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The literature on child sexual abuse suggests family functioning and support may be intervening variables which serve to ameliorate the long-term effects of such abuse. We advocate family therapy as effective treatment for extrafamilial child sexual abuse (especially in preschool children), and we present the essential elements of the family treatment process. Our supporting evidence is provided in the clinical evaluation and treatment of 10 children (and their families), ages 2-6 years, who reported sexual abuse in a daycare setting. 相似文献
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Philip Joseph Eva Lonn Jackie Bosch Patricio Lopez Jun Zhu Matyas Keltai Anthony Dans Christopher Reid Kamlesh Khunti William Toff Leopoldo Piegas Jae-Hyung Kim Balakumar Swaminathan Michael Bohm Salim Yusuf 《The Canadian journal of cardiology》2018,34(1):38-44
Background
It is unclear whether modifying cholesterol, blood pressure, or both affect erectile dysfunction. Also, there are concerns that erectile dysfunction is worsened by common medications used to treat these risk factors. In this study, we evaluated the effect of: (1) cholesterol-lowering with a statin; (2) pharmacologic blood pressure reduction; and (3) their combination, on erectile function.Methods
A priori, this was a secondary analysis of the Heart Outcomes Prevention Evaluation-3 (HOPE-3) randomized controlled trial. Men were 55 years of age or older with at least 1 cardiovascular risk factor. Erectile function was measured using the erectile function domain of the International Index of Erectile Function (IIEF-EF) score. Men with incomplete scores, or who did not engage in sexual activity, were excluded. Using a 2 × 2 factorial design, participants were randomized to rosuvastatin (10 mg/d) or placebo, and to candesartan with hydrochlorothiazide (HCTZ; 16 mg/12.5 mg/d; Cand+HCTZ) or placebo. Primary outcome was change in IIEF-EF from baseline to end of study follow-up.Results
Two thousand one hundred fifty-three men were included; mean age was 61.5 years, and mean follow-up was 5.8 years. Mean IIEF-EF score at baseline was 23.0 (SD 5.6). Least square mean change in the IIEF-EF score did not differ with rosuvastatin compared with placebo (?1.4; standard error [SE], 0.3 vs ?1.5; SE, 0.3; P = 0.74), Cand+HCTZ compared with placebo (?1.6; SE, 0.3 vs ?1.3; SE, 0.3; P = 0.10), or combination therapy compared with double placebo (P = 0.35).Conclusions
Cholesterol-lowering using a statin, and blood pressure-lowering using Cand+HCTZ, either alone or in combination, do not improve or adversely affect erectile function. 相似文献5.
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A G McDeller W D Toff R A Hobbs D J Robb A J Camm 《Journal of medical engineering & technology》1989,13(3):161-165
It has been recognized for many years that the electromagnetic (EM) environment within aircraft presents a potential hazard to the subject with a pacemaker. Most of the information currently available is, however, several years old and may not be strictly relevant to modern pacemakers and the electromagnetic environment found in today's civil aircraft. In mid 1986 it was therefore decided to investigate the effect on a number of currently available unipolar pacemakers of typical levels of electromagnetic interference encountered in civil aircraft. 相似文献
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G M Gribbin R A Kenny P McCue W D Toff R S Bexton J M McComb 《Europace : European pacing, arrhythmias, and cardiac electrophysiology》2004,6(6):552-560
AIMS: To examine the hypothesis that atrial based pacing improves Quality of Life (QoL) after pacing by undertaking a detailed QoL evaluation that includes an individualised assessment as well as disease specific evaluation. METHODS: Prospective study of patients randomised to VVI(R) or atrial based pacing modes using the Schedule for the Evaluation of Individual QoL (SEIQoL), the 36-item Medical Outcomes Study Short-Form General Health Survey (SF36), and a modified version of the Karolinska Cardiovascular Symptomatology Questionnaire (KCSQ). RESULTS: Seventy-three patients completed the two-year follow up of the study. Pacing improved SEIQoL scores, cardiovascular symptoms and the physical role limitation, social limitation and mental health domains of SF36 from baseline to one month. Pacing mode had no effect on QoL the major determinants of which were baseline QoL and a history of coronary artery disease. CONCLUSION: Atrial based pacing does not improve QoL in the two years after pacing when compared with VVI(R) pacing. 相似文献
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Bardy GH Lee KL Mark DB Poole JE Toff WD Tonkin AM Smith W Dorian P Yallop JJ Packer DL White RD Longstreth W Anderson J Johnson G Bischoff E Munkers CD Brown A McNulty S Ray LD Clapp-Channing NE Rosenberg Y Salive M Schron EB;HAT Investigators 《American heart journal》2008,155(3):445-454
Most cardiac arrests occur in the home, where emergency medical services (EMS) systems are challenged to provide timely care. Because a large proportion of sudden cardiac arrests (SCAs) are due to ventricular tachycardia or ventricular fibrillation, home use of an automated external defibrillator (AED) might offer an opportunity to decrease mortality in those at risk. Predicting who will have a cardiac arrest in the general population is difficult. Individuals at high risk are usually easily identified and may become candidates for implantable cardioverter defibrillators. It is within the population at lower risk where home AEDs may be most useful. The purpose of the Home Automatic External Defibrillator Trial (HAT) is to test whether providing home access to an AED can improve survival in patients at modest risk of SCA, such as those surviving an anterior myocardial infarction but in whom implantable cardioverter defibrillator therapy is not deemed necessary. Between January 23, 2003, and October 20, 2005, 7001 patients were enrolled, with completion of follow-up scheduled for September 30, 2007. Randomization was conducted in a 1:1 fashion between control therapy, comprising the standard lay response to SCA (calling the EMS and performing cardiopulmonary resuscitation), and the use of an AED first, followed by calling the EMS and performing cardiopulmonary resuscitation. The primary end point is all-cause mortality. Secondary outcomes include survival from SCA (witnessed and unwitnessed, in home and out of home), incremental cost-effectiveness, and quality of life measures for both the patient and the spouse/companion. The results of the trial should be available in mid 2008. 相似文献
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Toff WD Jones CI Ford I Pearse RJ Watson HG Watt SJ Ross JA Gradwell DP Batchelor AJ Abrams KR Meijers JC Goodall AH Greaves M 《JAMA》2006,295(19):2251-2261
Context The link between long-haul air travel and venous thromboembolism is the subject of continuing debate. It remains unclear whether the reduced cabin pressure and oxygen tension in the airplane cabin create an increased risk compared with seated immobility at ground level. Objective To determine whether hypobaric hypoxia, which may be encountered during air travel, activates hemostasis. Design, Setting, and Participants A single-blind, crossover study, performed in a hypobaric chamber, to assess the effect of an 8-hour seated exposure to hypobaric hypoxia on hemostasis in 73 healthy volunteers, which was conducted in the United Kingdom from September 2003 to November 2005. Participants were screened for factor V Leiden G1691A and prothrombin G20210A mutation and were excluded if they tested positive. Blood was drawn before and after exposure to assess activation of hemostasis. Interventions Individuals were exposed alternately (1 week apart) to hypobaric hypoxia, similar to the conditions of reduced cabin pressure during commercial air travel (equivalent to atmospheric pressure at an altitude of 2438 m), and normobaric normoxia (control condition; equivalent to atmospheric conditions at ground level, circa 70 m above sea level). Main Outcome Measures Comparative changes in markers of coagulation activation, fibrinolysis, platelet activation, and endothelial cell activation. Results Changes were observed in some hemostatic markers during the normobaric exposure, attributed to prolonged sitting and circadian variation. However, there were no significant differences between the changes in the hypobaric and the normobaric exposures. For example, the median difference in change between the hypobaric and normobaric exposure was 0 ng/mL for thrombin-antithrombin complex (95% CI, 0.30 to 0.30 ng/mL); 0.02 nmol/L for prothrombin fragment 1 + 2 (95% CI, 0.03 to 0.01 nmol/L); 1.38 ng/mL for D-dimer (95% CI, 3.63 to 9.72 ng/mL); and 2.00% for endogenous thrombin potential (95% CI, 4.00% to 1.00%). Conclusion Our findings do not support the hypothesis that hypobaric hypoxia, of the degree that might be encountered during long-haul air travel, is associated with prothrombotic alterations in the hemostatic system in healthy individuals at low risk of venous thromboembolism. 相似文献