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991.
Aboderin I 《The journals of gerontology. Series B, Psychological sciences and social sciences》2004,59(3):S128-S137
OBJECTIVES: Material family support for older people in Ghana, as in other African countries, has declined in recent decades, exposing increasing numbers especially of urban elderly to destitution and poverty. The nature and causes of this decline remain poorly understood, in particular the relative role of growing material constraints, as proposed by political economy perspectives, or weakening traditional values, as suggested by modernization perspectives. This article develops an interpretively grounded understanding of the processes underpinning the decline specifically in Accra, Ghana's capital. METHODS: A qualitative investigation of the perspectives of a three-generational respondent sample, spanning major income, ethnic, and gender groups, was conducted. RESULTS: The decline has been underpinned by two major shifts: (a) a declining resource capacity of the young to provide support and (b) a shift in the basis of filial support toward an increasing dependence on parents' past conduct and the principle of reciprocity. Normative expectations emphasizing self-reliance in old age are emerging as a result of the decline. DISCUSSION: The shifts have been caused by a complex interaction between growing resource constraints and changing values not captured by existing accounts. The dominant factor driving the change in support norms and patterns has been the change in families' material circumstances. 相似文献
992.
993.
Souza I Pinheiro MA Denardin D Mattos P Rohde LA 《European child & adolescent psychiatry》2004,13(4):243-248
Abstract.
Objective:
The aim of this study was to compare the pattern of comorbidity in referred samples of Attention-Deficit/Hyperactivity Disorder (ADHD) patients from two different geographic areas in Brazil.
Methods:
The diagnoses of ADHD and comorbid conditions, according to DSM-IV criteria, were achieved in both clinics through semi-structured interview methodology, complemented by clinical interviews with the children or adolescents and their parents.
Results:
We assessed 343 ADHD children and adolescents in Porto Alegre (capital of the southernmost state of the country) and 78 ADHD youths in Rio de Janeiro (capital of a southestern state). Although a significant difference in the prevalence of ADHD without comorbidity was detected between the two groups (p = 0.02), no significant difference was detected in the profile of comorbidities between them. Main ADHD comorbidities in both samples were: a) Oppositional Defiant Disorder (Porto Alegre = 39.1%; Rio de Janeiro = 51.3 %); b) Anxiety Disorders (Porto Alegre = 24.2%; Rio de Janeiro = 30.8 %); c) Conduct Disorder (Porto Alegre = 13.7%; Rio de Janeiro = 17.9 %); and d) Major Depression and/or Dysthymia (Porto Alegre = 11.4%; Rio de Janeiro = 10.3 %).
Conclusions:
Our results from clinical samples in a developing country with a diverse culture suggest the crosscultural validity of the ADHD comorbidity profile. 相似文献
994.
With their myriad of serious and occasionally life-threatening physical sequelae, in addition to their complex emotional issues, individuals with eating disorders can be among the most challenging a physician may see in primary practice. A two-page, 10-item survey based on a literature review of family physicians' experiences with individuals with eating disorders was distributed to a sample of 500 Manitoba family physicians. Two hundred and one surveys were returned for a province-wide return rate of 40%. Eighty percent of physicians who saw individuals with eating disorders felt there were some patients they were unable to treat for a variety of reasons including lack of physician skills, limited resources, problems with patient cooperation, the severity of the patient's illness, and a lack of time to deal with the demands of an eating disordered patient. The services most often provided by the physicians included medical management of symptoms, referral to specialized services, information on nutrition and exercise, and limited counseling. Referrals were most often made to psychiatrists, dieticians, Winnipeg's Eating Disorder Program, and community mental health workers. The strong response indicates that eating disorders are a serious concern in primary practice. The role of the family physician is very much dependent upon the individual physician's skills and degree of comfort in dealing with the disorders. Continuing education is seen as vital to improve diagnostic skills and enhance physicians' level of comfort. More support for physicians in the short term and enhanced interdisciplinary programming in the longer term are crucial in meeting patients' complex needs. 相似文献
995.
Serra-Pinheiro MA Schmitz M Mattos P Souza I 《Revista brasileira de psiquiatria (S?o Paulo, Brazil : 1999)》2004,26(4):273-276
Oppositional defiant disorder (ODD) is an independent diagnostic entity but it is frequently studied in conjunction with Attention-Deficit Hyperactivity Disorder (ADHD) or Conduct Disorder (CD). The purpose of this paper is to review the extant evidence, through the PubMed database, on the neurobiological correlates of oppositional defiant disorder and also describe the familiar and school functioning, comorbidities, prognosis and therapeutic options for oppositional defiant disorder. Evidence of hormonal, genetic and neuro-functional findings in oppositional defiant disorder, correlation with the family, school relations and performance, and the association with mood and anxiety and disruptive disorders are described. The risk of an evolution to conduct disorder and of persistence of the oppositional defiant disorder symptoms is depicted. A review of the effect of Cognitive-Behavioral Therapy and medication is presented. Analysis of the available evidence shows that the impact of oppositional defiant disorder should not be ignored and it should be properly addressed. The effect of treatment for oppositional defiant disorder on the long-term outcome of patients still needs to be addressed. 相似文献
996.
997.
Setola E Monti LD Galluccio E Palloshi A Fragasso G Paroni R Magni F Sandoli EP Lucotti P Costa S Fermo I Galli-Kienle M Origgi A Margonato A Piatti P 《European journal of endocrinology / European Federation of Endocrine Societies》2004,151(4):483-489
OBJECTIVE: The purpose of this study was (a) to study whether a folate and vitamin B12 treatment, aimed at decreasing homocysteine levels, might ameliorate insulin resistance and endothelial dysfunction in patients with metabolic syndrome according to the National Cholesterol Education Program-Adult Treatment Panel-III criteria and (b) to evaluate whether, under these metabolic conditions, there is a relationship between hyperhomocysteinemia and insulin resistance. DESIGN AND METHODS: A double-blind, parallel, identical placebo-drug, randomized study was performed for 2 months in 50 patients. Patients were randomly allocated to two groups. In group 1, patients were treated with diet plus placebo for 2 months. In group 2, patients were treated with diet plus placebo for 1 month, followed by diet plus folic acid (5 mg/day) plus vitamin B12 (500 microg/day) for another month. RESULTS: In group 2, folate treatment significantly decreased homocysteine levels by 27.8% (12.2+/-1.2 vs 8.8+/-0.7 micromol/l; P<0.01). A significant decrement was observed for insulin levels (19.9+/-1.7 vs 14.8+/-1.6 microU/ml; P<0.01) accompanied by a 27% reduction in the homeostasis model assessment levels. A positive relationship was found between the decrement of homocysteine and insulin levels (r=0.60; P<0.002). In parallel, endothelial dysfunction significantly improved in the treated group, since post-ischemic maximal hyperemic vasodilation increased by 29.8% and cGMP by 13.6% while asymmetrical dimethylarginine levels decreased by 21.7%. On the contrary, in group 1 patients, treated with placebo, no changes were shown in any of the variables. CONCLUSIONS: Folate and vitamin B12 treatment improved insulin resistance and endothelial dysfunction, along with decreasing homocysteine levels, in patients with metabolic syndrome, suggesting that folic acid has several beneficial effects on cardiovascular disease risk factors. 相似文献
998.
Plebani A Soresina A Notarangelo LD Quinti I Mattia DD Moschese V Rondelli R Pession A Ugazio AG 《Iranian journal of allergy, asthma, and immunology》2004,3(4):165-168
Primary immunodeficiencies are rare diseases, characterized by an increased susceptibility to infections. Early diagnosis and appropriate treatment are critical for reducing morbidity and mortality. Given the rarity of these diseases, the awareness of these disorders by physicians is often insufficient, leading to delayed diagnosis and inappropriate treatment which are the major causes of severe long term complications. In an attempt to address and resolve these problems an Italian Network on primary immunodeficiencies has been established with the aim to increase the awareness of these disorders among physicians and to provide the best clinical assistance to all patients on the national territory. 相似文献
999.
Prevention and treatment of poststroke depression with mirtazapine in patients with acute stroke 总被引:7,自引:0,他引:7
Niedermaier N Bohrer E Schulte K Schlattmann P Heuser I 《The Journal of clinical psychiatry》2004,65(12):1619-1623
BACKGROUND AND OBJECTIVE: Poststroke depression is one of the most frequent complications of stroke, affecting approximately 20% to 40% of all patients. In spite of the importance of this neuropsychiatric disorder, little attention has been given to the prevention of poststroke depression. The purpose of this study was to examine whether prophylactic treatment with the antidepressant mirtazapine in patients with acute stroke given from day 1 after the incidence prevents poststroke depression. METHOD: Patients with ischemic stroke received either 30 mg mirtazapine or no antidepressant medication from day 1 after the stroke in an open, randomized study design. Data were collected from August 2001 to December 2002. Seventy patients were enrolled in the study and were reexamined on days 7, 44, 90, 180, 270, and 360 using neurologic, functional, and depression rating scales. Those poststroke patients who developed depression (DSM-IV criteria) but had been randomly assigned to the nontreatment group were given the antidepressant mirtazapine after the diagnosis of depression had been established. RESULTS: Forty percent (14/35) of the nontreated patients and only 5.7% (2/35) of the patients who were treated with mirtazapine developed poststroke depression. Altogether, 16 patients developed poststroke depression, 15 of whom remitted after initiation of treatment with mirtazapine. CONCLUSION: Mirtazapine significantly reduced the rate of poststroke depression in patients with acute stroke. The study also demonstrated that this antidepressant was highly effective in treating poststroke depression. 相似文献
1000.
Creatine-supplemented diet significantly attenuates cortical damage after traumatic brain injury in rodents. The protective mechanism likely involves maintenance of mitochondrial homeostasis. In the present study, we used two separate contusion spinal cord injury (SCI) instruments--the NYU device and the PSI Infinite Horizon (IH) impactor--to assess the efficacy of creatine-supplemented diets on hind limb functional recovery and tissue sparing in adult rats. Rats were fed control versus 2% creatine-supplemented chow for 4-5 weeks prior to SCI (pre-fed), after which most resumed a control diet while some remained on a 2% creatine diet (pre & post-fed). Following long-term behavioral analysis (BBB), the amount of spared spinal cord tissue among the dietary regimen groups was assessed using stereology. Comparatively, both instruments caused similar amounts of gray matter damage while the NYU device rendered a greater loss of white matter, reflected in more severe hind limb functional deficits than with the IH impactor. Relative to the control fed groups injured with either instrument, none of the creatine fed animals showed improvements in hind limb function or white matter tissue sparing. Although creatine did not attenuate gray matter loss in the NYU cohort, it significantly spared gray matter in the IH cohort with pre-fed and pre & post-fed regimens. Such selective sparing of injured spinal cord gray matter with a dietary supplement yields a promising strategy to promote neuroprotection after SCI. The relationship between the efficacy of creatine and the magnitude of the insults is discussed. 相似文献