Mean Standardized Scores Research Articles

Ratings of Physician Communication by Real and Standardized Patients

Patient ratings of physician's patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. We assessed physician communication using a modified version of the Health Care Climate Questionnaire (HCCQ) among a sample of 100 community physicians. The HCCQ measures physician autonomy support, a key dimension in patient-centered communication. For each physician, the questionnaire was completed by roughly 49 real patients and 2 unannounced standardized patients. Standardized patients portrayed 2 roles: gastroesophageal disorder reflux symptoms and poorly characterized chest pain with multiple unexplained symptoms. We compared the distribution, reliability, and physician rank derived from using real and standardized patients after adjusting for patient, physician, and standardized patient effects. There were real and standardized patient ratings for 96 of the 100 physicians. Compared with standardized patient scores, real-patient-derived HCCQ scores were higher (mean 22.0 vs 17.2), standard deviations were lower (3.1 vs 4.9), and ranges were similar (both 5-25). Calculated real patient reliability, given 49 ratings per physician, was 0.78 (95% confidence interval [CI], 0.71-0.84) compared with the standardized patient reliability of 0.57 (95% CI, 0.39-0.73), given 2 ratings per physician. Spearman rank correlation between mean real patient and standardized patient scores was positive but small to moderate in magnitude, 0.28. Real patient and standardized patient ratings of physician communication style differ substantially and appear to provide different information about physicians' communication style.

Intelligence test scores and birth order among young Norwegian men (conscripts) analyzed within and between families

The present paper reports the results of a within and between family analysis of the relation between birth order and intelligence. The material comprises more than a quarter of a million test scores for intellectual performance of Norwegian male conscripts recorded during 1984–2004. Conscripts, mostly 18–19 years of age, were born to women for whom almost complete reproductive histories were obtained. Women with single births only 1967–1998 and first birth 1967–1976 were selected for analyses. The grand mean stanine score for intellectual performance standardized for age and calendar year was 5.05 (SD = 1.80). The mean standardized score decreased with size of sibship and with higher birth orders in all sibship sizes. These patterns as well as the size of the difference between birth orders 1 and 3 were rather similar between and within families. Among 63 951 adjacent sibling pairs the mean standardized scores were 5.18 (95% confidence interval [CI]: 5.16, 5.19) for the elder and 4.93 (95% CI: 4.91, 4.94) for the younger brother. The difference in mean of standardized scores between adjacent siblings was − 0.251 (95% CI: − 0.270, − 0.231). The difference in mean standardized scores between brothers of adjacent birth orders increased with higher maternal level of education, was highest between brothers of married women, higher with paternal income and decreased with sibship size and longer spacing between births.

Certification and Education

To determine whether wound care certification and education affect nursing knowledge. This study examined pressure ulcer knowledge among registered nurses who were (1) certified in wound care, (2) certified in specialty areas other than wound care, or (3) not certified in any specialty area. A convenience sample of 460 nurses, located in both urban and rural areas, provided demographic information and completed a standardized pressure ulcer knowledge test using (Pieper Pressure Ulcer Knowledge Tool). The mean standardized test score for the total sample was 78%, with nurses certified in wound care scoring 89%, nurses certified in specialties other than wound care scoring 78%, and nurses receiving no certification scoring 76.5%. Wound care certification and education significantly affect nursing knowledge.

The Correlation of Specific Orthopaedic Features of Polyostotic Fibrous Dysplasia with Functional Outcome Scores in Children

Polyostotic fibrous dysplasia has a wide clinical spectrum, with substantial variation between patients in terms of orthopaedic manifestations, including the number of fractures, the degree of deformity of the limbs, and the presence of scoliosis. Data from bone scans, skeletal surveys, and records were correlated with the Pediatric Outcomes Data Collection Instrument scales to examine whether any specific facet of orthopaedic involvement could be related to functional abilities. All patients who were sixteen years of age or younger and who were part of an ongoing natural history study of polyostotic fibrous dysplasia (including McCune-Albright syndrome) were sent an age-appropriate Pediatric Outcomes Data Collection Instrument outcomes tool. The medical records and radiographs of the patients who returned forms were reviewed. Radiographic measurements of scoliosis, the femoral neck-shaft angle, and limb deformities were then performed. The extent of skeletal involvement with polyostotic fibrous dysplasia (disease burden) was assessed on bone scans with use of a validated tool. A chart review was performed to determine the fracture rate, the use of bisphosphonates, and the endocrine status. These measurements were correlated with the Pediatric Outcomes Data Collection Instrument scores. The outcomes tool was sent to twenty-seven patients and the completed instrument was returned by twenty patients, for a response rate of 74%. The parent-child form was filled out for twelve patients and the parent-adolescent form was filled out for eight patients. The mean standardized Pediatric Outcomes Data Collection Instrument scores for all twenty patients were lowest for sports (62; range, 14 to 100) and happiness (72; range, 25 to 100). Adolescents and parents disagreed with regard to sports (with adolescent scores being higher than parental scores) and pain (with parental scores being higher than adolescent scores). However, the overall global scores correlated well between the parents and the adolescents (r = 0.78, p = 0.03). The femoral neck-shaft angle correlated strongly with the Pediatric Outcomes Data Collection Instrument score for sports (r = 0.46, p = 0.03) but not for transfers. The bone scan scores for the lower extremity disease burden correlated with both the transfer scale (r = 0.76, p = 0.03) and the sports scale (r = 0.77, p = 0.02). Deformity of the limbs, the presence of scoliosis, the prevalence of endocrine dysfunction, and the number of fractures did not correlate with the Pediatric Outcomes Data Collection Instrument scores. In patients with polyostotic fibrous dysplasia, the loss of the normal femoral neck-shaft angle and the disease burden in the lower extremities appear to have the greatest effect on functional activity as measured with the Pediatric Outcomes Data Collection Instrument tool.

THE CORRELATION OF SPECIFIC ORTHOPAEDIC FEATURES OF POLYOSTOTIC FIBROUS DYSPLASIA WITH FUNCTIONAL OUTCOME SCORES IN CHILDREN

Background: Polyostotic fibrous dysplasia has a wide clinical spectrum, with substantial variation between patients in terms of orthopaedic manifestations, including the number of fractures, the degree of deformity of the limbs, and the presence of scoliosis. Data from bone scans, skeletal surveys, and records were correlated with the Pediatric Outcomes Data Collection Instrument scales to examine whether any specific facet of orthopaedic involvement could be related to functional abilities. Methods: All patients who were sixteen years of age or younger and who were part of an ongoing natural history study of polyostotic fibrous dysplasia (including McCune-Albright syndrome) were sent an age-appropriate Pediatric Outcomes Data Collection Instrument outcomes tool. The medical records and radiographs of the patients who returned forms were reviewed. Radiographic measurements of scoliosis, the femoral neck-shaft angle, and limb deformities were then performed. The extent of skeletal involvement with polyostotic fibrous dysplasia (disease burden) was assessed on bone scans with use of a validated tool. A chart review was performed to determine the fracture rate, the use of bisphosphonates, and the endocrine status. These measurements were correlated with the Pediatric Outcomes Data Collection Instrument scores. Results: The outcomes tool was sent to twenty-seven patients and the completed instrument was returned by twenty patients, for a response rate of 74%. The parent-child form was filled out for twelve patients and the parent-adolescent form was filled out for eight patients. The mean standardized Pediatric Outcomes Data Collection Instrument scores for all twenty patients were lowest for sports (62; range, 14 to 100) and happiness (72; range, 25 to 100). Adolescents and parents disagreed with regard to sports (with adolescent scores being higher than parental scores) and pain (with parental scores being higher than adolescent scores). However, the overall global scores correlated well between the parents and the adolescents (r = 0.78, p = 0.03). The femoral neck-shaft angle correlated strongly with the Pediatric Outcomes Data Collection Instrument score for sports (r = 0.46, p = 0.03) but not for transfers. The bone scan scores for the lower extremity disease burden correlated with both the transfer scale (r = 0.76, p = 0.03) and the sports scale (r = 0.77, p = 0.02). Deformity of the limbs, the presence of scoliosis, the prevalence of endocrine dysfunction, and the number of fractures did not correlate with the Pediatric Outcomes Data Collection Instrument scores. Conclusions: In patients with polyostotic fibrous dysplasia, the loss of the normal femoral neck-shaft angle and the disease burden in the lower extremities appear to have the greatest effect on functional activity as measured with the Pediatric Outcomes Data Collection Instrument tool.

Domestic violence against women in Taiwan: their life-threatening situations, post-traumatic responses, and psycho-physiological symptoms. An interview study

The purpose of this study is to examine the following three aspects of domestic violence by men against women, and to look for possible correlations between them: life-threatening situations, post-traumatic responses, and psycho-physiological symptoms. A survey interview was used to collect data on abused women recruited from the Kaohsiung area in southern Taiwan. 109 out of 127 subjects completed the structured questionnaires. The findings showed that the medium- and high-risk groups of life-threatening situations accounted for 82.6% of all subjects, and 93.6% of all subjects were in a high score group of post-traumatic responses. Among the 10 symptom dimensions of psycho-physiological symptoms, anxiety had the highest standardized mean score, followed by obsession, depression, and somatization. The life-threatening situations had significant positive correlation with the overall post-traumatic responses, the responses of intrusion, and the general severity index (GSI). Overall post-traumatic responses, intrusion, and avoidance were all positively associated with GSI. This study provides evidence to healthcare professionals that they should not only treat the physical injuries of abused women, but must also learn how to assess and adequately attend to their mental health problems.

Post-traumatic Responses of Abused Women to Marital Violence

The objectives of this study were to explore the post-traumatic responses of abused women to marital violence and to examine the correlation between these responses and demographics. This study aimed to raise awareness of post-traumatic responses in abused women among health care providers, who are supposed to pay more attention to this problem. A cross-sectional survey-interview with structured questionnaires was used. Subjects were recruited from the Kaohsiung area. Of the 127 women who participated in this study, 109 (85.8%) completed the questionnaires. The most frequent post-traumatic response was: "I had a strong feeling toward this thing." The least frequent response was: "I felt it seemed that this thing had never happened or it was not true." The standardized mean score of the intrusion subscale (3.12) was higher than that of the avoidance subscale (1.84). The more children an abused woman had, the fewer avoidance responses she exhibited. Of the abused women, 93.6% had a high post-traumatic response score (> or = 19). The results indicate that marital violence leads to post-traumatic responses in abused women in Taiwan. The results can help health care providers to identify post-traumatic responses of abused women at an early stage and can also provide information for planning further treatment strategies for abused women.

Smoking and functional status among Medicare managed care enrollees

Background Smoking is a major determinant of health status and outcomes. Current smoking has been associated with lower scores on the Short Form-36 Health Survey (SF-36). Whether this occurs among the elderly and disabled Medicare populations is not known. This study assessed the relationships between smoking status and both physical and mental functioning in the Medicare managed-care population. Methods During the spring of 1998, data were collected from 134,309 elderly and 8640 disabled Medicare beneficiaries for Cohort 1, Round 1 of the Medicare Health Outcomes Survey. We subsequently used these data to calculate mean standardized SF-36 scores, self-reported health status, and prevalence of smoking-related illness, by smoking status, after adjusting for demographic factors. Results Among the disabled, everyday and someday smokers had lower standardized physical component (PCS) and mental component (MCS) scores than never smokers (−2.4 to −4.5 points; p <0.01 for all). Among the elderly, the lowest PCS and MCS scores were seen among recent quitters (−5.1 and −3.7 points, respectively, below those for never smokers; p <0.01 for both), but current smokers also had significantly lower scores on both scales. For the elderly and disabled populations, MCS scores of long-term quitters were the same as nonsmokers. Similar patterns were seen across all eight SF-36 scales. Ever smokers had higher odds of reporting both less-than-good health and a history of smoking-related chronic disease. Conclusions In the elderly and disabled Medicare populations, smokers report worse physical and mental functional status than never smokers. Long-term quitters have better functional status than those who still smoke. More effort should be directed at helping elderly smokers to quit earlier. Smoking cessation has implications for improving both survival and functional status.

Quality of life complements traditional outcome measures in immune-mediated polyneuropathies.

To determine whether quality of life complements traditional outcome measures in immune-mediated polyneuropathies using the Medical Outcome Study 36-item short-form health status scale (SF-36). The validity, reliability, and responsiveness of the SF-36 were also analyzed. SF-36 and three other measures (Medical Research Council sumscore, sensory sumscore, and Hughes functional scale) were assessed in 114 stable patients (83 with Guillain-Barré syndrome (GBS), 23 with chronic inflammatory demyelinating polyneuropathy (CIDP), eight with a gammopathy-related polyneuropathy) and serially in 20 patients with recently diagnosed GBS (n = 7) or CIDP (n = 13) with changing conditions. The SF-36 values were compared with reported healthy Dutch community scores (controls). The SF-36 validity and reliability were examined by correlation and regression studies with the other measures and by calculating its internal consistency. The standardized response mean and effect size techniques were applied to determine its responsiveness. In the stable group, all SF-36 scores were substantially lower (indicating worse clinical condition) compared with control subjects (p < 0.0001). Improvement in the longitudinal group resulted in a gradual shift of all SF-36 scores toward normal values. Acceptable validity and internal consistency values and moderate to good standardized response mean and effect size scores were demonstrated for the SF-36. The Medical Research Council sumscore and sensory sumscore explained SF-36 values only partially. The SF-36 as a generic health status complemented traditional strength and sensory measures in patients with immune-mediated polyneuropathies and appears to be a potentially valuable instrument for measuring quality of life in these conditions.

Reactions of Rp-Resistant, Processing Sweet Corn Hybrids to Populations of Puccinia sorghi Virulent on Corn with the Rp1-D Gene

Resistance to Puccinia sorghi Schwein. based on the Rp1-D gene has been used successfully in North America for the past 15 years to control common rust on sweet corn (Zea mays L.). The objective of this preliminary research was to examine rust reactions of Rp-hybrids grown for processing in the midwestern United States against biotypes of P. sorghi virulent against Rp1-D. In Sept. 1999, isolates of P. sorghi virulent on corn with the Rp1-D gene were collected throughout the midwestern United States. Rust reactions of 41 Rp-resistant, processing sweet corn hybrids and nine non-Rp hybrids were evaluated during the 1999-2000 season in Argentina, Hawaii, Mexico, and South Africa, where populations of P. sorghi are virulent against Rp1-D. Sporulating uredinia were observed on all hybrids in all locations. Although rust reactions varied among locations, mean standardized scores of nine non-Rp hybrids that were included in the trial as controls ranked nearly the same as in previous trials. Thirteen hybrids with standardized scores above 0.25 were more susceptible than the hybrid with the lowest mean rust rating, `Green Giant Code 27'. Thirty-two hybrids were intermediate in reaction to P. sorghi virulent against Rp1-D. Reactions were moderately resistant for nine hybrids with mean standardized scores below -0.50, including two moderately resistant, non-Rp hybrids (`GG Code 27' and `GG Code 6') that were included as controls. Additional trials are necessary to confirm reactions of these hybrids. If the Rp-hybrids that were moderately susceptible or susceptible in this trial are infected by P. sorghi virulent against Rp1-D, secondary inoculum will be abundant and infection will be severe if the weather is wet.

Assessing medical students' awareness of and sensitivity to diverse health beliefs using a standardized patient station.

To assess students' performances on a health-beliefs communication OSCE station to determine whether there were differences in cultural competence based on the students' ethnic backgrounds. A total of 71 students completed a health-beliefs communication OSCE station in which they were required to address the health beliefs and cultural concerns of a standardized patient (SP) portraying an African American woman with diabetes. The SPs rated students' performances on a ten-item interview assessment checklist. Scores on the station were standardized within SPs to adjust for differences in their use of the rating scale. A factor analysis was performed to determine conceptual constructs on the interview assessment checklist. Subscale means were computed for each student. T-tests of these subscale scores were conducted to investigate gender and ethnic differences between subgroups of students. The underrepresented minority (URM) students (five African Americans and three Mexican Americans) were compared with all other students, and the white students were compared with all others. To assess the magnitudes of the differences between subgroups, effect sizes (ES(m)) were computed for means comparisons. Factor analysis formed two factors: Disease Beliefs and Management, and Cultural Concerns. Two remaining items loaded on a third factor that had reliability too low to support further analysis. Meaningful differences were found in cultural sensitivity based on students' ethnic backgrounds. The URM students performed better than did all other students in addressing the patient's concerns about altering culturally-based dietary behaviors for diabetes self-care [URM students' mean standardized score (SD) = 0.42 (0.15); all others = -0.01 (0.67); ES(m) = 1.05]. White students performed better than did all other students in assessing the patient's concerns about using insulin to control her blood sugar levels [white students' mean standardized score (SD) = 0.13 (0.40); all others = -0.10 (0.64); ES(m) = 0.4]. Cultural competency deficits and differences were measurable using a health-beliefs communications station, and these differences were meaningful enough to warrant faculty discussion and research about how to ensure that students master this competency.

Assessing grip strength in healthy individuals and patients with immune‐mediated polyneuropathies

Grip strength reference values for a portable dynamometer, the hand-held Vigorimeter, were calculated, and its validity, reliability, and responsiveness were examined in patients with immune-mediated polyneuropathies. We studied 530 healthy controls (age 5–93 years), 113 patients with stable polyneuropathy (83 with Guillain-Barré syndrome [GBS], 22 with chronic inflammatory demyelinating polyneuropathy [CIDP], and 8 with a gammopathy-associated polyneuropathy), and 20 patients with GBS or CIDP and changing clinical conditions (longitudinal group). An arm-disability scale was also assessed. Grip-strength reference values were calculated depending primarily on age and gender. Significant association was obtained between the Vigorimeter and the arm scale (in stable group, Spearman rank: r = −0.52 to −0.62; P ≤ 0.0005; in longitudinal group, linear regressions: r = 0.62–0.64, P < 0.0001). Good interobserver and intra-observer agreements (analysis of variance, r = 0.95–0.97) and high responsiveness (standardized response mean scores ≥ 0.8) were demonstrated for the Vigorimeter. These results emphasize the clinical usefulness of the Vigorimeter, particularly in patients with immune-mediated polyneuropathies. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 1393–1401, 2000.

Assessing grip strength in healthy individuals and patients with immune-mediated polyneuropathies.

Grip strength reference values for a portable dynamometer, the hand-held Vigorimeter, were calculated, and its validity, reliability, and responsiveness were examined in patients with immune-mediated polyneuropathies. We studied 530 healthy controls (age 5-93 years), 113 patients with stable polyneuropathy (83 with Guillain-Barré syndrome [GBS], 22 with chronic inflammatory demyelinating polyneuropathy [CIDP], and 8 with a gammopathy-associated polyneuropathy), and 20 patients with GBS or CIDP and changing clinical conditions (longitudinal group). An arm-disability scale was also assessed. Grip-strength reference values were calculated depending primarily on age and gender. Significant association was obtained between the Vigorimeter and the arm scale (in stable group, Spearman rank: r = -0.52 to -0.62; P </= 0.0005; in longitudinal group, linear regressions: r = 0.62-0.64, P < 0.0001). Good interobserver and intra-observer agreements (analysis of variance, r = 0.95-0.97) and high responsiveness (standardized response mean scores > or = 0.8) were demonstrated for the Vigorimeter. These results emphasize the clinical usefulness of the Vigorimeter, particularly in patients with immune-mediated polyneuropathies.

Sources of acute stress and their appraisals and reappraisals among Australian police as a function of previous experience

Two studies investigated possible factors that are associated with experiencing acute stress in police work. Occupational acute stressors in law enforcement were identified by police officers in Study 1 (N = 39). Using standardized mean (Z) scores as the dependent variable, MANOVA indicated that four of the 17 acute stressors identified in Study 1 were significantly different than the remaining stressors in terms of their combined intensity and frequency. The purpose of Study 2 was to examine the intensity of primary and secondary appraisal and reappraisal of police officers (N = 95) related to these previously identified stressful events, and the extent to which these measures differed as a function of experience in the police force. An adapted version of the Stress Appraisal Measure (SAM) measured police officers' primary appraisals, secondary appraisals, reappraisals, and overall stress perceptions that were associated with these four acute stressors. Multiple regression analyses indicated that two primary appraisal dimensions, threat and challenge, were significant predictors of overall stressfulness, with centrality found as an important appraisal dimension. MANOVA revealed that years of experience as a police officer influenced the extent of the officers' beliefs that they could cope with stressful events.

Psychologic functioning, quality of life, and behavioral compliance in patients beginning hemodialysis.

Psychologic and demographic characteristics have been shown to correlate with behavioral compliance in studies of prevalent hemodialysis (HD) patients. Few data, however, exist on the psychologic characteristics or their relationship to compliance in patients initiating HD treatment, or incident patients. Our previous work with prevalent HD patients showed an interrelationship among social support, perception of the effects of illness, and depression measured by a standardized depression index and a cognitive depression index deleting somatic symptoms. To compare psychosocial and behavioral compliance parameters in incident and prevalent patients, 99 incident HD patients undergoing dialysis for less than 6 months were assessed by using a variety of questionnaires. The patients' mean standardized depression index score was in the range of mild depression. There was no difference in mean age, Karnofsky functional status, perception of effects of illness or standardized or cognitive depression scores between incident patients and 149 prevalent patients treated with HD for 6 to 246 months. Satisfaction with life scores and perception of sexual adjustment were better, but Kt/V (quantitative measure of the amount of dialysis provided) and protein catabolic rate were lower in incident than in prevalent patients. Social support and perception of illness scores correlated with depression measures in incident patients, findings that were similar to prevalent patients. Incident (as did prevalent) patients showed striking bivariate correlations between the psychosocial and depression variables, but fewer correlations between psychologic and compliance measures. Both standard compliance parameters, such as mean predialysis serum phosphorus and potassium concentration, and behavioral compliance were better in incident than in prevalent patients. Worsened sexual adjustment, functional status, and increased severity of illness were correlated with improved behavioral compliance in incident patients. Behavioral compliance styles correlated with different social support and severity of medical illness variables in incident and prevalent patients, when assessed by multiple linear regression analysis. These different patterns suggest the existence of different mechanisms of adaptation in the groups. Measures focused on increasing delivery of dialysis and enhancing social support in urban African-American patients starting HD therapy may be useful in improving compliance with the dialysis prescription, and indirectly improving survival.

Nested Subset Analyses of Colonization-Dominated Communities: Metazoan Ectoparasites of Marine Fishes

Communities have a nested subset structure if the species comprising depauperate assemblages represent non-random subsets of progressively richer communities. Nestedness results from differential extinction probabilities, differential dispersal and colonization probabilities, nested environmental tolerances, or facilitated succession. Previous research suggests that the frequency of significant nestedness, and the degree of nestedness as measured by a standardized index, C, should be greater for extinction-dominated communities than colonization-dominated communities. To test these hypotheses, we conducted nestedness analyses on 38 communities of metazoan gill and head ectoparasites infecting different species of marine fishes. Extinction, environmental tolerances and niche space, and interspecific interactions do not significantly influence the structure of these ectoparasite communities. As such, they provide an appropriate system in which to examine the frequency and degree of nestedness in colonization-dominated assemblages relative to extinction-structured communities. Using two common analyses, we found that nestedness in these ectoparasite communities was rare (1 of 38 communities after a conservative Bonferroni correction for multiple comparisons). However, the mean standardized nestedness score (C = 0.483 ± 0.243) was not significantly different from the mean nestedness score of extinction-structured communities reported in the literature. Therefore, although these communities do seem less nested than extinction-dominated communities (from the frequency analysis), the C statistic is unable to distinguish these groups. Also, neither the frequency of significant nestedness nor mean standardized C scores were related to mean water temperature, host habitat (benthic, pelagic, or benthopelagic), host trophic level (herbivore, planktivore, predator, or omnivore), or whether or not the host is a schooling species. These results confirm previous conclusions stating that these communities are largely random, unstructured assemblages.

The Consequences of a Positive Prenatal HIV Antibody Test for Women

As more women of childbearing age are affected by the human immunodeficiency virus (HIV), many providers have demanded routine perinatal HIV screening, arguing that the medical benefits of testing outweigh the socioeconomic, medical, and psychological risks of a positive HIV test for women. In this primarily urban poor population, we used a semistructured interview to evaluate differences in health care discrimination, economic losses, risk behaviors, relationships changes, and psychological status in 20 HIV-positive and 20 HIV-negative mothers matched for HIV risk, race, income, and delivery date. Many (35%) seropositive and no seronegative women cited health care discrimination due to HIV status. Although seropositive women reported greater satisfaction with social support from friends (100%) and family (80%), many women had not disclosed their HIV status to any friends (65%) or family (25%), indicating fear of abandonment. Only 56% of HIV positive and 44% of seronegative women knew their partners' HIV status, and many HIV-positive and HIV-negative women reported having sex without condoms after the HIV test. Mean standardized anxiety (p < 0.05) and depression scores were higher in seropositive women. Despite added social support and medical treatments, HIV-positive women showed higher levels of health care discrimination, personal isolation, and psychological sequelae than their seronegative counterparts. As the medical benefits to prenatal HIV testing increase, we will need to develop focused medical, social, and mental health services addressing the needs of HIV-positive women.

Final attained height in patients successfully treated for childhood acute lymphoblastic leukemia

We evaluated final adult height in 109 patients treated for childhood acute lymphoblastic leukemia on two multiarm Pediatric Oncology Group protocols between 1974 and 1981. Fifty-one patients received 2400 cGy cranial irradiation (XRT), and 58 patients received no XRT. All patients had no central nervous system involvement at diagnosis, achieved and maintained a complete response, entered puberty spontaneously, and had achieved final height. Height data were converted to standardized deviation scores. Mean age at diagnosis was 7.8 +/- 4.2 years. Distribution of heights at diagnosis was similar to that of the U.S. population. Relative to gender-specific heights for the population, female subjects in this study had lower attained heights than male subjects (p = 0.03). There was a monotonic trend of patients treated at an earlier age to have a reduction in final height (p = 0.057). Cranial irradiation was strongly associated with final height (mean standardized deviation score with XRT = -1.04 and without XRT = -0.14; p < 0.001). Final height was not associated with age at diagnosis, prognostic risk group, or Pediatric Oncology Group protocol. By multivariate analysis, only XRT and XRT x age were significantly associated with final height (p < 0.001 and p = 0.002, respectively). There was no significant gender effect. We conclude that XRT is significantly associated with reduced final adult height after treatment for childhood acute lymphoblastic leukemia. For survivors, therapy devoid of XRT does not appear to affect final height.

The Vineland Adaptive Behavior Scale in a Sample of Normal French Children: a Research Note

The Vineland Adaptive Behavior scale (survey form) was used in a sample of 151 normal children under age 18. Standardized mean scores of French children were comparable to those of the American normative sample. From the age of 6 onwards, French children scored consistently lower in the Daily Living Skills domain though the magnitude of this difference remained moderate. While the overall findings support the cross-cultural stability of the psychometric properties of this instrument, attention is drawn to potential problems in the use of the Vineland scales, with special reference to autistic samples.

Cocaine/Polydrug Use in Pregnancy

CHASNOFF, IRA J.; GRIFFITH, DAN R.; FREIER, CATHERINE; MURRAY, JAMES Author Information