After an initial period of adjustment, children with IDDM have equivalent psychosocial status to children without IDDM, but by 2 years after diagnosis, they have experienced twice the amount of depression and adjustment problems as their peers. Interventions should be aimed at this critical period between 1 and 2 years postdiagnosis.
Obesity is a significant risk factor for hypertension and the cardiovascular sequelae of hypertension. Weight loss has been shown to be effective in lowering blood pressure in overweight individuals. The purpose of this study was to show the impact of a weight loss intervention on overall medication requirements for obese, hypertensive patients. This was a substudy of the Hypertension Optimal Treatment (HOT) study. HOT study patients who had a body mass index > or =27 kg/m2 were randomized to receive either the weight loss intervention, which included dietary counseling and group support, or to serve as the control group. Patients' weights and number of medication steps (per HOT protocol) required to achieve target diastolic blood pressure were measured at 3, 6, 12, 18, 24, and 30 months. Patients in the weight loss group lost significantly more weight than the control group only at 6 months (-3.2+/-4.3 v. -1.8+/-2.7 kg [mean +/- SD] for weight loss group versus control, respectively, P = .05). The weight loss group tended to regain weight after the first 6 months of the study. However, patients in the weight loss group used a significantly fewer number of medication steps than the control group at all time intervals except 3 months. Weight loss appears to be a useful tool in blood pressure management in patients who require medication to control their blood pressure.
The aim of this investigation was to determine the contributions of coping behaviors used at diagnosis to medical (metabolic control) and psychosocial adjustment (self-perceived competence; adjustment) 1 year later. A total of 89 children (8 to 14 years of age; 48% male; 59% White) received follow-up quarterly from diabetes diagnosis to 1 year later. Findings indicated that, in general, although metabolic control worsened over the first year, psychosocial status and coping behaviors were stable. Boys had worse metabolic control than girls. Multiple regression analysis indicated that self-worth at 1 year postdiagnosis was associated with less use of spirituality (beta = -.44), more use of humor (beta = .28), and more positive self-care (beta = .28); and self-care was less likely to be positive in older children (r = .32). These variables accounted for 47% of the variance (39% adjusted) in general self-worth when entry self-worth was controlled. Poorer overall adjustment at 1 year postdiagnosis was associated with more use of avoidance behaviors (beta = -.47) and poorer self-care (beta = -.71); and more use of avoidance was associated with older age. These variables accounted for 62% of the variance (58% adjusted) in adjustment when adjustment at diagnosis was controlled. Poorer metabolic control was associated with more use of avoidance (beta = .30) and female gender (beta = .39), and avoidance behaviors were more common in older children (beta = .12). This model predicted 33% of the variance (25% adjusted) in metabolic control 1 year after diagnosis.
Physical affection was selected as an important aspect of family functioning that could be affected by characteristics of illness, including exacerbations, fatigue, and functional status. However, fatigue and functional status did not explain the perception of physical affection during an exacerbation.
Hyperactivity is a potentially confusing concept with different terminology and history in Europe and the U.S.A. There is a certain amount of suspicion among U.K. practitioners as to whether it is appropriate to recognise it as a primary condition. Perhaps because of this, assessment procedures vary between practitioners and centres. Using our experience of running a specialist overactivity and attention disorders clinic (now defunct) at St George's Hospital, London we draw together recommendations for the assessment of this serious clinical problem.
Hyperactivity is a potentially confusing concept with different terminology and history in Europe and the U.S.A. There is a certain amount of suspicion among U.K. practitioners as to whether it is appropriate to recognise it as a primary condition. Perhaps because of this, assessment procedures vary between practitioners and centres. Using our experience of running a specialist overactivity and attention disorders clinic (now defunct) at St George's Hospital, London we draw together recommendations for the assessment of this serious clinical problem.
User interface development systems for software environments have to cope with the broad, extensible and dynamic character of such environments, must support internal and external integration, and should enable various software development strategies. The Chiron-1 system adapts and extends key ideas from current research in user interface development systems to address the particular demands of software environments. Important Chiron-1 concepts are: separation of concerns, dynamism, and open architecture. We discuss the requirements on such user interface development systems, present the Chiron-1 architecture and a scenario of its usage, detail the concepts it embodies, and report on its design and prototype implementation.
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