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PubMed1985

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↗
PubMed2005

Effect of structured interviews on evaluation time in pediatric community mental health settings.

OBJECTIVE: The purpose of this study was to determine whether a structured interview administered by a master's-level clinician and reported to physicians before an initial evaluation would reduce physicians' evaluation time without compromising diagnostic accuracy or clinical outcomes in a pediatric sample. METHODS: A sample of 225 children and adolescents who were seen in public-sector community facilities was randomly assigned either to receive a structured interview (the Schedule for Affective Disorders and Schizophrenia for School-aged Children-Present and Lifetime Versions) by a trained interviewer before the initial physician visit or to receive assessment as usual. Clinical outcome data were collected prospectively, with follow-up at four months. RESULTS: Physicians' evaluation time was reduced by approximately half among physicians who were given preliminary diagnostic information. Physicians' diagnoses were strongly related to the results of the structured interview. Physicians' having access to previously obtained diagnostic information was associated with better psychosocial functioning at follow-up in terms of peer relations and spare-time activities compared with assessment as usual. CONCLUSIONS: Adding a trained diagnostic interviewer to the clinical team could reduce physicians' initial diagnostic evaluation time and improve diagnostic reliability and psychosocial outcomes.

Adolescent↗
PubMed1996

Relationships among affect in play, interpersonal themes in fantasy, and children's interpersonal behavior.

Relationships among children's affective expression in fantasy play, interpersonal themes in projective stories, and concurrent interpersonal behaviors were investigated in 49 children. Participants completed a play task, a projective storytelling task, and a brief IQ measure. Peer and teacher ratings provided measures of interpersonal functioning. Results found that access to and comfort with affect is related to the ability to think in interpersonal ways. Neither affective expression in play nor interpersonal themes in projective stories were related to actual interpersonal behavior.

Journal Article↗
PubMed2002

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↗
PubMed2000

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↗
PubMedDate not supplied

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↗
PubMed2002

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↗
PubMed2006

Minimally invasive total hip replacement: the posterolateral approach.

Our experience with the posterolateral mini-incision technique over the last 8 years has shown that total hip arthroplasty can be performed safely and effectively in properly selected patients through a much smaller incision than the one traditionally used. The main advantage of the posterolateral approach compared with other mini-incisions is its simplicity, with shortened operating time as a result. While the surgical time for a posterior approach is an average of 37 to 70 minutes throughout the literature, the 2-incision approach prolongs the surgery by a factor of 2 or 3. Compared with the anterior or 2-incision approach, the posterolateral and anterolateral approaches also have a much lower incidence of perioperative complications, with the rate being similar to rates seen with a standard incision. For the 2-incision technique and the anterior mini-incision approach, perioperative periprosthetic fracture rates of up to 8.7% and 8.4%, respectively, have been described. Surgeons who traditionally used an anterolateral standard approach might prefer an anterolateral mini-incision. The anterolateral mini-incision total hip arthroplasty has demonstrated excellent results; in the past it was suggested that the anterolateral approach has a higher incidence of heterotopic bone formation and impaired early abductor function, but more recent studies show no difference in abductor strength and limping between the anterolateral and posterior approaches. On the other hand, the posterior approach has been associated with an increased risk of postoperative dislocations. We did not encounter an increased incidence of postoperative dislocation at our institution. This might be related to the routine repair of the external rotators and the capsule in all patients. In summary, both the anterolateral and the posterior mini-incision approaches are reasonable alternatives, and surgeons should choose the approach that they feel most comfortable with. Statements in the press and by some members of the orthopedic community suggest that a smaller incision has revolutionized total hip replacement by accelerating the recovery and improving the functional outcome, but most articles in the peer-reviewed literature fail to confirm these hypotheses. Considering that mini-incision total hip replacement has no dramatic clinical benefits other than the cosmetic appeal, the use of mini-incision total hip replacement by the average orthopedic surgeon should be carefully monitored. In the meantime, the patient should be informed about the true merits of the technique, and any marketing that misleads patients' perception of the technique should be avoided. Because the mini-incision leads to results similar to those obtained with the standard approach, we will, encouraged by the enthusiasm of our patients, continue to use this approach.

Arthroplasty, Replacement, Hip↗
PubMed1987

A professional recognition system using peer review.

The concept of a Professional Recognition System or a Clinical Ladder is not new. In fact, many models appear in the literature and have been implemented in hospitals across the country. However, few models contain the element of peer review. This article describes the development process, structure, and function of a Clinical Ladder program at a pediatric tertiary level hospital. The program grew out of a desire and recognized need on the part of the professional nursing staff to reward outstanding nursing care. Based on the concept of peer review, it underwent many revisions and revealed many lessons that can be put to use by other persons attempting to implement such a program.

California↗
PubMed1992

Five- to fifteen-year follow-up after Fontan operation.

BACKGROUND: The purpose of this study was to estimate survival and quality of outcome and assess factors associated with outcome for patients out 5 to 15 years from their Fontan operation. METHODS AND RESULTS: We studied 352 patients who had the Fontan operation prior to 1985. The overall 1-, 5-, and 10-year survival was 77%, 70%, and 60%, respectively. The following factors were significantly associated with lower survival: univentricular heart or complex congenital anomalies other than tricuspid atresia, early calendar year of operation, heterotaxia syndromes, early age at operation, increased pulmonary artery pressure, atrioventricular valve dysfunction, and higher (worse) New York Heart Association class. Reoperations were necessary for 103 of the 352 patients. At least 20% of the survivors have or have had cardiac arrhythmias requiring antiarrhythmic medication or mechanical pacemaker insertion. Between 7% and 10% of the patients have had or had protein-losing enteropathy/hypoproteinemia. At 5 years postoperatively, 122 patients (34.7%) were alive with a better New York Heart Association functional classification than preoperatively. Fifty-eight patients (16.5%) were alive and in the same functional classification, but 126 (35.8%) died within the first 5 years or were in a worse functional classification. Thirty-nine patients were doing excellently and 29 patients poorly 5 years after the operation. Of the surviving patients, 43% can do as much exercise as their peers, whereas 3% are incapable of exercise. CONCLUSIONS: To assure good functional long-term outcome in addition to survival, clinicians must exclude from selection for Fontan operation patients known to be at high risk for death or poor outcome.

Adolescent↗
PubMed1980

Effects of the labels "mentally retarded" and "retard" on the social acceptability of mentally retarded children.

Effects of the labels "mentally retarded" and "retard" on fifth- and sixth-grade children's attitudes toward peers were studied. Results indicated that children's attitudes (feelings and behavioral intentions) were more positive toward the target child labeled "mentally retarded" than labeled "retard." The data also showed that children's reactions to the two labels were, in part, a function of the physical appearance and academic competence of the peer being rated. Children had the most negative attitudes toward a child labeled "retard" who appeared to be "normal." In contrast, children reacted favorably to the target child labeled "mentally retarded," even when he or she was academically incompetent. Finally, boys were more negative than were girls toward the target child, especially when the child was labeled "retard." Implications for the movement to abandon the use of labels were discussed.

Attitude↗
PubMed2004

Psychosocial functioning of young children with learning problems.

BACKGROUND: In this study, psychosocial functioning of different groups of young children with learning problems was investigated using a diverse set of psychosocial variables (including behaviour problems, academic motivation, social preference, and self-concept). METHODS: For this purpose, children with low academic achievement, with a specific learning disability based on an IQ-achievement discrepancy, and with a specific learning disability based on an achievement discrepancy, were selected out of 276 children of the first grade of regular primary schools. By means of multivariate analyses, their psychosocial functioning was compared to the functioning of children without learning problems. RESULTS: The total set of psychosocial variables was able to discriminate between children with and without learning problems, with medium effect size. Attention problems as reported by the teachers turned out to be the most important single psychosocial predictor for group discrimination. However, results varied according to the type of learning problem and the type of psychosocial problem. Children with a specific reading/spelling disability and children with low general academic achievement differed most from their peers without learning problems with regard to their psychosocial functioning. Poor cognitive self-concept was related primarily to low academic achievement, poor learning motivation might be specific for math problems, and a low social preference score seemed most characteristic of children with a specific learning disability. CONCLUSIONS: Studying several psychosocial variables simultaneously in different groups of children with learning problems leads to a further refinement of the current knowledge.

Child↗
PubMed1990

LD status and achievement: confounding variables in the study of children's social status, self-esteem, and behavioral functioning.

The purpose of the present study was to examine the role of achievement in explaining the poor social and behavioral functioning associated with LD status, and to evaluate potential gender differences in patterns of interpersonal functioning among youth with learning disabilities (LD) and nondisabled (NLD) youth. Thirty-two students with learning disabilities (21 boys, 11 girls) were matched with same-sex, same-race classmates whose reading achievement was low (LA) or average (AA), and these groups were compared on peer ratings of liking and disliking, perceptions of self-worth and social acceptance, and teacher ratings of conduct problems, anxiety-withdrawal, and attention problems. Students with learning disabilities were less accepted and less well-liked than children in the LA or AA groups and also perceived their self-worth and social acceptance to be lower than LA or AA students. Group by Sex interactions were apparent for several of the peer rating and behavioral variables, indicating that different patterns of social and behavioral functioning distinguished LD boys and LD girls from their NLD peers. The findings highlight the potential role of low achievement in peers' dislike of LD girls and suggest the importance of investigating well-defined subgroups of youth with LD in future research.

Achievement↗
PubMed2002

The development and psychometric properties of a measure of social and adaptive functioning for children and adolescents.

Developed, piloted, and examined the psychometric properties of the Child and Adolescent Social and Adaptive Functioning Scale (CASAFS), a self-report measure designed to examine the social functioning of young people in the areas of school performance, peer relationships, family relationships, and home duties/self-care. The findings of confirmatory and exploratory factor analysis support a 4-factor solution consistent with the hypothesized domains. Fit indexes suggested that the 4-correlated factor model represented a satisfactory solution for the data, with the covariation between factors being satisfactorily explained by a single, higher order factor reflecting social and adaptive functioning in general. The internal consistency and 12-month test-retest reliability of the total scale was acceptable. A significant, negative correlation was found between the CASAFS and a measure of depressive symptoms, showing that high levels of social functioning are associated with low levels of depression. Significant differences in CASAFS total and subscale scores were found between clinically depressed adolescents and a matched sample of nonclinical controls. Adolescents who reported elevated but subclinical levels of depression also reported lower levels of social functioning in comparison to nonclinical controls.

Adaptation, Psychological↗
PubMed2000

[Phenomenologic and functional variability of violence among children].

Examination of ten-year old children's everyday interactions with peers observed in natural settings of a school demonstrates that violence was present in many situations of help, sanctions, and rough-and-tumble play. Thorough analysis reveals diverse functions of violence in children's interactions: affirmation of reciprocity and justice, experience of agency and control, preservation of territories against intruders, clear messages, compensations of lacking capacities, and defense of the self.

Child↗
PubMed1998

Parental and peer influences on the onset of heavier drinking among adolescents.

OBJECTIVE: Less is known about heavier drinking in adolescents than about alcohol initiation. The present study examined the emergence of regular (weekly) and heavy episodic (five or more drinks at a time) adolescent drinking as a function of social influence (modeling and social control) from parents and peers. METHOD: A three-wave study was conducted using a representative household sample of families in metropolitan Buffalo, New York (N = 612). Over half (54%) of the adolescent respondents were female. Black families made up 30% of the sample. Interviews were conducted at 1-year intervals. Adolescent drinking was dichotomized at each wave into abstinence/light drinking versus regular drinking. Logistic regression including only adolescents who were abstainers/light drinkers at Wave 1 was performed to assess which Wave- variables could predict regular-drinking onset by Wave 2; a similar analysis examined the onset of heavy episodic drinking by Wave 2. Parallel analyses using Wave-2 variables to predict the onset of the drinking outcomes by Wave 3 were also conducted. RESULTS: Across the different analyses, the strongest psychosocial predictors of advancement to heavier drinking were friend's drinking and low parental monitoring. Also, white adolescents were at greater risk than their black counterparts. CONCLUSIONS: A multidimensional approach to prevention that addresses different processes of influence (e.g., modeling and social control) involving both parental and peer domains is likely to be most successful in deterring the onset of heavier drinking in adolescents.

Adolescent↗
PubMedDate not supplied

Neurocognitive functioning and magnetic resonance imaging in children with sickle cell disease.

OBJECTIVE: To examine neurocognitive functioning in children classified with overt cerebral vascular accidents (CVAs), silent infarcts, or without central nervous system (CNS) pathology on magnetic resonance imaging. METHODS: Participants were 63 children and adolescents with sickle cell disease (SCD). RESULTS: Children with overt CVAs and silent infarcts differed from their peers without CNS pathology on measures of attention and executive functioning. CONCLUSIONS: We consider these deficits the result of the high frequency of frontal lobe deficits incurred by children with SCD. Recommendations include the use of tests designed to measure attention and executive functioning as a way of screening children with SCD for possible CNS pathology. We also suggest that future research examine the mechanism underlying frontal lobe involvement for individuals with SCD.

Adolescent↗