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PubMed2004

Chewing and swallowing after surgical treatment for oral cancer: functional evaluation in 196 selected cases.

One hundred ninety-six patients treated for oral cancer between 1992 and 1999 self-scored their speech, chewing, and swallowing using a new self-questionnaire (Functional Intraoral Glasgow Scale) developed at Canniesburn Hospital, Glasgow, to assess the functional efficiency of patients treated for intraoral cancer. The patients were distributed into 12 homogeneous groups, according to the site and size of surgical resection, carefully mapped out on standard diagrams of the oral cavity. The functional outcome for chewing and swallowing was correlated to the site and size of resected tissue, to the reconstruction modality, and to radiotherapy and compared with the speech quality. The general trend is very similar for both chewing and swallowing; the smaller the resections, the better the functional outcome. Chewing was mostly affected by resections of the floor of the mouth, whereas swallowing was mostly affected by demolition of the base of the tongue and of the retromolar trigone. Speech showed a better postoperative recovery than chewing and swallowing. The reconstruction modality did not influence the eventual outcome for either function. Radiotherapy in combination with surgery is a negative functional prognostic factor. A correlation between site and size of excision and functional outcome is presented using color multiple-view diagrams for immediate appreciation to identify positive and negative prognostic factors.

Adult↗

PubMed2002

Exactly solvable model with stable and metastable states for a polymer chain near an adsorbing surface.

We report on the conformational properties and transitions of an ideal polymer chain near a solid surface. The chain is tethered with one of its ends at distance z(0) from an adsorbing surface. The surface is characterized by an adsorption parameter c. The exact expression for the partition function is available. We obtained the distribution of complex zeros of this function. The comparison with the Yang-Lee theory allows the characterization of the phase transitions. A first-order conformational transition from a coil to a (adsorbed) flower conformation occurs at c(*)=6z(0)/N. The flower is composed of a strongly stretched stem and a pancake that collects the remaining adsorbed segments. The degree of stretching of the coil or of the stem serves as an order parameter which parametrizes the analytical expressions of the Landau free energy. The phase diagram with one binodal and two spinodal lines is presented. The height of the barriers between metastable and stable states is obtained and the lifetime of metastable states is estimated. A two-state ansatz is used to develop scaling arguments to account for the effects of excluded volume.

Journal Article↗

PubMed2005

Characteristic periodic motion of polymers in shear flow.

The motion of both free and tethered polymer molecules as well as rigid Brownian rods in unbound shear flow is found to be characterized by a clear periodicity or tumbling frequency. Periodicity is shown using a combination of single molecule DNA experiments and computer simulations. In all cases, we develop scaling laws for this behavior and demonstrate that the frequency of characteristic periodic motion scales sublinearly with flow rate.

Computer Simulation↗

PubMed2006

Researching medical trust in the United States.

PURPOSE: This article reviews research in the U.S.A. bearing on trust in physicians and medical institutions. DESIGN/METHODOLOGY/APPROACH: This article provides a conceptual analysis, and general review of the literature. FINDINGS: Empirical research of medical trust is burgeoning in the U.S.A., and a fairly clear conceptual model of interpersonal physician trust has emerged. However, most studies focus on individual patients and their physicians, due to the highly individualistic attitudes that prevail in the U.S.A. Lacking are studies of more social dimensions of trust in broader medical institutions. A conceptual model of trust is presented to help draw these relevant distinctions, and to review the US literature. Also presented are the full set of trust scales, developed at Wake Forest University, which follow this conceptual model. These conceptual categories may differ, however, in other languages and cultures. ORIGINALITY/VALUE: The considerable body of research in the USA on patients' trust in individual physicians should help inform and focus international efforts to study social trust in medical institutions.

Cross-Cultural Comparison↗

PubMed1993

Drinking contexts and drinking problems among black and white women.

This study explored whether black and white women differ in how often they drink in particular types of social settings and if drinking in different contexts independently predicts alcohol-related problems. The analysis was based on the interview responses of 635 black and 663 white women drinkers who represent sub-samples from a nationwide survey of 5221 respondents conducted in 1984. The findings revealed that white women are more likely to attend restaurants, bars and parties away from home than black women and that a larger proportion of their alcohol consumption occurs in these settings than among black women. Factor analysis was used to develop scales on the the frequency of drinking in different social contexts. The results confirmed a three-dimensional factor structure that distinguished between drinking at home; drinking in social settings such as bars, restaurants and parties; and drinking in outdoor public areas like streetcorners and parks. A simultaneous equations path analysis was used to model the relationships among drinking contexts, the frequency of heavier drinking, drinking problems, race and other social characteristics. The major findings of the resulting models were that drinking contexts independently predict drinking problems and that race is not directly associated with drinking contexts or alcohol-related problems. However racial differences do exert significant indirect effects on social settings and drinking problems through differences in socio-economic status and normative attitudes. The conclusion emphasizes the complexity of the interrelationships of ethnic and social characteristics that underlie visible racial differences in the social patterns and situational contexts of alcohol use.

Adolescent↗

PubMed2005

The objective severity assessment of atopic dermatitis (OSAAD) score: validity, reliability and sensitivity in adult patients with atopic dermatitis.

BACKGROUND: The Objective Severity Assessment of Atopic Dermatitis (OSAAD) score is a recently developed scale for evaluation of severity of atopic dermatitis, constructed from the assessment of epidermal barrier function, and properties using noninvasive bioengineering methods and computer-assisted estimates of disease extent. The method has been validated for use in infants and children with atopic dermatitis and compared with a referent scoring system. OBJECTIVES: The aim of the present study was to test the validity, reliability and sensitivity of the OSAAD score as an objective tool for the assessment of the severity of atopic dermatitis in adult patients. METHODS: Thirty-two adult patients with atopic dermatitis were included in the study. To assess the validity of the OSAAD score we tested it against the Severity Scoring of Atopic Dermatitis (SCORAD) index of the European Task Force on Atopic Dermatitis as a referent clinical severity scale, and the serum levels of interleukin (IL)-16 as a laboratory variable for monitoring the activity of atopic dermatitis. Responsiveness to change was assessed in a longitudinal study comparing OSAAD, SCORAD and serum levels of IL-16 before and after treatment. To test the reliability of the OSAAD score we studied the interobserver variability of the score recorded by three independent board-certified dermatologists in 16 patients and compared it with SCORAD. RESULTS: We report a significant correlation between the OSAAD and the SCORAD index as an acknowledged referent severity scale. The OSAAD score correlated significantly with the serum levels of IL-16 in the acute stage of atopic dermatitis. In a longitudinal study, the OSAAD score decreased significantly, parallel with improvement of the skin findings and a significant decrease in the SCORAD score and IL-16 serum levels. We report improved interobserver variability for the OSAAD score compared with SCORAD. CONCLUSIONS: This is the first study validating the OSAAD score as a sensitive and reliable tool for the assessment of the severity of atopic dermatitis in adult patients.

Acute Disease↗

PubMed1990

Empathy: a review of the literature with suggestions for an alternative research strategy.

Although empathy is regarded as a necessary component of good quality nursing care, defining and measuring empathy have both been fraught with problems. A historical overview helps to explain these difficulties, as nurses have tended to accept the views of psychotherapists uncritically, and have used scales developed for clients in counselling with people who are physically ill. Methodological difficulties combined with the results of studies demonstrating low levels of empathic ability in nurses have culminated in disenchantment with this topic. A framework is used to show why nurses cannot always demonstrate empathic awareness of every patient's need and an alternative approach for exploring the nature of empathy is suggested.

Empathy↗

PubMed1991

The effect of employment on the relationship between gender-role preference and self-esteem in married women.

The purpose of this study was to examine relationships among gender-role preference, self-esteem and employment category (full-time, part-time, homemaker) while controlling for the effects of income and religion. Data were collected from 79 White married women using the Rosenberg Self-Esteem Scale and a gender-role preference scale developed by the author. Findings indicated that: (a) there are significant differences in gender-role preference among categories of employment, with full-time workers having more modern views; (b) category of employment did not influence self-esteem; and (c) women with mixed gender-role preference had lower self-esteem than those with modern gender-role preference. The strength of the relationship between self-esteem and gender-role preference varied by category of employment. Gender-role preference made a significant contribution as a predictor of self-esteem (above and beyond the effects of income and religion) for full-time workers only.

Adult↗

PubMed1996

Role conception and role discrepancy: a comparison between hospital-based and degree nursing students in Hong Kong.

This paper reports on a cross-sectional survey that aimed to compare the role conception types and role discrepancy between 140 certificate and 81 degree nursing students in Hong Kong. Non-probability convenience sampling was used and the participants selected from the hospital-based training were first, third and fourth study block students. Second-, third- and fourth-year students from the degree programme were selected for comparison. The role conception scale developed by Pieta was modified and adopted to measure the role conception and discrepancy. ANOVA test was performed to examine differences across and within the two groups. The results showed that the degree students had a significantly higher ideal but lower actual professional role conception than the certificate students. An interaction effect between the groups (certificate--degree) and grades (stages of education) was detected in the ideal professional role, indicating a marked drop of the score for the fourth-year degree students. For the discrepancy role conception score, the degree students had a significantly higher discrepancy score in all the three role conception types compared with their certificate counterparts. In summary, the impact of the educational process on the development of role conception was demonstrated. Compared to the certificate students, the ward practice seemed to exert a far greater impact on degree students' role conception.

Analysis of Variance↗

PubMed2006

Nursing assistants' behaviour during morning care: effects of the implementation of snoezelen, integrated in 24-hour dementia care.

AIM: This paper reports an investigation of the effects of the implementation of snoezelen, or multisensory stimulation, on the quality of nursing assistants' behaviour during morning care. BACKGROUND: Nursing assistants in long-term dementia care are often unaware of the impact of their behaviour on patient functioning. Snoezelen is a psychosocial intervention that might improve the quality of caregiver behaviour by combining a person-centred approach with the integration of sensory stimuli. METHODS: A quasi-experimental pre- and post-test design was implemented in 12 wards for older mentally infirm patients at six nursing homes. The experimental group intervention was a 4-day in-house 'snoezelen' training, stimulus preference screening and supervision meetings. The control group received usual nursing home care. The effectiveness of the intervention was studied by analysing 250 video recordings, which were assessed by independent observers using a 4-point measurement scale developed for this study and based on Kitwood's Dialectical Framework. RESULTS: The results showed a statistically significant increase in 'Positive Person Work' and decrease in 'Malignant Social Psychology' (total scores) after the implementation of snoezelen. Nursing assistants in the experimental group also improved by statistically significant amounts on all subitems of 'Positive Person Work'. The mean number of sensory stimuli, offered explicitly, increased. CONCLUSION: The implementation of snoezelen succeeded in effecting a change to a more person-centred approach during morning care. The results indicate that nursing assistants' behaviour can be positively changed provided that the new care model has been successfully implemented.

Adult↗

PubMed2005

Ulcerative colitis: factors affecting difficulties of life and psychological well being of patients in remission.

BACKGROUND: Ulcerative colitis is a chronic disease of unknown aetiology characterized by alternating periods of remission and relapses. The difficulties in the patients with ulcerative colitis daily life mostly arise from symptoms associated with bowel inflammation but there are many patients who have difficulties despite being in the remission phase. This study was conducted to elucidate factors that influence perception of difficulties of life and psychological well being of patients with ulcerative colitis in remission. METHODS: A questionnaire survey was carried out in 72 outpatients with ulcerative colitis in remission. The perception of difficulties of life was assessed using the scale developed by Tanaka et al. Psychological well being was assessed using the Japanese version of the 'profile of mood states'. Physical condition, demographic attributes and psychosociological states were also investigated as related factors. RESULTS: There was no outstanding aspect of psychological well being, but a relatively large number of patients perceived a 'decline of vitality or vigour' despite being in the remission phase. In the presence of irritable bowel syndrome-like symptoms, the scores for 'difficulties of life in society' or 'difficulties concerned with bowel movements' were high. Scores for 'decline of vitality or vigour' were high when the emotive coping scores were high, social support was lower, disease durations were short and relapses occurred more than once. When the emotive coping scores were high, psychological well being was not fine. RELEVANCE TO CLINICAL PRACTICE: Strategies need to be developed to allow patients to recover and maintain their strength in the remission phase. Further, the strategies should take the above factors into consideration.

Activities of Daily Living↗

PubMed1993

Prediction of transmembrane beta-strands from hydrophobic characteristics of proteins.

The assembly of outer-membrane proteins consisting of beta-strands as transmembrane segments is somewhat more complex when compared to the assembly of inner membrane proteins having alpha-helices as transmembrane parts. This is probably due to the difference in the amino acid sequences of the transmembrane part strands and helices. Because of this feature, most predictive schemes which are successful in predicting transmembrane helical segments fail to predict transmembrane strand segments. Here we propose a new predictive scheme for forecasting the transmembrane strand segments in outer-membrane proteins with the use of the general surrounding hydrophobicity scale developed both for the globular and membrane proteins in the preceding article. Two major features of the scheme are (i) that it does not solely depend on the amphipathic character of a sequence segment while identifying it as a transmembrane strand, and it is capable of predicting strands in varied lengths, a facility to reflect the variation in the membrane surfaces. This scheme predicts the transmembrane beta-strands in porin from R. capsulatus at 76% accuracy (giving due weights to over- and under-predictions when compared to X-ray results). The predicted beta-structure contents in OmpA, porin from E. coli and maltoporin compared with the Raman spectroscopic results at 95% level. These accuracy levels are far superior than the levels obtained from other existing methods. Apart from the above four proteins for which experimental informations are available, ten other outer-membrane proteins, for which there is no information about their secondary structure, are considered in the forecast. The results are analysed and the common features in the folds of the set of fourteen outer-membrane proteins are deduced.

Amino Acid Sequence↗

PubMed1996

Predictive value of the Griffiths assessment in extremely low birthweight infants.

OBJECTIVE: To assess the relationship between the Griffiths Mental Development Scales at 1 and 3 years and the Stanford-Binet Intelligence Scale (S-B) and Beery Test of Visual-Motor Integration (VMI) at 5 years in extremely low birthweight (ELBW) children. METHODOLOGY: Prospective study of 45 ELBW infants, without severe neurosensory impairment, cared for in a single Level III neonatal intensive care unit. RESULTS: At 5 years, 36 (80%) children were of average intelligence, 8 (18%) had borderline intelligence and one was mentally retarded. The Griffiths general quotient (GQ) at 1 year had a weak correlation with the 5 year IQ (corr. coeff. = 0.47), with only 17% of children with a GQ < -1 s.d. at 1 year receiving an IQ < -1 s.d. at 5 years. In contrast, the Griffiths GQ at 3 years correlated strongly with 5 year IQ (corr. coeff. = 0.78). Among those children with a 3 year GQ < -1 s.d., 67% had a 5 year IQ < -1 s.d. and all had a 5 year 1Q < 89. The 3 year hearing and speech subscale correlated strongly with the 5 year S-B verbal comprehension factor (corr. coeff. = 0.753) and the 3 year combined eye/hand co-ordination/performance quotient had a moderate correlation with the S-B non-verbal reasoning factor (corr. coeff. = 0.597) and with the Beery VMI (corr. coeff. = 0.49). CONCLUSIONS: The 3 year Griffiths GQ is a good predictor of 5 year S-B IQ in ELBW children and can be used to identify children who may benefit from intervention prior to school entry.

Analysis of Variance↗

PubMed2004

Complex glycerol kinase deficiency leads to psychomotor and body-growth failure.

Complex glycerol kinase deficiency usually presents with Duchenne muscular dystrophy, glycerol kinase deficiency and adrenal hypoplasia congenital. We describe a follow-up patient with complex glycerol kinase deficiency who had appropriate intrauterine development, but who at 1 month of age manifested severe growth delay and psychomotor retardation. Targeted therapy did not bring about the regression of symptoms: both bodyweight and height were below the 3rd centile until 8 years of age, and his Griffith's Mental Development scale score was 71 at age 5 years.

Biopsy↗

PubMedDate not supplied

Compliant behaviour: relationship to attitudes and control in diabetic patients.

A study was conducted to examine patient performance of certain safety measures in relation to 'attitude' and glycaemic control. One hundred and thirty consecutive routinely attending insulin-dependent diabetic patients (IDDM) were asked to show a source of sugar and diabetes identification (ID). An attitude scale, developed and psychometrically evaluated with intent to examine 'general attitude to diabetes', was used to study attitudes. Fifty-eight per cent of the IDDM patient sample carried both sugar and ID. The mean HbA1c of these patients (8.4%) was 2% lower (p less than 0.01) compared with patients carrying either ID only (24% of sample: mean HbA1c 10.4%), sugar only (6% of sample: mean HbA1c 10.3%) or neither item (12% of sample: mean HbA1c 10.7%). The general attitude score in these patients was significantly higher if sugar was carried (p less than 0.02) but there was no relationship with HbA1c (p greater than 0.1). A seven-item subcluster representing attitudes to diabetic management was more strongly related to sugar carriage (p less than 0.001) and was inversely correlated with HBA1c (r = 0.252: p less than 0.02). These findings indicate that attitudes to diabetes management may influence specific behavioural elements (i.e. compliance with advice always to carry sugar and ID). However, there was also a significant trend to higher carriage rates for sugar with a higher frequency of perceived hypoglycaemia (p less than 0.05) but no relationship between perceived hypoglycaemia and HbA1c. Absence of sugar of ID appears to represent a useful indicator of poor diabetic control and may assist in the definition of relevant attitudinal differences.

Adult↗

PubMed1998

Changing attitudes and beliefs of staff working in methadone maintenance programs.

Starting in 1989, an attempt was made to change the aim of methadone treatment in NSW from abstinence to harm-minimisation. A study was undertaken to measure change in attitudes among staff working in public methadone programs in Sydney. Using scales developed in a 1989 survey, we found a statistically significant and meaningful reduction in support for abstinence-oriented policies had occurred by 1992. There was no change in staff's support for the punishment of illicit drug use or their knowledge of the risks and benefits of methadone maintenance. This suggests problems with staff attitudes and, indirectly, the effectiveness of public health interventions, can be addressed using educational campaigns.

Attitude of Health Personnel↗

PubMed1986

Maternal behavior and attachment in low-birth-weight twins and singletons.

Early mother-infant interaction and later security of attachment were assessed for 17 pairs of twins, 5 singleton survivors of twin pairs, and 20 singletons, all low-birth-weight preterm infants. Mother and infant behavior during home observations at 6 weeks and 3, 6, and 9 months was rated on scales developed by Ainsworth and Egeland and Brunquell. A, B, and C patterns of behavior in the Strange Situation conformed to the frequencies predicted from prior full-term samples and were not affected by twinship. However, the proportion of B1 and B4 dyads in the B group significantly exceeded that predicted from normative data. Mothers in B2 and B3 dyads were rated more sensitive and responsive than all others at all 4 observations. Contrary to our expectations that mothers in A and C dyads would receive the lowest ratings, this occurred only at 6 weeks. At later observations mothers in B1 and B4 dyads consistently received the lowest ratings. The discussion focuses on possible reasons for this unexpected finding.

Birth Weight↗

PubMed1992

The cross-ethnic equivalence of parenting and family interaction measures among Hispanic and Anglo-American families.

Recently there has been concern over the need for developmental research within ethnic minority populations and interest in family processes within, and variability across, ethnic groups. Unfortunately, most of the research using standard scales of family processes has sampled middle-class Anglo-Americans, and the potential absence of cross-ethnic measurement equivalence threatens the validity of the research using these scales with ethnic minority populations. This study reports confirmatory factor analyses and construct validity coefficients for several parenting and family interaction scales among Anglo-American and Hispanic 8-14-year-old children and mothers. The findings indicate that the Children's Report of Parental Behavior Inventory (except the hostile control subscale), the Parent-Adolescent Communication Scale (open communication subscale only), and the Family Adaptability and Cohesion Evaluation Scales II appear to have sufficient cross-ethnic equivalence for English-speaking Hispanic samples. Further, the Family Routines Inventory and the problem communication subscale could benefit from additional scale development.

Adolescent↗