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PubMedDate not supplied

[Selected ethical problems in neonatology -- opinions of physicians and nurses based on questionnaire study].

UNLABELLED: AIM OF THIS PAPER: To present the opinions of doctors and nurses on the limitations of resuscitation and treatment of extremely premature newborns. MATERIAL AND METHODS: Anonymous questionnaire studies were carried out in 342 doctors and 1194 nurses from 6 provinces of Poland. The authors compared the answers of doctors and nurses as well as the answers form different provinces. The results were processed using the Chi2 test, with the significance level p<0.05. RESULTS: The will to resuscitate the neonate, regardless of its birth weight was declared by 29% of the physicians and 49% of the nurses, regardless of the gestational age - by 21% of the physicians and 47% of the nurses. Resuscitation of an extremely immature, asphyctic newborn was declared by 71% of the physicians and 59% of the nurses. Limitation of therapy after diagnosing severe intracranial hemorrhage is declared by 67% of the physicians and 45% of the nurses. 37% of the doctors and 30% of the nurses would comply with parents' will when deciding about resuscitation. 44% of the physicians and 31% of the nurses declare taking parents' decision into account in the matter of abandoning resuscitation. CONCLUSIONS: 1. There is a higher percentage of persons convinced about the necessity of resuscitation of every newborn, regardless of its maturity, among the nurses than among the doctors. 2. Among the nurses there are more persons, who are sceptical about saving the extremely premature newborns born with asphyxia, whereas among the doctors there are more persons inclined to stop therapy in case of a severe intracranial hemorrhage. 3. The most controversial are problems concerning the consideration of parents' will in decision about whether to continue or abandon resuscitation, but physicians are more apt to regard parents' will in resuscitation in some situations. 4. The analysis of the questionnaire points to the need for deeper knowledge of the present mortality rates of the extremely immature newborns and further development of the surviving ones among the physicians and nurses.

Adult↗

PubMed1997

Childhood suicidal behavior. A developmental perspective.

This article provides an overview of the sociocultural and psychosocial features and implications for treatment of prepubertal suicidal children. It provides cross-sectional and longitudinal information about specific risk factors of prepubertal suicidal behavior with a focus on how these factors also predict future suicidal behavior. A developmental focus addresses issues of cognitive and emotional immaturity as related to early onset suicidal behavior.

Adolescent↗

PubMed1998

Further validation for the Cramer Defense Mechanism Manual.

This article presents psychometric properties of the Cramer Defense Mechanism Manual (Cramer, 1991b) for the Thematic Apperception Test (Murray, 1943). The developmental hierarchy of defenses originally postulated by Cramer was supported in this cross-sectional sample. Gender differences and the validity of distinguishing between "mature" and "immature" levels of defense were also investigated. Findings for gender differences largely replicate those previously reported by Cramer (1987, 1991a). Results also support the view of a developmental hierarchy of defenses and the validity of distinguishing between mature and immature levels of two of the three types of defenses.

Adolescent↗

PubMed2003

Spinal blood flow in 24-hour megadose glucocorticoid treatment in awake pigs.

OBJECT: Because of the controversy regarding the benefits of 24-hour administration of methylprednisolone in patients with spinal cord injury (SCI), it is important to investigate its mechanism of action and side effects. This study was conducted to determine if high-dose methylprednisolone modulates neural and vertebral blood flow in an awake large-sized animal model without SCI. METHODS: From a group of 18 immature female domestic pigs born to nine different litters, nine animals were randomly allocated to receive methylprednisolone treatment, whereas their nine female siblings served as controls. Drug or placebo was applied in a blinded fashion by a third person not involved in the study. The following treatment for SCI, as suggested by the North American Spinal Cord Injury Study, was administered to the awake pig: methylprednisolone (30 mg/kg of body weight) was infused into the jugular vein during a 15-minute period, followed by a 45-minute pause, and the infusion was maintained over a 23-hour period at a dose of 5.4 mg/kg body weight/hour. By means of the radioactive tracer microsphere technique, spinal cord blood flow (SCBF) was measured in the awake standing pig in the cerebrum, and in spinal gray and white matter, nerve roots, endplates, cancellous bone, cortical shell, and T12-L2 discs. Blood flow was measured before, 1 hour after initiation of infusion, and 24 hours postinfusion. Examination of blood flow in the neural and vertebral tissue samples, as well as of central hemodynamics, revealed no significant difference between the experimental and control groups, and this parity was maintained throughout the experimental phases. CONCLUSIONS: In the awake pig model, 24-hour methylprednisolone treatment does not modulate cerebral or SCBF, nor does it increase the risk for vertebral osteonecrosis by producing vertebral ischemia.

Animals↗

PubMed1999

Craniofacial maturity and perceived personality in children with Down syndrome.

In this pair of studies, we examined whether the common perception of a positive Down syndrome personality is associated with a youthful craniofacial appearance, similar to Zebrowitz's (1997) "babyface." In Study 1, 43 observers rated photographs of age-matched children with Down syndrome, another mental retardation syndrome (5p- syndrome), and typically developing children. Those with Down syndrome were perceived as being more physically babyfaced and more likely to behave in an immature manner. We controlled for the effect of familiarity with Down syndrome in Study 2 by employing a within-etiology design in which 128 observers rated 12 pictures of 10-year-old children with Down syndrome. Results showed that more physically babyfaced children with Down syndrome are more subject to the overgeneralization.

Adult↗

PubMedDate not supplied

[Personal experience with ultrasonic diagnosis of hypertrophic pyloric stenosis in infants].

Until wide use of ultrasound in diagnostic procedures took its part, the only relevant procedures to diagnose Infantile Hypertrophic Pyloric Stenosis (IHPS) were clinical examination and X-ray of gastroduodenal tract. Use of diagnostic ultrasound avoids harmful effects of X-rays on immature children's tissues. Reliability of the procedure is very high. In the period between July 1993 and January 1999 we diagnosed 12 cases of IHPS in our Hospital by ultrasound examinations. Eleven patients were males between five and eight weeks of age, and one female was six weeks old. In six of them the finding was confirmed by radiological examination (on surgeon's request), in one neither radiological examination not surgery was performed, and five were operated on the basis of only ultrasound finding. In eleven operated patients ultrasound finding is proven by surgery.

Female↗

PubMedDate not supplied

Rationale for and work of the Perinatal Trials Service.

The Perinatal Trials Service provides a service to busy clinicians who wish to mount large simple-in-design randomized trials. The trials aim to identify moderate, but clinically useful, effects of promising treatments for the most important problems in perinatal care. A combination of a flexible five-person core resource and a cadre of staff employed to work on specific trials allows a programme of trials to be conducted successfully and efficiently. The Perinatal Trials Service has three main areas of work: prevention and treatment of immaturity and its consequent morbidity; identification and management of the compromised fetus or baby; and prevention and treatment of maternal morbidity. Examples of projects from each area are described.

Perinatology↗

PubMed2004

[Neuropsychological profile of intractable partial epilepsies].

The neuropsychological assessment is an essential part of the clinical work-up of patients suffering from pharmaco-resistant epilepsy. The aim of the present article is to give an overview of the assessment with regard to the functions tested, the techniques employed and the factors influencing the interpretation of the results. In the first part of the article, the role of the neuropsychological evaluation is discussed in relation to other methods of clinical investigation, such as EEG, brain imaging techniques and sodium amytal exploration, all of which intend to identify the localization (region and laterality) of the epileptogenic focus. This is particularly important for patients slated for epilepsy surgery. In addition, the neuropsychological exam aims to determine the extent of the deficits in various cognitive and sensori-motor domains by taking into account the structural and/or functional reorganization that may have taken place and the compensatory mechanisms that are available to the patient. In this context, the effect of various factors influencing the mental and emotional functioning of the patient, such as the age at onset and duration of the epilepsy, the presence of a structural lesion, the type and number of anticonvulsant drugs, the personality and the adaptability of the patient must be considered. In children, the effect of recurrent seizures may be more devastating since these risk to interfere with normal brain development. On the other hand, the greater plasticity of the immature brain provides a larger window in which compensation can take place. Evidence suggests that attentional processes are affected in all types of epilepsy. Furthermore, the antiepileptic medication may have a deleterious effect on the cognitive and emotional status of the patient, particularly in patients with pharmaco-resistant epilepsy who are usually taking a combination of anticonvulsant drugs. The second part of the article presents localization-specific neuropsychological impairments and the tests most suited to reveal these deficits. Thus, in temporal lobe epilepsy, memory functions are more affected than in other types of partial epilepsy, whereas intellectual functions are usually preserved. However, recent studies cast some doubt on the prevailing view that left-hemisphere foci are associated with verbal memory deficits only and that right-hemisphere foci solely affect visuo-spatial memory. The dichotomy appears to be more subtle, especially in patients with a long-standing seizure history. Frontal foci produce deficits in motor coordination, attention, working memory and executive functions. These deficits appear to be more pronounced in children than in adults. Few studies have explored the neuropsychological consequences of parieto-occipital foci given that this type of epilepsy is relatively rare. The neuropsychological profile of the patient should guide healthcare providers to implement the necessary remedial measures to facilitate the patient's social integration and to improve his quality of life.

Adult↗

PubMed1988

[Analysis of different lymphocyte subpopulations in patients with nonspecific ulcerative colitis].

A complex of methods based on a rosette forming reaction, was used to study the content of different lymphocytic populations in the peripheral blood of persons with nonspecific ulcerative colitis. Imbalance in the system of immunocompetent cells was shown to develop in this disease: a decrease in the amount of suppressors (T gamma and theophylline sensitive lymphocytes) and a increase in the amount of immature postthymic cells: cells forming rosettes with autologous erythrocytes, and theophylline dependent lymphocytes.

Adolescent↗

PubMed1998

[Forensic psychiatric examinations of the mentally retarded].

3,343 forensic psychiatric examinations were recorded in Norway from 1980 to 1996. 294 patients were diagnosed as mentally retarded. The annual number of mentally retarded persons increased during the observation period, but the relative percentage remained stable. The majority of the retarded persons being discussed had been charged with sexual felony, and some with arson. About half had previous convictions. Few had problems with alcohol or other intoxicants. Every fourth retarded person examined was considered not only to be mentally retarded, but also to suffer from other psychiatric disorders. We discuss to what extent deinstitutionalization of retarded persons and the accompanying social isolation they experience could contribute to the increase in maladaption and criminal behaviour. It is stressed that many of the sexual felonies may be explained by the fact that the mentally retarded are mentally immature.

Female↗

PubMed2005

'Wristlock restraint' and physeal injuries of the distal radius.

Wristlock is a commonly used physical restraining manoeuvre to control aggressive and violent persons in penal and medical institutions. We report three cases of similar physeal injuries to the distal radius sustained consequent to a wristlock restraint. There may be a higher morbidity involved when wristlock restraint is used on those with an immature skeleton. We recommend that caution must be exercised whenever a wristlock restraint is used on individuals under 16 years of age.

Adolescent↗

PubMed1986

Basophil histamine release in cord blood. Regulatory role of IgE.

Thirty-two cord blood samples were studied for histamine releasing capability by using a sensitive glass microfibre-based histamine analysis. Histamine was obtained after challenge with anti-IgE in 24 of the 32 samples. However, the net release in cord blood was only 25% of that in adult blood and no relationship was found between histamine release response, total IgE in cord plasma, and a family history of atopic diseases. The low histamine release in cord blood seemed to be associated with the immunological IgE receptor complex activation and not with an immature basic cell function, since the calcium ionophore A23187 which bypasses the receptor complex induced identical histamine release curves in cord and adult blood. Furthermore, when comparing the results of passive sensitization of basophils from new-born and adult persons, the new-born basophils possessed a significant fraction of free IgE receptors, whereas in adults most of the receptors were occupied by IgE.

Adult↗

PubMed2002

Psychological defenses of Danish medical students.

Patterns in the psychological defenses of medical students may have implications for the way they handle and respond to the pressures and developmental issues they encounter in medical school and beyond. Using the Defense Style Questionnaire (DSQ40) to assess psychological defenses, a sample of first-year Danish medical students was compared with a sample of students at a short-term boarding school for general education. The medical students scored significantly higher on items connected with pseudo-altruism, denial, and undoing. Trends in the data furthermore suggest a greater use of sublimation, rationalization, and dissociation among medical students. When defense mechanisms were labeled into mature, neurotic, and immature categories, there were no differences between the groups or in the total defense scores.

Adult↗

PubMed2005

Reports on defense styles in depression.

INTRODUCTION: 'State effect' of depression on personality makes its assessment during depression difficult. Many clinicians do not only refer to the patient, but use additional information sources, especially reports from close informants. Our hypothesis was that an informant could assess the defensive functioning of the depressed patient. The objective of this study was to investigate the validity of the informants' assessment of defense styles in depressed patients. METHODS: Sixty-three inpatients with DSM-IV major depression as primary diagnosis were included. They were administered the Defense Style Questionnaire (DSQ) at admission (D0) and 28 days after treatment (D28) according to their current state. At the same time, informants rated an adapted version of the DSQ (INF-DSQ), according to the patient's current (D0 and D28) and premorbid defensive functioning (D0). Otherwise, severity of depression was assessed using the 17-item Hamilton Depression Rating Scale at D0 and D28. RESULTS: Agreement between patient's and informant's DSQ scores was moderate, both at D0 and D28, even if comparison of mean defense scores does not show significant difference. Mature defense scores significantly increased between D0 and D28, whereas immature defense scores significantly decreased, with both the DSQ and INF-DSQ. During the episode, informants are able to discriminate premorbid from current D0 defenses, but not from current D28 defenses. CONCLUSION: Even if this study has strong limitations, our results argue for the interest of close informants to assess premorbid personality. Before it could be validated, the INF-DSQ should be further studied in other subgroups of patients, especially its ability to give accurate descriptions of patient's premorbid defenses during an acute episode.

Adaptation, Psychological↗

PubMed2006

Personality traits as risk factors of depression and anxiety among Japanese students.

The aim of this study is to examine the effects of personality (temperament and character) on specific depression and specific anxiety. A total of 541 Japanese undergraduates were investigated by using the Temperament and Character Inventory (TCI) and the Hospital Anxiety and Depression (HAD) scale. Hierarchical multiple regression analyses demonstrated that specific depression was predicted by lower Reward-Dependence, Persistence, Self-Directedness, Cooperativeness, and Self-Transcendence; specific anxiety was predicted by higher Novelty-Seeking, Harm-Avoidance, Persistence, and Self-Transcendence, and lower Self-Directedness. Immaturity of Self-Directedness is a risk factor for negative affectivity. Immaturity of all character dimensions is a risk factor for specific depression. The relationship between Harm-Avoidance and depression in previous studies may be linked partly to somatic symptoms that were deliberately eliminated in the HAD scale.

Adult↗

PubMedDate not supplied

Begnign bone tumors of childhood.

The diagnosis of a bone tumor in a child can be a source of great anxiety for the patient, the parents, and the treating physician. Fortunately, most bone tumors in children are benign. Although there are a variety of benign bone tumors that affect skeletally immature patients, most have such characteristic clinical and radiographic presentations that the diagnosis can be made with reasonable accuracy without a biopsy. However, some benign bone tumors can simulate a malignant process and may be best handled by referral to a person trained in orthopaedic oncology for additional evaluation. Treatment alternatives are in part related to the Musculoskeletal Tumor Society stage of the lesion. Recurrences of certain lesions, such as aneurysmal bone cysts and osteoblastomas, can be problematic. By becoming familiar with the presentation of the more common benign bone tumors in children, physicians will be able to alleviate fears, establish a diagnosis, and make treatment recommendations in the most effective manner.

Bone Neoplasms↗

PubMed2003

Coping and defending: age differences in maturity of defence mechanisms and coping strategies.

Previous studies have examined either coping strategies or defence mechanisms; however, few have considered both. This research examined age differences in the type of defence mechanisms and coping strategies that people employ. In addition, gender differences, personality, and environmental variables were taken into account. The three age groups used in this study included: 17-23 year olds, 40-47 year olds, and 63-70 year olds. The youngest participants used significantly less mature defence mechanisms and significantly more immature defence mechanisms than the middle-aged and the oldest group. However, there was no significant difference in maturity of defence mechanisms between the middle-aged and the oldest group. In contrast, there were no age differences revealed for effectiveness of coping strategies people employ. One further interesting finding was that people with a higher purpose in life were more likely to use mature defence mechanisms. This research concludes that when developing theories on stress, psychologists might benefit from considering both defence mechanisms and coping strategies.

Adaptation, Psychological↗

PubMedDate not supplied

Immunodeficiency of the elderly.

The elderly are at risk for an increased incidence and severity of certain infections. The contribution of age-related immunologic impairment to the pathogenesis of these infections has been difficult to determine because of a number of confounding variables associated with aging. Nevertheless, studies in vitro and in animals support the hypothesis that immunodeficiency accompanies the aging process. Multiple factors may be responsible for altered cell-mediated immunity in the elderly, including thymic involution, reduced levels of thymic hormones, and an increase in the number of immature T lymphocytes. While studies of T cell subpopulations have yielded conflicting results, it appears that T cell proliferative responses are diminished. Aging is also associated with abnormalities of humoral immunity. Although the number and functional activities of neutrophils from healthy elderly persons are relatively intact, diminished bactericidal activity and altered oxygen metabolism have been reported in extremely old individuals. While the relative importance and clinical impact of these immunologic abnormalities remain unclear, future studies may provide new strategies for the prevention and treatment of infections in this rapidly growing segment of the population.

Aged↗