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Peer relationship problems in children with Tourette's disorder or diabetes mellitus.

Peer relationships, social skills, self-esteem, parental psychopathology, and family functioning of children with Tourette's disorder and a chronic disease control group of children with diabetes mellitus were compared. Children with Tourette's disorder had poorer peer relationships than their classmates and were more likely to have extreme scores reflecting increased risk for peer relationship problems than children with diabetes mellitus, but did not report self-esteem problems or social skills deficits. Measures of peer relationships were not related to severity or duration of tics. Children with Tourette's disorder and Attention Deficit Hyperactivity Disorder were at increased risk for poor peer relationships. The psychosocial problems of children with Tourette's disorder do not appear to be the generic result of having a chronic disease.

Adolescent↗

Exaggerated responsiveness to thyrotrophin releasing hormone: a risk factor in women with coronary artery disease.

Thyroid function tests were performed and thyroid antibodies and serum cholesterol concentrations measured in 12 women aged 60 years or under with severe coronary artery disease proved by coronary angiography. This group was compared with 11 women with normal coronary angiography. Ten out of the 12 women with coronary artery disease had an exaggerated response of thyroid stimulating hormone to thyrotrophin releasing hormone compared with two out of 11 controls (p less than 0.008). The mean serum cholesterol concentration was significantly higher in those with coronary artery disease than in the controls. Thyroid antibodies were present in four of those with coronary artery disease and one of the controls. There was no difference in the risk factors for coronary artery disease between the two groups except for cigarette smoking. Eleven out of 12 in the coronary artery disease group smoked cigarettes compared with four out of 11 in the control group (p less than 0.01). Minimal impairment of thyroid function is an important risk factor for coronary artery disease in women.

Coronary Disease↗

Cognitive, and behavioural and emotional functioning of young children awaiting elective cardiac surgery or catheter intervention.

AIMS: To assess the cognitive, and behavioural and emotional functioning of children aged 3 months to 7 years shortly before elective cardiac surgery or elective interventional catheterisation. METHODS: We used the Bayley Scales of Infant Development, and the McCarthy Scales of Children's Abilities, to measure cognitive functioning. The Child Behavior Checklist was used to assess behavioural and emotional problems. RESULTS: We found no significant differences in mean cognitive scores for children scheduled for cardiac surgery or interventional catheterisation when compared with reference groups. This was also the case for children awaiting cardiac surgery as opposed to those awaiting interventional catheterisation, and for those below as compared to those above the age of 2.5 years. Overall, our results regarding behavioural and emotional functioning were comparable to those of normative reference groups. The only difference found was that the children scheduled for cardiac surgery and aged from 2 to 3 years had significantly higher scores on the Child Behavior Checklist than did peers from normative groups. CONCLUSION: Cognitive, and behavioural and emotional functioning, both for young children awaiting elective cardiac surgery and interventional catheterisation, can be considered as quite favourable.

Age Factors↗

Risk factors in schizophrenia: the Stony Brook High-Risk Project.

The goals of the Stony Brook High-Risk Project are to identify precursor patterns, environmental stressors, and protective factors that are differentially predictive of psychopathology. In phase I we assessed 219 families and 544 children aged 7-15, including 31 families and 80 children with a schizophrenic parent, 70 families and 154 children with a unipolar depressed parent, 58 families and 134 children with a bipolar parent, and 60 normal control families with 176 children. A 3-year followup was conducted on 84 percent of the sample, and an additional followup is underway. Our data include measures of: (1) psychological functioning of the parents; (2) the environment, including family functioning, marital adjustment, and parenting practices; (3) child adjustment, including peer, or teacher, parent, and self-ratings; (4) early signs or precursors to the development of schizophrenia or affective disorder, including cognitive slippage, attentional deficits, hedonic capacity, depressogenic attributional styles, and subsyndromal affective patterns. Considerable deviance in family functioning, expressed in conflict, marital discord, and parenting skills, was characteristic of the families with an ill parent, and this discord was related to child adjustment. Children with a schizophrenic parent showed multiple and extensive cognitive, attentional, and social impairments, and at the 18+ followup, 22.8 percent of them compared with 9.6 percent of the normal controls were assigned a DSM-III diagnosis.

Adolescent↗

Impact of peer review in reduction of permanent pacemaker implantations.

Because of a sharp increase in the number of permanent pacemakers inserted at The Brooklyn Hospital between 1972 and 1976, a peer-review committee was established to monitor subsequent pacemaker implantation. Total initial implants declined from 48 to 22 per year in the two years that followed. The number of implantations for sinoatrial bradycardias declined from 50 to 27 and the number of implantations for intraventricular conduction defects declined from 32 to five in the two years after peer review, compared with the two years before. There was no change in the number of pacemakers implanted for complete or advanced heart block. Almost 10% of patients who received a pacemaker between 1972 and 1976 had other conditions that might have accounted for the events that precipitated the decision to implant a pacemaker. The symptoms for which the pacemaker was implanted persisted in 19% of patients, despite a normally functioning pacemaker system. Patients receiving a permanent pacemaker before peer review had a 17% one-year and a 43% three-year mortality. When a more critical patient selection process was instituted, a smaller percentage remained symptomatic (9% vs 19%) and three-year survival rate was improved (86% vs 57%). From 1977 through 1978, when permanent pacemaker implantations declined, the number of hospital, medical service, and coronary care unit admissions increased. It is concluded that peer review can have substantial impact on permanent pacemaker implantations.

Arrhythmias, Cardiac↗

Gender differences in a clinic-referred sample of attention-deficit-disordered children.

This study of attention-deficit-disordered children revealed that females were more frequently retained in school and evidenced greater impairment on spatial memory tasks. Moreover, there was a trend for girls to be older at the time of referral. With age, the girls evidenced more severity across a wider array of measures, including cognitive functioning, poorer academic achievement, and more problems with peers.

Achievement↗

IPRO's Health Care Quality Improvement Program.

IPRO is a peer-review organization in New York State that functions under a contract with the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services for assuring quality of care for Medicare patients. In 1993, IPRO initiated its Health Care Quality Improvement Program (HCQIP). The purpose of this program is to develop information on patterns of care and outcomes, to share this with health care providers, and in so doing effect measurable improvements in care and outcomes. In order to achieve improvements in the quality of care, IPRO has initiated a series of cooperative projects which combine pattern analysis and feedback. These cooperative projects cover a broad range of medical care issues and areas. They have demonstrated that IPRO, providers, and physicians can collaborate to establish and implement efforts to achieve the ultimate goal of improved quality of care for Medicare beneficiaries.

Aged↗

Use of wearable technologies for physical activity promotion in older adults: A systematic review.

This systematic review, conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251055299), examined the use of wearable technologies for promoting physical activity (PA) in adults aged 60 years and older. Searches across five databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane) identified 2438 records, of which only six randomized controlled trials published between 2021 and 2025 met inclusion criteria, with sample sizes ranging from 36 to 551 participants and mean ages between 65 and 79 years. Given the small number of included studies, findings should be interpreted as preliminary. The studies ranged from the standalone use of commercial trackers (Fitbit, Polar, ActiGraph) to multicomponent interventions combining wearables with physiotherapist feedback, telephone counseling, web-based platforms, or interactive cognitive-motor training. Wearables used alone, as in the REACT trial, produced small or non-significant PA effects. In contrast, interventions integrating devices with personalized feedback, professional support, or digital platforms, such as PROMOTE and TASMANIA, were associated with more consistent improvements in PA, physical function, and cognitive outcomes. Multicomponent programs, such as PEER and ICMT, reported broader benefits, including cognition, balance, and reductions in sedentary behavior, though these findings derive from individual trials and require replication. Risk of bias, assessed with the Cochrane Risk of Bias tool version 2 (RoB 2.0), was rated as "some concerns" for five studies and low for only one, mainly due to gaps in randomization reporting, missing data, and lack of preregistration. Tentatively, and based on a very limited evidence base, wearables may have greater impact when embedded within broader behavioral systems, incorporating feedback, coaching, or interactive components, rather than when used in isolation as passive monitoring tools. Adherence and psychosocial outcomes appeared related to comfort and perceived usefulness among older adults, though larger and more robust trials are needed to confirm these patterns.

Humans↗

The EARLY ALLIANCE prevention trial: an integrated set of interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure.

Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.

Adolescent↗

How did Project Northland reduce alcohol use among young adolescents? Analysis of mediating variables.

Project Northland is a randomized trial designed to create, implement and evaluate multilevel, community-wide strategies to prevent alcohol use among adolescents. This paper will focus on the mediating outcomes of the early adolescent phase of Project Northland when the students in the study cohort were in Grades 6-8. The project was conducted in 24 school districts and adjacent communities in northeastern Minnesota. The intervention consisted of social-behavioral curricula in schools, peer leadership activities, parental involvement and education, and community-wide activities. At the end of 3 years of intervention, significantly fewer students in the intervention school districts reported alcohol use than students in the reference districts. Mediation analyses were conducted to investigate if the intervention's effects on mediating variables could explain the reduction in alcohol use. Important mediators of Project Northland's effect on alcohol use were: (1) peer influence to use, including normative estimates, (2) functional meanings of alcohol use, (3) attitudes and behaviors associated with alcohol and drug problems like stimulus seeking, rule violations and bad judgement, and (4) parent-child alcohol-related communication around alcohol use. In addition, among those who did not use alcohol at baseline, self-efficacy to refuse offers of alcohol was a significant mediator.

Adolescent↗

Psychosocial adjustment in children with port-wine stains and prominent ears.

OBJECTIVE: To evaluate psychosocial adjustment in children with port-wine stain (PWS) and children with prominent ears (PE). METHOD: Thirty-two children aged 7 to 16 years with facial PWS and 42 children with PE were evaluated using the Harter Self-Perception Profile, the Revised Children's Manifest Anxiety Scale, the Children's Depression Inventory, the Disfigurement Perception Scale, and the Child Behavior Checklist. Results were compared with normative data for the local population or with a control group. Profile scores were correlated with severity of the PWS or prominence of the ears. RESULTS: Children with PE had poorer self-perception, higher concentration anxiety, and more internalizing and externalizing symptoms, and they were more withdrawn and had more social problems than children with PWS. The children with PWS functioned as well as or better than nondisfigured peers on measurements of psychosocial adjustment, while children with PE scored lower than nondisfigured peers on measures of self-perception and parent-rated social and attention problems. There was no correlation between degree of disfigurement and level of psychosocial adjustment. CONCLUSIONS: Psychosocial adjustment varied according to the nature of the disfigurement or deformity and was unrelated to the severity of the disfigurement.

Adaptation, Psychological↗

Illnesses among United States veterans of the Gulf War: a population-based survey of 30,000 veterans.

Despite numerous studies on veterans of the 1990 to 1991 Gulf War, the fundamental questions of how healthy they are and how their health compares with that of their military peers who were not deployed to the Gulf have not been fully answered. We conducted a health survey in which the health outcomes of a population-based sample of 15,000 Gulf veterans representing various military branches and unit components (regular, reserve, National Guard) were compared with those of 15,000 non-Gulf veterans who were randomly sampled to mirror the number in the same military strata in the Gulf veteran group. In comparison with their peers, Gulf veterans had a higher prevalence of functional impairment, health care utilization, symptoms, and medical conditions and a higher rate of low general health perceptions. A longitudinal follow-up of the health of these veterans will be needed to detect changes in health status and to detect diseases with a long latency period.

Adult↗

Agreement between parents' and teachers' ratings of behavioral/emotional problems of children aged 4-12.

Parents' and teachers' reports of behavioral/emotional problems in 1161 children aged 4-12 from the general population and assessed via the Achenbach Child Behavior Checklist were compared. Low to moderate agreement was found, with parents reporting more problems than teachers. Agreement was higher for externalizing problems than for internalizing problems and higher for children receiving special education than for those receiving regular education. Agreement was slightly higher for older than younger children. Sex of the child did not influence parent-teacher agreement. Teachers scored children higher on problems related to peer relations and on problems interfering with academic functioning, whereas parents scored their children higher on problems associated more strongly with externalizing than with internalizing syndromes.

Affective Symptoms↗

Atherosclerosis precursors in Finnish children and adolescents. XII. Smoking behaviour and its determinants in 12-18-year-old subjects.

The cross-sectional study of 1980 for atherosclerosis precursors in Finnish children and adolescents aimed at a wide coverage of the relevant relationships of the smoking behaviour to socioeconomic and psychosocial factors. The initiation and establishment of the smoking habits were primarily viewed as a function of the youngsters' main socializing agents: the peer group and the family. A subpopulation comprising 1,790 children and adolescents aged 12, 15 and 18 years of the total sample was included in the study on smoking behaviour. The information on smoking habits was collected in connection with the medical examination in a solitary room where the youngsters could respond undisturbed. Data on the children's families were obtained by means of a general questionnaire filled out by the parents. The prevalence of daily smoking was 1% in the 12-year-old, 10% in the 15-year-old, and 30% in the 18-year-old subjects. The best friend's behaviour was the best predictor of an adolescent's smoking behaviour, although the family had retained its role as an important model as regards the learning of smoking behaviour. Quitting school turned out to be a major event leading to an increased risk of becoming a habitual smoker. No clear associations between socioeconomic status of the family and daily smoking were found, except that farmers' children had generally lower rates of daily smoking than children from other socioeconomic groups. First contacts with tobacco formed part of a normal behaviour pattern at a certain age, and this experimentation was unrelated to a later regular habit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Why do teens smoke? American Indian and Hispanic adolescents' perspectives on functional values and addiction.

Tobacco use by the young is one of the greatest public health concerns in the United States and is targeted by a number of prevention and control programs. A fuller understanding of the social and cultural values that youths attach to smoking is important in achieving focused, effective prevention strategies. Drawing on data collected through individual and focus group interviews, this article examines reasons that Hispanic and American Indian youths give to explain their smoking. The analysis presented here focuses on two interrelated sets of reasons: the functional values of tobacco use (including mood management, peer influences, and image maintenance) and addiction. This article concludes with a discussion of the implications these data may have for prevention and cessation programs aimed at youth and outlines ideas for an anthropological research agenda on youth and tobacco.

Adolescent↗

Reducing substance dependence in elderly people: the side effects program.

OBJECTIVES: To reduce benzodiazepine, narcotic and total prescription medication use in community-dwelling elderly people with suspected substance dependence. METHODS: A community-based substance dependence program for seniors was established, and referrals were accepted from a wide variety of sources (self-referral, families, emergency departments, family physicians, community agencies, etc). The service typically included several home visits by a nurse and/or social worker trained in recognizing and treating substance dependence in the elderly, medical assessment by a geriatrician and generation of a client-directed treatment plan. Treatment plans included individual and family counselling, recommendations regarding medication changes and involvement in a peer support/education group. Medication use, health care utilization, functional status, cognition and depression scales were collected before and six months after intervention. RESULTS: Of the 95 elderly patients with substance dependence that were seen over a period of 12 months, 55 agreed to participate in the program. Substance dependence included alcohol dependence in 23 participants, benzodiazepine dependence in 20 participants, narcotic dependence in six participants and mixed dependence in six participants. Involvement in the program was associated with significant reductions in depression scale scores (P=0.02), number of daily prescription medications (P=0.002), benzodiazepine use (P=0.01), narcotic use (P=0.04) and number of acute hospitalizations (P=0.001). No significant changes were noted in cognition, functional status, total prescription costs, office visits or emergency room visits. CONCLUSIONS: A community-based sub- stance dependence program for elderly people may significantly reduce narcotic, benzodiazepine and prescription medication use in this population. Further studies are needed to determine the cost effectiveness of such programs.

Activities of Daily Living↗

An integrated architecture for deploying a virtual private medical network over the web.

In this paper we describe a pilot architecture aiming at protecting Web-based medical applications through the development of a virtual private medical network. The basic technology, which is utilized by this integrated architecture, is the Trusted Third Party (TTP). In specific, a TTP is used to generate, distribute, and revoke digital certificates to/from medical practitioners and healthcare organizations wishing to communicate in a secure way. Digital certificates and digital signatures are, in particular, used to provide peer and data origin authentication and access control functionalities. We also propose a logical Public Key Infrastructure (PKI) architecture, which is robust, scalable, and based on standards. This architecture aims at supporting large-scale healthcare applications. It supports openness, scalability, flexibility and extensibility, and can be integrated with existing TTP schemes and infrastructures offering transparency and adequate security. Finally, it is demonstrated that the proposed architecture enjoys all desirable usability characteristics, and meets the set of criteria, which constitutes an applicable framework for the development of trusted medical services over the Web.

Certification↗

Chronically ill but still adolescent.

Most children with chronic conditions survive to, at least, age twenty. This increased survival means that primary care providers will have to deal with chronically ill adolescents. In this paper, we review the existing literature and we analyze whether or not there are differences with their healthy peers regarding their pubertal development, family structure and functioning, friends, academic achievement, and risky behaviors, using a non-categorical approach.

Adolescent↗