 102 meters at a self-selected velocity. Two orthosis types were tested, each three times. RESULTS: All children showed higher heart rate than peers who were nondisabled. No steady-state heart rate level that could be used as a basis for calculating physiological cost index was achieved in any subject. In this study group, no difference was seen in heart rate trends with respect to the two tested orthoses. The children who were household ambulators, all with weaker hip abductors and hip extensors, walked with lower velocity than those who were community ambulators (all with stronger hip muscles). The children in the former group also walked significantly shorter distances, however, with similar heart rate. CONCLUSIONS: Pausing when the heart rate reaches a strenuous activity level is interpreted as a solution to maintain functional walking by keeping the heart rate and thus the energy expenditure at a comfortable level.

Journal Article↗
PubMed1996

A quantitative map of nucleotide substitution rates in bacterial rRNA.

A recently developed method for estimating the variability of nucleotide sites in a sequence alignment [Van de Peer, Y., Van der Auwera, G. and De Wachter, R. (1996) J. Mol. Evol. 42, 201-210] was applied to bacterial 16S, 5S and 23S rRNAs. In this method, the variability of each nucleotide site is defined as its evolutionary rate relative to the average evolutionary rate of all the nucleotide sites of the molecule. Spectra of evolutionary rates were calculated for each rRNA and show the fastest evolving sites substituting at rates more than 1000 times that of the slowest ones. Variability maps are presented for each rRNA, consisting of secondary structure models where the variability of each nucleotide site is indicated by means of a colored dot. The maps can be interpreted in terms of higher order structure, function and evolution of the molecules and facilitate the selection of areas suitable for the design of PCR primers and hybridization probes. Variability measurement is also important for the precise estimation of evolutionary distances and the inference of phylogenetic trees.

Biological Evolution↗
PubMed2004

Intravenous immunoglobulin in autoimmune neuromuscular diseases.

CONTEXT: Intravenous immunoglobulin (IVIG) enhances immune homeostasis by modulating expression and function of Fc receptors, interfering with activation of complement and production of cytokines, providing anti-idiotypic antibodies, and affecting the activation and effector functions of T and B cells. These mechanisms may explain the effectiveness of IVIG in autoimmune neuromuscular disorders. OBJECTIVE: To systematically review the current status of the treatment of autoimmune neuromuscular diseases with IVIG, with emphasis on controlled trials. DATA SOURCES: Peer-reviewed publications identified through MEDLINE (1966-2003), EMBASE (1974-2003), and references from bibliographies of pertinent articles. Each autoimmune neuromuscular disease term was searched in combination with the term intravenous immunoglobulin. STUDY SELECTION AND DATA EXTRACTION: Criteria for selection of studies included controlled study design, English language, and clinical pertinence. Data quality was based on venue of publication and relevance to clinical care. DATA SYNTHESIS: Outcomes of controlled trials indicate that IVIG at a total dose of 2 g/kg is effective as first-line therapy in Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy and as second-line therapy in stiff-person syndrome, dermatomyositis, myasthenia gravis, and Lambert-Eaton myasthenic syndrome. In other controlled studies, IVIG produced a modest, variable, and transient but not statistically significant benefit in patients with inclusion body myositis and paraproteinemic anti-myelin-associated glycoprotein antibody demyelinating polyneuropathy. Intravenous immunoglobulin is not effective in patients with multiple sclerosis who have established weakness or optic neuritis. In myasthenia gravis, it should be reserved for difficult cases or before thymectomy in lieu of plasma exchange. CONCLUSION: Intravenous immunoglobulin is effective in many autoimmune neurologic diseases, but its spectrum of efficacy, especially as first-line therapy, and the appropriate dose for long-term maintenance therapy are not fully established. Further controlled studies of IVIG, combined with a dose-finding effect, pharmacoeconomics, and quality-of-life assessments, are warranted to improve the evidence base for clinical practice.

Autoimmune Diseases of the Nervous System↗
PubMed2006

State-dependent regulation of cortical activity by cortisol: an EEG study.

In the present study we investigated the effects of cortisol administration on EEG activity in eight healthy volunteers. We administered 35 mg of cortisol in a within-subjects double-blind placebo-controlled design. Cortisol administration caused a global decrease in cortical activity except for an increase frontally at the left, resulting in a significant change in frontal asymmetry. This pattern of results is almost the exact mirror image of one of our previous studies. Comparing subjective activation measures from the present and previous study showed that activation was substantially higher in the present study that was performed in formal testing conditions involving venipuncture, compared to the previous EEG study that was performed in non-formal testing conditions. However, the direction of the present cortisolinduced change in frontal activity asymmetry is consistent with the cortisolinduced change in asymmetric rotation behavior that we recently reported in similar testing conditions. We also found indications that, in contrast to the effects on the EEG measures, effects of cortisol administration on subjective anxiety and plasma oxytocin levels may be sex-dependent. These results are preliminary because of the post-hoc nature and the small number of subjects in the present study. However, they are in line with recent findings by others, suggesting that the effects of cortisol on cortical activity and subjective activation are state dependent and are influenced by testing conditions.

Adrenocorticotropic Hormone↗
PubMed2005

Intervention studies for caregivers of stroke survivors: a critical review.

The objective of this review was to evaluate the effectiveness of different types of intervention programs for caregivers of stroke patients. A systematic search using Medline, PsychINFO, AMED and CINAHL till March 2003 was carried out and 22 studies were identified. Four types of support programs could be studied: providing specialist services, (psycho)education, counselling and social support by peers. Many different outcome domains and a variety of measures were used. Ten studies reported positive results on one or more outcome domains: reduction of depression (two studies) and burden (one), improvement of knowledge on stroke (five), satisfaction with care (one), family functioning (one), quality of life (three), problem solving skills (two), social activities (two), and social support (one). Three studies reported a negative result on caregiver outcome. We could not identify sufficient evidence to confirm the efficacy of interventions but counselling programs (3 out of 4) appear to have the most positive outcome.

Activities of Daily Living↗
PubMed2006

Respiratory muscle training in persons with spinal cord injury: a systematic review.

The purpose of this paper was to review the effectiveness of respiratory muscle training (RMT) on respiratory muscle strength and endurance, pulmonary function, quality of life, respiratory complications and exercise performance in persons with spinal cord injury. A MEDLINE (National Library of Medicine, Bethesda, MD, USA) database was used for selection of the literature (from 1980 to November 2004), and relevant references from peer-reviewed articles were retrieved as well. Studies investigating the effects of RMT (i.e. resistive breathing weight lifting or normocapnic hyperpnea) in persons with spinal cord injury were selected. Two independent reviewers investigated controlled studies for methodological quality by using a modification of the framework for methodological quality. Methodological quality ranged between 15 and 29 (maximal feasible score=40). Twenty-three papers were retrieved and six controlled trials were kept for further analysis. A meta-analysis and calculation of effect-size of each individual study and weighted summary effect-size was intended. However, unreported data and heterogeneity in outcome variables did not allow performing a meta-analysis. From the systematic review it is concluded that RMT tended to improve expiratory muscle strength, vital capacity and residual volume. Insufficient data was available to make conclusions concerning the effects on inspiratory muscle strength, respiratory muscle endurance, quality of life, exercise performance and respiratory complications.

Exercise Therapy↗
PubMed1995

Predicting serious delinquency and substance use among aggressive boys.

Early aggressive behavior puts boys at increased risk for involvement in a variety of later problem behaviors, including delinquency and drug abuse. However, not all boys who evidence aggressive behavior in childhood continue to engage in problem behaviors in adolescence. This 3.5-year prospective study examined the role of factors hypothesized by the social development model to inhibit or increase the likelihood of subsequent involvement in serious delinquency and substance use within a sample of boys identified as aggressive by teacher report at ages 10 and 11. At ages 12 and 13, a combination of the constructs of skills for prosocial involvement, school bonding and achievement, family bonding and management practices, norms against substance use, and interaction with peers and adults involved in antisocial behavior significantly discriminated between boys who were and were not involved in serious delinquent behavior and substance use at ages 13 and 14, although family bonding and management practices appeared to contribute little to the discriminant function. Implications of the results for preventive interventions with aggressive boys are discussed.

Adolescent↗
PubMed2002

Human non-synonymous SNPs: server and survey.

Human single nucleotide polymorphisms (SNPs) represent the most frequent type of human population DNA variation. One of the main goals of SNP research is to understand the genetics of the human phenotype variation and especially the genetic basis of human complex diseases. Non-synonymous coding SNPs (nsSNPs) comprise a group of SNPs that, together with SNPs in regulatory regions, are believed to have the highest impact on phenotype. Here we present a World Wide Web server to predict the effect of an nsSNP on protein structure and function. The prediction method enabled analysis of the publicly available SNP database HGVbase, which gave rise to a dataset of nsSNPs with predicted functionality. The dataset was further used to compare the effect of various structural and functional characteristics of amino acid substitutions responsible for phenotypic display of nsSNPs. We also studied the dependence of selective pressure on the structural and functional properties of proteins. We found that in our dataset the selection pressure against deleterious SNPs depends on the molecular function of the protein, although it is insensitive to several other protein features considered. The strongest selective pressure was detected for proteins involved in transcription regulation.

Databases, Genetic↗
PubMed1993

Social Adjustment Inventory for Children and Adolescents: concurrent validity in ADHD children.

OBJECTIVE: The assessment of children's adaptive functioning has broad-range implications for clinical practice, research, and public health, and relatively few well-developed assessment instruments are available. The validity of the Social Adjustment Inventory for Children and Adolescents (SAICA), a semistructured interview schedule that assesses adaptive functioning in children and adolescents, was examined. METHOD: Two groups of index children were examined: 140 attention-deficit hyperactivity disorder (ADHD) children (both psychiatric and pediatric referrals) and 120 normal comparisons. RESULTS: Concurrent validity was found for the SAICA in its significant association with the social competence scales of the Child Behavior Checklist and DSM-III-R's Global Assessment of Functioning. It was also found that among ADHD children, psychiatric comorbidity conferred an increased risk for worse adaptive functioning. CONCLUSIONS: These findings suggest the SAICA is an effective way to assess adaptive functioning. Moreover, its ability to discriminate ADHD from control children and its association with psychiatric comorbidity indicate the SAICA measures adaptive functioning within a range relevant for studies of psychopathology.

Adolescent↗
PubMed1981

The assessment of continuing medical education.

There is a close link between audit of clinical competence and audit of continuing medical education. Some of the earlier assumptions about the organisation of continuing medical education need to be reviewed. The increasing provision of resources for continuing medical education by the NHS means that added safeguards are necessary to ensure that professional standards are not subordinated to service exigencies. The introduction of higher educational methodology into continuing medical education should be critically examined with awareness of the limitations and controversies concerning many methods of teaching and assessing educational outcome. The methodology of higher education may need to be substantially modified to suit the uniqueness of the clinical process and the problems of altering the behaviour of experienced and practising doctors. Criticism of behaviourist educational methods should be based on an understanding and knowledge of these methods. A new functional clinical educational domain is proposed which links educational methods with the clinical application of new learning.

Clinical Competence↗