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PubMed1998

Influence of age on extended thymectomy as a treatment for myasthenia gravis.

This retrospective study examines the influence of age on extended thymectomy as a treatment for myasthenia gravis. From 1979 to 1997, 58 patients with myasthenia gravis underwent extended thymectomy at Miyazaki Medical College Hospital. We used the onset age of the disease to divide these patients into two groups: Group A included 14 patients >/= 50 years of age; Group B, 44 patients < 50. Using Osserman's classification and the duration of the disease prior to hospitalization, we observed no significant differences between the two groups although thymoma were more prevalent in Group A. All 58 patients underwent extended thymectomy, with no surgical mortalities. The mean duration of tracheal intubation after thymectomy for Group A was 6.25 days; for Group B, 4.66 days without statistically significant differences between both groups. Using Masaoka's criteria, we evaluated the clinical course of myasthenia gravis following extended thymectomy for each of the 58 patients. The remission rates in Groups A and B were 28.6% and 29.5%, respectively; the improvement rates, 71.4% and 79.5%, respectively with no significant differences among groups. These findings suggest that the clinical course of myasthenia gravis following extended thymectomy is not age-dependent and that extended thymectomy is a clinically safe and effective treatment option for myasthenia gravis patients >/= 50 years of age.

Adolescent↗

PubMed1998

Emotional and behavioural problems in primary school children from nuclear and extended families in Korea.

The changes occurring within Korean society provide an opportunity for studying the influence of family structure on children's emotional and behavioural problems. Children aged 7-13 years from two Korean cities were assessed for emotional and behavioural problems in school by their teachers, using the Children's Behaviour Questionnaire. In Study 1, 326 children from extended families were compared with demographically matched nuclear family children in the same school classes. In Study 2, a further sample of 204 extended family children was compared with pair-matched nuclear family children, in order to replicate the findings. Children from Study 1 were followed up 2.5 years later. Children from extended families had lower behaviour problems scores and the prevalence of serious problems was lower in extended family children. These differences were most marked in relation to externalising behaviour problems and were stable over the studies and time. Grandparents in extended families may increase children's resiliency by providing sources of attachment, affection, and knowledge, as well as having indirect effects through their support of parents. Consistent with recent ideas about the cognitive bases for behaviour problems, it may be that rules for behaviour derived from traditional cultural beliefs and values are internalised by children from extended families and generalise to prevent behaviour problems in school.

Adolescent↗

PubMed1998

Radical cystectomy: extending the limits of pelvic lymph node dissection improves survival for patients with bladder cancer confined to the bladder wall.

PURPOSE: We assess the influence of the limits of pelvic lymph node dissection on survival following radical cystectomy for bladder cancer. MATERIALS AND METHODS: From January 1990 to September 1997, 194 patients underwent radical cystectomy without prior treatment. Between March 1993 and September 1997, 126 consecutive patients underwent radical cystectomy with extended pelvic lymph node dissection beginning at the bifurcation of the aorta, including the common and external iliac vessels, presacral nodes and obturator fossa. Between January 1990 and March 1993, 68 consecutive patients underwent radical cystectomy, with limited pelvic lymph node dissection beginning at the bifurcation of the common iliac vessels, including the external iliac vessels and obturator fossa. The cystectomy procedure remained unchanged throughout this period and 1 surgeon performed all procedures. RESULTS: A total of 117 patients had tumors confined to the bladder wall (stage pT3a or less) and 77 had tumors penetrating beyond the bladder into perivesical fat or adjacent structures (stage pT3b or greater). The prevalence of patients with tumors penetrating the bladder was higher in the extended dissection group (42.9 versus 33.8% limited dissection). The incidence of lymphatic involvement was 26.2% and slightly higher in the extended than the limited dissection group. There was a modest improvement in the 5-year recurrence-free survival for the extended dissection group (62 versus 56% limited dissection, p = 0.33), and a substantial improvement for the subgroups with tumors confined to the bladder wall (tumor stage pT3a or less) (85 versus 64%, p <0.02) and without lymph node metastasis (stage pT3a or less, pN0) (90 versus 71%, p <0.02). Accordingly, extended pelvic lymph node dissection reduced the 5-year probabilities for pelvic and distant metastasis (2 versus 7% limited dissection, p = 0.17 and 10 versus 21%, p = 0.15, respectively) for patients with tumors confined to the bladder wall (stage pT3a or less). Survival was similar for patients with pT3b or greater tumor. CONCLUSIONS: This retrospective analysis suggests that extending the limits of pelvic lymph node dissection from the bifurcation of the common iliac vessels to the bifurcation of the aorta improves the recurrence-free survival rate for patients undergoing radical cystectomy for bladder cancer confined to the bladder wall (stage pT3a or less).

Adult↗

PubMed1989

The relative risk of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. A case-control study. Microbial Keratitis Study Group.

Over 13 million people in the United States wear soft contact lenses for refractive correction. Ulcerative keratitis is considered the most serious adverse effect of the use of contact lenses. We performed a case-control study with 86 cases patients, estimating separately for hospital-based (n = 61) and population-based (n = 410) controls the relative risk of ulcerative keratitis among users of extended-wear as compared with daily-wear soft contact lenses. The relative risk of ulcerative keratitis for extended-wear as compared with daily-wear lenses among the population-based controls was 3.90 (95 percent confidence interval, 2.35 to 6.48) and among the hospital-based controls, 4.21 (95 percent confidence interval, 1.95 to 9.08). Thirty-eight percent of those with extended-wear lenses used them only during the day, and 11 percent of those with daily-wear lenses occasionally wore them overnight. When lens wearers were distinguished according to their overnight use of lenses, the users of extended-wear lenses who wore them overnight had a risk 10 to 15 times as great as the users of daily-wear lenses who did not, and the users of daily-wear lenses who sometimes wore them overnight had 9 times the risk of the users of such lenses who did not. For the users of extended-wear lenses, the risk of ulcerative keratitis was incrementally related to the extent of overnight wear. A reduction in risk associated with more frequent attention to lens hygiene was almost significant. We conclude that soft contact lenses worn overnight carry a significantly greater risk for ulcerative keratitis than soft lenses worn only during the day.

Contact Lenses, Extended-Wear↗

PubMed1990

Is daily wear better than extended wear? Arguments in favor of daily wear.

The use of contact lenses for extended wear appears to be accompanied by an increase in several complications, the most serious of which is corneal infection. It has been proposed that infection is due to corneal epithelial layer microtrauma and lens care system contamination, but noncompliance, contamination of care systems, and microtrauma [especially among keratoconics and polymethylmethacrylate (PMMA) lens users, for example] are so common in daily wear that we believe they are insufficient to explain the approximately sixfold increase in the rate of corneal infection with extended wear. Perhaps the chronic hypoxic stress of extended wear use of contact lenses substantially reduces the resistance of the epithelium to either injury or microbial infection. Until evidence is provided that new contact lenses have sufficient oxygen transmissibility (Dk/L) to fully satisfy corneal oxygen needs under extended wear conditions, and the extended wear use of such lenses is thoroughly tested in a study population, we believe that the majority of contact lens patients should be maintained on daily wear schedules.

Contact Lenses, Extended-Wear↗

PubMed1983

Comparison of results obtained with keratophakia, hypermetropic keratomileusis, intraocular lens implantation, and extended-wear contact lenses.

The limited experience with LRK precludes a valid comparison with IOLs and extended-wear contact lenses. Only observations, unsupported by valid statistical analysis, are possible. Some of these observations follow. Technically, LRK is very difficult. In their present form, the classic Barraquer procedures could never be used widely. However, if lenticle banks were to supply preground lenticles, the level of difficulty of LRK procedures would be comparable to IOL implantation. The magnitude of refractive correction possible with LRK compares favorably with that of contact lenses and IOLs. However, the accuracy of achieving a given correction is lower with LRK. Unlike contact lenses or IOLs, LRK induces both regular and irregular astigmatism. The latter accounts, in part, for the delayed visual result with LRK. The percentage of patients with 20/40 or better vision following LRK compares favorably with the percentages for contact lenses or IOLs, whereas the percentage of patients with 20/25 or better vision does not. This is true for at least 1 year following surgery. Compared to extended-wear contact lenses, IOLs and LRK typically require less commitment, fewer postoperative visits, and less expenditure by the patient, in terms of time and money, to achieve full-time correction. Although LRK is associated with a number of postoperative complications, none are known to be intraocular, and there have been no known reports of permanent severe visual loss. In contrast, the patient with an extended-wear contact lens or IOL is permanently at risk to develop sight-threatening complications. This is not the case with LRK, which has no known complications after the early postoperative period. Application of the IOL or extended-wear contact lens to the neonate or pediatric patient is associated with increased risk and difficulty. This may not be true with LRK, especially epikeratophakia. The major advantages of LRK appear to be permanent optical correction without the threat of intraocular or long-term complications and the ability to correct contact lens failures without the necessity of reentering the eye. Its major disadvantage is a slightly reduced visual acuity with delayed visual result. Extended-wear contact lenses, IOLs, and LRK are each unique enough that they should be adjuncts to one another. These corrective modalities should be applied judiciously by the patient-surgeon team to the best advantage of the given patient.

Aphakia, Postcataract↗

PubMed1996

An apparent pH-induced effect on extended wear hydrogel lens water content.

Numerous studies have examined the separate issues of precorneal tearfilm pH and hydrogel lens water content. None have examined the two issues in an associated, clinical fashion. Earlier research by this author has shown that stabilized hydrogel lens anterior surface pH correlates with established values for the precorneal tearfilm pH. This technique was therefore paired with two different methods of hydrogel lens water content assessment to determine if there was a predictable tear pH-related effect on soft lens hydration. Sixty-five volunteer subjects were fitted with either 38% (polymacon) or 58% (etafilcon A) water content hydrogel lenses on an extended-wear basis. The in situ hydrogel lens anterior surface pH was measured with a flat-surfaced, self-referenced pH electrode 5 min after initial fitting, and on subsequent extended wear follow-up examinations. On each follow-up, associated lens water content was determined by gravimetric and/or refractive analysis, yielding a total of 517 paired data points over a 33 month period. While the anterior lens surface pH increased in a nonlinear fashion with immediate duration of extended lens wear [p < 0.001 analysis of variance (ANOVA) by number of days extended lens wear], the water content decreased in a nonlinear fashion under the same conditions (p < 0.001 by ANOVA). Correlation of these two nonlinear functions yielded a negatively sloped linear regression (r = 0.99 and 0.97) for each material. The slopes of the resultant linear functions were significantly different (p < 0.01) by t-test; the higher water content material exhibited a greater sensitivity to pH. The routine labeling of pH-induced water content changes by hydrogel lens manufacturers would provide an objective model for clinical lens behavior, and assist in lens type and parameter selection when fitting extended-wear soft lenses. Additionally, as other lens materials are characterized, it may be possible to model the "ideal" hydrogel material in terms of apparent pH-dependent or-independent behavior.

Contact Lenses, Extended-Wear↗

PubMed1999

Changes in myopic refractive error with nine months' extended wear of hydrogel lenses with high and low oxygen permeability.

BACKGROUND: A small but significant increase in myopia after extended wear of low oxygen permeability (Dk) hydrogel lenses has been previously reported; however, the specific impact of hypoxia on refractive status and corneal curvature with extended wear are not well documented. The purpose of this study was to compare the refractive changes induced over a period of 9 months' extended wear with high-Dk fluorosiloxane hydrogel lenses and low-Dk hydrogel lenses. METHODS: Adapted daily wear contact lens wearers were randomly assigned to one of two groups. The low-Dk group wore etafilcon A (Dk = 28) for up to 7 days and 6 nights and the high-Dk group wore lotrafilcon A (Dk = 140) for up to 30 days and nights. Refractive error and corneal curvature were measured at 3-month intervals over 9 months of extended wear. RESULTS: The etafilcon A group demonstrated an average increase in myopia of 0.30 D over the 9-month period; however, no change in spherical myopic correction was measured in the lotrafilcon A group. The cylindrical component did not change in either group. A stratified analysis revealed a greater increase in myopia for low myopes than moderate myopes in the etafilcon A group but no difference in the lotrafilcon A group. Keratometric analysis revealed no change in the etafilcon A group and a small degree of central corneal flattening in both major meridians of 0.35 D in the lotrafilcon A group. CONCLUSIONS: Nine months of extended wear of low-Dk lenses is associated with a small degree of myopic progression in adult myopes that appears to be reversible. Wearing fluorosiloxane-hydrogel lenses of high-Dk had no impact on refractive error and may be associated with a small degree of central corneal flattening.

Adult↗

PubMed2001

Vascular response to extended wear of hydrogel lenses with high and low oxygen permeability.

PURPOSE: The purpose of this study was to determine the impact of extended wear of high and low oxygen permeability (Dk) lenses on the development or resolution of limbal hyperemia and corneal neovascularization in a randomized prospective clinical trial. METHODS: Adapted daily-wear contact lens wearers were randomly assigned to one of two groups. The low-Dk group (N = 23) wore etafilcon A lenses (Dk/t = 40) for up to 7 days and 6 nights, and the high-Dk group (N = 39) wore lotrafilcon A lenses (Dk/t = 175) for up to 30 days and nights. Limbal hyperemia and neovascularization were assessed and graded during 9 months of extended wear. A stratified analysis to determine how change in ocular redness depended on initial presentation was also conducted. RESULTS: On a 0 to 100 scale, extended wear of low-Dk lenses resulted in a 16-point increase in limbal hyperemia (p < 0.0001); no significant change occurred with the high-Dk lenses. The difference was greatest for low-Dk participants who initially presented with lower levels of hyperemia (N = 18). There was a slight resolution of redness in participants who initially presented with higher levels of hyperemia (N = 10) after wearing the high-Dk lenses. Neovascularization increased by an average of 0.5 on a scale of 0 to 4 in low-Dk lens wearers (p < 0.0001) but remained unchanged in the high-Dk lens wearers. The increase was most marked for the low-Dk group with lower levels of neovascularization at baseline. CONCLUSIONS: Subjects who wore lenses with higher oxygen permeability for 9 months of extended wear exhibited a lower vascular response of the ocular surface compared with subjects who wore lenses of lower oxygen permeability for the same period. This result was found both for the surface limbal vessels and in the deeper neovascular stromal vessels. Moderate neovascularization also developed after 3 months of extended wear of low-Dk hydrogels, whereas high-Dk lenses caused no neovascularization.

Adult↗

PubMedDate not supplied

Extended wear soft contact lenses: to market or not to market.

1. Today, cosmetic extended wear lenses have numerous aliases; continuous wear, provisional extended wear, and flexible wear, all referring to the same products, but on a relative scale of wearing time. Cosmetic extended wear lenses are elective and differ from the medical necessity of extended wear that few patients require. Refractive surgery has made significant advances in the cosmetic extended wear lens market. 2. Despite growing conservatism, positive marketing kept growing the EW philosophy for almost a decade until the FDA laid down some new rules, including a 1-week maximum for overnight wear. Coincidentally, this mandate came with the advent of the disposable lens in 1989. Since then, 1-week EW with disposable contacts has proved to be a safer modality for cosmetic EW; however, the concern of corneal complications continues to decline the market. 3. Patients risk a microbial ulcerative keratitis secondary to cosmetic EW. If daily wear contact lens options or occasional part-time EW is not amenable to the patient, refer the patient to an experienced refractive surgeon. Today, patients have more healthful vision choices than ever before.

Consumer Product Safety↗

PubMed2005

Efficacy of aspirin plus extended-release dipyridamole in preventing recurrent stroke in high-risk populations.

OBJECTIVE: To assess the efficacy of aspirin plus extended-release dipyridamole compared with aspirin alone for the prevention of recurrent stroke among high-risk groups. DESIGN: A post hoc analysis was conducted using data from the European Stroke Prevention Study 2. Rates of annual strokes and vascular events were determined for the aspirin plus extended-release dipyridamole group (n = 1650) and the aspirin-only group (n = 1649), and were stratified by risk subgroup and univariate risk factors. Stroke models from the Framingham Study and the Stroke Prognostic Instrument II were applied to subjects in the European Stroke Prevention Study 2 to categorize patients into risk groups. RESULTS: Compared with aspirin alone, aspirin plus extended-release dipyridamole demonstrated a more pronounced efficacy in reducing the risk for stroke and vascular events among patients younger than 70 years; those with hypertension, prior stroke, or transient ischemic attack; current smokers; and those with any prior cardiovascular disease. Relative hazard reductions favored the combination of aspirin plus extended-release dipyridamole, and were greatest for the high-risk Framingham Study group and the moderate-risk Stroke Prognostic Instrument II subgroup. CONCLUSION: Aspirin plus extended-release dipyridamole is more effective than aspirin alone at preventing stroke, and the difference in efficacy increases in higher-risk patients.

Adult↗

PubMed1983

Corneal edema accompanying aphakic extended lens wear.

Corneal swelling was monitored for nine hours in 14 unilateral aphakic patients who wore +13.25-diopter extended-wear lenses. After closed-eye wear, the corneal swelling was 6.9% and 11.4% for aphakic and phakic eyes, respectively. To determine if aphakic corneal swelling could be predicted from either corneal epithelial oxygen uptake or hypoxic corneal swelling, we measured epithelial oxygen uptake and corneal swelling from hypoxia. These were 3.67 mm Hg/s and 3.96 mm Hg/s and 8.0% and 12.1% for the aphakic and phakic eyes, respectively. Differences in these measurements between aphakic and phakic eyes were significant, but correlations of oxygen uptake rate and hypoxic swelling response to extended-wear edema were modest. A high intrasubject correlation between the edema accompanying extended-wear was found indicating that postsurgical extended-wear corneal edema may be predicted by measuring presurgical extended-wear corneal edema.

Adult↗

PubMed2003

Staging of head and neck squamous cell cancer with extended-field FDG-PET.

BACKGROUND: Accurate baseline staging is necessary to appropriately treat head and neck squamous cell carcinoma. [F-18]-fluorodeoxyglucose positron emission tomography (FDG-PET) is valuable for locoregional staging of primary head and neck disease. The effectiveness of FDG-PET for the detection of distant metastatic or synchronous disease remains unproven. OBJECTIVE: To investigate the utility of FDG-PET extended into the abdomen (extended-field FDG-PET) for wide-field staging of head and neck tumors. METHODS: This is a prospective institutional study of 35 consecutive patients diagnosed with American Joint Committee on Cancer (AJCC)-defined stage II-IV squamous cell carcinoma of the oral cavity, oropharynx, or larynx between September 2000 and June 2002. Thirty-three patients (94%) were eligible for analysis. All patients were routinely staged with chest radiography, liver function tests, and extended-field FDG-PET. Chest or abdominal computed tomographic scans were used as corroborative studies and were obtained only when one of the above tests indicated distant disease. RESULTS: Of 33 patients, 7 (21%) had evidence of distant disease by extend-field FDG-PET-4 with metastases and 3 with synchronous primary cancers of the aerodigestive tract. [F-18]-fluorodeoxyglucose PET detected hepatic, bone, gastrointestinal, and mediastinal disease not identified by chest radiography or liver function tests. Two of the 7 patients with FDG-avid distant disease had false-negative staging by all other tests, including computed tomography. CONCLUSIONS: Extended-field FDG-PET is feasible and may improve staging of primary head and neck squamous cell carcinoma. Use of staging FDG-PET must be explicitly described in reports from centers engaged in prospective research to facilitate comparison with historical results.

Carcinoma, Squamous Cell↗

PubMed2003

Extended esophagectomy with 3-field lymph node dissection for esophageal cancer.

OBJECTIVE: To review the surgical outcomes of extended esophagectomy with 3-field lymph node dissection (3FLND) for esophageal cancer. DATA SOURCES: Only articles written in English and written after 1980 were selected from MEDLINE. The following terms were identified: 3FLND, extensive or extended lymph node dissection (lymphadenectomy), radical lymph node dissection, cervical lymph node dissection, and extended or radical esophagectomy in esophageal cancer. STUDY SELECTION: There were no exclusion criteria for published information relevant to the topic. The most representative articles were selected when there were several articles from the same institution. Case reports were excluded. DATA EXTRACTION: Twenty-six articles were finally col-lected from MEDLINE. Eleven articles were also selected from reference lists of the pertinent literature. DATA SYNTHESIS: The collected information was organized. CONCLUSIONS: The conclusions drawn from those articles showed that extended esophagectomy with 3FLND would be a safe procedure in experienced hands, with low morbidity and acceptable mortality rates. When strict patient selection criteria were maintained, this procedure reduced locoregional recurrence and improved long-term survival rates. Although the therapeutic value of 3FLND is unproved in a randomized trial, extended esophagectomy with 3FLND would be the treatment of choice in selected patients.

Esophageal Neoplasms↗

PubMed2003

Indications for extended hepatectomy in the management of stage IV hilar cholangiocarcinoma.

HYPOTHESIS: In operations for hilar cholangiocarcinoma, simultaneous extended hepatectomy and removal of extrahepatic bile ducts are considered curative resection. However, the effect of extended operations for stage IV hilar cholangiocarcinoma on survival is still unclear. DESIGN: Retrospective review of the treatment of hilar cholangiocarcinoma from 1981 to 2001. PATIENTS AND METHODS: Fifty-seven patients with stage IVA or IVB hilar cholangiocarcinoma were enrolled. Thirty-three of these patients underwent extended hepatectomy to achieve macroscopic radical resection (surgical group). A self-expandable metallic biliary stent (EMBS) was implanted in 24 patients (EMBS group) in whom radical treatment was judged to be impossible. Main Outcome Measure Survival in patients with stage IV hilar cholangiocarcinoma treated by means of extended operation or stenting. RESULTS: Survival was 25.7 +/- 40.9 months in the surgical group vs 6.5 +/- 5.8 months in the EMBS group (P =.03). In the surgical group, radical resection results were macroscopically and histologically successful in 21 patients (64%). In patients with stage IVB disease, survival did not differ between the surgical and EMBS groups. CONCLUSIONS: In patients with stage IVA disease, radical extended hepatectomy should be performed after excluding patients who have extensive invasion of the hepatic artery or portal vein. However, in patients with stage IVB disease with carcinomatous peritonitis or distant metastasis, there is little possibility of achieving long-term survival with surgery, and stent implantation should be the first choice.

Aged↗

PubMed1999

Key adhesion molecules are present on long podia extended by hematopoietic cells.

BACKGROUND: We recently reported that CD34(+) hematopoietic cells and the KG1a cell line extend long, thin podia. These podia can dynamically extend and retract, often adhere to the substrate, and appear to connect cells up to 300 microm apart. The surface receptors found on these podia have not been described. METHODS: By using time-lapse fluorescent microscoscopy and immunostaining techniques, we describe a method for detecting surface receptors on these podia. This includes an in situ antibody staining procedure without fixing cells. RESULTS: We demonstrate, using CD34 selected mobilized peripheral blood cells and KG1a cells, that adhesion molecules known to play important roles in blood-cell migration and adhesion are present on these podia. These include: CD11a, CD18, CD29, CD34, CD45, CD49d, CD49e, and CD62L. Additionally, CD54 and CD44 were present on the podia extended by KG1a cells, but were not detectable on the primary CD34(+) cells. The integrin CD49d localized at the base of these podia in a time-dependent manner in KG1a cells. The frequency and morphology of these long podia on three myeloid leukemia-cell lines (KG1a, MV4-11, and AML-193) and a CD34-negative T-cell line (CEM) are also compared. KG1a and CEM cell lines extend long, dynamic podia that are similar to the podia on primary CD34(+) cells in morphology and adhesion molecule expression. The AML-193 and MV4-11 cell lines, however, did not extend these long podia. CONCLUSIONS: We describe a technique that provides a method of detecting surface receptors on thin cell membrane projections. These results support the likely role of these podia in cell migration and cell-cell communication.

Antigens, CD34↗

PubMed1976

Survival and complications of radiotherapy following involved and extended field therapy of Hodgkin's disease, stages I and II. A collaborative study.

A collaborative trial with random assignment to involved field or extended field radiotherapy for localized Hodgkin's disease was begun in 1967. Case accession was completed in 1973, with 224 eligible patients assigned to involved field and 243 to extended field. With a median follow-up time of 27 months no significant survival difference is found between involved and extended field regimens for the total patient group or for most subgroups defined by age, sex, histology, stage, class, and use of laparotomy for staging. A single exception is an improved survival in the involved field group for female patients. Survival free of distant extension shows a similar lack of treatment effect, but survival free of any extension, local or distant, shows a significant benefit from extended field treatment. Complications of radiotherapy are significantly increased following extended field treatment. Survival following local extension is similar to survival following periods free of any extension.

Adolescent↗

PubMed2000

Mental health of elderly Asians in Britain: a comparison of Hindus from nuclear and extended families of differing cultural identities.

OBJECTIVE: To compare the psychological adjustment of grandmothers from nuclear and extended families within British Hindu communities, and to investigate the influence of cultural identity. DESIGN: Interviews were carried out with Hindu grandmothers, mothers and granddaughters living in both nuclear and extended families. SETTING: The sample was drawn from the total population of Asian Hindu girls aged between 13 and 17 years at four comprehensive schools in the London Borough of Redbridge. PARTICIPANTS++: The final sample consisted of 36 and 34 sets of individuals in extended and nuclear families, respectively. MEASURES: Questionnaire measures were obtained of the following variables: cultural integrity, traditionalism, religious participation, ethnic identity, anxiety, depression, self-esteem. RESULTS: Grandmothers were better adjusted in extended families than in nuclear families. This adjustment was in part mediated by the level of traditional belief within the family. Elders whose granddaughters had an exclusively 'Indian' or 'Hindu' ethnic identity were better adjusted than those whose granddaughters included a 'British' ethnic identity. CONCLUSIONS: This study confirmed findings from earlier studies that grandmothers in extended families were significantly better adjusted in comparison to those from nuclear families. Ethnic identity of the adolescent, independent of its salience and commitment to the adolescent, had a significant relationship to the grandmother's mental health.

Acculturation↗