Higher Levels Of Problems Research Articles

Acknowledging Alcohol Problems

Despite the frequent mention of denial in the alcohol treatment literature, there appears to be no consensus about its measurement. At its most basic, an operational definition of the term should contain the notion of the drinker refusing to acknowledge or at least minimizing the role of alcohol in his or her difficulties. Visual analogue scales provide a technique for measuring subjective experiences of this type. Subjects from a community-based voluntary agency and an alcohol treatment unit were asked to indicate the magnitude of their problems with alcohol on this scale. Both groups acknowledged high levels of problems with alcohol. Despite this, there was evidence of systematic bias in that half of the sample underestimated the severity of their drinking in comparison to an interviewer's rating using the same scale. A small group was identified that seemed to fit the stereotype of the alcoholic "denier" mentioned so frequently in the treatment literature. There was no relationship between "denial" and subsequent compliance with treatment.

Psychosocial Adjustment of Children with Short Stature (Achondroplasia): Social Competence, Behavior Problems, Self-Esteem, Family Functioning, Body Image, and Reaction to Frustrations

While mythical elfin figures, dwarfs, and leprechauns have fired the imagination of story tellers for centuries, the social adjustment of short children with growth retardation lacks the fairy tale luster, and the economic, social, and psychological impact of their body size often result in deviant and marginal status (Ablon, 1985). Growth retardation, a major universal clinical problem, is caused by a great variety of en docrine, genetic, and chronic illnesses, and Ablon (1988) refers to more than 100 types of differing etiology and physical characteristics. According to Rimoin and Lachman (1983), more than 80 specific cases of skeletal dysplasias and primary disorders of the bone struc ture result in short stature. Regardless of etiology, early literature described children with short stature as a single group and studies of personality characteristics have generally por trayed them as psychologically maladjusted (Young-Hyman, 1986). Holmes, Karlsson, and Thompson (1988), in a brief review of psychological adjustment problems of short stature, list more internalizing behavior problems, a greater number of somatic complaints and with drawal, less aggressive and dominant behaviors than their peers of average stature. Parents report high levels of problems related to internalizing and externalizing behavior and their teachers describe more internalization at school (Holmes, Hayford, & Thompson, 1982). Low self-esteem, high degree of social isolation, withdrawal, immaturity, and distur bance of body image are listed by Richman, Gordon, Tegtmeyer, Grouthamel, and Post (1986). The notion of psychological maladjustment of children with short stature has been chal lenged by Drotar, Owens, and Gotthold (1980) who report no significant differences in gen eral psychological adjustment, sex role development, or body image maturity between growth hormone-deficient children and a matched control group, and by Stabler and Underwood (1977) who found no significant differences in locus of control as anxiety in chil dren with the same etiology. Gordon, Grouthamel, Post, and Richman (1982) warned that since children with hypopituitarism represent less than 1% of the short children, the findings were not generalizable to children with short stature of different etiologies. These re searchers compared a group of children with constitutional short stature with children of nor mal height, both groups without a previous history of psychiatric difficulties, and found that children with constitutional short stature had significantly more behavior problems and less self-esteem than their matched control. The children with constitutional short stature were socially withdrawn and aloof individuals who expressed emotional concerns internally and tended to view themselves less favorably than children of normal height. Children with short stature were reported to be equally satisfied with their physical appearance. These divergent results may well reflect a lack of homogeneity in the adjustment process of children with short stature due to differing etiologies and to availability or nonavailability of treatment.

The relationship between alcohol dependence and alcohol–related problems in a clinical population

The relationship between alcohol dependence and alcohol-related problems was studied in a group of 103 problem drinkers. Responses to a 46-item Alcohol Problems Questionnaire (APQ) were compared with the Severity of Alcohol Dependence Questionnaire (SADQ), alcohol consumption and demographic data. A strongly positive correlation was found between aggregate problems and dependence scores (r = 0.63; p = 0.001) which existed independently of the quantity of alcohol consumed. Analysis of questionnaire subscales revealed that certain problem domains were more closely related to particular aspects of dependence than others. A higher level of problems was found in subjects of younger age and lower socio-economic class. No significant sex differences were found. The implications of these findings are discussed.

Trash Screens on Culverts in Urban Areas

ABSTRACTThis PAPER DEALS with the performance of trash screens on culverts on urban watercourses. An assessment of the scope of problems associated with screens has been obtained from a survey of land drainage authorities in urban areas in England and Wales. The findings have been analysed and this has resulted in the development of four basic design criteria for screens. A detailed survey of the performance of some 17 sites in the river Ravensbourne catchment of the Thames Water Authority was undertaken over a number of years allowing relationships to be identified between debris amounts and types of upstream catchment area, screen/culvert area ratios, and priority of location.The paper describes considerations to be taken when providing a screen and advocates an individual design for each location rather than installing a standard arrangement. The lack of practical information in the UK, and the high level of problems experienced overall underlines the need for proper consideration to be given to this subject. Current research work is being undertaken to obtain preferred efficient screen configurations, but it is concluded that this should complement rather than replace the need for good trash screen design.

Regional diversity in United States drinking practices.

SummaryRecent studies have noted significant regional changes in American patterns of alcohol use. The present paper discusses regional differences in drinking patterns, problems, attitudes, and contexts as these have emerged along with the ‘wettening’ of the previously drier Southern and Mountain states. Data come from a 1984 national survey. Results indicate the persistence of regional differences in abstention rates and in apparent consumption levels when calculated on a per‐drinker basis. The higher per‐drinker apparent consumption levels in the historically drier regions are accompanied by higher levels of problems in the categories of belligerence, accidents, and trouble‐with‐the‐police. These differences in problem rates, however, are apparent only among men, indicating an interplay between gender and region. Attitude measures do not show notable regional differences, which indicates unresolved tensions, in the drier regions, between relatively high (per drinker) consumption and relatively conservative drinking attitudes. Contextual evidence indicates that the limitation of public drinking opportunities in the drier regions is accompanied by more drinking in the home.

Influence of emotional distress among supporters on the outcome of psychogeriatric day care.

From a sample of consecutive referrals for psychogeriatric day care, the influence of the supporters' emotional distress and self-reported strain, together with the number of problems presented by the patient, was examined in relation to outcome, 6-7 months after initial attendance. A higher level of problems and the failure to achieve any reduction in reported distress were both found to contribute to the breakdown of community care and to the subsequent institutionalisation of the patient. Day hospital care was associated with a significant reduction in emotional distress for the majority of relatives, although for relatives whose distress was not alleviated by their dependents' attendance, admission to long-term care did produce such a reduction.

大腿骨頚部外側骨折の治療 Ｅｎｄｅｒ釘とＣＨＳの比較

Seventy-four patients with trochanteric fractures of the femur were treated with Ender rods and thirty-eight patients with Compression Hip Screw.Comparison was made between the two devices to acertain either of which is better.Operative blood loss was less and operative time was shorter for the Ender method than for the Compression Hip Screw. But Ender method offered high level of problems, such as backout of the rods, external rotation, varus deformity of the femoral neck, and especially knee pains.Conclusively, Compression Hip Screw system is more preferable to use in the treatment of trochanteric fractures of the femur.

Ender Rod Versus Compression Screw Fixation of Hip Fractures

Eighty-seven matched pairs of patients with extracapsular hip fractures were treated with either Ender rod or compression screw and plate fixation. The data obtained both perioperatively and from one to 39 months postoperatively showed no significant differences with respect to infection rate, mortality, length of stay, or ultimate functional status. In the Ender rod group, 66.7% of the patients experienced technical problems, compared with 10.3% of patients in the compression screw group. The Ender technique offered few practical advantages and an unacceptably high level of problems, even when patients with only stable fractures were considered.

Relationship between the course of primary alcoholism in men and family history.

Structured interviews were conducted with 453 men primary alcoholics and with up to two resource persons for each patient to investigate the association between the sex of an alcoholic parent and the course of alcoholism in the subject. Earlier and more severe alcohol-related and antisocial problems were found among subjects with any alcoholic parent than among those without an alcoholic parent. The highest level of problems was noted for subjects with both parents alcoholics. There were few differences between the sons of alcoholic fathers and the sons of alcoholic mothers but the latter demonstrated significantly more drug misuse.

Factors related to grade retention in children with short stature.

A recent study by Holmes et al. (1982) revealed a high degree (23%) of grade retention in a group of children with significant short stature secondary to growth hormone deficiency (GHD), constitutional delay (CD); or Turner's Syndrome (TS). Parents indicated in a free response format that 'immaturity' and 'small size' were the reasons for retention. The present follow-up study obtained academic achievement data on 47 of the 56 short children from the Holmes et al. (1982) study to assess what role academic factors, not spontaneously mentioned by parents, may have had in the retention decision. Results indicated that despite repeating a year in the primary grades, the group of retained children were still functioning 6 months below grade expectation, compared to grade appropriate achievement in the never-retained group. Parents and teachers were both accurate in their perceptions of children's academic achievement. Behavioural ratings by teachers indicated more adjustment difficulties for retained children, while parent ratings of behaviour showed a similar high level of problems for short children regardless of retention status. Although both groups of children possessed average intellectual abilities, the retained children obtained lower IQ scores than the never retained children. In summary, a majority of short children were achieving appropriate grade levels, but a substantial minority were experiencing under-achievement, behaviour problems, and grade retention, despite average intelligence.