?Developmental Stifling? is a term recently developed by us to denote a symptom pattern observed in a variety of clinical practice sites. The purpose of our paper is to define developmental stifling and compare this recently identified condition with Munchausen Syndrome by Proxy. A case example of developmental stifling is provided, as well as recommendations for early identification and treatment.

This paper describes two studies that had three purposes: (a) to modify a parent-child interaction tool used previously in a neonatal intensive care unit (NICU); (b) to demonstrate interrater reliability, Chronbach's Alpha reliability, and construct validity of the tool with adolescent mothers, and (c) to determine the ability of nurses engaged in usual work duties to observe maternal behaviors. The first study tested interrater reliability. Two NICU nurses were trained, observed adolescent mothers (n=20) for the same 15 min, and then separately completed the measure. The second study tested internal consistency reliability and construct validity with 107 adolescent mothers with infants in a NICU. Nurses in the neonatal intensive care unit completed the measure, and data on maternal visits were gathered for construct validity. The intraclass correlation coefficient for the first study was r=.83. Results of the second study demonstrated a Chronbach's Alpha of .85 and a significant correlation between ratings of maternal behavior and visits. The instrument obtained acceptably reliable and valid estimates of adolescent mothers' affectionate behaviors toward their infants. In addition, the studies demonstrated that nurses can observe maternal behaviors while performing their usual duties.

This paper reports the observed difference between two measures of compliance in wearing an orthopedic brace among teenagers affected by idiopathic scoliosis. The first measure was obtained with a small device called a "compli-o-meter" that was developed specifically for this purpose. When fastened to an orthopedic brace, this instrument determines the brace's actual wearing time. The second compliance measure was derived from a questionnaire-interview administered to the participants. The subjects were 40 female teenagers aged between 10 and 16 years who had been wearing an orthopedic brace for 18 months or less. While the compliance rate reported by the participants averaged 88%, the actual rate measured by the compli-o-meter was only 33%. Pearson's correlation was r = .33, with a significance of p < .05 between these two measurements. Care should be exerted in assessing the therapeutic efficiency of an orthopedic brace based exclusively on a patient's reported compliance level. In particular, basing a recommendation to change the brace based solely on this information may result in erroneous and serious therapeutic actions. The efficiency of orthopedic braces should be assessed on objective measures of the actual compliance rate wherever possible.

Pneumatic otoscopy is a universally recommended method of diagnosing otitis media by detecting the presence of a middle ear effusion and hypomobility of the tympanic membrane. This review presents a synthesis of the existing research on the value of pneumatic otoscopy as a diagnostic tool. A literature search from 1987 to 1997 produced 11 applicable research articles. In five studies, which compared pneumatoscopy with myringotomy, the mean sensitivity score was 89% and the mean specificity score was 80%. In the only study of clinical use of pneumatic otoscopy, 21% of respondents always used it, while 42% never used it as part of their routine examinations. Education level of the examiner had no affect on the value of pneumatoscopic findings. Pneumatic otoscopy is an important diagnostic tool available to all health care providers, but replication of these studies is essential to support these results. Furthermore, research is needed to quantify its actual application on the clinical level.

Although self-esteem is an important concept, nursing has only begun to focus on the significance of self-esteem as a mechanism for achieving wellness among adolescents, and as a variable for targeted intervention. Nursing studies identifying self-esteem as the primary focus of their research in an adolescent population seeking treatment in mental health settings are scarce. The Roy Adaptation Model's Theory of a Person as an Adaptive System was used to guide this descriptive, correlational study. Research examined the self-report of self-esteem on age, gender, smoking, exercise, depression, anger, and parental alcohol use in a sample of adolescents ages 12-19 years who were being treated in an outpatient mental health setting.

The administration of baclofen by intrathecal pump is a new technique used to reduce spasticity for individuals with upper motor neuron system injuries. Children with cerebral palsy often have difficulty in mobility because of this form of spasticity. The purpose of this study was to assess the functional outcomes of intrathecal baclofen pump therapy with spasticity in children with cerebral palsy. A retrospective review of medical records for pediatric cerebral palsy patients receiving intrathecal baclofen for intractable spasticity was performed. Of 23 sequential medical records meeting requirements for inclusion in the study, 17 subjects had sufficient recorded data to be included in the study. Data from the medical records included Ashworth scores, therapy complications, and changes in mobility and independence. Although no significant changes in the upper extremities with intrathecal baclofen occurred at one and three months, the trial bolus showed statistically significant changes in mean Ashworth scores. The pre- and posttrial bolus Ashworth scores for the lower extremities showed statistically significant decreases in the posttrial scores and at one and three months when compared with the pretrial scores (p <.001). Complications were resolved with conservative management without long-term sequelae. No infections, respiratory depressions, or deaths occurred as a result of intrathecal baclofen therapy in this study. Although intrathecal baclofen had a significant effect in reducing lower extremity spasticity in children with cerebral palsy, further prospective studies are needed to determine the effects of intrathecal baclofen on such indicators as activities of daily living.

The purpose of this cross-sectional study was to compare the mental health, physical health, and healthcare practices of homeless, previously homeless, and never homeless poor school-aged children. The sample was comprised of 134 children who ranged in age from 8 to 12 years. The children participated in health assessments and completed two psychometric tests: the Children's Depression Inventory (CDI) (Kovacs, 1985) and the Revised Children's Manifest Anxiety Scale (RCMAS) (Reynolds & Richmond, 1985). Their mothers completed the Child Behavior Problem Checklist (CBCL) (Achenbach, 1991) and participated in an interview. The homeless (n = 67), previously homeless (n = 30), and never homeless children (n = 37) were similar in regard to their health assessment findings, reported health problems, healthcare practices, and CBCL scores. The proportions of homeless and previously homeless children with CDI scores in the clinical range were significantly greater than the never homeless poor children. The homeless children had significantly higher anxiety scores than the previously homeless and never homeless children. All three groups of children were at risk for physical and mental health problems; however, the findings suggest that school-aged children who experience homelessness may be at greater risk for depression and anxiety than never homeless poor children.

The study evaluated the effects of an AIDS prevention program on 179 high school students’ sexual risk-taking behavior. Young actors role modeled behaviors to reduce the risk of AIDS. Sexual risk-taking behavior was assessed prior to and 3 months after attending the program. The pre-test mean sexual risk-taking score was 1.8 (SD = 3.5) with 0 to 30 as the potential range. There were significant differences between pre- and post-test sexual risk-taking behavior for the low-risk group (1.8), Wilcoxon (127) = -4.5, p =. 000, and high-risk group (1.8), Wilcoxon (52) = -2.2, p =. 03. Findings suggest support for role modeling strategies in decreasing sexual risk-taking behavior among high school students.