The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the prevalence of psychopathology and level of behavioral symptomatology in incarcerated youth versus youth receiving community mental health services or hospitalization. We randomly recruited youth from middle South Carolina served by a local CMHC (n = 60), youth served by the state adolescent inpatient program (n = 50), and youth in the S.C. Dept. of Juvenile Justice facilities from the same region (n = 75). We used the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and the CBCL and YSR to evaluate behavioral symptomatology. On the DISC, incarcerated youth had significantly higher mean number of diagnoses and symptoms than CMHC youth, but lower numbers than hospitalized youth. Level of "caseness" (at least one diagnosis) was 86% in hospital youth, 72% in incarcerated youth, and 60% in CMHC youth. The groups differed in CBCL mean total T, internalizing T, and externalizing T scores as well as mean YSR internalizing T scores. Our results indicate the comparability in level of psychopathology in incarcerated and community-treated populations of youth, and the need to develop diversionary programs to prevent the entry of such youth into the juvenile justice system.

Introduction: Limited information is available about the clinical features of Paget's disease of bone among unselected patients in the community. We examined morbidity and mortality associated with this condition in a large inception cohort of Olmsted County, MN, residents with a new diagnosis of Paget's disease from 1950 through 1994. Materials and Methods: Survival was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to assess the impact of various covariates on death. Results: Paget's disease of bone was diagnosed in 236 Olmsted County residents (mean age at diagnosis, 69.6 yr; 55% men). The majority were symptomatic at diagnosis (58%), and the proportion with symptoms did not change from the prescreening era (1950 to June 1974) to the postscreening era (July 1974-1994). Most patients had polyostotic disease (72%), and the pelvis (67%), vertebra (41%), and femur (31%) were the most common sites of involvement. Skeletal complications attributable to Paget's disease included bowing deformities (7.6%), fracture of pagetic bone (9.7%), and osteosarcoma (0.4%). Osteoarthritis was observed in 73% of patients, and 11% had a hip or knee replacement. Nonskeletal complications related to Paget's disease included cranial nerve (0.4%), peripheral nerve (1.7%), and nerve root (3.8%) compression, basilar invagination (2.1%), hypercalcemia (5.2%), and congestive heart failure (3.0%). Hearing loss, noted in 61%, was significantly higher than previously reported. Conclusions: Compared with white Minnesota residents, overall survival was slightly better than expected (p = 0.010). No clinical risk factors were identified that were associated with an increased risk of death.

Background Maternal morbidity (MM) describes adverse pregnancy-related outcomes, excluding mortality, among the pregnant and postpartum population. It is a concept without a universal definition, and most of the literature consists of clinical definitions rooted within the biomedical model of health. The MM perspectives of women and people with pregnancy experience (WPPE) are less well understood, which has resulted in a recent increase in qualitative research on the topic. However, the literature varies in its descriptions of MM which limits data comparisons across institutions and regions that measure differently. Objectives This study aims to a) understand the conditions and events that WPPE conceptualize as MM, b) identify the themes that arise across WPPE’s experiences, and c) produce a schematic representation of how WPPE conceptualize MM. Methods A concept analysis adapted from the evolutionary model investigated MM from WPPE’s perspectives. The steps included: 1) Identifying and naming the concept and surrogate terms (synonyms) 2) Data collection: literature search consisting of title/abstract and full-text screenings, appraisal, and chart extraction 3) Identifying the concept’s ‘antecedents’ (events that lead to the concept), ‘attributes’ (events that form concept), and ‘consequences’ (events that result from the concept) 4) Analyzing data using thematic analysis 5) Developing a model of the concept Results A literature search identified 40 eligible studies. Analysis of WPPE’s MM perceptions from these studies resulted in a MM concept consisting of four attributes – physical (themes relating to pain, bleeding, and adverse infant outcomes), social (themes relating to financial distress, lack of support, abuse, and mothering), psychological (themes relating to fear and distress), and healthcare-related (themes relating to the provider-patient relationship and healthcare facility). Antecedents that preceded MM included being labelled high-risk, access to care, financial stress, cultural norms, physical symptoms, previous adverse experience, lack of support, lack of information, effects of pregnancy on WPPE’s life, and lack of resources. The consequences that followed MM included continued morbidity, inability or reluctance to conceive again, changes to bodily function, strained relationship with partner, financial stress, and in some instances positive outcomes (e.g., gratitude for surviving, good health of baby). Conclusions This study illustrated the concept of MM from WPPE’s perspectives by identifying its antecedents, attributes and consequences. In doing so, it demonstrated that MM as perceived by WPPE encompasses more than physical attributes, which largely form the basis of current classification systems. Incorporating these findings into clinical definitions can help inform health and community care approaches to increasingly meet WPPE’s needs. / Thesis / Master of Public Health (MPH) / Reducing poor maternal health outcomes is a global health priority. An indicator of maternal health is maternal morbidity (MM), which describes adverse pregnancy-related outcomes, excluding death, among the pregnant and postpartum population. However, MM is a concept without a universal definition. There has been a recent increase in qualitative research on the MM perspectives of women and people with pregnancy experience (WPPE), which are less well-understood than clinical MM definitions. Therefore, our aim was to understand the conditions and events that WPPE consider as MM. We collected our data from qualitative studies that interviewed WPPE about their MM experiences and analyzed the data for themes that we presented in a concept model. Our findings resulted in a MM concept consisting of physical, social, psychological, and healthcare-related attributes. Factors from the pre-pregnancy period contributed to WPPE’s perceived MM experiences and postpartum events with long-term consequences were also relevant to their health and wellbeing. Protective factors including having good support and faith increased WPPE’s resilience in the face of unexpected MM events. This understanding of WPPE’s perspectives may support future research and interventions to reflect their needs and improve healthcare approaches to MM.

Reference intervals are important estimates used to determine whether an individual is healthy or unhealthy. They are the most widely used decision making tool in medicine and heavily influence doctor’s decisions regarding patient care. Despite the abundance of reference interval research in the field of clinical chemistry, age-related reference intervals have yet to be well-established for elderly populations. Many physiological and biochemical changes have been documented to occur with age however limited attempts have been made to quantify these changes. As a result, it is typical in clinical practice to assess geriatric patient data using an adult reference interval. Such practices can result in over-medicalization, unnecessary medical procedures and/or missed diagnoses. This thesis aims to address this gap in literature by summarizing what geriatric reference intervals are available and by investigating how reference intervals are affected by the presence of morbidity, a common characteristic of the elderly. The first chapter of the thesis introduces the reader to reference intervals, summarizes the current guidelines used in their determination and provides a rationale for the use of age-related reference intervals in geriatrics. Chapter 2 presents a systematic review that summarizes all available reference intervals for populations ≥65 years of age and the methodology used in their determination. Despite extreme variability in methodology, evidence suggests that geriatric reference intervals are significantly different from those of adults for many analytes. Chapter 3 presents a study that evaluates the effect morbidity has on reference intervals. In this study data from the National Health and Nutrition Examination Survey (NHANES) was used to calculate age-specific reference intervals for creatinine, a marker of kidney function known to increase with age. Findings suggest that the presence of morbidity significantly increases the upper limit for creatinine in elderly populations. Finally, the concluding chapter summarizes the overall findings of the thesis, proposes areas for future research and reinforces the importance of the above findings. / Thesis / Master of Science (MSc) / Reference intervals are estimates used to determine whether an individual is healthy or unhealthy. In particular this thesis investigates reference intervals for blood test results. Currently no age-specific reference intervals for the elderly are used clinically, instead the normalcy of a blood test result for an elderly person is based on adult reference intervals. This process may lead to over-medicalization or missed diagnoses in geriatrics. Within this thesis is a systematic review of the literature that was performed to capture any available reference intervals that have been published for populations greater than 65 years of age. It was determined that a multitude of geriatric reference intervals are available in literature but they are not used clinically and have no standardized methodology for their determination. Despite this lack of standardization, studies proved that geriatric reference intervals are significantly different from those of adult populations. Given that morbidity or the presence of disease is common in older patients it was suspected this may be a reason for the difference in reference intervals. A separate study was then performed to determine whether the presence of disease affects reference interval calculations. Results from this study showed that the presence of disease affects reference intervals in older individuals more so than younger individuals.

There are increasing concerns about the excessive use of cesarean delivery in the United States, as cesarean deliveries have been associated with adverse maternal and infant health outcomes. Currently, the cesarean section (C/S) rate for Florida is the second highest in the nation. Furthermore, preliminary reports from the Florida Department of Health (FDOH) have implicated the increasing rate of cesarean delivery to an increase in the rate of late preterm births (PTB) in Florida (births at 34 to 36 weeks gestational age). Information on the impact of late PTB associated with cesarean delivery on the rate of maternal and infant morbidity in Florida as well as corresponding utilization of health care services is scarce. Information on the validity of data sources used to investigate infant and maternal health outcomes in Florida is also scarce. Therefore, the objectives of this research project were: (1) to determine the validity of data sources used to investigate low documented risk C/S and late PTB, and (2) to assess the impact of low documented risk C/S on maternal and infant morbidity and subsequent healthcare utilization. To determine the accuracy of data elements reported on the Florida birth certificate and hospital discharge data, sensitivity, specificity, positive predictive value, negative predictive value, kappa statistics and likelihood ratios were calculated. To assess differences in morbidity by route of delivery, generalized estimating equations and survival analyses were employed. Markov Chain Monte Carlo methods were used to determine appropriate morbidities for inclusion in all analyses. Differences in accuracy of data by data source was observed, with linked birth certificate and hospital discharge data demonstrating improved accuracy compared to birth certificate and discharge data alone. Further, significant differences in the rate of maternal and infant morbidity by route of delivery were observed, with cesarean delivery increasing the risk of adverse health outcomes, and intensive use of healthcare services.

The purpose of the study was to describe and analyze the living condition for individuals with co-morbidity in different spheres of life based on a survey conducted in Blekinge county council. The aim has also been to examine the relation between individuals with co-morbidity and the care and support that is available under current legislation. The study examined how two hypotheses about comorbidity is related to different spheres of life as well as health care and support. Both hypotheses was confirmed by the results of the study. Individuals with co-morbidity has often a troublesome living situations and they do not receive adequate care and support. The study's perhaps most unexpected result is the result that emerged in addition to the hypotheses. The young group of people with co-morbidity is high and the group has a great need for extended care and support activities in all areas of life. Individuals with co-morbidity needs to be a continued research focus, especially the young persons.

No description available.

Age-related bone fractures are usually painful and have highly negative effects on a geriatric patient's functional status, quality of life, and survival. Currently, there are few analgesic therapies that fully control bone fracture pain in the elderly without significant unwanted side effects. However, another way of controlling age-related fracture pain would be to preemptively administer an osteo-anabolic agent to geriatric patients with high risk of fracture, so as to build new cortical bone and prevent the fracture from occurring. A major question, however, is whether an osteo-anabolic agent can stimulate the proliferation of osteogenic cells and build significant amounts of new cortical bone in light of the decreased number and responsiveness of osteogenic cells in aging bone. To explore this question, geriatric and young mice, 20 and 4 months old, respectively, received either vehicle or a monoclonal antibody that sequesters sclerostin (anti-sclerostin) for 28 days. From days 21 to 28, animals also received sustained administration of the thymidine analog, bromodeoxyuridine (BrdU), which labels the DNA of dividing cells. Animals were then euthanized at day 28 and the femurs were examined for cortical bone formation, bone mineral density, and newly borne BrdU+ cells in the periosteum which is a tissue that is pivotally involved in the formation of new cortical bone. In both the geriatric and young mice, anti-sclerostin induced a significant increase in the thickness of the cortical bone, bone mineral density, and the proliferation of newly borne BrdU+ cells in the periosteum. These results suggest that even in geriatric animals, anti-sclerostin therapy can build new cortical bone and increase the proliferation of osteogenic cells and thus reduce the likelihood of painful age-related bone fractures.

Worldwide, more than 1 million infants die as a result of premature birth. In the United States, where 1 in 10 births occurs preterm, premature birth is the leading cause of infant mortality. Premature infants have high rates of mortality and morbidity, with the highest rates seen in those infants born extremely preterm -- prior to 30 weeks gestation. Severe morbidity in these infants often contributes to life-long health problems. Maternal hypertension (HTN) is one contributor to preterm birth and also contributes to fetal growth restriction, resulting in birth weights which are small for gestational age (SGA, and generally within the lowest 10th percentile). Within this high risk population, SGA infants have increased risk of mortality compared to appropriate for gestational age infants. Therefore the impact of maternal HTN on neonatal outcome might be presumed to be negative. Previous studies however, have been contradictory, with both higher and lower rates of infant mortality reported in infants born to mothers with HTN, as well as differing reports analyzing the relationship between serious morbidity and maternal HTN. Utilizing the Vermont Oxford Network Very Low Birth Weight database, a collaborative database of Level III Neonatal Intensive Care Units across the world, 88,275 North American infants born between 22+0 and 29+6 weeks gestational age between 2008 and 2011 were identified. This dissertation explores the relationship between maternal HTN and gestational age at time of birth within this population, and the reported rates of morbidity and mortality in infants born prior to 30 weeks gestation. The independent contributions of maternal HTN with neonatal morbidity and mortality in our population were estimated using logistic regression and adjusting for factors previously known to be associated with risk, including birth weight, antenatal steroid exposure, infant sex, maternal race/ethnicity, prenatal care, inborn/outborn status, and birth year. We hypothesized that mortality rates would be lower for infants born to mothers with HTN compared to those born due to other factors, when corrected for the noted confounding variables and surviving infants would have better prognoses, as evidenced by lower rates of severe morbidity, including bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and infection. Within the higher-risk SGA population, we hypothesized that mortality rates would be higher than observed in appropriately grown infants, but decreased in those born to mothers with HTN, despite the association between maternal HTN and SGA. This dissertation begins with an explanation of current knowledge about preterm birth, maternal HTN, and their associations. Chapter 2 focuses on the relationship between maternal HTN and infant mortality in extremely preterm infants. Chapter 3 examines the risk associated with severe morbidities in surviving infants. In addition, we also use a combined morbidity risk assessment score which has previously been used to determine future risk of long term disability. In Chapter 4, SGA infants are separately evaluated for their risk of mortality and the association with maternal HTN. These analyses support the high mortality and morbidity rates seen in extremely preterm infants. Maternal HTN, after adjustment, results in reduced risk of both mortality and severe morbidities in infants compared to infants born to mothers with other underlying contributors to preterm birth. This suggests that clinical practices and parental counseling should reflect differing risk profiles in sub-populations of extremely preterm infants.

Magister Artium (Psychology) - MA(Psych) / Over time, the ‘normal’ experience of pregnancy transitioned to the hospital setting, leading to a discourse steeped in the notions of risks and complications. Risks and complications refer to health problems expectant women may experience, causing them to have a high-risk pregnancy. High-risk pregnancy refers to a pregnancy that negatively affects the health of the mother, the baby, or both, and evoking a range of emotional and psychological experiences. Research on high-risk pregnancy is predominantly found in the medical arena. Such research usually concerns the disease, while women’s emotional/psychological experiences are not sufficiently documented. For this reason, the objectives of this study was to explore the emotional and psychological experiences of women in the reviewed articles throughout their high-risk pregnancies, and identify the medical conditions and complications in the same reviewed articles. Ethics clearance was obtained from the senate research committee at UWC. The systematic review examined qualitative studies, including the qualitative components of mixed method studies published between January 2006 and June 2017. The databases that were searched are EbscoHost, JSTOR, Sage Journals Online, ScienceDirect, SpringerLink, Sabinet, Scopus, Emerald eJournals Premier, Pubmed, as well as Taylor and Francis Open Access eJournals. The study evaluated the literature found on these databases for methodological quality by using three stages of review (i.e. abstract reading, title reading, and full-text reading) and applying a meta-synthesis to the current evidence on the research topic. The findings provide empirical evidence based on sound research that medical conditions and complications (i.e. HELLP syndrome, thrombophilia, gestational diabetes, maternal near-miss syndrome, foetal abnormality, preterm birth, hypertension, and uterine rupture) are associated with women’s emotional and psychological experiences (i.e. fear, shock, feeling frightened, sadness, worry, alienation, frustration, grief, guilt, anger, ambivalence, despair, upset, loneliness and isolation, anxiety, depression, and PTSD) throughout their high-risk pregnancies. As a result of this, survivors of severe pregnancy complications have subsequent psychological and emotional challenges. It is therefore recommended that future researchers consider including quantitative studies in a systematic review on the same topic.