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Risk Status (risk + status)
Selected AbstractsOn-screen print: the role of captions as a supplemental literacy toolJOURNAL OF RESEARCH IN READING, Issue 2 2010Deborah Linebarger Children living in poverty are 1.3 times as likely as non-poor children to experience reading difficulties and lack key oral experiences that contribute to early literacy development. The purpose of this research was to study the effects of viewing commercially available educational television with closed captions. Seventy second- and third-grade economically disadvantaged children living in urban locations participated in this experimental research design. Children were randomly assigned to view videos with or without closed captions. Captions helped children recognise and read more words, identify the meaning of those words, generate inferences regarding programme content and transfer these skills to a normative code-related skill task. Risk status moderated word recognition performance: those at risk benefited from captions while those who were not at risk recognised more words when captions were absent. [source] Prenatal and family risks of children born to mothers with epilepsy: effects on cognitive developmentDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2008Karl Titze PhD The offspring of mothers with epilepsy are considered to be at developmental risk during pregnancy from: (1) generalized maternal seizures (hypoxia); (2) teratogenicity of antiepileptic drugs (AEDs); and (3) adverse socio-familial conditions associated with having a chronically sick mother. Sixty-seven children of mothers with epilepsy and 49 children from non-affected mothers, matched for control variables, were followed from birth to adolescence (53 males, 63 females; mean age 14y 2mo, range 10-20y). Prediction of intellectual performance of these children during adolescence was calculated from the following variables: maternal generalized seizures, prenatal exposure to AEDs, and quality of family stimulation (HOME Inventory) assessed in children at 2 years of age. Children who were prenatally exposed to AEDs achieved lower IQs than control children at adolescence. This effect was moderately significant for children who had been exposed to monotherapy (6 IQ points lower), but was considerable in those exposed to polytherapy (12 IQ points lower). Generalized seizures during pregnancy, observed in half the mothers, did not exacerbate this effect. Relative to prenatal risk status, the quality of the family environment had varied effects on intellectual development. Children with prenatal risks appeared to be more vulnerable to environmental disadvantage than control children, but they also showed longer-lasting effects of environmental support. [source] ,It'll never happen to me': understanding public awareness of local flood riskDISASTERS, Issue 2 2008Kate Burningham Following the severe flood events of 1998 and 2000, the United Kingdom's Environment Agency prioritised the need to increase public flood risk awareness. Drawing on data collected during research undertaken for the Environment Agency, this paper contributes to understanding of one aspect of flood awareness: people's recognition that their property is in an area that is potentially at risk of flooding. Quantitative analyses indicate that class is the most influential factor in predicting flood risk awareness, followed by flood experience and length of time in residence. There are also significant area differences. Our qualitative work explores how those defined as ,at risk' account for their lack of awareness or concern about their risk status. We conclude that the problem is often not simply a lack of awareness, but rather, assessments of local risk based on experience that underestimate the impact of rare or extreme events. We underline the importance of engaging with local perspectives on risk and making local people part of ,awareness-raising' processes. [source] Effects of parental supportiveness on toddlers' emotion regulation over the first three years of life in a low-income African American sample,INFANT MENTAL HEALTH JOURNAL, Issue 5 2009Erika London Bocknek The purpose of this study was to examine how parental supportiveness and child gender are related to toddlers' emotion regulation over time among low-income African American mothers and their children (n = 803). Data for the current study were collected as part of the Early Head Start Research and Evaluation Project. Using latent growth curve modeling, results indicated that parental supportiveness predicted toddlers' emotion regulation skills, on average (intercepts), and rates of growth of parental supportiveness predicted the rates of growth in emotion regulation over time (slope), beyond the effects of initial parental risk status, child gender, Early Head Start treatment effects, and infant emotionality. However, parental supportiveness over time did not differentially predict toddler emotion regulation over time for boys as compared to girls. Results suggest that parental supportiveness may represent a subtle form of emotion socialization by providing a context in which toddlers may be better able to utilize their mothers as effective resources in managing emotions. Practitioners should emphasize with the parents the role of parent,child interactions as a context for development. The lack of gender differences suggests that differential parenting towards boys and girls, evident in research with older children, may not yet be present in toddlerhood. Recognizing similarities in parenting across racial groups early on as well as being sensitive to differences that may emerge later will position practitioners to provide support within a culturally sensitive framework. [source] Bone mineral density and perceived menopausal symptoms: factors influencing low back pain in postmenopausal womenJOURNAL OF ADVANCED NURSING, Issue 6 2009Sukhee Ahn Abstract Title.,Bone mineral density and perceived menopausal symptoms: factors influencing low back pain in postmenopausal women. Aim., This paper is a report of a study of the relationships between the factors influencing low back pain in postmenopausal women (i.e. menopausal symptoms, bone mineral density, duration of menopause, hormonal therapy, obesity, inactivity during leisure time, parity, osteoarthritis and drinking coffee). Background., Previous studies have shown that low back pain in postmenopausal women is associated with bone mineral density, menopausal symptoms and lifestyle factors, yet the factors influencing low back pain are not clear and vary with ethnicity. Method., A survey was conducted with postmenopausal women (n = 134) in Korea in 2006. Bone mineral density in the lumbar spine, back pain status, menopausal symptoms and health habits were assessed. Results., Participants' mean age was 59 years. About 70% experienced back pain on more than 1 day during the week prior to the survey and 35% suffered back pain daily. Women with back pain reported more severe menopausal symptoms than those without back pain. Based on bone mineral density scores, 26·9% of the women were considered to be at risk of osteoporosis. However, there was no association between back pain status and fracture risk status. Based on a multiple logistic regression model, menopausal symptoms, drinking coffee and inactivity during leisure time were statistically significant influencing factors for low back pain in this sample. Conclusion., The prevalence of low back pain in postmenopausal women should be recognized in association with menopausal symptoms and health habits. Further research is needed to develop interventions for the management of low back pain in postmenopausal women. [source] The development of pressure ulcers in patients with hip fractures: inadequate nursing documentation is still a problemJOURNAL OF ADVANCED NURSING, Issue 5 2000Lena Gunningberg MSC RN The aims of the study were to investigate, on a daily basis: (i] the development and progress of pressure ulcers, (ii) the documented nursing interventions for prevention and treatment of pressure ulcers, and (iii) when nursing interventions regarding prevention and treatment of pressure ulcers were documented, in relation to patient risk status and the development of pressure ulcers. The study design was prospective, comparative and descriptive. A total of 55 patients with hip fracture were included. To facilitate the nurse's assessment, a ,pressure ulcer card' was developed, consisting of the Modified Norton Scale (MNS) and descriptions of the four stages of pressure ulcers. The incidence of pressure ulcers was 55%. The mean rank of the lowest MNS score was significantly lower for patients who developed pressure ulcers than for patients without pressure ulcers. The majority of the pressure ulcers occurred between admission to the ward and the fourth day after surgery. Documented interventions regarding prevention and treatment were: repositioning, overlays, cushions, use of lotion and observation. The mean number of interventions per patient was 2·2 for patients who developed pressure ulcers during their hospital stay. The comprehensiveness and quality of the nursing record was unsatisfactory, and only three nursing records reached the level required by Swedish law. Preventive interventions such as repositioning were documented when the pressure ulcer had already occurred. The lack of nursing documentation regarding prevention and treatment of pressure ulcers may indicate that nurses did not identify pressure ulcers as a prioritized nursing problem for this patient group. The Modified Norton Scale could be a valuable tool for nurses, both identifying the patient at risk and acting as a guide for nursing interventions. The study was approved by the ethics committee of the Faculty of Medicine at Uppsala University. [source] The Effect of Changing Practice on Fall Prevention in a Rehabilitative Hospital: The Hospital Injury Prevention StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2004Michael Vassallo FRCP Objectives: To determine whether a change in practice to introduce a multidisciplinary fall-prevention program can reduce falls and injury in nonacute patients in a rehabilitation hospital. Design: A quasi-experimental study. Setting: Three geriatric wards with a similar design, equipment, staffing levels, and skill mix. Participants: Eight hundred twenty-five consecutive patients. Intervention: The patients' fall-risk status was assessed using the Downton Score. Current practice was maintained on the two control wards (n=550). On the experimental ward (n=275), a fall-prevention program was introduced. A multidisciplinary team met weekly specifically to discuss patients' fall risk and formulate a targeted plan. Patients at risk were identified using wristbands; risk factors were corrected or environmental changes made to enhance safety. Measurements: Primary outcomes were number of fallers, recurrent fallers, total falls, patients sustaining injury, and falls per occupied bed days. Secondary outcomes were place of discharge and mortality. Results: Patients were matched for age and risk status. Control wards had proportionally more fallers (20.2% vs 14.2%: P=.033), patients sustaining injury (8.2% vs 4%: P=.025), and total number of falls (170 vs 72: P=.045). These results did not remain significant after controlling for differing length of stay. There was no reduction in recurrent fallers (6.4% vs 4.7%: P=.43) and no effect on place of discharge (home discharges; 57.5% vs 60.7%: P=.41) or mortality (15.3% vs 13.8%: P=.60). Conclusion: This study shows that falls might be reduced in a multidisciplinary fall-prevention program, but the results are not definitive because of the borderline significance achieved and the variable length of stay. More research on fall prevention in hospital is required, particularly as to what interventions, if any, are effective at reducing falls in this group of patients. [source] Risk factors for readmission after initial diagnosis in children with acute lymphoblastic leukemia,PEDIATRIC BLOOD & CANCER, Issue 3 2008Tamra L. Slone MD Abstract Background Specific hospital discharge criteria following the initial diagnosis of children with acute lymphoblastic leukemia (ALL) have not been reported. This retrospective cohort study was designed to identify risk factors for readmission during induction therapy, to assist with development of discharge guidelines. Procedure We reviewed the records of 142 consecutive children with newly diagnosed B-precursor ALL and found 129 eligible patients. Chi square, t -test, and multivariate logistic regression analysis were used to compare differences in absolute neutrophil count (ANC), NCI risk status, age, type of corticosteroid administered, and other potential risk factors for readmission during induction therapy. Results ANC at initial hospital discharge was the only significant predictor of readmission for fever during induction therapy (P,=,0.006) by multivariate analysis. Specifically an ANC ,200/mm3 at discharge had the strongest association with readmission for fever (OR 3.3, 95% CI 1.422, 7.729). Conclusion An ANC >200/mm3, in a clinically stable patient, is associated with minimal risk of readmission during induction therapy following the initial diagnosis of ALL. Pediatr Blood Cancer 2008;51:375,379. © 2008 Wiley-Liss, Inc. [source] What Is It About Antenatal Continuity of Caregiver That Matters to Women?BIRTH, Issue 4 2005DipAppSc, Mary-Ann Davey RN, PGDipSoc ABSTRACT:,Background:Continuity of care and of caregiver are thought to be important influences on women's experience of maternity care. The aim of this study was to analyze the influence of two aspects of continuity of caregiver in the antenatal period on women's overall rating of antenatal care: the extent to which women saw the same caregiver throughout pregnancy, and the extent to which women thought that their caregiver knew and remembered them and their progress from one visit to the next. Methods:An anonymous, population-based postal survey was conducted of 1,616 women who gave birth in a 14-day period in September 1999 in Victoria, Australia. Multivariate methods were used to analyze the data. Results:Most women saw the same caregiver at each antenatal visit (77%), and thought that caregivers got to know them (65%). This finding varied widely among different models of maternity care. Before adjustment, women were much more likely to describe their antenatal care as very good if they always or mostly thought the caregiver got to know them (OR 5.86, 95% CI 4.3, 7.9), and if they always or mostly saw the same caregiver at each visit (OR 2.91, 95% CI 2.0, 4.3). Adjusting for sociodemographic factors, parity, risk status of the pregnancy, and several specific aspects of antenatal care revealed that seeing the same caregiver was no longer associated with rating of care (adjusted OR 0.65, 95% CI 0.3,1.2), but women who thought that caregivers got to know and remember them remained much more likely to rate their care highly (adjusted OR 3.18, 95% CI 2.0, 5.1). Conclusions:These findings suggest that changing the delivery of antenatal care to increase women's chances of seeing the same caregiver at each visit is not by itself likely to improve the overall experience of care, but time spent personalizing each encounter in antenatal care would be well received. The analysis also confirmed the importance that women place on quality interactions with their doctors and midwives. (BIRTH 32:4 December 2005) [source] Temperament, Tympanum, and Temperature: Four Provisional Studies of the Biobehavioral Correlates of Tympanic Membrane Temperature AsymmetriesCHILD DEVELOPMENT, Issue 3 2002W. Thomas Boyce Previous research in both humans and nonhuman primates suggests that subtle asymmetries in tympanic membrane (TM) temperatures may be related to aspects of cognition and socioaffective behavior. Such associations could plausibly reflect lateralities in cerebral blood flow that support side-to-side differences in regional cortical activation. Asymmetries in activation of the left and right frontal cortex, for example, are correlates of temperamental differences in child behavior and markers of risk status for affective and anxiety disorders. Tympanic membrane temperatures might thus reflect the neural asymmetries that subserve individual differences in temperament and behavior. This report merged findings from four geographically and demographically distinctive studies, which utilized identical thermometry methods to examine associations between TM temperature asymmetries and biobehavioral attributes of 4- to 8-year-old children (N= 468). The four studies produced shared patterns of associations that linked TM temperature lateralities to individual differences in behavior and socioaffective difficulties. Warmer left TMs were associated with "surgent," affectively positive behaviors, whereas warmer right TMs were related to problematic, affectively negative behaviors. Taken together, these findings suggest that asymmetries in TM temperatures could be associated with behavior problems that signal risk for developmental psychopathology. [source] What is the best approach to an apparently nonmetastatic adrenocortical carcinoma?CLINICAL ENDOCRINOLOGY, Issue 5 2010Martin Fassnacht Summary In suspected nonmetastatic adrenocortical carcinoma (ACC) a careful preoperative diagnostic work up is needed including comprehensive endocrine analysis as recommended by the European Network for the Study of Adrenal Tumors (http://www.ENSAT.org/ACC.htm). Staging prior surgery, in particular chest CT, is indispensable to exclude distant metastases. Open surgery is still the recommended approach in ACC. However, in localized non-invasive ACC with a diameter <10 cm laparoscopic adrenalectomy by an expert surgeon is probably similarly effective and safe. As many patients will suffer from tumor recurrence after seemingly complete removal of ACC, adjuvant treatment based on the individual risk status is recommended. Key factors for risk assessment are tumor stage, resection status and the proliferation marker Ki67. All patients considered at high risk for recurrence should receive adjuvant mitotane for a minimum of 2 years aiming at a drug level of 14,20 mg/l. In selected patients (e.g. R1 resection) we recommend additional radiotherapy of the tumor bed. Patients with a low/intermediate risk for recurrence should be included in the Adiuvo trial comparing adjuvant mitotane with observation only (http://www.adiuvo-trial.org). In low/intermediate risk patients who cannot be included in this trial observation only can be justified in cases with a tumor diameter of <8 cm and no microscopic evidence for invasion of blood vessels or tumor capsule. In all patients a structured follow-up for 10 years is strongly recommended. [source] Subjective Response to Alcohol: A Critical Review of the LiteratureALCOHOLISM, Issue 3 2010Meghan E. Morean Background:, Subjective response to alcohol (SR), which reflects individual differences in sensitivity to the pharmacological effects of alcohol, may be an important endophenotype in understanding genetic influences on drinking behavior and alcohol use disorders (AUDs). SR predicts alcohol use and problems and has been found to differ by a range of established risk factors for the development of AUDs (e.g., family history of alcoholism). The exact pattern of SR associated with increased risk for alcohol problems, however, remains unclear. The Low Level of Response Model (LLR) suggests that high-risk individuals experience decreased sensitivity to the full range of alcohol effects, while the Differentiator Model (DM) asserts that high risks status is associated with increased sensitivity to alcohol's positive effects but decreased sensitivity to negative effects. Aims:, The current paper (1) reviews two prominent models of subjective response, (2) reviews extant laboratory-based research on subjective response, (3) highlights remaining gaps in our understanding and assessment of subjective response, and (4) encourages collaborative efforts to address these methodological and conceptual concerns. Methods:, This paper reviews studies which employed placebo-controlled and non-placebo-controlled alcohol challenge paradigms to assess a range of alcohol effects including impairment, stimulation, and sedation. Results:, The research literature provides at least partial support for both the LLR and DM models. High-risk individuals have been shown to have a reduced response to alcohol with respect to sedative or impairing effects, particularly on the descending limb of the blood alcohol curve (BAC). There is also evidence that ascending limb stimulant effects are more pronounced or operate differently for high-risk individuals. Discussion:, Despite commendable advances in SR research, important questions remain unanswered. Inconsistent results across studies may be attributable to a combination of an inadequate understanding of the underlying construct and methodological differences across studies (e.g., number and timing of assessments across the BAC, inclusion of a placebo condition). With respect to the underlying construct, existing measures fail to adequately distinguish between cognitive/behavioral impairment and sedation, aspects of which may be perceived positively (e.g., anxiolysis) due to their ability to act as negative reinforcers. Conclusions:, Addressing the concerns raised by the current review will be integral to making meaningful scientific progress in the field of subjective response. [source] | |||||||||||||