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Study Variables (study + variable)
Selected AbstractsEvaluation of a Pediatric-sedation Service for Common Diagnostic ProceduresACADEMIC EMERGENCY MEDICINE, Issue 6 2006Wendalyn K. King MD Abstract Background: Pediatric patients often require sedation for diagnostic procedures such as magnetic resonance imaging and computed tomography scanning. In October 2002, a dedicated sedation service was started at a tertiary care pediatric facility as a joint venture between pediatric emergency medicine and pediatric critical care medicine. Before this service, sedation was provided by the department of radiology by using a standard protocol, with high-risk patients and failed sedations referred for general anesthesia. Objectives: To describe the initial experience with a dedicated pediatric-sedation service. Methods: This was a retrospective analysis of quality-assurance data collected on all sedations in the radiology department for 23-month periods before and after sedation-service implementation. Study variables were number and reasons for canceled or incomplete procedures, rates of referral for general anesthesia, rates of hypoxia, prolonged sedation, need for assisted ventilation, apnea, emesis, and paradoxical reaction to medication. Results are reported in odds ratios (OR) with 95% confidence intervals (95% CI). Results: Data from 5,444 sedations were analyzed; 2,148 before and 3,296 after sedation-service activation. Incomplete studies secondary to inadequate sedation decreased, from 2.7% before the service was created to 0.8% in the post,sedation-service period (OR, 0.29; 95% CI = 0.18 to 0.47). There also were decreases in cancellations caused by patient illness (3.8% vs. 0.6%; OR, 0.16; 95% CI = 0.10 to 0.27) and rates of hypoxia (8.8% vs. 4.6%; OR, 0.50; 95% CI = 0.40 to 0.63). There were no significant differences between the groups in rates of apnea, need for assisted ventilation, emesis, or prolonged sedation. The implementation of the sedation service also was associated with a decrease in both the number of patients referred to general anesthesia without a trial of sedation (from 2.1% to 0.1%; OR, 0.33; 95% CI = 0.06 to 1.46) and the total number of general anesthesia cases in the radiology department (from 7.5% to 4.4% of all patients requiring either sedation or anesthesia; OR, 0.56; 95% CI = 0.45 to 0.71). Conclusions: The implementation of a dedicated pediatric-sedation service resulted in fewer incomplete studies related to inadequate sedation, in fewer canceled studies secondary to patient illness, in fewer referrals for general anesthesia, and in fewer recorded instances of sedation-associated hypoxia. These findings have important implications in terms of patient safety and resource utilization. [source] Laparoscopic Procurement of Kidneys with Multiple Renal Arteries is Associated with Increased Ureteral Complications in the RecipientAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2005Jonathan T. Carter This study investigates the effect of renal artery multiplicity on donor and recipient outcomes after laparoscopic donor nephrectomy. Three-hundred and sixty-one sequential procedures were performed over a 4-year period. Forty-nine involved accessory renal arteries; of these, 36 required revascularization and 13 were small polar vessels and ligated. The 312 remaining kidneys with single arteries served as controls. Study variables included operative times, blood loss, hospital stay, graft function and donor and recipient complications. Kidneys with multiple revascularized arteries had a longer mean warm ischemia time (35.3 vs. 29.2 min, p = 0.0003), and more ureteral complications (6/36 vs. 10/312, p = 0.0013) than single-artery controls. In contrast, ligation of a small superior accessory artery had no significant effect on donor operative time, blood loss, or complication rate while providing similar recipient graft function compared to single-artery controls. Renal artery number is important in selecting the appropriate kidney for laparoscopic procurement. Given the current excellent results with right-sided donor nephrectomy, kidneys with single arteries should be preferentially procured, irrespective of side. [source] Soil fertility evolution and landscape dynamics in a Mediterranean area: a case study in the Sant Llorenç Natural Park (Barcelona, NE Spain)AREA, Issue 2 2009Jordi Nadal The cartography of land covers was used to study fertility and soil evolution in a mountainous Mediterranean area during the anthropocene period (Crutzen P J 2002 Geology of mankind Nature 415 23). The aim was to determine changes in fertility as agricultural lands were abandoned in the 14 000 hectare area that constitutes Sant Llorenç del Munt Natural Park in a pre-coastal Catalan mountain range (north-eastern Iberian Peninsula). The analysis of land covers using vegetation maps, orthorectified images and aerial photography has allowed us to differentiate six vegetation groups: holm-oak wood, pine grove, oak wood, scrub, active agricultural fields and abandoned agricultural fields. The anthropic covers over the past 100 years were subdivided into five categories: active fields and those abandoned over four time periods. Study variables include field shape (concave, convex, flat), orientation (north, south) and slope (ranging from 12º to 24º). The parameters used for the physical-chemical soil analysis included organic material, phosphorous and potassium; fertility was classified based on groups, types and classes. The results indicate that even when the visual appearance of certain landscapes is similar, the edaphic characteristics may be very different. Changes induced by human disturbance share this phenomenon. Therefore, land management should be considered globally, taking into account vegetation, soils and water as interdependent factors, since it is their interaction that produces landscape and most affects its evolution over time. [source] Leadership and management skills of first-line managers of elderly care and their work environmentJOURNAL OF NURSING MANAGEMENT, Issue 6 2010FATHYA ABDELRAZEK PhD abdelrazek f., skytt b., aly m., el-sabour m.a., ibrahim n.& engström m.(2010) Journal of Nursing Management 18, 736,745 Leadership and management skills of first-line managers of elderly care and their work environment Aim, To study the leadership and management skills of first-line managers (FLMs) of elderly care and their work environment in Egypt and Sweden. Background, FLMs in Egypt and Sweden are directly responsible for staff and quality of care. However, FLMs in Sweden, in elderly care, have smaller units/organizations to manage than do their colleagues in Egypt. Furthermore, family care of the elderly has been the norm in Egypt, but in recent years institutional care has increased, whereas in Sweden, residential living homes have existed for a longer period. Methods, A convenience sample of FLMs, 49 from Egypt and 49 from Sweden, answered a questionnaire measuring leadership and management skills, structural and psychological empowerment, job satisfaction and psychosomatic health. Results, In both countries, FLMs' perceptions of their leadership and management skills and psychological empowerment were quite high, whereas scores for job satisfaction and psychosomatic health were lower. FLMs had higher values in several factors/study variables in Egypt compared with in Sweden. Conclusion and implications, The work environment, both in Egypt and Sweden, needs to be improved to increase FLMs' job satisfaction and decrease stress. The cultural differences and levels of management have an effect on the differences between the two countries. [source] Factors predicting arrest for homeless persons receiving integrated residential treatment for co-occurring disordersCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 5 2009Blake Barrett Background,Homeless individuals are at increased risk for health and criminal justice problems. Aims,The aim of this study was to examine risk factors affecting arrest rates in a cohort of homeless people with co-occurring psychiatric and substance-abuse disorders. Methods,Baseline data were collected from 96 homeless individuals residing in a residential treatment facility for people with co-occurring disorders. Arrest data were obtained for 2 years following treatment intake. Regression analyses were employed to examine interactions between study variables. Results,One third of the sample was arrested during the 2-year follow-up period, principally for drug offences. People referred to treatment directly from the criminal justice system were four times more likely to re-offend than those referred from other sources. Participants' perceived need for mental-health services reduced risk of arrest while their perception of medical needs increased this risk. Conclusions,The relationship between referral from a criminal justice source and re-arrest after admission to the treatment facility is unsurprising, and consistent with previous literature, but the suggestion of an independently increased risk in the presence of perceived physical health-care needs is worthy of further study. The lower risk of arrest for people who perceive that they have psychological needs is encouraging. Copyright © 2009 John Wiley & Sons, Ltd. [source] An Empirical Taxonomy of Hospital Governing Board RolesHEALTH SERVICES RESEARCH, Issue 4 2008Shoou-Yih D. Lee Objective. To develop a taxonomy of governing board roles in U.S. hospitals. Data Sources. 2005 AHA Hospital Governance Survey, 2004 AHA Annual Survey of Hospitals, and Area Resource File. Study Design. A governing board taxonomy was developed using cluster analysis. Results were validated and reviewed by industry experts. Differences in hospital and environmental characteristics across clusters were examined. Data Extraction Methods. One-thousand three-hundred thirty-four hospitals with complete information on the study variables were included in the analysis. Principal Findings. Five distinct clusters of hospital governing boards were identified. Statistical tests showed that the five clusters had high internal reliability and high internal validity. Statistically significant differences in hospital and environmental conditions were found among clusters. Conclusions. The developed taxonomy provides policy makers, health care executives, and researchers a useful way to describe and understand hospital governing board roles. The taxonomy may also facilitate valid and systematic assessment of governance performance. Further, the taxonomy could be used as a framework for governing boards themselves to identify areas for improvement and direction for change. [source] Emotion avoidance in patients with anorexia nervosa: Initial test of a functional modelINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 5 2010Jennifer E. Wildes PhD Abstract Objective: This study aimed to evaluate emotion avoidance in patients with anorexia nervosa (AN) and to examine whether emotion avoidance helps to explain (i.e., mediates) the relation between depressive and anxiety symptoms and eating disorder (ED) psychopathology in this group. Method: Seventy-five patients with AN completed questionnaires to assess study variables. Rates of emotion avoidance were compared to published data, and regression models were used to test the hypothesis that emotion avoidance mediates the relation between depressive and anxiety symptoms and ED psychopathology in AN. Results: Patients with AN endorsed levels of emotion avoidance that were comparable to or higher than other psychiatric populations and exceeded community controls. As predicted, emotion avoidance significantly explained the relations of depressive and anxiety symptoms to ED psychopathology. Discussion: Findings confirm that emotion avoidance is present in patients with AN and provide initial support for the idea that anorexic symptoms function, in part, to help individuals avoid aversive emotional states. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source] Nurses' perceptions of individualized careJOURNAL OF ADVANCED NURSING, Issue 5 2010Riitta Suhonen suhonen r., gustafsson m.-l., katajisto j., välimäki m. & leino-kilpi h. (2010) Nurses' perceptions of individualized care. Journal of Advanced Nursing,66(5), 1035,1046. Abstract Title.,Nurses' perceptions of individualized care. Aim., This paper is a report of a study of nurses' perceptions of individualized care, the factors associated with these perceptions, and nurses' perceptions of the provision of individualized care in different types of healthcare organization. Background., Although individualized care has been an internationally-challenging and long-standing research topic in nursing, the current literature on individualized care from the perspective of nurses is limited. Methods., A cross-sectional, descriptive and exploratory design using a questionnaire (Individualised Care Scale,Nurse) was employed to survey a stratified sample of 544 nurses (response rate 59%) working as Registered or Enrolled Nurses in one hospital district in Finland in 2008. Data were analysed using descriptive and inferential statistics (General Linear Model, one-way analysis of variance) and Cronbach's alpha coefficients for reliability analysis. Results., Nurses perceived that they supported patient individuality well and that the care they provided took into account patient individuality. Based on the General Linear Model, nurses' background variables were not associated with their perceptions of individualized care delivery. However, between-organization differences were found in all study variables: mental health ward nurses had the most positive perceptions, and nurses working in primary health centre long-term care wards the lowest. Conclusion., Healthcare organizations and work environments need to be evaluated as they may have an influence on individualized care provision. The Individualised Care Nurse instrument is sensitive to healthcare working environments and can be used in evaluating nurses' perceptions of individualized care. [source] Do cultural factors predict mammography behaviour among Korean immigrants in the USA?JOURNAL OF ADVANCED NURSING, Issue 12 2009Hanju Lee Abstract Title.,Do cultural factors predict mammography behaviour among Korean immigrants in the USA? Aim., This paper is a report of a study of the correlates of mammogram use among Korean American women. Background., Despite the increasing incidence of and mortality from breast cancer, Asian women in the United States of America report consistently low rates of mammography screening. A number of health beliefs and sociodemographic characteristics have been associated with mammogram participation among these women. However, studies systematically investigating cultural factors in relation to mammogram experience have been scarce. Methods., We measured screening-related health beliefs, modesty and use of Eastern medicine in 100 Korean American women in 2006. Hierarchical logistic regression was used to examine the unique contribution of the study variables, after accounting for sociodemographic characteristics. Findings., Only 51% reported past mammogram use. Korean American women who had previously had mammograms were statistically significantly older and had higher perceived benefit scores than those who had not. Perceived benefits (odds ratio = 6·3, 95% confidence interval = 2·12, 18·76) and breast cancer susceptibility (odds ratio = 3·18, 95% confidence interval = 1·06, 9·59) were statistically significant correlates of mammography experience, whereas cultural factors did not correlate. Post hoc analysis showed that for women with some or good English skills, cultural factors statistically significantly correlated with health beliefs and breast cancer knowledge (P < 0·05). Conclusion., Nurses should consider the inclusion in culturally tailored interventions of more targeted outreach and healthcare system navigation assistance for promoting mammography screening in Korean American women. Further research is needed to unravel the interplay between acculturation, cultural factors and health beliefs related to cancer screening behaviours of Korean American women. [source] Parenting stress in mothers of adults with an intellectual disability: parental cognitions in relation to child characteristics and family supportJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 12 2009C. Hill Abstract Background There is a body of evidence that indicates that the cognitions of parents of children with intellectual disabilities (ID) play an important role in influencing parental stress. However, there is a paucity of evidence about the experience of parents of adult children with ID. This study sought to apply a model of parenting stress to mothers of adults with ID. Of particular interest were the parental cognitions of parenting self-esteem and parental locus of control. Method Face-to face interviews were administered with 44 mothers of adults with ID. They completed the Vineland Adaptive and Maladaptive Behaviour Scale, the Family Support Scale, the Parenting Sense of Competence Scale, a shortened version of the Parental Locus of Control Scale and the Parenting Stress Index. Results Correlations were observed between parenting stress and the other study variables. Regression analysis revealed that parental cognitive variables predicted 61% of the variance in parenting stress. Parenting satisfaction, a subscale of the measure of parenting sense of competence, mediated the relationships between adaptive behaviour and parenting stress and between family support and parenting stress. Conclusions These results indicate the importance of cognitive variables in the stress of mothers of adults with ID. Potential avenues of future research might focus on the experience of fathers and the impact of positive perceptions as a cognitive factor. [source] Empowerment, engagement and perceived effectiveness in nursing work environments: does experience matter?JOURNAL OF NURSING MANAGEMENT, Issue 5 2009HEATHER K. SPENCE LASCHINGER RN Aims, We examined the impact of empowering work conditions on nurses' work engagement and effectiveness, and compared differences among these relationships in new graduates and experienced nurses. Background, As many nurses near retirement, every effort is needed to retain nurses and to ensure that work environments are attractive to new nurses. Experience in the profession and generational differences may affect how important work factors interact to affect work behaviours. Methods, We conducted a secondary analysis of survey data from two studies and compared the pattern of relationships among study variables in two groups: 185 nurses 2 years post-graduation and 294 nurses with more than 2 years of experience. Results, A multi-group SEM analysis indicated a good fit of the hypothesized model. Work engagement significantly mediated the empowerment/effectiveness relationship in both groups, although the impact of engagement on work effectiveness was significantly stronger for experienced nurses. Conclusions, Engagement is an important mechanism by which empowerment affects nurses feelings of effectiveness but less important to new graduates' feelings of work effectiveness than empowerment. Implications for nursing management, Managers must be aware of the role of empowerment in promoting work engagement and effectiveness and differential effects on new graduates and more seasoned nurses. [source] Haemodilution induced by hydroxyethyl starches 130/0.4 is similar in septic and non-septic patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2008P. MEYER Background: Fluid therapy induces haemodilution related to plasma volume expansion. The aim of our study was to compare haemodilution after a single hydroxyethyl starches (HES) 130/0.4 infusion in two groups of patients, one with and one without sepsis. We hypothesized that a single HES challenge would induce similar sustained haemodilution in both groups. Methods: In this prospective preliminary study, patients predicted to require a single further volume-expander infusion were included immediately before receiving 500 ml of 6% HES 130/0.4 over a 15-min period. No additional fluid was administered over the next 8 h. Haematocrit, and serum albumin and protein were determined immediately before HES infusion then after 1, 2, 3, 4, and 8 h. Results: Twelve patients were included in each group. In both groups, all three haemodilution markers had significantly lower values after 1 h than at baseline. None of the values after 1 and 3 h differed significantly between the two groups. Neither did any of the other study variables show significant differences between the groups with and without sepsis. Conclusion: We found that a starch-based compound was as effective in inducing haemodilution in patients with sepsis as in controls without sepsis, suggesting that HES may remain within the intravascular space even in patients with sepsis. Haemodilution parameters such as haematocrit, serum albumin and serum protein are useful for assessing the duration of plasma volume expansion induced by fluid therapy in critically ill patients. [source] A STRUCTURAL EQUATION MODELING OF ALCOHOL USE AMONG YOUNG ADULTS IN THE U.S. MILITARY: COMPLEXITIES AMONG STRESS, DRINKING MOTIVES, IMPULSIVITIY, ALCOHOL USE AND JOB PERFORMANCEALCOHOLISM, Issue 2008Sunju Sohn Aims:, Young male adults in the U. S. military drink at much higher rates than civilians and females of the same age. Drinking has been shown to be associated with stress and individuals' ability to effectively cope with stressors. Despite numerous studies conducted on young adults' drinking behaviors such as college drinking, current literature is limited in fully understanding alcohol use patterns of the young military population. The aim of the present study was to develop and test the hypothesized Structural Equation Model (SEM) of alcohol use to determine if stress coping styles moderate the relationship between stress, drinking motives, impulsivity, alcohol consumption and job performance. Methods:, Structural equation models for multiple group comparisons were estimated based on a sample of 1,715 young (aged 18 to 25) male military personnel using the 2005 Department of Defense Survey of Health Related Behaviors among Military Personnel. Coping style was used as the grouping factor in the multi-group analysis and this variable was developed through numerous steps to reflect positive and negative behaviors of coping. The equivalences of the structural relations between the study variables were then compared across two groups at a time, controlling for installation region, race/ethnicity, marital status, education, and pay grade, resulting in two model comparisons with four coping groups. If the structural weight showed differences across groups, each parameter was constrained and tested one at a time to see where the models are different. Results:, The results showed that the hypothesized model applies across all groups. The structural weights revealed that a moderation effect exists between a group whose tendency is to mostly use positive coping strategies and a group whose tendency is to mostly use negative coping strategies (,,2(39)= 65.116, p<.05). More specifically, the models were different (with and without Bonferroni Type I error correction) in the paths between "motive and alcohol use" and "alcohol use and alcohol-related consequences (job performance)." Conclusions:, It seems plausible that coping style significantly factors into moderating alcohol use among young male military personnel who reportedly drink more excessively than civilians of the same age. The results indicate that it may be particularly important for the military to assess different stress coping styles ofyoung male military personnel so as to limit excessive drinking as well as to promote individual wellness and improve job performance. [source] Clinical correlates of depressive symptoms in familial Parkinson's disease,,MOVEMENT DISORDERS, Issue 15 2008Nathan Pankratz PhD Abstract Depression is one of the most common nonmotor complications of Parkinson's disease (PD) and has a major impact on quality of life. Although several clinical factors have been associated with depression in PD, the relationship between depression and stage of illness as well as between depression and degree of disability remains controversial. We have collected clinical data on 1,378 PD cases from 632 families, using the Unified Parkinson's Disease Rating Scale (UPDRS) Parts II (activities of daily living) & III (motor), the Mini-Mental State Exam, the Geriatric Depression Scale (GDS), and the Blessed Functional Activity Scale (Blessed). Analyses were performed using the 840 individuals with verified PD and without evidence of cognitive decline. Logistic regression was used to identify study variables that individually and collectively best predicted the presence of depressive symptoms (GDS , 10). After correcting for multiple tests, depressive symptoms were significantly associated with Hoehn and Yahr stage and other clinical measures but not with any genetic variant (parkin, LRRK2, APOE). The Blessed score, education, presence of a first degree relative with signs of depression, and UPDRS Part II were found to best predict depressive symptomatology (R2 = 0.33; P = 4 × 10,48). Contrary to several reports, the results from this large study indicate that stage of illness, motor impairment, and functional disability are strongly correlated with depressive symptoms. © 2008 Movement Disorder Society [source] The influence of sexual maturation on blood pressure and body fatness in African-American adolescent girls and boysAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2009Xiaoli Chen To examine the influence of sexual maturation (SM) on blood pressure (BP) and body fatness during puberty among African-American children. Longitudinal data were collected from 283 African-American children aged 9,15 years over a 1.5-year period. Measured anthropometric measures included height, weight, skinfold thickness, waist circumference (WC), and systolic and diastolic BP (SBP/DBP) at baseline, 1-year, and 1.5-year follow-up were used. SM was assessed using self-reported Tanner stages (range 1,5) at baseline. Spearman correlation and regression analyses were conducted to test associations between study variables. Early maturing girls had higher BP and body mass index (BMI = weight (kg)/height (m)2) at follow-up than nonearly maturing girls (SBP: 117.4 vs. 111.7; DBP: 66.3 vs. 60.7; BMI: 27.7 vs. 23.5; all P < 0.05, respectively). Baseline Tanner stage was positively associated with follow-up SBP (r = 0.28), DBP (r = 0.37), BMI (r = 0.45), skinfold thickness (r = 0.37), and WC (r = 0.40) in girls, but not in boys. The influence of SM on BP independent of body size was tested via several different multiple linear regression models by adding measures of body size and their changes (height and BMI) between baseline and follow-up. Early maturing girls had higher SBP and DBP (, = 4.30, P < 0.05; , = 3.28, P < 0.05; respectively) and BMI (, = 1.69, P < 0.05) at 1.5-year follow-up than their counterparts. In boys, a marginally significant reverse association (, = ,1.05 to ,1.19) between SM stages and DBP was detected. SM affects BP and body fatness in girls, and should be considered in assessment of BP and obesity in adolescents. Am. J. Hum. Biol., 2009. © 2008 Wiley-Liss, Inc. [source] Pathways Among Exposure to Violence, Maternal Depression, Family Structure, and Child Outcomes Through Parenting: A Multigroup AnalysisAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2010T'Pring R. Westbrook The present study examined the impact of proximal (maternal depression, family structure) and distal (exposure to violence) risk factors on parenting characteristics (warmth, control), which were in turn hypothesized to affect child social-emotional functioning. Using the Family and Child Experiences Study (FACES) 2000 cohort, findings revealed that study variables were significant predictors of child social-emotional functioning. Despite limited significant pathways in the structural equation models, the cumulative effect of the variables resulted in models accounting for 21%,37% of the outcome. Multigroup analysis revealed that although the amount of variance explained varied, the model held across subgroups. Findings support theories such as the family stress model that suggest that family risk factors negatively influencing children's development through influencing parenting behaviors. Findings also support considering both warmth and control as key parenting dimensions. It may be impractical for practitioners to address the myriad of potential risks encountered by low-income families, but parents can be equipped with mental health services, parent education, and other assistance to help them maintain positive parenting practices in the face of challenges. [source] Frequency and difficulty in caregiving among spouses of individuals with cancer: effects of adult attachment and genderPSYCHO-ONCOLOGY, Issue 8 2007Youngmee Kim Abstract How caregivers relate to care recipients can affect how well care is provided and how much burden is experienced in providing it. We conceptualized the relationship of spousal caregivers via adult attachment theory and examined how attachment qualities of caregivers related to level of caregiving involvement and difficulties in caregiving. Gender differences in the associations were also explored. From participants in the ACS Quality of Life Survey for Caregivers, 400 spousal caregivers provided valid data for the study variables. Findings indicated that frequency of various types of care was a joint function of attachment orientation and gender. In contrast, the difficulty that caregivers experienced in providing care related directly to attachment, without moderation by gender. Our findings suggest that ineffective caregivers of cancer patients, who can be identified by their attachment orientation and/or gender, may benefit from educational programs to improve their caregiving skills and to encourage them to utilize resources from other family members or community. Copyright © 2006 John Wiley & Sons, Ltd. [source] Algorithm for Reconstruction After Endoscopic Pituitary and Skull Base Surgery,THE LARYNGOSCOPE, Issue 7 2007Abtin Tabaee MD Abstract Introduction: The expanding role of endoscopic skull base surgery necessitates a thorough understanding of the indications, techniques, and limitations of the various approaches to reconstruction. The technique and outcomes of endoscopic skull base reconstruction remain incompletely described in the literature. Study Design and Methods: Patients undergoing endoscopic skull base surgery underwent an algorithmic approach to reconstruction based on tumor location, defect size, and presence of intraoperative cerebrospinal fluid (CSF) leak. A prospective database was reviewed to determine the overall efficacy of reconstruction and to identify risk factors for postoperative CSF leak. Results: The diagnosis in the 127 patients in this series included pituitary tumor in 70 (55%) patients, encephalocele in 16 (12.6%) patients, meningioma in 11 (8.7%) patients, craniopharyngioma in 9 (7.1%) patients, and chordoma in 6 (4.7%) patients. Successful reconstruction was initially achieved in 91.3% of patients. Eleven (8.7%) patients experienced postoperative CSF leak, 10 of which resolved with lumbar drainage alone. One (0.8%) patient required revision surgery. Correlation between postoperative CSF leak and study variables revealed a statistically significant longer duration of surgery (243 vs. 178 min, P = .008) and hospitalization (12.1 vs. 4.5 days, P < .0001) and a trend toward larger tumors (mean, 3.2 vs. 2.3 cm; P = .058) in patients experiencing postoperative CSF leak. Conclusion: The algorithm for reconstruction after endoscopic surgery presented in this study is associated with excellent overall efficacy. A greater understanding of risk factors for postoperative CSF leak is imperative to achieve optimal results. [source] Schools as Socialisation Contexts: Understanding the Impact of School Climate Factors on Students' Sense of School BelongingAPPLIED PSYCHOLOGY, Issue 2 2010Zeynep Cemalcilar Education is a top priority of the European Union (EU). The EU Education Council has declared that to be the world leader in terms of the quality of education and training systems by 2010, fundamental transformations in education should be carried out in each country according to its national context and traditions. As a candidate country, Turkey shares this common objective. Yet, the mean school attainment and net education enrollment rates in Turkey are still behind the EU averages. The education literature indicates students' sense of school belonging as an important predictor of school attainment. This study aims to identify the policy manipulable social aspects of schools that can be instrumental in increasing students' sense of school belonging in a sample of 799 middle school students attending public schools in Istanbul, Turkey. The conceptual model posits that students' satisfaction with both the social relationships in the school and the school environment has consequences for their sense of school belonging. The results of the structural equation model analysis revealed a plausible model. Satisfaction with social relationships emerged as a stronger predictor of sense of school belonging than satisfaction with the school environment. Further comparisons of the same conceptual model for schools with low and high socioeconomic conditions yielded different associations among the study variables. The findings are discussed in terms of their relevance to the education system in Turkey and other less affluent societies with similar social, cultural, and economic conditions. L'éducation est une priorité majeure de l'Union Européenne (UE). Le Conseil de l'Education de l'UE a déclaré que pour devenir le leader mondial de la qualité de l'éducation et de la formation en 2010, il fallait opérer des réformes d'importance dans le système d'éducation de chacun des pays dans le respect de leurs traditions et de leur contexte national. En tant que candidate pour intégrer l'Union, la Turquie partage cet objectif commun. Pourtant, les performances scolaires moyennes et le taux de scolarisation sont en Turquie toujours en-dessous des moyennes européennes. La littérature concernée montre que la conviction de l'élève d'être intégréà l'école est un prédicteur important de ses résultats scolaires. Cette étude cherche à définir les possibilités d'action politique sur les variables sociales scolaires susceptibles d'améliorer le sentiment d'appartenance à l'école, cela sur un échantillon de 799 élèves de collège fréquentant des établissements publics d'Istanbul. Le modèle pose que la satisfaction des élèves relative aux relations sociales à l'école et à l'environnement scolaire est en relation avec leur sentiment d'intégration à l'établissement. Les résultats de l'analyse en modèle d'équation structurale fournissent une structure plausible. La satisfaction liée aux relations sociales ressort comme un prédicteur du sentiment d'appartenance plus puissant que la satisfaction relative à l'environnement scolaire. Des manipulations complémentaires de ce même modèle à partir de conditions socio-économiques élevées ou basses débouchèrent sur de nouvelles associations entre les différentes variables. Ces résultats sont évalués sur la base de leur pertinence pour le système scolaire turque et celui d'autres pays moins prospères présentant des conditions économiques, sociales et culturelles analogues. [source] Occupational stress, negative affectivity and physical health in special and general education teachers in GreeceBRITISH JOURNAL OF SPECIAL EDUCATION, Issue 4 2006Lambros Lazuras Teacher stress has attracted considerable attention, yet few studies have focused on special education teachers. This article, by Lambros Lazuras of the South-East European Research Centre (SEERC) in Thessaloniki, reports research designed to explore differences in the stress levels of general and special educators in Greece and provides preliminary evidence for a framework to understand the process of special education teacher stress. A total of 70 teachers from general and special education schools from a large Greek city participated in the study by completing questionnaires. Measures included occupational stress deriving from interpersonal conflict, organisational constraints, workload, work-related negative affectivity and health outcomes. Data analyses allowed for inferences regarding the dynamic interaction among the study variables. Findings appear interesting in terms of advancing current understanding of the relationships between different sources of job stress within the special education teaching context and provide general guidelines for future policies aiming to counter special education teacher stress. [source] Postoperative serum carcinoembryonic antigen levels in patients with pathologic stage IA nonsmall cell lung carcinomaCANCER, Issue 4 2004Subnormal levels as an indicator of favorable prognosis Abstract BACKGROUND Elevated serum carcinoembryonic antigen (CEA) levels are sometimes attributable to the production of CEA by malignant cells, and in turn, the antigen itself can enhance the metastatic potential of malignant cells. The authors speculated that low serum CEA levels might be indicative of relatively low levels of malignant cells and a low probability of disease recurrence. This hypothesis led them to investigate whether low CEA levels in serum represented a useful prognostic factor for patients with pathologic Stage IA nonsmall cell lung carcinoma. METHODS Between 1993 and 2001, 724 patients underwent surgery for NSCLC at Toneyama National Hospital (Toyonaka, Japan). Of these patients, the 242 who were diagnosed with pathologic Stage IA disease were included in the current study. Smoking behavior, gender, age, tumor diameter, disease histology, and preoperative and postoperative serum CEA levels were chosen as study variables, with the cutoff level between subnormal and normal serum CEA levels set at 2.5 ng/mL and the cutoff level between normal and high serum CEA levels set at 5.0 ng/mL. Prognostic indicators were evaluated using a Cox hazard model. In addition, survival probabilities were calculated using the Kaplan,Meier method, and differences in survival were assessed by log-lank analysis. RESULTS Subnormal postoperative serum CEA levels were found to be an independent prognostic indicator (hazard ratio, 2.3; 95% confidence interval, 1.1,4.7; P = 0.03 for comparison with patients who had normal CEA levels) on multivariate analysis. Furthermore, the 5-year survival rate was 87% for patients with subnormal postoperative CEA levels (n = 146), compared with 75% for patients with normal postoperative CEA levels (n = 80) and 53% for patients with high postoperative CEA levels (n = 16) (P < 0.0001). CONCLUSIONS Among patients with pathologic Stage IA NSCLC, those who had an extremely favorable prognosis were distinguished by their subnormal postoperative serum CEA levels. Cancer 2004. © 2004 American Cancer Society. [source] Post-stroke quality of life and depressionACTA NEUROPSYCHIATRICA, Issue 5 2002Krystyna Jaracz Background: Studies on the determinants of the quality of life (QOL) after stroke bring differing results depending on the applied concept of QOL. This may lead to confusion about the contribution of various factors to the post-stroke QOL. Objective: The aim of the study was: (i) to investigate functional and psychological QOL in the individuals after the first ischemic stroke; (ii) to identify the most important correlates of QOL; and (iii) to examine the significance of depression among the other possible predictors of QOL. Methods: A hospital-based sample of 72 stroke patients was followed up to 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index and the Sickness Impact Profile. A multiple regression procedure was performed to examine relationships between QOL and the study variables. Results: In spite of good recovery, the psychological and functional QOL of the examined patients was impaired, although the negative impact of stroke was greater on the objective QOL than on the subjective QOL. Stroke-related impairment, depression, functional disability and marital status predicted 80% of the variance in the functional QOL. Emotional support, depression and functional disability explained 38% of the variance in psychological well-being. Conclusions: Depression and physical disability were the most important predictors of QOL after stroke since their impact on QOL was more robust in comparison to the remaining variables. For improving QOL, a comprehensive care for patients aimed at reducing physical dependence and ameliorating depressive symptoms could be recommended. [source] Paranoid beliefs and self-criticism in studentsCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 5 2007A. Mills Paranoid beliefs are associated with negative and malevolent views of others. This study, however, explored hostile and compassionate self-to-self relating in regard to paranoid beliefs. A total of 131 students were given a series of scales measuring paranoid ideation, forms and functions of self-criticism, self-reassurance, self-compassion and depression. Test scores were subjected to correlation and hierarchical regression analyses to explore the relative contribution of study variables to paranoid beliefs. In this population, paranoid beliefs were associated with forms and functions of self-criticism, especially self-hating and self-persecution. Paranoid beliefs were negatively correlated with self-kindness and abilities to be self-reassuring. These variables were also associated with depression (as were paranoid beliefs). A hierarchical regression found that self-hatred remained a predictor of paranoid ideation even after controlling for depression and self-reassurance. Paranoid beliefs seem to be associated with a critical and even hating experience of self. These inner experiences of self may be profitable targets for therapeutic interventions.,Copyright © 2007 John Wiley & Sons, Ltd. [source] Self-Concealment, Social Self-Efficacy, Acculturative Stress, and Depression in African, Asian, and Latin American International College StudentsAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2004Madonna G. Constantine PhD The primary purpose of this exploratory investigation was to examine self-concealment behaviors and social self-efficacy skills as potential mediators in the relationship between acculturative stress and depression in a sample of 320 African, Asian, and Latin American international college students. The authors found several differences by demography with regard to the study's variables. After controlling for regional group membership, sex, and English language fluency, they found that self-concealment and social self-efficacy did not serve as mediators in the relationship between African, Asian, and Latin American international students' acculturative stress experiences and depressive symptomatology. Implications of the findings are discussed. [source] | ||||||||||||||||