DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2005
Nancy Murphy MD
This review presents a discussion of the sexual development of children and adolescents with disabilities, described in the framework of body structure and function, individual activities, and societal perspectives presented in the World Health Organization's International Classification of Functioning, Disability and Health. Issues of sexual development, gynecological care and contraception, sexual functioning, societal barriers, sexual victimization, and sexuality education are presented. Overall, adolescents with disabilities seem to be participating in sexual relationships without adequate knowledge and skills to keep them healthy, safe, and satisfied. Although their sexual development may be hindered both by functional limitations and by intentional or unintentional societal barriers, the formal and informal opportunities for teenagers with disabilities to develop into sexually expressive and fulfilled persons do exist. Health care providers are urged to increase their awareness of this unmet need and to implement strategies that promote the physical, emotional, social, and psychosexual independence of children, teenagers, and young adults with disabilities. [source]

Separating the influence of resource ,availability' from resource ,imbalance' on productivity,diversity relationships

ECOLOGY LETTERS, Issue 6 2009
Bradley J. Cardinale
Abstract One of the oldest and richest questions in biology is that of how species diversity is related to the availability of resources that limit the productivity of ecosystems. Researchers from a variety of disciplines have pursued this question from at least three different theoretical perspectives. Species energy theory has argued that the summed quantities of all resources influence species richness by controlling population sizes and the probability of stochastic extinction. Resource ratio theory has argued that the imbalance in the supply of two or more resources, relative to the stoichiometric needs of the competitors, can dictate the strength of competition and, in turn, the diversity of coexisting species. In contrast to these, the field of Biodiversity and Ecosystem Functioning has argued that species diversity acts as an independent variable that controls how efficiently limited resources are utilized and converted into new tissue. Here we propose that all three of these fields give necessary, but not sufficient, conditions to explain productivity,diversity relationships (PDR) in nature. However, when taken collectively, these three paradigms suggest that PDR can be explained by interactions among four distinct, non-interchangeable variables: (i) the overall quantity of limiting resources, (ii) the stoichiometric ratios of different limiting resources, (iii) the summed biomass produced by a group of potential competitors and (iv) the richness of co-occurring species in a local competitive community. We detail a new multivariate hypothesis that outlines one way in which these four variables are directly and indirectly related to one another. We show how the predictions of this model can be fit to patterns of covariation relating the richness and biomass of lake phytoplankton to three biologically essential resources (N, P and light) in a large number of Norwegian lakes. [source]

Measurements in the Addictions for Triage and Evaluation (MATE): an instrument based on the World Health Organization family of international classifications

ADDICTION, Issue 5 2010
Gerard M. Schippers
ABSTRACT Aims To present and evaluate a measurement tool for assessing characteristics of people with drug and/or alcohol problems for triage and evaluation in treatment. Measurements in the Addictions for Triage and Evaluation (MATE) is composed of 10 modules, selected on the basis of a detailed set of specifications. Conceptually, the MATE was constructed according to the ICD and International Classification of Functioning (ICF) in the World Health Organization (WHO) classification system. Two of the ICF-related modules were newly designed. Design Monitoring feasibility and field-testing in a treatment-seeking population with researcher and clinician-administered test,retest interviews, construct validation with related instruments and evaluation of the dimensional structure of the ICF-related modules. Setting The research was conducted in a large, regional substance abuse treatment centre in the Netherlands and at the Municipal Health Service of Amsterdam. Participants A total of 945 treatment-seeking patients were recruited during routine intakes, 159 of whom were interviewed twice; 32 problem drug users were also recruited from the Amsterdam cohort studies among problem drug users. Findings Completion time was reasonably short, and there were relatively few missing data. The factor structure of the ICF-related modules revealed a three-factor model with an acceptable fit. Inter-rater reliability ranged between 0.75 and 0.92 and was satisfactory, but interviewer reliability ranged between 0.34 and 0.73, indicating that some of subscales need to be improved. Concurrent validity was indicated by significant correlations (>0.50) between the ICF-related modules and the WHO Disability Assessment Schedule II (WHODAS II) and WHO Quality of Life brief version (WHOQOL-BREF). Conclusions The MATE can be used to allocate patients to substance abuse treatment. Because it is a comprehensive but flexible measurement tool that is also practical to use, the MATE is well suited for use in a heterogeneous population. [source]

A Conceptual Framework for a Psychometric Theory for Standard Setting with Examples of Its Use for Evaluating the Functioning of Two Standard Setting Methods

EDUCATIONAL MEASUREMENT: ISSUES AND PRACTICE, Issue 2 2006
Mark D. Reckase
A conceptual framework is proposed for a psychometric theory of standard setting. The framework suggests that participants in a standard setting process (panelists) develop an internal, intended standard as a result of training and the participant's background. The goal of a standard setting process is to convert panelists' intended standards to points on a test's score scale. Psychometrics is involved in this process because the points on the score scale are estimated from ratings provided by participants. The conceptual framework is used to derive three criteria for evaluating standard setting processes. The use of these criteria is demonstrated by applying them to variations of bookmark and modified Angoff standard setting methods. [source]

Assessing Differential Item Functioning in Performance Assessment: Review and Recommendations

EDUCATIONAL MEASUREMENT: ISSUES AND PRACTICE, Issue 3 2000
Randall D. Penfield
How can we best extend DIF research to performance assessment? What are the issues and problems surrounding studies of DIF on complex tasks? What appear to be the best approaches at this time? [source]

Social Functioning, Psychological Functioning, and Quality of Life in Epilepsy

EPILEPSIA, Issue 9 2001
Theo P. B. M. Suurmeijer
Summary: ,Purpose: Part of our research intended to explain "Quality of Life" (QoL) differences between people with epilepsy. To this end, a series of already existing generic and disease-specific health status measures were used. In this study, they were considered as determinants of people's QoL, whereas QoL itself was conceived as a general "value judgment" about one's life. Methods: From the records of four outpatient clinics, 210 persons with epilepsy were randomly selected. During their visit to the outpatient clinic, they completed a questionnaire assessing, among other things, health perceptions and social and psychological functioning. Additional information about their medical and psychosocial status was gathered from the patient files. Data were analysed by using a hierarchical regression analysis. Results: In decreasing order of importance, "psychological distress,""loneliness,""adjustment and coping," and "stigma perception" appeared to contribute most significantly to the outcome QoL as judged by the patients themselves, regardless of their physical status. In the final model, none of the clinical variables (onset, seizure frequency, side effects of antiepileptic drugs) contributed significantly anymore to the patients' "quality-of-life judgement." Apparently the effect of other variables such as seizure frequency and health perceptions, medication and side effects, life fulfilment, self-esteem, and mastery is mediated by these variables. Conclusions: Because all of the variance in QoL of the patients was explained by the psychosocial variables included in this study, health professionals should be aware of the significance of the psychosocial functioning of the patients and the role it plays in the achievement of a good QoL. Both informal and professional support may be an adjunct to conventional treatment. In future research, this issue should be given high priority. [source]

A case series evaluation of a modified version of interpersonal psychotherapy (IPT) for the treatment of bulimic eating disorders: A pilot study

EUROPEAN EATING DISORDERS REVIEW, Issue 4 2009
Jon Arcelus
Abstract Objective To determine the therapeutic outcome of a modified form of (IPT-BNm) amongst patients with Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS). Method Following initial assessment, 59 patients with diagnoses of BN or EDNOS entered treatment in the form of 16 sessions of IPT-BNm. At initial assessment, patients completed measures of general psychopathology (SCL-90), Self esteem (RSE), eating psychopathology (EDE-Q), interpersonal functioning (Inventory of Interpersonal Functioning; IIP-32) and depression (BDI). At the middle and end of treatment, EDE-Q, IIP-32 and BDI measures were repeated. Results By the middle of therapy, patients had made significant improvements in terms of their eating disordered cognitions and behaviours (including reductions in EDE-Q scores, bingeing and self-induced vomiting), interpersonal functioning and levels of depression. Conclusions IPT-BNm is an effective treatment for patients with Bulimic Eating Disorders and appears to work quickly, as there were significant reductions in eating disorders symptoms within the first eight sessions of treatment. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

School-aged children after the end of successful treatment of non-central nervous system cancer: longitudinal assessment of health-related quality of life, anxiety and coping

EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2009
H. MAURICE-STAM phd
The aim of the study was to investigate: (1) health-related quality of life (HRQoL) and anxiety in school-aged cancer survivors during the first 4 years of continuous remission after the end of treatment; and (2) correlations of disease-related coping with HRQoL and anxiety. A total of 76 survivors aged 8,15 years completed questionnaires about HRQoL, anxiety and disease-related cognitive coping at one to five measurement occasions. Their HRQoL was compared with norm data, 2 months (n = 49) and 1 year (n = 41), 2 years (n = 41), 3 years (n = 42) and 4 years (n = 27) after treatment. Through longitudinal mixed models analyses it was investigated to what extent disease-related cognitive coping was associated with HRQoL and anxiety over time, independent of the impact of demographic and medical variables. Survivors reported worse Motor Functioning (HRQoL) 2 months after the end of treatment, but from 1 year after treatment they did no longer differ from the norm population. Lower levels of anxiety were associated with male gender, being more optimistic about the further course of the disease (predictive control) and less searching for information about the disease (interpretative control). Stronger reliance on the physician (vicarious control) was associated with better mental HRQoL. As a group, survivors regained good HRQoL from 1 year after treatment. Monitoring and screening survivors are necessary to be able to trace the survivors at risk of worse HRQoL. [source]

Borrowing Hydrogen: Indirect "Wittig" Olefination for the Formation of C,C Bonds from Alcohols

EUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 19 2006
Phillip J. Black
Abstract The successful development of an indirect three-step domino sequence for the formation of C,C bonds from alcohol substrates is described. An iridium-catalysed dehydrogenation of alcohol 1 affords the intermediate aldehyde 2. The desired C,C bond can then be formed by a facile Wittig olefination, yielding the intermediate alkene 3. In the final step the alkene is hydrogenated to afford the indirect Wittig product, the alkane 4. The key to this process is the concept of borrowing hydrogen; hydrogen removed in the initial dehydrogenation step is simply borrowed by the iridium catalyst. Functioning as a hydrogen reservoir, the catalyst facilitates C,C bond formation before subsequently returning the borrowed hydrogen in the final step. Herein we present full details of our examination into both the substrate and reaction scope and the limitations of the catalytic cycle. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2006) [source]

Family Secrets and Family Functioning: The Case of Donor Assistance

FAMILY PROCESS, Issue 4 2008
RONI BERGER PH.D.
The purpose of this study was to examine the relationship between adult offspring's perception of family functioning and of parental use of topic avoidance to maintain secrecy regarding the use of donor assistance to conceive. A cross-sectional design was used to study a convenience sample of 69 young adult donor offspring who completed a demographic questionnaire, a topic avoidance scale relative to each of their rearing parents, and the Beavers Self Report Family Instrument. Findings indicated that participants perceived both parents as avoiding the topic of donor assistance more than other topics, mothers as avoiding all topics less than fathers, and topic avoidance was negatively associated with family functioning. Mothers' general topic avoidance was the strongest predictor of family functioning. Parents' disclosing together was predictive of higher family functioning. Implications for practice and future research are suggested. RESUMEN El propósito de este estudio era examinar la relación entre la percepción que los hijos adultos tienen del funcionamiento familiar y de la práctica, por parte de los padres, de evitar ciertos temas para mantener en secreto el haber recurrido a un donante para concebir. Se utilizó un diseño transversal para estudiar una muestra de conveniencia de 69 adultos jóvenes hijos de donantes que rellenaron un cuestionario demográfico, una escala de evasión del tema sobre sus padres por separado y el Instrumento Familiar Beavers de Autoinformes (Beavers Self Report Family Instrument). Los resultados indicaron que los participantes percibían que sus padres evitaban el tema de la ayuda del donante más que otros temas, que las madres evitaban temas en general menos que los padres, y que la evasión de temas se veía negativamente asociada al funcionamiento familiar. La evasión por parte de las madres de temas en general era el factor pronóstico más fuerte del funcionamiento familiar. El afrontar el tema por parte del padre y la madre juntos era pronóstico de un funcionamiento familiar más alto. Se sugieren implicaciones para futuras prácticas e investigaciones. Palabras clave: secretos familiares, funcionamiento familiar, evasión de tema [source]

Assessment of Family Functioning in Caucasian and Hispanic Americans: Reliability, Validity, and Factor Structure of the Family Assessment Device

FAMILY PROCESS, Issue 4 2007
GREGORY A. AARONS PH.D.
The purpose of this study was to examine the factor structure, reliability, and validity of the Family Assessment Device (FAD) among a national sample of Caucasian and Hispanic American families receiving public sector mental health services. A confirmatory factor analysis conducted to test model fit yielded equivocal findings. With few exceptions, indices of model fit, reliability, and validity were poorer for Hispanic Americans compared with Caucasian Americans. Contrary to our expectation, an exploratory factor analysis did not result in a better fitting model of family functioning. Without stronger evidence supporting a reformulation of the FAD, we recommend against such a course of action. Findings highlight the need for additional research on the role of culture in measurement of family functioning. [source]

Measuring disability in older adults: The International Classification System of Functioning, Disability and Health (ICF) framework

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2008
W Jack Rejeski
Background: Despite the importance of disability to geriatric medicine, no large scale study has validated the activity and participation domains of the International Classification System of Functioning, Disability, and Health (ICF) in older adults. The current project was designed to conduct such as analysis, and then to examine the psychometric properties of a measure that is based on this conceptual structure. Methods: This was an archival analysis of older adults (n = 1388) who had participated in studies within our Claude D Pepper Older Americans Independence Center. Assessments included demographics and chronic disease status, a 23-item Pepper Assessment Tool for Disability (PAT-D) and 6-min walk performance. Results: Analysis of the PAT-D produced a three-factor structure that was consistent across several datasets: activities of daily living disability, mobility disability and instrumental activities of daily living disability. The first two factors are activities in the ICF framework, whereas the final factor falls into the participation domain. All factors had acceptable internal consistency reliability (>0.70) and test,retest (>0.70) reliability coefficients. Fast walkers self-reported better function on the PAT-D scales than slow walkers: effect sizes ranged from moderate to large (0.41,0.95); individuals with cardiovascular disease had poorer scores on all scales than those free of cardiovascular disease. In an 18-month randomized clinical trial, individuals who received a lifestyle intervention for weight loss had greater improvements in their mobility disability scores than those in a control condition. Conclusion: The ICF is a useful model for conceptualizing disability in aging research, and the PAT-D has acceptable psychometric properties as a measure for use in clinical research. [source]

Assessing functional health status in adults with haemophilia: towards a preliminary core set of clinimetric instruments based on a literature search in Rheumatoid Arthritis and Osteoarthritis

HAEMOPHILIA, Issue 4 2005
P. De Kleijn
Summary., People with haemophilia experience a progressive deterioration of their functional health status. Regular clinical assessment of functional health status provides insight into their process of disablement. As such, the development of a core-set of measurement tools is warranted. The aim of this study was to gather data to prepare a (preliminary) core set of clinically relevant and feasible instruments to assess the functional health status of adults with haemophilia, and to indicate their psychometric qualities. Therefore, clinimetric instruments frequently used in two haemophilia-resembling diseases (Rheumatoid Arthritis and Osteoarthritis) were reviewed from the literature. An extensive search in Medline yielded 13 relevant review articles, incorporating a total of 182 instruments, of which 40 were appropriate for haemophilia. Of these 40 instruments 3 measure body structures, 13 body functions, 19 activities (of which 5 are performance based and 14 self-report based), and 3 measure participation. This classification is based on the International Classification of Functioning, Disability and Health. Detailed information regarding the psychometrics (reliability, validity and responsiveness) of four instruments is described fully in the literature, whereas the psychometrics of the majority of the other instruments are only partly described. The results of this literature study may contribute to the formation of a (preliminary) core set of clinimetric instruments to assess the functional health status of adults with haemophilia. Decisions on the final core set should be held within the Musculoskeletal Committee of the World Federation of Haemophilia. [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]

Augmentation of atypical antipsychotics with valproic acid.

HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2009
An open-label study for most difficult patients with schizophrenia
Abstract Objective Most difficult inpatients with schizophrenia are in serious needs but obviously underrepresented in clinical trials. Methods Very challenging patients received open-label treatment with atypical antipsychotics concurrently augmented with valproic acid. The primary outcome was the newly developed Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz). Patients improving more than 20 points were classified as responders. Results Mean age and illness duration of 28 participants (22male) were 42 y.o. and 20 years, respectively. They had spent a half of their life admitted after the onset. The average Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression-Severity (CGI-S) were very severe at 79 and 6.1, respectively, with the baseline Global Assessment of Functioning (GAF) of as low as 21. As a result of augmentation, there were nine responders, 12 partial responders, and seven non-responders including only two patients who got worse. The main antipsychotics were mostly either risperidone or olanzapine. Mean maximum oral dose and blood level of valproic acid were 1907,mg and 91.7,µg/ml, respectively. Overall significant improvements whilst to an inadequate degree were noted in clinical parameters. Valproate augmentation was generally well tolerated but serious adverse effects included thrombocytopenia, anaemia and sedation/falls. Conclusions While these preliminary results need to be tested against tenacious monotherapy or polypharmacy involving clozapine, augmenting atypical antipsychotics with valproic acid can be useful for very severe schizophrenia. Copyright © 2009 John Wiley & Sons, Ltd. [source]

The efficacy of reboxetine in the treatment-refractory patients with panic disorder: an open label study

HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 7 2002
P. N. Dannon
Abstract Background and Objective Selective serotonin reuptake inhibitors (SSRIs) are currently the first-line treatment for panic disorder, although up to 30% of patients either do not respond to SSRIs or withdraw due to adverse events. Reboxetine, a selective norepinephrine reuptake inhibitor (selective NRI), is effective in treating depression and may alleviate depression-related anxiety. This study aimed to investigate the efficacy of reboxetine in the treatment of patients with panic disorder who did not respond to SSRIs. Method In this 6-week, open-label study, 29 adult outpatients with panic disorder who had previously failed to respond to SSRI treatment received reboxetine 2,mg/day, titrated to a maximum of 8,mg/day over the first 10 days. Efficacy was assessed using the Panic Self-Questionnaire (PSQ), the Hamilton Rating Scale for Anxiety (HAM-A), the 17-item Hamilton Rating Scale for Depression (HRSD) and the Global Assessment of Functioning (GAF) Scale. Results The 24 patients who completed the study responded well to reboxetine treatment. Significant improvement (p,<,0.001) was observed in the number of daily panic attacks, and on the scales measuring anxiety, depression and functioning. Reboxetine was generally well tolerated. Five patients withdrew due to adverse events. Conclusions Reboxetine appears to be effective in the treatment of SSRI-refractory panic disorder patients and warrants further clinical investigation. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Are there subgroups of bulimia nervosa based on comorbid psychiatric disorders?

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 1 2005
Alexis E. Duncan MPH
Abstract Objective The current study sought to determine whether there are subtypes of bulimia nervosa (BN) differentiated by comorbid psychiatric disorders. Method Data on comorbid psychiatric diagnoses in female relatives of probands and controls in the Collaborative Study of the Genetics of Alcoholism (COGA) who met criteria for BN (as outlined in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders) were analyzed using latent class analysis. Resulting latent classes were compared on a variety of variables related to impulsive behaviors and psychological functioning. Results The best-fitting solution, a two-class model, yielded one class (72%) characterized by substance dependence, depression, antisocial personality disorder (ASPD), and anxiety disorders, and another characterized by depression. The highly comorbid class had more suicidality, more daily smokers, sought help for emotional problems, and had lower Global Assessment of Functioning (GAF) scores compared with those in the comorbid depression only class. Discussion Latent class findings suggest the existence of two classes of BN differentiated by substance dependence, impulsive behaviors, and poorer psychological functioning. © 2004 by Wiley Periodicals, Inc. [source]

Contribution of PTSD/POW history to behavioral disturbances in dementia

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2001
Swapna Verma
Abstract As many World War II and Korean Conflict veterans suffering from posttraumatic stress disorder (PTSD) grow older, increasing numbers will be diagnosed with dementia. We retrospectively analyzed patients with dementia, comparing the behavioral disturbances of those with PTSD to those without PTSD. We hypothesized that due to the additive effect of the neurobiological and behavioral changes associated with PTSD and dementia, the dementia with PTSD group would show more agitation and disinhibition than the dementia without PTSD group. Sixteen patients with diagnoses of dementia and PTSD were matched on age and Mini-Mental States Examination (MMSE) scores to 16 patients with dementia without PTSD. Demographic characteristics, co-morbid diagnoses, global Assessment of Functioning (GAF), Cohen-Mansfield Agitation Inventory (CMAI), and paranoid items of Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale for Schizophrenia (PANSS) were assessed. The patients with diagnoses of dementia with PTSD did not differ significantly in their clinical presentation, hospital course, and condition at discharge from patients with dementia without PTSD. Chi-square analysis showed that significantly more subjects in the PTSD group were prescribed anti-depressants compared to the non-PTSD group. Interestingly, within the PTSD group, the subgroup of patients who were former prisoners of war had a significantly higher mean score for paranoia and significantly less verbal agitation. This pilot study reveals that a diagnosis of PTSD alone is not sufficient to influence behavior in veterans with dementia; however, we also present provocative results that patients with more severe trauma (POW) do have changes in their behavior. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Gender differences in the prediction of 5-year outcome in first episode psychosis

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2007
Maria Mattsson
Abstract Objective: To examine gender differences in prediction of long-term outcome in first episode psychosis (FEP). Method: Eighty-one male and 72 female FEP patients were compared regarding the sensitivity and specificity of the Predictive Rating Scale (PRS). The contributions of pre-admission clinical and socio-demographic characteristics to a poor 5-year outcome were analysed for males and females separately. Gender differences in the relations between predictors and outcome were examined using the equality of correlation comparing correlation coefficients. Results: The sensitivity of the PRS was significantly better for males than for females. The following items: ,the highest Global Assessment of Functioning (GAF) the year before first admission ,70' and ,GAF at first admission ,30' explained most of the variance of a poor 5-year outcome for males, whereas for females the corresponding items were ,the highest educational level is compulsory school', ,living with parents' and ,contact with friends ,2,3 times/month'. When the PRS was adapted assigning a weight of two to the item ,the highest educational level is compulsory school' for females, the sensitivity increased. Conclusion: This study revealed that the predictors for poor outcome differ between male and female patients with FEP. Copyright © 2008 John Wiley & Sons, Ltd. [source]

A standardized and reliable method to apply the Global Assessment of Functioning (GAF) scale to psychiatric case records

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2000
Dr M. Mirandola
Abstract The Global Assessment of Functioning (GAF) scale is widely used both in routine clinical practice and in research. However, its reliability has never been assessed when used to rate information in clinical records. The present study focuses on the development of a standardized method (an ongoing modelling process between raters) for establishing desired levels of inter-rater reliability (IRR) in the application of the GAF to psychiatric case records. Fifty-one patients at first-ever contact with mental health services were included in the study. They were selected from a total sample of 662 first-ever patients by using a systematic sampling. Three raters (resident psychiatrists at their third year of training) took part in a 12-hour training programme, during which they were asked to assess the global psychological functioning of patients, taking into account information recorded in case records. The extent of agreement between raters was estimated by applying the ,limits of agreement' method and the ,concordance correlation coefficient'. The training programme proved to be feasible, easy to administer and acceptable to psychiatrists in training with limited previous experience of using rating scales. Very high levels of concordance (all greater than 0.95) emerged between the three raters. The GAF, completed using information from case records included in the initial assessment form, appeared to be a reliable instrument, even when used by clinical psychiatrists in training. Copyright © 2000 Whurr Publishers Ltd. [source]

Structure and Functioning of the "Egg Bank" of a Fairy Shrimp in a Temporary Pool: Chirocephalus ruffoi from Pollino National Park (Southern Italy) as a Case Study

INTERNATIONAL REVIEW OF HYDROBIOLOGY, Issue 1 2004
Graziella Mura
Abstract To investigate their distribution and total numbers, resting eggs of the anostracan Chirocephalus ruffoi were collected from the bed of a temporary pool in southern Italy. Samples were taken at 0.5 m intervals along six transects oriented at 30° from each other, by means of a cylindrical core sampler. The horizontal distribution of intact resting eggs was extremely patchy, with cyst number per core ranging from 191 to 1,400 (CV = 32.7%), corresponding to a mean of between 0.8 and 4.3 cysts cm,3. Differences observed were related to core position and transect orientation, total cyst numbers being markedly higher in the leeward area of the pool compared to the windward area. Marked variation was also evident in vertical distribution, a significant, though weak correlation was recorded between egg density and sediment depth. Cyst-bank size (± 95% confidence limits) of the pool bed, estimated from the mean cyst number cm,3 obtained for the 6 transects, ranged between 1.0 × 108 and 1.3 × 108 cysts. Hatching in the laboratory was very erratic. Despite significant differences in hatching, the observed variation was unrelated to most of the variables considered (position within sections, cores and transects, pre-incubation treatment) and was explained only by initial sediment conditions (moist/dry). In none of the experimental conditions tested was synchronous hatching obtained. Possible causal factors (mixing of the bottom sediments by cattle, egg age, storage conditions, differential exposure to environmental cues as well as variability in hatching response even at clutch level) are discussed. (© 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Negative Life Events, Patterns of Positive and Negative Religious Coping, and Psychological Functioning

JOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION, Issue 2 2007
JEFFREY P. BJORCK
Religious coping may or may not be adaptive depending upon whether such coping is positive or negative. We investigated the potential moderating effects of positive and negative religious coping patterns on the relationship between negative life events and psychological functioning. Questionnaires included measures of negative life events, positive and negative religious coping, and psychological functioning, and were completed by 336 adult, Protestant church members. Even after controlling for religious participation, negative events were related to increased use of positive and negative religious coping and decreased psychological functioning. Moreover, negative events and positive religious coping produced an interaction effect on depression, such that the high use of positive religious coping buffered the deleterious effects of negative events. [source]

The International Classification of Functioning, Disability and Health (ICF) and nursing

JOURNAL OF ADVANCED NURSING, Issue 2 2004
Penelope M. Kearney BHlthSci MN RN MCN MRCNA
Background., Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care. Aim., The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing. Method., The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing. Conclusion., The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses' thinking and practice by increasing awareness of the social, political and cultural dimensions of disability. [source]

Behaviours of Medicago truncatula,Sinorhizobium meliloti Symbioses Under Osmotic Stress in Relation with the Symbiotic Partner Input: Effects on Nodule Functioning and Protection

JOURNAL OF AGRONOMY AND CROP SCIENCE, Issue 3 2009
H. Mhadhbi
Abstract Three genotypes of the model legume Medicago truncatula were assessed for symbiotic effectiveness in cross inoculation with two strains of Sinorhizobium meliloti under mannitol-mediated osmotic stress. Symbioses showed different tolerance levels revealed on plant growth, nitrogen-fixing capacity and indices of nodule functioning and protection. The variability of stress response was essentially correlated with performance at non-stressful conditions. Symbiosis attitude depended on bacterial partner, host-plant genotype and their interaction. Plant genotype manifested the highest contribution to symbiotic efficiency indices under osmotic stress, even for nodulation and nitrogen fixation where the bacterial strain effect is highly pronounced. Contrasting (tolerant/sensitive) associations were identified for tolerance behaviours, involving the same plant genotype with different rhizobial strains and vice versa. In nodules, osmotic stress leads to accumulation of oxidized lipids and decrease in total protein and leghaemoglobin contents. Antioxidant responses were manifested as induction of guaiacol peroxidase (POX, E.C. 1.11.1.7) and superoxide dismutase (E.C. 1.15.1.1). POX induction was higher in tolerant symbioses and both enzymes were suggested as contributors to the protection of nodule integrity and functioning under osmotic stress. In conclusion, symbiotic efficiency in M. truncatula,S. meliloti combinations under osmotic stress is determined by each symbiont's input as well as the plant,microbe genotype interaction, and POX induction could prove a sensitive marker of tolerant symbioses. [source]

Prevalence and Comorbidity of Insomnia and Effect on Functioning in Elderly Populations

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S7 2005
Sonia Ancoli-Israel PhD
A good night's sleep is often more elusive as we age, because the prevalence of insomnia in older people is high. Insufficient sleep can have important effects on daytime function by increasing the need to nap, reducing cognitive ability including attention and memory, slowing response time, adversely affecting relationships with friends and family, and contributing to a general sense of being unwell. However, rather than aging per se, circadian rhythm shifts, primary sleep disorders, comorbid medical/psychiatric illnesses, and medication use cause sleep difficulties in older people, which psychosocial factors may also affect. Clinicians should ask elderly patients about satisfaction with sleep. Any sleep complaints warrant careful evaluation of contributing factors and appropriate treatment. [source]

Psychosocial Functioning of Carcinoid Cancer Patients: Test of a Stress and Coping Mediated Model,

JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 3 2004
Elizabeth Soliday
This study examined a mediated-effects stress and coping model among cancer patients with carcinoid tumors to identify specific pathways with a view toward determining (a) which coping strategies predict more positive adjustment, (b) which strategies predict less positive adjustment, and (c) whether coping would mediate the effect of optimism on psychosocial outcomes. Coping strategies partially mediated the effects of optimism on the psychological adjustment in cancer patients with carcinoid tumors. Specifically, self-blame and active coping significantly predicted outcomes of distress. Thirty-seven percent of the respondents met criteria for elevated depressive symptoms warranting intervention. Generalizability of the mediated-effects stress and coping model and findings unique to the carcinoid population are discussed. [source]

Cognitive, Linguistic and Adaptive Functioning in Williams Syndrome: Trajectories from Early to Middle Adulthood

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2010
Patricia Howlin
Background, Little is known about trajectories of cognitive functioning as individuals with Williams syndrome (WS) move though adulthood. Method, The present study investigated cognitive, linguistic and adaptive functioning in adults with WS aged 19,55 years, using both cross-sectional and longitudinal approaches. Results, Data from the cross-sectional study (n = 92; mean age = 32 years) indicated that IQ was comparable across age groups (Full-Scale IQ mean = 56,57) with Verbal IQ being slightly higher than Performance IQ. Daily Living Skills (as measured by the Vineland Adaptive Behavior Scales) were significantly higher in older individuals. Language abilities showed no consistent age-related differences. On formal tests of language, comprehension scores were higher than expressive language scores for almost all individuals, although this pattern was not replicated on the Vineland. In the longitudinal study, a follow-up of 47 individuals (mean age = 37 years) first assessed 12 years previously, similar trajectories were found. IQ remained very stable (FSIQ = 61,62 at both time points); there were significant improvements on the Social and Daily Living domains of the Vineland and significant decreases in Maladaptive scores. There were no improvements in language over time. Conclusions, The data indicate that adults with WS (at least up to the age of 50 years) show no evidence of deterioration in cognitive skills. Adaptive abilities continue to develop although language shows relatively little improvement with time. [source]

I-CAN: A New Instrument to Classify Support Needs for People with Disability: Part I

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2009
Vivienne C. Riches
Background, The supports paradigm has shifted focus from assessing competence and deficits among people with disabilities to identifying supports needed to live meaningful and productive lives in inclusive settings. Consequently, a rigorous and robust system is required that is capable of accurately determining the type and intensity of support needed and of allocating resources accordingly. The aim of the present study was to develop such a system to identify and classify support needs of people with disabilities based on the conceptual framework of the International Classification of Functioning, Disability and Health (ICF) [WHO, The International Classification of Functioning, Disability and Health (ICF), Author, Geneva, 2001], and the supports concept [Mental Retardation: Definition, Classification and Systems of Support, 9th edn (1992), 10th edn (2002), American Association on Mental Retardation, Washington, DC). Method, A total of 1012 individuals with disabilities who were supported by accommodation and day programme organizations across the eastern states of Australia were assessed. The instrument was used in a team setting involving the person, their family and friends and staff as appropriate. Version 1 was administered with 595 people with disability. This version was refined according to qualitative and quantitative analyses. Another 342 individuals were assessed using Version 2, resulting in a combined data set for 936 individuals. Version 3 was then trialled with a further 76 individuals with disabilities. Results, Ten domain scales in Health and Well Being (HWB) and Activities and Participation (A&P) were explored and refined. The scales effectively discriminated a range of intensities of support for people with various disabilities, with the highest support needs generally recorded by individuals with multiple disabilities who were ageing. The instrument can be used to develop a profile of needed supports across the domain scales. These measure current and predicted support needs, and contribute to future planning. The team approach proved beneficial in this regard. Conclusions, The I-CAN is a useful instrument for effectively assessing the support needs of people with a disability using a person centred approach. It is effective in identifying support needs across health and well-being areas, and activities of daily living. [source]

The Impact of Personal Characteristics of People with Intellectual and Developmental Disability on Self-determination and Autonomous Functioning

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2003
Michael L. Wehmeyer
Background, Many people assume that the presence of an intellectual disability precludes a person from becoming self-determined. Recent research, however, has suggested that the environments in which people live, learn, work or play may play a more important role in promoting self-determination then do personal characteristics of the person, including level of intelligence. Methods, This study examined the self-determination and autonomous functioning of 301 adults with intellectual disability or a developmental disability without concomitant intellectual impairments (e.g. persons with cerebral palsy, epilepsy and spina bifida) as a function of personal characteristics of individuals. Results, Intellectual capacity was not a significant contributor to either self-determination or autonomous functioning for this group. Opportunities to make choices, however, contributed significantly and positively to greater self-determination and autonomy. Intelligence scores did, however, predict whether the person worked or lived in more or less restrictive settings, though for the latter, both self-determination and autonomous functioning also contributed significantly. Conclusions, These findings are discussed with regard to the role of personal characteristics, particularly intelligence level, in promoting self-determination and more positive adult outcomes. [source]