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PubMed2000

Evaluation of treatment and posttreatment changes of protraction facemask treatment using the PAR index.

The purpose of this study was to use the Peer Assesment Rating (PAR) index score to evaluate the treatment and posttreatment changes of Class III patients treated by protraction facemask. The sample consisted of 20 Chinese children, 6 to 11 years old, with Class III skeletal malocclusion who had been treated with maxillary expansion and a protraction facemask. The average treatment time was 8.2 months, followed by 1 year of retention with a Class III functional appliance. Study casts were taken pretreatment (T1), posttreatment (T2), 1 year follow-up (T3), and 2 years follow-up (T4). After treatment, PAR scores were calculated for each time period. Differences among the 4 time periods were analyzed with the Wilcoxin matched-pairs test. Significant reductions in PAR scores were found at T2 (56%), T3 (70%), and T4 (63%) compared with T1. Immediately posttreatment (T2), 17 (85%) of 20 patients had improved PAR scores by a reduction of at least 30%. Reductions were caused primarily by correction of the anterior crossbite. One year after treatment (T3), further reductions in PAR score were noted (P <.01) as a result of better alignment of the anterior segment, improvement of the buccal occlusion, and overbite and midline corrections. Two years after treatment (T4), PAR scores were higher than at the previous time period. The increases were due to relapses in overjet (4 of 20 patients), overbite, and centerline corrections. These results indicate that significant reductions in the severity of Class III malocclusion can be achieved with early orthopedic facemask treatment. In most cases, further improvement in the PAR score can be expected 1 and 2 years after treatment. In a few patients, the benefits of early treatment are negated by relapses in overjet, overbite, and centerline corrections during the follow-up period.

Child↗
PubMedDate not supplied

Quality of life in children and adolescents with cancer. First results of an evaluation of 49 patients with the PEDQOL questionnaire.

BACKGROUND: The assessment of Quality of Life (QoL) in childhood cancer survivors is a new field of research, which is important for a better understanding of how children with cancer feel and how treatment can be optimized. The purpose of our examination in a sample of patients treated in our institution was the evaluation of the questions: How do children with cancer reflect on their QoL in comparison to healthy children of the same age? Are there any significant differences in QoL between children with hematological disorders and children with solid tumors and if that is so, which domains are affected? PATIENTS AND METHODS: We used for the evaluation a pilotversion of a self-rating QoL questionnaire for children between 8 and 18 years (PEDQOL), who was developed for pediatric oncology. 49 children off treatment of whom 51% had leukemia/lymphoma and 49% had solid tumors compared to 62 healthy school children were examined. RESULTS: The PEDQOL questionnaire was a good accepted measure among the examined children. The reliability scores of the pilotform for the evaluated domains were also satisfactory (Cronbach's-Alpha > 0.60). In general QoL was scored good by healthy as well as by ill children. In the group of children with leukemia/lymphoma impairment of QoL was more apparent than in children with solid tumors (domains autonomy, emotional functioning, cognition and familial interactions). Survivors of solid tumors reported less impairment of QoL which was mainly seen in physical functioning and body image. CONCLUSION: In general QoL scored with the PEDQOL pilotquestionnaire was good for most of the childhood cancer survivors. Children with solid tumors show less impairment than children with leukemia/lymphoma. Therefore it could be suggested, that young age at diagnosis and the following longer period of being dependent on familial support, the isolation from peer groups and the longer way to become independent may be reflected by these results. To obtain reliable results how children with cancer express their QoL and what consequences illness, treatment and long term effects of therapy have on the childrens' QoL a multicenter prospective study is needed. This will be realized in the near future in a project on "Long term effects and quality of life in children with leukemia or medulloblastoma", which is supported by the "Kompetenznetz Pädiatrische Onkologie and Hämatologie".

Adolescent↗
PubMed2002

Biological, psychological and social processes in the conduct disorders.

BACKGROUND: This paper reviews recent evidence on the causes and maintenance of aggressive and disruptive behaviours in childhood and adolescence. It considers the relative merits of several different ways of conceptualising such problems, in relation to the contribution of biological, psychological and social factors. METHOD: It focuses on conduct problems appearing in young childhood, which greatly increase the likelihood of persistent antisocial behaviours in adolescence and adult life in association with wider interpersonal and social role impairments. It considers the contribution of individual factors, including impaired verbal skills, deficits in executive functions, and an imbalance between behavioural activation and inhibition systems. These are viewed in interaction with commonly associated environmental disadvantages such as hostile or intrusive parenting. The roles of attributional biases, unrealistic self-evaluations, and insecure attachment are considered in relation to affect regulation, and effective social action. The contributions of the wider social environments of peers, neighbourhood and socio-economic conditions are evaluated. CONCLUSIONS: The paper concludes that, although considerable progress has been made over the past ten years, there is a need to further refine our conceptualisation of the behaviours to be explained, to develop a coherent theory of the causal and maintaining processes, and to carry out prospective studies with adequate numbers of high risk children.

Adolescent↗
PubMed1977

Experimenter prestige and feedback related to acceptance of genuine personality interpretations and self-attitude.

The present study examined the relationship between the prestige of the diagnostician and subjects' (a) personal validation of genuine, test-based personality evaluations and (b) pre- and postfeedback changes in self-attitudes. It was found that (a) subjects in all conditions rated the interpretations as being fairly accurate descriptions of their personalities; (b) the acceptance of the feedback did not vary as a function of experimenter prestige; and (c) receiving personality feedback had no effects on subjects' self-attitudes. This latter finding was examined from the viewpoint of social judgment theory.

Feedback↗
PubMed2005

Functional promoter analysis using an approach based on an in vitro evolution strategy.

In vitro evolution imitates the natural evolution of genes and has been very successfully applied to the modification of coding sequences, but it has not yet been applied to promoter sequences. We propose an alternative method for functional promoter analysis by applying an in vitro evolution scheme consisting of rounds of error-prone PCR, followed by DNA shuffling and selection of mutant promoter activities. We modified the activity in embryogenic sugarcane cells of the promoter region of the "Goldfinger" isolate of banana streak virus and obtained mutant promoter sequences that showed an average mutation rate of 2.5% after applying one round of error-prone PCR and DNA shuffling. Selection and sequencing of promoter sequences with decreased or unaltered activity allowed us to rapidly map the position of one cis-acting element that influenced promoter activity in embryogenic sugarcane cells and to discover neutral mutations that did not affect promoter function. The "selective-shotgun" approach of this promoter analysis method immediately after the promoter boundaries have been defined by 5' deletion analysis dramatically reduces the labor associated with traditional "linker-scanning" deletion analysis to reveal the position of functional promoter domains. Furthermore, this method allows the entire promoter to be investigated at once, rather than selected domains or nucleotides, increasing the prospect of identifying interacting promoter regions.

Cloning, Molecular↗
PubMed2004

Theory of Mind and social beliefs in adolescents with traumatic brain injury.

Impairments in social performance are common consequences of TBI, yet the neuropsychological basis of these impairments is not well understood. This is particularly true for adolescents, who have the highest incidence of TBI and are at a critical stage of developing social and relationship skills. To address this, adolescents with TBI were compared to their typically developing peers on a social cognition task that included Theory of Mind (ToM) questions. As ToM may be necessary for the development of culture-specific social knowledge, the two groups also were compared in regard to their social beliefs. There were significant differences between injured and uninjured adolescents in social cognition, with group differences increasing as a function of the requirement for ToM. There were few differences in self-reported social knowledge and social beliefs. The implication of this discrepancy for the rehabilitation of adolescents with TBI is discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Sexual concerns after heart transplantation.

Sexual concerns after heart transplantation are commonly experienced yet seldom voiced. Forty-five patients approved for this procedure were surveyed regarding sexual issues. Twenty-one (47%) persons responded, of whom 16 had undergone heart transplantation, and five were waiting for a donor. Sexual dysfunction included impotence, ejaculation problems, altered libido, and avoidance of sexual opportunities. Contributing factors to these sexual difficulties were fear of death during coitus, effects of medication on interest and ability to function, body-image concerns, depression, uncertainty about the sexuality of the donor, and altered roles and responsibilities within the family. Recommendations for members of heart transplant teams include (1) obtaining a routine sexual history during the evaluation of candidates, (2) heightening awareness of the sexual concerns of these persons, (3) aggressively treating clinical depression, (4) establishing peer support groups for spouses of transplant patients, (5) presenting didactic material on sexual issues after transplant, (6) adjusting medications when sexual problems arise, and (7) addressing one's own level of comfort in discussing sex-related topics with transplant patients.

Adult↗
PubMed2003

The hospital board at risk and the need to restructure the relationship with the medical staff: bylaws, peer review and related solutions.

This article argues that the current structure of the hospital governing board and medical staff relationship does not support and promote quality and patient-centered care. The fundamental flaw in the current structure is the interdependent, yet independent and discordant relationships between hospital governing boards and medical staffs. These relationships are described as cultures and fit into three types of "silos": organizational (the "structural silo"); professional (the "professional silo", including the "culture of blame"); and the fragmented quality information silo (the "informational silo"). While case law, statutory requirements and regulatory expectations clearly state that governing boards are ultimately responsible for quality of patient care, governing boards delegate these functions to medical staff without having sufficient information to measure and monitor quality. As a result, problems manifest because of these failures of oversight and compliance. Dramatic lapses in quality occur due to overuse, underuse, and misuse of healthcare services. Furthermore, the challenges and opportunities from improved quality and patient safety, as a strategic business driver, cannot be seized until the underlying structural flaws are understood and addressed. This article proposes that solutions become apparent when the various health care constituencies are educated about these cultural impacts and when multidisciplinary bodies, with board leadership and direct authority, integrate and consider quality information.

Constitution and Bylaws↗
PubMed2003

Childhood sexual abuse, PTSD, and the functional roles of alcohol use among women drinkers.

The present study investigated whether a history of childhood sexual abuse (CSA) or current post traumatic stress disorder (PTSD) was associated with alcohol-related expectancies and recalled effects of drinking reported by women in substance user treatment. The results indicate that CSA status was not associated with the alcohol-related expectancies or effects of drinking reported by women in substance user treatment. However, those currently manifesting PTSD were more likely than their peers without PTSD to report greater alcohol-related expectancies of tension reduction and having experienced greater positive enhancement from drinking. Theoretical and clinical implications of these findings are considered.

Adult↗
PubMed2000

Perceived body image and eating behavior in young adults with cystic fibrosis and their healthy peers.

Treatment aimed at achieving an ideal nutritional status is an integral part of the management of patients with cystic fibrosis (CF). Emphasis is continually placed upon dietary intake and weight. The effects of this on eating behavior and self-perceptions are unclear. This work compared male and female CF adults with a healthy male and female control population with regard to (a) clinical variables, (b) actual, perceived, and desired body shape/body mass index (BMI), and (c) body satisfaction, eating behaviors and attitudes, and self-esteem. Clinical data were recorded for 221 adults with CF and 148 healthy controls. All subjects completed BMI Charts (perception of body weight/BMI), the Eating Attitudes Test, and scales of body satisfaction and self-esteem. CF patients had poorer lung function and nutritional status than controls. Control males accurately perceived their body shape/BMI and were content with it, whereas CF males viewed their BMI as greater than it actually was and desired to be much heavier. Control females viewed their body shape/BMI as less than it actually was and desired to be even slimmer, in comparison with CF females, who perceived their BMI as less than it actually was but were happy with their perceived shape/weight. Control subjects, especially females, dieted to a greater extent and were more preoccupied with food (with binge eating and intended vomiting) than CF patients. Conversely, those with CF reported greater pressure from others to eat than did controls. More problems with food/eating behavior were associated with less body satisfaction and reduced self-esteem. In comparison with a healthy control population, the perceptions and behaviors of CF adults relating to eating, weight, and body image are not abnormal. Indeed, females with CF have fewer problems than their healthy peers.

Adolescent↗
PubMed1998

Breastfeeding provides passive and likely long-lasting active immunity.

OBJECTIVES: The reader of this review will learn about the mechanisms through which breastfeeding protects against infections during and most likely after lactation, as well as possibly against certain immunologic diseases, including allergy. DATA SOURCES: I have followed the literature in the area closely for the last 30 to 40 years and have made repeated literature searches through MEDLINE, most recently in 1998. Textbooks and peer-reviewed journals have been sought for, as well as books representing meeting reports in English, French, German, and Spanish. RESULTS: Human milk protects against infections in the breastfed offspring mainly via the secretory IgA antibodies, but also most likely via several other factors like the bactericidal lactoferrin. It is striking that the defense factors of human milk function without causing inflammation, some components are even directly anti-inflammatory. Protection against infections has been well evidenced during lactation against, e.g., acute and prolonged diarrhea, respiratory tract infections, otitis media, urinary tract infection, neonatal septicemia, and necrotizing enterocolitis. There is also interesting evidence for an enhanced protection remaining for years after lactation against diarrhea, respiratory tract infections, otitis media, Haemophilus influenzae type b infections, and wheezing illness. In several instances the protection seems to improve with the duration of breastfeeding. Some, but not all studies have shown better vaccine responses among breastfed than non-breastfed infants. A few factors in milk like anti-antibodies (anti-idiotypic antibodies) and T and B lymphocytes have in some experimental models been able to transfer priming of the breastfed offspring. This together with transfer of numerous cytokines and growth factors via milk may add to an active stimulation of the infant's immune system. Consequently, the infant might respond better to both infections and vaccines. Such an enhanced function could also explain why breastfeeding may protect against immunologic diseases like coeliac disease and possibly allergy. Suggestions of protection against autoimmune diseases and tumors have also been published, but need confirmation. CONCLUSIONS: Breastfeeding may, in addition to the well-known passive protection against infections during lactation, have a unique capacity to stimulate the immune system of the offspring possibly with several long-term positive effects.

Breast Feeding↗
PubMed1984

Central nervous system prophylaxis. Studies showing impairment in verbal skills and academic achievement.

School attendance and school achievement were the parameters studied to assess the pediatric cancer patient's ability to learn and keep pace with their peers. Effects of CNS prophylaxis, as either intrathecal methotrexate (IT) alone or intrathecal methotrexate given in addition to cranial radiation (CRT), were studied in two groups. A third group of cancer patients who received no CNS prophylaxis, and two comparison groups, siblings and a matched sample of children, also participated in the study. Impairment in central nervous system function was measured by means of psychological testing, neurological examination, and computer-assisted tomography. Patients who received central nervous system prophylactic treatments at an early age had poorer performance on verbal IQ scores, with comprehension and arithmetic subscores being most affected. Patients who received both cranial radiotherapy plus intrathecal methotrexate showed a decrease in six out of seven categories of instruction when grades from the year prior to diagnosis were compared to those obtained 3 years after diagnosis. The combined groups of patients with leukemia had a lower grade point average and poorer school attendance than did the comparison groups.

Achievement↗
PubMed2007

Formation of the indigo precursor indican in genetically engineered tobacco plants and cell cultures.

The production of the blue dye indigo in plants has been assumed to be a possible route to the introduction of novel coloration into flowers or fibres. As the human cytochrome P450 mono-oxygenase 2A6 (CYP2A6) can form indigo in bacterial cultures, we investigated whether the expression of the corresponding cDNA in transgenic plants could lead to indigo formation. In a first attempt, we generated tobacco cell suspension cultures expressing the cDNA encoding human CYP2A6. Supplementation of the medium with indole led to the generation of indican (3-hydroxyindole-beta-d-glucoside), a metabolite usually exclusively present in indigoferous dye plants. Hence, the recombinant CYP2A6 converted indole to the reactive metabolite 3-hydroxyindole (indoxyl), whereas rapid glucosylation is obviously conducted by ubiquitous plant glucosyl transferases (GTs). Interestingly, of nine additionally tested plant cell suspension cultures from various plant families, five were also capable of the formation of indican after indole supplementation, although this metabolism was more pronounced in transgenic tobacco cell suspension cultures expressing CYP2A6 cDNA. To evaluate whether indican or even indigo could be produced in whole plants, we generated transgenic tobacco plants harbouring active CYP2A6 together with an indole synthase (BX1) from maize. The genetically engineered tobacco plants accumulated indican, but did not develop a blue coloration. Although the de novo formation of indican in transgenic tobacco plants hampered indigo formation, it supports the contention that biosynthetic pathways can be efficiently mimicked by metabolic engineering.

Aryl Hydrocarbon Hydroxylases↗
PubMed2005

The evaluation of first aid and basic life support training for the first year university students.

In Turkey, the first aiders are few in quantity and yet they are required in many settings, such as earthquakes. It was thought that training first year university students in first aid and basic life support (FA-BLS) techniques would serve to increase the number of first aiders. It was also thought that another problem, the lack of first aid trainers, might be addressed by training medical students to perform this function. A project aimed at training first year university students in FA-BLS was conducted at Hacettepe University. In the first phase, medical student first aid trainers (MeSFAT) were trained in FA-BLS training techniques by academic trainers and in the second phase, first year university students were trained in FA-BLS techniques by these peer trainers under the academic trainers' supervision. The purpose of this study was to assess the participants' evaluation of this project and to propose a new program to increase the number of first aiders in the country. In total, 31 medical students were certified as MeSFATs and 12 of these trained 40 first year university students in FA-BLS. Various questionnaires were applied to the participants to determine their evaluation of the training program. Most of the participants and the authors considered the program to be successful and effective. This method may be used to increase the number of first aid trainers and first aiders in the community.

Adolescent↗
PubMed2002

Do written action plans improve patient outcomes in asthma? An evidence-based analysis.

OBJECTIVE: Current guidelines recommend use of written action plans and peak flow monitoring as key components of asthma care. Our study assesses whether written action plans, with or without peak flow monitoring, have an independent effect on outcomes when used as a component of asthma self-management. STUDY DESIGN: This was a systematic review of published studies. Two independent reviewers followed a prospective protocol for study selection and data abstraction. Outcome data were synthesized qualitatively; they were not appropriate for quantitative meta-analysis. Our comprehensive literature search used MEDLINE, EMBASE, the Cochrane Library, and a hand search of recent bibliographies. The search was limited to full-length, peer-reviewed articles with abstracts in English. The studies were randomized controlled trials that compared the outcomes of an asthma self-management intervention with and without the use a written action plan. The primary outcomes of interest are utilization measures, such as hospitalizations and ER visits. Other outcomes of interest include measures of symptom control and lung function. POPULATION: There were 1501 evaluable patients with asthma; 1410 adults and 91 children. OUTCOMES MEASURED: We measured the frequency of waiting and examination room companions, the reasons for accompaniment, the influence on the encounter, and the overall helpfulness of the companion as assessed by patients and companions. We also determined the physicianamprsquos assessment of the companionamprsquos influence, helpfulness, and behavior during the encounter. RESULTS: Nine randomized controlled trials enrolling a total of 1501 patients met selection criteria. The majority of comparisons in these studies do not demonstrate improved outcomes associated with a written action plan. There are notable methodologic limitations: studies reporting negative findings lack sufficient power, and studies reporting positive findings demonstrate systematic bias. CONCLUSIONS: Although written action plans are widely used, there is insufficient evidence to determine whether their use, with or without peak flow monitoring, improves outcomes.

Adult↗
PubMed1987

Attention deficit disorder in childhood.

Attention deficit disorder refers to a syndrome of pervasive inattention, impulsivity, and hyperactivity that is found in between 3 and 6 per cent of the population. It is commonly associated with conduct disorders and learning disabilities. The etiology of ADD is unknown, but family and adoption studies demonstrate an important role for genetic transmission. Pre- or postnatal central nervous system damage is suggested in only a few cases. Animal models as well as pharmacologic and clinical studies point to abnormalities in the catecholamine system, particularly dopamine function. Although certain psychometric tests are suggestive, no single laboratory marker is specific to ADD, and information from several sources is usually necessary before reaching the diagnosis. These sources may include parents, teachers, and pediatric psychology consultation, as well as clinical interview and physical examination. Children with ADD often suffer ridicule or rejection from family members, teachers, and peers. Treatment may interrupt the cycle of negative reinforcement that can have devastating effects on the self and public image of the child. Educational and behavioral management are the first line of intervention. Pharmacotherapy is also often helpful with stimulants considered the drugs of choice. Methylphenidate may be administered at a dose of 0.3 to 0.6 mg/kg in the morning. This dose may be repeated at noon. D-amphetamine at approximately half this dose is usually equally effective. Other medications such as the antidepressants and clonidine have proven to be effective in the treatment of ADD and may play a role in the management of some children.

Attention↗
PubMed1993

Perspectives of effective treatment for alcohol and drug disorders.

Of the 1918 patients in the follow-up sample used for illustration, 63% reported total abstinence for the year after treatment, and an additional 24% reported at least 6 months of abstinence out of 12. Most relapses occurred during the first 6-month interval; 88% of patients who were abstinent the first 6 months maintained this status for the full year. Patients abusing drugs other than alcohol had much poorer outcomes than those abusing alcohol only, and this finding held up even when drug choice was controlled for sex and age of patients. Intravenous drug use was an important predictor of relapse, as was a history of antisocial behavior. A strong relationship to outcome was seen for patient participation in an aftercare program, and for weekly attendance at peer support group meetings. Emotional distress, relationship difficulties and family problems, financial difficulties, craving, and being around others who use alcohol and drugs are all seen as making the commitment to abstinence more difficult. There is clear evidence also that increased difficulty in these areas is predictive of later relapse. Comparisons of pretreatment and posttreatment measures of patient functioning revealed a decreased need for expensive health care services, such as hospitalization and emergency room care. The motor vehicle accident rate, traffic arrest rate, and criminal offense arrest rate all showed posttreatment declines. On-the-job problems also decreased dramatically following treatment. Posttreatment difficulties were disproportionately higher among patients who had returned to substance use than among patients who remained abstinent, documenting that successful treatment can have an affect in many areas that improve the quality of life for patients themselves (along with their families and communities) as well as reduce the high economic costs associated with alcohol and drug abuse in our society. Cost offsets for chemical dependency treatment are substantial and of broad scope; they also are related directly to the recovery rate. In general, the findings for outpatient programs tend to parallel those of the inpatients. Initial chemical severity and range of other clinical problems are lower, but significant reductions are noted. For both inpatients and outpatients monitored by CATOR, the posttreatment improvement in health care utilizations, reductions in work-related problems, and fewer arrests are related directly to recovery status. That is to say that recovering patients show significantly better improvement than relapsed patients. This means that treatment efficacy must be considered as a key element in estimating treatment benefits.

Alcoholism↗
PubMedDate not supplied

Smoking among adolescent girls: prevalence and etiology.

The prevalence of regular cigarette smoking among 12th-grade girls is about 28%, with the highest rates among whites and the lowest in African-Americans and Asians. Adolescent girls who do not go on to college are more likely to smoke cigarettes than those with college plans. Girls initiate smoking for diverse reasons; it may be instrumental in attaining a desired self-image that includes feelings of maturity, independence, sexuality, health, and sociability. In addition, tobacco advertisements have exploited white, middle-class women's concerns with staying slim by emphasizing the weight-controlling benefits of smoking. Parents, peers, and friends are influential in creating norms that support or discourage smoking. Reasons for ethnic differences in smoking prevalence among adolescent females are poorly understood, but may be linked to economic and sociocultural factors. Future prevention and treatment programs targeting young women should address their reasons for smoking and identify healthful alternative behaviors that will serve psychosocial functions previously met by cigarette smoking.

Adolescent↗