Authoritative parenting and parental stress in parents of pre-school and older children with developmental disabilities

BACKGROUND

Rearing a child with a developmental disability is associated with increased parental stress. Theories of stress and adjustment and bi-directional theories of child development suggest that parenting could influence these negative outcomes.

METHODS

Relationships between parenting approaches and stress in parents of children with developmental disabilities (DD) (N = 53) were examined across two age groups, 3-5 years and 9-11 years and compared with a contrast group of typically developing children (TD) (N = 60). Measures used were the Parenting Stress Index-Short Form and Rickel and Biasatti's modification of Block's Child Rearing Practices Report, classified into Baumrind's parenting styles using Reitman and Gross's method.

RESULTS

Parents in the older DD group used Authoritative parenting less than parents in the younger DD group, while the opposite developmental pattern was seen in the TD group. Multivariate analysis of variance showed a significant group x parenting style interaction for Parental Distress, Parent-Child Dysfunctional Interaction and Difficult Child. Stress measures were higher for the DD group and seemed to be associated with Authoritative parenting approaches, an effect that was not observed in the TD group.

CONCLUSIONS

Findings suggest that the well-established effect of group on stress may be moderated by parenting style. Authoritative parenting may be highly stressful for parents of children with DD to implement, resulting in a decrease in its use across the two age groups.

The AD8: a brief informant interview to detect dementia

BACKGROUND

Brief measures that accurately discriminate normal cognitive aging from very mild dementia are lacking. Cognitive tests often are insensitive to very mild dementia. Informant-based measures may be more sensitive in detecting early dementia.

OBJECTIVE

To identify informant-reported clinical variables that differentiate cognitively normal individuals from those with very mild dementia.

METHODS

A 55-item battery of informant queries regarding an individual's cognitive status was derived from a semistructured interview and a consensus panel of dementia experts. The battery was evaluated with informants for 189 consecutive participants of a longitudinal study of memory and aging and compared with an independently obtained Clinical Dementia Rating (CDR) score for the participant. Multiple regression and receiver operator characteristic curves assessed subsets of the items to discriminate between CDR 0 (no dementia) and CDR 0.5 (very mild dementia).

RESULTS

The final version (AD8) querying memory, orientation, judgment, and function was administered to an additional sample of 112 CDR 0 and 68 CDR 0.5 participants. Using a cut-off of two items endorsed, the area under the curve was 0.834, suggesting good to excellent discrimination, sensitivity was 74%, and specificity was 86% (prevalence of 0.38 for very mild dementia). Inclusion of 56 additional individuals with mild to severe dementia (increasing dementia prevalence to 0.53) increased sensitivity to 85%.

CONCLUSIONS

The AD8 is a brief, sensitive measure that reliably differentiates between nondemented and demented individuals. Use of the AD8 in conjunction with a brief assessment of the participant could improve diagnostic accuracy in general practice.

Testing an intervention to reduce negative thinking, depressive symptoms, and chronic stressors in low-income single mothers

PURPOSE

To test the effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, negative thinking, and chronic stressors in low-income, single mothers at risk for depression.

DESIGN AND METHODS

A randomized, controlled prevention trial was conducted with 136 low-income, single mothers with children between the ages of 2 and 6 years. Each participant was screened before enrollment and was determined to be at risk for depression. Participants were randomly assigned to either the control or experimental group. The experimental group was invited to participate in a 4- to 6-week cognitive-behavioral group intervention. Data on depressive symptoms, negative thinking, and chronic stressors were collected via self-report questionnaires from control and experimental groups at baseline, 1 month, and 6 months after the intervention to assess the effects of the intervention.

FINDINGS

Compared with those in the control group, women who received the intervention had a greater decrease in depressive symptoms, negative thinking, and chronic stressors; these beneficial effects were maintained over a 6-month period.

CONCLUSIONS

The findings indicate the effectiveness of this cognitive-behavioral group intervention and show the beneficial effects of reducing negative thinking via the use of affirmations and thought-stopping techniques.

Predictors of preclinical Alzheimer disease and dementia: a clinicopathologic study

BACKGROUND

To understand the earliest signs of cognitive decline caused by Alzheimer disease (AD) and other illnesses causing dementia, information is needed from well-characterized individuals without dementia studied longitudinally until autopsy.

OBJECTIVE

To determine clinical and cognitive features associated with the development of AD or other dementias in older adults.

DESIGN

Longitudinal study of memory and aging.

SETTING

Alzheimer's Disease Research Center, St Louis, Mo.

MAIN OUTCOME MEASURES

Clinical Dementia Rating, its sum of boxes, and neuropathologic diagnosis of dementia.

PARTICIPANTS

Eighty control participants who eventually came to autopsy.

RESULTS

Individuals who did not develop dementia showed stable cognitive performance. Entry predictors of dementia were age, deficits in problem solving as well as memory, slowed psychomotor performance, and depressive features. Minimal cognitive decline occurred prior to dementia diagnosis, after which sharp decline was noted. Even individuals who were minimally cognitively impaired (Clinical Dementia Rating = 0.5) typically had neuropathologic AD at autopsy. Histopathologic AD also was present in 34% of individuals who did not have dementia at death; these individuals without dementia showed an absence of practice effects on cognitive testing.

CONCLUSIONS

Increased age, depressive features, and even minimal cognitive impairment, as determined clinically by Clinical Dementia Rating sum of boxes and by slowed psychomotor performance, identify older individuals without dementia who develop dementia. Older adults who do not develop dementia have stable cognitive performance. The absence of practice effects may denote the subset of older adults without dementia with histopathologic AD, which may reflect a preclinical stage of the illness.

Negative thinking and the mental health of low-income single mothers

PURPOSE

To test a conceptual model of predictors of depressive symptoms in low-income single mothers with children from 2 to 6 years of age.

DESIGN

Data were collected from September 2000 to October 2002 as part of the baseline data collection for a larger study in the eastern part of the United States. A volunteer sample of 205 women who were at risk for depression was recruited.

METHODS

Each woman completed a survey that included the Center for Epidemiologic Studies-Depression Scale, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, the Crandall Cognitions Inventory, and the Everyday Stressors Index.

FINDINGS

More than 75% of the participants scored at least in the mild depressive range on the Beck Depression Inventory or in the high depressive range on the CES-D. Negative thinking mediated the relationship between self-esteem and depressive symptoms and partially mediated the relationship between chronic stressors and depressive symptoms.

CONCLUSIONS

These findings are consistent with earlier research by this team. Negative thinking is an important factor in the development of depressive symptoms in at-risk women. As a symptom, negative thinking might be more amenable to nursing intervention than to interventions focused on reducing chronic stress.

Holoprosencephaly--topologic variations in a liveborn series: a general model based upon MRI analysis

We present an MRI-based anatomic analysis of a series of 9 human brains, representing lobar, semilobar and alobar forms of holoprosencephaly. The analysis of these variable forms of the malformation is based upon a topologic systematics established in a prior analysis of a homogeneous set of semilobar malformations. This systematics has the dual advantage that it serves both as a uniform reference for qualitative description and as a quantitative descriptive base for mathematical correlations between parameters of topology and of growth and development. Within this systematics, the prosencephalic midline is divided from caudal to rostral into diencephalic (DD-right and left, subthalamus through suprachiasmatic junction with telencephalon), telencephalic (TT-right and left, suprachiasmatic border of telencephalon midline to hippocampal commissure) and diencephalic-telencephalic (DT-right and left-hippocampal commissure through temporal limb of choroid fissure) segments. The topologic abnormality of the initial semilobar series was expressed in an orderly rostral to caudal gradient along the TT segment. In each malformation, normal midline topology began with a small posterior corpus callosum. Although the topologic anomaly in the present series invariably also involved the TT segment, this involvement was not continuous and was variably associated with anomalies of the DD in 6 and unilaterally of the DT in 1 brain. In the present as well as with the earlier series of HPE malformations but not in "normative brains," total telencephalic growth is strongly correlated with the length of the midline telencephalic segment. We propose that this system of analysis will be sensitive to the developmental stage and locus of expression of genetic and non-genetic determinants of the formal origin of HPE. For all of the present series, karyotype anlyses were normal. Mutations in the Shh and Zic2 genes were excluded in 2 cases.

The accuracy of preoperative orthognathic predictions

We assessed the accuracy of preoperative OPAL trade mark orthognathic predictions by retrospective analysis of 25 Class II patients who had had orthodontic treatment combined with mandibular advancement osteotomy. Preoperative and postoperative lateral cephalographs were digitised and surgical predictions generated using OPAL software. Each prediction was compared with the corresponding clinical changes. We also made a method error study by doing a random retracing of 25 cephalographs. Predictions of some of the principal OPAL values (SNA, ANB, LAFH%, OJ, OB) were reasonably accurate in terms of mean values. However, there were large individual variations for most variables and predictions of the vertical skeletal, incisor, and Wits measurements were imprecise. In particular, there was a bias towards under-prediction of the vertical skeletal changes when there was more backward mandibular rotation than anticipated. Immediate postoperative cephalographs were also affected by a 2.1mm mean downward displacement of the mandible as a result of the surgical wafer.

Measurement of lateral preferences and schizophrenia: results of the Edinburgh High-Risk Study and methodological issues

The assessment and measurement of handedness has varied across studies, limiting the comparability of results. Data from the Edinburgh High Risk for Schizophrenia Study were analyzed to investigate the effect of different methods of assessment and scoring of hand preferences on the prevalence of handedness type and on between-group differences in handedness. Handedness was measured using both the Edinburgh Handedness Inventory and the Annett Handedness Scale in 143 subjects at high risk for schizophrenia, 31 control subjects, and 27 patients with a first episode of schizophrenia. Hand preferences were identified through demonstration of items and by verbal report. No group differences were found, although the prevalence of hand preferences changed substantially depending on the definition used. Significant correlations with socio-demographic factors were found in some instances, but these correlations depended on the definition of handedness. No sex differences were identified. The magnitude of group differences remained similar, although the prevalence of handedness types varied greatly with changes in definition of handedness. Care should be taken in correlation studies to avoid spurious relationships between handedness and other factors. To allow for comparability of results across studies, researchers should adopt a standard definition of handedness.

Semilobar Holoprosencephaly with Midline 'Seam': A Topologic and Morphogenetic Model Based Upon MRI Analysis

We present an MRI-based anatomic analysis of a series of seven human brains with the semilobar form of holoprosencephaly. The analysis defines a set of common descriptors for a pattern of topological anomaly which is uniform for the set of seven brains. The core of the anomaly is a rostro-caudally aligned midline gray matter 'seam' that extends from the telencephalic-suprachiasmatic junctional region to abut the posterior aspect of the callosal commissure. The seam forms the ventricular roof throughout its extent. Rostrally it is formed by the conjoined heads of caudate/accumbens nuclei. It continues caudally as a gray matter bridge in the fundus of the interhemispheric fissure, where it bridges right and left neocortex. Fornix, septal nuclei and septal limb of the choroid plexus are absent, and the telencephalic ventricles communicate with the diencephalic via open septal limbs of the choroid fissures. By contrast, the temporal limb of hippocampal formation and the choroid plexus are normal and the temporal limb of the choroid fissure is closed. This topological anomaly of conjoined left and right cortical and nuclear gray matter into a midline seam and absent septal structures is thus confined to the region of the midline telencephalic hemisphere evagination. Total telencephalic growth is strongly correlated with the length of this topologically abnormal midline telencephalic segment. The set of findings is consistent with graded failure of induction of rostral to caudal specification in the midline rostral telencephalic zone.

Clinical outcomes of possible versus probable Alzheimer's disease

OBJECTIVE

To determine whether Alzheimer's disease (AD) associated with comorbidities or atypical features (possible AD) is marked by differences in clinical course and outcomes compared with uncomplicated AD (probable AD).

METHODS

Annual evaluations were made of patients with AD, for up to 11 years. Six hundred forty subjects with AD were clinically classified into two groups: 1) possible AD (n = 208), and 2) probable AD (n = 432). Data on demographics, Mini-Mental State Examination (MMSE), Short Blessed Test (SBT), psychometric performance, and Clinical Dementia Rating (CDR) were collected at baseline. Kaplan-Meier survival curves and Cox proportional hazards models were conducted to evaluate whether possible AD would have different outcomes on dementia progression, nursing home placement, and death compared with probable AD.

RESULTS

The possible AD group was slightly younger and less well educated than the probable AD group, but there were no group differences at baseline in MMSE, SBT, and CDR scores. Controlling for age and education, the possible AD group had poorer baseline psychometric performance (p = 0.022). There were no group differences, however, for rate of dementia progression, nursing home admission, and death.

CONCLUSIONS

Comorbidities and atypical features in this sample of patients with Alzheimer's disease did not substantially affect dementia outcomes. The primary determinant of the clinical course of dementia in this sample was the presence of clinically diagnosed Alzheimer's disease, independent of the presence or absence of comorbidities or atypical features. Therefore, patients with possible Alzheimer's disease may be considered for inclusion in investigations of Alzheimer's disease, including clinical trials, to improve the generalizability of the findings.

International clinical placements for undergraduate students

This paper reports the findings of a study that sought to gain insight into the experiences of third year nursing students who participated in a 4-week clinical placement in an international setting. This study is different from many studies describing international placements for undergraduate nursing students as it concentrates on clinical experiences on placement. Students' reflective journals and face-to-face discussions were used to collect data, which were analysed by thematic content analysis. Categories were identified describing a focus on micro clinical-based issues that expanded over time to a focus on broader issues reflecting the "nursing culture" of the placement. Students described both positive and negative aspects of being placed in an international clinical setting, with the concept of "being different" emerging. Whilst the findings cannot be generalized beyond the sample, the study highlights the importance of adequate preparation and support for students on international clinical placements, with emphasis on attention to clinical detail.

The validity of computerized orthognathic predictions

OBJECTIVE

utilizing OPAL cephalometric prediction software.

DESIGN

A retrospective investigation involving the random selection of Class II orthognathic patients from surgical records.

SUBJECTS

These 25 cases had undergone treatment aimed at producing Class I incisors. This involved fixed orthodontic appliances and a mandibular advancement osteotomy with rigid internal fixation.

METHODS

Lateral cephalographs from three key stages were digitized and processed using the OPAL software. Pre-treatment predictions were generated and compared with the actual clinical changes.

RESULTS

Prediction of some of the principal OPAL variables (SNA, ANB, LAFH%, OJ, OB) was reasonably accurate in terms of mean values. However, there were large individual variations for most measurements, and prediction of Wits, MxP/MnP, LAFH, and LPFH was prone to systematic error. In particular, there was a tendency towards over-prediction of the surgically-induced backward mandibular rotation.

CONCLUSION

In lieu of further validation caution should be exercised with the interpretation of individual OPAL predictions, especially vertical skeletal changes, and an explanation given to patients that orthognathic predictions are based on generalizations.

Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers

OBJECTIVE

To describe the experiences of illness and needs and use of services in two groups of patients with incurable cancer, one in a developed country and the other in a developing country.

DESIGN

Scotland: longitudinal study with qualitative interviews. Kenya: cross sectional study with qualitative interviews.

SETTINGS

Lothian region, Scotland, and Meru District, Kenya.

PARTICIPANTS

Scotland: 20 patients with inoperable lung cancer and their carers. Kenya: 24 patients with common advanced cancers and their main informal carers.

MAIN OUTCOME MEASURES

Descriptions of experiences, needs, and available services.

RESULTS

67 interviews were conducted in Scotland and 46 in Kenya. The emotional pain of facing death was the prime concern of Scottish patients and their carers, while physical pain and financial worries dominated the lives of Kenyan patients and their carers. In Scotland, free health and social services (including financial assistance) were available, but sometimes underused. In Kenya, analgesia, essential equipment, suitable food, and assistance in care were often inaccessible and unaffordable, resulting in considerable unmet physical needs. Kenyan patients thought that their psychological, social, and spiritual needs were met by their families, local community, and religious groups. Some Scottish patients thought that such non-physical needs went unmet.

CONCLUSIONS

In patients living in developed and developing countries there are differences not only in resources available for patients dying from cancer but also in their lived experience of illness. The expression of needs and how they are met in different cultural contexts can inform local assessment of needs and provide insights for initiatives in holistic cancer care.

Neuropsychology, genetic liability, and psychotic symptoms in those at high risk of schizophrenia

Neuropsychological assessments were compared among individuals at enhanced genetic risk of schizophrenia (n = 157) and controls (n = 34). The relationship between cognitive impairments and the presence of psychotic symptoms and measures of genetic risk was explored in the high-risk subjects. Neuropsychological differences were identified in many areas of function and were not accounted for by the presence of psychotic symptoms. Genetic liability was not associated with neuropsychological performance or with psychotic symptoms, but exploratory analysis showed some tests were associated with both liability measures. These results suggest that what is inherited is not the disorder itself but a state of vulnerability manifested by neuropsychological impairment, occurring in many more individuals than are predicted to develop the disorder.

A good death in rural Kenya? Listening to Meru patients and their families talk about care needs at the end of life

What constitutes a good death sub-Saharan Africa? In Meru District in Eastern Kenya, we listened to 32 patients with ongoing cancer or AIDS, and to their carers as they talked about end-of-life experiences and care needs. Patients described how the support of close family relationships, and the care shown by their community and religious fellowships helped meet many of their emotional, social, and spiritual needs. But physical needs often went unmet. Patients died in pain. Some suffered in poverty, others were troubled by the guilt of using all available family resources to pay for treatment and care. Accessible pain relief, affordable clinic or inpatient care when required, and help to cope with the burden of care were among the key needs of patients. Until these are available, many will not die well.