Latina mothers' attributions, emotions, and reactions to the problem behaviors of their children with developmental disabilities

We examined the applicability of attribution theory to mothers' perceptions and reactions to their child's problem behavior. Participants were 149 Latina mothers of children with developmental disabilities who were interviewed regarding specific incidents in which their child exhibited a behavior problem. The findings indicate that most mothers viewed their child as not being responsible for the behavior problem. Furthermore, as predicted by attribution theory, mothers who ascribed relatively high responsibility to the child were significantly more likely to report negative emotions (anger and frustration) and aggressive/harsh behavioral reactions than mothers who ascribed low responsibility. Also. mothers were more likely to ascribe high responsibility to the child when the problem was characterized as a behavioral excess than as a behavioral deficit. The results provide support for the applicability of an attributional framework and may have important implications for helping parents in addressing the problem behaviors of their children with developmental disabilities.

NOF-11: a one-year pediatric randomized double-blind comparison of neoral versus sandimmune in orthotopic liver transplantation

BACKGROUND

Although cyclosporine (CsA) has been a mainstay in liver transplantation immunosuppression the original formulation [Sandimmune (SIM)] has variable absorption, particularly in children. Neoral is a new formulation of CsA that may have improved biovailability that would be advantageous in children. This study was undertaken to assess the pharmacokinetics (PK) and effects on outcome of Neoral versus Sandimmune (SIM) in primary pediatric liver transplant recipients.

METHODS

Thirty-two patients were randomized to receive Neoral (17 patients) or SIM (15 patients) in the early posttransplant period (days 1-7) in a double-blind fashion. Intravenous CsA was instituted immediately posttransplant followed by Neoral or SIM as soon as the patient was tolerating oral fluids (days 1-7). PK were compared after the first dose (1-7 days), 3 weeks, and 6 and 12 months posttransplant. In addition, side effects, effect of age and food on absorption, and rejection episodes were assessed by intent to treat analysis. Notable characteristics of this study include the use of a central laboratory for all sample analyses and the assessment of renal function using radioisotopic evaluation of glomerular filtration rates.

RESULTS

At baseline the two groups were comparable. Neoral resulted in higher peak levels of CsA and total drug exposure with comparable time to peak drug levels at days 1-7 and week 3. This trend was maintained at 6 and 12 months. Time on i.v. CsA was reduced in the Neoral group (8.4 vs. 11.1 days) and the weight adjusted daily dose of SIM required to achieve target trough levels was about 2-fold more than Neoral from day 22 onward. In addition, biopsy proven and treated and steroid-resistant rejection episodes were fewer in the Neoral group (6 vs. 12; P=0.01 and 1 vs. 8: P=0.004, respectively). Side effects were comparable in both treatment groups.

CONCLUSIONS

Neoral was well tolerated and had greater biovailability than SIM without any increase in the incidence of side effects. In addition fewer episodes of rejection were observed with Neoral versus SIM. We conclude that Neoral is the CsA formulation of choice for use in pediatric liver transplant recipients.

Androgenetic alopecia. New approved and unapproved treatments

Although there are new FDA-approved drug therapies to treat hair loss, there are many unapproved agents with claims of effectively treating hair loss. A variety of new over-the-counter agents are available for consumers to use; however, it is difficult to assess how these agents work, costs of these agents, and efficacy. This article covers the new approved and the large multitude of unapproved treatments that are used to treat hair loss.

Alopecia areata-like hair loss in C3H/HeJ mice and DEBR rats can be reversed using topical diphencyprone

This study demonstrates the ability to treat successfully alopecia areata-like hair loss in both mouse and rat models using topical immunotherapy with diphencyprone.

Demographic and attitudinal variables related to high-risk behaviors in Asian males who have sex with other men

Although AIDS is spreading rapidly in minority communities, little is known about attitudes, knowledge, and behavior related to AIDS and HIV in the Asian community. The purpose of this study was to examine these variables in a sample of gay Asian males, as well as to investigate the relationship between knowledge, sources of information, culturally influenced attitudes and high-risk behaviors in this population. Results from a sample of 60 young Asian men who self-identified as "having sex with other men" indicated they were generally knowledgeable about methods of transmission and prevention, and appeared linked to a large information network that included informal sources such as peers and formal sources. However, significant percentages held culturally biased views of AIDS, such as believing race of partner or one's own gender role in the sexual encounter determined level of risk; and one third of the sample did not use condoms regularly. Having been tested for HIV was associated with holding less traditional cultural beliefs and a higher sexual activity level. Open communication about safer sexual practices was associated with monogamous as opposed to multiple relationships and with decreased tendency to engage in alcohol-related unprotected sex. Variance in overall risk was predicted by demographic variables such as education, age, and level of sexual activity, rather than by the attitudinal factors measured. Limitations of this exploratory study include a time-limited subject recruitment period and consequent small sample size, a homogeneous sample weighted toward young, well-educated, and middle-class respondents, and the exclusion of non-English speaking individuals. Nevertheless, study findings suggest that educational outreach targeting Asians who have sex with other men needs to address inaccurate cultural beliefs about HIV/AIDS, emphasize consistent condom use, and encourage models of open communication with partners about safer sexual practices.

Generational differences in psychosocial adaptation and predictors of psychological distress in a population of recent Vietnamese immigrants

While first-wave Vietnamese immigrants adapted well to life in the United States, subsequent immigrants have had greater adjustment difficulties, including more evidence of psychological distress. This study aimed to analyze psychosocial adaptation differences among three generations of recent Vietnamese immigrants, as well as to examine predictors of mental distress in the sample as a whole. A community sample of 184 recent Vietnamese immigrants, categorized as either elderly, middle-aged, or young adults, was assessed for levels of psychological distress, including depression, anxiety, and PTSD, as well as family conflict, dissatisfaction with life in the U.S., acculturation and biculturalism, social support, coping, and premigratory stressors. Young Vietnamese adults were most acculturated, most bicultural, and reported themselves as healthiest and least depressed. They were most often working, least often on welfare, and had the highest family income. However, they also reported most dissatisfaction with their current lives in the U.S. and most family conflict. Regression analysis explaining approximately one-quarter of the variance in mental distress implicated current dissatisfaction with and lack of adjustment of life in the United States, as well as greater acculturation and increased family conflict. Although young adults scored significantly higher than other generations on most of the risk factors for psychological distress, they appeared to be buffered against poorer mental health outcomes by factors of generation and perceived positive overall well-being. In terms of testing a predictive model of psychological distress, this study found current adjustment factors significantly more important in determining mental health outcomes than premigratory stressors such as war-related traumas.

Willingness to treat HIV-positive patients at different stages of medical education and experience

The willingness of physicians to provide care to HIV-positive patients has been linked to a number of attitudinal factors, but little is known concerning the impact of premedical, medical, and residency training on these factors. The purpose of this study is to elicit responses to the same series of questions concerning HIV and its treatment from respondents at different stages of training, to detect trends in attitudes and to measure the impact of those attitudes on willingness to provide care for HIV/AIDS patients. Study data come from a cross-sectional survey (n = 249) of respondents across the training continuum, from premedical students to faculty physicians, using a self-administered questionnaire at a single medical school. The response rate was 59.6%. The study showed significant decreases in personal fear and misgivings concerning HIV, coupled with a substantial decrease in the perceived need for testing of non-high-risk individuals, as respondents gained additional education and training. Overall, the intent to treat HIV did not change significantly by training level, but multivariate analyses showed that while the initially strong influence of attitudes toward AIDS and its attendant risks diminishes, comfort relative to being around homosexuals per se continues to exert an impact on the intent to treat. Appropriate use of protective measures when providing care becomes far more common once individuals enter their clinical training years. The impact of medical education through its entire continuum therefore shows a positive impact on attitudes toward HIV, despite the absence of a significant trend in respondents' stated intent to treat. However, negative attitudes toward homosexuals continue to exert a negative influence on intent to treat that endures into the clinical training years.

The scalp biopsy: making it more efficient

BACKGROUND

The scalp biopsy plays an important role in diagnosis and subsequent management of many scalp disorders. This simple diagnostic procedure can be time-consuming and frustrating for most dermatologists.

OBJECTIVE

To outline an efficient technique for performing a scalp biopsy.

METHODS

The technique of performing a scalp biopsy is reviewed and suggestions are made to make this time-consuming procedure more efficient.

RESULTS

Sufficient specimen for histopathologic evaluation in a short perid of time is obtained.

CONCLUSION

Attention to specific details in performing a scalp biopsy allows the physician to obtain a quick and histopathologically informative scalp biopsy.

Correlates of family-oriented physician communications

BACKGROUND

Family orientation in patient care has long been one of the primary tenets of the practice of family medicine. Yet we know surprisingly little about how frequently family-oriented transactions occur in actual doctor-patient encounters, or about what other aspects of physician communication patterns might be associated with increased family orientation. The purpose of this study was to investigate both frequency and correlates of family orientation in a residency-based practice.

METHODS

Sixty videotapes representing 38 second and third-year residents interviewing a range of multiethnic patients over a 2-year period at a community clinic were analysed for evidence of family-oriented communications, as well as other interaction behaviours such as information exchange and partnership building. Inter-rater agreement was 78%.

RESULTS

Asking for medical information, clarifying patient information, and giving medical information and explanations were the most common types of resident actions. Family orientation was much less common, but was more frequently observed than the eliciting of a patient-centered agenda or suggestion of a psychosocial intervention or referral. Family orientation was associated with longer interviews, non-interpreted interviews, more physician questions and clarifying behaviours, and greater tendency to elicit the patient's agenda.

CONCLUSIONS

Findings of this investigation suggest that family orientation in the medical interview is enhanced by having more time and a shared language, as well as a generally probing, clarifying, patient-centered style on the part of the physician.

Primary care groups. Lending a hand

High-quality, dedicated management support was crucial to the GP commissioning pilots. A fifth of the pilots reported difficult relationships with their health authority. There are concerns about bringing prescribing 'outliers' into line. Involving the public will be a considerable challenge for PCGs.

Testosterone and other anabolic steroids as cardiovascular drugs

There has been much interest in the effect of sex hormones on cardiovascular risk factors and as a therapeutic modality in both men and women. In this article, testosterone is considered as a possible therapy for cardiovascular disease. It has been shown that the level of serum testosterone decreases in men as they age. Healthy men with low testosterone levels have increased cardiovascular risk factors, including high fasting and 2-hour plasma glucose, serum triglycerides, total cholesterol and low-density lipoprotein (LDL) cholesterol, and apo A-I lipoprotein. Injections of testosterone to raise the levels to midnormal range have been shown to decrease total cholesterol and LDL cholesterol, while increasing high-density lipoprotein (HDL) cholesterol. Testosterone affects the clotting system by increasing thromboxane A (2) receptor activity and platelet aggregability. Testosterone has also been shown to augment the fibrinolytic system and antithrombin III activity. In men, testosterone has been shown to have antianginal effects, and endogenous levels have an inverse relationship to systolic blood pressure. Testosterone can be given in oral, injectable, pellet, and transdermal patch forms. There may be a role in administering testosterone to return men to normal physiologic range who have low serum levels. This treatment increases the risk of prostatic cancer, benign prostatism, erythrocytosis, and edema. No long-term studies of the effects of long-term testosterone replacement have been undertaken, so it is difficult to recommend this treatment as yet, but it is being considered as a therapy for augmenting skeletal muscle strength in patients with congestive heart failure.

Sexual behavior and AIDS-related knowledge among community college students in Orange County, California

Whereas college students are not identified as a high-risk group for acquiring the HIV infection, they exhibit high-risk behaviors consistent with their age group, including multiple sexual partners and high rates of unprotected intercourse. This study was conducted to determine levels of HIV-related sexual behavior, along with knowledge and attitudes among students attending community colleges in a relatively affluent multiethnic community. This study used a random sample survey (N = 319) of students attending selected classes at four community colleges in Orange County, California, to assess HIV/AIDS knowledge, attitudes, and patterns of past and present sexual behavior. The level of student knowledge concerning HIV disease was found to be relatively high, and pronounced differences in knowledge and sexual permissiveness were identified as a function of ethnicity and religion, with Asians showing lower knowledge and lower concern about HIV, and religion/religiosity related to these variables and also to levels of sexual permissiveness. Respondents' comfort in asking a partner about his/her sexual history was positively associated with their level of self-esteem, and negatively related to peer pressure in this population. As in previous studies of college populations, HIV knowledge per se does not confer a protective effect against high-risk behavior. However, knowledge was found to be an enabling factor with regard to students' comfort levels in asking about their partner's sexual histories, and in requesting that partners take an AIDS test.

A descriptive analysis of health insurance coverage among farm families in Minnesota

This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis-St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems.

Benchmarking radiation protection programs

Results are presented of a modest benchmarking project with eight institutions as part of a program review. Four of the institutions had programs with both research and clinical components. Metrics were derived from the data acquired. They included Registered Users per total Technical Staff (mean 284, SD 42%); Principal Investigators per Senior IP staff (mean 68.7, SD 49.6%); and Principal Investigators per HP staff (mean 44.7, SD 34.4%). Reasons for the differences among institutions were identified. The benchmarking exercise was an effective tool in providing guidance in setting staffing levels.

Do patients want to talk to their physicians about organ donation? Attitudes and knowledge about organ donation: a study of Orange County, California residents

This study surveyed Orange County, California residents to determine their attitudes and knowledge about organ donation and in particular to determine what factors influence the decision to donate one's organs upon death. Respondents were recruited from the Orange County Superior Court jury pool (N = 378). Each completed a 44 item questionnaire. Findings from the analysis of Questionnaire Data reveal that nearly three-quarters of respondents had considered donating their organs, yet less than one-third had made arrangements to donate. Having an accurate knowledge about organ donation and being willing to accept a donated organ were particularly robust factors associated with the likelihood to donate. Having spoken with a physician was also a positive factor, yet just 5% of the sample had done so, and two-thirds of respondents did not want to discuss organ donation with their physician. The study's findings suggest that enhanced recruitment may be achieved by focusing on education (especially increased emphasis on the family's role) and by targeting both parents and their children. Finally, although physicians are encouraged to discuss organ donation with patients, more information is needed to explain why patients may not want to talk about this topic with their doctors.

Plaque-type multinucleate cell angiohistiocytoma

BACKGROUND

Multinucleate cell angiohistiocytoma (MCAH) is a rare cutaneous disorder that usually presents as papules or nodules.

OBJECTIVE

This article reports a case of MCAH that appeared clinically as a large cutaneous plaque.

METHODS AND RESULTS

A 74-year-old woman presented with a large painless, dusky red, indurated plaque measuring 12 x 6 cm on the trunk that was found on histopathologic examination to be a MCAH. Based on a literature review, this is the first reported case of MCAH presenting as a plaque rather than a papule or nodule.

CONCLUSION

Multinucleate cell angiohistiocytoma may manifest clinically as a solitary cutaneous plaque.