Adherence-Facilitating Behaviors of a Multidisciplinary Pediatric Rheumatology Staff

Investigated the behaviors of pediatric rheumatology healthcare providers that were expected to be related to patient orparent adherence. Medical charts of 108 patients ages 1 to 20years diagnosed with Juvenile Rheumatoid Arthritis were examined.The 473 outpatient visits over 15 months yielded a total of2,578 treatment recommendations, but only 1,390 adherence-facilitatingbehaviors by medical staff were documented. Providing informationabout how often to perform the recommendation was the most commonstaff behavior. In contrast, care providers rarely indicatedthat they addressed their patients' concerns and barriers toimplementing the recommendations, or employed behavior modificationstrategies to increase adherence. Implications of these findingsfor development of programs designed to increase treatment adherencein children with chronic diseases requiring time-consuming,intrusive medical regimens are discussed.     

THE EFFECTS OF CHANGES IN AROUSAL LEVEL ON CRITICAL FLICKER FUSION FREQUENCY AND FIGURAL REVERSAL TASKS

The present study was designed to investigate the relationship between intra-and inter-individual differences in arousal level and performance on both critical flicker fusion frequency and figural reversal tasks. Forty male undergraduate Ss were used. Electrical skin conductance was used as the indicant of arousal level. For the intra-individual comparisons white noise was used to increase the Ss’arousal levels. Significant inverted U-shaped relationships were found between both flicker fusion thresholds and rates of figural reversal and skin conductance between individuals. A significant curvilinear relationship was found between rates of figural reversal and level of conductance within individuals. No significant curvilinear relationship was found between flicker fusion thresholds and level of conductance within individuals.     

The importance of chronicity and controllability of stress in the context of stress-illness relationships

The primary purpose of the present study was to increase our understanding of the roles of chronicity and controllability in the measurement of stress within the context of stress-illness relationships. Controllability and chronicity were assessed directly using a modified version of the Everyday Problems Scale. In addition to this scale, measures of depression, psychosomatic symptoms, and social support were administered to 128 women and 100 men. The results indicated that, for both men and women, the number of stressors was the best single predictor of symptoms. However, for women, chronicity and controllability of the stressors accounted for a significant amount of the variance in health outcomes over and above that accounted for by the number of stressors endorsed; for men, the addition of neither chronicity nor controllability consistently increased the strength of the association. While available social support was not found to influence the stress-illness relationships, greater willingness to utilize social support was associated with lower levels of depression.     

Vasoactive intestinal peptide and bipolar affective illness. Evidence for an effect of lithium

In an attempt to evaluate the role of VIP in affective disorder, measurements of lymphocyte VIP receptors, and plasma and CSF VIP levels were made in unmedicated and lithium-treated euthymic bipolars and controls. Lithium decreased plasma (P = 0.01) and CSF (P = 0.05) VIP levels and increased the affinity (decreased the KD) of the VIP lymphocyte receptor (P less than 0.01). This effect may be relevant to the psychotropic action of lithium in manic-depressive illness.     

Blood lactate in trained cyclists during cycle ergometry at critical power

Summary The purposes of this investigation were to determine the validity of critical power (CP) as a measure of the work rate that can be maintained for a very long time without fatigue and to determine whether this corresponded with the maximal lactate steady-state (la_ss,max). Eight highly trained endurance cyclists (maximal oxygen uptake 74.1 ml · kg^–1 · min^–1, SD 5.3) completed four cycle ergometer tests to exhaustion at predetermined work rates (360, 425, 480 and 520 W). From these four co-ordinates of work and time to fatigue the regression of work limit on time limit was calculated for each individual (CP). The cyclists were then asked to exercise at their CP for 30 min. If CP could not be maintained, the resistance was reduced minimally to allow the subject to complete the test and maintain a blood lactate plateau. Capillary blood was sampled at 0, 5, 10, 20 and 30 min into exercise for the analysis of lactate. Six of the eight cyclists were unable to maintain CP for 30 min without fatigue. In these subjects, the mean power attained was 6.4% below that estimated by CP. Mean blood lactates (n = 8) reached a steady-state (8.9 mmol · l^–1, SD 1.6) during the last 20 min of exercise indicating that CP slightly overestimated la_{ss, max}. Individual blood lactates during the last 20 min of exercise were more closely related to the y-intercept of the CP curve (r=0.78, P<0.05) than either CP (0.34, NS) or mean power output (r=0.42, NS). The present investigation has shown that highly trained endurance cyclists can tolerate previously unreported levels of blood lactate during 30 min of exercise at or near their CP. Blood lactates during continuous exercise are higher than at the same work rate during an incremental test. The CP provides a simple and inexpensive means of assessing the exercise intensity which can be maintained continuously, while avoiding the methodological difficulties associated with ventilatory and lactate thresholds.     

A Contextual Family/Systems Approach to Pediatric Psychology: Introduction to the Special Issue

Introduced the special issue on "Family System in PediatricPsychology" by organizing the papers around a series of themesrelevant to understanding families in pediatric psychology.Themes reflect the relationships between parent and child adjustment,family subsystems, legacies and traditions, social support systems,family interventions, the constancy of change in families, thechallenges of conducting longitudinal research, the inclusionof fathers, and the importance of a competency framework inpediatric family psychology. The paper concludes with recommendationsfor pediatric family psychology, including suggestions for increasingdiversity, expanding methodological approaches, and enhancingfamily competence.     

Are subjective health complaints a result of modern civilization?

Subjective health complaints without or with minimal somatic findings (pain, fatigue) are common and frequent reasons for encounter with the general practitioner and for long-term sickness leave and disability. The complaints are often attributed to the stressors of modern life. Is this true? We interviewed 120 Aborigine Mangyans (native population, M age = 33.5 years, 72.5% women) living under primitive conditions in the jungle of Mindoro, an island in the Philippines, and 101 persons living in a small coastal town on the same island (coastal population, M age = 33.8 years, 60.4% women). Both groups had more musculoskeletal complaints, fatigue, mood changes, and gastrointestinal complaints than a representative sample from the Norwegian population (N = 1,243). Our common subjective health complaints, therefore, are not specific for industrialized societies.     

A framework for measuring costs to society of IgE-mediated food allergy

Both immunoglobulin E (IgE)-mediated food allergy and food intolerance can lead to many changes in personal behaviour and health care resource use which have important economic consequences. These costs will impact directly, indirectly and intangibly on both individuals and society in general. It is important to measure the cost of illness (COI) of food allergy as a first step in developing and evaluating measures to reduce and control the burden of illness. This paper outlines a framework for assessing COI of food allergy from different viewpoints. It offers a structure for identifying the different cost impacts on allergic and nonallergic consumers, food producers and society as a whole, and for scoping, measurement and valuation of relevant costs. Within this structure, the existing literature is reviewed. This review illustrates the lack of information and clear methodology for assessing costs of food allergy. The paper concludes that there is a need for a more structured research programme to generate data essential for future evaluations of procedures and technologies for the diagnosis, treatment and management of food allergy.     

Integrated sibling-parent group intervention to improve sibling knowledge and adjustment to chronic illness and disability

OBJECTIVE: To evaluate an integrated group intervention for siblings and parents designed to increase sibling understanding of and adjustment to chronic illness and developmental disability (CI/DD). METHODS: Fifty-four well siblings (ages 8-13 years) and their parents were recruited through hospital-based and community agencies serving children with CI/DD. Measures of sibling knowledge, sibling adjustment to the disorder, sibling connectedness, and sibling global behavioral functioning were collected before and after the intervention. A subsample of 20 families completed a 3-month follow-up to assess maintenance of results. RESULTS: Sibling knowledge of the child's disorder and sibling connectedness increased, while sibling reports of negative adjustment to the disorder and parent reports of sibling global behavioral functioning decreased significantly from pre- to posttreatment for both boys and girls, regardless of the type of diagnostic condition. Improvements in sibling knowledge, connectedness, and behavioral problems maintained at 3-month follow-up. Parent satisfaction with the program was high. CONCLUSIONS: Results support the future conduct of more controlled evaluation of the integrated sibling and parent group intervention model to improve sibling knowledge of and adjustment to CI/DD.     

A multimethod assessment of behavioral and emotional adjustment in children with asthma

OBJECTIVE: Examine behavioral adjustment and emotion regulation among 6-year-old children with asthma and a group of healthy controls. METHOD: Subjects were 81 children with asthma and 22 healthy controls. Asthma and allergy statuses were confirmed by objective measures. Emotional and behavioral functioning were assessed through parent report, child interview, and child participation in an emotional regulation paradigm. RESULTS: Maternal report revealed more internalizing and total behavior problems for children with asthma compared to controls. Child interview and behavioral observations of emotion regulation yielded no differences between groups. Severity of asthma was related to increased emotional difficulties by clinician interview and observation but not by maternal report. CONCLUSIONS: Two groups of children with asthma who have psychological difficulties include those with increased anxiety and those with poor emotion regulation and more asthma symptoms. Different measures of child adjustment yield a complex picture of the behavioral difficulties associated with pediatric asthma.