Mutation in the prion protein gene at codon 232 in Japanese patients with Creutzfeldt-Jakob disease: a clinicopathological, immunohistochemical and transmission study

The societal and economic forces driving change in medical education are affecting communities as well as universities. Each of the four authors of this paper is deeply involved in one of the components of their locale's well-developed community-based medical educational system, and each describes how change is influencing his role in that system, whether the role be managing a community hospital, directing a local Area Health Education Center, participating as a family medicine faculty member, or being a community preceptor. They agree on some common themes: (1) that it is good that medical students' education is moving into the community (e.g., this validates the importance of the community hospital to medical education, is an acknowledgment of the importance of generalism, and provides students invaluable learning experiences); (2) that educating medical students in the community is expensive, and more funding and resources are needed so that the area's hospitals, community faculty, preceptors, and support services can be fairly compensated for their commitment; and (3) that their community-based education system can no longer absorb the costs of training more medical students. This is not a criticism of academic medical centers, which are under tremendous financial pressures themselves, but is simply to state the community perspective and to urge fairness in the distribution of resources for medical education. Community institutions and academic medical centers will work individually to create their own integrated health care systems but must work together to create a better, more cost-effective system for educating medical students.     

Adult day care: Psychological practice and evaluation.

The unnecessary institutionalization of frail adults most often occurs when emotional factors exhaust the relationship between the caretaker and the frail adult. 14 60–93 yr olds with diagnoses of depression, chronic schizophrenia, or organic brain syndrome participated in a program that attempted to remediate depression and enrich affective involvement with caretakers. The program met twice weekly for 6 hrs and provided an intervention structured around familylike relationships, group psychotherapy, and task activity. Salient themes for the group were family relations, fear of institutionalization, and grief. Analysis of pre- and posttest scores on the Life Satisfaction Index (Form A), Mental Status Questionnaire, and the Self-Rating Depression Scale showed a reduction in depression, improved life satisfaction, increased knowledge of community resources, and a broader range of community activities. The role of psychology in adult daycare and the usefulness of linking evaluation to service delivery are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptoms and personality in patients with chronic functional dyspepsia

Twenty-five patients, 12 men and 13 women, aged 24-50 yr, who had consulted physicians and had received the diagnosis functional dyspepsia after extensive examination 6-8 years prior to this study, and were still suffering from this condition, were compared with community control subjects pair-wise matched for age and sex. Control subjects who had ever consulted a physician for gastrointestinal symptoms were excluded. Questionnaires measuring symptoms, job strain, social support and personality traits were used. Relatively few differences were found between groups. Compared to the community controls, however, the patients reported more gastrointestinal and nervous symptoms, and higher somatization, measured by Symptom Check List-90. The extent of reported overall distress was greater in patients than in control subjects. The detachment score (Karolinska Scales of Personality) was significantly lower in patients than in control subjects; this difference was also significant in separate analysis for men. Female patients had lower socialization and higher suspicion scores than female control subjects. Male patients reported more decision latitude (job control) than male control subjects.     

Family dynamics of families with mental health problems in Finland

This study forms part of the International Family Dynamics Project. Its purpose was describe the family functioning of families with mental health problems on the basis of Barnhill's framework for healthy family systems. The sample consisted of 160 families in which one family member had mental health problems. Both the patients and their relatives took part. The data were collected by questionnaires, i.e. The Family Dynamics Measure and The Family Dynamics Questionnaire. According to the results, mental health patients described family functioning as fairly poor, while relatives described it as fairly good. However, patients' and relatives' perceptions of family functioning did not differ significantly. There were some statistically significant differences between patients' and relatives' perceptions of different family dynamics dimensions. Relatives reported more mutuality (P = 0.006) and clearer communication (P = 0.009) than patients. Older mental health patients reported more isolation than patients under 30. Relatives who mentioned some serious illness in the family reported more role conflict than those who didn't. No differences were found by gender, family structure or education. The results indicated that the mental health problems of a single family member did not impair family dynamics. The study showed that the resources and functioning of families are fairly good in spite of the illness in the family.     

Day care and early childhood settings. Fostering mental health in young children

The authors, with research supporting the relationship between experience and the developing brain, envision a new and innovative model of child care in which principles of child development and mental health play an integral role. The School of the Twenty-first Century, although housed in existing school buildings, will be far more than a traditional 8:00 AM-to-3:00 PM educational facility. It will become a hub of child and family life in the community and provide institutional and outreach services for children from birth to 12 years of age. Active developmental and mental health programs that provide education for parents, primary caretakers, and other providers are central to the model. These programs will include preventive, evaluative, and treatment services for children. The child psychiatrist is viewed as an important member of the mental health team, who helps identify, assess, and treat children with developmental and psychiatric difficulties.     

History of patient education in rheumatic diseases in Croatia]

OBJECTIVE: This report examined the acceptability to mothers of a dietary educational and behavioral intervention for preadolescent children with elevated levels of serum low-density lipoprotein cholesterol (LDL-C) who were enrolled in the Dietary Intervention Study in Children (DISC). DESIGN: DISC is a randomized, controlled clinical trial. Subjects were randomly assigned to either an intervention or usual-care (control) group. SUBJECTS/SETTING: To be eligible for the study, participants were required to have the average of 2 fasting LDL-C values fall between the 80th and 98th sex-specific percentiles. Three hundred thirty-four 8-to 10-year-old children and their families were randomly assigned to an intervention group, and 329 were assigned to a usual-care (control) group. This study examined data from 232 subjects in the intervention group. Data were collected at 6 intervention sites around the United States. INTERVENTION: Those assigned to the intervention group participated in a multidisciplinary dietary intervention that included a series of group and individual sessions over a 3-year period. Children and their caretakers were taught to follow a nutritionally adequate diet that was low in total fat, saturated fat, and cholesterol and high in polyunsaturated fat. MAIN OUTCOME MEASURES: Three nonconsecutive 24-hour diet recalls were collected at baseline and at 1 year by trained and certified dietitians. A questionnaire designed to assess diet acceptability was administered at months 4, 8, 11, and 15. Demographic measures were collected at the onset of the study. STATISTICAL ANALYSIS PERFORMED: Statistical procedures included factor analysis and regression analysis. RESULTS: Regression analysis suggested that perceived effectiveness of the dietary intervention and mothers' having few concerns about disadvantages of the diet were significantly related to higher overall fat intake in children in one-parent families. Maternal willingness to implement the diet was significantly related to lower saturated fat intake. APPLICATIONS/CONCLUSIONS: In attempts to change eating behavior of children, interest and cooperation of the parents are essential to achieving successful results. These analyses further suggest that maternal acceptability translates into willingness to implement the diet and may facilitate changes that are associated with reduced saturated fat intake in children.     

Family obligation and the transition to young adulthood.

Changes in a sense of obligation to assist, support, and respect the family were examined among an ethnically diverse group of 745 American individuals as they began to move from secondary school into young adulthood. A sense of family obligation increased for all young adults, with slight variations according to ethnic and financial backgrounds. Young adults from Filipino and Latin American families reported the strongest sense of familial duty during young adulthood, which partially explained their tendency to live with and contribute financially to their families. The implications of family obligation for employment and educational persistence depended on age and academic performance in high school. Finally, a sense of family obligation was associated with more positive emotional well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intrapersonal and interpersonal functioning among middle-aged female adult children of alcoholics.

Examined group differences among a middle-aged, middle-class, community sample (N?=?616) of female adult children of alcoholics (ACOAs) and female non-ACOAs with regard to features of intra- and interpersonal functioning. Consistent with previous research, ACOAs reported higher levels of depression and lower levels of self-esteem. ACOAs also reported lower levels of perceived social support, family cohesion, and marital satisfaction and higher levels of marital conflict. ACOAs also indicated more parental role distress and perceived themselves as more powerless than non-ACOAs to control the actions of their offspring. ACOAs were more likely to drink for coping purposes (e.g., to relieve stress), although their level of alcohol consumption did not differ significantly from that of non-ACOAs. Although consistent differences were indicated between groups, ACOAs were still functioning in the nonpathological range on all measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.     

Effects of resources and stressors on burden and depression of family members who provide care to an HIV-infected woman.

This article describes the effect of resources and stressors on 156 family members who provided care and support for an HIV-infected woman. Both resources and stressors were related to the family members' perceived burden and depressive mood, and resources did little to buffer the associations between stress and burden and between stress and depression. Together, resources and stressors accounted for 50% of the variance in family members' perceived burden and 21% of the variance in their depressive mood. The only variable important in predicting both burden and depressive mood was the family member's feelings of stigma. These results suggest that efforts should be made to reduce the stigma felt by family members and to help them obtain additional family and community resources to ameliorate the burden of caregiving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of triple pelvic osteotomy on the articular contact area of the hip joint in dysplastic dogs: an in vitro experimental study

This study compares the frequency of signs and symptoms from the cervical spine in 24 patients diagnosed with Meniere's disease and 24 control subjects from a population sample. From a previous controlled comparative study concerning signs and symptoms of craniomandibular disorders, 24 patients diagnosed with Meniere's disease (10 males and 14 females) and their 24 matched control subjects participated in this investigation on the state of the cervical spine. Symptoms of cervical spine disorders, such as head and neck/shoulder pain, were all significantly more frequent in the patient group than in the control group. Most of the patients (75%) reported a strong association between head neck movements in the atlanto-occipital and atlanto-axial joints and triggered attacks of vertigo. Also, 29% of the patients could influence their tinnitus by mandibular movements. Signs of cervical spine disorders, such as limitations in side-bending and rotation movements, were significantly more frequent in the patient group than in the control group. Tenderness to palpation of the transverse processes of the atlas and the axis, the upper and middle trapezius, and the levator scapulae muscle were also significantly more frequent in the patient group. The study shows a much higher prevalence of signs and symptoms of cervical spine disorders in patients diagnosed with Meniere's disease compared with control subjects from the general population.     

Veridicality of social support: A comparison of principal and network members' responses.

Examined (1) the extent to which there is agreement between an individual and his/her social network member in their report of whether social support is provided or received (i.e., veridicality); (2) the relation between veridicality and feelings of closeness; and (3) the effect of veridicality on well-being. Ss were part of a larger national study and included 218 principal Ss (aged 70–95 yrs) and 497 network members (aged 18–92 yrs). Veridicality was assessed by matching the congruence of perception between the principal and network Ss. Overall well-being was measured through an assessment of life satisfaction. Specific veridicality ranged from 49 to 60%; overall veridicality reached a high of 79%. When examined by relationship, both specific and overall veridicality was highest between spouses, somewhat high among other family members, and lowest among friends. Feelings of closeness were significantly related to veridicality; principal Ss who reported feeling close to their network members had greater veridicality. Veridicality was not significantly related to life satisfaction, happiness, or negative affect. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of prenatal cocaine exposure on embryonic expression of sonic hedgehog

PURPOSE: To estimate the impact of visual impairment in older Australians on the use of community support services. METHODS: In the Blue Mountains Eye Study, 3654 people aged 49 or older were examined- 82.4% of eligible residents in an area west of Sydney, Australia. Presenting and best-corrected visual acuities were measured using a LogMAR chart. Subjects were categorized as having visual impairment if their better eye read 40 or fewer letters (20/40 or worse). Interview data included marital and other socioeconomic status measures, living status (alone or with spouse or other person), use of community support services, reliance on regular help from nonspouse family members or friends, and perceived ability to go out alone. RESULTS: After adjusting for age, gender, education, living status, walking disability, and health-related factors, for each one-line (five-letter) decrease in best-corrected visual acuity, there was a corresponding increase in reliance on community support services (odds ratio [OR], 1.17; 95% confidence interval, [CI] 1.07-1.28) or combined community and family support (OR 1.22; 95% CI, 1.12-1.32). Visually impaired persons were three times as likely to use regular support services provided by the municipality (OR 3.1; 95% CI, 1.8-5.1). A similar increased reliance on regular help from community, nonspouse family members, or friends was found. Visually impaired persons were also much more likely to state that they thought they were unable to go out alone (OR 6.2; 95% CI, 2.6-14.3). The findings were similar when presenting visual acuity was used to define visual impairment or after subjects with walking disabilities were excluded. Visual impairment seemed to have a greater effect on use of community support services in women than in men. CONCLUSIONS: After adjustment was made for confounding factors, visual impairment was found to affect significantly and negatively the independence of elderly people, particularly older women. Presenting visual acuity closely approximated best-corrected visual acuity in its impact on the use of community support services.     

Response to urinary incontinence by older persons living in the community

PURPOSE: To investigate the responses to urinary incontinence (UI) of older persons living in the community. DESIGN: Detailed interviews were completed on a sample of 42 independent, community-dwelling persons who were at least 60 years of age. Nineteen participants reported UI, and their experiences are reported in detail. SETTING AND SUBJECTS: Subjects were recruited from 3 sources: volunteers who acknowledged having UI, those with known UI who were invited by their doctors to participate, and those who selected "Loss of bladder control" in a 20-card sort of common ailments. All interviews were conducted in a private setting at a seniors center or at participants' church or home. INSTRUMENTS: Twenty cards with a common ailment printed in large type and an interview schedule with questions relating to the ailment selected as having the most impact were used; demographic data were collected on a standardized form. METHODS: Interviews were recorded on audiotape and lasted from 20 to 60 minutes. These recordings were analyzed for themes with use of Ethnography software. MAIN OUTCOME MEASURES: Demographic and other data from the interview schedule were tabulated. The communication style of the 19 subjects with UI was analyzed to determine how freely they spoke about problems with bladder control to family and friends and their sources of information for managing urinary leakage. Analysis was done both by the researcher and a faculty member; an interrater reliability of 1.00 was achieved. RESULTS: There was little difference in the self-rating of health for those with or without UI. Subjects recruited by letters sent to doctors' patients ranked the impact of loss of bladder control higher than other subjects did. Of the 19 subjects with UI, 10 spoke freely to family and friends, but 9 seldom discussed the subject--and then only to a family member. Four of the 9 with a closed communication style reported no current source of information about UI or its management. CONCLUSION: Though UI had a major effect on the lives of these subjects, they were more willing to admit having "loss of bladder control" than "urinary incontinence." Communication style is related to prior sources of information about UI, but not its perceived impact on health. This relationship helps to determine the teaching methods that are most likely to influence elderly persons with UI who have either on open or closed communication style.     

Beyond hearing: Where the real-world and online support meet.

A random sample survey of an online self-help group for people with hearing loss was conducted. Two factors predicted active participation in the group: a lack of real-world social support and being comparatively effective (having less disability, coping more effectively, and using real-world professional services). More active participation in the group was associated with more benefits from the group and stronger reports of community orientation. The authors also found evidence that integration of online and real-world support (if it existed) benefited participants. That is, if supportive family and friends in the real world shared the online group with participants, participants reported above average benefits, whereas if supportive family and friends were uninvolved in the online group, participants reported below average benefits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educating families and caretakers of traumatically brain injured patients in the new health care environment: a three phase model and bibliography

Shorter inpatient stays for traumatically brain injured patients frequently allow less time for comprehensive education of families and caretakers. What is needed to compensate for the shortened duration of brain injury rehabilitation in many settings is a family educational programme that (1) satisfies the family's acute information needs as they arise, and (2) standardizes the delivery of information so that certain knowledge criteria are met. The following article proposes a three phase model of family and caretaker education with an accompanying bibliographical index.     

Family responses to HIV/AIDS in Mexico

This paper presents findings from a qualitative study of household and community responses to HIV/AIDS in Mexico. Fieldwork took place in two contrasting settings: (a) Ciudad Netzahualcóyotl, a socially marginalized urban community and (b) the homosexual community of Mexico City, a sexually marginalized social network. 113 in-depth interviews were conducted with people with HIV/AIDS, their relatives and members of their social networks. This paper describes findings from interviews conducted with family members of persons with AIDS. Four stages of response are identified and characterized within each community: (i) life before AIDS, (ii) life during the discovery of AIDS, (iii) living with a person with AIDS and (iv) surviving those who have died from AIDS. The social marginalization of both communities is central in explaining how families respond to the disease. In Ciudad Netzahualcoyotl, social support derives from a local culture of kinship. In the gay community, on the other hand, solidarity arises out of friendship. Between social support and discrimination, many more "ambivalent" behaviours (neither fully supportive nor discriminating) are displayed by family members and friends. Fear, pre-existing family conflicts and prejudice nurture these negative responses. Family responses and the processes to which they give rise, also differ depending on whether or not a male or female household member is affected. Policy recommendations are made concerning how best to promote positive family and household responses to persons with HIV/AIDS and how to inhibit negative ones.     

Subgrouping children with familial phonologic disorders

Familial aggregation of speech and language disorders was examined as a basis of subgrouping children with phonologic disorders. Fifty-nine children with phonologic disorders were subgrouped according to whether or not other nuclear family members reported a history of speech/language disorders. Thirty-four subjects (58%) reported at least one other nuclear family member affected and 25 subjects (42%) reported no other nuclear family members affected. Groups were compared on measures of articulation, phonology, language, and oral motor skills to determine if the familial phonologic subgroup presented a unique profile of speech and language deficits. Significant group differences were not observed. However, children with positive nuclear family histories tended to perform more poorly than children without histories on all tasks, although not reaching significance. Although all parents were considered to have achieved normal adult articulation, parents of children with positive family histories also tended to perform more poorly than parents of children with negative histories. Results suggested that poorer oral motor coordination and productive phonology may distinguish individuals with familial phonologic disorders from individuals with phonologic disorders of unknown origin.     

Interpersonal Stressors and Resources as Predictors of Parental Adaptation Following Pediatric Traumatic Injury.

The authors examined the relationship of preinjury interpersonal resources and stressors to parental adaptation following pediatric traumatic brain injury (TBI) and orthopedic injury. Parents of children with severe TBI (n = 53), moderate TBI (n = 56), and orthopedic injuries (n = 80) were assessed soon after injury, 6 and 12 months after the initial evaluation, and at an extended follow-up with a mean of 4 years postinjury. General linear model analyses provide support for both main and moderating effects of stressors and resources on parental adjustment. Support from friends and spouse was associated with less psychological distress, whereas family and spouse stressors were associated with greater distress. The results also reveal a marked decline in injury-related stress over follow-up for families in the severe TBI group who reported a combination of high stressors and high resources. The decline suggests that interpersonal resources attenuated long-term family burden because of severe TBI. The findings are discussed in terms of their implications for intervention following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)