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PubMed1991

Disability exaggeration as a predictor of functional restoration outcomes for patients with chronic low-back pain.

Many of the individual biological, psychological, and social factors attributed to low-back disability have been tested previously for their ability to predict treatment outcomes. To test the assumption that disability exaggeration affects treatment outcomes, models were developed to quantify this complex characteristic and to test its predictive value. Two hundred fifty-eight patients with chronic back disability entering a program of functional restoration were initially evaluated with a battery of tests, including measurements of trunk flexibility, lifting capacity, cycling endurance, self-assessments of pain and disability, and psychological attributes. On the basis of these measurements, patients were characterized as disability exaggerators if by peer comparison their self-assessments of pain and disability were in the most severe range despite high levels of physical capacity. Program completion and work status 1 and 2 years after treatment were compared between disability exaggerators and their peers. Individual initial attributes associated with program completion included pain intensity and Million Visual Analogue scores, lifting capacity, trunk flexibility, some Minnesota Multiphasic Personality Inventory and Million Behavioral Health Inventory scales, and cigarette smoking. One-year re-employment was associated with Minnesota Multiphasic Personality Inventory Scale 8, Wechsler Adult Intelligence Score-Revised, and cycling endurance. There were no significant associations between any individual factor and 2-year work status. Only two of the 12 disability exaggeration models distinguished between program graduates and dropouts, and none of the models accurately predicted return to work following treatment. Prescription of intensive multidisciplinary treatment should not be denied on the basis of any individual patient attribute or of disability exaggeration, as measured in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Associations between phenylalanine-to-tyrosine ratios and performance on tests of neuropsychological function in adolescents treated early and continuously for phenylketonuria.

Phenylketonuria (PKU) is a genetic disorder characterized by hyperphenylalaninemia. Treatment involves dietary phenylalanine restriction to prevent mental retardation. Because phenylalanine is involved in tyrosine synthesis and tyrosine is a catecholamine precursor, low tyrosine may lead to brain dopamine deficiencies. Because dopamine is involved in the modulation of prefrontally orchestrated executive functions, deficiencies may lead to executive impairments. Despite treatment, impairments in executive cognitive functions have been reported in young children with PKU. Outcome beyond middle childhood has not been extensively investigated. In this study, PKU-affected adolescents (N = 18) with normal-range IQ scores completed neuropsychological tests, and their performance was compared with unaffected peers (N = 16) and chronically ill controls (N = 17). Results demonstrated that the overall performance of the PKU group did not differ from that of the other two groups, but that performance of the PKU proband was associated with phenylalanine and tyrosine levels, and most strongly with phenylalanine-to-tyrosine ratios at several points in development. These findings provide a preliminary test of the dopamine hypothesis of PKU as it applies to adolescents and young adults.

Adolescent↗
PubMedDate not supplied

Development of the Nursing Outcome (NOC) label: hyperactivity level.

TOPIC: Hyperactivity, a persistent, severe pattern of inattention or impulsivity, places children at risk for impaired functioning in many developmental areas. This behavior is characterized by short attention span, low frustration tolerance, impulsivity, distractibility, and increased physical activity. Responses from multiple sources in the child's environment must be monitored to manage childhood hyperactivity. PURPOSE: Success at school, in peer relationships, and parent-child interactions is frequently affected by hyperactivity. Using a focus group approach, a Nursing Outcomes Classification (NOC) label, definition, and indicators were developed for Hyperactivity Level. SOURCES: Review of the literature allowed for a content analysis approach and conceptualization of hyperactivity at several levels. CONCLUSION: Twenty three (23) measurable indicators were formulated and refined into conceptually and clinically coherent outcomes. Clinical relevance and utility were presented through a case study approach.

Adaptation, Psychological↗
PubMed1978

Medial preoptic lesions and male sexual behavior: age and environmental interactions.

In all species studied, the medial preoptic area has been found to be necessary for male copulatory behavior. No recovery of sexual function from the medial preoptic area lesions appears to have been reported. This study demonstrates that rats with large lesions of the medial preoptic area exhibit adult male sexual behavior when the surgery is performed prepuberally and the rats have interacted socially with peers.

Animals↗
PubMed2005

Neuropsychological and educational problems at school age associated with neonatal encephalopathy.

BACKGROUND: Adverse cognitive and educational outcomes are often ascribed to perinatal hypoxia without good evidence. OBJECTIVE: To investigate neurocognitive and behavioural outcomes after neonatal encephalopathy. METHODS: Sixty five children with neonatal encephalopathy, identified using the Trent Neonatal Survey database for 1992-1994, were followed up at the age of 7 years. They were examined at school, with a classmate for those in mainstream school, by a paediatrician and a psychologist. Neonatal encephalopathy was graded as moderate or severe using published definitions. FINDINGS: Fifteen children had major disability, all with cerebral palsy; eight were in special school with severe cognitive impairment (IQ<55). Disability was present in 6% of the moderate and 42% of the severe encephalopathy group. Of the 50 children without motor disability, cognitive scores were lowest in the severe group (mean IQ difference from peers -11.3 points (95% confidence interval (CI) -19.0 to -3.6) and with similar scores for the moderate group compared with classmates (mean difference -1.7 points (95% CI -7.3 to +3.9). Neuropsychological testing showed similar findings in all domains. In particular, memory and attention/executive functions were impaired in the severe group. Despite relatively small differences in performance of the moderate group, special educational needs were identified more often in both encephalopathy groups, associated with lower achievement on national curriculum attainment targets. INTERPRETATION: After neonatal encephalopathy, subtle cognitive impairments are found in the absence of neuromotor impairment. Subtle impairments are found more commonly after a more severe clinical course. Studies of brain protection strategies require long term follow up to study effects on cognitive outcome.

Brain Diseases↗
PubMed2003

Investigations of protein structure and function using the scientific literature: an assignment for an undergraduate cell physiology course.

Undergraduate biology curricula are being modified to model and teach the activities of scientists better. The assignment described here, one that investigates protein structure and function, was designed for use in a sophomore-level cell physiology course at Earlham College. Students work in small groups to read and present in poster format on the content of a single research article reporting on the structure and/or function of a protein. Goals of the assignment include highlighting the interdependence of protein structure and function; asking students to review, integrate, and apply previously acquired knowledge; and helping students see protein structure/function in a context larger than cell physiology. The assignment also is designed to build skills in reading scientific literature, oral and written communication, and collaboration among peers. Assessment of student perceptions of the assignment in two separate offerings indicates that the project successfully achieves these goals. Data specifically show that students relied heavily on their peers to understand their article. The assignment was also shown to require students to read articles more carefully than previously. In addition, the data suggest that the assignment could be modified and used successfully in other courses and at other institutions.

Attitude↗
PubMed2005

Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation.

PURPOSE: To examine health-related quality of life (HRQOL) and growth, and spiritual well-being in adult survivors of hematopoietic stem-cell transplantation (HSCT) for a malignant disease. METHODS: HSCT survivors (n = 662) were recruited through the International Bone Marrow Transplant Registry/Autologous Blood and Marrow Transplant Registry and were drawn from 40 transplantation centers. HSCT survivors completed a telephone interview and a set of questionnaires a mean of 7.0 years post-HSCT (range, 1.8 to 22.6 years). Study measures included a variety of standardized measures of HRQOL and growth and spiritual well-being. An age- and sex-matched healthy comparison (HC) group (n = 158) was recruited using a peer nomination method. The HC group completed a parallel telephone interview and set of questionnaires. RESULTS: Multivariate analysis of variance analyses found the HSCT survivor group reported poorer status relative to the HC group for all HRQOL outcome clusters including physical health, physical functioning, social functioning, psychological adjustment, and dyadic adjustment. In contrast, the HSCT survivor group reported more psychological and interpersonal growth. Mean effect size for the 24 outcome indices examined was 0.36 standard deviations, an effect size often considered clinically meaningful or important. The largest group differences were found for measures of general health, physical function and well-being, depression, cognitive function, and fatigue. CONCLUSION: The experience of HSCT for a malignant disease has a wide-ranging, longstanding, and profound impact on adult recipients. Relative to healthy controls, HSCT survivors reported poorer physical, psychological, and social functioning but, conversely, more psychological and interpersonal growth, differences that appeared to persist many years after HSCT.

Adult↗
PubMed2005

Comparison of maximal oxygen consumption between obese black and white adolescents.

The purpose of this investigation was to determine whether maximal oxygen consumption (VO2max) differed between clinically obese black and white children and if a difference existed to determine whether it was related to hematological profiles and/or physical activity/inactivity levels. Twenty-three black and 21 white adolescents were matched for age, BMI, and Tanner stage (II-V). Body composition was determined by DEXA and CT scan. Daily physical activity/inactivity was assessed by questionnaire. VO2max was assessed using the Bruce treadmill protocol. Black participants had significantly lower VO2max and VO2maxFFM values when compared with white adolescents (26.1 +/- 4.2 versus 29.9 +/- 3.1 mL . kg(-1) . min(-1); 48.3 +/- 8.8 versus 55.6 +/- 5.2 mL . kgFFM(-1) . min(-1), respectively). Black adolescents also had significantly lower Hb concentrations ([Hb]) than white children (12.7 +/- 1.3 versus 13.4 +/- 0.7 g/dL). Black adolescents were more physically inactive than their white peers. VO2max correlated with [Hb] for the combined groups. Obese black adolescents had lower VO2max compared with white children and this difference was explained, in part, by the lower [Hb] observed in the black participants. Further investigations should study Hb flow rate (a function of [Hb] . maximal cardiac output) and physical activity/inactivity patterns in obese black and white children as it relates to VO2max.

Absorptiometry, Photon↗
PubMed1993

The educational structure and the self-image of Jamaican adolescents.

The Offer Self-image Questionnaire was used to assess the self-image of 141 Jamaican adolescents attending three types of secondary (High, Technical, and New Secondary) schools in Jamaica. Owing to the different status given each type of school, differences among students' self-perceptions were hypothesized as a function of the type of secondary school they attended. Analysis showed significant differences on dimensions of the self-image of Jamaican adolescents relative to the hierarchical status afforded their respective schools. Adolescents attending the more prestigious (High) schools scored significantly better than peers from the less prestigious Technical and New Secondary schools on eight self-image dimensions of impulse control, emotional tone, social relationships, morals, sexual attitudes, vocational and educational goals, emotional health, and superior adjustment. Students from Technical schools had significantly better adjustment scores than New Secondary students on social relationships, sexual attitudes, and emotional health. Results are discussed with regard to the Jamaican cultural, educational and economic setting. International implications are noted.

Adolescent↗
PubMedDate not supplied

The effects of Internet-based distance learning in nursing.

Distance learning has been the turning point for accomplishing adult learning in nursing education. This article describes the development and structure of a distance-learning course used to deliver distance learning to the RN-BSN students at Yonsei University, College of Nursing. The distance-learning course was developed cooperatively by content experts, instructional designers, programmers, and graphic designers. The course content, "Growth and Development", was a computerized instructional course delivered using the Internet. The programming system was developed on the Web Server and Oracle DB through the Internet. The characteristics of adult learners--graduates with 3-year RN diplomas and working full-time--were considered during development of the course. For a semester, the students studied the growth and development of a person from infancy to adolescence through interactions with peers and instructors using alternative menus on the Internet. The course was evaluated from feedback of 60 RN-BSN students on their satisfaction with this distance-learning course in regard to instructional design, the arrangement and structure of instruction, and the function and feasibility of the courseware. When the self-reported questionnaire with 25 open questions was evaluated, students' general responses were relatively positive. Insufficient feedback from the professor, excessive time and difficulties experienced when connecting to the Internet, and the lack of information about related websites were primary negative responses. For an effective use of the distance-learning system, improvements to the telecommunications network service are crucial. School authorities should support the professors who are interested in developing distance-learning courses so that the courses can be developed with technical perspectives. More distance-learning courses applying interactive multimedia instructional design through the Internet should be developed with the improved network service in the future.

Computer Systems↗
PubMed2006

Assessing and inducing neuroplasticity with transcranial magnetic stimulation and robotics for motor function.

OBJECTIVES: To describe 2 new ways of assessing and inducing neuroplasticity in the human brain--transcranial magnetic stimulation (TMS) and robotics--and to investigate and promote the recovery of motor function after brain damage. DATA SOURCES: We identified recent articles and books directly bearing on TMS and robotics. Articles using these tools for purposes other than rehabilitation were excluded. From these studies, we emphasize the methodologic and technical details of these tools as applicable for assessing and inducing plasticity. STUDY SELECTION: Because both tools have only recently been used for rehabilitation, the majority of the articles selected for this review have been published only within the last 10 years. DATA EXTRACTION: We used the PubMed and Compendex databases to find relevant peer-reviewed studies for this review. The studies were required to be relevant to rehabilitation and to use TMS or robotics methodologies. Guidelines were applied via independent extraction by multiple observers. DATA SYNTHESIS: Despite the limited amount of research using these procedures for assessing and inducing neuroplasticity, there is growing evidence that both TMS and robotics can be very effective, inexpensive, and convenient ways for assessing and inducing rehabilitation. Although TMS has primarily been used as an assessment tool for motor function, an increasing number of studies are using TMS as a tool to directly induce plasticity and improve motor function. Similarly, robotic devices have been used for rehabilitation because of their suitability for delivery of highly repeatable training. New directions in robotics-assisted rehabilitation are taking advantage of novel measurements that can be acquired via the devices, enabling unique methods of assessment of motor recovery. CONCLUSIONS: As refinements in technology and advances in our knowledge continue, TMS and robotics should play an increasing role in assessing and promoting the recovery of function. Ongoing and future studies combining TMS and robotics within the same populations may prove fruitful for a more detailed and comprehensive assessment of the central and peripheral changes in the nervous system during precisely induced recovery.

Brain Mapping↗
PubMed2006

AL-57, a ligand-mimetic antibody to integrin LFA-1, reveals chemokine-induced affinity up-regulation in lymphocytes.

Affinity of integrin lymphocyte function-associated antigen 1 (LFA-1) is enhanced by conformational changes from the low-affinity closed form to the high-affinity (HA) open form of the ligand-binding inserted (I) domain as shown by work with purified I domains. However, affinity up-regulation of LFA-1 on the cell surface by physiological agonists such as chemokines has yet to be demonstrated by monovalent reagents. We characterize a mAb, AL-57 (activated LFA-1 clone 57), that has been developed by phage display that selectively targets the HA open conformation of the LFA-1 I domain. AL-57 discriminates among low-affinity, intermediate-affinity, and HA states of LFA-1. Furthermore, AL-57 functions as a ligand mimetic that binds only upon activation and requires Mg2+ for binding. Compared with the natural ligand intercellular adhesion molecule-1, AL-57 shows a tighter binding to the open I domain and a 250-fold slower off rate. Monovalent Fab AL-57 demonstrates affinity increases on a subset (approximately 10%) of lymphocyte cell surface LFA-1 molecules upon stimulation with CXCL-12 (CXC chemokine ligand 12). Affinity up-regulation correlates with global conformational changes of LFA-1 to the extended form. Affinity increase stimulated by CXCL-12 is transient and peaks 2 to 5 min after stimulation.

Amino Acid Sequence↗
PubMed2005

Group balance skills class for people with chronic stroke: a case series.

BACKGROUND AND PURPOSE: A history of stroke increases risk of falls even years after stroke, and subsequent fear of falling causes individuals to reduce their activities. The purpose of this case series is to describe a group balance skills class for individuals poststroke living in the community, and to assess the feasibility and outcomes of this class. EXAMINATION AND INTERVENTION: Twice a week for 8 weeks, 4 individuals >6 months poststroke attended a group class designed to challenge their balance. The group was carried out under the supervision of one physical therapist assisted by physical therapy students. Changes in balance were measured using Berg Balance Scale (BBS), Performance Oriented Mobility Assessment (POMA), and a post-test questionnaire addressing changes in daily activities. OUTCOMES: Participants responses to the questionnaire and pretest/post-test differences in scores on BBS and POMA suggest trends towards improvement in balance. RELEVANCE: A group balance skills class for individuals who had a stroke >6 months ago appears feasible. Further research is needed to determine the effectiveness of this class for improving functional balance and decreasing incidence of falls.

Accidental Falls↗
PubMed1997

Interpersonal relationship and prisoner of war concerns of rated military male and female aircrew.

BACKGROUND: The issue of women flying military aircraft in a combat role has been very controversial. HYPOTHESIS: To succeed, female military aircrew are very similar to their male peers. METHODS: We conducted a comprehensive anonymous questionnaire survey of all U.S. Army and U.S. Air Force rated female aircrew, with an equal number of age and duty matched male aircrew. We are reporting on the interpersonal relationship and prisoner of war (P.O.W.) responses here. RESULTS: Male and female aircrew respond in a similar manner to posed questions, although differences do exist. Women reported: unequal treatment by opposite gender peers; problems relating to peers, superiors and subordinates; their gender influences assignments; the need to perform to higher standards and the need to work harder to be accepted as equals; ability to bond equally to their own and opposite gender peers; improved squadron cohesiveness in mixed gender squadrons; problems with peers' spouses; and, in a P.O.W. situation, fear of rape and sexual abuse. Men reported: women get inappropriate privileges and get special "breaks"; a gender difference in how flight duties are performed; worsened squadron cohesiveness in mixed gender squadrons; less likeliness to recommend their career path to their daughters; and a higher concern for welfare of families in a P.O.W. situation. CONCLUSIONS: Although responding in a similar manner to most questions, male and female military aircrew differ in the perception of their ability to function in mixed squadrons because of their gender. Some of these perceptions can be modified through training, others may need to be resolved through high level orders/policy; while in others, the military may have to accept women are different from men in some aspects.

Adult↗
PubMed1980

In vivo effects of peer modeling on drinking rate.

One female subject drank beer with four female confederate models and two participant observers in a small town tavern. A single subject repeated measures reversal design was used. Condition 1 indicated subject baseline drinking rate. For the first intervention one confederate modeled at a rate 50% less than the subject's baseline rate. Interventions II and III were identical to Intervention I except that two confederates modeled at a rate 50% less than the subject's baseline rate for Intervention II and four confederates modeled at a rate 50% less than the subject's baseline rate for Intervention III. Interventions were separated by returns to baseline. The study was concluded with a final return to baseline. There was no change in subject drinking rate as a function of either one or two confederates modeling the 50% rate. However, when four models drank at the lower rate, subject drinking rate matched that of the four confederate models. Implications and suggestions for further research on modeling are presented.

Adult↗
PubMed1990

Does neuropsychological test performance predict resumption of drinking in posttreatment alcoholics?

The prediction of resumption of drinking in posttreatment alcoholics was investigated as a function of five possible confounding variables: depression, anxiety, childhood symptoms of attention deficit and conduct disorders and family history of alcoholism. Male and female detoxified alcoholics (n = 103) in inpatient treatment programs were administered a neuropsychological battery and retested as outpatients 14 months later; peer nonalcoholics (n = 73), given the same battery, had a similar interest interval. Alcoholics who resumed drinking (N = 41) performed significantly poorer on an overall neuropsychological performance index than abstainers (N = 62) who performed significantly poorer than nonalcoholics. Stepwise multiple regression equations using the variables noted above revealed that depressive symptoms, ADD and the performance index were the only variables to enter the prediction (R2 = .26, p less than .001); depression accounted for most of the variance. At retest all three groups improved significantly, but not differentially, and were as significantly different at retest as at initial testing. Implications of these results are discussed.

Adult↗
PubMed2006

Adverse effects of childhood lead poisoning: the clinical neuropsychological perspective.

Elevated blood lead levels in children can result in brain injury and, as a consequence, have negative effects on cognitive functioning and behavior. Risk assessment studies have focused on psychological measures, especially IQ, and also school achievement and behavioral adjustment as endpoints. Such studies, like epidemiological work in other areas, by necessity examine effects in large groups rather than in individuals. Since the peer-reviewed literature primarily describes those adverse effects noted in epidemiological studies, little or no attention has been directed to what is observed in the individual. The present review describes the presentation of individual lead-poisoned children from the perspective of the clinical neuropsychologist. The sequelae of lead poisoning typically observed in evaluation of individuals provide information in addition to that gained from risk assessment studies and has implications for the mechanisms and treatment of this disease. In addition, attention to certain aspects of individual case presentation does provide information relevant to issues of public health.

Child↗
PubMed2002

Eating disorders in young women with type 1 diabetes mellitus.

Research findings from the past decade regarding the association of type 1 diabetes mellitus and eating disorders are critically reviewed in this paper. Although there has been much debate regarding the specificity of this association, a recent large multisite case-controlled study demonstrated that the prevalence rates of both full syndrome and subthreshold eating disorders among adolescent and young adult women with diabetes are twice as high as in their nondiabetic peers. Further, a 4-year follow-up study showed that disordered eating behavior in young women with diabetes often persists and is associated with a threefold increase in the risk of diabetic retinopathy. These eating disturbances tend to be associated with impaired family functioning and with poor diabetes management. Health care professionals should maintain a high index of suspicion for the presence of an eating disturbance among young women with diabetes, particularly among those with persistently poor metabolic control and/or weight and shape concerns. Screening for such disturbances should begin during the prepubertal period among girls with diabetes. A brief psychoeducational intervention leads to a reduction in disturbed eating attitudes and behavior but is not sufficient to improve metabolic control. More intensive treatment approaches, which should include a family-based component, may be needed to improve metabolic control. The evaluation of these and other treatment approaches is indicated in view of the serious short- and long-term health risks associated with eating disorders in young women with diabetes.

Adolescent↗