[Burden and capability of damaged parents--how refugee children can grow in exile]. / Last und Kraft beschädigter Eltern--Wie Flüchtlingskinder im Exil gesund wachsen können.

In trauma, dialectical tension arises between the inner perspective of the traumatized subject and the outside perspective (objective situation), between environmental stress and the subjective attribution of meaning, as well as between experience and behaviour. The traumatic process--the subject's endeavour to comprehend the overwhelming, often inconceivable experience and integrate it into its concepts of self and world--is understood against the backdrop of these interacting dimensions. The process phases "emerge from each other, run parallel, and permeate each other" (Fischer u. Riedesser, 2003). Problems that arise in the aftermath of trauma are rarely overcome by the victims alone. Attempts to process and self-heal have a social dimension, and family members are affected by war, persecution and flight in individual, varying ways. The impacts of violence experienced by parents from different crisis regions are examined in case studies with regard to the psychological development of indirectly impacted children growing up in exile.

Online self-management in rheumatoid arthritis: a patient-centered model application.

OBJECTIVE: The aim of this study was to describe the online transformation of an empirically validated, clinic-based, self-management (SM) program for rheumatoid arthritis. MATERIALS AND METHODS: A cognitive-behavioral framework served as the theoretical basis for the intervention. As with the clinic-based approach, the psychoeducational program included educational modules, weekly homework assignments, and self-evaluation. The dynamic online environment included secure communication tools to support a virtual community for the participants to garner peer support. In addition to peer support, weekly follow-up support was provided by a trained clinician via telephone. We describe the process and structure of the online self-management (OSM) intervention. Administrative issues including clinical monitoring and management, data collection, and security safeguards are considered. Utilization and management data are provided and explored for 33 initial subjects. RESULTS: Individuals who volunteer to participate in an online modality are eager to receive this home-based programming. They readily engaged with all aspects of the OSM program and experienced few difficulties navigating the environment. CONCLUSION: An OSM site provides a convenient, effective, and securely maintained health service, once restricted to clinic settings. The OSM application can be used to extend the benefits of SM programs to broad target audiences and serves as a model for the emerging generation of Internet-based clinical management/delivery systems.

Golimumab improves patient-reported outcomes in daily practice of inflammatory rheumatic diseases in Germany.

Aim: To analyze the quality of life (QoL), work productivity and activity impairment (WPAI) and healthcare resource utilization (HCRU) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients receiving golimumab under routine clinical settings in Germany. Materials & methods: Prospective observational study, GO-ART, analyzed changes in WPAI, QoL and HCRU during 24 months of golimumab therapy. Results: Seven hundred and forty-eight patients (RA = 250, PsA = 249 and AS = 249) were enrolled. Substantial improvements in WPAI scores presenteeism, activity impairment and total work productivity impairment and QoL were observed at month three and were maintained through month 24. Fewer patients had disease-related hospitalizations and consulted physician at month 24 than at the baseline. Conclusion: Golimumab induces sustained improvements in WPAI and QoL and reduces healthcare resource utilization in RA, PsA and AS.

How Do Patients with Chronic Diseases Make Usage Decisions regarding Mobile Health Monitoring Service?

Objectives: The increasing population of patients with chronic diseases generates great challenge of chronic disease management. The occurrence of mobile health monitoring service (MHMS) is beneficial to chronic disease prevention and health promotion. The objective of this study is to investigate how patients with chronic diseases make usage decisions on MHMS. Study Design: A survey. Methods: 213 respondents with chronic diseases were asked to rate their level of health severity, negative health emotions, and health uncertainty avoidance. SmartPLS was used to test the measurement model. Results: Of 213 research respondents, 159 of them have one chronic disease, while 54 have more than one such disease. Perceived health severity of patients with chronic diseases positively influences MHMS usage intentions, while negative health emotions do not. Health uncertainty avoidance strengthens the effect of health severity but weakens the effect of negative health emotions on MHMS usage intentions. Conclusion: Patients with chronic diseases have a unique decision-making process regarding MHMS usage in which their special health-related factors and tendencies play a critical role in determining behavioral intentions.

Mothers' knowledge about acute rheumatic fever.

AIM: Mothers' understanding and co-operation is an important factor supporting primary prevention and secondary prophylaxis for controlling rheumatic fever and rheumatic heart disease. We sought to determine mothers' knowledge about different aspects of rheumatic fever. METHOD: Participation of 500 mothers referred to healthcare centers in Guilan province was sought for the study which used a questionnaire to evaluate their knowledge about five different aspects of rheumatic fever. RESULTS: Among the 443 respondents, good knowledge about treatment was high (86 per cent); fewer mothers had a good level of knowledge about other aspects of treatment: epidemiology 34 per cent, symptoms 4 per cent, route of infection 27 per cent and complications 10.5 per cent. More educated women had significantly better knowledge about rheumatic fever. CONCLUSION: Expanded health education is required to improve knowledge about this condition among the population.

Language Impairment in Adolescents With Sydenham Chorea.

BACKGROUND: Neuropsychiatric comorbidities are frequent in Sydenham chorea. However, cognitive impairment in Sydenham chorea has not been sufficiently described. The objective of this study was to evaluate expressive and receptive language deficits in adolescents with Sydenham chorea. METHODS: Twenty patients with Sydenham chorea were compared with 20 patients with rheumatic fever without chorea and 20 healthy controls. Participants were matched for age and gender. Participants were assessed with verbal fluency tasks (phonemic and semantic) and with verbal comprehension tasks (Token Test). Patients with Sydenham chorea were also assessed with the Universidade Federal de Minas Gerais Sydenham Chorea Rating Scale. RESULTS: Performance in verbal fluency and in verbal comprehension tasks differed significantly (P < 0.01) among the three groups. Patients with Sydenham chorea performed significantly worse than healthy control group in phonemic and semantic verbal fluency tasks as well as in the Token Test. The group with rheumatic fever also performed worse than healthy controls in phonemic verbal fluency. Severity of motor signs in Sydenham chorea inversely correlated with performance in phonemic verbal fluency (words beginning with letter S, and total sum of words beginning with letters F, A, and S). CONCLUSIONS: Adolescents with Sydenham chorea show difficulties in verbal fluency and in verbal comprehension. Patients with rheumatic fever also have some degree of language impairment. Future studies must investigate language impairment in difference stages of Sydenham chorea (acute, persistent, and remission) and putative biological markers.

High prevalence of obsessive-compulsive symptoms in patients with Sydenham's chorea.

The 20-item Leyton Obsessional Inventory--Child Version was completed by children and adolescents who had had Sydenham's chorea (N = 23) or rheumatic fever without chorea (N = 14). The Sydenham's chorea subjects had significantly more obsessive thoughts and compulsive behaviors and significantly greater interference from these behaviors. Three Sydenham's chorea patients but no rheumatic fever patients had substantial obsessional interference and met criteria for obsessive-compulsive disorder when interviewed by telephone. This suggests that obsessive-compulsive disorder, at least in some patients, may be due to basal ganglia dysfunction.

The psychiatric symptoms of rheumatic fever.

OBJECTIVE: This study examined the frequency and age at onset of psychiatric disorders among children with rheumatic fever, Sydenham's chorea, or both and a comparison group. METHOD: Twenty children with rheumatic fever, 22 with Sydenham's chorea, and 20 comparison children were assessed by means of a semistructured interview and rating scales for tic disorders and obsessive-compulsive disorder. RESULTS: Obsessive-compulsive symptoms were more frequent in both the Sydenham's chorea and rheumatic fever groups than in the comparison group. The Sydenham's chorea group had a higher frequency of major depressive disorder, tic disorders, and attention deficit hyperactivity disorder (ADHD) than both the comparison and rheumatic fever groups. ADHD symptoms were associated with a higher risk of developing Sydenham's chorea. CONCLUSIONS: Both the rheumatic fever and Sydenham's chorea groups were associated with a higher risk of developing neuropsychiatric disorders than the comparison group. ADHD appears to be a risk factor for Sydenham's chorea in children with rheumatic fever.

Is AIDS a biasing factor in teacher judgment?

This study examined the effect that knowledge of a student having AIDS (Acquired Immune Deficiency Syndrome) would have on regular-education teacher judgment regarding special education placement. Regular-education, third-grade teachers in Indiana were sent one of two psychological reports. The reports were identical except that one report stated that the student had AIDS and the other stated that the student had rheumatic fever. AIDS was not found to be a biasing factor in teachers' judgments regarding special education services.

Awareness about sore-throat, rheumatic fever and rheumatic heart disease in a rural community.

This I.C.M.R. study was conducted in 74 villages of Chiraigaon block, Varanasi, U.P., during the period March 1983 and December 1986. Before and after health education awareness survey about sore throat, rheumatic fever and rheumatic heart disease was carried out by interviewing 315 persons by stratified random sampling. The study shows that there is significant increase in the knowledge about most of the symptoms, causes, consequences and preventive measures of sore throat, rheumatic fever and rheumatic heart disease. This paper highlights the importance of health education as a vital component of rheumatic heart disease control programme.

Low adherence to secondary prophylaxis among clients diagnosed with rheumatic fever, Jamaica.

OBJECTIVES: To determine the level of adherence and possible barriers to secondary prophylaxis among clients with rheumatic fever in Kingston, Jamaica. METHODS: Cross-sectional survey of 39 clients diagnosed with rheumatic fever, receiving penicillin prophylaxis for more than a year using a 22-item self-administered questionnaire on adherence to secondary prophylaxis and knowledge of rheumatic fever. The patients' records were reviewed to determine the number of prophylaxis injections the patients received for the year 2010. RESULTS: The majority of participants (74%) were females and 51% were adults. Only 48·7% had a high level of adherence. The majority (72%) had low knowledge levels regarding their illness, while only 5% had a high knowledge level score. Most clients (70%) strongly agreed that nurses and doctors encouraged them to take their prophylaxis. However, over 60% reported that they travelled long distances and or waited long periods to get their injections. One-third reported that they missed appointments because of fear of injections and having to take time off from work or school. DISCUSSION: Clients attending the health centers studied had limited knowledge about rheumatic fever. Barriers to adherence included fear of the injections, long commutes, and long waiting periods at the facilities studied.

Two to five repeated measurements per patient reduced the required sample size considerably in a randomized clinical trial for patients with inflammatory rheumatic diseases.

BACKGROUND: Patient reported outcomes are accepted as important outcome measures in rheumatology. The fluctuating symptoms in patients with rheumatic diseases have serious implications for sample size in clinical trials. We estimated the effects of measuring the outcome 1-5 times on the sample size required in a two-armed trial. FINDINGS: In a randomized controlled trial that evaluated the effects of a mindfulness-based group intervention for patients with inflammatory arthritis (n=71), the outcome variables Numerical Rating Scales (NRS) (pain, fatigue, disease activity, self-care ability, and emotional wellbeing) and General Health Questionnaire (GHQ-20) were measured five times before and after the intervention. For each variable we calculated the necessary sample sizes for obtaining 80% power (α=.05) for one up to five measurements.Two, three, and four measures reduced the required sample sizes by 15%, 21%, and 24%, respectively. With three (and five) measures, the required sample size per group was reduced from 56 to 39 (32) for the GHQ-20, from 71 to 60 (55) for pain, 96 to 71 (73) for fatigue, 57 to 51 (48) for disease activity, 59 to 44 (45) for self-care, and 47 to 37 (33) for emotional wellbeing. CONCLUSIONS: Measuring the outcomes five times rather than once reduced the necessary sample size by an average of 27%. When planning a study, researchers should carefully compare the advantages and disadvantages of increasing sample size versus employing three to five repeated measurements in order to obtain the required statistical power.

Quality of life of children and adolescents with rheumatic fever.

OBJECTIVE: To assess the quality of life of patients with rheumatic fever receiving outpatient treatment at two hospitals. METHODS: Cross-sectional study using the Child Health Questionnaire (CHQ) administered to the parents of 133 patients with rheumatic fever aged between 5 and 18 years. The scores of the several dimensions of the questionnaire were calculated and compared within the categories of clinical and sociodemographic variables using a nonparametric test. RESULTS: Patients' age ranged from 5 to 18 years old, with a mean age of 12 years and standard deviation of 2.8 years. The most common manifestation of the disease was articular symptoms associated with cardiac problems, present in 74 cases (56.1%). Most patients belonged to low-income families. Subjects had higher scores on the following concepts of the questionnaire: physical functioning, role/social-physical; role/social-emotional/behavioral; bodily pain; and family activities. The items with the lowest scores were: family cohesion; general health; global behavior; and parental impact-emotional. Girls had higher scores on: self-esteem; role/social-emotional/behavioral; and general health. Patients belonging to middle-income families had higher scores on: mental health; physical functioning; role/social-physical; and family activities. Children from the lowest social class had higher scores on bodily pain and psychosocial aspects. CONCLUSIONS: The quality of life of patients with rheumatic fever is similar to that of patients with other chronic diseases, showing intermediate scores on the several concepts included both in the physical and the psychosocial domains. Social class was the variable most frequently associated with the CHQ concepts.

Obsessive-compulsive symptoms in heart disease patients with and without history of rheumatic fever.

By comparing 51 heart disease patients with history of rheumatic fever and 46 heart disease patients with no rheumatic fever history, the authors found a higher prevalence of obsessive-compulsive symptoms in rheumatic fever subjects. This suggests that rheumatic fever activity is not a necessary condition for the expression of neuropsychiatric symptoms.

MMPI profiles of rheumatic fever adolescents and adults.

MMPI elevations for adolescent and adult groups (N = 162) who had experienced rheumatic fever (RF) were generally lower than Mayo Clinic norms, particularly on scales K, 1, 2, 3, and 6. Significant age effects on Scales F, 3, 4, 8, and 9 confirm previous findings that adolescent groups score higher on the MMPI. Contrary to expectation, patients who had not experienced carditis as part of their RF scored significantly higher than carditis patients on scales 2, 3, and 4. The results are discussed from a chronic disease perspective.

Sydenham's chorea and psychopathology.

Sydenham's chorea is a movement disorder seen in rheumatic fever with basal ganglia pathology. This disorder has been associated with an increased frequency of psychopathology in both the acute choreiform stage and later in life. We conducted a prospective study of 29 subjects with Sydenham's chorea and 29 age- and sex-matched controls. The total number of psychiatric symptoms 10 years after the initial contact was much greater in the study group than in controls (p less than 0.001). Similarly, schizophrenia was more common in the study group compared to controls (p less than 0.01). Possible neuropathological associations and treatment are discussed.

Qualidade de vida de crianças e adolescentes portadores de febre reumática / Quality of life of children and adolescents with rheumatic fever

OBJETIVO: Avaliar a qualidade de vida de portadores de febre reumática em acompanhamento ambulatorial em dois hospitais. MÉTODOS: Estudo seccional utilizando o Questionário de Saúde da Criança (Child Health Questionnaire, CHQ) aplicado aos pais de 133 pacientes com febre reumática, com idade entre 5 e 18 anos. Foram calculados os escores das diferentes dimensões do questionário e comparados nas categorias de variáveis clínicas e sociodemográficas, utilizando-se teste não paramétrico. RESULTADOS: A idade dos pacientes variou de 5 a 18 anos, com média de 12 e desvio padrão de 2,8. A forma de apresentação mais comum da doença foi a articular associada à cardíaca, presente em 74 casos (56,1 por cento). A maioria das famílias pertencia à classe média baixa/pobre. Os seguintes parâmetros do questionário tiveram melhor performance: função física; atividade física social; aspectos sociais, emocionais e comportamentais na vida diária; dor corporal; e atividades familiares. Os itens com pior performance foram: coesão familiar; saúde geral; comportamento global; e impacto emocional nos pais. As meninas apresentaram melhor desempenho para: autoestima; aspectos sociais, emocionais e comportamentais; e saúde geral. A classe social B apresentou melhor performance para: saúde mental; função física; atividade física social; e atividades familiares. A classe social D/E, para dor corporal e aspectos socioemocionais. CONCLUSÕES: A qualidade de vida observada foi semelhante à de outras doenças crônicas estudadas, com resultado da performance nos diferentes parâmetros com valores intermediários, tanto no domínio físico como no domínio psicossocial. A classe social foi a variável que se associou a um maior número de componentes do CHQ.

OBJECTIVE: To assess the quality of life of patients with rheumatic fever receiving outpatient treatment at two hospitals. METHODS: Cross-sectional study using the Child Health Questionnaire (CHQ) administered to the parents of 133 patients with rheumatic fever aged between 5 and 18 years. The scores of the several dimensions of the questionnaire were calculated and compared within the categories of clinical and sociodemographic variables using a nonparametric test. RESULTS: Patients' age ranged from 5 to 18 years old, with a mean age of 12 years and standard deviation of 2.8 years. The most common manifestation of the disease was articular symptoms associated with cardiac problems, present in 74 cases (56.1 percent). Most patients belonged to low-income families. Subjects had higher scores on the following concepts of the questionnaire: physical functioning, role/social-physical; role/social-emotional/behavioral; bodily pain; and family activities. The items with the lowest scores were: family cohesion; general health; global behavior; and parental impact-emotional. Girls had higher scores on: self-esteem; role/social-emotional/behavioral; and general health. Patients belonging to middle-income families had higher scores on: mental health; physical functioning; role/social-physical; and family activities. Children from the lowest social class had higher scores on bodily pain and psychosocial aspects. CONCLUSIONS: The quality of life of patients with rheumatic fever is similar to that of patients with other chronic diseases, showing intermediate scores on the several concepts included both in the physical and the psychosocial domains. Social class was the variable most frequently associated with the CHQ concepts.