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PubMed1989

Health promoting attitudes and behaviors among persons with disabilities.

Despite the recognized importance of maintaining and improving the health status of persons with disabilities, there has been little research conducted to determine their health care attitudes and behaviors and what interventions might serve to enhance their health. Using Pender's Model of Health Promotion (1987), this study investigated the factors associated with the occurrence of health promoting behaviors among 135 adults with disabilities. Staff and peer counsellors from two Independent Living Centres in Texas administered the questionnaires and conducted brief semi-structured interviews with participants. Seventy-three percent of the sample rated their current health as good or excellent. Findings from both interviews and questionnaires suggest that participants are more likely to define health as being able to function well than as simply the absence of illness. High scores on Adaptive definition of health, the Self-Efficacy-Scale, age, and low scores on the Barriers to Health Promotion Activity for Disabled Persons scale accounted for 31% of the variance in scores on a self-report measure of health promoting behaviors. These findings suggest that interventions which address self-perceived barriers to health promotion, work to build participants' sense of mastery of their health behaviors, and encourage a definition of health that is broader than simply absence of illness may be more effective than those that focus only on information about good health practices.

Adolescent↗
PubMed1986

Dental and social effects of malocclusion and effectiveness of orthodontic treatment: a strategy for investigation.

Study of the effectiveness of orthodontic treatment is complicated by a variety of factors, including the need for longitudinal, multidisciplinary appraisal and difficulties of randomisation, control and sample composition. This report outlines a recent initiative adopting a longitudinal, observational approach with a cohort of approximately 1000 12-yr-olds, selected by disproportionate stratified sampling in order that occlusal features of low prevalence, but high orthodontic interest, would be well represented. In the event, 4810 subjects were listed and after certain exclusions, 3420 children were screened. Using preselected screening criteria, 663 with specific occlusal features were selected and an additional 355 children with nonspecific features were randomly allocated on a pro-rata basis. This gave a final study population of 1018. Baseline dental data included the recording of caries, periodontal status and mandibular function. Study models were obtained and analysed using a new standardised technique for recording the alignment of individual teeth. Photographs of the face and dentition were collected and a rating system developed to score dental and facial attractiveness. Social-psychological data were recorded via self-rating questionnaires, interviews, parental questionnaires, teacher questionnaires and peer ratings.

Child↗
PubMed1976

Adolescents with spina bifida. How they see their situation.

Forty-six adolescents with spina bifida were interviewed at home to find out how they felt about their situation. Some degree of misery was very common indeed but was more likely to be severe in girls than in boys. About half the girls had, on some occasion in the past year, felt that life was hopeless or not worth living. Since these feelings are related to their social isolation outside school, they might be alleviated by improved opportunities for contract with peers. This seems particularly important in view of the capacity of most teenagers to make reasonable relationships where the opportunity exists, e.g. at school or within the family. Over half those who had left school were either unemployed or very dissatisfied with their job. In addition to worries about work, preoccupations about sexual relatinships, sexual function, and marriage were common. About two-thirds of the teenagers hoped to get married and half of these thought they could have children. Girls were particularly worried about their capacity to conceive and boys had understandable concerns about potency. Very few had consulted anyone about this or had had advice about the genetic aspects of the condition and there is a clear need for adequate counseling to help such teenagers to distinguish between real and imagined fears about the consequences of their condition.

Adolescent↗
PubMed1995

Tropospheric ozone: respiratory effects and Australian air quality goals.

OBJECTIVE: To review the health effects of tropospheric ozone and discuss the implications for public health policy. DESIGN: Literature review and consultation with scientists in Australia and overseas. Papers in English or with English language abstracts were identified by Medline search from the international peer reviewed published reports. Those from the period 1980-93 were read systematically but selected earlier papers were also considered. Reports on ozone exposures were obtained from environmental agencies in the region. RESULTS: Exposure to ozone at concentrations below the current Australian air quality goal (0.12 ppm averaged over one hour) may cause impaired respiratory function. Inflammatory changes in the small airways and respiratory symptoms result from moderate to heavy exercise in the presence of ozone at levels of 0.08-0.12 ppm. The changes in respiratory function due to ozone are short lived, vary with the duration of exposure, may be modified by levels of other pollutants (such as sulphur dioxide and particulates), and differ appreciably between individuals. Bronchial lavage studies indicate that inflammation and other pathological changes may occur in the airways before reductions in air flow are detectable, and persist after respiratory function has returned to normal. It is not known whether exposures to ozone at low levels (0.08-0.12 ppm) cause lasting damage to the lung or, if such damage does occur, whether it is functionally significant. At present, it is not possible to identify confidently population subgroups with heightened susceptibility to ozone. People with asthma may be more susceptible to the effects of ozone than the general population but the evidence is not consistent. Recent reports suggest that ozone increases airway reactivity on subsequent challenge with allergens and other irritants. Animal studies are consistent with the findings in human populations. CONCLUSION: A new one hour air quality ozone goal of 0.08 ppm for Australia, and the introduction of a four hour goal of 0.06 ppm are recommended on health grounds.

Adaptation, Physiological↗
PubMed1999

Cognitive development in benign focal epilepsies of childhood.

Benign focal epilepsy of childhood (BFEC) is the most common form of epilepsy, in children from 3 to 12 years. Its prognosis is always favourable as far as the epilepsy is concerned. Nevertheless, recent clinical data suggest that children affected by BFEC are more likely to show learning difficulties and behavioural disturbances than their peers. We report here the preliminary findings of a prospective study of 22 children affected with BFEC. Electroclinical and neuropsychological changes observed during the first 18 months of the follow-up strengthen the conclusion of recent neuropsychological studies stressing the correlation between epilepsy and cognitive performances. The cognitive deficits affecting mainly non-verbal functions were significantly correlated with the frequency of seizures and spike-wave discharges and to the lateralization of the epileptic focus in the right hemisphere, whereas frontal functions like attention control, response organization and fine motor speed, were impaired in the presence of active BFEC independently of the lateralization of the epileptic focus. Our results indicate that maturing cognitive functions subserved by a cortical area distant from the epileptic focus are susceptible to interference with epilepsy.

Brain↗
PubMedDate not supplied

Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting.

We evaluated blood pressure control, quality of life, quality of care, and satisfaction of patients who were monitored by specially trained community pharmacists in a group medical practice. After participating in an intensive skill development program, pharmacists performed in an interdisciplinary team in a rural clinic. The primary objective was assessed by evaluating outcome variables at 6 months compared with baseline in 25 patients randomly assigned to a study group. A control group of 26 patients was also evaluated to determine if outcome variables remained constant from baseline to 6 months. Systolic blood pressure was reduced in the study group (151 mm Hg baseline, 140 mm Hg at 6 mo, p<0.001) and diastolic blood pressure was significantly lower at 2, 4, and 5 months compared with baseline. Ratings from a blinded peer review panel indicated significant improvement in the appropriateness of the blood pressure regimen, going from 8.7 +/- 4.7 to 10.9 +/- 4.5 in the study group (p<0.01), but they did not change in the control group. Several quality of life scores improved significantly in the study group after 6 months (p<0.05). These included physical functioning (61.6 vs 70.7), physical role limitations (56.8 vs 72.8), and bodily pain (60.0 vs 71.7) at baseline and 6 months, respectively. There were no significant changes in the control group. Patient satisfaction scores were consistently higher in the study group at the end of the study. Our results indicate that when community pharmacists in a clinic setting are trained and included as members of the primary care team, significant improvements in blood pressure control, quality of life, and patient satisfaction can be achieved.

Adult↗
PubMed1998

Criterion validity and the utility of reactive and proactive aggression: comparisons to attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, and other measures of functioning.

Examined the criterion validity and the utility of Dodge and Coie's (1987) measure of reactive and proactive aggression. Participants were 405 children in kindergarten through 5th grade attending an urban elementary school. Examined criterion validity by testing whether reactive aggression or proactive aggression was significantly correlated with criterion measures of overall impairment as measured by the Impairment Rating Scale (Pelham, Gnagy, et al., 1996), classroom behavior as measured by a frequency count of classroom rule violations, and peer adjustment as measured by teacher ratings of peer behavior on the Pittsburgh Modified IOWA Conners (Pelham, Milich, Murphy, & Murphy, 1989). Examined utility by testing whether reactive aggression or proactive aggression was significantly correlated with criterion measures after controlling for each other and after controlling for attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder as measured by the Disruptive Behavior Disorder Rating Scales (Pelham, Gnagy, Greenslade, & Milich, 1992). Results showed good evidence of criterion validity for both reactive and proactive aggression, but mixed evidence for their utility.

Aggression↗
PubMed1999

Modulation of recombinant human cardiac L-type Ca2+ channel alpha1C subunits by redox agents and hypoxia.

1. Whole-cell patch clamp recordings were used to investigate the modulation by reducing and oxidizing agents of recombinant human cardiac L-type Ca2+ channel alpha1C subunits stably expressed in human embryonic kidney (HEK 293) cells. 2. The oxidizing agents thimerosal (10 microM) and p-chloromercuribenzene sulphonic acid (PCMBS; 2 microM to 2 mM) caused irreversible inhibition of Ca2+ channel currents. The reducing agent 1,4-dithiothreitol (DTT; 2 mM) was without effect on Ca2+ channel currents, but reversed the inhibitory actions of thimerosal and PCMBS. 3. Ca2+ channel currents were also inhibited by pretreatment with the methanethiosulphonate compound (2-aminoethyl)methanethiosulphonate (MTSEA, 2.5 mM), but were unaffected by identical pretreatment with (2-sulphonatoethyl)methanethiosulphonate (MTSES, 10 mM). The effects of MTSEA could be fully reversed by DTT (2 mM). The degree of current inhibition caused by 200 microM PCMBS was not significantly affected by pretreatment with MTSEA, and following PCMBS treatment, MTSEA caused a similar degree of inhibition to that observed in cells that were not previously treated with PCMBS. These findings suggested that distinct thiol groups were modulated by these two agents. 4. Hypoxic inhibition of Ca2+ channel currents was unaffected by pretreatment of cells with MTSEA but was fully prevented by treatment with PCMBS. Our results indicate that distinct cysteine residues on the alpha1C subunit can undergo redox modulation and in so doing alter channel function. Some, but not all, of these residues appear to be associated with the mechanism underlying inhibition of this channel by hypoxia.

Calcium Channel Blockers↗
PubMed1999

Micronized fenofibrate: a new fibric acid hypolipidemic agent.

OBJECTIVE: To review the efficacy and safety of fenofibrate in the management of hyperlipidemias. DATA SOURCES: A MEDLINE search (1974-October 1998), Current Contents search, additional references from article bibliographies, and the package insert from the manufacturer were used to identify data for evaluation. Studies evaluating fenofibrate (peer-reviewed publications, package insert data) were considered for inclusion. Abstracts and data on file with the manufacturer were not considered for inclusion. STUDY SELECTION: English-language literature was reviewed to evaluate the pharmacology, pharmacokinetics, clinical use, and tolerability of fenofibrate. Data from animals and in vitro systems were included only when necessary to explain the drug's pharmacology. DATA SYNTHESIS: Micronized fenofibrate is a fibric acid derivative approved by the Food and Drug Administration (FDA) in February 1998 for the treatment of types IV and V hyperlipidemia. Data from the peer-reviewed literature also support the use of fenofibrate in types IIa, IIb, and III hyperlipidemias. Micronized fenofibrate 67-201 mg/d is useful as monotherapy or as an adjunct to other hypolipidemics and dietary therapy. In placebo-controlled clinical trials, regular formulation fenofibrate 300-400 mg/d lowered serum triglyceride (TG) concentrations by 24-55%, total cholesterol by 9-25%, low-density lipoprotein cholesterol (LDL-C) concentrations by 6-35%, and raised high-density lipoprotein cholesterol (HDL-C) concentrations by 8-38%. Few comparative data exist regarding fenofibrate versus clofibrate and gemfibrozil. In noncomparative and comparative clinical trials, fenofibrate appeared to be well tolerated. The most common causally related adverse events were digestive, musculoskeletal, and dermatologic in nature. Concurrent use of fenofibrate and a hydroxymethylglutaryl-coenzyme A inhibitor may increase the risk of myopathy and/or rhabdomyolysis, although recent data suggest that concurrent use of fenofibrate with low-dose simvastatin or pravastatin is safe. Fenofibrate may enhance the effect of oral anticoagulants. CONCLUSIONS: Fenofibrate reduces serum TG, total cholesterol, and LDL-C, and raises HDL-C to clinically relevant degrees. Its spectrum of activity appears to exceed that recommended for types IV and V hyperlipidemia to encompass types IIa, IIb, and III hyperlipidemias as well. To this extent, it may be considered a broader-spectrum fibrate than is indicated by its FDA approval. Adverse effects of fenofibrate appear to be similar to those of other fibrates and require routine monitoring (clinical, liver function). Long-term safety data are readily available from drug registries in many countries where the product has been available for nearly two decades. Cost-effectiveness studies comparing fenofibrate with other hypolipidemics demonstrate benefits of fenofibrate over simvastatin in types IIa and IIb hyperlipidemia. The need for dosage titration of the micronized preparation from 67 mg/d upward to a final dose of 200 mg/d is also not supported by peer-reviewed literature (except in the case of renal impairment). Although preliminary data on plaque regression are encouraging, published clinical studies evaluating the impact of fenofibrate on cardiovascular morbidity and mortality are awaited. Micronized fenofibrate is worthy of formulary inclusion.

Clinical Trials as Topic↗
PubMed1993

Benefits of a multidisciplinary approach to breast care.

The University of Michigan Breast Care Center (BCC) was established in 1985 to provide comprehensive, multidisciplinary diagnosis and treatment of benign and malignant breast disease. This work presents an overview of our experience in the BCC and assesses the clinical, academic, financial, and educational effectiveness of the program. A database was used to generate a list of all patients seen in the BCC between February 1, 1985 and December 31, 1991. Participating departments provided information regarding outpatient, inpatient, clinical and consultative activities, and referral patterns attributable to BCC endeavors. BCC educational and academic activities were reviewed and profiled. Clinical information was culled from the BCC database, hospital records, and the hospital tumor registry. The BCC has resulted in a fivefold increase in breast care related activity at the University of Michigan Medical Center. Over half of the patients treated in the BCC with primary operable breast cancer receive breast-conserving therapy. The BCC performs a unique educational function, providing the primary breast care experience for house staff as well as one third of the third year medical school class. The BCC supports over 20 clinical research protocols, and patient enrollment in clinical trials has increased dramatically since 1985. The BCC also provides support to basic science researchers receiving over 2.5 million dollars in peer reviewed direct cost support. These data suggest that a multidisciplinary approach to patient care as embodied by the BCC can be clinically, financially, and academically superior and productive. This model warrants further investigation not only in the field of breast care, but also in other clinical situations that require multidisciplinary input and therapy.

Breast Diseases↗
PubMed2001

Clinical applications of the relaxation response and mind-body interventions.

Several hundred peer-reviewed studies in the past 20 years have shown that the relaxation response and mind-body interventions are clinically effective in the treatment of many health problems that are caused or made worse by stress. Recent studies show that mind-body interventions may improve prognosis in coronary heart disease and can enhance immune functioning. It is hypothesized that mind-body interventions reduce sympathetic nervous system activation and increase parasympathetic nervous system activity, and thereby restore homeostasis. Researchers have also concluded that cognitive therapy is as effective, and possibly more effective than antidepressant medication in the treatment of major depression. This report provides an overview of some studies that have shown a beneficial role of the relaxation response and cognitive restructuring in the treatment of headaches, insomnia, and cardiovascular disorders. Studies to date suggest that mind-body interventions are effective and can also provide cost savings in patient treatment. It is also clear, however, that mind-body therapies are not panaceas, and should be used in conjunction with standard medical care.

Cardiovascular Diseases↗
PubMedDate not supplied

The use of the Staggered Spondaic Word and the competing environmental sounds tests in the evaluation of central auditory function of learning disabled children.

Children aged 6 to 12 years with intelligence and pure-tone hearing within the normal range (91 functioning academically within the middle 50% and having uneventful hearing health histories and 76 demonstrating learning disabilities) were evaluated with dichotic central auditory listening tasks. Auditory response patterns were established and analyzed for normal and learning disability-specific performance. Children with learning disability-specific performance. Children with learning disabilities performed more poorly than "normal" peers on verbal and nonverbal listening tasks, suggesting learning disabled children may be identified by auditory performance on dichotic listening skills.

Age Factors↗
PubMed2001

Small bowel transplantation: selection criteria, operative techniques, advances in specific immunosuppression, prognosis.

Intestinal transplantation is now an accepted therapy for intestinal failure when parenteral nutrition therapy cannot be tolerated. During the past year, evidence has been provided indicating that neither stomach nor colon need to be included in the transplant, even if a primary motility disorder is the indication for surgery. The liver should be included in the composite allograft when there are clinical indications of portal hypertension resulting from parenteral nutrition associated cholestasis. When liver disease develops, operations intended to improve gut function should be avoided in preference of early listing for transplantation. During the past year, initial attempts at adult to child intestinal transplantation were carried out with some success; reduction in the diameter of the adult donor bowel may not be uniformly necessary. New immunosuppressive therapies have been employed recently, but few have been subjected to peer review. Experimental models have clarified the pathology, if not the immunobiology, of chronic intestinal allograft rejection and the ability of the liver to promote tolerance of a cotransplanted intestinal allograft. Treatment of posttransplant lymphoproliferative disease has been augmented by the use of anti-CD 20 antibody that targets Epstein-Barr virus infected B-cells for destruction with high specificity.

Child↗
PubMed2005

Impact of an effective multidrug-resistant tuberculosis control programme in the setting of an immature HIV epidemic: system dynamics simulation model.

This study sought to determine the impact of an effective programme of multidrug resistant tuberculosis control (MDRTB) on a population that is witnessing an explosive HIV epidemic among injecting drug users (IDUs), where the prevalence of MDRTB is already high. A transmission model was constructed that represents the dynamics of the drug-susceptible tuberculosis (DSTB), MDRTB and HIV spread among the adult population of Samara Oblast, Russia: from official notifications of tuberculosis and of HIV infection, estimates of MDRTB derived from surveillance studies, population data from official regional statistics, data on transmission probabilities from peer-reviewed publications and informed estimates, and policy-makers' estimates of IDU populations. Two scenarios of programme effectiveness for MDRTB were modelled and run over a period of 10 years to predict cumulative deaths. In a population of 3.3 million with a high prevalence of MDRTB, an emerging epidemic of HIV among IDUs, and a functioning directly observed therapy-short course (DOTS) programme, the model predicts that under low cure rates for MDRTB the expected cumulative deaths from tuberculosis will reach 6303 deaths including 1900 deaths from MDRTB at 10 years. Under high cure rate for MDRTB 4465 deaths will occur including 134 deaths from MDRTB. At 10 years there is little impact on HIV-infected populations from the MDRTB epidemic, but as the HIV epidemic matures the impact becomes substantial. When the model is extended to 20 years cumulative deaths from MDRTB become very high if cure rates for MDRTB are low and cumulative deaths in the HIV-infected population, likewise, are profoundly affected. In the presence of an immature HIV epidemic failure to actively control MDRTB may result in approximately a third more deaths than if effective treatment is given. As the HIV epidemic matures then the impact of MDRTB grows substantially if MDRTB control strategies are ineffective. The epidemiological starting point for these scenarios is present in many regions within the former Soviet Union and this analysis suggests control of MDRTB should be an urgent priority.

AIDS-Related Opportunistic Infections↗
PubMed1991

University students and AIDS: knowledge, attitudes and behavioral adjustment.

This study addresses the relations between AIDS-related knowledge, attitudes, and behavior change among university students. A questionnaire covering such issues and personal background variables was administered to 750 students at the University of Zagreb. Over-all, 62.7% of the knowledge items were answered correctly, while functional, self-protective aspects of knowledge proved to be much better than general knowledge. On the average, attitudinal responses were moderately liberal. Both self-reported change in risk-reduction behavior and personal concern due to the appearance of AIDS were very small. Correlations of risk-reducing behavior with permissive (.15) and restrictive (.14) attitude orientations and with general and functional knowledge (.08) were modest. The level of personal concern correlated neither with permissive attitudes nor with functional knowledge, while it correlated negatively with restrictive attitudes (-.20) and with general knowledge (-.08). Substantial association was only established between functional knowledge and permissive (.51) and restrictive attitude orientations (-.23). It is concluded that, in addition to knowledge and attitudes, a number of factors which restrain desired behavioral adjustment should be considered in anti-AIDS campaigns, such as perceived level of exposure to HIV in a particular environment, young age-specific illusion of invulnerability, peer norms, and others.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence.

Cost-effective psychotherapeutic interventions can enhance pharmacotherapy and improve outcomes in major depression and schizophrenia, but they are rarely studied in bipolar disorder, despite its often unsatisfactory response to medication alone. Following a literature search, we compiled and evaluated research reports on psychotherapeutic interventions in bipolar disorder patients. We found 32 peer-reviewed reports involving 1052 patients-14 studies on group therapy, 13 on couples or family therapy, and five on individual psychotherapy-all supplementing standard pharmacotherapy. Methodological limitations were common in these investigations. Nevertheless, important gains were often seen, as determined by objective measures of increased clinical stability and reduced rehospitalization, as well as other functional and psychosocial benefits. The results should further encourage rising international interest in testing the clinical and cost-effectiveness of psychosocial interventions in these common, often severe and disabling disorders.

Bipolar Disorder↗
PubMed1991

Nursing management of the adolescent with idiopathic scoliosis.

Management of the adolescent idiopathic scoliosis patient has many intricate considerations. Whether the patient is braced or surgery is recommended, there is a lot of teaching, assessing, and compassion when dealing with adolescents whose biggest concern is being like their peers. It is important to allow as much independence in decision making as possible, whether it be about bracing or surgical intervention, as long as they clearly understand the consequences. Newer, better surgical instruments, anesthesia, nursing care, and postoperative mobility all have changed the management of the operative scoliosis patient significantly. Nursing assessment of neurologic, respiratory, function, emotional, and developmental needs of the adolescent patient, however, have not changed. If we, as nurses, understand the rationale for assessments, treatments, and restrictions, we can teach our patients and their families.

Adolescent↗
PubMed1997

Exercise tolerance and behavior of blood pressure in children and adolescents after renal transplant.

OBJECTIVE: The purpose of the study was to evaluate the exercise tolerance and the behaviour of blood pressure during a maximal exercise testing on treadmill for a group of patients with renal transplant carried out at least 6 months earlier. EXPERIMENTAL DESIGN, SETTING AND PATIENTS: In a retrospective study, nineteen patients were examined in our laboratory: 13 boys and 6 girls, mean age 15.8 years (range 10.5-22). INTERVENTIONS: All patients were given a clinical examination, an ECG at rest, a maximal exercise testing on treadmill (Bruce protocol), a mono-2D echo, a lung function test and 24-hour Holter monitoring. The results of the exercise test were compared with those of two control groups of same age and body surface area. RESULTS: The clinical examination of their cardiovascular apparatus gave normal results. The echo revealed anatomical and heart function anomalies related to the original disease. Exercise testing on treadmill showed a reduction in exercise tolerance (p < 0.001) and the maximal heart rate showed a statistically significant difference (p < 0.001) in comparison to control groups. Maximal systolic blood pressure was higher than in patients with same body surface area (p < 0.001) and higher than in peers (p = 0.133). CONCLUSIONS: In view of this hypertensive response, strenuous physical activity should be undertaken with caution and indeed submaximal aerobic activity is more suitable for this population of patients.

Adolescent↗