bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Talking About Chance”: The Presentation of Risk Information During Genetic Counseling for Breast and Ovarian Cancer
Authors: Hallowell Nina , Statham Helen , Murton Frances , Green Jo , Richards Martin 
Published: September 2003

AbstractUsing observations, questionnaires, and interviews, this study describes the formats used to present risk information during genetic counseling for breast and ovarian cancer. Counselees' preferences for different types of qualitative and quantitative presentation formats are also discussed. The data indicate that there is considerable variation in the presentation of risk information both within and between consultations. The counselees were positive about the way the counselors had described their risk. Seventy‐three percent of the sample expressed a preference for risk to be described using quantitative formats, and there was little difference in the number who stated a preference for percentages, proportions, or population comparisons. Comparing preferred formats with those used in the consultations indicated that in over 40% of cases, risk information was not presented in the counselees' preferred quantitative format. This descriptive study raises questions about the presentation of risk information which warrant further research.
Knowledge of Breast Cancer Genetics Among Breast Cancer Patients and First‐Degree Relatives of Affected Individuals
Authors: Wonderlick Aimee L. , Fine Beth A. 
Published: September 2003

AbstractThe cloning of BRCA1, a susceptibility gene for inherited breast cancer, has made genetic screening possible for individuals and families whose medical histories are suggestive of an inherited predisposition to breast cancer. To date, few systematic attempts have been made to determine the level of knowledge about breast cancer genetics among women who are likely to seek BRCA1 screening when it becomes widely available. The present study attempted to assess the general knowledge about BRCA1 mutations in two groups: (1) first‐degree relatives (FDRs) of breast cancer patients; and (2) women with a previous diagnosis of breast cancer. A self‐administered, thirty‐item questionnaire was developed through a pilot study. Ten of the items were objective, factual questions about breast cancer genetics. Responses to these questions were used to generate an overall knowledge score for each respondent. The study population was moderately knowledgeable about breast cancer genetics, with an average score of 5.35 out of 10. Counselors should not underestimate the importance of evaluating each counselee's existing knowledge about breast cancer, which can affect the provision and reception of genetic information. In particular, specific areas of knowledge that may be confusing or misunderstood were identified and these topics are discussed in detail.
Family, School, and Community Factors and Relationships to Racial–Ethnic Attitudes and Academic Achievement
Authors: Smith Emilie Phillips , Atkins Jacqueline , Connell Christian M. 
Published: September 2003

AbstractThis study examined family, school, and community factors and the relationships to racial–ethnic attitudes and academic achievement among 98 African American fourth‐grade children. It has been posited that young people who feel better about their racial–ethnic background have better behavioral and academic outcomes, yet there is a need for more empirical tests of this premise. Psychometric information is reported on measures of parent, teacher, and child racial–ethnic attitudes. Path analysis was used to investigate ecological variables potentially related to children's racial–ethnic attitudes and achievement. Parental education and level of racial–ethnic pride were correlated and both were related to children's achievement though in the final path model, only the path from parental education level was statistically significant. Children whose teachers exhibited higher levels of racial–ethnic trust and perceived fewer barriers due to race and ethnicity evidenced more trust and optimism as well. Children living in communities with higher proportions of college‐educated residents also exhibited more positive racial–ethnic attitudes. For children, higher racial–ethnic pride was related to higher achievement measured by grades and standardized test scores, while racial distrust and perception of barriers due to race were related to reduced performance. This study suggests that family, school, and community are all important factors related to children's racial–ethnic attitudes and also to their academic achievement.
Underemployment in America: Measurement and Evidence
Authors: Jensen Leif , Slack Tim 
Published: September 2003

AbstractAn important way in which employment hardship has come to be conceptualized and measured is as underemployment. Underemployment goes beyond mere unemployment (being out of a job and looking for work), to include those who have given up looking for work, part‐time workers whose employer(s) cannot give them full‐time work, and the working poor. To provide needed background for the other articles in this special issue, we trace the history of the concept of underemployment, review existing empirical literature, offer a critique of the measurement of underemployment as conventionally operationalized, and provide up‐to‐date evidence on the trends and correlates of underemployment in the United States.
Economic Antecedents of Foster Care
Authors: Catalano Ralph , Lind Samuel , Rosenblatt Abram , Novaco Raymond 
Published: September 2003

AbstractIndividual and ecological research suggests that rising unemployment may affect the incidence of violence through two countervailing mechanisms suggested by frustration–aggression theory. The first, or provocation effect, assumes increased violence among persons who feel anger because they believe their job loss was arbitrary. The second, or inhibition effect, posits less violence among employed persons who attempt to reduce their chances of job loss by curtailing behavior objectionable to employers. The literature also reports that these mechanisms affect victimization measured as foster care sought by the state for abused children. The foster care finding, although consistent with theory and important for basic as well as applied reasons, arises from methods that cannot rule out several rival hypotheses. We revisit this research and apply improved methods to test the reported association in Los Angeles and San Francisco counties. We find that, as implied by the provocation and inhibition mechanisms, differences in monthly prevalence of foster care placements increase with modest increases in unemployment but decline when unemployment becomes much higher than usual levels.
Periodontal ultrasonography
Authors: Tsiolis Fotis I. , Needleman Ian G. , Griffiths Gareth S. 
Published: September 2003

AbstractObjectives: The aim of this study was to investigate high‐frequency ultrasound imaging for periodontal assessment.Material and methods: A newly developed ultrasonic scanner with a frequency of 20 MHz was used. Pig jaws were selected as the experimental model. Three teeth per jaw were imaged with the scanner and duplicate measurements were made of the distance from a fixed landmark on the teeth to the alveolar bone crest. These measurements were compared to transgingival and direct measurements of the same teeth following reflection of the soft tissues. One further jaw was used for histological comparison with the ultrasound image.Results: Using ultrasonography, it was possible to image the main periodontal structures. The ultrasound measurements showed better repeatability than either of the other two methods (repeatability coefficient: 0.44 mm for ultrasound, 0.93 mm for transgingival probing and 0.6 mm for direct measurements). Also, ultrasound was in better agreement with direct, open probing measurements (0.004±0.58 mm) than transgingival probing with direct measurements (0±0.7 mm).Conclusions: Ultrasonography provides a highly accurate and repeatable technique for periodontal assessment in this model.
Psychotherapies and Older Adults
Authors: Garner Jane 
Published: September 2003

Objective: To confirm clinical experience which suggests that older people are offered psychotherapies significantly less often than younger ones. For those who are able to access psychotherapeutic help the outcome is comparable, sometimes better, than for younger patients.Method: Contemporary and older seminal literature was reviewed for psychodynamic, cognitive–behavioural, reminiscence and systemic family therapies treating older patients.Results: The main findings supported the experience of staff in old age psychiatry that if the reluctance of referrers and sometimes of older patients themselves can be overcome this type of work is valuable and effective.Conclusions: Each patient is unique. Generalizations are not always appropriate, however, with advancing years some common themes emerge in therapeutic work. It may be necessary to make modifications to the therapeutic technique to accommodate the difficulties experienced by people in later life but also to use their strengths.Staff working in this field need to have the capacity to be aware of and to understand their own feelings and prejudices about the second half of life. For patients not offered formal therapy a psychotherapeutic approach will nevertheless enhance their psychiatric care.Although the body of research is growing, more work needs to be done in evaluating all of the psychotherapies offered to older people.
Borderline Personality Disorder and the Search for Meaning: An Attachment Perspective
Authors: Holmes Jeremy 
Published: September 2003

Objective: To explore the links between the attachment theory-derived concept of disorganized attachment, and the psychiatric diagnosis of borderline personality disorder (BPD). Method: Literature search for characteristics of disorganized attachment. Clinical case material from psychotherapeutic work with patients suffering from BPD. Results: Disorganized attachment can be understood in terms of an approach-avoidance dilemma for infants for whom stressed or traumatized/traumatizing caregivers are simultaneously a source of threat and a secure base. Interpersonal relationships in BPD including those with caregivers is similarly seen in terms of an approach-avoidance dilemma, which manifests itself in disturbed transference/countertransference interactions between therapists and BPD sufferers. Borderline personality disorder sufferers lack meaning in their lives because they are unable to play ‘language games’ with their potential intimates, resorting to actions rather than words to express feelings. Conclusions: Possible ways of handling these phenomena are suggested, based on Main's (1995) notion of ‘meta-cognitive monitoring’, in the hope of re-instating meaning and more stable self-structures, in these patients’ lives.
Community Study of Dementia in the Older Korean Rural Population
Authors: Je Cho Maeng , Kyu Kim Jang , Suh Guk-Hee 
Published: September 2003

Objective: This study aims to estimate the prevalence of all dementias, including Alzheimer's disease (AD) and vascular dementia (VaD) in a population of Korean elderly and to identify possible risk factors which correlated with specific types of dementia. Method: A two-phase survey, based on a door-to-door survey, was conducted. Initially, the Korean version of the Psychogeriatric Assessment Scale (PAS-K) was administered to all 1037 participants aged 65 years and older. Three hundred and seventy people sampled from the case groups (n = 320) of PAS-K subscales and the non-case group (n = 50) entered the second phase for clinical evaluation. Dementia was defined using the DSM-III-R, NINCDSADRDA and NINDS-AIREN criteria. Results: Among 1037 elderly people aged 65–94 years who completed the interview, 74 cases of dementia were detected, giving an overall age-standardized prevalence (95% CI) of 6.8% (6.1–7.5) (male 6.3%[5.3–7.4]; female 7.1% [6.1–8.0]). The prevalence (95% CI) of AD was 4.2% (3.6–4.7) (male 2.4% [2.0–2.8]; female 5.3% [4.5–6.1]), and it increased with age. The prevalence (95% CI) of VaD was 2.4% (2.0–2.8) (male 3.5% [2.7–4.3]; female 1.6% [1.2–2.1]). Smoking for longer than 30 pack-years significantly increased the risk of VaD (OR = 11.5 [2.8–44,6]). Conclusion: Long-term smoking, much more prevalent in men, may be closely related to higher risk of cerebrovascular disease that leads to vascular dementia.
A Classification Tree for Predicting Recurrent Falling in Community‐Dwelling Older Persons
Authors: Stel Vianda S. , Pluijm Saskia M. F. , Deeg Dorly J. H. , Smit Johannes H. , Bouter Lex M. , Lips Paul 
Published: September 2003

Objectives: To develop a classification tree for predicting the risk of recurrent falling in community‐dwelling older persons using tree‐structured survival analysis (TSSA).Design: A prospective cohort study.Setting: A community in the Netherlands.Participants: One thousand three hundred sixty‐five community‐dwelling older persons (≥65) from the Longitudinal Aging Study Amsterdam (LASA).Measurements: In 1995, physical, cognitive, emotional, and social aspects of functioning were assessed. Subsequently, a prospective fall follow‐up, specifically on recurrent falls (two falls within 6 months) was conducted for 3 years.Results: The classification tree included 11 end groups differing in risk of recurrent falling based on a minimum of two and a maximum of six predictors. The first split in the tree involved two or more falls versus fewer than two falls in the year preceding the interview. Respondents with two or more falls in the year preceding the interview (n=193) and with at least two functional limitations (n=98) had a 75% risk of becoming a recurrent faller, whereas respondents with fewer than two functional limitations were further divided into a group with regular dizziness (n=11, risk of 68%) and a group with no regular dizziness (n=84, risk of 30%). In respondents with fewer than two falls in the year preceding the interview (n=1,172), the risk of becoming a recurrent faller varied between 9% and 70%. Predictors in this branch of the tree were low performance, low handgrip strength, alcohol use, pain, high level of education, and high level of physical activity.Conclusion: This classification tree included 11 end groups differing in the risk of recurrent falling based on specific combinations of a maximum of six easily measurable predictors. The classification tree can identify subjects who are eligible for preventive measures in public health strategies.
Cross‐Linked Fibrin Degradation Products (D‐Dimer), Plasma Cytokines, and Cognitive Decline in Community‐Dwelling Elderly Persons
Authors: Wilson Craig J. , Cohen Harvey Jay , Pieper Carl F. 
Published: September 2003

Objectives:To investigate the effect of coagulation and inflammatory pathway activation on future cognitive decline in older persons.Design:Prospective cohort study.Setting:Rural and urban communities in North Carolina.Participants:Community‐dwelling older people enrolled in the Duke Established Populations for Epidemiologic Studies of the Elderly in 1986.Measurements:In 1992, blood was drawn for assay of D‐dimer (1,723 subjects), Interleukin‐6 (1,726 subjects), and other cytokines (1,551 subjects). Cognitive and functional assessments were performed in 1986, 1989, 1992, and 1996. Cognition was measured using the Short Portable Mental Status Questionnaire.Results:Cognitive decline over a 4‐year period was significantly correlated (P<.001) with D‐dimer, age, race, and physical performance status as measured using the Rosow‐Breslau and Nagi instruments. After controlling for demographics, functional status, and comorbidities, D‐dimer remained predictive of cognitive decline. Proinflammatory cytokines were not associated with current cognitive status in cross‐sectional analyses or with incident cognitive decline in prospective analyses.Conclusion:In a large sample of community‐dwelling elders, higher levels of D‐dimer were predictive of cognitive decline over a 4‐year period. No clinically significant associations were found between age‐related peripheral cytokine dysregulation and cognition.
Screening for Dementia by Telephone Using the Memory Impairment Screen
Authors: Lipton Richard B. , Katz Mindy J. , Kuslansky Gail , Sliwinski Martin J. , Stewart Walter F. , Verghese Joe , Crystal Howard A. , Buschke Herman 
Published: September 2003

Objectives: To develop and assess telephone‐based screening tests for dementia, especially Alzheimer's disease (AD).Design: A cross‐sectional validation study nested within a longitudinal study of aging and dementia.Setting: The Einstein Aging Study of the Albert Einstein College of Medicine, Bronx, New York.Participants: Three hundred elderly community volunteers living in Bronx County, 27 of whom were diagnosed with dementia based on in‐person clinical evaluation. Of the 27 individuals with dementia, 18 had AD.Measurements: A telephone battery was administered that included the Memory Impairment Screen by telephone (MIS‐T, a test of semantic memory), the Category Fluency Test (CF‐T), and the Telephone Instrument for Cognitive Status (TICS). An in‐person evaluation then followed that included a neurological examination, a neuropsychological battery, demographics, and medical history.Results: The telephone battery was well accepted. The MIS‐T required 4 minutes; the CF‐T, 3 minutes; and the TICS, 10 minutes. The MIS‐T had excellent sensitivity and specificity when compared with the CF‐T and the TICS. Using cutscores on all three tests that provide a sensitivity of 78%, specificity was significantly higher for the MIS‐T (93%) than for the CF‐T (78%, P<.05) or the TICS (80%, P<.05). Combining the MIS‐T and CF‐T improved discriminative validity but increased screening time and the complexity of scoring. Normative data for the MIS‐T, the CF‐T, and the TICS for use in settings with different base rates (prevalence) of dementia are presented in this study.Conclusion: The MIS‐T outperforms the CF‐T and the TICS as a valid and time‐efficient telephone screen for dementia. For applications that require optimal efficiency and accuracy, the MIS‐T is recommended.
Why Would Caregivers Not Want to Treat Their Relative's Alzheimer's Disease?
Authors: Karlawish Jason H. T. , Casarett David J. , James Bryan D. , Tenhave Tom , Clark Christopher M. , Asch David A. 
Published: September 2003

Objectives: To determine family caregivers' willingness to use Alzheimer's disease (AD)‐slowing medicines and to examine the relationships between this willingness, dementia severity, and caregiver characteristics.Design: Cross‐sectional survey.Setting: In‐home interviews of patients from the Memory Disorders Clinic of the University of Pennsylvania's Alzheimer's Disease Center.Participants: One hundred two caregivers of patients with mild to severe AD who were registered at an Alzheimer's disease center.Measurements: Subjects participated in an in‐home interview to assess their willingness to use a risk‐free AD‐slowing medicine and a medicine with 3% annual risk of gastrointestinal bleeding.Results: Half of the patients had severe dementia (n=52). Seventeen (17%) of the caregivers did not want their relative to take a risk‐free medicine that could slow AD. Half (n=52) did not want their relative to take an AD‐slowing medicine that had a 3% annual risk of gastrointestinal bleeding. Caregivers who were more likely to forgo risk‐free treatment of AD were older (odds ratio (OR)=1.7, P=.04), were depressed (OR=3.66, P=.03), had relatives living in a nursing home (OR=3.6, P=.02), had relatives with more‐severe dementia according to the Mini‐Mental State Examination (MMSE) (OR=2.29, P=.03) or Dementia Severity Rating Scale (DSRS) (OR=2.55, P=.002), and rated their relatives' quality of life (QOL) poorly on a single‐item global rating (OR=0.25, P=.001) and the 13‐item quality‐of‐life (QOL)‐AD scale (OR=0.38, P=.002). Caregivers who were more likely to forgo a risky treatment were nonwhite (OR=6.53, P=.005), had financial burden (OR=2.93, P=.02), and rated their relative's QOL poorly on a single‐item global rating (OR=0.61, P=.01) and the QOL‐AD (OR=0.56, P=.01).Conclusion: These results suggest that caregivers are generally willing to slow the progression of their relative's dementia even into the severe stage of the disease, especially if it can be done without risk to the patient. Clinical trials and practice guidelines should recognize that a caregiver's assessment of patient QOL and the factors that influence it affect a caregiver's willingness to use AD‐slowing treatments.
Prognosis Communication in Serious Illness: Perceptions of Older Patients, Caregivers, and Clinicians
Authors: Fried Terri R. , Bradley Elizabeth H. , O'Leary John 
Published: September 2003

Objectives:To examine agreement between patients, caregivers, and clinicians regarding prognosis communication and to examine patients' and caregivers' desire for prognostic information.Design: Cross‐sectional survey.Setting: Participants' homes.Participants: Two hundred fourteen persons aged 60 and older with a limited life expectancy secondary to cancer, congestive heart failure, or chronic obstructive pulmonary disease; caregivers; and clinicians.Measurements: Patient–clinician and caregiver–clinician agreement about the occurrence of prognosis discussions and patient and caregiver desire for prognostic information.Results: In 46% of patient/clinician and 34% of caregiver/clinician pairs, the clinician reported saying that the patient could die of the underlying disease, whereas the patient or caregiver reported no discussion. In 23% of patient/clinician and 30% of patient/caregiver pairs, the clinician reported discussing an approximate life expectancy, whereas the patient or caregiver reported no discussion. Of 205 patients who reported no life expectancy discussion, 40% did not want this discussion. Whereas 83% of those believing they had 1 year or less to live wanted to discuss prognosis, 79% of those believing they had 1 to 2 years, 53% of those believing they had 2 to 5 years, and 50% of those believing they had more than 5 years or who were unwilling to answer wanted this discussion (P=.007).Conclusion: Although clinicians report that they are discussing prognosis, patients and caregivers frequently do not corroborate these reports. Furthermore, many patients do not want prognostic information. Despite previous reports concluding that patients want full disclosure about their illness, many seriously ill older persons and caregivers may not be ready or able to receive prognostic information.