THE GRIEF EVALUATION MEASURE (GEM): AN INITIAL VALIDATION STUDY

ABSTRACT

This article describes the development of the Grief Evaluation Measure (GEM), a new instrument designed to screen for the development of a complicated mourning response in a bereaved adult. The GEM provides a quantitative and qualitative assessment of risk factors, including the mourner's loss and medical history, coping resources before and after the death, and circumstances surrounding the death. It is designed to provide an in-depth evaluation of the bereaved adult's subjective grief experience and associated symptoms. Reliability and validity studies were conducted with two samples of bereaved adults (n = 23 and n = 92, respectively) from various clinical and support settings. Data on the two central sections of the GEM that assess the mourner's grief response and the level of symptomatology are described. Results indicate that the GEM's internal consistency and test–retest reliability are high. The GEM demonstrates good concurrent validity for established measures of bereavement, trauma, and physical and psychiatric symptoms, and good predictive validity for mourner adjustment one year after initial assessment. Plans for future development and an invitation for other researchers to collaborate with research on the GEM are also discussed.     

Modulators of length of gestation: A study in Greece

In order to ascertain correlates of gestational age and predictorsof prematurity, all the mothers delivered in 1993 at the maternityclinic of the First University Department of Obstetrics andGynaecology and at one division of a private maternity hospitalin Athens, Greece, were interviewed. From a total of 3,770 deliveries,those involving multiple pregnancies or Caesarean deliverieswere excluded, as were pregnancies with an apparent durationof less than 150 or more than 300 days. The analysis was eventuallybased on 2,538 singleton deliveries. The duration of gestationwas modelled as an outcome variable through multiple regression.The following factors were found to be significantly (p<0.05)related to the duration of gestation: maternal education, +0.8day per 3 schooling years; family integrity, single comparedto currently married mother, –3.7 days; parity, muttiparous(4+ births) compared to primiparae, +2.8 days; age at menarche,+1.8 days per 2 years; maternal age, +3.9 days for younger than20 years and –1.7 days for older than 30 years in comparisonto women 20–29 years old; maternal weight before pregnancy,+0.4 day per 5 kg; coffee drinking, +0.7 day per cup per day;tobacco smoking, –1.8 days per 0.5 pack per day. Bleedingduring any trimester of pregnancy and maternal diabetes weresignificantly associated with shorter duration of gestationby 6.7 and 8.2 days respectively. The constellation of riskfactors for a pre-term delivery in Greece appears similar tothat in other populations. However, a positive association betweencoffee drinking and duration of pregnancy has not always beendemonstrated in other studies and the longer duration of pregnancyamong very young women represents an unusual finding. At therange of variation under investigation the individual factorsare not powerful predictors but their combination could identifywomen at high risk for prematurity.     

Parent–child communication and adolescent self-esteem in separated, intercountry adoptive and intact non-adoptive families

The purpose of the present study was to verify whether there are some differences in parent–child communication and in adolescent self-esteem among adoptive, separated and intact non-adoptive families and to investigate the extent to which parent–child communication is related to adolescent self-esteem in the three types of families. The study sample was composed of 450 adolescents aged between 11 and 17 years (160 from intact non-adoptive families, 140 from separated or divorced families and 150 from intercountry adoptive families). Subjects completed the Parent–Adolescent Communication Scale by Barnes and Olson, the Rosenberg Self-esteem Scale and some socio-demographic items. The results show that adolescents from separated families have more difficulties in their relationships with both the mother and the father than their peers, and that adoptive children perceive a more positive communication with their parents than biological children. Moreover, adoptees showed lower self-esteem than the other two groups of adolescents. Lastly, it emerged that male and female adolescents' self-esteem is related to positive communication with both parents in intact non-adoptive families, while no link was significant for male and female children of divorced parents or for adoptees.     

Concentrations of calmodulin in sperm in relation to their motility in fertile euspermic and infertile asthenozoospermic men

The relationship between calmodulin and sperm motility was assessed in euspermic and asthenozoospermic men using radioimmunoassay and time-lapse photography, respectively. There was a significant decrease in the % sperm motility, mean sperm velocity, motility index and % of progressively motile sperm in the asthenozoospermic group when compared with euspermic men. The former also exhibited a higher % of sperm with erratic or circular motility. Calmodulin concentration in sperm from the asthenozoospermic men was 4.8 +/- 1.4 micrograms/mg protein compared with 12.6 +/- 2.3 in euspermic men (P less than 0.0005). The differences observed in sperm motility characteristics between the two groups may, thus, be due to the observed differences in the concentration of calmodulin.     

Clinical Utility of Rapid Clonidine-naltrcxone Detoxification for Opioid Abusers

Clonidine hydrochloride (an alpha-2 adrenergic agonist) and naltrexone hydrochloride (an opioid antagonist), given in combination, provide a safe and effective treatment of abrupt opioid withdrawal over 4 or 5 days in an outpatient/day setting. Following a naloxone challenge test to verify and quantify opioid dependence, 14 of 17 (82%) heroin users successfully withdrew from opioids and attained maintenance levels of naltrexone. Eight of 9 (89%) successfully completed the 4-day study in which naltrexone therapy was begun on day I. Three to 5 days of clonidine hydrochloride treatment with a peak mean dose of 0.6 mg/day on day 2 for the patients in the S-day study, and 0.5 mg on days 1 and 2 for patients in the 4-day study, attenuated the withdrawal inducing effects of naltrexone. Both groups received naltrexone in single morning doses which were rapidly increased from 12.5 mg on the first day of naltrexone therapy to SO mg on the third day. Clonidine significantly decreased blood pressure in both groups without producing clinical problems. This study has improved the availability of the clonidine-naltrexone combination by developing a single dose per day naltrexone regimen with naltrexone doses generally available to any opioid treatment facility.     

Biopharmaceutics: Changes in Gastric Mucosal Permeability Induced by Haemorrhagic Shock in the Anaesthetized Rat: Modulation by Acid

Gastric mucosal damage induced by haemorrhagic shock in the anaesthetized rat has been evaluated by studying changes in capillary-to-lumen clearance of fluorescein isothiocyanate (FITC)-labelled dextran. Haemorrhagic shock (20 min ischaemia + 20 min reperfusion) induced a significant increase in blood-to-lumen permeability to FITC-dextran of different molecular weight (10 000, 40 000 and 70 000) without modifying the macroscopic integrity of the gastric mucosa. The increase in vascular permeability was dependent on the time of administration of the tracer and was correlated with an elevation of the protein content of the gastric lumen. Intravenous administration of the secretagogue pentagastrin (20 or 50 μg kg^?1 h^?1) did not significantly modify the vascular permeability to dextran in control animals or in animals subjected to haemorrhagic shock. When the intraluminal pH was reduced by intragastric administration of acidic saline solution, only pH 1, which itself induced the appearance of macroscopic mucosal lesions, significantly increased vascular permeability to dextran, both in control animals and in animals subjected to haemorrhagic shock. These findings suggest that stress induced by haemorrhagic shock increases vascular gastric permeability to dextran, by an acid-independent mechanism, without affecting the macroscopic integrity of the gastric mucosa.     

Outcomes of Patients with Coronary Artery Perforation Complicating Percutaneous Coronary Intervention and Correlations with the Type of Adjunctive Antithrombotic Therapy: Pooled Analysis from REPLACE-2, ACUITY, and HORIZONS-AMI Trials

Background: The lack of a specific counteragent to bivalirudin may complicate the management of patients with coronary artery (CA) perforation during percutaneous coronary intervention (PCI).
Aim: Assess outcomes of patients with CA perforation from three PCI trials comparing intravenous bivalirudin with provisional glycoprotein (GP) IIb/IIIa inhibition versus unfractionated heparin (UFH) plus GP IIb/IIIa.
Methods: A pooled analysis of patients treated with PCI in three randomized trials including REPLACE-2, ACUITY, and HORIZONS-AMI.
Results: Among a total of 12,921 patients, CA perforation occurred in 35 patients (0.27%). By multivariable analysis, baseline creatinine clearance was the only independent predictor of CA perforation (per 10 mL/min decrease, odds ratio [95% confidence interval]= 1.28 [1.11, 1.47], P = 0.0007). At 30 days, patients with versus without CA perforation had significantly (all P values ≤0.001) higher rates of 30-day mortality (11.4% vs. 1.0%), myocardial infarction (MI) [Q wave: 22.9% vs. 5.7%; non-Q wave: 17.1% vs. 4.9%], target vessel revascularization (TVR) [20.1% vs. 1.8%], and composite end-point of death/MI/TVR (31.4% vs. 7.8%). Patients assigned to bivalirudin versus UFH plus a GP IIb/IIIa inhibitor had nonsignificantly lower rates of death (0% vs. 18.8%, P = 0.08), similar rates of MI (26.7% vs. 25.0%, P = 0.92), significantly lower rates of TVR (6.7% vs. 37.5%, P = 0.04), and similar rates of the composite end-point of death/MI/TVR (35.5% vs. 26.7%, P = 0.54).
Conclusion: In three PCI trials, treatment of patients experiencing CA perforation with adjunctive antithrombotic therapy of bivalirudin monotherapy was not associated with worse outcomes compared to treatment with UFH plus GP IIb/IIIa inhibitors.     

A Single Institution Experience with Pacemaker Implantation in a Pediatric Population over 25 Years

Background: With the development of new technical devices and software more appropriate for pediatric patients, pacemaker implantations in children and young adults have increased over time. It is necessary to monitor the mid‐ and long‐term consequences. The decision for the implantation of a cardiovertor defibrillator (ICD) in children remains challenging despite technical improvements. Objective: To assess the safety of pacemaker implantation in children, to review old and new indications, and to point out changes of management over time. Patients and Methods: Between 1984 and 2009, 181 patients required the implantation of a pacemaker or an ICD device at the Heart and Diabetes Centre in Bad Oeynhausen, Germany. Their charts have been reviewed pro‐ and retrospectively for indications, complications, longevity of the device, and the natural course. Results: Indications have been high‐degree atrioventricular block in 65% (postoperative 55%) and sinus node dysfunction in 24% (postoperative 90%), including three patients with vasovagally mediated significant bradycardia. Eleven percent required the implantation of an ICD device secondary to significant ventricular arrhythmias. The indication was class II in one‐third of all patients. Complications requiring revision occurred in six patients (3.3%); one of them required removal of the device due to an infection. Ten patients died, but none related to pacemaker implantation. Conclusion: Pacemaker implantation even in young pediatric patients is generally safe. No complication led to the death of a patient. The number of class II indications has been increasing. The future aim is to improve pediatric algorithms and to prevent unnecessary pacing. (PACE 2010; 33:1112–1118)     

Immunoreactivity and conformation of the P-P-G-M-R-P-P repetitive epitope of the Sm autoantigen

Anti-Sm antibodies are usually considered highly specific for systemic lupus erythematosus (SLE), while anti-UI RNP antibodies are found in high titers in patients with mixed connective tissue disease (MCTD). The sequence P¹-P-G-M-R-P-P⁷, present in three copies in the Sm (Ul-U6 RNA-protein complex) autoantigen, is an important functional domain of the antigenic determinants. The immunoreactivity of this proline-rich repetitive epitope was investigated by testing sera with various autoantibody specificities for reactivity against this epitope, as well as its conformational properties by means of ID and 2D ¹HNMR spectroscopy. It was found that the P-P-G-M-R-P-P epitope is recognized mainly by anti-UlRNP and/or anti-Sm positive sera, but also by anti-Ro(SSA) (hY1RNA-protein complex) and anti-La(SSB) (hY1RNA-protein complex) positive sera, although these sera are negative for anti-UlRNP and anti-Sm. Conformational analysis of the proline-rich epitope in DMSO-d₆ solution obtained from lyophilized aqueous solution at pH 5 showed the presence of at least three conformers. The main conformer A (62%) is stabilized by an ionic interaction between the guanidinium and the C-terminal carboxylate groups, and the Pro⁶-Pro⁷ peptide bond adopts the cis form. A type II β-turn is also present in the N-terminal sequence (Pro¹-Pro-Gly-Met⁴-) of this conformer. Conformer B (21%) is also stabilized by a similar ionic interaction, as in conformer A, while the NMR data indicate the absence of a folded structure in the N-terminal tetrapeptide of this conformer. Conformer C (17%) adopts a completely extended structure. The multiple conformers of the P-P-G-M-R-P-P may offer some explanation for the reactivity of sera with various autoantibody specificities against this epitope. © Munksgaard 1996.