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Descriptors:
Child Abuse; Child Care; Medical Services; Mothers; Mental Disorders; Clinical Diagnosis; Chronic Illness; Symptoms (Individual Disorders); At Risk Persons; Fathers; Parent Child Relationship; Health Services

Abstract:
Although child maltreatment due to abuse or neglect is pervasive within our society, less is known about fabricated or induced illness by carers (FII), which is considered to be a rare form of child abuse. FII occurs when a caregiver (in 93% of cases, the mother) misrepresents the child as ill either by fabricating, or much more rarely, producing symptoms and then presenting the child for medical care, disclaiming knowledge of the cause of the problem. The growing body of literature on FII reflects the lack of clarity amongst professionals as to what constitutes FII, the difficulties involved in diagnosis, and the lack of research into psychotherapeutic intervention with perpetrators. This lack of clarity further complicates the identification, management and treatment of children suffering from FII and may result in many cases going undetected, with potentially life-threatening consequences for children. It has been suggested that there is a national under-reporting of fabricated or induced illness. In practice these cases are encountered more frequently due to the chronic nature of the presentations, the large number of professionals who may be involved and the broad spectrum including milder cases that may not all require a formal child protection response. Diagnosis of fabricated disease can be especially difficult, because the reported signs and symptoms cannot be confirmed (when they are being exaggerated or imagined) or may be inconsistent (when they are induced or fabricated). This paper highlights and discusses the controversies and complexities of this condition, the risks to the child and how it affects children; the paucity of systematic research regarding what motivates mothers to harm their children by means of illness falsification; how the condition should be managed and treated for both mother and child; and implications for policy and practice. (Contains 1 table and 1 note.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Attention Deficit Hyperactivity Disorder; Social Environment; Anxiety; Clinical Diagnosis; Personal Narratives; Adults; Psychological Patterns; Self Concept

Abstract:
This study systematically analyzed life stories of adults with attention-deficit hyperactivity disorder (ADHD) who were diagnosed in adulthood, using an adapted version of Labov's textual-analysis method. These life stories provided an opportunity to examine the processes experienced by these individuals before and after the diagnosis of ADHD, from their perspective. The results indicate that the narrators experienced repeated failures in many aspects of life. Many of them internalized negative views to which they have been subjected to in their social environment. Consequently, they developed self-blame that subsequently further hampered their functioning. Once diagnosed with ADHD, these adults were able to construct a more coherent view of their life and of their difficulties, move beyond guilt, and understand that they could overcome their challenges. Consequently, many of them began to take a more positive view of themselves and of the course of their lives, and to admit to some positive aspects of having ADHD. (Contains 1 table.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Identification; Risk; Posttraumatic Stress Disorder; Severity (of Disability); Predictor Variables; Symptoms (Individual Disorders); Clinical Diagnosis; Employees; Banking; Victims of Crime; Cutting Scores; Measures (Individuals)

Abstract:
Unfortunately, the number of bank robberies is increasing and little is known about the subsequent risk of posttraumatic stress disorder (PTSD). Several studies have investigated the prediction of PTSD through the presence of acute stress disorder (ASD). However, there have only been a few studies following nonsexual assault. The present study investigated the predictive power of different aspects of the ASD diagnosis and symptom severity on PTSD prevalence and symptom severity in 132 bank employees. The PTSD diagnosis, based on the three core symptom clusters, was best identified using cutoff scores on the Acute Stress Disorder scale. ASD severity accounted for 40% and the inclusion of other risk factors accounted for 50% of the PTSD severity variance. In conclusion, results indicated that ASD appears to predict PTSD differently following nonsexual assault than other trauma types. ASD severity was a stronger predictor of PTSD than ASD diagnosis. (Contains 4 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Mental Disorders; Mental Retardation; Drug Therapy; Evaluation Methods; Clinical Diagnosis; Comparative Analysis; Behavior Patterns; Patients; Outcomes of Treatment

Abstract:
This article describes a psychotropic PRN Evaluative Tool developed by interprofessional clinicians to address inconsistent reporting and assessment of the effectiveness of PRN medications used for people who are developmentally disabled. Fifty-nine participants (37 males, 22 females), ages 16 to 60 years, were included in the review, all diagnosed with an intellectual disability and a serious mental illness. Participants' range of intellectual disability varied from severe to mild. The review was conducted over a 2-year period. Data was evaluated by comparing differences in a number of patient pre and post behaviors after having received PRN medication. Results indicated a statistically significant decrease in the total number of post-PRN behavior variables observed compared with the pre-PRN behavior variables. This tool has improved patient outcomes through the reduction of unnecessary and/or ineffective PRNs by providing a more thorough assessment of the effectiveness of PRN medications and thereby reducing subjective and ambiguous language. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Science Activities; Science Instruction; Science Laboratories; Physiology; Biology; Research Design; Student Motivation; Problem Based Learning; Case Method (Teaching Technique); Symptoms (Individual Disorders); Animals; Veterinary Medicine; Clinical Diagnosis; Problem Solving

Abstract:
Students are provided with a mystery concerning dogs that are paralyzed. This motivates a laboratory exercise to measure parameters from the dog's "blood" to determine whether the paralysis is due to pesticide poisoning or an autoimmune attack on nerve myelin. Most of the materials are available from the grocery store. The real-world nature of the problem, and the mystery, engages the students in thinking about nerve, muscle, and immune system function. Alternative versions require less familiarity with physiology and can be used as engagement activities to encourage learning laboratory skills and experimental design or as motivation for learning nerve and muscle physiology. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Foreign Countries; Case Studies; Plants (Botany); Agronomy; Rural Extension; Clinical Diagnosis; Validity

Abstract:
Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based on five validation criteria applied on the ten most common crops. Quality of advice was assessed for the four major problems considering efficacy and feasibility. Findings: The quality of diagnoses varied between crops, from 68% completely validated in maize to 1% in tomato. Complete and partially validated diagnoses were 44% of all queries. The remaining 56% were rejected. Several basic weaknesses were found in data recording and symptom recognition. A greater consistency and precision in naming diseases would increase the number of completely validated diagnoses. The majority of recommendations (82%) were assessed "partially effective". "Best practice" was recommended for 10% and ineffective advice was given in 8% of the cases with considerable variation between diseases. Practical implications: Plant doctors need more training in symptom recognition, pest management and record keeping as well as better technical backstopping to solve unknown problems. Common standards and procedures for clinic data collection and analysis should be established, and roles and responsibilities clearly defined. Originality/value: This is the first time plant clinic registers have been used to systematically assess quality of plant clinic services. Apart from being a valuable tool for quality assessment of extension, the plant clinic registers constitute a novel source of regular information about pests, diseases and farmer demand that can help improve decision-making of extension service providers, researchers, plant health authorities as well as information and technology providers. (Contains 8 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Therapy; Mental Health; Counseling Techniques; Severity (of Disability); Client Characteristics (Human Services); Quasiexperimental Design; Intervention; Mental Health Programs; Adventure Education; Gender Differences; Age Differences; Clinical Diagnosis; Scores; Behavior Change; Counseling Effectiveness; Predictor Variables

Abstract:
Background: There is an increasing need to identify effective mental health treatment practices for children and adolescents in community-based settings, due to current mixed findings of existing interventions. This study looked at adventure therapy (AT) as a viable option to meet this need. Objective: Using a sample of 1,135 youth from a community-based mental health center, this study addressed the following questions: (1) Is AT an effective treatment modality for youth compared to traditional counseling? (2) How do changes in problem severity associated with participation in AT-based interventions compare with those associated with traditional counseling across gender, age, primary diagnosis, and race? (3) What are the predictors of changes in problem severity in clients? Methods: In this exploratory non-equivalent groups quasi-experimental design study, pre- and post- mean scores of problem severity as reported by youth's primary clinician were compared by type of treatment and client characteristics. Treatment and client characteristics were used as predictors of changes in problem severity. Findings: Participants in AT had significant reported mean decreases in problem severity larger than those of clients not involved in counseling with an adventure component with larger decreases in female and African American clients. AT and psychological counseling were found to be significant predictors of decreases in problem severity; however, length of counseling, not length of AT, was a significant predictor. Discussion: These findings suggest that community-based AT may be a viable treatment for youth in community settings; yet these findings should be interpreted with caution due to several study limitations. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Assistive Technology; Experiential Learning; Older Adults; Medical Education; Research Methodology; Nonverbal Communication; Nursing Homes; Clinical Diagnosis; Student Attitudes; Longitudinal Studies; Patients; Barriers; Medical Students; Outcomes of Education; Educational Gerontology

Abstract:
The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living) was piloted in 2006 as an experiential medical education learning model. Since its inception, medical and other health professions students have been "admitted" into nursing homes to live the life of an older adult nursing home resident for approximately 2 weeks--24 hours a day/7 days a week--complete with a medical diagnosis and "standard" procedures of care. The Learning by Living Project applies qualitative ethnographic/autobiographic research methods to collect students' perspectives and experiences about life lived as an older adult with functional challenges in a residential setting. To date, all students have completed their extended stay successfully and felt that this experiential learning project provided life-altering medical education. Longitudinal data reveals that students' maintain patient-centered attitudes and skills such as the use of eye contact, touch, body position, and voice cadence. Barriers to working with older adults are decreased; understanding is gained by "wheeling a mile in an older person's wheelchair." Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Females; Birth Order; Family Size; Males; Clinics; Clinical Diagnosis; Children; Socioeconomic Background; Questionnaires; Referral; Age Differences; Human Body; Medicine

Abstract:
Background: Nocturnal Enuresis (NE) is one of the most prevalent childhood disorders and has significant negative psychosocial impact on the child and family. Objective: To assess the characteristics of children with NE and trends over a 15-year period. Methods: The study included 18,677 children [11,205 (60%) boys and 7,472 (40%) girls] referred to a network of clinics specializing in treatment of voiding problems (Age range: 4-12 years; Mean age = 7.06) between the years 1995-2009. We analyzed socio-demographic characteristics and trends over time using a standard questionnaire administered in the clinics. Results: Over the course of the 15-year period, children were referred to treatment at a younger age (Mean age 1st period = 7.52, Mean age 2nd period = 7.12, Mean age 3rd period = 6.71) and the likelihood of referrals of younger children (4-5 years) increased (1st period = 24.5%; 2nd period = 33.6%; and 3rd period = 41.9%). More children were referred during winter than summer or transition seasons. The higher prevalence of boys was maintained across this period. In addition, girls had 34% higher chance to suffer from primary NE compared to boys and had 12% higher chance to suffer from NE only compared to boys. Birth order and children's age predicted NE type (primary/secondary) and in addition to family size also predicted enuresis pattern (NE only/combined NE and Diurnal Enuresis). Conclusions: The findings of this largest study on children referred for NE treatment provides a wider understanding of important associated factors to this phenomenon. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Foreign Countries; Probability; Males; Heart Disorders; Diabetes; Followup Studies; Clinical Diagnosis; Older Adults; Medical Evaluation; Death; Cancer; Mortality Rate; Risk; Multivariate Analysis

Abstract:
Purpose: Of all Canadian and American men who live to age 75 years, about half can expect to live to age 85. Our objective is to examine how clinical diagnoses made before age 75 relate to a man's survival to age 85 years. Design and Methods: Since 1948, a cohort of 3,983 young men (mean age of 31 years at entry) has been followed with routine contact and medical examinations to prospectively document incident disease. Over 62 years of follow-up, 2,414 of the cohort lived to celebrate their 75th birthday. Of these survivors, 1,060 (44%) died before their 85th birthday. Cox proportional hazard models were used to examine the effects of ischemic heart disease, cancer, cerebrovascular disease, diabetes mellitus, peripheral arterial disease, and chronic obstructive pulmonary disease on all-cause mortality between age 75 and 85 years. Results: Modeled as six binary risk factors at age 75 years, all were significantly (p less than 0.01) and independently related to 10-year mortality. Multivariate risk ratios ranged from 1.36 to 1.46 except for chronic obstructive pulmonary disease with a risk ratio of 1.85 (95% CI: 1.38, 2.49). The cumulative 10-year probability of survival from age 75 to 85 among men with none of these diagnoses was 63%, 52% for any one diagnosis, 39% for two diagnoses, and 22% for three or more diagnoses. Implications: Joint independence of these six common clinical diagnoses implies that each is important and their effects on mortality are cumulative. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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