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PubMed2006

A qualitative examination of the relationships that serve a mentoring function for Mexican American older adolescents.

This exploratory study was an in-depth examination of Mexican American adolescents' relationships with nonparental adults. Qualitative interviews with 10 Mexican American adolescents revealed 23 nonparental adults who served a mentoring function in their lives. Six of these nonparental adults were also interviewed. Data analyses were conducted using a grounded theory approach so that the relationships were described in participants' words and experiences. The nonparental adults identified by adolescents included siblings, extended family members, older peers, and institutional figures. The support provided took many different forms, from emotional to informational/experiential support, to modeling behavior, for example. Further, adolescents were supported in eight different areas of their lives. Participants also discussed the perceived benefits of these relationships for adolescents. Future research directions and implications for youth programming are discussed.

Adolescent↗
PubMedDate not supplied

Some evidence for distinctive language use by children with Attention Deficit Hyperactivity Disorder.

This paper reports early findings from a wider study that sought to test the hypothesis that differences in language use exist between children who have a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and their non-ADHD peers. Twenty-two, 8 to 12 year-old children (11 with a diagnosis of ADHD and 11 matched peers) comprised the community-based sample. There were nine boys and two girls in each group. All the children were ranked at least average for their language ability on standardised language testing. This case-control study used an approach derived from Systemic Functional Linguistics (SFL) to examine and then compare spoken and written elicited language samples. SFL was thought to be particularly suitable because of its potential to richly describe language in use while taking contextual variation into account. Statistically significant overall differences between the subject and the control groups were found for the measure of grammatical intricacy (GI). Further analyses revealed these differences to be largely attributed to differences between group scores for written material. Discussion explores the potential relevance of these findings to the clinical evaluation of language ability in young school-aged children who have been diagnosed with ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

A model for management of delirious postacute care patients.

Although delirium has been shown to be a common, morbid, and costly problem for hospitalized older people, evidence has mounted that it may persist for weeks or months. Therefore, concern about delirium can no longer be confined to acute care. After an acute hospitalization, many older people are discharged to postacute care (PAC) facilities--rehabilitation hospitals and skilled nursing facilities. Although several models designed to prevent delirium in the hospital setting have been described, there have been few such efforts in the PAC setting. This article describes the development of a multifactorial delirium abatement program (DAP), a new model of care for older patients admitted to the postacute skilled nursing facility with delirium. The DAP is a nurse-led, unit-based intervention. The program consists of four modules based on best practices as defined by the peer-reviewed literature: standardized screening for symptoms and signs of delirium upon admission to the PAC unit, assessment and treatment of possible causes of and contributors to delirium, prevention and management of common delirium complications, and restoration of patient cognitive and self-care function. This article also presents the process of facility introduction, staff education on DAP content, and multidisciplinary outreach. Key strategies for DAP implementation are reviewed. Program adoption challenges and corresponding model refinements to enhance adherence and overall care quality are highlighted. Last, clinical adaptation of this research-derived program is discussed.

Aged↗
PubMed1997

Two families with autosomal recessive spastic paraplegia, pigmented maculopathy, and dementia.

OBJECTIVE: Two families with autosomal recessive hereditary spastic paraplegia and pigmented maculopathy are described. METHODS: All family members were examined by two neurologists. An assessment of cognitive function in affected members was made using the mini mental state examination (MMSE) or Cambridge cognitive examination (CAMCOG). RESULTS: Six patients from two families presented with a slowly progressive, autosomal recessive, spastic tetraplegia. Although they were always considered to be intellectually slower than their peers, further intellectual deterioration was noted during the second decade. Five had a pigmented maculopathy with mild decrease in visual acuity and all had distal amyotrophy, mild cerebellar signs, and developed faecal and urinary incontinence late in the course of the disease. CONCLUSION: The association of hereditary spastic paraplegia and pigmented maculopathy has rarely been described; only 11 families with 32 affected members have been reported, showing considerable heterogeneity in presentation. These described conditions may be allelic or more probably reflect mutations at different genetic loci.

Adult↗
PubMed1992

Environmental and personality differences between children of alcoholics and their peers.

Nonclinical, adolescent children of alcoholics (COAs) and their peers from nonalcoholic homes (CONAs) responded to questionnaires of environmental variables, depression, and anxiety. Multivariate (discriminant) analyses revealed several meaningful differences between the two groups. Although the two groups differed on the measures of anxiety and depression, environmental stressors contributed most to the discriminant function that differentiated between the two groups. Also, gender differences were discovered, suggesting that males and females perceive problem drinking differently and that home environments may be different for the two genders. Implications for research and intervention are discussed.

Adolescent↗
PubMed1980

Comparison of the effects of theophylline, prednisolone and sleep withdrawal on airway obstruction and urinary cyclic AMP/cyclic GMP excretion of asthmatic children with and without nocturnal asthma.

Asthmatic children suffering from nocturnal asthmatic paroxysms showed not only a reduced peak exspiratory flow rate (PEER) but also a diminished excretion of cyclic AMP (cAMP) at night. In contrast, in asthmatic children without nocturnal asthmatic attacks, neither in PEFR nor in cAMP excretion did a circadian rhythm occur. Prednisolone, theophylline, and sleep withdrawal were able to reestablish normal airway function and cAMP excretion in those patients with nocturnal bronchoconstriction. Cyclic GMP (cGMP), which has been suggested as a mediator for cholinergic mechanisms, shows the exact opposite behavior of that of cAMP. In children suffering from nocturnal asthmatic attacks, cGMP increases during the night, whereas under sleep withdrawal it decreases. Hence we propose that a reduced responsiveness of beta-adrenergic receptors as well as an increased cholinergic activity are due to nocturnal asthmatic attacks. Therapeutic interventions taking the form of increasing cAMP or decreasing cGMP levels may thus be most helpful in treating nocturnal asthma.

Adolescent↗
PubMed1982

The irresponsible expert witness: a failure of biomedical graduate education and professional accountability.

Many forces have created the epidemic of negligence and malpractice litigation. One of the contributing factors to the rising rate of nonmeritorious litigation is the increasing number of unequalified and irresponsible expert witnesses. The high remuneration has attracted physician-scientists who are unaware of the proper role of an expert witness. They are frequently manipulated by the attorneys and function as partisans rather than scholars. The role of the expert witness should be taught in medical and graduate school. Testimony should be taught in medical and graduate school. Testimony should be treated as a scholarly endeavor and experts should be encouraged to seek peer review of their opinions and not to testify secretly and in isolation. It is suggested that greater visibility of experts and their testimony (light of day phenomenon) should raise the quality of expert witness testimony and encourage more qualified experts to participate as expert witnesses, thus removing the stigmata usually associated with unqualified expert witnesses.

Adult↗
PubMed2002

Social and political factors influencing the functioning of regional health boards in British Columbia (Canada).

Health reform is associated with changes in the way the health system works and in the roles of major stakeholders, such as governments, health professionals, and the lay public. This paper reviews the immediate relevance of these social and political elements to health boards, particularly those with lay board members; source documents include peer-reviewed articles, and government documents and news releases in Canada especially. Also presented are the perceptions of 130 regional health board members in British Columbia (BC), Canada, who responded to our 1996 survey questionnaire. Two sets of social and political factors are identified and discussed in this paper. The first set deals with the composition of health board members (qualifications, representation, and selection). Our findings suggest that there is now less attention focusing on the composition of health boards in BC. This may contribute to a re-focusing of attention on the boards' effectiveness in working with stakeholders and in influencing the health system. The other set of social and political factors deals with the relations of health boards with key stakeholder groups. The responses to our questionnaire suggest that the health boards in BC may have had some success in addressing the concerns of various stakeholder groups. However, the respondents also suggested that the stakeholder groups needed to be more understanding and involved in the regionalization (decentralization) process. Health boards that have lay representatives, including regional health authorities in Canada, face similar social and political factors immediate to their operation.

British Columbia↗
PubMed2003

Concepts of self-rated health: specifying the gender difference in mortality risk.

PURPOSE: This study addresses the question of how the relation between self-rated health (SRH) and mortality differs between genders. In addition to the general question, four specific concepts of SRH are distinguished: SRH in comparison with age peers, SRH in comparison with one's own health 10 years ago, and current and future health perceptions. For these concepts, the gender-specific risks of mortality were evaluated for a short and a longer follow-up period. DESIGN AND METHODS: Baseline and mortality data from the Longitudinal Aging Study Amsterdam (N = 1917, initial ages 55-85 years) were used. Mortality risks were evaluated in Cox regression models at 3 and 7.5 years of follow-up, both adjusted for age and for sociodemographic characteristics, indicators of functional and mental health, lifestyle, and social involvement. All SRH measures were scaled from 1 (positive) to 5 (negative). RESULTS: Baseline correlations between SRH concepts were similar for men and women. After 3 years, 12% of the men and 7% of the women had died; after 7.5 years, these percentages were 27 and 15, respectively. In fully adjusted models, current health perceptions predicted 3-year mortality in men (risk ratio of 1.33). At 7.5 years, mortality in men was predicted by current health perceptions and by SRH compared with age peers (risk ratios of 1.25 and 1.23, respectively). In women, no SRH concept predicted either 3-year or 7.5-year mortality. IMPLICATIONS: SRH was a predictor of mortality only in men, not in women. The gender difference showed most clearly at longer follow-up, in the SRH concept "comparison with age peers."

Age Distribution↗
PubMed1986

Moderate-intensity physical activity and cardiovascular risk factors: the Stanford Five-City Project.

There is evidence that low to moderate levels of physical activity can reduce risk of cardiovascular disease, even though they do not produce substantial changes in cardiorespiratory function. In this study of a representative population sample of 5,930 adult men and women, participants in moderate-intensity activities, such as walking and climbing stairs, were compared with nonparticipants. Men and women who reported more moderate activities were less overweight than sedentary peers. Moderate activity was associated with more risk factor benefits in men than in women. The apparent health benefits of moderate-intensity physical activity have implications for public health education.

Adult↗
PubMed1997

Capitation. Theory, practice, and evaluating rates for gastroenterology.

Capitation risk contracting has the potential to combine insurance functions with medical care functions. Success depends on a careful consideration of the capitation rate and a thorough understanding of all capitation contract issues. Proper incentives to physicians in a specialty network stimulate a major reengineering effort to squeeze the inefficiency out of the system. Within the network, true peer review can effectively diminish variability in medical care. Such variability leads to increased cost without benefit to health status. The superior medical management of a capitated specialty network can create added value by coordinating more cost-effective and appropriate evaluation and therapy.

Capitation Fee↗
PubMed2003

Pompe disease and physical disability.

This study describes the physical disability of 30 children and adolescents with Pompe disease (23 males, 7 females; mean age 7 years 7 months, SD 5 years 6 months; range 6 months to 22 years 1 month) using a disease-specific functional instrument. Data were collected by telephone interview with parents using a modified version of the Pediatric Evaluation of Disability Inventory. The sample included mostly males of Caucasian origin, recruited from several countries. Disability profiles in mobility and self-care skills were heterogeneous because functional status was not related to chronological age. Most children had severe functional deficits: nearly two-thirds of the sample was non-ambulatory and could not perform age-expected self-care skills. Three-quarters of the children used a ventilator. Two children were able to participate in age-appropriate sports and peer activities. Although the mean chronological age of the sample was 7 years 7 months, the mean age-performance for self-care skills was under 2 years 6 months and under 1 year 6 months for mobility. Implications of physical disability findings for individuals with Pompe disease are discussed.

Adolescent↗
PubMed2003

Factors associated with volatile solvent use among junior high school students in Kanto, Japan.

AIMS: To estimate the relative association between life-time volatile solvent use and risk factors for usage. DESIGN: Cross-sectional anonymous questionnaire survey. SETTING: Junior high schools in Kanto, Japan. PARTICIPANTS: Junior high school students (n = 7744). MEASUREMENTS: Data on life-time and past-year solvent use, demographic variables, urbanization, regularity of waking patterns, school life, family life, peer relationships, prior alcohol and cigarette use and knowledge on harmful effects of solvent use. FINDINGS: Uni- and multivariate logistic regression analyses were conducted to estimate crude and adjusted odds ratios for each index. The primary findings were (1) 'smoking cigarettes nearly every day' (adjusted OR = 9.88, 95% Cl = 3.74, 26.12) and peer pressure measured by 'been tempted to use solvents' (adjusted OR = 9.53, 95% Cl = 4.84, 18.74) demonstrated the highest adjusted odds ratios; (2) being male (adjusted OR = 2.56, 95% Cl = 1.37, 4.76), seeing school life as 'not at all enjoyable' (adjusted OR = 2.69, 95% Cl = 1.03, 7.01) and family environment as 'neither good nor bad' (adjusted OR = 2.15, 95% Cl = 1.19, 3.88) also showed significant association; (3) life-time alcohol use did not show a significant association in the multivariate model (adjusted OR = 0.80, 95% Cl = 0.30, 2.12); and (4) solvent use appeared independent of knowledge regarding its effects ('death by acute intoxication', 'psychotic symptoms', 'amotivational syndrome', 'flashbacks' adjusted ORs all non-significant). CONCLUSION: Alcohol use may not function as a gateway to solvent use in Japan. The reasons may be culture-bound. A longitudinal study is required to test this hypothesis.

Adolescent↗
PubMed1976

The quandary of quality assessment.

Inevitably, quality assurance reflects the context of which it is a part (e.g., underuse or overuse of services is partly a function of their availability and financing). Thus, it can promote change or rationalize lack of it, save money or cost money. Given the current state of the art, it is imperative to develop quality assurance on an evolutionary path while options are kept open and focus is clearly on outcomes. Also, quality assessment must be conceptualized as a behavioral tool, not a policing mechanism; its scope must be broadened to include the total episode of illness, taking into account life-style and environmental factors, with criteria developed and applied as close to the point of patient care as possible, within broad guidelines; it is essential to build on in-place capacities -- e.g., carrier data -- rather than to create new overlapping systems. Finally, the management setting within which quality assurance functions, in both the public and private sectors, must be improved.

Community Participation↗
PubMed1987

Prolonged volume depletion imitating end-stage renal failure.

Four patients with chronic renal insufficiency were erroneously diagnosed as reaching the "end stage" of their disease. All of them had had insidious salt and water depletion prolonged over a period of 5 to 8 weeks. The correct diagnosis was missed because the signs and symptoms of slowly developing volume depletion were indistinguishable from the clinical picture of terminal uremia. Correction of the salt and water depletion was followed by marked clinical improvement and return of renal function to baseline values. Postural hypotension and hyponatremia are important clues for the diagnosis of insidiously developing mild or moderate volume depletion super-imposed on chronic renal insufficiency.

Aged↗
PubMed1993

Emotional reactions of children to war stress in Croatia.

OBJECTIVE: The main purpose of the research was to assess the emotional reaction of children exposed to different levels of war stress in Croatia. METHOD: Four hundred eighty children completed the Croatian version of the Child Depression Inventory (CDI) and the Mood Scale. Their parents and teachers also completed the analogue Mood Scale. RESULTS: Both groups, refugees and local children, showed more depressive symptoms on the CDI in comparison with the children of the same age assessed before the war in Croatia. Displaced children manifested more negative emotions (especially sadness and fear) than did their local peers, based on self-report as well as parents' and teachers' reports. Poor correlations were found between the children's self-report and their parents' and teachers' report on the Mood Scale. CONCLUSIONS: The war stress had a negative impact on the emotional functioning of all children, especially the refugees. The findings of parents' and teachers' knowledge about their children's mood, more obvious in the group of displaced children, deserve special attention because of the increased risk for the children. It is recommended that we consider working with the parents, not just children, in promoting children's mental health during times of stress.

Adaptation, Psychological↗
PubMed2006

Identification and analysis of evolutionarily cohesive functional modules in protein networks.

The increasing number of sequenced genomes makes it possible to infer the evolutionary history of functional modules, i.e., groups of proteins that contribute jointly to the same cellular function in a given species. Here we identify and analyze those prokaryotic functional modules, whose composition remains largely unchanged during evolution, and study their properties. Such "cohesive" modules have a large number of internal functional connections, encode genes that tend to be in close proximity in prokaryotic genomes, and correspond to physical complexes or complex functional systems like the flagellar apparatus. Cohesive modules are enriched in processes such as energy and amino acid metabolism, cell motility, and intracellular trafficking, or secretion. By grouping genes into modules we achieve a more precise estimate of their age and find that the young modules are often horizontally transferred between species and are enriched in functions involved in interactions with the environment, implying that they play an important role in the adaptation of species to new environments.

Computational Biology↗