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PubMed2006

Social incompetence in children with ADHD: possible moderators and mediators in social-skills training.

Children with attention-deficit/hyperactivity disorder (ADHD) often encounter problems in social interactions with peers and are confronted with peer rejection and social isolation. The most common approach to social problems in children is social skills training. This intervention concept represents a variable mixture of cognitive-behavioral intervention elements. In this article the outcome of social skills training (SST) for children with ADHD is reviewed. Four experimental SSTs are detected and analyzed for potential mediators and moderators of treatment efficacy. Candidate mediators (social cognitive skills, parenting style and medication-induced reduction of key symptoms) are discussed within an empirical and theoretical context. Candidate moderators (subtype, comorbidity, gender and age) are evaluated for their empirical support. It is argued that, although fragmented, there is ample evidence and knowledge to adapt the SST-paradigm towards the specific needs of children suffering from ADHD and to guide future research towards more effective, "well established" interventions.

Attention Deficit Disorder with Hyperactivity↗

PubMed2001

[Prevalence of depression in patients over 65 years of age. Profile of the elderly at risk].

OBJECTIVES: To calculate the prevalence of emotional disorders in primary care, using a screening test--the Yesavage--and the association of emotional disorders with other variables, with the aim of identifying the profile of an elderly person most likely to be depressed at some juncture of his/her life. DESIGN: Cross-sectional, descriptive study. SETTING: Urban health care. PATIENTS AND OTHER PARTICIPANTS: Sample of 173 patients over 64 years old. MEASUREMENTS AND RESULTS: An integrated geriatric assessment was conducted. The complete version of the Yesavage scale was used (30 items). 16% prevalence of depression (score over 15) was established. The following variables were associated with depression in a statistically significant way: feminine sex (p = 0.000009), age > or = 75 (p = 0.04), illiteracy or completion of only primary education (p = 0.01), dependence in one or more activities of daily life according to the Katz index (p = 0.0000006), personal history of depression (p = 0.01), current treatment for depression (p = 0.0002), daily consumption of three or more drugs (p = 0.0009) and social isolation (p = 0.00006). Multivariate analysis revealed that low educational level (p = 0.006), dependence in one or more activities of daily life (p = 0.008) and social isolation (p = 0.0008) are the variables most associated with depression. CONCLUSIONS: The association between low educational level and depression may be due to difficulty in understanding certain questions. A therapeutic intervention into established undiagnosed depressions took place. The Yesavage geriatric scale was useful in primary care for identifying undetected cases of emotional disorder.

Aged↗

PubMed2005

Combating loneliness among persons with severe mental illness: social network interventions' characteristics, effectiveness, and applicability.

More than half of people with severe mental illness are lonely, the subjective state associated with social isolation and lack of desired relationships. Their loneliness is related to impaired ability to make and keep friends, lack of opportunities to participate in social activities, and stigma associated with mental illness that creates barriers between them and their communities. Treatment for people with severe mental illness often fails to include social network interventions that have the potential to decrease loneliness. Knowledge of social network interventions-their characteristics, effectiveness, and applicability for specific patients-can guide nurses' use of these treatment modalities.

Attitude to Health↗

PubMed2000

Developing a college men's growth group.

The higher rates of disease and death associated with male gender have been widely documented, yet little is being done in the college health setting to address men's health issues. Many of men's health risks are related to social isolation and prohibitions on showing weakness. The authors describe the Virginia Tech University experience with 3 Man Alive groups that were developed to (a) create a supportive social structure for male college students who may otherwise be socially isolated, (b) model healthy expression of emotions, such as anger, fear, sadness, and joy; (c) create a safe space for men to discuss sensitive issues, such as relationships with significant others, sexuality, and substance abuse.

Adult↗

PubMed2000

Social functioning of patients with schizophrenia in high-income welfare societies.

OBJECTIVE: The study assessed the level of reintegration into the community of patients with schizophrenia in Oslo, Norway, a country with a well-developed social welfare system and low unemployment rates. METHODS: Eighty-one patients with a DSM-III-R diagnosis of schizophrenia treated in 1980 and in 1983 in a short-term ward of a psychiatric hospital were followed up after seven years. Seventy-four of 76 patients alive at follow-up agreed to participate. Social functioning was measured by the Strauss-Carpenter Level of Functioning Scale and the Social Adjustment Scale. RESULTS: At follow-up 78 percent of patients lived independently, 47 percent were socially isolated, and 94 percent were unemployed. Thirty-four percent had lost employment in the follow-up period. A poor outcome in terms of social functioning and community reintegration was associated with loss of employment. A good outcome was predicted by short periods of inpatient hospitalization, high levels of education, being married, male gender, and not having a late onset of psychosis. CONCLUSIONS: The level of homelessness among these patients with schizophrenia was encouragingly low, which may have been expected in a high-income welfare society. However, insufficient efforts were aimed at social and instrumental rehabilitation, and the level of unemployment was alarmingly high.

Activities of Daily Living↗

PubMed2004

Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: the Neighborhood Asthma Coalition.

BACKGROUND: Low-income African Americans exhibit disproportionate prevalences, morbidity rates, and mortality rates for asthma. OBJECTIVE: To determine whether a community-based intervention, the Neighborhood Asthma Coalition (NAC), conducted through a well-established neighborhood organization in St. Louis could improve awareness of asthma, change attitudes about its care, improve asthma management practices, and reduce the need for acute care for asthma. METHODS: The NAC included educational programs for parents and children, promotional activities, and individualized support provided by trained neighborhood residents. African American children, 5 to 14 years of age, with at least 1 incident of acute care (emergency department visit or hospitalization) within the previous year were enrolled from 8 zip code areas with low-income residents and high proportions of Medicaid-eligible children, ie, 4 NAC neighborhoods and 4 comparable control neighborhoods. Evaluations included quarterly telephone interviews to assess asthma attitudes and management and sites of care. Audits of acute care sites covered 12 months before initiation of the NAC through 3 years of the program. RESULTS: A total of 371 patients were contacted and determined to be eligible for the study, and 345 agreed to participate, representing a recruitment rate of 93%. Of those, 15 withdrew and 24 were lost to follow-up monitoring after the initial contact. In addition, 57 were excluded from analysis because of relocation or for other reasons. Utilization data to determine rates of acute care (emergency department visits and hospitalizations) were collected for 249 patients (100 NAC subjects and 149 control subjects). Acute care rates decreased for both the NAC and control groups from the year before intervention to the last year of intervention, with no significant differences between the NAC and control groups. Participation in NAC programming affected the acute care outcome; the NAC-low participation and control groups did not differ but the NAC-high participation group differed significantly from the pooled control and NAC-low participation groups in reductions in acute care rates. Both contacts with NAC staff members and attendance at educational events were associated with changes toward stronger views that asthma can be managed (partial correlation = .27 and partial correlation = .24, respectively). Structural equation modeling demonstrated that participation in the NAC was associated with positive changes on the Index of Asthma Attitudes scale and lower rates of acute care. Social isolation was associated with greater participation in the program and thus reduced care rates. CONCLUSIONS: The NAC reached its intended audience, including those who were socially isolated, brought about changes in management practices, and was associated with promising reductions in acute care rates among active participants in the program.

Acute Disease↗

PubMed2003

The relative playfulness of juvenile Lewis and Fischer-344 rats.

The relative playfulness of inbred Lewis and Fischer-344 rats was characterized. Fischer rats were consistently less playful than Lewis rats, with rats of this strain less likely to initiate playful interactions with either responsive or unresponsive partners and also less likely to respond playfully when playful solicitations were directed to them. While less playful, Fischer rats were more socially inquisitive than Lewis rats when tested with an unresponsive partner, suggesting that Fischer rats are less likely to escalate a social encounter into a playful one. Strain differences in playful responsiveness were present with or without prior social isolation, suggesting that this aspect of play represents a relatively stable trait difference. Unlike play responsiveness, strain differences in play solicitation were only apparent after a period of social isolation. Low levels of play were still present in Fischer rats that had been reared by Lewis dams, suggesting a genetic source for the altered play in rats of this strain. Further studies of play behavior in Lewis and Fischer rats could illuminate relevant neural involvement in rough-and-tumble play and also help understand the genetic bases for this complex social behavior.

Aging↗

PubMed2002

Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men.

The authors prospectively examined the effects of social ties and change in social ties, as measured by a well-known social network index, on total and cause-specific mortality and on coronary heart disease incidence in 28,369 US male health professionals aged 42-77 years in 1988. Over 10 years, the relative risk of total mortality for men in the lower two levels of social integration compared with more socially integrated men was 1.19 (95% confidence interval: 1.06, 1.34) after controlling for age, occupation, health behaviors, general physical condition, coronary risk factors, and dietary habits. In multivariate analysis, deaths from accidents and suicide and from other noncancer, noncardiovascular causes were significantly increased among less socially connected men. Socially isolated men also had an increased risk of fatal coronary heart disease (multivariate relative risk = 1.82, 95% confidence interval: 1.02, 3.23). An increase in the overall social network index between 1988 and 1996 was not significantly associated with subsequent 2-year mortality. In analyses of change in social network components restricted to older men, each categorical unit increase in number of close friends was significantly associated with a 29% decrease in risk of death. Increase in religious service attendance over time was also significantly predictive of decreased mortality.

Accidents↗

PubMed1999

Health and well-being of women family carers: a comparative study with a generic focus.

OBJECTIVE: To examine differences between women family carers of people with chronic illnesses or disabilities and a group of women 'non-carers' in self-reported physical health, psychological well-being, life satisfaction, social support and feelings of overload. METHOD: Using a computer-assisted telephone interviewing system, a random survey of more than 26,000 households was conducted in Victoria to identify and then interview a representative sample of family carers of people with disabilities or chronic illnesses. The women in the sample (n = 857) were then compared with a sample of women with 'usual family responsibilities' (n = 219) in terms of physical and emotional states. RESULTS: We found higher rates of self-reported ill-health and use of medication, more negative effect, and less life satisfaction and perceived social support, among carers than among women in the comparison group. Even though the latter were more likely to be caring for one or more children, compared with the carers they reported less overload. Irrespective of carers status, women without partners expressed less life satisfaction, and more social isolation and negative effect. CONCLUSIONS AND IMPLICATIONS: The poorer health status and emotional well-being of carers compared with non-carers among women, and associations between overload, social isolation, negative effect and health problems within carers, point to a number of practical interventions such as promoting an awareness in GPs and other health professionals of the impact of caregiving on the health of their patients; informing them about relevant community services; and encouraging appropriate referrals.

Adaptation, Psychological↗

PubMed1993

Quality of life following lower limb amputation for peripheral arterial disease.

Lower limb amputations for peripheral arterial disease are performed predominantly on an elderly population with poor social support and concomitant medical problems. The effect of amputations on the quality of life of this population has not been properly assessed. The quality of life of 149 amputees from one hospital was evaluated using the Nottingham Health Profile and compared to that of a control group matched for age and sex. One hundred and thirty (87%) amputees and 115 (77%) controls responded to the questionnaire. Amputees reported significantly more problems with mobility, social isolation, lethargy, pain, sleep and emotional disturbance than controls (p < 0.001). However, mobility was the only significant independent factor after matched logistic regression analysis (p < 0.001). The differences in social isolation and emotional distress lost their significance after adjustment for mobility. The overall quality of life following lower limb amputation for peripheral arterial disease is poor, but much of this is secondary to restricted mobility. Rehabilitation following amputation should therefore focus on attempts to improve mobility.

Activities of Daily Living↗

PubMed1977

Social-olfactory experience and initiation of copulation in the virgin male rat.

Two experiments examined the role of olfactory sensation for initiation of normal copulatory behavior of mature male rats. Experiment 1 compared copulatory performance of peripherally anosmic social isolates with that of intact isolate controls. The results revealed significantly lower mounting, intromission, and ejaculation frequencies of the anosmic group and suggested that nonolfactory cues attain significance via an associative-learning process. Experiment 2 compared three social isolate groups of mature males with varying sexual experience prior to anosmia. Four 1-hr tests were conducted at 5-day intervals. The results indicated comparable copulatory performance of the experienced groups and absence of copulation by the majority of the nonexperienced group. With a 12-day continuous exposure to intact females, all noncopulators eventually impregnated. The results are discussed with reference to the requirement of social experience for initiation of normal sexual performance in the male rat.

Animals↗

PubMed1995

Comparison of Nottingham Health Profile (NHP) scores with exercise duration and measures of ischaemia during treadmill exercise testing in patients with coronary artery disease.

A cross-sectional study of patients with stable coronary artery disease was performed to compare perceived health status with the results of a treadmill exercise test. One hundred and twenty one patients, mean age 55.07 years, 106 male, who had all suffered a myocardial infarction under the age of 56 years, up to 9 years earlier were studied. Perceived health status was assessed using the Nottingham Health Profile, part 1 of which assesses six dimensions of normal living, and part 2 seven areas of daily life. Nottingham Health Profile scores were higher (worse perceived health status) in patients with poor treadmill exercise capacity within all dimensions of part 1 (energy, pain, physical mobility P < 0.001, emotional reactions, sleep P < 0.01, social isolation P < 0.05) and most of those within part 2 (care of home, taking holidays P < 0.001, hobbies P < 0.01, relationships at home, sex life P < 0.05). The perceived health status of patients without a history of angina is significantly better than those with angina (pain, physical mobility P < 0.001, energy, emotional reactions, social isolation P < 0.01, sleep P < 0.05, within part 1, taking holidays P < 0.01, care of the home, social life, sex life, hobbies P < 0.05, within part 2). Thus, patients with a poor perceived health status, also have poorer results using more conventional clinical measures of coronary artery disease. The Nottingham Health Profile may be a useful adjunct in patient assessment.

Activities of Daily Living↗

PubMed1999

Depersonalization, fantasies, and coping behavior in clinical context.

The main purpose of the present study was to determine the relation between specific dissociative experiences (depersonalization, fantasies) and self-reported coping behavior in a clinical (depression, anxiety, schizophrenia) and nonclinical sample (normal adults). Dissociative experiences were assessed with the Questionnaire of Experiences of Dissociation (QED) of Riley (1988) and coping behavior with the Stress-Process Questionnaire (SPQ; Janke, Erdmann, & Boucsein, 1985). A factor analysis of the QED items revealed a two-factor extraction: Factor 1 "depersonalization" and Factor 2 "fantasies/daydreams." The clinical group scored higher on the QED factor "depersonalization" and had more passive forms of coping behavior (resignation, social isolation, self-compassion, self-blame) than the normal adults. Similar correlation patterns were found for both groups: The QED factor "depersonalization" correlated highly with the coping behaviors "resignation," "social isolation," "self-blame," "self-compassion," and "rumination." No correlation between Factor 2 "fantasies/daydreams" and the coping behavior was found. Finally, correlations between depersonalization, trait anxiety, and personal need for structure were reported.

Adaptation, Psychological↗

PubMed2004

Agreement between dementia patient report and proxy reports using the Nottingham Health Profile.

OBJECTIVE: The aim of the study was to examine the agreement between patient reports and their proxy reports (family and care provider proxies) on Health Status in a sample of patients with dementia. METHOD: Ninety-nine patients with mild to moderate dementia and proxies completed the 38-item Nottingham Health Profile (NHP) questionnaire. RESULTS: Completion rates for the different NHP dimensions ranged from 78 to 90% for the dementia subjects. Inter-rater agreement between different proxies and subject was from moderate to good for physical assessment (ICCs from 0.54 to 0.78 for physical mobility scales). Patient/family proxy concordance was moderate to good for five out of six dimensions (physical mobility, social isolation, pain, energy, sleep) and poor for emotional reaction. Family proxies systematically reported lower functioning than did patients in the four subscales assessing: physical mobility (p <0.0001), energy (p <0.005), social isolation (p <0.01) and sleep (p <0.03). Care provider proxies only estimated physical mobility as lower (p <0.0001). CONCLUSION: Age and physical status of the patient significantly affected agreement in patient-care provider proxy ratings. Thus, caution is appropriate when resorting to proxies to estimate the Health Status of a dementia patient.

Aged↗

PubMed2005

Social interaction improves experimental stroke outcome.

BACKGROUND AND PURPOSE: Social interaction can have a profound effect on health. The purpose of the present study was to determine whether affiliative social interactions before and after stroke improve ischemic outcomes as assessed through histological analysis and behavioral assays. METHODS: Male and female C57BL/6 mice were housed individually or with an ovariectomized female. Behavioral assessments were made 24 hours before 60 or 90 minutes of transient intraluminal middle cerebral artery occlusion (MCAO) or SHAM surgery and after 7 days of reperfusion. Two hours after behavioral testing on day 7, infarct size was determined by 2,3,5-triphenyltetrazolium histology, and blood samples were collected for assessment of corticosterone and C-reactive protein (CRP) concentrations. RESULTS: Pair housing significantly decreased infarct size and improved contralateral paw use in 60-minute MCAO males and 90-minute MCAO females compared with socially isolated cohorts. Housing condition had no significant effect on infarct size in females that underwent 60 minutes of MCAO, but pair housing was associated with improved contralateral paw use relative to socially isolated mice. In a separate cohort of males, intraischemic CRP concentration was significantly reduced in pair-housed males relative to isolated males. CONCLUSIONS: Affiliative interaction during the peri-ischemic period reduces intraischemic CRP concentration, decreases ischemic damage in male and female mice, and improves behavioral outcome.

Animals↗

PubMed1996

Quality of life and anxiety in pregnancies after late pregnancy loss: a case-control study.

Pregnant women with (n = 24) and without (n = 26) a previous pregnancy loss (> 16 weeks) due to congenital anomalies were compared on quality of life and anxiety. Pregnant women with a previous loss were divided into those with and those without a normal livebirth since the loss [cases+ (n = 6) and cases- (n = 18), respectively]. Psychological measurements were carried out before and after an ultrasound scan in the second trimester of the pregnancy. Women with a previous loss who had not delivered a healthy infant between the loss and the present pregnancy showed a lower quality of life as revealed by feelings of social isolation, negative emotional reactions, and pain than the other groups. In addition, they showed more pregnancy-related anxiety. The negative emotions were particularly present just before the anomaly scan. Feelings of social isolation, negative emotional reactions, pain, and pregnancy-related anxiety were significantly positively related to trait anxiety, irrespective of having experienced late pregnancy loss. The implications of this study are that the referring gynaecologist, physician, or midwife should be aware of the strong emotions and major concerns of women in a pregnancy subsequent to a late pregnancy loss. In addition, they should offer these women the opportunity to express their emotional distress.

Abortion, Spontaneous↗

PubMed2006

Lower limb atherosclerotic disease causes various deteriorations of patients' health-related quality of life.

BACKGROUND: Lower limb atherosclerotic disease (LLAD) is a worldwide health problem. Approximately 100,000 Finns have LLAD. Currently, a large number of health-related quality of life (HRQoL) studies are available, but we still have scant comprehensive information of HRQoL of patients with LLAD. OBJECTIVES: The aim was to describe the HRQoL of women and men with LLAD in relation to the age- and sex-matched general population. In addition, the purpose was to study which demographic and relevant clinical and psychologic factors are connected with HRQoL of patients with LLAD. METHODS: Patients with LLAD (N = 180, 62 women and 118 men) were recruited to participate in this study in the Clinic of Surgery, Oulu University Hospital, from 2001 to 2004. The control sample consisted of an age- and sex-matched general population (N = 2126; 1081 women and 1045 men). The HRQoL of the women and men with LLAD was evaluated using the Nottingham Health Profile (NHP) instrument, in relation to an age- and sex-matched general population (N = 2126) as well as demographic and relevant clinical and psychologic factors. RESULTS: The HRQoL of men was significantly (P < .05) poorer on all dimensions of the NHP instrument in the age groups 55 to 74 years. HRQoL was also clearly affected in the youngest age group of men on the dimensions of pain (P < .05) and mobility (P < .05) and further in the oldest age group on the dimension of energy (P < .05). The HRQoL of women with LLAD was only significantly poorer (P < .05) on the dimension of pain in the age group of 65 to 74 years than the HRQoL of age-matched Finnish women. The most emphasized relationships between poor HRQoL and the demographic, relevant clinical and psychologic factors were male sex, lack of exercise, retirement, a short painless walking distance, other atherosclerotic disease, poor subjective health status, problems with ability to cope at home, problems with the treatment of illness, and sex life. Male patients with LLAD had poorer HRQoL than the corresponding female patients on the dimensions of energy (P = .023), emotional reaction (P = .050), social isolation (P = .028), and NHP total score (P = .023). Those who did not exercise regularly had poorer HRQoL on the dimensions of energy (P = .005), pain (P = .049), emotional reaction (P = .007), social isolation (P = .001), and physical mobility (P = .028) than those who did exercise regularly. CONCLUSIONS: The HRQoL of middle-aged men was significantly poorer than that of controls. Male sex, retirement, asymptomatic walking distance, other atherosclerotic disease, lack of exercise, and feeling incapable of performing daily activities are important causes of impaired HRQoL. Health care professionals should pay extra attention to the development of rehabilitation programs aimed at preventing patients with LLAD from experiencing a myriad of problems.

Activities of Daily Living↗

PubMed1996

Coronary heart disease: a review of the role of psychosocial stress and social support.

BACKGROUND: The role of psychosocial factors in the aetiology of coronary heart disease continues to be debated. Despite public perception of a major role for their effect, scientific opinion on their relevance remains divided. This paper reviews the literature on the influence of social support and life stress on coronary heart disease incidence and mortality. METHODS: Observational studies published in English, based on over 100 human subjects from the general population, investigating life stress or social support were considered. Fourteen studies derived from MEDLINE searches on MeSH headings: coronary disease; stress, psychological; social support; social isolation; life change events. An equivalent search of BIDS and studies referenced by papers identified using these sources was carried out. RESULTS AND CONCLUSIONS: The review concludes that both life stress and social support were found to have an influence on coronary heart disease, social support more so than stress. Both have a stronger influence on coronary heart disease mortality than on initial incidence of clinical disease. Measures of the quality of support, in particular emotion support, show the largest effects. The review highlights problems in drawing conclusions from the available literature; in particular, the inconsistency in measures used to define the psychosocial factors. Further studies are needed to investigate interrelationships between stress and social support, and a recommendation is made to adopt pragmatic measures in future studies, which if proven to have an effect, may be open to modification.

Adult↗