Generalized resistance to thyroid hormone associated with possible selective cardiac nonresistance.

OBJECTIVE: To review the condition of generalized resistance to thyroid hormone and to report a case of generalized thyroid hormone resistance associated with atrial fibrillation. METHODS: A case report is presented of a 52-year-old man with atrial fibrillation who was referred by a cardiologist for thyroid ablation because of "hyperthyroidism," when his free thyroxine was found to be 4.35 ng/dL (normal, 0.55 to 2.46) and his free triiodothyronine was 6.5 pg/mL (normal, 1.4 to 4.4). RESULTS: This clinically euthyroid man with no signs or symptoms of hyperthyroidism except for the possibly related atrial fibrillation had a thyrotropin level of 3.45 mIU/L (normal, 0.46 to 4.7) in conjunction with the aforementioned increased levels of thyroid hormones. Further evaluation revealed normal 6-hour (11.7%) and 24-hour (27.6%) (123)I uptakes. Magnetic resonance imaging of the pituitary revealed a normal-sized gland with no masses. CONCLUSION: This is a rare case of generalized resistance to thyroid hormone in a patient with only atrial fibrillation. Whether the heart was selectively nonresistant to thyroid hormone as the cause of his atrial fibrillation or whether his atrial fibrillation was due to his mitral valve prolapse documented on echocardiography could not be determined with certainty. His ventricular rate of 83 per minute and laboratory evaluation suggest that thyroid hormone was not the cause of the atrial fibrillation.

Fixation of odontoid fractures by an anterior screw.

We have reviewed 81 patients with fractures of the odontoid process treated between May 1983 and July 1997, by anterior screw fixation. There were 29 patients with Anderson and D'Alonzo type-II fractures and 52 with type III. Roy-Camille's classification identified the direction and instability of the fracture. Operative fixation was carried out on 48 men and 33 women with a mean age of 57 years. Associated injuries of the cervical spine were present in 15 patients, neurological signs in 13, and 18 had an Injury Severity Score of more than 15. Nine patients died and 11 were lost to follow-up. Of 61 patients, 56 (92%) achieved bony union at an average of 14.1 weeks. Two patients required a secondary posterior fusion after failure of the index operation. A full range of movement was restored in 43 patients; only six had a limitation of movement greater than 25%. We conclude that anterior screw fixation is effective and practicable in the treatment of fractures of the dens.

A retrospective study of clubhouse-based transitional employment.

This study of clubhouse-based transitional employment (TE) examined the ability of demographic data, diagnosis, and data on TE participation to predict TE tenure and a one-year competitive employment outcome following TE among clubhouse members. Baseline data on 138 club members who participated in TE over a 6-year period were retrospectively retrieved from a computerized database and written records. Most of the jobs held by members were maintenance or production jobs; members' average tenure on TE was 131.26 days. Older members, those with a longer club membership before their last TE job, and those working more days per week had longer average tenure on TE. Average tenure was unrelated to the severity of disability. Forty-two (30.4%) members obtained competitive employment in the one year following their last TE job. Members who worked more total hours on TE were more likely to obtain competitive employment. While aspects of the TE experience predict the move to competitive employment, further studies are needed.

Development of a measure of adolescent leisure interests.

OBJECTIVE: Two studies examined the internal consistency and test-retest reliability of the Adolescent Leisure Interest Profile (ALIP), an 86-item measure of adolescent leisure activity interest, leisure participation, and feelings about leisure. In addition, leisure activity interests and participation of adolescents with and without disabilities were described, and the ability of the ALIP to discriminate among four groups of adolescents was examined. METHOD: After preliminary item development, two separate reliability studies of the ALIP were conducted. The ALIP was administered twice to 88 adolescents with psychiatric, learning, and physical disabilities and to 28 adolescents without disabilities. In both studies, the second administration took place from 7 days to 14 days after the first. In addition, data from the first administration in both reliability studies were combined to examine the ability of the ALIP to discriminate among adolescents with and without disabilities. RESULTS: Using Cronbach's alpha to estimate internal consistency and Pearson product-moment correlations to examine test-retest reliability, acceptable levels of reliability for total scores derived from the ALIP were found in both studies. Virtually all test-retest reliability coefficients for the six total scores exceeded .60 for all participants except those with learning disabilities. Internal consistency estimates for a total score of overall level of interest in the activities exceeded .90 in both studies. Although there were few differences among the four study groups in terms of activity leisure interests or participation, there was some evidence that total scores on the ALIP can discriminate among adolescents with and without disabilities. CONCLUSION: The ALIP appears to have good reliability and may be useful as a clinical and research tool.

Development and investigation of the occupational performance history interview.

This article describes the development of the Occupational Performance History Interview, an instrument designed to gather an accurate and clinically useful history of an individual's work, play, and self-care performance from psychosocially and/or physically disabled adolescents, adults, and older persons. Following the identification and validation of content and the development of format, the instrument was field-tested and revised. An examination of reliability across time and raters indicated that although part of the instrument ratings met or exceeded levels of acceptable stability, further development and testing is indicated.

Predictors of functional outcome among adolescents and young adults with psychotic disorders.

Adolescents and young adults who experience the onset of a psychotic disorder often demonstrate major disruptions in occupational and social functioning. Yet, certain persons appear to be at a greater risk for impaired functioning after an episode of psychosis than others. This review of the psychiatric research literature on outcomes in psychotic disorders identifies several variables predictive of occupational and social functioning among young persons with both affective and nonaffective psychoses. Variables predictive of functional outcomes include diagnosis, symptom severity, duration of onset of symptoms, age of onset of symptoms, gender, stressful life events, premorbid functioning, and social supports. A model for conceptualizing the relationships of these variables to functioning is presented, and the implications for occupational therapy practice and research are discussed.

Competency beliefs and occupational role behavior among adolescents: explication of the personal causation construct.

According to the Model of Human Occupation (MOHO), beliefs regarding competency can influence whether a person's occupational role behavior is adaptive or maladaptive. Such beliefs are considered to be part of a person's sense of "personal causation." This article reviews some of the theoretical underpinnings of the personal causation construct. Issues addressed are the distinction between competency beliefs and locus of control (another aspect of personal causation according to the MOHO); the domain-specific nature of competency beliefs; and, in particular, the evidence for a relationship between competency beliefs and actual behavior. The article focuses on competency beliefs and their relationship to three domains of occupational behavior that have relevance for adolescents: academic ability, social competence, and physical competence. Implications for clinical practice with adolescents with psychiatric disorders are addressed.

Reliability and validity of the self-assessment of occupational functioning.

OBJECTIVE: Two studies examined the reliability and validity of the Self-Assessment of Occupational Functioning (SAOF), a 23-item self-assessment of perceptions of strengths, and weaknesses relative to occupational functioning, grounded in the Model of Human Occupation. METHOD: The first study examined the test-retest reliability of the SAOF, and involved 37 college students without disabilities who completed the SAOF twice. The second study, which involved 39 young persons hospitalized with psychiatric disorders, examined internal consistency reliability of the SAOF, and examined correlations between SAOF scores and composite scores on the Self-Perception Profile, a widely used measure of perceived competence. In addition, data from both studies were combined to examine the ability of the SAOF to discriminate between the college students without disabilities and the young persons with psychiatric disorders. RESULTS: Kappa and intraclass correlation coefficients (ICCs) were used to examine test-retest reliability and Cronbach's alpha was used to examine internal consistency. Acceptable levels of test-retest (ICCs) and internal consistency (Cronbach's alpha) reliability were found for the subscale and total scores of the SAOF. However, test-retest reliability (kappa) was lower than desirable for many of the individual SAOF items. The young persons with psychiatric disorders had lower item, subscale, and total scores on the SAOF than did the college students without disabilities. In addition, a discriminant analysis predicting group membership (college students without disability vs. young persons with psychiatric disorder) correctly classified 76.6% of the participants based on the four subscale scores of the SAOF. CONCLUSION: The SAOF has the potential to be a reliable and valid clinical assessment; however, additional research is needed.

Choice making in group and individual activity.

A guiding premise of occupational therapy practice is that it is beneficial to allow clients freedom of choice in selecting and participating in activities. This study examined subjects' affective responses to having or lacking freedom of choice in completing an activity and explored how those responses might differ when subjects did the activity in individual as opposed to group settings. Forty female undergraduate and graduate students participated in an origami activity under four different experimental conditions: a) individual--choice; b) individual--no choice; c) group--choice; and d) group--no choice. Afterward, each subject rated how she felt about herself while participating in the activity by using Osgood's semantic differential designed to elicit responses in terms of three affective factors: evaluation, power, and activity. Data analysis revealed an interaction between the two independent variables on the power factor such that subjects who were not permitted choice responded significantly differently from those who were permitted choice only in the group setting. Implications of this finding for occupational therapy practice are discussed.

The relationship of the Allen Cognitive Level Test to demographics, diagnosis, and disposition among psychiatric inpatients.

OBJECTIVE: This study examined the relationship of the Allen Cognitive Level Test (ACL) to demographics, diagnosis, and disposition after hospitalization among persons with psychiatric disorders. METHOD: Data were retrospectively collected from medical records, including initial occupational therapy evaluation notes, on 62 female and 38 male patients consecutively admitted to an urban, acute psychiatric inpatient unit. Collected was information on demographics, diagnosis, mental and physical health history, initial ACL scores, role involvement, and discharge living situation (DLS). RESULTS: Patients with higher initial ACL scores were more likely to be younger, to have lived independently before admission, to have been given nonpsychotic diagnoses, and to have been suicidal before admission. Although DLS was most strongly correlated with living situation before admission, ACL scores showed the second strongest correlation to DLS. Patients with higher ACL scores were significantly more likely to be discharged to independent living than were patients with lower ACL scores. CONCLUSIONS: These results provide evidence that patients' cognitive level, as measured by the ACL, may be a useful predictor of community functioning. However, further research is needed to validate the Cognitive Disabilities Model.

Time use, time management and academic achievement among occupational therapy students.

The purpose of this study was to examine time use patterns and variables related to time use, including feelings about time use, time management, and academic achievement, among normal college students. Time use was examined from the perspective of the model of human occupation. One hundred and six male and female occupational therapy students enrolled at Worcester State College in Worcester, MA completed two self-report questionnaires and a demographic questionnaire. The subjects completed the Occupational Questionnaire (Riopel Smith, Kielhofner, and Watts, 1986) which measured time use (activities engaged in during a typical 24-h period), and feelings about time use (related to competence, value, enjoyment) for the activities they reported. In addition, they completed the Time Management Questionnaire (Britton and Tesser, 1990, which measured their time attitudes, preferences for short range planning, and preferences for long range planning. The results of the study suggest that older students and those experiencing role overload perceive themselves as less competent, and value and enjoy their time use less than younger students and those with fewer role demands. In addition, the use of time management was related to academic achievement. Implications of the findings are discussed.