Multivariate impact of health and caretaking risk factors on the school adjustment of first graders

The current investigation examined seven health and caretaking risk factors that threaten children's school adjustment: low birth weight, low Apgar score, lead poisoning, birth to a single mother, birth to a teen mother, child maltreatment, and out‐of‐home care. The purpose of this study was to assess the relationships among these risk factors and several indicators of school adjustment in an entire population of students. Participants included 9,088 first‐grade students in a large urban school district. Information on risk factors and school adjustment was obtained from computerized records that were combined using record linkage. The independent and interactive effects of the risk factors on school adjustment were assessed using logistic regression. Results showed that six of the seven risk factors significantly increased children's risk for poor school adjustment. Findings were stable across several subsamples. No significant interactive effects were found among the risk factors. Implications for research and practice were discussed. © 2001 John Wiley & Sons, Inc.     

复旦大学附属儿科医院职工学科评估导向优化激励政策的意愿分析及影响因素研究

目的 了解儿科医院职工对基于学科评估优化激励政策的意愿强弱,分析影响职工意愿的相关因素,为医院管理层制定相关激励政策提供参考依据。方法 于2019年3月~5月采用自制调查问卷以网络问卷的形式向我院职工推送调查问卷,调查医院激励机制的实施情况、职工对医院激励机制的满意情况,分析职工对学科评估导向的激励政策的意愿及其影响因素。结果 共回收有效问卷427份,涵盖了临床、护理、医技、行政管理等各类岗位,涉及共43个科室。约3/4的职工对医院的激励制度的了解程度在一般及以下。认为医院采取的激励措施效果比较好和非常好的占33.73%。医院职工对学科评估导向优化激励政策的整体意愿得分（3.62±0.75）分,介于“一般”与“愿意”之间,更靠近“愿意”。各二级维度中,调整带薪休假天数、调整医务人员数量、调整科研配套经费、调整研究生招生名额及分配进修交流名额这五项意愿得分高于平均意愿得分,差异有统计学意义（P＜0.05）;分配晋升名额、调整床位数量、年终科研奖励进行调整、对规/专培招录名额进行调整这四项意愿得分与平均意愿得分比较,差异无统计学意义（P＞0.05）;分配每月薪资、分配季度奖、分配年终奖三项意愿得分低于平均意愿得分,差异有统计学意义（P＜0.05）。根据学科评估结果调整医院激励政策总体意愿（St）的影响因素有性别（女性＞男性）、学历（大专及以下＞硕士＞本科＞博士及以上）和工作岗位（其他＞行政＞护士＞医技＞医生）。结论 儿科医院职工对医院的激励机制还不是非常了解,医院应加强激励制度的宣传公告。医院采取的激励措施效果一般,但职工对学科评估导向优化激励政策表现出较强的意愿,管理层可优先考虑从调整带薪休假天数、调整医务人员数量、调整科研配套经费、调整研究生招生名额、分配进修交流名额等政策入手,调整优化激励政策方案。制定激励政策时,可根据不同对象分类制定,针对意愿较弱的人群,可加大激励力度,以充分调动每一类职工的主观能动性,推动学科发展。     

妊娠期营养的个性化指导

妊娠期是育龄妇女的特殊的时期,由于身体经历了一系列复杂的生理调整过程,明显增加了身体的消耗并最终影响了母体各种营养素的需要量。妊娠期营养与胎婴儿发育及孕妇健康密切相关,孕妇营养状况受诸多因素的影响,对孕妇的营养评估和指导要根据她们的具体情况加以判断,确定相应的营养目标及调整方案。本文就有关孕期营养对母儿的影响及影响个体营养的相关因素、制定个性化的营养干预计划做一阐述。     

Exposure to community violence and African American children: A multidimensional model of risks and resources

The present study seeks to investigate how various facets of social and emotional adjustment, in a sample of urban African American children, are affected by their chronic exposure to community violence and other risk factors in their lives. It further explores how various resources in their environment sustain these children's adjustment at home and in school. In examining these issues, we endeavored to account for both the general and the differential effects of risk factors and resources on social-emotional adjustment. The fundamental problem explored in this study is the extent to which the various indicators of adjustment are differentially impacted by a common set of risk factors, and enhanced through a common set of protective mechanisms. © 1996 John Wiley & Sons, Inc.     

Development of the benefit finding in multiple sclerosis (MS) caregiving scale: A longitudinal study of relations between benefit finding and adjustment

Benefit finding (BF) is a meaning‐making construct that has been shown to predict carer and care recipient adjustment. Purpose This longitudinal study investigated the dimensions, stability, and validity of the benefit finding in multiple sclerosis caregiving (BFiMSCare) scale. Methods Participants were 232 carers of persons with MS and their care recipients. Questionnaires were completed at Time 1 and 12 months later (Time 2). Results Factor analysis of the BFiMSCare scale revealed six psychometrically sound factors: enriched relationship; spiritual growth; family relations growth; life‐style gains; inspiration; and relationship opportunities. Results of regression analyses indicated that the Time 1 BFiMSCare factors and the total score accounted for significant amounts of variance in each of the Time 1 positive adjustment outcomes (life satisfaction, positive affect, dyadic adjustment) and in Time 2 positive affect and dyadic adjustment. The BFiMSCare total score predicted all Time 2 adjustment domains (positive affect, dyadic adjustment, care recipient adjustment ratings of carer) except life satisfaction and distress, whereas the six factors as a block predicted positive affect and life satisfaction. Conclusions Findings delineate the dimensional structure of BF in caregiving and the differential links between BF dimensions and adjustment, and have implications for the measurement of BF.     

Social Support, Health and Satisfaction among the Elderly with Chronic Conditions in Taiwan

This study examines possible relationships between perceived social support, physical and mental health, satisfaction towards hospital services, and satisfaction towards life-asa-whole, among the community elderly with chronic conditions. A sample of 172 Chinese elderly living in a metropolitan Taiwanese city were home-interviewed. Results indicated that (a) the elderly perceived good social support, and tangible support was the most important aspect; (b) the elderly did not perceive great impact of illness(es) upon their life, and both physical and mental health were satisfactory; (c) the elderly were generally satisfied with both the hospital services and life-as-a-whole; (d) apart from health and illness factors, social support appeared to have profound and pervasive protective effects on adjustment and satisfaction of the elderly.     

A review of psychological correlates of adjustment in patients with multiple sclerosis

Multiple Sclerosis (MS) is a chronic neurological disease which poses significant psychological adjustment challenges. The purpose of this systematic review was to identify factors that are related to adjustment in people with MS and may be modifiable through psychological intervention. It aimed to gain an overview of the strength of evidence for relationships between psychological factors and adjustment and identify limitations to existing studies and directions for future research. Seventy two studies met inclusion criteria and were included in the review and a narrative synthesis was conducted. A wide range of psychological factors have been studied in relation to adjustment outcomes. The strongest and most consistent finding was that perceived stress and certain emotion-focussed coping strategies are related to worse adjustment in MS. Uncertainty was fairly robustly associated with worse adjustment. There was also more tentative evidence available for relationships between adjustment outcomes and a range of other factors including social support and interactions with others, cognitive errors and biases, illness and symptom cognitions, control perceptions, positive psychology factors, and health behaviours. Implications for therapeutic interventions are discussed and a preliminary model of adjustment to MS is outlined. In light of the shortcomings of extant studies, suggestions for future research are offered.     

海勤人员社会适应度调查分析

目的 调查海勤人员社会适应特点,研究海勤人员社会适应度评定的方法.方法 以症状自评量表(SCL- 90)中与社会适应有关的3个因子(人际关系、敌对、偏执),对1128名海勤人员进行测评,调查海勤人员的社会适应情况.利用自行研制的社会适应度评定量表,对海勤人员的社会适应度进行评定.结果 ①海勤人员3个因子有阳性症状的百分比为人际关系6.83％、敌对7.36％、偏执6.21％;②海勤人员的人际关系因子得分低于军人常模(t=71.49)和地方常模(t=41.89);海勤人员的敌对因子得分低于军人常模(t=23.76)和地方常模(t=12.44);海勤人员的偏执因子得分低于军人常模(t=50.78)和地方常模(t=6.20);统计学分析均有显著性差异(P＜0.01);③海勤人员的社会适应度量表评定结果:社会适应度好882人,占78.19％;社会适应度良好198人,占17.55％;社会适应度一般42人,占3.73％.社会适应度较差6人,占0.53％.结论 SCL-90中与社会适应有关的3个因子(人际关系、敌对、偏执)和社会适应度评定量表可从某些方面反映社会适应状况,对社会适应度的评定有一定的参考价值.     

Consultation/liaison psychiatry utilization patterns in different cultural groups.

This study examined the effect of cross-cultural factors on psychiatric consultations in a general hospital. Using a retrospective case review, 476 patients receiving a psychiatric consultation were contrasted with 14,620 who did not receive a psychiatric consultation. The rate of psychiatric referral was lower for Hispanics compared with Anglos, blacks, and Asians (p less than 0.001). The reason for requesting psychiatric consultation was also different across the ethnic groups. There were more requests for evaluation of depression and suicide in Hispanics and fewer such requests in blacks. More requests for evaluation of grossly abnormal mental status were found in blacks. The different cultural groups also had differences in psychiatric diagnosis. Hispanics were more frequently diagnosed with an adjustment disorder; blacks were more frequently diagnosed with a primary thought disorder and delirium; and Anglos were more frequently diagnosed with dementia.     

Association between air pollution and asthma admission among children in Hong Kong

OBJECTIVE: To examine the association of air pollutants with hospital admission for childhood asthma in Hong Kong. METHODS: Data on hospital admissions for asthma, influenza and total hospital admissions in children aged < or =18 years at all Hospital Authority hospitals during 1997-2002 were obtained. Data on daily mean concentrations of particles with aerodynamic diameter <10 microm (i. e. PM10) and <2.5 microm (i. e. PM2.5), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) and data on meteorological variables were associated with asthma hospital admissions using Poisson's regression with generalized additive models for correction of yearly trend, temperature, humidity, day-of-week effect, holiday, influenza admissions and total hospital admission. The possibility of a lag effect of each pollutant and the interaction of different pollutants were also examined. RESULTS: The association between asthma admission with change of NO2, PM10, PM2.5 and O3 levels remained significant after adjustment for multi-pollutants effect and confounding variables, with increase in asthma admission rate of 5.64% (3.21-8.14) at lag 3 for NO2, 3.67% (1.52-5.86) at lag 4 for PM10, 3.24% (0.93-5.60) at lag 4 for PM2.5 and 2.63% (0.64-4.67) at lag 2 for O3. Effect of SO2 was lost after adjustment. CONCLUSION: Ambient levels of PM10, PM2.5) NO2 and O3 are associated with childhood asthma hospital admission in Hong Kong.     

Adjustment disorders in medically ill inpatients referred for consultation in a university hospital

The study examined medical records of 121 medical-surgical inpatients diagnosed with adjustment disorder by psychiatric consultants in a university hospital. Medical illness was the primary stressor, evoking the maladaptive reaction in 83 (68.6%) cases. These patients were largely free of preceding psychiatric problems, suffering protracted hospitalizations for advanced illnesses, particularly malignancy and diabetes; in contrast, the 38 (31.4%) patients whose adjustment disorder was precipitated by a stressor other than medical illness had established psychiatric histories and recurrent problems with relationships or finances. The data suggest that in the medically ill, identifying the primary stressor producing an adjustment disorder is more instructive than focusing upon "predominant" symptomatology and "subtypes."     

青少年适应障碍患者人格特质分析

目的对青少年适应障碍患者与正常青少年的人格特质进行比较。方法采用《修订卡氏16种人格因素量表》,对88例青少年适应障碍患者与88例正常青少年进行测评。结果适应障碍组的因素A（乐群性）、C（稳定性）、F（兴奋性）、Q 2（独立性）、H（敢为性）均分别低于正常人组（P〈0.001或P〈0.05）,因素O（忧虑性）、Q 4（紧张性）、I（敏感性）、L（怀疑性）均分别高于正常人组（P〈0.001或P〈0.05） 适应障碍组的心理健康因素、新环境中的成长能力因素均分低于正常人组（P〈0.001） 适应障碍组适应与焦虑型均分明显高于正常人组（P〈0.001）,适应障碍组内向与外向型、感情用事与安详机警型、怯懦与果断型均分明显低于正常人组（P〈0.05）。结论青少年适应障碍患者人格特质与正常青少年之间存在显著性差异。     

Development of a validation algorithm for 'present on admission' flagging

Background  

The use of routine hospital data for understanding patterns of adverse outcomes has been limited in the past by the fact that pre-existing and post-admission conditions have been indistinguishable. The use of a 'Present on Admission' (or POA) indicator to distinguish pre-existing or co-morbid conditions from those arising during the episode of care has been advocated in the US for many years as a tool to support quality assurance activities and improve the accuracy of risk adjustment methodologies. The USA, Australia and Canada now all assign a flag to indicate the timing of onset of diagnoses. For quality improvement purposes, it is the 'not-POA' diagnoses (that is, those acquired in hospital) that are of interest.     

Temperament, health-related behaviors, and autonomic cardiac regulation: the cardiovascular risk in young Finns study

Temperament, as indicated by Cloninger's psychobiological model predicts coronary heart disease risk, but its association with autonomic cardiac regulation, a potential mediating mechanism, is unclear. We examined the associations between temperament traits and autonomic cardiac regulation in a resting situation in 798 women and 580 men derived from a population-based sample. After adjustment for age and sex, harm avoidance was associated with lower level of high-frequency (HF) variation, root mean square successive differences (RMSSDs), the percentage of successive R–R intervals >50 ms (pNN50) and higher heart rate (HR) (all p ≤ 0.005), suggesting that harm avoidance is related to low parasympathetic activity. Additional adjustments for behavioral factors attenuated these associations more than the adjustment for biological risk factors. Novelty seeking was associated with higher RMSSD (p = 0.007) and pNN50 (p = 0.012) and lower heart rate (p < 0.001). With adjustment for behavioral risk factors, the associations with RMSSD (p = 0.136) and pNN50 (p = 0.236) attenuated to the null, but adjustment for biological risk factors had little effect. Reward dependence and persistence were unrelated to indices of cardiac regulation.     

A qualitative study of the experiences of people who identify themselves as having adjusted positively to a visible difference

Individual and group interviews explored experiences of positive adjustment among 12 people with a range of visible differences. Thematic analysis identified four main themes: importance of appearance; personal growth; relationships with others; and coping (factors in the coping theme considered to be paramount to positive adjustment were inner strength and positivity, active coping techniques, downward social comparisons, taking things day-by-day, spirituality and humour). The findings provide insight into behaviours and personal outlooks that may contribute to adaptive coping and have implications for future research and interventions aimed at those who exhibit poor adjustment to visible difference. The article reflects on the use of both individual and group interviews for research in this field.     

Community adjustment of older schizophrenics

Community adjustment among older schizophrenics is a virtually unresearched area. This study addressed two questions related to this problem: Does the community adjustment of older schizophrenics differ from that of younger schizophrenics?, and Do “older” old schizophrenics differ from “younger” old schizophrenics? Patients from 79 psychiatric wards across the country completed a self-rating adjustment scale within 5 days of admission to the hospital and again 3 months after discharge. Significant others rated these patients for adjustment also. For the first analysis two groups were selected: Those patients diagnosed schizophrenic and at least 55 years of age and those below the age of 55. A second analysis divided patients into “younger” old (between 55 and 60) and “older” old (>60). Results show that older schizophrenics adjust about as well as those younger on selfratings, but less well when rated by others. Also, “older” old schizophrenics adjust better than the “younger” old in both self-and significant other ratings. These findings are discussed.     

Early Stage Breast Cancer: Explaining Level of Psychosocial Adjustment Using Structural Equation Modeling

In many women, the diagnosis of breast cancer leads to psychosocial adjustment problems. Biodemographic variables, coping, and social support are factors that influence psychosocial adjustment. The main objective of the present study was to identify and estimate the associations between psychosocial adjustment and biodemographic variables, coping, and social support by using Structural Equation Modeling (SEM). Eighty-seven women with newly diagnosed early stage breast cancer completed several questionnaires covering these areas. It appeared that in the period shortly after surgery, coping style, especially illness-specific coping, is of high relevance for psychosocial adjustment. In our study, we could not confirm the positive role of social support found in other studies on psychosocial adjustment. Biodemographic variables had both direct and indirect associations with psychosocial adjustment: older women and women who had had breast-conserving treatment used a more optimistic coping style; the latter group also reported higher body image; and finally, women with a more advanced stage of disease reported a reduction in recreational activities.     

Incidence,risk factors,and adverse outcomes of acute kidney injury in very premature neonates: a single center experience

Background/aim Acute kidney injury (AKI) is a serious morbidity in premature neonates. The aim of this study was to determine the incidence of AKI and to evaluate its impact on morbidity and mortality in very premature infants.Materials and methodsThis retrospective cohort study was conducted in the neonatal intensive care unit (NICU). A total of 410 preterm infants who were born before 32 gestational weeks were screened and 318 were included in this analysis. AKI was defined according to the modified neonatal Kidney Disease: Improving Global Outcomes criteria.ResultsThe incidence of AKI was 32.1% (102/318). Regression analyses revealed that lower gestational age, vasopressor use, and hemodynamically significant patent ductus arteriosus were significantly associated with an increased risk for AKI. After adjustment for potential confounders, those with AKI had a higher risk of death before 36 weeks of corrected gestational age (adjusted hazard ratio: 3.02, 95% confidence interval 1.47– 6.22). Additionally, the AKI group had a higher rate of bronchopulmonary dysplasia (BPD) (46% vs. 24%, p < 0.001) and longer hospital stay with a mean difference of 38 days.ConclusionAKI is common in very premature neonates and associated with higher mortality, longer hospital stay, and BPD. Identification of risk factors and preventive strategies for AKI may improve the outcomes in this vulnerable population.     

The psychosocial impact of play on hospitalized children

Compared the effects of play on the psychosocial adjustment of 46 children hospitalized for acute illness, who were placed in one of four groups: therapeutic play, diversionary play, verbal support, and no treatment. Ratings of psychological adjustment included self-report, as well as nurse and parent ratings. Children in the therapeutic play condition evidenced a significant reduction in self-reported hospital fears. Parent ratings were not affected by therapeutic treatments; rather, parents in all four groups rated their children less anxious from pre- to posttesting. Results are discussed in terms of methodological considerations that have affected outcomes in this type of research.