The Adjustment of Children in Stepfamilies: Lessons from Community Studies

Evidence from community studies on the adjustment of children in stepfamilies is described. The diversity of stepfamilies, and the importance of taking account of this diversity are stressed. Children in stepfamilies are on average more likely to have adjustment problems, but average differences are small and individual differences are great. Key risks for children's outcome include family conflict, parental mental health, economic and social stress, multiple family transitions, and parental life-course patterns; much of the impact on children is mediated through parent-child relationships, and the links between family relationships. The importance of taking account of children's perspectives on their family lives, and of biological relatedness rather than family type, are highlighted.     

Vereinfachte Lithiumeinstellung durch Belastungstest

The lithium blood level 24 hrs after a priming dose of lithium is a prognosticator for the therapeutic dosage required. Exactly 24 hrs following the intake of 24 mval lithium (lithium carbonate, retard form) venous blood serum is analyzed for lithium content. The necessary therapeutic dose can be inferred from a regression line which shows the negative interrelation between the 24 hr value and the therapeutic quantity of lithium necessary to achieve a blood level of 0.9 mval/l under steady state conditions. Low 24 hr levels require high maintenance doses and vice versa. This procedure shortens the time of dose adjustment and avoids undesirable side-effects in the beginning of treatment which otherwise are not seldom the cause for the cessation of lithium intake.

     

Begivenheder inden for psykiatrisk videnskab 1952

Oligofreni inndeles i imbecilitet (IQ < 50) og debilitet (IQ 50-70). Prevalensen av imbecilitet synes uforandret 0.3-0.4% og arsaksfaktorer (saerlig prenatale) er kjent hos flertallet. Et kvantitativt scoringssystem for non-optimale forhold i svangerskap og fødsel vil sannsynligvis avsløre flere non-optimale forhold ved imbecilitet «uten kjent årsak» (Saugstad, 1973a). Prevalensen av debilitet synes betraktelig redusert siste 30 år (fra > 2% til 0.4%). Dette gjenspeiler hevning av gj.sn. IO i befolkningen med ca. 15 IQ poeng og samtidig forskyvningav normalfordelingskurven mot høyre. Et resultat av bedret miljø (oppvekst, skole, ut- dannelse) og en bekreftelse på teorien om intelligens som polygent arvelig betinget. Den samtidige halvering av organisk betinget debilitet (fra ca. 0.5% til < 0.2%) betraktes som en virkning av bedret medisinsk standard. Uvisst om en IQ over 70 idag er tilstrekkelig til at individet ikke fungerer «psykisk utviklingshemmet», d.v.s. ikke klarer å tilpasse seg samfun-nets krav.

Den betydelige overvekt av gutter blant oligofrene, men også ved IQ over 130 diskuteres, likeledes guttenes szrlige dyktighet på non-verbale tester. Er dette biologisk betinget, eller kan guttenes overlegenhet på visuo-spatial tester for eksempel forklares som en miljøtilpasning.

Etter 3 års psykologistudier, medisinsk embedseksamen, spesialitet i klinisk nevrofysiologi med klinisk nevrologisk og psykiatrisk tjeneste arbeidet forfatteren 196S78 som spesiallege ved Oslo Åndsvakeomsorg. Gjennem studier av barn med Føllingssykdom (dr.avh. 1975) og barn med hjerneskader av forskjellige typer ble hun spesielt interessert i samspillet mellem arv og miljøfaktorer ved forskjellige grader av mental subnormalitet.     

质量调整生命年(QALY)的相关问题探讨

作为健康期望评价体系中的重要指标,质量调整生命年一直备受学者关注,本文结合国内外相关文献,针对质量调整生命年的应用、优缺点等问题进行探讨.     

Adjustment disorder with anxiety in old age: Comparing prevalence and clinical management in primary care and mental health care

PurposeAdjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age.MethodsThis cross-sectional study examined the prevalence of AjD-A in outpatients over the age of 60 who consecutively consulted 34 general practitioners and 22 psychiatrists during a 2-week period. The diagnosis of AjD-A was obtained using the optional module for diagnostic of adjustment disorder of the Mini International Neuropsychiatric Interview (MINI). The study procedure also explored comorbid psychiatric conditions and documented recent past stressful life events, as well as social disability and current pharmacological and non-pharmacological management.ResultsOverall, 3651 consecutive subjects were screened (2937 in primary care and 714 in mental health care). The prevalence rate of AjD-A was 3.7% (n = 136). Up to 39% (n = 53) of AjD-A subjects had a comorbid psychiatric condition, mostly of the anxious type. The most frequently stressful life event reported to be associated with the onset of AjD-A was personal illness or health problem (29%). More than 50% of the AjD-A patients were markedly to extremely disabled by their symptoms. Compared to patients who consulted psychiatrists, patients who were seen by primary care physicians were older, had obtained lower scores at the Hamilton Anxiety Rating Scale, benefited less frequently from non-pharmacological management and received benzodiazepines more frequently.ConclusionsAjD-A appears to be a significantly disabling cause of anxiety symptoms in community dwelling elderly persons, in particular those presenting personal health related problems. Improvement of early diagnosis and non-pharmacological management of AjD-A would contribute to limit risks of benzodiazepine overuse, particularly in primary care settings.     

Adjustment Difficulties in Preschool Education: Greek Educators' Aspects

The preschool curriculum programme in Greece lacks concern about well-organized insertion procedures that would allow the child's smooth entry in nursery school. Therefore, practitioners are left to handle such issues using their own judgement and according to their personal attitude towards them. The present study has sought to investigate practitioners' aspects on the process of children's insertion and the difficulties they face in the adjustment period. One hundred early years educators from the city of Thessaloniki were asked to fill in an equivalent number of questionnaires during an interview. The percentage analysis conducted showed that practitioners seem to overlook the importance of the problems in children's adjustment. Such problems are attributed to the family and social environment, whereas educators feel less involved in the procedure. The findings seem to reveal the growing need for well-organized reception provisions in the preschool settings and the need for appropriate training for early years practitioners, so that they are eventually able to help the childs' passage from the home environment to early years schooling.     

The role of goal management for successful adaptation to arthritis

Objective

Persons with polyarthritis often experience difficulties in attaining personal goals due to disease symptoms such as pain, fatigue and reduced mobility. This study examines the relationship of goal management strategies – goal maintenance, goal adjustment, goal disengagement, goal reengagement – with indicators of adaptation to polyarthritis, namely, depression, anxiety, purpose in life, positive affect, participation, and work participation.

Methods

305 patients diagnosed with polyarthritis participated in a questionnaire study (62% female, 29% employed, mean age: 62 years). Hierarchical multiple-regression-analyses were conducted to examine the relative importance of the goal management strategies for adaptation. Self-efficacy in relation to goal management was also studied.

Results

For all adaptation indicators, the goal management strategies added substantial explained variance to the models (R²: .07–.27). Goal maintenance and goal adjustment were significant predictors of adaptation to polyarthritis. Self-efficacy partly mediated the influence of goal management strategies.

Conclusion

Goal management strategies were found to be important predictors of successful adaptation to polyarthritis. Overall, adjusting goals to personal ability and circumstances and striving for goals proved to be the most beneficial strategies.

Practice implications

Designing interventions that focus on the effective management of goals may help people to adapt to polyarthritis.     

Adjustment effect during shoulder abduction training with the Hybrid Assistive Limb in a patient with postoperative C5 palsy

Standard shoulder rehabilitation procedures for patients with postoperative C5 palsy have not yet been established. We applied a wearable robot suit hybrid assistive limb (HAL) for a patient with postoperative C5 palsy and conducted shoulder abduction training with HAL. A 65-year-old woman was diagnosed with postoperative C5 palsy after undergoing cervical spine surgery. Five days after surgery, shoulder abduction training with HAL was initiated. The shoulder abduction angle and power and trapezius and deltoid activities were evaluated. Ten rehabilitation sessions were conducted until 82 days after surgery. Shoulder abduction training was safely and effectively performed from the first session. Her shoulder abduction angle and power improved at every session, and she could fully elevate her arm without any compensatory motion after the 10th session. Shoulder HAL training suppressed the muscular activity of the trapezius and activated that of the deltoid, especially in the earlier stages of rehabilitation. Moreover, it had an adjustment effect for obtaining normal shoulder motion, which might have promoted smoother arm elevation using errorless motor learning. These findings suggest that HAL is a useful tool for shoulder rehabilitation in patients with postoperative C5 palsy.     

调节训练与近视儿童屈光度发展关系临床研究

目的 观察调节训练对近视儿童屈光度发展的影响.方法 选择6 ～12岁近视儿童患者62例（117眼）,根据近视程度分为3组：Ⅰ组（＜-3.00D）48眼;Ⅱ组（-3.00D～-6.00D）37眼;Ⅲ组（＞-6.00D）32眼,分析进行调节训练1年后的屈光状态、年近视增长幅度的变化.结果 同原近视增长幅度比较,调节训练后,年近视增幅显著减缓（P＜0.05）;不同近视程度组间比较差异有统计学意义（P＜0.05）,Ⅰ组、Ⅱ组与Ⅲ组比较差异显著（P＜0.01）.结论 调节训练能有效延缓近视儿童屈光度的发展,尤其对低中度近视患者控制的效果更为明显.