The relationship between proxy reported health-related quality of life and parental distress: gender differences

OBJECTIVE

Although primary caregiver proxy reports of health-related quality of life (HRQOL) are often used for healthcare decision making when child self-reports are unable to be collected (because of a variety of reasons such as child illness, disability or age), we have little understanding of the correlates of parent-proxy reports. The aim of this study was to examine the relationship between parental depression and parent-proxy reported QOL for primary caregivers (mothers and fathers), using a multidimensional HRQOL instrument. It was hypothesized that maternal depression would be negatively correlated with maternal reported HRQOL, but that paternal depression would not be correlated with paternal reported HRQOL.

METHODS

Data were from parents of children aged 4-5 years (n = 4983) involved in the Longitudinal Study of Australian Children. A questionnaire assessing parental depression (Kessler-6) and proxy reported HRQOL (Pediatric Quality of Life Inventory) was completed by the primary caregiver.

RESULTS

For maternal primary caregivers, maternal depression was negatively correlated with all domains of maternal proxy reports of HRQOL (r = -0.24 to r = -0.36). For paternal primary caregivers, there was no relationship between paternal depression and paternal proxy reports of HRQOL. Multiple regression analyses demonstrated that maternal depression was a significant predictor of total HRQOL, accounting for 12% of the variance. For paternal mental health, depression did not predict parent-proxy reported total HRQOL.

CONCLUSION

These results highlight the importance of assessing maternal mental health when measuring proxy reported QOL. Further research is needed in this area to examine the relationship between parental depression and proxy reported HRQOL (including both mothers and fathers, where possible), as well as child self-reported HRQOL.

The impact of childhood conditions and concurrent morbidities on child health and well-being

BACKGROUND

Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions.

METHODS

We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5-18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0-100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems).

RESULTS

Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9-23.2%, dental 11.9-22.7%, vision 7.2-14.7%, chronic allergies 8.8-13.9%, attention problems 5.1-13.8% and behaviour problems 5.7-12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (-7.69 to -21.51) for physical health conditions, and 28 points (-5.15 to -33.81) for mental health conditions.

CONCLUSIONS

Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.

Discrepancy between expected and actual child support payments: predicting the health and health-related quality of life of children living in low-income, single-parent families

OBJECTIVE

Although the amount and frequency of child support payments received by single parents are often erratic and fluctuate, no study to date has quantitatively explored how the discrepancy between expected and actual payments relates to child health. This study aims to examine whether the discrepancy between expected and actual child support payments predicts a range of child health outcomes, including global health, health-related quality of life, involvement in activities and parental psychological distress.

METHODS

This study used results from the Longitudinal Study of Australian Children, which included a sample of parents of children aged 4-5 years (n = 4983). The questionnaire was completed by the parent who spent the most time with the child and knew the child best. From the 4983 families, 332 low-income single parents reliant on welfare with a formal or informal child support order in place were identified.

RESULTS

After controlling for income, the discrepancy between expected and actual child support predicted school functioning, conduct problems, total mental health problems and involvement in activities. Discrepancy between expected and actual child support payments did not predict the remaining health-related quality of life domains, mental health domains, global child health or parental psychosocial distress.

CONCLUSION

This was the first study to examine how the discrepancy between expected and actual child support payments relates to child health, providing important data on the effectiveness of the child support system for children's well-being. These findings highlight the potential impact of the discrepancy on school functioning, conduct problems, total mental health problems and involvement in activities.

The relationship between quality of life and functioning for children with cerebral palsy

Given that quality of life (QOL) is commonly confused with functioning, the aim of this study was to examine the association between functioning and QOL domains for children with cerebral palsy (CP). Two hundred and five parents of children aged 4 to 12 years with CP and 53 children aged 9 to 12 years with CP, completed the Cerebral Palsy Quality of Life Questionnaire for Children. Children were distributed reasonably evenly between sex (male, 54.6%) and Gross Motor Function Classification System levels (I 17.8%, II 28.3%, III 14.1%, IV 11.2%, and V 27.3%). For parent proxy-report, all domains of QOL were significantly associated with functioning level except access to services. For child self-report, feelings about functioning, participation and physical health, and pain and feelings about disability, were significantly associated with functioning level. Physical type domains of QOL accounted for more of the variance in functioning than psychosocial type domains. Children with CP have the potential to report a high psychosocial QOL score even if they have poor functioning.

Getting the complete picture: combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas

BACKGROUND

Childhood mental health problems are prevalent in Australian children (14-20%). Social exclusion is a risk factor for mental health problems, whereas being socially included can have protective effects. This study aims to identify the barriers to social inclusion for children aged 9-12 years living in low socio-economic status (SES) areas, using both child-report and parent-report interviews.

METHODS

Australian-born English-speaking parents and children aged 9-12 years were sampled from a low SES area to participate in semi-structured interviews. Parents and children were asked questions around three prominent themes of social exclusion; exclusion from school, social activities and social networks.

RESULTS

Many children experienced social exclusion at school, from social activities or within social networks. Overall, nine key barriers to social inclusion were identified through parent and child interviews, such as inability to attend school camps and participate in school activities, bullying and being left out, time and transport constraints, financial constraints and safety and traffic concerns. Parents and children often identified different barriers.

DISCUSSION

There are several barriers to social inclusion for children living in low SES communities, many of which can be used to facilitate mental health promotion programmes. Given that parents and children may report different barriers, it is important to seek both perspectives.

CONCLUSION

This study strengthens the evidence base for the investments and action required to bring about the conditions for social inclusion for children living in low SES communities.

Ectopic Tbx2 expression results in polyploidy and cisplatin resistance

T-box factors play critical roles in embryonic development and have been implicated in cell cycle regulation and cancer. For example, Tbx2 can suppress senescence through a mechanism involving the repression of the cyclin-dependent kinase inhibitors, p19(ARF) and p21(WAF1/CIP1/SDII), and the Tbx2 gene is deregulated in melanoma, breast and pancreatic cancers. In this study, several transformed human lung fibroblast cell lines were shown to downregulate Tbx2. To further investigate the role of Tbx2 in oncogenesis we therefore stably reexpressed Tbx2 in one such cell line. Compared to their parental cells, the resulting Tbx2-expressing cells are larger, with binucleate and lobular nuclei containing double the number of chromosomes. Moreover, these cells had an increase in frequency of several features of genomic instability such as chromosome missegregation, chromosomal rearrangements and polyploidy. While grossly abnormal, these cells still divide and give rise to cells that are resistant to the chemotherapeutic drug cisplatin. Furthermore, this is shown to be neither species nor cell type dependent, as ectopically expressing Tbx2 in a murine melanoma cell line also induce mitotic defects and polyploidy. These results have important implications for our understanding of the role of Tbx2 in tumorigenesis because polyploidy frequently precedes aneuploidy, which is associated with high malignancy and poor prognosis.

Article

OBJECTIVE

To document the efficacy of intratumoural injections of 5-fluorouracil for the treatment of equine sarcoids.

DESIGN

A prospective study that included 13 horses and one donkey.

PROCEDURE

Sarcoids were confirmed by histological examination and treated with intratumoural 5-fluorouracil every 2 weeks. If the sarcoids did not resolve after seven treatments, treatment was considered a failure. All cases were re-examined 6 months after treatment commenced and owners were telephoned 3 years after commencement of treatment to report on tumour recurrence. Outcome comparisons were performed to determine the effect of previous treatment, tumour size and tumour location on sarcoid resolution. The efficacy of intratumoural 5-fluorouracil was compared with other previously documented treatments of equine sarcoids.

RESULTS

Sarcoids smaller than 13.5 cm3 were significantly (P = 0.032) more likely to resolve with treatment than larger sarcoids. Sarcoids that were not responsive to previous therapies were significantly (P = 0.007) more likely to recur after 3 years than sarcoids that had not been treated prior to this study. In this study, there were similar rates of resolution in cases with mutiple tumours (66.6%) when compared to cases with single tumours (60%). The numbers in this study were too small to properly evaluate the effect of tumour location on the success of treatment. Intratumoural 5-fluorouracil appeared to have resolved sarcoids in 9 of 13 cases (61.5%) as determined by follow up conversation with the owners 3 years after the initial treatment.

CONCLUSION

The use of intratumoural 5-fluorouracil compares favourably with other treatment modalities for sarcoids, with a long term successful resolution rate of 61.5%. Owners should be warned that resistant sarcoids and sarcoids larger than 13.5 cm3 have a poorer prognosis for resolution and more aggressive therapeutic options should be considered.

In the students' own words: what are the strengths and weaknesses of the dental school curriculum?

Dental students have little input into the selection of course topics and subject matter included in their dental curricula. Curriculum requirements are framed by the Commission on Dental Accreditation, which has stipulated competencies and associated biomedical and clinical knowledge that must be addressed during dental school. Although these competency requirements restrict the variance of educational experiences, students are eager to share their views on the curriculum within the realm of their educational experience. The objective of this research project was to elicit the perspectives of dental students from a broad cross-section of U.S. and Canadian dental schools about their education. A total of 605 students (285 sophomores, 220 seniors, 100 residents) from twenty North American dental schools completed a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis to communicate their perceptions of the curriculum. Students were also asked to provide their impressions of the overall quality of the educational program in an open-ended written format. The students' qualitative comments were then reviewed and categorized into key issues or themes. Resulting themes for each category of the Curriculum SWOT (C-SWOT) analysis were the following. Strengths: 1) clinical learning experience, and 2) opportunity to work with knowledgeable faculty. Weaknesses: 1) disorganized and inefficient clinical learning environment, 2) teaching and testing that focus on memorization, 3) poor quality instruction characterized by curricular disorganization, and 4) inconsistency among instructors during student evaluations. Opportunities: 1) develop strategies to provide students with more exposure to patients, especially early in the curriculum, and 2) opportunities to learn new technology/techniques. Threats: 1) cost of dental education, 2) students' concerns about faculty "brain drain," i.e., lack of sufficient numbers of dental faculty capable of providing high-quality instruction, and 3) questionable treatment of patients in the dental clinic as a consequence of pursuing procedural requirements. This report presents commentaries selected from 2,421 total responses that communicate students' perspectives related to C-SWOT themes. Students at seven schools in this study reported that they completed all or portions of the first two years of the curriculum in combined classes with medical students. Sophomore and senior students at these schools provided their thoughts on this curricular approach; these perceptions are also reported. Findings from this study are compared to results from a similar investigation of dental student perceptions conducted fifty years ago. We conclude that students participating in this study were positive overall about their learning experiences in dental schools, but identified several areas that appear to be problematic for many students at a variety of different schools including fundamental concerns about instructional quality in some areas of the curriculum. Academic program administrators in dental schools can use these findings to guide modifications that will enhance the overall dental education experience.

The Met66 allele of the functional Val66Met polymorphism in the brain-derived neurotrophic factor gene confers protection against neurocognitive dysfunction in systemic lupus erythematosus

BACKGROUND

A common functional polymorphism of the brain-derived neurotrophic factor gene (BDNF Val66Met) was previously associated with diminished episodic memory performance in healthy people. As cognitive function is commonly impaired in patients with systemic lupus erythematosus (SLE), the association of the BDNF Val66Met with neurocognitive function was studied.

OBJECTIVE

To study the association of the BDNF Val66Met with neurocognitive function in a cohort of patients with SLE.

METHODS

Cognitive function was assessed in 59 patients with SLE with no previous or current central nervous system involvement. Cognitive tests were grouped into five domains (memory, attention/executive function, visuospatial skills, motor function and psychomotor speed) and used to obtain domain Z scores, reflecting the difference between averaged scores of performance on individual tests and published norms in each domain. Genotyping was carried out using a 5'-nuclease assay with 99.9% accuracy. Unpaired t test was used to assess the relationship between genotypes and cognitive function, whereas the effect of possible confounders was assessed in a multivariate analysis.

RESULTS

Patients carrying the Met66 allele scored significantly higher on psychomotor, attention/executive and motor function tests, resulting in significantly higher domain Z scores for the psychomotor (p = 0.005) and motor (p = 0.002) domains.

CONCLUSIONS

The BDNF Met66 allele was associated with better cognitive functioning in the psychomotor and motor domains, even after controlling for differences in ethnicity, sex, depression status and prednisone treatment. These data suggest that the BDNF Met66 allele confers protection against the decline of motor and psychomotor cognitive functions in patients with longstanding SLE.

North American dental students' perspectives about their clinical education

Many North American dental schools face the challenge of replacing the majority of their "boomer generation" clinical instructors over the next ten years as this cohort of faculty reaches retirement age. Developing a new cadre of clinical instructors poses a substantial faculty development challenge: what instructional techniques should be integrated into routine educational practice by the dental faculty of the future, and what aspects of the clinical learning environment should be addressed to improve the overall quality of the experience for patients, students, and the new cohort of instructors? To gain insight that might guide faculty development for new clinical instructors and enhance understanding of the learning environment in dental school clinics, this study addressed the following question: what are dental students' perceptions of their learning experiences in the clinical setting? The purpose of the study was to evaluate the effectiveness of the clinical instruction from the perspectives of the actual "consumer" of dental education: the student. This consumers' perspective was provided by 655 junior, senior, and graduate dental students at twenty-one North American dental schools who completed the Clinical Education Instructional Quality Questionnaire (ClinEd IQ) in 2003-04. The ClinED IQ examines four components of students' clinical experiences: 1) clinical learning opportunities, 2) involvement in specific learning activities, 3) interaction with clinical instructors, and 4) personal perceptions about clinical education. With the exception of inconsistent feedback and instruction and lack of continuous contact with the same instructors, juniors, seniors, and graduate students rated their interaction with clinical instructors favorably (mean=4.76 on a 6.00 scale), but provided lower ratings for clinical learning opportunities (mean=4.26 on a 6.00 scale) due to concerns about the efficiency of the dental clinic environment and lack of opportunity to treat patients in a variety of clinical settings. Analysis of more than 1,000 written comments provided by these students indicated four areas of concern: 1) inconsistent and sometimes insensitive (patronizing, rude) feedback from faculty; 2) excessive amounts of noneducational "legwork" such as billing, patient scheduling, phone calling, completing paperwork, and performing other clinic operations tasks; 3) limited access to faculty because of insufficient numbers of instructors on the clinic floor or difficulty locating faculty when they were needed for coaching, work evaluation, and chart signatures; and 4) concerns about the strategies employed to meet procedural requirements that some students saw as ethically questionable. Junior, senior, and graduate dental students at twenty-one North American dental schools perceived that the strongest aspect of their clinical education was their relationship with the faculty, but also reported that the dental school clinic was often an inefficient learning environment that hindered their opportunity to develop clinical competency. Students also sensed that faculty shortages, a growing crisis for dental education, hindered their progress in the clinic and made learning less efficient.

The Brl domain in Sec63p is required for assembly of functional endoplasmic reticulum translocons

Protein translocation into the endoplasmic reticulum occurs at pore-forming structures known as translocons. In yeast, two different targeting pathways converge at a translocation pore formed by the Sec61 complex. The signal recognition particle-dependent pathway targets nascent precursors co-translationally, whereas the Sec62p-dependent pathway targets polypeptides post-translationally. In addition to the Sec61 complex, both pathways also require Sec63p, an integral membrane protein of the Hsp40 family, and Kar2p, a soluble Hsp70 located in the ER lumen. Using a series of mutant alleles, we demonstrate that a conserved Brl (Brr2-like) domain in the COOH-terminal cytosolic region of Sec63p is essential for function both in vivo and in vitro. We further demonstrate that this domain is required for assembly of two oligomeric complexes of 350 and 380 kDa, respectively. The larger of these corresponds to the heptameric "SEC complex" required for post-translational translocation. However, the 350-kDa complex represents a newly defined hexameric SEC' complex comprising Sec61p, Sss1p, Sbh1p, Sec63p, Sec71p, and Sec72p. Our data indicate that the SEC' complex is required for co-translational protein translocation across the yeast ER membrane.

Immunofluorescence detection of clustered gamma-H2AX foci induced by HZE-particle radiation

We studied the spatial and temporal distributions of foci of the phosphorylated form of the histone protein H2AX (gamma-H2AX), which is known to be activated by double-strand breaks after irradiation of human fibroblast cells with high-energy silicon (54 keV/microm) and iron (176 keV/microm) ions. Here we present data obtained with the ion path parallel to a monolayer of human fibroblast cells that leads to gamma-H2AX aggregates in the shape of streaks stretching over several micrometers in an x/y plane, thus enabling the analysis of the fluorescence distributions along the ion trajectories. Qualitative analyses of these distributions provide insights into DNA damage processing kinetics for high charge and energy (HZE) ions, including evidence of increased clustering of DNA damage and slower processing with increasing LET.

Does a central MHC gene in linkage disequilibrium with HLA-DRB1*0401 affect susceptibility to type 1 diabetes?

Subtypes of HLA-DR4 are associated with susceptibility or protection against type 1 diabetes (T1DM). We addressed whether this reflects linkage disequilibrium with the true susceptibility locus by studying broader MHC haplotypes marked by alleles of HLA-B, IKBL (adjacent to TNFA) and complement C4. The study used a largely Caucasian cohort from Western Australia. HLA-DRB1*0401 and HLA-DRB1*0405 marked susceptibility to T1DM. In Caucasians, DRB1*0401 occurs predominantly in the 44.1 ancestral haplotype (AH; HLA-A2,B44, DRB1*0401,DQB1*0301) and the 62.1AH (HLA-A2,B15(62),DRB1*0401,DQB1*0302). HLA-B15 marked susceptibility and HLA-B44 marked with resistance to T1DM in patients and controls preselected for HLA-DRB1*0401. A gene between TNFA and HLA-B on the 8.1AH (HLA-A1,B8,;DR3,DQ2) modifies the effects of the class II alleles. Here, alleles characteristic of the 62.1AH (C4B3, IKBL+446*T and HLA-A2,B15) were screened in donors preselected for HLA-DRB1*0401. C4B3 was associated with diabetes, consistent with a diabetes gene telomeric of MHC class II. However, increases in carriage of IKBL+446*T and HLA-A2,B15 were marginal, as too few control subjects were available with the diabetogenic alleles. However, with these tools, selection of HLA-DRB1*0401, DQB1*0302 donors who are positive and negative for C4B3 will allow bidirectional mapping of diabetes genes in the central MHC.

Appraisal of the dental school learning environment: the students' view

The majority of studies examining dental school curriculum have addressed organization, structure, and content issues from the perspectives of administrators, faculty, practitioners/alumni, and professional organizations. However, few studies have focused on students' opinions of dental school. The purpose of this study was to determine students' perceptions of the learning environment, intellectual climate, and teacher-student relationships in dental school. This report describes how the "dental version" of the Medical Student Learning Environment Survey (MSLES) was used to identify students' perceptions of their dental education. Freshman and junior dental students' perceptions were measured with the Dental Student Learning Environment Survey (DSLES), which evaluates learning environment, intellectual climate, and relationships among students and teachers in seven areas: flexibility, student-to-student interaction, emotional climate, supportiveness, meaningful experience, organization, and breadth of interest. The DSLES was mailed to twenty-three dental schools in North America with eighteen of the schools distributing the inventory. A total of 619 dental students responded. Results were differentiated between freshman and junior dental students. Both freshman and junior students provided the highest (most positive) ratings for the DSLES subscales of "breadth of interest" (interest in dentistry and outside interests are encouraged) and "meaningful learning experience" (significance of courses to dentistry). Freshman students provided the lowest (least positive) ratings for "emotional climate" (students' responses to the way their courses were conducted and stress levels), and junior students provided the least positive ratings for "faculty supportiveness" (extent of faculty support and encouragement provided to students). The DSLES identified students' perceptions of their educational experience and localized areas for improvement. By addressing these areas of concern, faculty can increase student satisfaction with their dental education.

Mental health problems in the elderly in residential care in Greece--A pilot study

The aim of this study is to examine the mental health problems of older adults living in a residential home in a Greek rural area. A sample of 40 residents was compared with 40 matched controls attending a community open care centre for the elderly (OCCE). The following measures were used: Mini International Neuropsychiatric Interview (MINI), Geriatric Depression Screening Scale (GDSS), and the Mini Mental State Examination (MMSE). The group of the residents had a lower educational level and presented with a higher prevalence of depression and suicidality. Suicidal ideation was not significantly correlated to any of the examined independent social or psychological factors and was persistent during a period of two years follow-up. It is possible that, especially in rural areas, admission in the institution is per se a traumatic event precipitating suicidality. The issues of effective psychological care for older adults in residential care are discussed.

Using a distance-learning program to educate staff on the Joint Commission National Patient Safety

BACKGROUND

A motion picture expert group (MPEG) distance-learning program was created in 2003 at Brooke Army Medical Center (BAMC; San Antonio, Texas) on the Joint Commission National Patient Safety Goals. The 34 2-4-minute scripted video productions addressed the 7 goals and 13 recommendations for 2003 and 2004. For each goal, three MPEGs respectively describe sentinel events pertaining to that goal, root causes and risk-reduction strategies, and Army Medical Department and BAMC recommendations and policies.

CREATING THE PROGRAM

The program entailed creating the scripts, narrating video, editing the tapes, and compressing the videos into the MPEG format.

LAUNCHING THE PROGRAM

A featured MPEG was emailed weekly to over 3,000 hospital staff with a scripted endorsement and photograph of a key BAMC leader and a link to the MPEG. In addition, the MPEGs were placed on the hospital's intranet site.

DISCUSSION

As the National Patient Safety Goal MPEG distance-learning program gained more recognition, different branches of the Army used the program to educate their staff on the Joint Commission National Patient Safety Goals. The next step is to update the distance-learning program with new MPEGs that will provide guidance on the current National Patient Safety Goals.