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Psychosocial Problems (psychosocial + problem)

Distribution by Scientific Domains

Medical Sciences	68%
Psychology	15%
Humanities and Social Sciences	12%

Distribution within Medical Sciences

Neurology	17%
14 Other Subdomains	66%

Selected Abstracts

An Evaluation of Two Characterizations of the Relationships Between Problematic Internet Use, Time Spent Using the Internet, and Psychosocial Problems

HUMAN COMMUNICATION RESEARCH, Issue 4 2010
Robert S. Tokunaga
This article reports tests of the relationships between problematic Internet use (PIU), time spent using the Internet, and psychosocial problems from the two perspectives. Ten individual meta-analyses were first conducted to identify weighted mean correlations among the five variables included within the models. The correlations derived from the meta-analyses were subsequently used in path analysis to test the alternative characterizations. The results offer some support for the deficient self-regulation model but provide relatively little evidence consistent with the pathology perspective of PIU. Une évaluation de deux caractérisations des relations entre l'utilisation problématique d'Internet, le temps consacréà Internet et les problèmes psychosociaux Robert Shota Tokunaga & Stephen A. Rains Cet article rend compte de tests des relations entre l'utilisation problématique d'Internet (UPI), le temps consacréà Internet et les problèmes psychologiques du point de vue de deux perspectives : celle de la pathologie et celle de l'auto-régulation déficiente. Dix méta-analyses individuelles ont d'abord été menées pour identifier des corrélations moyennes pondérées parmi les cinq variables incluses dans les modèles. Les corrélations tirées des méta-analyses ont ensuite été utilisées dans des analyses causales afin de tester les caractérisations alternatives. Les résultats appuient en partie le modèle de l'auto-régulation déficiente, mais offrent relativement peu de soutien à la perspective pathologique de l'UPI. Zur Bewertung des Verhältnisses zwischen problematischem Internetgebrauch, Internetnutzungszeit und psychosozialen Problemen Robert Shota Tokunaga & Stephen A. Rains Dieser Artikel befasst sich mit der Überprüfung des Zusammenhangs zwischen problematischem Internetgebrauch, der Internetnutzungszeit und psychosozialen Problemen aus zwei Blickwinkeln. Wir führten zehn Meta-Analysen durch, um die gewichteten Mittelwertskorrelationen zwischen den fünf Variablen des Modells zu identifizieren. Die Korrelationen der Meta-Analysen wurden anschließend in eine Pfadanalyse überführt, um alternative Blickwinkel zu prüfen. Die Ergebnisse stützen zum Teil das defizitäre Selbstregulierungsmodell, bieten aber wenig Anhaltspunkte für eine pathologische Perspektive auf einen problematischen Internetgebrauch. Evaluando Dos Caracterizaciones de las Relaciones entre el Uso Problemático del Internet, el Tiempo Dedicado al Uso del Internet, y los Problemas Sicológicos Robert Shota Tokunaga & Stephen A. Rains Department of Communication, University of Arizona Resumen Este artículo reporta las pruebas de las relaciones entre el uso problemático del Internet PIU, el tiempo empleado en el uso del Internet, y los problemas psico-sociales desde 2 perspectivas. 10 meta análisis individuales fueron conducidos primero para identificar el promedio medido de las correlaciones entre las 5 variables incluías dentro de los modelos. Las correlaciones derivadas de los meta-análisis fueron usados subsecuentemente en el análisis de trayectoria para poner a prueba las caracterizaciones alternativas. Los resultados ofrecen algo de apoyo al modelo de auto regulación deficiente, pero proveen de relativamente poca evidencia consistente con la perspectiva patológica del PIU. [source]

Follicular Unit Transplantation: The Option of Beard Construction in Eunuchoid Men

DERMATOLOGIC SURGERY, Issue 9 2002
Kayihan, ahinoglu MD
background. Psychosocial problems are very common in eunuchoids and may be related to the impact of underlying disorders on the physical appearance which makes them unable to overcome the sense of inferiority of childhood. A beardless patient treated with follicular unit transplantation (FUT) is reported here. objective. Such patients desire to get rid of a boyish appearance and want to achieve a masculine appearance. One of the easiest methods to achieve this goal is FUT. methods. By using an 18-gauge needle, the recipient bed was prepared under local anesthesia after premedication, and 1200 one- or two-hair micrografts were transplanted to the perioral (goatee) and its extensions to the sideburns. results. After completion of the procedure to the planned area, we achieved restoration of a masculine appearance which made the patient seem quite satisfied. conclusion. The process of beard reconstruction is time consuming and tedious, but highly effective. [source]

Psychosocial problems and seizure-related factors in children with epilepsy

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2006
B Høie
In this study we describe psychosocial functions and seizurerelated factors in a population-based sample of children with epilepsy. Psychosocial problems (Achenbach scales), cognitive function, and socioeconomic status were studied in 117 children with epilepsy aged between 6 and 13 years (mean age 11y [SD 2y 1mo] and 10y 8mo [SD 2y]; 71 males, 46 females) and in randomly selected controls matched with 117 children for sex and age (mean age 11y 2mo [SD 2y 1mo] and 10y 5mo [SD 2y 4mo]; 69 males, 48 females). The children had partial (n=67), generalized (n=43), or undetermined (n=7) epilepsy syndromes, and partial (n=68), generalized (n=47), or other (n=2) main seizure types. Psychosocial problems were more common among children with epilepsy than controls (odds ratio 5,9) and significantly related to epilepsy syndrome, main seizure type, age at onset, and seizure frequency. Mothers and teachers reported males with epilepsy as having more problems than females. Females self-reported psychosocial problems, males did not. Psychosocial problems were common in childhood epilepsy. Females appreciated the problems more realistically than males. Psychosocial problems should be considered an integral part of epilepsy management. [source]

,Difficult Asthma': Can Symptoms be Controlled in a Structured Environment?

PEDIATRIC PULMONOLOGY, Issue 8 2009
K. De Boeck MD
Abstract Objective Difficult asthma implies persistent asthma symptoms despite therapy with high doses of inhaled corticosteroids. The objective was to evaluate children with difficult asthma in a setting that excludes aggravating factors such as poor treatment adherence and adverse environmental influences. Patients and Methods Sixty children (,6 years) had been referred because of difficult asthma to the rehabilitation centre over a period of 10 years. The diagnosis of poor asthma symptom control was confirmed if exacerbations continued during stay in the centre or if symptoms interfered with daily activities at least 3 times a week. Results The median stay at the centre was 5 months. In four patients a diagnosis other than asthma was made. In five patients symptom control remained difficult. In the remaining 51 children, asthma symptoms became well controlled. Many factors contributed to poor asthma control in the home setting: poor treatment adherence (n,=,32), parental smoking (n,=,22), allergen exposure (n,=,10). Psychosocial problems occurred in 36 children. Contributing factors often co-existed. During stay at the centre, lung function improved in the group with well controlled asthma symptoms (P,<,0.001) but not in the group with continued poor symptom control. In the majority of children who obtained good symptom control, this persisted in the years following discharge. Conclusion Of 60 children referred with a diagnosis of difficult asthma, optimal medical management in a structured environment resulted in good symptom control in 51 patients; symptom control remained poor in 5 patients, a diagnosis other than asthma was made in 4 patients. Pediatr Pulmonol. 2009; 44:743,748. © 2009 Wiley-Liss, Inc. [source]

Psychosocial problems and seizure-related factors in children with epilepsy

Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy

DIABETIC MEDICINE, Issue 9 2000
U. Bott
SUMMARY Aims To evaluate a treatment and teaching programme including psychosocial modules for patients with Type 1 diabetes mellitus on intensified insulin therapy who failed to achieve their treatment goals despite participation in standard programmes. Methods The 5-day inpatient programme comprises small groups of 4,6 patients, focusing on individual needs and problems. Beyond the teaching lessons (most topics are deliberately chosen by the patients), the programme provides intensive group discussions and offers individual counselling concerning motivational aspects, psychosocial problems and coping strategies. Of the first consecutive 83 participants, 76 were re-examined after 17.5 ± 5.5 months (range 9,31 months). Results At follow-up, HbA1c was not improved compared to baseline (8.0 ± 1.3% vs. 8.1 ± 1.5%). However, the incidence of severe hypoglycaemia per patient/year (glucose i.v., glucagon injection) was substantially decreased: 0.62 ± 1.5 episodes at baseline compared to 0.16 ± 0.9 at follow-up (P < 0.001). Twenty-six per cent of the patients at baseline, and 4% at re-examination had experienced at least one episode of severe hypoglycaemia during the preceding year (P < 0.001). Sick leave days per patient/year decreased from 17.0 ± 38.5,7.7 ± 13.6 days (P < 0.05). Patients improved their perceptions of self-efficacy, their relationship to doctors and felt less externally controlled (P < 0.001). The majority of patients perceived an improved competence regarding diet (80.6%) and adaptation of insulin dosage (82.4%), an improved knowledge (82.2%), and a renewed motivation for the treatment (84.5%). Treatment success was significantly associated with baseline HbA1c, stability of motivation, frequency of blood glucose self-monitoring, control beliefs and change in subsequent outpatient care. Conclusions The programme improved glycaemic control mainly as a result of a substantial reduction in the incidence of severe hypoglycaemia. Patients with persistent poor glycaemic control may benefit from structured follow-up care focusing on motivational aspects of self-management and psychosocial support. [source]

Are differences in guidelines for the treatment of nicotine dependence and non-nicotine dependence justified?

ADDICTION, Issue 12 2009
John R. Hughes
ABSTRACT Despite the many similarities between nicotine dependence and other drug dependences, national guidelines for their treatment differ in several respects. The recent national guideline for the treatment of nicotine dependence has (i) less emphasis on detailed assessment; (ii) less emphasis on treatment of psychiatric comorbidity; (iii) less acceptance of reduction of use as an initial treatment goal; (iv) greater emphasis on pharmacological interventions; and (v) less emphasis on psychosocial treatment than national guidelines for non-nicotine dependences. These treatment differences may occur because (i) nicotine does not cause behavioral intoxication; (ii) psychiatric comorbidity is less problematic with nicotine dependence; (iii) psychosocial problems are less severe with nicotine dependence; and (iv) available pharmacotherapies for nicotine dependence are safer, more numerous and more easily available. However, it is unclear whether these treatment differences are, in fact, justifiable because of the scarcity of empirical tests. We suggest several possible empirical tests. [source]

Changes and predictors of change in the physical health status of heroin users over 24 months

ADDICTION, Issue 3 2009
Anna Williamson
ABSTRACT Aims (i) To describe the course of physical health among the ATOS cohort over 24 months; and (ii) to examine the effects of treatment, drug use patterns and social and psychological factors on health status over 24 months. Design Longitudinal cohort. Setting Sydney, Australia. Participants A total of 615 heroin users recruited for the Australian Treatment Outcome Study (ATOS). Findings The general health of the cohort improved significantly over 24 months. Significant predictors of poor health over 24 months were: being older, being female, past month heroin, other opiate and tobacco use, past month unemployment and current major depression. Spending a greater proportion of time in residential rehabilitation (RR) was associated with better health over 24 months. No other treatment factors demonstrated a significant, independent relationship with health. Conclusions The physical health of dependent heroin users is affected by drug use and psychosocial problems. RR treatment appears to be particularly beneficial to the health of heroin users, suggesting the importance of a comprehensive approach to improving health among this group. [source]

Assessing the impact of late treatment effects in cervical cancer: an exploratory study of women's sexuality

EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2007
M. BURNS rn, m.phil, professional development nurse
Cancer survivorship has become a major issue due to people living longer with the effects of cancer treatment. A key issue in this area are the ,iatrogenic effects' of cancer treatments and their adverse impact on the quality of long-term patient survival. This paper considers the late physical effects of treatment for cervical cancer, in particular psychosocial problems associated with sexuality. The aim of this paper was to explore women's sexuality following treatment for cervical cancer. A qualitative phenomenological design was used to explore the lived experiences of a purposive sample of 13 women 2,3 years after treatment, using in-depth interviewing. The findings demonstrate that cancer treatment can result in a number of late physical effects, including bladder and bowel dysfunction. Moreover, the physical problems led to sexual difficulties experienced several years after treatment. Concerns were expressed by patients about perceived psychosexual difficulties encountered as a result of treatment. In conclusion, the study raises issues associated with the management of late treatment effects and its impact on sexuality. The findings underline the need for effective communication of possible iatrogenic effects of treatment during follow-up care and a need for research to consider the advice and information that women require about long-term treatment effects. [source]

Headache and Psychological Functioning in Children and Adolescents

HEADACHE, Issue 9 2006
Scott W. Powers PhD
Headache can affect all aspects of a child's functioning, leading to negative affective states (eg, anxiety, depression, anger) and increased psychosocial problems (for instance, school absences, problematic social interactions). For children and adolescents who experience frequent headache problems, comorbid psychological issues are a well-recognized, but poorly understood, clinical phenomenon. The confusion surrounding the relationship between pediatric headache and psychopathology exists for several reasons. First, in some cases, headache has been inappropriately attributed to psychological or personality features based on anecdotal observations or interpretations that go beyond the available data. Additionally, measures of psychopathology have not always adhered to the American Psychiatric Association's diagnostic criteria, thus reducing the reliability of diagnostic judgments. Furthermore, the diagnosis of headache has not always followed standard criteria, and has been complicated by the emergence of new terms and evolving measures. Finally, methodological shortcomings, such as incomplete descriptions of the procedures and criteria used for the study, inadequate descriptions of headache severity, lack of a control group for comparison with individuals without headaches, reliance primarily on cross-sectional research designs that are often discussed with inferences to causal hypotheses, and the use of unstandardized assessment measures, have significantly limited the validity of research findings. The goal of the current review is to examine the extant literature to provide the most up-to-date picture on what the research has made available about the magnitude, specificity, and causes of psychopathology in children and adolescents with headache, in an effort to further elucidate their relationship and prompt a more methodologically rigorous study of these issues. [source]

Psychological Symptoms Are Greater in Caregivers of Patients on Hemodialysis Than Those of Peritoneal Dialysis

HEMODIALYSIS INTERNATIONAL, Issue 4 2003
M. Tugrul Sezer
Background:,The purpose of this study was to evaluate and compare psychosocial characteristics in caregiving relatives (caregivers) of hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods:,Thirty-three caregivers (17 women, 16 men) of HD patients, 27 caregivers (11 women, 16 men) of PD patients, and a control group of 49 subjects who do not care for family members with chronic illness (23 women, 26 men) are included in this study. The brief symptom inventory (BSI), social disability schedule (SDS), and brief disability questionnaire (BDQ) were used for the psychosocial evaluation. Results:,The mean age, men-to-women ratios, duration of education, and distribution of marital status did not differ significantly among the three groups. In addition, dialysis duration and distribution of caregiver type were not different between the HD and PD groups. Although the mean global severity index scores of the three groups were similar, somatization and depression scores from BSI subitems were greater in the HD group than the scores of the PD and control groups. Although the mean SDS and BDQ scores were higher in the HD group, the differences did not achieve statistical significance. BSI subitems such as somatization, obsession,compulsion, interpersonal sensitivity, depression, and anxiety were positively correlated among themselves. Hostility and somatization were negatively correlated with age and education, respectively. Nevertheless, somatization was positively correlated with age. Social disability was negatively correlated with duration of education. Conclusion:,Somatization and depression are greater in the caregivers of center HD patients compared to PD and control groups. According to the findings of this study, we suggest that caregiving family members of dialysis patients especially on HD also should be evaluated for psychosocial problems and supported as needed. Further studies are needed to explore whether psychosocial parameters of caregivers predict outcomes for caregivers and patients. [source]

An Evaluation of Two Characterizations of the Relationships Between Problematic Internet Use, Time Spent Using the Internet, and Psychosocial Problems

Risk assessment: A regulatory strategy for stimulating working environment activities?

HUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 2 2001
Per Langaa Jensen
This article analyzes the Danish approach to workplace assessment (WPA) following European requirements to establish legislation on occupational health and safety. Quantitative studies show that WPA can be interpreted as a success within the larger Danish firms. However, data from qualitative studies modify this picture by showing how attention has been focused on physical working environment problems while wider psychosocial problems have been ignored. The article claims there is no evidence from either the quantitative or the qualitative studies that WPA,even though positively evaluated,has become a recurrent activity within firms. © 2001 John Wiley & Sons, Inc. [source]

Stability and prediction of parenting stress

INFANT AND CHILD DEVELOPMENT, Issue 2 2007
Monica Östberg
Abstract The study focused on stability and prediction of parenting stress experiences over a 6-year period. Mothers (N=93) who had received a clinical intervention for feeding or sleeping problems during infancy (Time 1; T 1) were followed-up when the children were 5,10 years old (Time 2; T 2). An age- and sex-of-child matched normal group was used for comparison of stress levels at T 2. Parenting stress was measured by the Swedish Parenthood Stress Questionnaire, which consists of a general parenting stress scale and sub-scales tapping different aspects of parenting stress experiences. T 1 predictors were clinical assessments of child problem load, maternal unresponsiveness, and family psychosocial problems. T 2 predictors were mother-reported concurrent child problem load and psychosocial problems. The individual stability in stress experiences was moderate. Effect sizes indicated that mothers with early clinical contacts had reduced their stress to levels close to those in the normal sample. Parenting stress at T 2 could be predicted from early and from concurrent child and family problems. The results point to the relevance of early clinical assessments and to the importance of a sub-area approach in parenting stress research, as there were differences between stress sub-areas regarding both prediction and stability. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Lived Experiences of Mothers Caring for Children With Thalassemia Major in Thailand

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2007
Suksiri Prasomsuk
ISSUES AND PURPOSE.,Thalassemic patients must be given continuous treatment throughout their lives due to the physical and psychological effects of their disorder; their families also are impacted. This qualitative study explored the lived experiences of 15 mothers of children with thalassemia major by conducting semistructured interviews; the data were analyzed utilizing content analysis. CONCLUSION.,Six themes were identified: lack of knowledge about thalassemia, psychosocial problems, concerns for the future, social support systems, financial difficulty, and the effectiveness of healthcare services. PRACTICE IMPLICATIONS.,These findings suggest that a holistic, culturally sensitive nursing approach should be considered when caring for children with thalassemia. [source]

Transformational experiences in adult-to-adult living-donor liver transplant recipients

JOURNAL OF ADVANCED NURSING, Issue 1 2010
Akemi Watanabe
Abstract Title.,Transformational experiences in adult-to-adult living-donor liver transplant recipients. Aim., This paper is a report of a study conducted to explore the transformational experiences of adult-to-adult living-donor liver transplant recipients. Background., Living-donor liver transplant was developed to overcome the shortage of cadaveric livers available for transplantation. However, living-donor liver transplant generates multifaceted psychosocial problems for recipients. Method., Data were collected from 2002 to 2004 through in-depth interviews and participant observations. We adopted a phenomenological approach that examined the experience of 30 recipients. Findings., We classified the experiences into three types: common, innate and unrealized. Analysis of the transcripts revealed four themes, all with associated sub-themes. The first theme, guilt and concrete issues, includes anguish when thinking about survival by hurting a potential donor and problems associated with donor and cost. The second theme, let it happen includes leave it to fate; ambivalence; and worry about the donor candidate and whether he/she will change their mind. The third theme, pain, includes extreme physical and mental pain for me and the donor; and worry about cost. The fourth theme, balancing gains and losses, includes grateful for and hoping to enjoy my new life; burden of new body; difficulty in adapting to modified life plan; and changes in family relationships. Conclusion., Nursing practice should be developed to (1) give support to patients and their families during decision-making; (2) give support for the dramatic life change; (3) help recipients accept the reality of the transplant; and (4) help achieve the essential balance between feelings of attainment and loss. [source]

Doctors' assistants' views of case management to improve chronic heart failure care in general practice: a qualitative study

JOURNAL OF ADVANCED NURSING, Issue 4 2009
Rebecca Olbort
Abstract Title.,Doctors' assistants' views of case management to improve chronic heart failure care in general practice: a qualitative study. Aim., This paper is a report of a study to explore the views, concerns and experiences of doctors' assistants of case management for patients with chronic heart failure, while experiencing the new role of being a case manager within the Heidelberg Integrated Case Management trial. Background., Case management is being investigated as part of a randomised controlled trial aiming to improve care for patients with chronic systolic heart failure. In a complex, multifaceted intervention, trained doctors' assistants (equivalent to a nursing role) adopted new tasks using standardised case management involving telephone monitoring, home visits and diagnostic screening. Method., In April 2007, 3 months after implementation of the intervention programme, 27 doctors' assistants participated in four focus group interviews discussing their views on, and experiences of, case management. Thematic analysis of the data was undertaken. Findings., Participants believed that the most positive factors in case management were about interaction with patients, including opportunities for identifying disease and psychosocial problems. However, barriers included lack of time allocated to perform case management in addition to their normal role and poor cooperation within the practice team. According to the doctors' assistants, the routine implementation of case management was acceptable, feasible and effective in improving the management of patients with chronic systolic heart failure. Conclusion., Case management enhanced the role of doctors' assistants, leading to increased awareness of the perspective of patients with chronic disease. In the wider international primary care practice nursing context, the orchestrated delegation of tasks using specific case management may be a promising strategy for improving the quality of care of chronically ill patients and enabling patient self-management. [source]

Complexity Prediction Instrument to detect ,complex cases' in respiratory wards: instrument development

JOURNAL OF ADVANCED NURSING, Issue 1 2008
Elena Lobo
Abstract Title.,Complexity Prediction Instrument to detect ,complex cases' in respiratory wards: instrument development. Aim., This paper is a report of a study to test the hypothesis that the Spanish version of the Complexity Prediction Instrument is a reliable and valid measure of complexity of patients with respiratory disease and to identify the frequency of positive indicators of potential complexity. Background., Respiratory patients are often disabled and severely ill, with co-morbid physical conditions and associated psychosocial problems and need complex nursing care. Method., Trained nurses assessed 299 consecutive adult patients admitted to a respiratory service in Spain from May 2003 until June 2004 with the new, Spanish version of the instrument. Criterion-related validity was tested by studying its ability to predict complexity of care in terms of: severity of illness, scored using the Cumulative Illness Rating Scale; length of hospital stay; ,multiple consultations' during admission; and ,multiple specialists' after discharge. Findings., The hypothesis was supported: patients rating above the standard cut-off point on the Complexity Prediction Instrument scored statistically significantly higher on most of the measures of care complexity studied. Linear regression models showed that the tool was associated with ,length of hospital stay', and predicted both ,multiple consultations' and ,multiple specialists', after controlling for potential confounders. The proportion of ,probable complex cases' was 59·5%. Five positive indicators of potential complexity had a frequency higher than 50%. Conclusion., The Complexity Prediction Instrument is reliable and valid in a new clinical area, respiratory disease. It may be used by nurses for the early prediction of complexity of care. International comparisons may be facilitated with this new Spanish version. [source]

Overt and covert aggression in work settings in relation to the subjective well-being of employees

AGGRESSIVE BEHAVIOR, Issue 5 2001
Ari Kaukiainen
Abstract Aggressive behavior was studied in workplaces having (1) predominantly male, (2) predominantly female, or (3) both male and female employees in equal or near equal frequencies. In addition to examining the occurrence of different types of aggression in these workplaces, the question of whether being a target of aggression is related to employees' subjective well-being was addressed. One hundred sixty-nine participants (mainly 30,50 years of age) employed in a wide range of organizations in the public sector completed a questionnaire measuring four types of observed and experienced aggression: direct overt, indirect manipulative, covert insinuative, and rational-appearing aggression. Indirect manipulative and rational-appearing aggression were perceived to be the most widely used aggression styles in the work context. In the predominantly male workplaces, the men were perceived to use more of all types of aggression than in the predominantly female workplaces. The women's aggression was not related to the relative number of females and males with whom they worked. Participants were divided into two groups on the basis of the extent to which they estimated themselves to be targets of workplace aggression. Those who considered themselves to be victims of workplace aggression suffered significantly more from psychosocial problems and physical symptoms than those who had been victimized to a lesser extent or not at all. The victimized group also considered the aggression they had suffered to be the reason for their psychosocial and health problems. Aggr. Behav. 27:360,371, 2001. © 2001 Wiley-Liss, Inc. [source]

Refining diagnoses: applying the DC-LD to an Irish population with intellectual disability

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2005
A. Felstrom
Abstract Background The diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation (DC-LD) is a diagnostic tool developed in 2001 to improve upon existing classification systems for adults with learning disability. The aim of this study was to apply the classification system described by the DC-LD to a residential intellectual disability (ID) population to examine whether it improved our diagnostic understanding of residents. Methods Chart reviews of 113 of 178 people in a residential ID service were conducted. For each resident, information was recorded according to the DC-LD multi-axial system. Each resident's case was then discussed with a member of nursing staff familiar with the resident. If diagnosis was unclear, the case was discussed with a senior clinical psychiatrist. Results The percentage of residents with a moderate to profound ID was 87.6%. In total, 94 diagnoses of psychiatric illness (Axis III, Level B, DC-LD) were made. Of those 94 diagnoses, seven new diagnoses were found because of DC-LD criteria. Of the total number of psychiatric diagnoses made, 72.3% were non-specific, residual category diagnoses. A total of 79 residents (69.9%) had at least one behaviour problem diagnosed on Axis III, Level D, Problem behaviours. Fifty-six (49.6%) of residents in this sample had co-morbid epilepsy. Conclusions In people with moderate to profound learning disabilities, diagnosis continues to be challenging. The DC-LD is a useful tool in helping to clarify diagnoses in this population by providing revised criteria and a system to classify problem behaviours. The DC-LD would be more helpful if specific axes were included to document medical and psychosocial problems independently from other diagnoses. Further research is warranted to determine whether the DC-LD hierarchical approach to diagnosis improves diagnostic validity. [source]

Women With High-Risk Pregnancies, Problems, and APN Interventions

JOURNAL OF NURSING SCHOLARSHIP, Issue 4 2007
Dorothy Brooten
Purpose: To (a) describe women's prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women's medical diagnosis (diabetes, hypertension, preterm labor). Design and Methods: Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women's homes. Patients' problems and APN interventions were classified with the Omaha Classification System. Findings: A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related behaviors (33.3%); postpartum were physiologic (44.0%) and psychosocial problems (31.6%). Antenatally, women with diabetes had significantly more health-related behavior problems; women with preterm labor had more physiologic problems. APN surveillance interventions predominated antenatally (65.6%) and postpartum (66.0%), followed by health teaching, guidance, and counseling both antenatally (25.4%) and postpartum (28.1%). Women with chronic hypertension required significantly more case-management interventions. Conclusions: The categories of women's problems were largely similar across medical diagnostic groups. Interventions to address women's problems ranged from assessing maternal and fetal physiologic states to teaching interpersonal relationships and self-care management to assisting with transportation and housing. Data show the range of APN knowledge and skills needed to improve maternal and infant outcomes and ultimately reduce healthcare costs in women with high-risk pregnancies. [source]

Preventing Pediatric Obesity: Assessment and Management in the Primary Care Setting

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2 2002
FAANP, Lorna Schumann PhD
Purpose To review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese. Data Sources Selected research, national guidelines and recommendations, and the professional experience of the authors. Conclusions The focus of primary care involves early detectionand family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems. Implications For Practice Pediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under-diagnosed and under-treated. It is essential to discuss prevention of obesity with parents at every well-child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender. [source]

Demographic Characteristics, Life Context, and Patterns of Substance Use Among Alcohol-Dependent Treatment Clients in a Health Maintenance Organization

ALCOHOLISM, Issue 12 2000
Tammy W. Tam
Background: Although individuals dependent only on alcohol and those dependent on both alcohol and drugs typically are not studied together in clinical trials, they are treated together in most treatment programs. In this study we compared epidemiological characteristics of the alcohol-only and alcohol-and-drug dependents in a treatment sample to assess differential treatment needs. Method: Patients admitted to treatment at a health maintenance organization's chemical dependency program were sampled and interviewed by using a structured questionnaire. The sample included 491 alcohol-only and 217 alcohol-and-drug dependents. Demographic characteristics, lifetime and current substance use, Addiction Severity Index composite scores, and DSM-IV criteria for alcohol and drug dependence were assessed at admission . Results: The odds of alcohol-and-drug dependence were higher among males, African Americans (when compared with whites), those who were younger, and those with less than college education. The risk was also higher among those who initiated heavy drinking or drug use before the age of 18. Increased psychiatric and family/social problems also were associated with combined dependence. Conclusions: Even in this relatively homogeneous socioeconomic status population, demographic characteristics were important predictors of type of dependence. Treatment programs which provide services that address prevention and psychosocial problems should pay attention to age of initiation as well as psychiatric and social problems. [source]

Effects of childhood exposure to familial alcoholism and family violence on adolescent substance use, conduct problems, and self-esteem

JOURNAL OF TRAUMATIC STRESS, Issue 2 2002
Jennifer Ritter
Abstract Exposure to familial alcoholism has been associated with many behavioral and emotional difficulties among offspring. However, few studies have examined environmental risks that often coexist with familial alcoholism, and which may influence the development of offspring psychosocial problems. This study examined potential additive and interactive effects of childhood exposure to family violence and childhood exposure to familial alcoholism on adolescent functioning. Three domains of adolescent functioning were examined in a high-risk community sample of 109 families: lifetime levels of substance use, conduct disorder behaviors, and self-esteem. Results indicated that both childhood exposure to familial alcoholism and childhood exposure to family violence were associated with psychosocial functioning of offspring during adolescence, although the relations differ according to domain of functioning and gender. [source]

Experience with Implantable Cardioverter-Defibrillator Therapy in Grown-Ups with Congenital Heart Disease

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2008
MAREN TOMASKE M.D.
Implantable cardioverter-defibrillators (ICD) are increasingly implanted for primary or secondary prevention of sudden death in young patients with congenital heart disease, cardiomyopathies, or channelopathies. Although major advances in ICD technology and implant techniques have facilitated ICD therapy in young patients, complications such as lead failures, inappropriate shocks, system infections, and negative psychosocial impacts are of concern. The various underlying cardiovascular disease states and a lack of standardized ICD protocols for young patients often necessitate individualized implant techniques, ICD programming, and follow-up. Young ICD patients need a thorough follow-up to ensure adequate therapy, and psychosocial problems have to be addressed. [source]

Mental Health and Emergency Medicine: A Research Agenda

ACADEMIC EMERGENCY MEDICINE, Issue 11 2009
Gregory Luke Larkin MD
Abstract The burden of mental illness is profound and growing. Coupled with large gaps in extant psychiatric services, this mental health burden has often forced emergency departments (EDs) to become the de facto primary and acute care provider of mental health care in the United States. An expanded emergency medical and mental health research agenda is required to meet the need for improved education, screening, surveillance, and ED-initiated interventions for mental health problems. As an increasing fraction of undiagnosed and untreated psychiatric patients passes through the revolving doors of U.S. EDs, the opportunities for improving the art and science of acute mental health care have never been greater. These opportunities span macroepidemiologic surveillance research to intervention studies with individual patients. Feasible screening, intervention, and referral programs for mental health patients presenting to general EDs are needed. Additional research is needed to improve the quality of care, including the attitudes, abilities, interests, and virtues of ED providers. Research that optimizes provider education and training can help academic settings validate psychosocial issues as core components and responsibilities of emergency medicine. Transdisciplinary research with federal partners and investigators in neuropsychiatry and related fields can improve the mechanistic understanding of acute mental health problems. To have lasting impact, however, advances in ED mental health care must be translated into real-world policies and sustainable program enhancements to assure the uptake of best practices for ED screening, treatment, and management of mental disorders and psychosocial problems. [source]

Women with co-occurring substance use and mental disorders (COD) in the criminal justice system: a research review

BEHAVIORAL SCIENCES & THE LAW, Issue 4 2004
JoAnn Y. Sacks Ph.D.
Associated with the dramatic increase in the numbers of women entering the criminal justice system is the recognition of the prominent role of co-occurring substance use and mental disorders (COD) in the lives of female offenders. This article reviews current research examining the prevalence and range of COD among female offenders, the variety of psychosocial problems faced by the female offender with COD, and the multiple treatment needs of women with COD who are under criminal justice supervision. Women with COD can enter the criminal justice system at several different points and, because both substance use and mental disorders carry significant risk of relapse, effective treatment approaches must address both disorders. The paper concludes with a discussion of several important treatment issues and provides suggestions regarding an agenda for future treatment and research. Copyright © 2004 John Wiley & Sons, Ltd. [source]

School experiences after treatment for a brain tumour

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2006
P. Upton
Abstract Background Children surviving a brain tumour face major difficulties including learning problems, lengthy school absences and psychosocial problems, all of which can impact on school functioning. Our aims were to provide information for parents and teachers about the skills and resources of this group. Specifically, we aimed to: ,,describe the special educational needs of these children; ,,document the impact of diagnosis and treatment on school attendance; ,,compare parent and teacher assessments of social, emotional and behavioural difficulties. Methods Forty families agreed to participate (response rate = 58.82%). The children (19 males and 21 females) were aged from 6 to 16 years and had completed treatment at least 2 years previously (range = 2 years,12 years 5 months). Questionnaires (Strengths and Difficulties and school experience) were completed by mothers and teachers. Results Survivors were experiencing a wide range of physical, learning and interpersonal difficulties, according to parent and teacher reports. Almost half the children (n = 19) had ongoing neurological problems that were significant enough to require special help at school. Literacy and numeracy were the most common learning difficulties. Parents also rated brain tumour survivors as having more behavioural and emotional problems than would be expected from population norms. For example, survivors were rated as having more Total Difficulties (t = 6.86, P < 0.001), Emotional Symptoms (t = 8.82, P < 0.001), Hyperactivity (t = 2.25, P = 0.03), Peer Relationship Problems (t = 7.58, P < 0.001) and poorer Pro-social Behaviour (t = ,3.34, P = 0.002) than would be expected from population norms. These problems were also seen to be having a significant impact on the child's functioning (t = 3.95, P < 0.001). Teachers rated these problems as less serious than parents. Conclusion These children experience significant problems in school some time after diagnosis and when they are considered medically cured. Closer school,hospital liaison is essential to maximize integration and achievement in these children. [source]

Covert fears and anxiety in asthma and congenital heart disease,

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2001
S Gupta
Summary Aim To compare anxiety, fears and behavioural problems in children with asthma and children with congenital heart disease, and with the normative population. To also review the influence of maternal anxiety, time since diagnosis and severity of disease. Design Children administered Fear Survey Scale (FSSC-R) and Child Manifest Anxiety Scale (R-CMAS). Mothers given Child Behaviour Checklist (CBCL) and State Trait Anxiety Scale (STAI-S and STAI-T). Normative means and SDs compared with means and SDs for both medical groups. The mother's scores on the STAI-S and STAI-T scales were correlated with the child's scores on the FSSC-R and the R-CMAS. Setting Outpatient Asthma and Cardiology multidisciplinary Clinics at a tertiary care paediatric facility, Alberta Children's Hospital. Subjects: Forty children with asthma (aged 6,17 years) were compared with 39 children with congenital heart disease. Intake questionnaires and interviews determined these children to be without obvious psycho-social problems. Results Children with asthma and children with congenital heart disease had more medical fears, and more physiological anxiety than normative samples. Increased maternal anxiety was correlated in both groups with increased child anxiety, medical fears and behavioural problems in the child. Similarly, increased severity of asthma or cardiac problems was associated with more physiological anxiety and more fears. Less time since diagnosis of the disease adversely affected social interactions in both groups of children. Conclusion Physiological anxiety, medical fears and maternal anxiety are important issues requiring attention in asthma and cardiac disease, even in the absence of obvious psychosocial problems. There may be specific problems with a recent diagnosis of a chronic illness. [source]

Child health services in transition: I. Theories, methods and launching

ACTA PAEDIATRICA, Issue 3 2005
C. SUNDELIN
Abstract Aim: To describe an evidence-based model for preventive child health care and present some findings from baseline measurements. Methods: The model includes: parent education; methods for interaction and language training; follow-up of low birthweight children; identification and treatment of postnatal depression, interaction difficulties, motor problems, parenthood stress, and psychosocial problems. After baseline measurements at 18 mo (cohort I), the intervention was tested on children from 0 to 18 mo at 18 child health centres in Uppsala County (cohort II). Eighteen centres in other counties served as controls. Two centres from a privileged area were included in the baseline measurements as a "contrasting" sample. Data are derived from health records and questionnaires to nurses and mothers. Results: Baseline experiment (n= 457) and control mothers (n= 510) were largely comparable in a number of respects. Experiment parents were of higher educational and occupational status, and were more frequently of non-Nordic ethnicity. Mothers in the privileged area (n= 72) differed from other mothers in several respects. Experiment nurses devoted considerably fewer hours per week to child health services and to child patients than did control nurses. Conclusions : Despite certain differences, experiment and control samples appeared comparable enough to permit, in a second step, conclusions about the effectiveness of the intervention. [source]