Malaise scores in adulthood of children and young people who have been in care

Junctional rhythm is commonly observed during radiofrequency catheter ablation of the fast or slow pathways of atrioventricular nodal reentrant tachycardia (AVNRT). However, the origin of these beats remains unclear. We analyzed the retrograde atrial activation sequence of 16 patients (mean +/- SD: 41.2 +/- 18.9 years old) undergoing catheter ablation for typical AVNRT with detailed catheter mapping of the triangle of Koch. The earliest atrial activations were concordant during tachycardia and junctional rhythm in only 5 of 16 patients. The findings suggest that junctional rhythm is unlikely to represent direct stimulation of the atrioventricular (AV) node via a discrete slow pathway but rather results from enhanced automaticity from > or =1 sites in the AV nodal transitional zone. The ensuing atrial activation pattern results from anisotropic spread from these sites. In addition, these data imply that the original concept of the AV node comprising 2 anatomically defined pathways may not be valid, and that a functionally defined pathway model may be a more accurate representation.     

Filial therapy with nonoffending parents of children who have been sexually abused.

Examined the effectiveness of a 10 wk filial therapy training model as a method of intervention for nonoffending parents (24–56 yrs old) and their children (4–10 yrs old) who have experienced sexual abuse. Ss were assigned to either an experimental or control group and were given pretraining sessions and assessments. The parents in the experimental group then conducted weekly 30 min special play sessions with their children, as recommended by Landreth (1991). One session was videotaped. The parents received constructive feedback and support from the facilitator and group members during meetings. A posttest battery of instruments was administered to parents and children following the training sessions. Analyses of covariance revealed that the nonoffending parents in the experimental group significantly increased their level of empathy in their interactions with their children, significantly increased their attitude of acceptance toward their children, and significantly reduced their level of stress. Measures of the children's behavior, anxiety, emotional adjustment, and self-concept indicated positive trends. The authors maintain that this study supports filial therapy as an effective intervention for nonoffending parents and their children who have experienced sexual abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thyroid and adrenal measures during late pregnancy and the puerperium in women who have been major depressed or who become dysphoric postpartum

Prior studies of thyroid, adrenal and mood measures during pregnancy and the puerperium, which we review, have not examined hormone-mood relationships over the full peripartum period during which hormone levels change nor have they compared prior depression history with hormone changes. In a pilot study we measured thyroid and adrenal hormones as well as mood at 38 weeks of pregnancy, and 1, 3, 6, 9 and 12 weeks postpartum in 12 women with major depression history and 14 women with negative psychiatric history. Subjects with prior depressions had significantly higher T3, T4, TSH and cortisol levels during the puerperium. Subjects with higher levels of postpartum dysphoria had lower T4 and free T4 levels as well as higher T3 uptake at 38 weeks of pregnancy and higher cortisol levels during the puerperium. The pathophysiological implications of these findings are discussed.     

Predictors of epilepsy in children who have experienced febrile seizures

We examined the frequency of development of afebrile seizures in 1706 children who had experienced at least one febrile seizure and were followed to the age of seven years. Epilepsy developed by seven years of age in 20 per 1000 (2 per cent), and another 10 per 1000 had at least one afebrile seizure that did not meet our definition of epilepsy. In children whose neurologic or developmental status was suspect or abnormal before any seizure and whose first seizure was complex (longer than 15 minutes, multiple or focal) epilepsy developed at a rate 18 times higher than in children with no febrile seizures (92 vs. 5 per 1000; P less than 0.001). In the largest group with febrile seizures, those previously normal with noncomplex first febrile seizures, epilepsy developed in 11 per 1000; this rate, although moderate, was greater than that for children with no febrile seizures (P = 0.027). Prior neurologic and developmental status and characteristics of the first febrile seizure are important predictors of epilepsy after febrile seizures.     

Evaluations of children who have disclosed sexual abuse via facilitated communication

OBJECTIVE: To review the findings of interdisciplinary team evaluations of children who disclosed sexual abuse via facilitated communication. DESIGN: Case series. SETTING: Tertiary care hospital outpatient child sexual abuse program in central New York. PATIENTS: Between January 1990 and March 1993, 13 children who disclosed sexual abuse via facilitated communication and were referred to a university hospital child abuse referral and evaluation center. The range of previously determined developmental diagnosis included mental retardation, speech delay, and autism. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Medical records were reviewed for (1) disclosure, (2) physical evidence, (3) child's behavioral and medical history, (4) disclosures by siblings, (5) perpetrator's confession, (6) child protective services determinations, and (7) court findings. RESULTS: Four children had evidence of sexual abuse: two had physical findings consistent with sexual abuse, one also disclosed the allegation verbally, and one perpetrator confessed. CONCLUSIONS: These results neither support nor refute validation of facilitated communication. However, many children had other evidence of sexual abuse, suggesting that each child's case should be evaluated without bias.     

The waiting list guarantee and its violation. Characteristics of patients who have been waiting more than five months

In Norway as a whole, an average of six percent of all patients who had been guaranteed treatment within six months had not received treatment as promised. A survey of 917 orthopaedic "guarantee patients" who had waited longer than five months for treatment showed that 486 patients had waited longer than six months. 28% of the patients were suffering from hip or back problems, and the majority were suffering from problems in the extremities. In the case of 11% treatment was, in their own view, no longer relevant, and 2/3 were not interested in receiving treatment at another hospital, if this were to be offered. In the case of 33% of the patients the referring doctor thought it reasonable that the waiting time had exceeded six months.     

Social perspective-taking skills in maltreated children and adolescents.

The primary goal of this study was to assess the ability of maltreated school-age children and adolescents to understand the thoughts, feelings, and points of view of others. Level of egocentrism and social perspective-taking coordination were assessed in a group of 49 maltreated and 49 demographically matched nonmaltreated children. Twenty-six elementary and 23 high school students in each group were individually interviewed and their responses to hypothetical interpersonal situations coded for egocentricity and level of perspective-taking ability. The findings revealed that maltreated children and adolescents were more egocentric and delayed in their social perspective-taking development than their nonmaltreated peers and that they reported lower levels of global self-worth. However, differences within the group of maltreated children and adolescents emerged with regard to negotiating novel relationships, as those with fewer internalizing or externalizing symptoms exhibited better skills in this area than their peers who displayed more symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer relationships among clinicians as an alternative to mentor-protégée relationships in hospital settings.

Peer relationships can provide important personal and professional benefits to clinicians at all levels of career development. They are often more available than mentor–protégée relationships and are well suited to hospital settings, with their intrinsic need for professional collaboration. Peer relationships have unique advantages based on their implicit mutuality and nonhierarchical nature. Clinicians in particular can benefit from the exploration of uncertainty in a context that explicitly acknowledges that neither peer has all the answers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The significance of focal glomerular sclerosis in children who have nephrotic syndrome

This study was undertaken to learn the significance of focal glomerular sclerosis in children who have nephrotic syndrome. Tissue obtained by percutaneous renal biopsy 10-15 years previously was re-examined. Initially, two of the 29 biopsy specimens contained focal segmental hyalinosis or sclerosis and five of the 29 had focal glomerular obsolescence. The paraffin blocks were serially sectioned and examined. Following this procedure, seven of the 29 biopsies had focal segmented hyalinosis and 16 of the 29 had focal glomerular obsolescence. The percentages of focal segmental hyalinosis and focal glomerular obsolescence were recorded. Only those patients whose focal segmental hyalinosis exceeded 2% progressed to renal failure. Age-matched autopsy material from patients dying without renal dysfunction was used as a control. Focal glomerular sclerosis was seen in 75.8% of the control specimens, although few glomeruli within each specimen were involved. Focal glomerular sclerosis may be found normally; it may be found in nephrotic children who do not develop renal failure. The quantification of sclerotic lesions may be of prognostic significance in childhood nephrosis.     

Sexual HIV risk behaviour among men who have sex with both men and women

The aim of this study was to describe the sexual behaviour of men who had sex with both men and women in the preceding five years (behaviourally bisexual men), specifically to examine their needs in relation to HIV prevention. Anonymous telephone interviews were carried out with respondents recruited though advertisements in UK newspapers and magazines with (sexual) 'personal' or 'contact' sections. Data are reported from 745 respondents. Respondents report relatively high and approximately equal numbers of male and female sexual partners in the year preceding interview. There is a clear patterning of sexual activity by type of partner (regular or casual). A high proportion report anal intercourse with female and male partners. A third disclose their homosexual practices to regular female partners. Although self-reported HIV seroprevalence is low (less than 1%), the levels of unprotected sex with multiple sexual partners indicate substantial potential for transmission of sexually transmitted infections, including HIV. While low seroprevalence suggests that there is little overlap with existing core groups of HIV infection, the study provides information to judge the priority of targeting HIV prevention initiatives and suggests ways in which initiatives could be undertaken.     

Licensing disciplinary actions for psychologists who have been sexually involved with a client: Some information about offenders.

A search through a large state's psychology-licensing disciplinary records for a 28-mo period identified the 22 cases in which sex with a client had led to disciplining a therapist. Information is presented about offender age, gender, and marital status; for each case, the number of clients involved and whether they were adults or minors are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachments to inanimate objects: Are children who have security blankets insecure?

The relation between insecurity and attachment to soft, inanimate objects is discussed. Much debate on whether this relation is positive, negative, or independent depends on the extent to which definitions of insecurity involve psychopathology or personality and temperament. Because attachments to nonsocial objects are common in some cultures and are beneficial for many children, there currently appears to be overwhelming agreement that such attachments do not presage maladjustment. Although several researchers have even concluded that nonsocial attachments are salutary, evidence for this position is insufficient. The results of a preliminary investigation with 108 20–41-month-old children indicated that attachment to blankets is not associated with one of the indices of insecurity, children's general fearfulness. However, a small proportion of the 50 specific fears examined was found to be either directly or inversely correlated with blanket usage. Although blanket-attached children appeared to be neither more nor less insecure than others, it was concluded that additional research is needed to determine the idiosyncratic characteristics of children who are attached or not attached to nonsocial objects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The utility of the MMPI with men who have sexually assaulted children.

Examined the ability of the Minnesota Multiphasic Personality Inventory (MMPI) to describe a sex offender population of 406 men (mean age 35.8 yrs) who had assaulted children and to differentiate this population on the basis of the following offense variables: (1) male vs female minor victimization, (2) nonincestual vs incestual sex offenses, (3) physical vs nonphysical assault methods, (4) rapist vs nonrapist molesters, and (5) assault on younger vs older victims. MMPI Scale 4 (Psychopathic Deviate) and Scale 8 (Schizophrenia) were both significantly elevated in Ss' mean profile. However, contrary to previous studies, no single 2-point MMPI code type was predominant, and two-thirds of the Ss had more than 2 MMPI scale elevations. Some statistically significant differences were found between Ss on Variables 1 and 5, but these differences were not considered to be clinically significant. The limitations of the MMPI in differentiating criminological defined subgroups and variables are discussed. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship-contingent self-esteem and the ups and downs of romantic relationships.

Relationship-contingent self-esteem (RCSE) emerges from perspectives on authenticity, need fulfillment, and relationship functioning and is an unhealthy form of self-esteem that depends on one's relationship. Four studies provided evidence of convergent, discriminant, incremental, and predictive validity for RCSE. Study 1 tested associations between RCSE and several conceptually related and unrelated constructs in multiple samples. In Study 2, the authors employed an event-contingent diary procedure to examine reports of self-esteem as a function of everyday relationship events. The association between event valence and changes in self-esteem became stronger with RCSE, and this interaction remained controlling for several parallel interactions by other constructs. Study 3 employed an interval-contingent diary procedure and found support for a mediation model in which the moderating role of RCSE largely occurred through momentary emotions, which in turn predicted momentary self-esteem. Study 4 sampled couples and found that partners who were both higher in RCSE felt more committed but not more satisfied or close. (PsycINFO Database Record (c) 2010 APA, all rights reserved)