Excess use of general practitioners by obese adults: does health-related quality of life account for the association?

As general practitioners (GP) are seeing, and are likely to continue to see, increasing numbers of obese patients in their practices, it is relevant to know with which needs these patients enter general practice. The present study aims to determine whether besides physical comorbidities, health-related quality of life (HRQOL) accounts for associations of obesity with GP use. In a general population survey in Augsburg, Germany (KORA-Survey S4 1999/2001), anthropometric body mass (BMI in kg/(m(2))), physical comorbidities, HRQOL (the 12-item Short Form; SF-12), and visits to GP were assessed, and analyzed by logistic and zero-truncated negative binomial regressions (two-part model). Gender, age, socio-economic status, marital status, health insurance, and place of residence were adjusted for. The sample consisted of N = 942 residents aged 25 - 74, who had been randomly sampled from 17 cluster-sampled communities, and were either normal-weight, overweight, moderately obese, or severely obese. The moderately obese group had higher odds than the normal-weight to report any GP use; however, while being predictive, neither physical comorbidity nor HRQOL mediated this. In contrast, with regard to number of GP visits among users, the severely obese group (BMI >/= 35) reported significantly more visits than the normal-weight group, and both physical comorbidity and physical (but not mental) HRQOL accounted for this. In conclusion, physical comorbidity and HRQOL mediate excess use of GP by severely obese users in terms of number of visits. Thus, for this group, subjective physical health seems to be important besides physical comorbidities, suggesting for general practice to focus both on evaluated and perceived needs of these patients.     

Attachment representations in mothers of preterm infants

The aim of the study was to assess attachment representations in mothers of preterm infants using the Working Model of Child Interview (WMCI) at the 12 months of the infant's corrected age. In addition, the relation between WMCI representation categories and the Edinburgh Postnatal Depression Scale score at 6 months of the infant's corrected age was studied. There were 38 mothers of preterm infants (<1500 g or <32 gestational weeks) and 45 mothers of full-term infants. The results showed no differences between the study groups in the distribution of the three main representation categories (balanced, disengaged and distorted). However, there were qualitative differences in representations between the groups. Furthermore, maternal depression symptoms were associated with distorted representation category. We suggest that despite the qualitative differences in the mothers’ representations, mothers of preterm infants are as likely to form balanced attachments with their infants as mothers of full-term infants.     

Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted. Principal Investigators and Coinvestigators of Longitudinal Assessment of Manic Symptoms (LAMS) Group are listed in Appendix.     

H.R.成人成套神经心理测验在我国的修订

本文是修订Halstead—Reitan成套神经心理测验(H·R·B)成人本的总结。从15个省市取样,正常组885名,脑病组350例。根据测验结果按性别和年龄制定了各分测验的划界分,按划界分计算了两组受试的损伤指数(DQ)。并制定了脑病损的诊断和定侧的标准。按此标准对样本病人进行了脑损伤的诊断和定侧。诊断符合率为80.3％,右侧病损的符合率为70.8％,左侧为45.7％。分测验的重则相关系数分别为0.93—0.39。     

4—11岁儿童数学概念稳定性的发展的研究

设计了四组试验项目,每组3或5个难度不同的项目,在掩盖操作和不掩盖操作条件下分别检查儿童数、长度、面积、体积等概念的稳定性。全国13个地区每地区以“临床法”个别试验4—6岁儿童每年龄组30人,或7—11岁儿童每年龄组20—30人。总的结果初步表明:儿童数学概念的稳定性随年龄而发展,表现于解答课题的成绩和解答过程的认知水平两个方面。数学概念稳定性的发展因课题的类型和难易而异其先后。数学稳定性在不掩盖操作条件下表现高于在掩盖操作条件下。在不掩盖操作演示的启发下,掩盖操作条件下的成绩有提高。这两者都是在相应数学概念正处于发展中的阶段比较明显。在文化条件相等的情况下未发现儿童数学概念稳定性的民族差异和性别差异。儿童数学概念稳定性发展的顺序似乎是数、长度、面积、体积。作者认为,数学概念从不稳定到稳定有一个发展过程;稳定性本身不是绝对的,而是有条件的,并非出现于特定的年龄。     

The Impact of First-Grade “Friendship Group” Experiences on Child Social Outcomes in the Fast Track Program

Many interventions for childrens behavior problems successfully utilize a group format for social skills training, providing opportunities for practice and performance feedback from peers. Recent studies however, suggest that grouping aggressive children together may reduce intervention effectiveness or even increase risk. The present study examined the relative impact of childrens own behavior and their experiences with peers in the first-grade friendship groups of Fast Track, a multi-component preventive intervention program. Two-hundred sixty-six children (56% minority, 29% female) participated in 55 friendship groups. Childrens own positive and negative behavior in friendship groups was related to relative improvements in social cognitive skills, prosocial behavior, and aggression, assessed through child interviews, teacher ratings, and peer sociometric nominations. Results from hierarchical linear models also revealed that the amount of peer escalation children received for their disruptive behavior during sessions impeded some intervention gains, whereas mere exposure to other childrens positive or negative behavior was rarely related to outcomes.Members of the Conduct Problems Prevention Research Group are, in alphabetical order, Karen L. Bierman, Pennsylvania State University; John D. Coie, Duke University; Kenneth A. Dodge, Duke University; E. Michael Foster, Pennsylvania State University; Mark T. Greenberg, Pennsylvania State University; John E. Lochman, University of Alabama; Robert J. McMahon, University of Washington; and Ellen E. Pinderhughes, Tufts University