Body-image boundaries and adjustment to poliomyelitis.

In a group of 56 polio patients, a relationship between psychological adjustment to physical handicap and a measure of body-image boundaries was shown to exist. "Apparently, individuals who conceive of their body boundaries as possessing defensive, armoring, barrier-like qualities are significantly better able to adapt to the circumstances surrounding physical loss than are those individuals whose body concept does not contain these features." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amniocentesis before 14 completed weeks as an alternative to transabdominal chorionic villus sampling: a controlled trial with infant follow-up

Plasma cortisol, prolactin, oestrogen, progesterone, thyroxine, thyrotrophin (TSH) were collected from 23 pregnant, 70 postpartum women at 7 days postpartum, and 38 non-gravid controls. Sixty two postpartum women were screened for depression by the Edinburgh Postnatal Depression Scale (EPDS) on day 7 after delivery and 34 of them were assessed by the Present State Examination (PSE) at 8 +/- 2 weeks after delivery. Postpartum women had a significantly greater level of cortisol, prolactin, thyroxine and oestrogen than non-puerperal women. Postpartum women with current depression (EPDS > or = 11) had significantly lower plasma prolactin levels than those without depression and those who developed depression within 6-10 weeks after delivery (PSE level > or = 5) had significantly lower plasma prolactin and significantly greater progesterone levels than those who were not depressed. There were significant correlations between age and plasma cortisol and prolactin levels. Higher thyroxine levels predicted greater severity of concurrent symptoms of depression (total EPDS score) whilst higher progesterone and lower prolactin levels predicted the occurrence of depression (total PSE score) 6-10 weeks after delivery. Women who breastfed had significantly lower EPDS and total PSE scores and higher plasma prolactin levels than those who did not breastfed their infants whilst women who had previous episodes of depression had significantly greater EPDS and PSE scores, lower prolactin and higher TSH levels than those who had not suffered from previous episodes of depression.     

Assessing relationship standards: The Inventory of Specific Relationship Standards.

The current study explored the importance of relationship standards in marital functioning through the use of a new self-report inventory: the Inventory of Specific Relationship Standards (ISRS). The findings indicate that community couples who hold relationship-focused standards (i.e., those who ask for a great deal from their marriages) score higher on all of the indixes of marital functioning than spouses with less relationship-focused standards. The results demonstrate that two pieces of information about a spouse's standards are important: the actual standards and differences between spouses' standards were somewhat less related to marital functioning. The findings confirm that spouses' standards in the areas of boundaries, control-power, and investment in the relationship are important dimensions to assess. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fentanyl analgesia increases the incidence of postoperative hypothermia in neonates

Postoperative hypothermia remains a clinical problem in neonates undergoing surgery. Intraoperative analgesia can blunt the metabolic and hormonal response to operative stress in neonates. However, its effects on heat production and thermoregulation are not known. The aim of this review was to characterise the effects of intraoperative analgesia on body temperature in neonates undergoing surgery. The case notes of 25 consecutive neonates who underwent major operations were retrospectively reviewed. Axillary temperature was measured before the operation, and postoperatively after returning to the neonatal intensive care unit (NICU). Patients were divided into groups based on the intraoperative analgesic used: (1) 9 neonates received fentanyl; (2) 5 received morphine; and (3) 11 received epidural bupivacaine. All groups were comparable in terms of conceptional age, postnatal age, body weight, duration of operation, and operative stress score. In all groups the body temperature was significantly lower at the time of returning to the NICU than preoperatively. Three patients (33%) who received fentanyl became hypothermic during the operation, whereas none of those who received either morphine or bupivacaine had hypothermia. The drop in temperature between preoperative and initial postoperative values was significantly greater in patients who received fentanyl intraoperatively (median drop 0.8 degreesC, range 0.6 - 2.4) when compared with patients who received morphine (P = 0.02) or epidural bupivacaine (P = 0.01). These data suggest that intraoperative fentanyl modulates the postoperative body temperature in neonates. We hypothesise that fentanyl blocks metabolic heat production, which results in a reduction in postoperative body temperature.     

Individual versus group therapy for obesity: Effects of matching participants to their treatment preferences.

This study examined the effects of matching participants to treatments on the basis of their preferences for either individual or group therapy for obesity. Seventy-five obese adults who expressed a clear preference for either individual or group therapy were randomly assigned to either their preferred or their nonpreferred treatment modality within a 2 (individual vs group therapy)?×?2(preferred vs nonpreferred modality) factorial design. At posttreatment, group therapy produced significantly greater reductions in weight and body mass than individual therapy, and no significant effects were observed for treatment preference or the interaction for treatment preference by type of therapy. All treatment conditions showed equivalent improvements in psychological functioning. These findings suggest that group therapy produces greater weight loss than individual therapy, even among those clients who express a preference for individual treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tooth recontouring/reshaping a must in the preparation for removable partial denture

OBJECTIVE: To assess the extent of functional and vocational rehabilitation achieved by elderly inner-city patients sustained on maintenance hemodialysis. DESIGN: Inception cohort study of elderly patients who have end-stage renal disease using a modified Karnofsky rating system. The need for a wheelchair, participation in household activities, and effect of comorbid conditions were noted. Current status was compared with patient's recollection of functional activity level 2 years before commencing maintenance hemodialysis. SETTING: Seven outpatient, hospital-affiliated and private hemodialysis units in Brooklyn, NY. PATIENTS: One hundred four patients aged 65 years or older who were receiving maintenance hemodialysis for at least 6 months. MAIN OUTCOME MEASURES: A score of 76 or greater on a modified Karnofsky scale indicated independent function at a level that permitted participation in activities beyond those mandated by the hemodialysis regimen. A comorbidity score 6 or greater on a newly constructed index correlated with severe debility. Employment status was also recorded. RESULTS: Present functional activity had deteriorated to a modified Karnofsky score of 66 +/- 12.3 (+/- SD) compared with patients' recollection of a mean score of 84 +/- 14.3 (P < .001) 2 years before initiation of hemodialysis. Diabetic patients had a lower score than nondiabetic patients. The mean comorbidity index of the entire study group was 7.8 +/- 2.9 (mean +/- SD). Within the diabetic subset, severe debility constrained 71 patients (68%) to limit all activity to their residence with the exception of travel to and from their dialysis facility. By contrast, 2 years prior to commencing dialytic therapy, 81 diabetic patients (78%) had interests and activities that took them outside their homes (P < .001). Generalized weakness was the most common explanation given for the lack of outside activity by nine patients (9%) who were wheelchair bound. Erythropoietin, though regularly administered to 87 patients (84%) in the study group, was unsuccessful in raising mean hematocrit reading above 0.28 +/- 0.05 (mean +/- SD). CONCLUSIONS: Maintenance hemodialysis does not return inner-city elderly patients to their predialysis level of functioning. Few elderly, diabetic hemodialysis patients conduct any substantive portion of their lives outside their homes. For nondiabetic patients, the modified Karnofsky score of whites (70.4 +/- 11.9) and blacks (66.5 +/- 15.3), though low, was equivalent (P < .4).     

Changes in scholastic achievement and intelligence of Indian children enrolled in a foster placement program.

Attempted to determine whether Indian students participating in a foster home placement program would show educational gains greater than those previously found with other Indian education programs. 84 children who had been enrolled for 5 or more yrs were selected as Ss and their standardized testing records obtained from the schools. The tests, administered when the Ss were 8-14 yrs old, included the Iowa Test of Basic Skills and California Test of Mental Maturity. Although testing records were incomplete, it was found that compared to national norms, the mean achievement score for this group declined with successive yrs of participation in the program and total IQ scores showed no significant changes. It is concluded that results are similar in this respect to those obtained on Indian students who remain at home and are educated in public schools. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Carbide precipitation in welds of two-phase austenitic-ferritic stainless steel

Transmission electron microscopy (TEM) and microanalytical chemistry were performed on sensitized samples of duplex welds that exhibited both skeletal ferrite microstructures and lath ferrite microstructures. The objective was to understand why welds with lath ferrite, contrary to a theoretical prediction, are not immune to sensitization. Most of the ferrite-austenite (α-γ) interphase boundaries in the welds with skeletal ferrite were curved and incoherent, while those in welds with lath ferrite were predominantly planar and semicoherent. The density of carbide precipitation on incoherent boundaries was much greater than that on semicoherent boundaries. Carbide precipitates on incoherent boundaries were typically equiaxed, while those on semicoherent boundaries had very high aspect ratios and appeared to form along ledges in the interphase boundary. During sensitizing heat treatments, the chromium-depleted zone on the ferrite side of the interphase region transformed to austenite, causing the α-γ interphase boundary to move into the ferrite region. This markedly increased the width of the chromium-depleted zone in the austenite phase and extended the time of heat treatment required to replenish the zone with chromium. It is proposed that migration of the α-γ interphase boundary, which occurs to a much greater extent in the welds with lath ferrite, is responsible for their unexpected susceptibility to sensitization at 550°C.     

Use of the Work Components Study with new college-level employees.

Reports data based on 869 male and 344 female new college-level employees which show the reliability and structure of the Work Components Study (WCS). A comparison of those persons who remain with the company with those who leave at the company's initiative and with those who leave of their own initiative shows few differences in their orientations toward work as measured by the WCS. However, when the company's rating of how many years it will take the new hires to reach the 3rd level of management was taken as a criterion, it was found that those who score highest on WCS Score 3, Competitiveness desirability, highest on the School and College Abilities Test verbal ability score, and highest on a personality measure of responsibility are those perceived by the company as moving ahead fastest. These results suggest that it is not the "organization man" type who is likely to be promoted, but the man perceived to be highly competitive, intelligent, and responsible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Laparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility

Impaired esophageal body motility is a complication of chronic gastroesophageal reflux disease (GERD). In patients with this disease, a 360-degree fundoplication may result in severe postoperative dysphagia. Forty-six patients with GERD who had a weak lower esophageal sphincter pressure and a positive acid reflux score associated with impaired esophageal body peristalsis in the distal esophagus (amplitude <30 mm Hg and >10% simultaneous or interrupted waves) were selected to undergo laparoscopic Toupet fundoplication. They were compared with 16 similar patients with poor esophageal body function who underwent Nissen fundoplication. The patients who underwent Toupet fundoplication had less dysphagia than those who had the Nissen procedure (9% vs.44%; P=0.0041). Twenty-four-hour ambulatory pH monitoring and esophageal manometry were repeated in 31 Toupet patients 6 months after surgery. Percentage of time of esophageal exposure to pH <4.0, DeMeester reflux score, lower esophageal pressure, intra-abdominal length, vector volume, and distal esophageal amplitude all improved significantly after surgery. Ninety-one percent of patients were free of reflux symptoms. The laparoscopic Toupet fundoplication provides an effective antireflux barrier according to manometric, pH, and symptom criteria. It avoids potential postoperative dysphagia in patients with weak esophageal peristalsis and results in improved esophageal body function 6 months after surgery.     

The adequacy of medical school education in musculoskeletal medicine

A basic familiarity with musculoskeletal disorders is essential for all medical school graduates. The purpose of the current study was to test a group of recent medical school graduates on basic topics in musculoskeletal medicine in order to assess the adequacy of their preparation in this area. A basic-competency examination in musculoskeletal medicine was developed and validated. The examination was sent to all 157 chairpersons of orthopaedic residency programs in the United States, who were asked to rate each question for importance and to suggest a passing score. To assess the criterion validity, the examination was administered to eight chief residents in orthopaedic surgery. The study population comprised all eighty-five residents who were in their first postgraduate year at our institution; the examination was administered on their first day of residency. One hundred and twenty-four (81 per cent) of the 154 orthopaedic residency-program chairpersons who received the survey responded to it. The chairpersons rated twenty-four of the twenty-five questions as at least important. The mean passing score (and standard deviation) that they recommended for the assessment of basic competency was 73.1 +/- 6.8 per cent. The mean score for the eight orthopaedic chief residents was 98.5 +/- 1.07 per cent, and that for the eighty-five residents in their first postgraduate year was 59.6 +/- 12 per cent. Seventy (82 per cent) of the eighty-five residents failed to demonstrate basic competency on the examination according to the chairpersons' criterion. The residents who had taken an elective course in orthopaedic surgery in medical school scored higher on the examination (mean score, 68.4 per cent) than did those who had taken only a required course in orthopaedic surgery (mean score, 57.9 per cent) and those who had taken no rotation in orthopaedic surgery (mean score, 55.9 per cent) (p = 0.005 and p = 0.001, respectively). In summary, seventy (82 per cent) of eighty-five medical school graduates failed a valid musculoskeletal competency examination. We therefore believe that medical school preparation in musculoskeletal medicine is inadequate.     

Apparent body tilt and postural aftereffect

Apparent orientation of the body tilted laterally in the frontal plane was studied with the methods of absolute judgments in four experiments. In Experiment 1, 17 subjects, who maintained the normal adaptation of body to gravity, estimated their body tilts under the condition of seeing the gravitational vertical and under the condition of eliminating it. The results showed that (1) there was not a significant difference between the two conditions and (2) the small tilts of less than 45 degrees were exactly estimated, whereas the large tilts of 45 degrees-108 degrees were overestimated. In Experiment 2, 10 subjects estimated their body tilts under three velocities of a rotating chair on which each subject was placed. Although both body tilt and chair velocity were found to influence tilt estimation, the effect of body tilt was overwhelmingly greater than that of chair velocity. In Experiment 3, 11 subjects adapted their bodies to a 72 degrees left tilt for 10 min and then estimated various body tilts around the adapting tilt. The estimations obtained under the 72 degrees adaptation were lower than those obtained under the 0 degree adaptation, and this reduction was greater for the test tilt that was farther away from the adapting tilt. In Experiment 4, 11 subjects adjusted their own body tilts to designated angles. The results confirmed the outcomes of absolute estimation in Experiments 1-3. From these findings and past literature, the judgments of body tilt were considered to be subserved by a single sensory process that was based on the cutaneous and muscular proprioceptors, rather than the vestibular and joint proprioceptors.     

A mammographic evaluation of the morphostructural variations of the breast during hormone-replacement therapy in the postmenopause

OBJECTIVE: To compare i.v. ketorolac with i.v. prochlorperazine as the initial treatment of migraine headaches in the ED. METHODS: A prospective, double-blind comparison study was performed, using a convenience sample of 64 patients suffering from migraine headaches presenting to the ED at a tertiary care university teaching hospital. Patients were randomly assigned to receive either 10 mg of prochlorperazine i.v. or 30 mg of ketorolac i.v.. Patients scored the severity of their headaches using a 10-cm visual analog pain scale. An initial mark was made on the scale at the time of entry into the study and later another mark was made on a new unmarked pain scale 1 hour after medication administration. Changes in pain scores within each treatment group and between groups were analyzed using the Wilcoxon rank sum test. RESULTS: Prior to treatment, the patients assigned to receive prochlorperazine had a median score of 9.2 cm (mean +/- SD pain score of 8.3 cm +/- 2.1 cm), while the patients receiving ketorolac had a median score of 9.0 (mean pain score of 8.4 cm +/- 1.7 cm). There was no significant difference between the pain scores of the participants in the 2 groups prior to treatment (p = 0.80). One hour after medication administration, the patients in the prochlorperazine group had a median score of 0.5 cm (mean 2.1 +/- 3.2 cm), while those patients receiving ketorolac had a median pain score of 3.9 (mean 4.0 +/- 3.3 cm). The decrease in pain score was significant for both groups of patients (p = 0.0001). The change in pain score for the patients in the prochlorperazine group (median 7.1) was significantly greater than the change in pain score for the patients in the ketorolac group (median 4.0; p = 0.04). CONCLUSION: Although both drugs were associated with a significant reduction in pain scores, benefit over a placebo agent was not tested. Furthermore, the patients who received prochlorperazine i.v. for migraine headaches had a statistically significant greater decrease in their pain scores than did those receiving ketorolac i.v.     

The effect of light drinking on HCV liver disease: the jury is still out

We carried out a study to determine if light drinking (1 unit alcohol/d) adversely affected liver histology in hepatitis C virus (HCV)-associated liver disease. Twenty-eight women who developed chronic hepatitis C (all genotype 1b) as a result of receiving contaminated anti-D immunoglobulin (Ig) had their alcohol intake assessed. Group I (n = 8) took no alcohol, Group II (n = 8) consumed less than one unit monthly and Group III (n = 12) took between two and 18 units (mean = 6.7 units) per week. All 28 subjects had a liver biopsy performed and their histology scored according to the global Knodell score (KI) and the international score for both inflammatory grading (II) and fibrotic staging (FI). The three scores were compared between the three groups and differences tested for significance. The median score for the three groups were Group I: KI = 2, II = 2 and FI = 0; Group II: KI = 4, II = 3.5 and FI = 0.5; Group III: KI = 5.5, II = 4 and FI = 1.5. Initial analysis showed that there was no difference between those who abstained from alcohol and those with a less than monthly consumption; these groups were united and compared with the light drinkers. On Mann-Whitney U test analysis, the P values for the differences between the light drinkers and the combined groups were 0.666 (KI), 0.159 (II) and 0.080 (FI) These results show a trend towards greater histological abnormality in people drinking one unit of alcohol per day, but larger groups will need to be assessed to determine if this is a true or chance finding.     

In-group members' perceptions of a social mobility attempt: Effects of boundary permeability and outcome.

This study examined in-group members' impressions of a fellow member who attempted to join a higher power group, along with the interactive effects of the permeability of group boundaries and relative success of this social mobility attempt on impressions. Because groups with less permeable boundaries are typically more cohesive, a group member's relative success in achieving mobility should have meaning for these groups, as opposed to those with more permeable boundaries. Thus, it was predicted that the effect of success versus failure on in-group members' evaluations would be stronger when group boundaries were less permeable. The results showed that a member successful at social mobility was evaluated more positively than one who was unsuccessful, and this difference was larger when boundaries were less permeable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Grip strength changes over 27 yr in Japanese-American men

The aim of this study was to describe changes in grip strength over a follow-up period of approximately 27 yr and to study the associations of rate of strength decline with weight change and chronic conditions. The data are from the Honolulu Heart Program, a prospective population-based study established in 1965. Participants at exam 1 were 8,006 men (ages 45-68 yr) who were of Japanese ancestry and living in Hawaii. At follow-up, 3,741 men (age range, 71-96 yr) participated. Those who died before the follow-up showed significantly lower grip-strength values at baseline than did the survivors. The average annualized strength change among the survivors was -1.0%. Steeper decline (>1.5%/yr) was associated with older age at baseline, greater weight decrease, and chronic conditions such as stroke, diabetes, arthritis, coronary heart disease, and chronic obstructive pulmonary disease. The risk factors for having very low hand-grip strength at follow-up, here termed grip-strength disability (相似文献   

Lower levels of physical functioning are associated with higher body weight among middle-aged and older women

OBJECTIVE: To compare levels of physical function, across levels of body mass index (BMI), among middle- to older-aged women. DESIGN: Cross-sectional study. Physical function, body weight and other covariates were measured in 1992. SUBJECTS: 56510 women aged 45-71 y, free of cardiovascular disease and cancer, participating in the Nurses' Health Study. MAIN OUTCOME MEASURES: The four physical function scores on the Medical Outcomes Study (MOS) Short Form-36 (SF36) Health Survey: physical functioning, vitality, bodily pain and role limitations. RESULTS: After adjusting for age, race, smoking status, menopausal status, physical activity and alcohol consumption, there was a significant dose-response gradient between increasing levels of BMI in 1992 and reduced function. For example, women with a BMI between 30-34.9 kg/m2 averaged: 9.0 point lower physical functioning score (95% Confidence interval (CI) -9.5, -8.5), 5.6 point lower vitality score (95% CI: -6.1, -5.1), and 7.0 point lower freedom from pain score (95% CI: -7.6, -6.4). These declines represent an approximate 10% loss of function compared to the reference category of women with BMIs ranging from 22.0-23.9 kg/m2. For the same BMI comparison, heavier women were at 66% increased risk of limitations in ability to work or perform other roles (RR = 1.66; 95% odds ratio (OR) CI: 1.56, 1.76). These findings were replicated when the sample was restricted to women who had maintained their BMI over a ten year period. CONCLUSIONS: In addition to increasing risk of chronic health conditions, greater adiposity is associated with lower every day physical functioning, such as climbing stairs or other moderate activities, as well as lower feelings of well-being and greater burden of pain.     

Derogation and distancing as terror management strategies: The moderating role of need for closure and permeability of group boundaries.

Previous research has revealed that when individuals are confronted with criticism of a personally relevant group, mortality salience can lead to either derogation of the source of criticism or distancing from the group. In this article, the authors investigated closure as a potential moderator of these reactions. In Study 1, salience led to greater derogation of a critic of a relevant group among high-need-for-closure participants but led to distancing from the group among low need-for-closure participants. Study 2 showed that when a relevant group was criticized, mortality salience led to greater derogation among participants who were led to believe that the boundaries of that group were impermeable but led to greater distancing among participants who were made aware of the permeable nature of the group boundaries. These findings demonstrate that closure of group membership moderates reactions to criticism of a personally relevant group after mortality salience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching medical ethics to orthopaedic surgery residents

Orthopaedic surgery residents will be faced with a variety of ethical issues when they enter clinical practice. A previous survey suggested that they lack knowledge about how to approach several types of medical ethics dilemmas. We developed a medical ethics curriculum for orthopaedic surgery residents and presented it over a one-year period to the residents in one training program. The effect of the educational intervention on the residents' knowledge of medical ethics and their ability to handle hypothetical situations was measured by comparing their responses to a questionnaire, administered before and after the intervention, with those of residents in a training program in which the intervention was not provided. The twenty-five residents at the site of the educational intervention had a mean improvement of 0.10 in the overall score, from a mean score of 0.71 on the baseline survey to a mean score of 0.81 on the follow-up survey. This improvement was significantly greater than the mean improvement of 0.02 for the thirty residents at the control site, who had a mean score of 0.72 on the baseline survey and a mean score of 0.74 on the follow-up survey (p = 0.002). Six residents who participated in the medical ethics curriculum rated it as very useful; seventeen, as somewhat useful; one, as slightly useful; and one, as not at all useful. A medical ethics curriculum can increase orthopaedic residents' knowledge of medical ethics. Whether this curriculum also will lead to behavioral changes requires additional evaluation.