Although social skills group interventions for children with autism are common in outpatient clinic settings, little research has been conducted to determine the efficacy of such treatments. This study examined the effectiveness of an outpatient clinic-based social skills group intervention with four high-functioning elementary-aged children with autism. The group was designed to teach specific social skills, including greeting, conversation, and play skills in a brief therapy format (eight sessions total). At the end of each skills-training session, children with autism were observed in play sessions with typical peers. Typical peers received peer education about ways to interact with children with autism. Results indicate that a social skills group implemented in an outpatient clinic setting was effective in improving greeting and play skills, with less clear improvements noted in conversation skills. In addition, children with autism reported increased feelings of social support from classmates at school following participation in the group. However, parent report data of greeting, conversation, and play skills outside of the clinic setting indicated significant improvements in only greeting skills. Thus, although the clinic-based intervention led to improvements in social skills, fewer changes were noted in the generalization to nonclinic settings.
Adolescents' health attitudes and adherence to treatment for insulin-dependent diabetes mellitus (IDDM) were evaluated using the protection motivation theory (PMT). We expected cognitive appraisals of adherence (self-efficacy for treatment management, response efficacy of treatment, response costs of adherence) to be more influential for adherence than appraisals of nonadherence (rewards of nonadherence, perceptions of the risks of nonadherence, perceived severity of the risks). Adolescents (N = 101) with IDDM completed self-report measures of treatment adherence and of the PMT variables. Hierarchical regression analyses revealed that cognitions concerning adherence explained a statistically significant proportion of the variance in treatment adherence (sr2 = .17). Response costs of adherence produced the strongest correlations with overall adherence and with three of the four individual components of IDDM treatment (insulin injections, blood glucose monitoring, diet). The findings suggest that persuasive health communications might focus on appraisals of adherence rather than on risks of nonadherence.
Diabetic patients have been shown to excrete increased quantities of albumin, which is undetectable by conventional albumin antibodies (immunounreactive) using high-performance liquid chromatography (HPLC) (1). Furthermore, the lead time for the development of microalbuminuria (albumin excretion rate [AER] Ͼ20 g/min) measured by HPLC has been shown to occur 3.9 and 2.4 years earlier than that determined by radioimmunoassay (RIA) for type 1 and type 2 diabetic patients, respectively (2). This study not only identified that progression from normo-to microalbuminuria is associated with an increase in urinary immunounreactive albumin, but also raises the possibility that measurement of total albumin (immunoreactive plus immunounreactive) may allow earlier detection of progression to kidney disease.The aim of this study was to determine whether a group of type 2 diabetic patients with a low glomerular filtration rate (GFR) of Ͻ60 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2 , as measured by a single-injection isotopic technique using 99m Tc-DTPA (3), and normoalbuminuria, as measured by RIA, excrete increased quantities of immunounreactive albumin. Total albumin was measured by HPLC analysis (1,2), and immunoreactive albumin was measured by RIA on two to three consecutive urine samples collected from 38 type 2 diabetic patients attending the Austin & Repatriation Medical Centre, Victoria, Australia. Patients who had recurrent urinary tract infections or hematuria, known nondiabetic renal disease, or severe intercurrent illness, such as a malignancy or symptomatic cardiac failure, were excluded from the study.The major finding of this study is that 24% (9 of 38) of patients had an AER Ͼ20 g/min and 37% (14 of 38) of patients had an AER Ͼ15 g/min, as measured by HPLC, in comparison with RIA analysis, which detected 0% (0 of 38) of patients with an AER Ͼ20 g/min and 13% (5 of 38) of patients with an AER Ͼ15 g/min. There was no significant difference between HPLC and RIA analysis of albumin in urine from nondiabetic subjects (1). These results identify that type 2 diabetic patients with a GFR Ͻ60 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2 , and therefore presumably some form of kidney dysfunction, have an increased prevalence of urinary immunounreactive albumin. The possible pathogenesis of increased urinary immunounreactive albumin in these patients is limited given the absence of renal ultrastructural data. In fact, there is a paucity of information available regarding the renal morphology of normoalbuminuric patients with type 2 diabetes, regardless of their GFR. Nevertheless, the discrepancy between the HPLC and immunochemical assays demonstrates that conventional albumin assays may provide a relatively late diagnosis of incipient kidney disease at a threshold of 20 g/min.The combination of impaired renal function and normoalbuminuria in patients with diabetes was first highlighted by Lane et al. (4). For healthy nondiabetic individuals, the rate of decline in GFR with age has been reported to range from 0.6 to 1.0 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2⅐ year Ϫ1 (5). We ...
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