685 research outputs found
Mortality of patients with multiple sclerosis: a cohort study in UK primary care
We aimed to estimate rates, causes and risk factors of all-cause mortality in a large population-based cohort of multiple sclerosis (MS) patients compared with patients without MS. Using data from the UK General Practice Research Database, we identified MS cases diagnosed during 2001â2006 and validated using patientsâ original records where possible. We also included MS cases during 1993â2000 identified and validated in an earlier study. Cases were matched to up to ten referents without MS by age, sex, index date (date of first MS diagnosis for cases and equivalent reference date for controls), general practice and length of medical history before first MS diagnosis. Patients were followed up to identify deaths; hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox-proportional regression. MS patients (N = 1,822) had a significantly increased risk of all-cause mortality compared with referents (N = 18,211); adjusted HR 1.7 (95 % CI 1.4â2.1). Compared with referents, female MS patients had a higher but not significantly different HR for death than males; adjusted HR 1.86 (95 % CI 1.46â2.38) vs. HR 1.31 (95 % CI 0.93â1.84), respectively. The most commonly recorded cause of death in MS patients was âMSâ (41 %), with a higher proportion recorded among younger patients. A significantly higher proportion of referents than MS patients had cancer recorded as cause of death (40 vs. 19 %). Patients with MS have a significant 1.7-fold increased risk of all-cause mortality compared with the general population. MS is the most commonly recorded cause of death among MS patients. Electronic supplementary material The online version of this article (doi:10.1007/s00415-014-7370-3) contains supplementary material, which is available to authorized users
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The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up.
PurposeTo investigate, in adolescents referred for psychiatric services, the associations of initial self-esteem and family functioning with level and change of quality of life (QoL) over a 3-year period, over and above the effect of their emotional problems.MethodsOf 1648 eligible 13-18 years old patients attending the child and adolescent psychiatric clinic (CAP) at least once, 717 (54.8% females) were enrolled at baseline (a response rate of 43.5%). Self- and parent reports on the McMaster Family Assessment Device were obtained. Adolescents reported self-esteem on the Rosenberg Scale, and emotional problems on the Symptom Check List-5. Adolescents completed the Inventory of Life Quality in Children and Adolescents (ILC). After 3 years, 570 adolescents again completed the ILC, and for 418 adolescents parent information was available. The longitudinal analysis sample of 418 adolescents was representative of the baseline sample for age, gender, emotional problems, and QoL. We used modified growth-model analysis, adjusted for SES, age, gender and time of contact with CAP, where residual variances for ILC at baseline and follow-up were fixed to 0.ResultsA poorer family functioning at baseline, reported by parents, was significantly associated with worsening QoL during the 3 years follow-up period (pâ=â0.001).ConclusionsParents have important knowledge about their families that may reflect long-term influences on QoL development in adolescent psychiatric patients. Health care providers and policy makers should optimize treatment outcomes by addressing family functioning in adolescents with emotional problems
Cognitive status as a risk factor for maladjustment in children with a physical disability
Investigated the association between cognitive
status and adjustment in children who have a physical
disability, in three independent studies. In Study 1, 119
mothers reported on the cognitive status and behavioral
adjustment of their children, ages 2-18, who had
varying physical or sensory impairments. In Study 2,
the intellectual level of 50 children, ages 6-1 1, with
either spina bifida or cerebral palsy, was estimated
from cognitive test information while mothers reported
on the childrenâs behavioral adjustment. In Study 3,66
adolescents, ages 11-18, with a physical disability
completed an IQ test and reported on their behavioral
adjustment, as did their mothers. Severity of physical
disability was also assessed in each study. No relationships
could be found between any index of
cognitive status and any adjustment measure when
controlling for severity of physical disability. The
overwhelming majority of zero-order relationships
were also not significant. These findings were discussed
in relation to Wallander and Varniâs Disability-
Stress-Coping model of adjustment in children with
chronic physical conditions.Este artigo descreve investigag6es sobre a associação entre o estatuto cognitivo e o ajustamento em
crianças com deficiĂȘncia fĂsica, em trĂȘs estudos independentes.
No Estudo 1, 1 19 m5es prestaram informaq20
acerca do estatuto cognitivo e do ajustamento
comportamental dos seus filhos, com idades entre OS 2
e OS 18 anos, e com graus variĂĄveis de deficiĂȘncia fĂsica
ou sensorial. No Estudo 2, o nĂvel intelectual de
50 crianças, com idades entre OS 6 e OS 11 anos e com
spina bifida ou com paralisia cerebral, foi estimado a
partir de testes cognitivos e de relatos maternos sobre
o seu ajustamento comportamental. No Estudo 3, 66
adolescentes, com idades entre OS 11 e OS 18 anos e
com deficiĂȘncia fĂsica, realizaram um teste de QI e
prestaram informação sobre o seu ajustamento comportamental,
relato que tambĂ©m foi feito pelas suas mĂŁes. Em cada estudo, a gravidade da deficiĂȘncia fĂsica
foi também avaliada. Controlando a variåvel
«gravidade da deficiĂȘncia fĂsica», nĂŁo foi possivel
encontrar relação entre qualquer Ăndice de estatuto
cognitivo e qualquer medida de ajustamento. A grande
maioria de relaçÔes de ordem zero também não era
significativa. Estes resultados são discutidos em função
do modelo de Wallander e Varni «Disability-Stress-Coping» sobre o ajustamento em crianças com deficiĂȘncias
fĂsicas cronicas.National Institutes of Healthinfo:eu-repo/semantics/publishedVersio
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Racial/ethnic disparities in health-related quality of life and health status across pre-, early-, and mid-adolescence: a prospective cohort study.
PURPOSE:To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL) and overall health status among Black, Latino, and White youth during adolescence; (2) whether socioeconomic status (SES) and family contextual variables influence disparities; and (3) whether disparities are consistent from pre- to early- to mid-adolescence. METHODS:A population sample of 4823 Black (1755), Latino (1812), and White (1256) youth in three US metropolitan areas was prospectively assessed in a longitudinal survey conducted on three occasions, in 5th, 7th, and 10th grades, when youth reported their HRQOL using the PedsQLâą short-form Total, Physical and Psychosocial scales and youth and parents separately reported on youth's overall health status. Parents reported their education and household income to index SES, family structure, and use of English at home. RESULTS:Based on analysis conducted separately at each grade, marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring White and disfavoring Black, and especially Latino youth. More strongly present in 5th and 7th grade, HRQOL disparities decreased by 10th grade. Most disparities between White and Black youth disappeared when adjusting for SES. However, even after adjusting for SES, family structure, and English use, overall health status disparities disfavoring Latino youth remained across all three assessments. CONCLUSIONS:Racial/ethnic disparities in adolescent HRQOL and health are substantial. These disparities appear consistent from pre- to early-adolescence but diminish for HRQOL by mid-adolescence. As disparities appear influenced by SES and other family contextual variables differently in different racial/ethnic groups, efforts to reduce health disparities in youth should address culturally specific conditions impinging on health
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Patterns of Exposure to Cumulative Risk Through Age 2 and Associations with Problem Behaviors at Age 4.5: Evidence from Growing Up in New Zealand.
Exposure to cumulative risk (CR) has important implications for child development, yet little is known about how frequency, persistence, and timing of CR exposure during early childhood predict behavioral problems already before school start. We examine prospective longitudinal associations between patterns of CR exposure from third trimester through 2 years and subsequent behavior problems at 4.5 years. In 6156 diverse children in the Growing Up in New Zealand longitudinal study, the presence of 12 risk factors, spanning maternal health, social status, and home and neighborhood environment, defined CR and were assessed at last trimester and 9 months and 2 years of age. At child age 4.5 years, mothers completed the Strengths and Difficulties Questionnaire, where a scoreââ„â16 indicated an abnormal level of problem behaviors (ALPB). Children exposed to a CRââ„â1 at least once in early development, compared to those with consistent CRâ=â0, showed a significantly higher likelihood of ALPB at 4.5 years. Consistent high exposure to CRââ„â4 across all three assessments had the highest prevalence (44%) of ALPB at age 4.5. Children with high CR exposure on two of three, compared to on all three, time points in early development did not evidence a significantly reduced prevalence (32%-41%) of ALPB. The common co-occurrence of risk factors and their significant developmental impact when accumulated early in life underscore the need for systematic multisector intervention and policy implementation during pregnancy and shortly after birth to improve outcomes for vulnerable children
Racial and Ethnic Health Disparities among Fifth-Graders in Three Cities
http://dx.doi.org/10.1056/NEJMsa111435
Perceptual Pluralism
Perceptual systems respond to proximal stimuli by forming mental representations of distal stimuli. A central goal for the philosophy of perception is to characterize the representations delivered by perceptual systems. It may be that all perceptual representations are in some way proprietarily perceptual and differ from the representational format of thought (Dretske 1981; Carey 2009; Burge 2010; Block ms.). Or it may instead be that perception and cognition always trade in the same code (Prinz 2002; Pylyshyn 2003). This paper rejects both approaches in favor of perceptual pluralism, the thesis that perception delivers a multiplicity of representational formats, some proprietary and some shared with cognition. The argument for perceptual pluralism marshals a wide array of empirical evidence in favor of iconic (i.e., image-like, analog) representations in perception as well as discursive (i.e., language-like, digital) perceptual object representations
What factors influence training opportunities for older workers? Three factorial surveys exploring the attitudes of HR professionals
The core research questions addressed in this paper are: what factors influence HR professionals in deciding whether to approve training proposals for older workers? What kind of training are they more likely to recommend for older employees and in which organizational contexts? We administered three factorial surveys to 66 HR professionals in Italy. Participants made specific training decisions based on profiles of hypothetical older workers. Multilevel analyses indicated that access to training decreases strongly with age, while highly-skilled older employees with low absenteeism rates are more likely to enjoy training opportunities. In addition, older workers displaying positive performance are more likely to receive training than older workers who perform poorly, suggesting that training late in working life may serve as a reward for good performance rather than as a means of enhancing productivity. The older the HR professional evaluating training proposals, the higher the probability that older workers will be recommended for training.
keywords: training; older workers; HR professionals; factorial survey; multilevel model
Age-specific symptom prevalence in women 35â64 years old: A population-based study
<p>Abstract</p> <p>Background</p> <p>Symptom prevalence is generally believed to increase with age. The aim of this study was to evaluate the age specific prevalence of 30 general symptoms among Swedish middle-aged women.</p> <p>Methods</p> <p>A cross-sectional postal questionnaire study in seven Swedish counties in a random sample of 4,200 women 35â64 years old, with 2,991 responders. Thirty general symptoms included in the Complaint Score subscale of the Gothenburg Quality of Life Instrument were used.</p> <p>Results</p> <p>Four groups of age specific prevalence patterns were identified after adjustment for the influence of educational level, perceived health and mood, body mass index, smoking habits, use of hormone replacement therapy, and use of other symptom relieving therapy. Only five symptoms (insomnia, leg pain, joint pain, eye problems and impaired hearing) increased significantly with age. Eleven symptoms (general fatigue, headache, irritability, melancholy, backache, exhaustion, feels cold, cries easily, abdominal pain, dizziness, and nausea) decreased significantly with age. Two symptoms (sweating and impaired concentration) had a biphasic course with a significant increase followed by a significant decrease. The remaining twelve symptoms (difficulty in relaxing, restlessness, overweight, coughing, breathlessness, diarrhoea, chest pain, constipation, nervousness, poor appetite, weight loss, and difficulty in urinating) had stable prevalence with age.</p> <p>Conclusion</p> <p>Symptoms did not necessarily increase with age instead symptoms related to stress-tension-depression decreased.</p
Development of parent- and teacher-reported emotional and behavioural problems in young people with intellectual disabilities: Does level of ID matter?
This study described similarities and differences in the 5-year stability and change of problem behaviour between youths attending schools for children with mild to borderline (MiID) versus moderate intellectual disabilities (MoID). A two-wave multiple-birth-cohort sample of 6 to 18-year-old was assessed twice across a 5-year interval using the Developmental Behaviour Checklist Primary Carer version (n = 718) and Teacher version (n = 313). For most types of problem behaviour youths with MiID and MoID showed similar levels of stability of individual differences, persistence and onset of psychopathology. Whenever differences were found, youths with MoID showed the highest level of stability, persistence and onset across informants. Mean levels of parent-reported, but not teacher-reported, problem behaviour, regardless of level of intellectual disability, decreased during the 5-year follow-up period. Youths with MoID and MiID are at risk for persistent psychopathology to a similar degree. Different informants showed to have a different evaluation of the level and the amount of change of problem behaviour, and should be considered complementary in the diagnostic process. © 2007 BILD Publications
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