Predictors of psychological adjustment in school-age children infected with HIV.

OBJECTIVE: To assess for significant differences in psychological functioning between HIV-infected children and a demographically matched healthy control group and to examine the utility of applying a stress and coping model to children with HIV disease. METHODS: Participants included HIV-infected children (ages 6-16) and their caregivers (n = 36) and a control group of healthy children and their caregivers (n = 32). During routine clinic visits, children completed measures of psychological adjustment, health locus of control, and coping style, and caregivers completed measures of their own and their child's psychological adjustment. RESULTS: Caregiver-reported and child self-reported psychological adjustment scores did not significantly differ between the HIV and control groups, with the exception of significantly more internalizing behavior problems reported in the control group. Hierarchical multiple regression analyses revealed that the stress and coping model accounted for 36% of the variance in HIV-infected children's self-reported psychological adjustment. In addition, child age and coping style were significant predictors of child self-reported psychological adjustment, but not of caregiver-reported child adjustment. CONCLUSIONS: Approximately 25% of children with HIV disease exhibited clinically significant emotional or behavioral problems; however, even higher rates of psychological adjustment problems were found in healthy children. Children with HIV disease who have not been told their diagnosis and children who endorse more emotion-focused coping strategies tend to exhibit more psychological adjustment problems.

Psychological adjustment in caregivers of school-age children infected with HIV: stress, coping, and family factors.

OBJECTIVE: To assess for significant differences in psychological functioning between caregivers of HIV-infected children and caregivers of healthy children, and to examine the utility of applying a stress and coping model to caregivers of children with HIV disease. METHODS: Participants included caregivers of HIV-infected children (n = 36) and caregivers of a demographically matched control group of healthy children (n = 32). During their child's pediatric clinic visits, caregivers completed measures of psychological adjustment, stress, coping style, and family resources and support. They also completed a measure of their child's psychological adjustment. RESULTS: Caregiver psychological distress scores did not significantly differ between the HIV and control groups, and clinically significant rates of psychological distress were reported by more than a third of caregivers in both groups. Hierarchical multiple regression analyses revealed that independent of their child's illness status, stress and coping style were significant predictors of caregiver's psychological adjustment. In addition, caregiver psychological distress was a significant predictor of children's maladjustment. CONCLUSIONS: High rates of psychological distress were observed in caregivers of children with HIV disease; however, similarly high rates of psychological adjustment problems were found in caregivers of healthy children. Caregivers who reported high levels of daily stress and emotion-focused coping styles tended to report more psychological distress. Further, caregivers who reported more psychological distress also reported more internalizing and more externalizing behavior problems in their children, regardless of the child's illness status. These findings reflect the impact of poverty and environmental stress on caregivers' adjustment.

Re-emergent tremor of Parkinson's disease.

OBJECTIVE: To characterise postural tremors in patients with Parkinson's disease. Rest tremor is a well recognised cardinal symptom of Parkinson's disease, but postural tremors associated with the disease may cause more disability than the more typical rest tremor. Postural tremor of Parkinson's disease has been attributed to enhanced physiological tremor, clonus, or coexistent essential tremor. It is postulated that one type of postural tremor in Parkinson's disease represents a rest tremor that re-emerges after a variable delay while maintaining posture, hence "re-emergent tremor". METHODS: Accelerometry, peak frequency, peak frequency amplitude, root mean square (RMS) amplitude, and latency were determined in 18 patients (mean age: 63.2 (SD 9.8) years) with Parkinson's disease who had clinically evident postural tremor, 20 (mean age: 66.9 (SD 5. 8) years) with typical essential tremor, and seven (mean age: 68.7 (SD 15.3) years) with the combination of pre-existing essential tremor and subsequent Parkinson's disease (essential tremor/Parkinson's disease). Latency, the time interval starting with the assumption of an outstretched posture and ending with the onset of postural tremor, was measured by marking the start time by a pulse produced from interrupting a beam to a photocell when the arm reached a horizontal position. RESULTS: The latency for the re-emergent tremor (9.37 (SD 10.66) s), present in 12 of 18 patients with Parkinson's disease, was significantly (p<0.0005) longer than the latency for postural tremor of essential tremor (1.29 s in one patient, absent in 19 others); five of seven essential tremor/Parkinson's disease patients had an observed latency (6.57 (SD 8.23 s) which was also significantly (p<0.005) longer than that for essential tremor. There was no difference in the mean tremor frequency ( approximately 5.5 Hz) between the re-emergent tremor and the more typical Parkinson's disease rest tremor. The amplitudes were generally higher for the postural tremor associated with Parkinson's disease compared with those of essential tremor. CONCLUSION: These studies suggest that the re-emergent tremor of Parkinson's disease can be differentiated from the postural tremor of essential tremor and that it may share pathophysiological mechanisms with the more typical rest tremor.

Use of botulinum toxin in the treatment of hand dystonia.

Forty-six patients with hand dystonia, considered disabling despite optimal pharmacologic therapy, were injected in the forearm musculature with botulinum A toxin. Thirty of these patients were followed long enough to provide adequate data for analysis of 86 treatment sessions. There was a 63% female preponderance, with an average age at initial evaluation of 46 years and symptom duration of 7.9 years. Average baseline severity of dystonia was rated as 3.5 on a severity rating scale (0-4 rating; 4 = maximum severity). The average peak effect response for all injections (79 into wrist flexors and 29 into wrist extensors) was 2.2 for dystonia and 3.0 for pain (0-4 rating; 0 = no response, 4 = maximum benefit). The latency from injection to onset of effect averaged 5.6 days. Total response duration averaged 9.3 weeks and maximum improvement was 7.5 weeks. Only local complications occurred and consisted primarily of hand weakness (25 patients, 44 sessions). The results show that botulinum toxin injections effectively control hand dystonia in instances where other forms of therapy have failed.

Psychosocial support of trauma patients in the emergency department by nurses, as indicated by communication.

OBJECTIVE: To test the hypothesis that a difference exists between the perception of the nurse and that of the observer regarding the extent of verbal and nonverbal communication that occurs between nurses and trauma victims (and their families) in the emergency setting. DESIGN AND SETTING: Typical descriptive design study completed in a large metropolitan emergency and trauma center in central Michigan. METHODS: Verbal and nonverbal interaction between nurses and trauma victims and their families were observed by one of two researchers and scored with the Moore-Schwartz Data Collection Tool. The nurses then self-reported these same items. RESULTS: Significant differences existed between the researchers' scores and the nurses' self-report scores. This was demonstrated by the Spearman Rank Correlation Coefficient (0.2361, p = 0.05), the Wilcoxon Signed-Ranks Test (61.50, p = 0.0004), and the test (-3.35, p = 0.01). The Spearman Rank Correlation Coefficient also demonstrated significant relationships between the nurses' self-report scores and age (0.3716, p = 0.05), gender (-0.360, p = 0.05), and educational level (-0.4209, p = 0.05). No relationship was found between the nurses' self-report scores and the trauma score or age of the patient, or years of emergency department nursing experience. CONCLUSION: Nurses report that they are communicating verbally and nonverbally with trauma victims and their families in the emergency setting, but often were not observed to be doing so. Emergency nurses may not be delivering the holistic care and psychosocial support that they believe they are.

Longitudinal experience with botulinum toxin injections for treatment of blepharospasm and cervical dystonia.

We performed a longitudinal analysis of the effects of repeat botulinum toxin (BTX) injections in 42 patients with blepharospasm (BL) and 115 patients with cervical dystonia (CD) who received BTX injections between 1984 and 1992 in at least five separate treatment sessions. Although the BL patients were significantly older (59.8 years) than the CD patients (50.6 years; p < 0.001), there were no other demographic differences between the two groups. While the total dose per treatment session and the peak effect rating remained the same, the duration of benefit increased and the number of complications decreased during the course of treatment. We concluded that chronic treatment with BTX in patients with BL and CD is not associated with any decline in benefit, and that efficacy may improve slightly with repeat treatments.

Clinical correlates of response to botulinum toxin injections.

We studied 242 patients with cervical dystonia who had adequate follow-up after botulinum toxin injections to determine which clinical variables had a predictive value in the treatment outcome. Twenty-one patients (16%) categorized as nonresponders were compared with 113 patients (47%) considered to be definite responders. On average, the nonresponders had symptoms for 14 years longer than responders. Seventy-eight of 100 patients with complications were female compared with 54% of 190 patients without complications. In addition, patients with complications weighed less than those without complications. Both findings suggest that the occurrence of complications is related to smaller mean neck muscle mass. Botulinum toxin antibodies were detected in 35.7% of the nonresponders tested and in none of the responders. This comprehensive analysis of outcome variables leads us to conclude that patients with a long duration of dystonia before their first botulinum toxin injection respond less well than those with a short duration of symptoms, that some patients lose their responsiveness because of the development of blocking antibodies, and that women are more likely to develop complications, such as dysphagia and neck weakness, than are men.

Injection-corrosion-lavage. Techniques for study and description of vascular anatomy in the hand.

The venous anatomy of the human hand has not been accurately described. Two main reasons for this deficiency in our knowledge are apparent: technical difficulties involved with dissection and imaging of the vessels, and the seemingly limitless number of topographic patterns in this field. This paper introduces firstly, a method for injection and corrosion of hand specimens, and secondly, a routine for describing the venous anatomy, primarily based on their function, and only secondarily on their position or topography.

Free flap circulation and modes of arterial insertion: an experimental study.

Using electromagnetic flowmetry, the circulation through free flaps was studied in an experimental animal model. It was demonstrated that the total circulation of blood through a free flap is not affected by the establishment of an arterial through-flow or end-flow model in the recipient bed.