Managing juvenile idiopathic arthritis within the context of their life: What we learnt from children and youth living with juvenile idiopathic arthritis and their parents.

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and causes short- and long-term disability. Optimal management requires pharmacologic and non-pharmacologic interventions. Few studies have explored the youth and family experience of the management of JIA. This study's objective was to explore the management experience of youth with JIA and their parents. METHODS: This qualitative study used semi-structured interviews with youth 12-18 years of age with JIA receiving biological medication and parents of children with JIA on biological medication. Participants were recruited in clinics using convenience sampling. A thematic analysis approach was employed for data analysis. RESULTS: Nine youth and 14 parents participated. Four themes were identified that encompassed an overarching theme of participants managing JIA within the context of their life: aspects of life affected by JIA and its management, lived experience with JIA management, medication decision-making, and involvement in decision-making. Juvenile idiopathic arthritis management is situated within the context of their life but is normally (outside acute events) not central. CONCLUSION: Two dimensions were added to those in the literature: parents' overall approaches to health and the sense of urgency surrounding decision-making. Our findings reinforce the importance of person- and family-centred care in paediatric rheumatology. That is, identifying what matters most to youth and their parents given their current life circumstances to provide a foundation for discussions of how they want to manage their JIA.

Women on the editorial boards of major journals.

PURPOSE: To determine the percentages of women on the editorial boards of general and specialty medical journals in comparison with the numbers of women physicians in the journals' respective specialties. METHOD: The numbers of women editors, deputy editors, assistant editors, and members of editorial boards of 12 major journals in 1999 were counted and compared with the percentages of women physicians in the journals' specialties, as published by the American Medical Association. RESULTS: Parity between the percentages of women on editorial boards of specialty journals and women physicians in the journals' specialties was found for five journals. Only one journal had more women on the editorial board than there were women physicians in the specialty. CONCLUSIONS: Fewer than half of the journals studied had parity between the percentages of women members of editorial boards and the percentages of women physicians in the specialties. Parity should be maintained to accurately reflect the numbers of women physicians in these fields.

Assessment of state and trait anxiety in subjects with anxiety and depressive disorders.

The State-Trait Anxiety Inventory (STAI) is one of the most widely used scales for the evaluation of anxiety in medical and, to a lesser extent, psychiatric patients. Although there is a relatively large amount of STAI data about anxiety for individuals with a variety of psychiatric disorders, the results of many anxiety studies include only state or trait and many studies have been influenced by comorbidity and by variations in diagnostic criteria used. We studied state and trait anxiety and compared the revised form of the STAI (Form Y) with the original (Form X) to evaluate the anticipated improvement in the measure. In addition, we compared the STAI results with those of another self-report measure (the Symptom Checklist-90 anxiety and depression scales) and also with interviewer-rated measures of anxiety (Hamilton Rating Scale for Anxiety) and depression (Hamilton Rating Scale for Depression). Results indicate that the STAI does not clearly differentiate anxiety disorders from depressive disorders and support the use of multiple tests and of both self-report and interviewer ratings in the evaluation of anxiety and depression in psychiatric patients.

Defense styles and Personality dimensions of research subjects with anxiety and depressive disorders.

We used the Bond Defense Style and Cloninger Tridimensional Personality questionnaires to assess defense styles and personality dimensions in subjects with anxiety and depressive disorders. When measured against a comparison group, maladaptive defense style scores were significantly higher in those with major depression, panic disorder, generalized anxiety disorder, and social phobia, and higher at a trend level in the subjects with obsessive-compulsive disorder and mixed anxiety and depression. However, there were no differences in adaptive defense style scores between the subjects and the comparison group. The harm avoidance personality dimension scores were significantly higher in subjects with both anxiety and depressive disorders than in the comparison group. The harm avoidance scores correlated positively with the maladaptive defense scores, but negatively with the adaptive defense scores. These findings are discussed in terms of severity of illness, level of functioning, and relationships between Axis I and II disorders.

The ability of the Symptom Checklist SCL-90 to differentiate various anxiety and depressive disorders.

We studied the use of the Symptom Checklist-90 (SCL-90) to differentiate between specific anxiety and depressive disorders and/or their symptoms in 280 patients with 6 DSM-III-R diagnoses: major depression (MD), panic disorder (PD), generalized anxiety disorder (GAD), social phobia (SP), obsessive-compulsive disorder (OCD), and mixed anxiety and depression (MAD). Using a comparison group, we found specific patterns for some of the diagnostic categories. Both the MD and MAD subjects had significantly high paranoid ideation, interpersonal sensitivity, hostility, and psychoticism, as well as high depression subscale scores; those with PD and GAD has the highest anxiety and somatization scores; and those with SP or OCD had a mixed pattern. When ranking the severity of psychopathology, the disorders ordered from most to least were MAD, MD, PD, GAD, SP, and OCD. Subsyndromal levels of symptoms frequently were associated with the various conditions. Use of the SCL-90 subscale helps to enlarge our understanding of the various anxiety and depressive disorders.

Derivation and pilot assessment of a health promotion program for Mandarin-speaking Chinese older adults.

As the percentage of older adults of diverse ethnicities increases in the United States, the call for culturally sensitive health care service strategies that target the special needs of older people grows. The present report describes methods used to adapt a health care program so that it would better meet the needs of a group of well, older Mandarin-speaking Chinese residents of Los Angeles. The specific qualitative research procedures that we used to adapt the treatment program are described, along with the particular adaptations that emerged. Additionally, outcomes from a randomized pilot experiment are presented that are consistent with the notion that the adapted program was effective in reducing health-related declines among older Mandarin-speaking men and women. The overall outcome of this project is in agreement with other reports in the health care literature that address the importance of providing culturally sensitive health care service for elders.

Assessment of locus of control in patients with anxiety and depressive disorders.

We studied Levenson's Internal (I), Powerful Others (P), and Chance (C) locus of control scales in 193 patients with six DSM-III-R diagnoses: Major Depression (MD), Panic Disorder (PD), Generalized Anxiety Disorder (GAD), Social Phobia (SP), Obsessive Compulsive Disorder (OCD), and Mixed Anxiety Depressive Disorder (MAD). Compared to the comparison groups (CG), we found specific patterns for some of the diagnostic categories. There were no significant differences between the I scale scores and of those in the different anxiety and depressive disorder groups and the CG. But, patients with MD, SP, or MAD had significantly higher P scale scores than the CG. Patients with MD, PD, SP, and MAD had higher C scale scores than the CG. The OCD patients had the lowest P and C scale scores of any of the groups and not significantly different than the CG. The findings have some research and clinical implications.

Utilization of medical specialists by anxiety disorder patients.

The purpose of this study was to determine the utilization of medical specialists by anxiety disorder patients. The setting was a university's clinical outpatient drug trails for anxiety disorders. The participants were subjects identified by advertisement and diagnosed by psychiatric interviews and, in some instances, also by structured interviews. The main outcome measures were the subject responses on a questionnaire listing medical specialists. A total of 94 subjects were surveyed. Primary care physicians (family medicine and internal medicine) were seen more often by panic disorder (PD) subjects than by obsessive-compulsive disorder (OCD) or generalized anxiety disorder (GAD) subjects. Gastroenterologists were seen most frequently by the GAD subjects; dermatologists and cardiologists by the OCD subjects; and otolaryngologists, obstetricians-gynecologists, neurologists, and urologists by the PD subjects. The PD subjects saw more specialists than the subjects with the other disorders. Medical specialists need to increase identification of patients with various anxiety disorders to relieve suffering, improve health care practices, and obtain favorable cost:benefit ratios.

Self-inflicted eye injuries: case presentations and a literature review.

OBJECTIVE: The authors' aim was to determine demographic and clinical correlates of self-inflicted eye injury. METHODS: The authors reviewed 41 cases of patients with self-inflicted eye injuries identified through MEDLARS searches of medical literature for the period from 1980 to 1993 and four cases from the first author's clinical practice. RESULTS: Most patients with self-inflicted eye injuries were male, about 31 years old, and had a diagnosis of schizophrenia, drug or alcohol abuse, depressive disorders, or other psychosis. Some patients experienced cognitive distortions, often involving religious and sexual ideation, and intense fear around the time they injured themselves. Thirty-three percent of the patients with self-inflicted eye injuries also showed other types of self-injurious behavior. CONCLUSIONS: Enucleation of the eye may serve as a defense against witnessing or experiencing a forbidden act. Psychodynamic theories addressing self-mutilation do not explain self-induced eye injury particularly well but may assist the therapist in understanding motivation and in restructuring patients' behavior. Management of these patients requires multidisciplinary, multimodal efforts involving medical specialists, patients, family members, and staff.

Factors compelling psychiatric hospitalization in crisis.

At a time in a large community mental health center when all adjunct facilities were geared for crises, the compelling determinants in those patients still requiring hospitalization were studied. It was found that all patients answered affirmatively to one or more of the following six categories as occurring in their prehospital life: 1) alcohol abuse; 2) other drug abuse; 3) suicidal attempt; 4) a recent loss; 5) stoppage (or reduction) of medication; 6) stoppage of outpatient treatment. It was found that those patients diagnosed schizophrenic (69 per cent) did not significantly differ in the number of affirmative answers given in each of the six categories when compared to the total patient population. The most frequent categories to which an affirmative answer was given were stoppage of medication and stoppage of outpatient treatment. There did appear to be a trend for various combinations of these categories in a give patients. The schizophrenic group tended to have more affirmative answers in combinations of categories 3 and 4. The importance of these findings in the hospitalization and follow-up treatment of psychiatric patients is discussed.

Inotropic actions of lignocaine and phenytoin.

1. The inotropic effects of two antiarrhythmic drugs, lignocaine and phenytoin, were studied in electrically driven isolated rabbit atrial preparations. The time-effect relationship of each drug was investigated with different concentrations and frequencies of stimulation.2. The effects of time of exposure, drug concentration and heart rate on the development of beat alterations (cessation of beat, skipped beat, alternating variation of force of contraction and extrasystole) were also studied.3. When the chronotropic effects of both drugs were prevented, the inotropic effects were positive or negative depending on the concentration of drug, time of exposure and frequency of stimulation.4. At concentrations higher than those obtained in the blood of man on maintenance doses, alteration of the beat occurred but was consistent with the peak blood concentrations immediately after the injection of standard clinical doses. The time of onset of beat alteration shortened when either drug concentration or frequency of stimulation was increased.5. The beat alteration produced by antiarrhythmic drugs can account for various adverse effects associated with their clinical use. These effects include transient ventricular tachycardia and extrasystole during and shortly after injection of drug, ventricular tachycardia, ventricular fibrillation and cardiac arrest due either to excessive dose or to persistent tachyarrhythmia if the dose is not excessive.