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PubMed2003

Recognition of expertise: an important concept in the acquisition of nephrology nursing expertise.

The present article, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept of recognition of expertise. The study used grounded theory methodology and involved 17 registered nurses who were practising in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participant observations and interviews. According to nurses in this study, patients, doctors and other nurses recognized that some nurses were experts while others were not. In addition, being trusted, being a role model and teaching others were important components of being recognized as an expert nephrology nurse. Of importance for nursing, the results of the present study indicate that knowledge and experience are not sufficient to ensure expert practice; recognition of expertise by others is an important function of expertise acquisition.

Attitude of Health Personnel↗
PubMed1996

Invasive pneumococcal infections in children infected with HIV are not associated with splenic dysfunction.

OBJECTIVES: Children infected with HIV-1 are more likely to acquire infections associated with the encapsulated bacterial pathogens of childhood than their non-HIV-infected peers. The goal of the current study was to determine what proportion of community-acquired, invasive pneumococcal disease in HIV-infected children could be attributed to splenic dysfunction, as measured by enumerating the number of pocked red blood cells (RBCs) in peripheral blood. METHODS: Splenic reticuloendothelial function was assessed semiquantitatively by examining the morphology of the RBCs of 84 children born to HIV-infected mothers using phase interference microscopy. Surveillance of medical records, and a review of the Yale-New Haven Hospital Clinical Microbiology computerized database, revealed that all of the bacterial cultures of blood and cerebrospinal fluid from these patients were positive. RESULTS: Of the 84 children assessed, 70 were infected with HIV (median age 66 months) and 14 were uninfected seroreverters (controls). Sixty-one of the 70 HIV-infected children met the CDC criteria for moderate or severe immunodeficiency and/or moderate or severe symptomatic conditions. Seventeen of the 70 HIV-infected children experienced 23 invasive bacterial infections. Streptococcus pneumoniae was responsible for all 23 infections. The median age at the time of first infection among these 17 subjects was 20 months (range, 10-58 months). There were no episodes of invasive bacterial infections in the remaining 53 HIV-infected children nor among the 14 controls. All 84 children studied, including those with invasive pneumococcal disease, had normal proportions (i.e., < 2%) of pocked erythrocytes in peripheral blood. CONCLUSION: Splenic dysfunction, as measured by the pocked RBC count, does not account for the increased occurrence of invasive pneumococcal disease found in children infected with HIV.

AIDS-Related Opportunistic Infections↗
PubMed2000

The low lumbar spine below Cotrel-Dubousset instrumentation: long-term findings.

STUDY DESIGN: Retrospective review of long instrumented fusions down to the low lumbar spine for the treatment of adolescent idiopathic scoliosis. OBJECTIVES: To evaluate whether the use of instrumentation systems that preserve the sagittal profile could reduce the incidence of early degenerative changes. SUMMARY OF BACKGROUND DATA: Long fusions and distractive Harrington instrumentation in the surgical treatment of adolescent idiopathic scoliosis (AIS) are known to produce pain and degenerative changes in the free lumbar segments. Reports on the use of Cotrel-Dubousett instrumentation (CDI) confirm that the instrumentation maintains physiologic lumbar lordosis, but the evolution of the spine below the fusion is not addressed. METHOD: Thirty-five patients with AIS and CDI were studied. Their spines were fused to L3 or lower, and they had a minimum follow-up of 10 years. Radiologic measurements were recorded from frontal and lateral radiographs. At the time of last examination, lateral flexion-extension dynamic radiographs and magnetic resonance imaging evaluated the health of the disks below the fusion. Clinical outcome was assessed with the Scoliosis Research Society instrument. A control group consisting of 35 peers without scoliosis served as a reference for the outcome questionnaire. RESULTS: Surgery kept the sagittal profile in a physiologic range. All but two patients were satisfied with the results of surgery. There were no differences between patients and control group insofar as pain, self-image, general function, and daily activity were concerned. Eleven patients showed instability signs in dynamic radiographs and more than half of patients showed incipient degeneration on magnetic resonance images. These findings are similar to those found in the general population, according to the literature, and could evidence normal aging processes. CONCLUSIONS: Cotrel-Dubousset instrumentation maintains the physiologic sagittal contour. Although there are some degenerative changes in magnetic resonance images and dynamic radiographs, the quality of life and daily activities of the patients after surgery are similar to those of a normal population of the same age.

Adolescent↗
PubMed2003

Pathogen-responsive expression of a putative ATP-binding cassette transporter gene conferring resistance to the diterpenoid sclareol is regulated by multiple defense signaling pathways in Arabidopsis.

The ATP-binding cassette (ABC) transporters are encoded by large gene families in plants. Although these proteins are potentially involved in a number of diverse plant processes, currently, very little is known about their actual functions. In this paper, through a cDNA microarray screening of anonymous cDNA clones from a subtractive library, we identified an Arabidopsis gene (AtPDR12) putatively encoding a member of the pleiotropic drug resistance (PDR) subfamily of ABC transporters. AtPDR12 displayed distinct induction profiles after inoculation of plants with compatible and incompatible fungal pathogens and treatments with salicylic acid, ethylene, or methyl jasmonate. Analysis of AtPDR12 expression in a number of Arabidopsis defense signaling mutants further revealed that salicylic acid accumulation, NPR1 function, and sensitivity to jasmonates and ethylene were all required for pathogen-responsive expression of AtPDR12. Germination assays using seeds from an AtPDR12 insertion line in the presence of sclareol resulted in lower germination rates and much stronger inhibition of root elongation in the AtPDR12 insertion line than in wild-type plants. These results suggest that AtPDR12 may be functionally related to the previously identified ABC transporters SpTUR2 and NpABC1, which transport sclareol. Our data also point to a potential role for terpenoids in the Arabidopsis defensive armory.

ATP-Binding Cassette Transporters↗
PubMed1997

Behavioural development in children of divorce and remarriage.

We employed an autoregressive modelling technique with data from the Québec Longitudinal Study to prospectively examine the developmental impact of family transition on behaviour while controlling for predivorce and preremarriage effects. Teachers rated children's anxious, hyperactive, physically aggressive, oppositional, and prosocial behaviour every 2 years from kindergarten through to the end of elementary school. Once individual and parental characteristics and antecedent family events were controlled, children who experienced parental divorce before age 6 exhibited comparatively more behavioural disturbance than their peers whose parents divorced later. With the exception of a protective effect on hyperactive behaviour, remarriage did not have a significant impact on children's behaviour when the legacy of divorce was controlled. Although the results suggest that children of divorced parents show difficulty in many areas of functioning, the effects of family transition on behavioural development were dependent on the child's age and the specific behavioural dimension assessed. Compared to other points in development, early childhood divorce was associated with long-term increases in anxious, hyperactive, and oppositional behaviour during later childhood. The effects of divorce on children's fighting were short-lived. Unlike previous prospective studies that suggest predivorce effects, we did not observe behavioural disturbance prior to divorce or remarriage.

Age Factors↗
PubMed1999

Consultation of mental health professionals by French adolescents with probable psychiatric problems.

A national sample of school-attending adolescents aged 12-20 years (n = 8435) filled out an anonymous self-administered questionnaire. We considered a group of 868 adolescents with probable psychiatric problems (PPP) in order to identify personal, psychological and environmental factors as well as help-seeking behaviour associated with consultation of mental health professionals (MHP). Among the adolescents with PPP, 13.7% consulted MHP at least once during the year. Logistic regression analysis showed that consultation with MHP was more frequent for adolescents with multiple problems (OR = 2.3), functional physical disorders (OR = 1.9), family problems (OR = 2), separated parents (OR = 4.4) or multiple contacts with other doctors (GP, school doctor and other specialists, OR = 2.2, 3.6 and 2.6, respectively), and among those who confided in teachers or youth group advisors (OR = 2.2). Those who confided in peers consulted MHP less often (OR = 0.5). However, consultation with MHP was not associated with other sociodemographic or educational characteristics, with type of problem (internalized or externalized), or with confiding in one's parents.

Adolescent↗
PubMed1991

Social impact of stimulant treatment for hyperactive children.

Most children diagnosed with ADHD have extensive and enduring problems in the social arena. Despite its limitations, the standard stimulant treatment regimen for children with ADHD is a useful therapeutic modality as well as an heuristic tool for increasing our understanding of both optimal and problematic interpersonal functioning. This article explores the social impact of stimulant treatment, delineating documented improvements, identifying elusive domains and puzzling patterns, and highlighting unintended and potentially undesirable outcomes. Medication-related changes in the behaviors and perceptions of the diagnosed child's adult caretakers are distinguished from those observed in peers, and the need to enhance our understanding of peer cultures is underscored. We present new findings on the effects of stimulant treatment on social cognition and affect, and then discuss the critical need to map the attributional sequelae of any treatment approach. The final sections explore contemporary controversies and improved strategies for balancing the costs, risks, and benefits of stimulant treatment in the service of enhancing interpersonal competence, satisfaction, and harmony.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

Chronic posttraumatic stress disorder: a review and checklist of factors influencing prognosis.

Mental health clinicians are often asked to evaluate prognosis in individuals with posttraumatic stress disorder (PTSD) in clinical, administrative, and legal contexts. Although chronicity of PTSD has been addressed in a number of trauma studies, the data have not been integrated into a coherent approach to the assessment of prognosis. In this paper, the peer-reviewed PTSD literature is surveyed to assist clinicians in making informed prognostic evaluations of the course of PTSD in adults. Potential risk factors, grouped into 11 categories (PTSD stressors, PTSD symptoms, current comorbidity, lifetime comorbidity, childhood separation and abuse, demographics, life stressors, family history, support, treatment, and functional impairment), are reviewed. Knowledge of these risk factors, and of factors associated with chronic PTSD, is helpful in assessing the potential for or degree of chronicity present at the initial evaluation of the patient, as well as in measuring treatment response during the course of therapy. Early identification and the appropriate treatment and management of remediable risk and associated factors may help prevent the development of chronic PTSD. Longitudinally assessing the response of treatable risk factors should provide an additional means for evaluating prognosis. A PTSD Prognostic Checklist, which rates risk and associated factors in each category, is proposed. Validity and reliability have not yet been established for this instrument. It is hoped that clinicians will use and conduct research on it as an initial step toward advancing its scientific utility.

Adult↗
PubMed1983

Improving the utilization of occupational therapy: a quality assurance study.

Concerned about the lack of referrals to occupational therapy for patients with activities of daily living (ADL) deficiency, the occupational therapy section of an acute-care community hospital conducted a quality assurance study. Referral standards were established by the occupational therapy department and approved by the medical staff. Initial measurements indicated that 71 percent of patients requiring a referral did not receive it. Since the staff standard for missed referrals was only 15 percent, improvement actions were implemented. After improvements were made in the referral system, missed referrals dropped from 71 to 27 percent, marking an improvement of 44 points. The study produced several other benefits, including better communication among health care providers, improved patient functional assessment, and greater staff commitment to quality assurance activities.

Activities of Daily Living↗
PubMed1995

[The adolescent's lexicon: study of lexical variations in normal adolescents depending upon the listener].

Clinicians and parents are familiar with the fact that adolescents have a special vocabulary, but very few studies have examined this. Linguists describe it as deeply metaphoric, creative and lively, thus showing that young people have a deep knowledge of language and truly experience pleasure using words. This contrasts with teachers' complaints about the little taste adolescents show for oral school activities and how poorly they express themselves. Some of them link this to the use of this polysemic and all purpose vocabulary. The context of locution is probably the explanation for these diverging opinions. Using this hypothesis, we have realised a quantitative study of the lexical variations depending on the person the adolescent is talking to in two groups (20 and 19 subjects), from very different social and educational backgrounds. Each teen-ager had to perform the same linguistic task: the description of a photograph on two occasions, once with an adult examiner and once with a friend. We studied the lexical differences between the two narratives. When adolescents are together they use their particular vocabulary four times more than when with an adult. But this qualitative difference is not a quantitative one, such as the length of the narrative or the number and repetition of whole words, and isn't correlated with the lexical stock. The use of this vocabulary runs across gender and social class categories. It can equally be found in high performance and upper class students as well as in underprivileged youngsters of technical schooling. It is the only variable that does not change between the two high schools. Thus this special vocabulary would not be connected to the subject's lexical competence, nor to gender or social background. It is the psychological function of this language that seems to be prominent.

Adolescent↗
PubMed1993

Integrated play groups: a model for promoting the social and cognitive dimensions of play in children with autism.

This investigation provides a description of a multifaceted model to promote peer play, and an evaluation of its impact on the social and cognitive dimensions of play in three children with autism. A combination of quantitative and qualitative methodologies were used to evaluate the effectiveness of the model application. A multiple-probe design across participants demonstrated (a) decreases in isolate play and collateral gains in more social forms of play, and (b) decreases in stereotyped object play and collateral gains in functional object play. While no symbolic play was observed in any of the participants during baseline, two participants demonstrated symbolic play in the final condition. Generalization and social validation measures indicated (a) advances in play behaviors were not limited to the play groups but observed in other contexts, and (b) were accompanied by language gains. Implications are discussed in terms of preferred service delivery models as well as of the importance of social interaction for the development of play and language.

Autistic Disorder↗
PubMed1977

Academic achievement as a function of specific and global measures of self-concept.

This study examined the correlations between academic achievement and factor specific, as well as global, measures of self-concept for 314 fourth and sixth grade boys and girls divided into grade level groups with and without Spanish surnames. The Primary Self-Concept Inventory was used to measure self-concept on six scales: physical size, emotional state, peer acceptance, helpfulness, success, and student-self. A global self-concept score was derived by totaling the scores on the six scales. Achievement was measured as total score on the Comprehensive Tests of Basic Skills. The two specific measures of self-concept that were most reflective of school performance, success and student-self, tended to show low positive correlations with achievement. The remaining specific measures, as well as the global measure, tended to show no relationship to achievement. These results suggest that an area specific model of self-concept is more useful than a global or undifferentiated model. Further, the low correlations between school related self-concept and achievement suggest that, as a group, students frequently have rather inaccurate academic self-concepts.

Achievement↗
PubMed2005

Prediction of drug and alcohol abuse in hospitalized adolescents: comparisons by gender and substance type.

The authors examined psychosocial correlates of drug and alcohol abuse in 462 hospitalized adolescents, and the extent to which these associations may be affected by gender or by substance type. Participants completed a battery of psychometrically-sound, self-report measures of psychological functioning, environmental stress, drug abuse, and alcohol abuse. Four multiple regression analyses were conducted to determine the joint and independent predictors of drug abuse and alcohol abuse, for males and for females. Multiple regression analysis revealed that seven variables--age, depression, impulsivity, low self-esteem, delinquent predisposition, low peer insecurity, and history of child abuse--jointly predicted both drug and alcohol abuse, for both males and females. However, several differences were found with respect to which variables made independent contributions to the predictive models--with only delinquent predisposition making a significant independent contribution for all four conditions. We found distinct patterns of psychosocial predictor variables for drug and alcohol abuse, as well as distinct patterns for males and females. These results may reflect differing risk factors for drug abuse and alcohol abuse in adolescent psychiatric patients--and differing risk factors for males and females. Such differences have potential implications for prevention and treatment.

Adolescent↗
PubMed2005

A longitudinal study of cognition change during early menopausal transition in a rural community.

OBJECTIVE: To characterize changes in cognition that occur during the hormonal transitions of menopause. METHOD: We conducted a longitudinal population-based study in Kinmen, Taiwan, recruiting all women age 40-54 years who were premenopausal and without a history of hormone replacement therapy (HRT) or hysterectomy. The cognitive measures used to assess function included the Auditory-Verbal Learning Test, visual memory, verbal fluency, Trail Making Test and digit span. RESULTS: A total of 694 eligible women participated in the baseline study, and 573 women (83%) completed follow-up 18 months later. After excluding 78 women who received hysterectomy or HRT, the final sample was composed of 495 subjects, of whom 114 (23%) progressed to perimenopause during follow-up. Women who remained premenopausal were younger than those who became perimenopausal (44.7 +/- 2.3 years versus 47.1 +/- 3.0 years, p < 0.01). All follow-up cognitive scores in women who entered perimenopause were slightly better than baseline measures except for Rey Auditory-Verbal Learning Test, which decreased by 0.23 (S.D. = 2.9, p = 0.3). At follow-up, cognitive function except for verbal fluency did not differ significantly between women who stayed premenopausal and those became perimenopausal after controlling for age, education, and baseline cognitive scores. Women who entered perimenopause have an average of 1.3 items (S.D. = 0.4) less in verbal fluency measures as compared with their premenopausal peers at the follow-up period. CONCLUSIONS: The menopausal transition might not accompany significant cognitive decline except for verbal fluency.

Adult↗
PubMedDate not supplied

Aging among persons with intellectual disability in Israel in relation to type of residence, age, and etiology.

This study was conducted to compare aging phenomena of persons with intellectual and developmental disability (ID) aged 40 years and older living in community residence (N = 65) with those living with their families (N = 43) in Jerusalem, Israel. All 108 persons and care givers were interviewed to ascertain health problems, sensory impairment, activity of daily living (ADL), cognitive skills, and leisure activities. Health problem had already developed by age 40 years. The most frequent were visual (33%), hearing impairments (20%) and dental problems (30%). The community residence group displayed more medical problems, whereas individuals living at home had more dental problems. Health problems in persons with Down syndrome were significantly higher. ADL functioning for all participants was high, but persons with Down syndrome and cerebral palsy had more dependence. A decline in functioning in both residential groups was observed concerning leisure time, but scores for social life leisure activities were better for the community residential group. The data provided in this study can serve as information to develop geriatric services for persons with ID and provide a basis for comparison with peers in the general population in Israel. Dental service to persons with ID living at home should be improved.

Activities of Daily Living↗
PubMed2003

Examining the effectiveness of an outpatient clinic-based social skills group for high-functioning children with autism.

Although social skills group interventions for children with autism are common in outpatient clinic settings, little research has been conducted to determine the efficacy of such treatments. This study examined the effectiveness of an outpatient clinic-based social skills group intervention with four high-functioning elementary-aged children with autism. The group was designed to teach specific social skills, including greeting, conversation, and play skills in a brief therapy format (eight sessions total). At the end of each skills-training session, children with autism were observed in play sessions with typical peers. Typical peers received peer education about ways to interact with children with autism. Results indicate that a social skills group implemented in an outpatient clinic setting was effective in improving greeting and play skills, with less clear improvements noted in conversation skills. In addition, children with autism reported increased feelings of social support from classmates at school following participation in the group. However, parent report data of greeting, conversation, and play skills outside of the clinic setting indicated significant improvements in only greeting skills. Thus, although the clinic-based intervention led to improvements in social skills, fewer changes were noted in the generalization to nonclinic settings.

Ambulatory Care Facilities↗
PubMed2002

Excess mortality or institutionalization after hip fracture: men are at greater risk than women.

OBJECTIVES: To assess 2-year excess mortality or institutionalization risk associated with hip fracture in community-dwelling people aged 60 and over. DESIGN: Cohort study. SETTING: Auckland, New Zealand, from July 1991 to February 1996. PARTICIPANTS: Five hundred sixty-five community-dwelling older people recently hospitalized with a hip fracture and 782 randomly selected controls, frequency matched for age and gender, living in the same catchment area as the cases. MEASUREMENTS: Two-year mortality or institutionalization status. RESULTS: Over half (52.1%) of male hip fracture cases and 12.4% of male controls were dead or institutionalized, compared with 39.2% of female hip fracture cases and 19.7% of female controls. The odds ratio, adjusted for baseline demographic characteristics, medical status, and physical function, for death or institutionalization was 6.89 (95% confidence interval (CI) = 2.75-17.27) for men and 1.48 (95% CI = 1.02-2.19) for women. CONCLUSIONS: For both men and women who incur a hip fracture, the risks of dying or being institutionalized within 2 years are higher than for their peers. The independent effect of hip fracture on this outcome was significantly greater for men than women. The marked influences of prefracture health status, physical limitations, and gender on outcome have important implications for preventative strategies.

Activities of Daily Living↗
PubMed2006

Portfolio as a tool to stimulate teachers' reflections.

Portfolios are increasingly being used to stimulate teachers' reflections. Frameworks for reflection on teaching often emphasize competencies and behaviours. However, other aspects of teacher functioning are also important, such as the teaching environment and individual teachers' beliefs, professional identity and mission. In a study among five medical school teachers, we explored how a portfolio stimulated reflections on the various aspects of teaching functioning. Outcomes of written portfolio assignments were collected and analysed to identify examples of reflections on the various aspects of teacher functioning. Examples of reflections on all aspects of teacher functioning were found, although examples of reflections on competencies were easier to find than those on beliefs, identity and mission. This study might help teachers and their trainers and coaches to recognize different aspects of teacher functioning when discussing portfolios for professional development purposes. However, further development of assignments and other methods to stimulate reflections on beliefs, identity and mission are needed. Furthermore, apart from the content of teachers' reflections, teachers' reflection processes should be researched, as well as the effects of portfolio meetings with peers and coaches.

Education, Medical↗