Sunita M. Stewart

Dexamethasone therapy for bacterial meningitis

We enrolled 200 infants and older children with bacterial meningitis in two prospective double-blind, placebo-controlled trials to evaluate the efficacy of dexamethasone therapy in addition to either cefuroxime (Study 1) or ceftriaxone (Study 2). Altogether, 98 patients received placebo and 102 received dexamethasone (0.15 mg per kilogram of body weight every six hours for four days). At the beginning of therapy, the clinical and demographic characteristics of the patients in the treatment groups were comparable. The mean increase in the cerebrospinal fluid concentration of glucose and the decreases in lactate and protein levels after 24 hours of therapy were significantly greater in those who received dexamethasone than in those who received placebo (glucose, 2.0 vs. 0.4 mmol per liter [36.0 vs. 6.9 mg per deciliter], P less than 0.001; lactate, 4.0 vs. 2.1 mmol per liter [38.3 vs. 19.8 mg per deciliter], P less than 0.001; and protein, 0.64 vs. 0.25 g per liter [64.0 vs. 25.3 mg per deciliter], P less than 0.05). One patient in the placebo group in Study 1 died. As compared with those who received placebo, the patients who received dexamethasone became afebrile earlier (1.6 vs. 5.0 days; P less than 0.001) and were less likely to acquire moderate or more severe bilateral sensorineural hearing loss (15.5 vs. 3.3 percent; P less than 0.01). Twelve patients in the two placebo groups (14 percent) had severe or profound bilateral hearing loss requiring the use of a hearing aid, as compared with 1 (1 percent) in the two dexamethasone groups (P less than 0.001). We conclude that dexamethasone is beneficial in the treatment of infants and children with bacterial meningitis, particularly in preventing deafness.

Teacher's Corner: The MACS Approach to Testing for Multigroup Invariance of a Second-Order Structure--A Walk through the Process.

The overarching intent of this article is to exemplify strategies associated with tests for measurement invariance that are uncommonly applied and reported in the extant literature. Designed within a pedagogical framework, the primary purposes are 3-fold and illustrate (a) tests for measurement invariance based on the analysis of means and covariance structures (MACS), (b) use of the MACS approach in testing for an invariant higher order factor structure, and (c) tests for latent mean differences relative to both levels of a higher order factor structure. Addressing additional application limitations, the secondary purposes are 2-fold and illustrate (a) determination of invariance based on two substantially different sets of criteria and (b) interpretation of noninvariant measurement items within the context of an item response theory perspective. We are hopeful that readers will find the didactic approach to be helpful in gaining a better understanding of the invariance-testing process.

A prospective analysis of stress and academic performance in the first two years of medical school

This study provides prospective, longitudinal data on the relationship between stress‐related measures and academic performance during the first two years of medical school.

The MACS approach to testing for multigroup invariance of a second-order structure

The overarching intent of this article is to exemplify strategies associated with tests for measurement invariance that are uncommonly applied and reported in the extant literature. Designed within a pedagogical framework, the primary purposes are 3-fold and illustrate (a) tests for measurement invariance based on the analysis of means and covariance structures (MACS), (b) use of the MACS approach in testing for an invariant higher order factor structure, and (c) tests for latent mean differences relative to both levels of a higher order factor structure. Addressing additional application limitations, the secondary purposes are 2-fold and illustrate (a) determination of invariance based on two substantially different sets of criteria and (b) interpretation of noninvariant measurement items within the context of an item response theory perspective. We are hopeful that readers will find the didactic approach to be helpful in gaining a better understanding of the invariance-testing process.

Nonadherence in Adolescent Oncology Patients: Preliminary Data on Psychological Risk Factors and Relationships to Outcome

Published nonadherence rates in the adolescent oncology population range from 33 to 60% though little is known about the psychological factors that contribute to adherence and the relationship between outcome and nonadherence. Our study was designed to investigate psychological and family factors related to adherence and the relationship between adherence and survival in this population. We evaluated 44 (27 males, 17 females) patients with cancer (13–17 years) who were at least 6-months postdiagnosis. Adherence with trimethoprim/sulfamethoxazole (TMP/SMX) was determined at one point in time, using serum assay. Twelve of the patients (27%) had no detectable TMP/SMX. Patients without detectable drug had higher levels of depression, lower self-esteem, and higher levels of parent–child incongruence. Survival rates, 6 years after the initiation of the study, were lower in the group of participants categorized as nonadherent. These findings, if confirmed, have implications for the management of nonadherence and mood in this population.

Depressive Symptoms Predict Hospitalization for Adolescents With Type 1 Diabetes Mellitus

Objective. To examine the role of self-reported depressive symptoms in predicting hospitalization for complications of diabetes mellitus over a period of up to 2 years. Study Design. Two hundred thirty-one adolescent outpatients (age range: 11–18 years) with type 1 diabetes completed the Center for Epidemiological Studies Depression Scale, a self-report measure of depressive symptoms. Glycosylated hemoglobin levels were also assessed, to account for this known predictor of hospitalization. With survival analysis methods, hospitalizations for medical complications that occurred up to 2 years after this assessment were recorded. Results. After controlling for age, gender, socioeconomic status, and glycosylated hemoglobin levels at baseline, the odds ratio for prediction offered by Center for Epidemiological Studies Depression Scale scores above the cutoff point (12 for boys and 22 for girls) was 2.58 (95% confidence interval: 1.12–5.98). Conclusions. Young people with type 1 diabetes who show high levels of depressive symptoms are at increased risk for hospitalization for disease complications. Interventions aimed at improving their depressive symptoms may result in positive health outcomes, as well as improved quality of life.

Life satisfaction, self-concept, and family relations in Chinese adolescents and children

Subjective well-being across the life span may be affected by both age-specific and age-general factors within a cultural context. Thus, this study explored both developmentally invariant and variable predictors of life satisfaction among 115 second-graders and 74 eighth-graders from Hong Kong. In a regression model, general self-concept and ratings of parental warmth and autonomy/detachment predicted life satisfaction equally across the two age groups. However, social self-concept was a strong predictor of life satisfaction among adolescents only, whereas actual academic test scores predicted life satisfaction only among the children. Mean group differences emerged as well, with adolescents scoring significantly lower in life satisfaction and self-concept and higher in emotional detachment than children. Results are explained in relation to both development and culture.

Stress and vulnerability in medical students

One hundred and forty Hong Kong Chinese students were surveyed early in the second year of their medical education (year 2), and compared with 138 students surveyed prior to beginning their first year of medical school and with 74 non‐medical university students in their second year. In year 2 students, distress as reflected in their scores on anxiety and depression self‐report scales was high, and these students reported greater utilization of health professional services as compared with the other two groups. In year 2 students, concerns related to the medical school environment and curriculum, and whether one has the endurance and ability to be successful were significant correlates with depression and anxiety. Loss of opportunity to maintain social and recreational sources of gratification correlated with anxiety. There was no difference between the sexes with regard to the development of anxiety and depression symptoms. Academically less successful students reported somewhat higher levels of depressive ideation and symptomatology. Trait anxiety correlated with the development of distress, while optimism protected against the development of distress. Active coping styles and positive reinterpretation as a coping strategy correlated negatively with distress, while wishful thinking correlated positively with distress. These findings emphasize the need for greater attention to the psychological well‐being of doctors‐in‐training, in Hong Kong as in the Western world. These findings should be further explored in longitudinal studies, and may be helpful in designing intervention and support programmes for vulnerable students.

Validating the Beck Depression Inventory-II for Hong Kong Community Adolescents

The primary purpose of this study was to test for the validity of a Chinese version of the Beck Depression Inventory-II (C-BDI-II) for use with Hong Kong community (i.e., nonclinical) adolescents. Based on a randomized triadic split of the data (N = 1460), we conducted exploratory factor analysis on Group1 (n = 486) and confirmatory factor analysis (CFA) within the framework of structural equation modeling on Groups 2 (n = 487) and 3 (n = 487); the second CFA served as a cross-validation of the determined factor structure. Factor analytic results, based on a 4-factor structure that comprised 1 2nd-order general factor of Depression and 3 1st-order factors representing Negative Attitude, Performance Difficulty, and Somatic Elements, replicated those reported previously for Canadian (Byrne & Baron, 1993), Swedish (Byrne, Baron, Larsson, & Melin, 1995), and Bulgarian (Byrne, Baron, & Balev, 1998) nonclinical adolescents. Based on this cross-validated factor structure, findings related to internal consistency reliability, stability over a 6-month time lag, and relations with relevant external criteria provided strong support for the valid use of the C-BDI-II in measuring depressive symptoms for Hong Kong community adolescents.

Mental and motor development, social competence, and growth one year after successful pediatric liver transplantation+

We measured intellectual and motor function, social competence, and growth in 29 children (mean age 4 years 7 months) before liver transplantation and 1 year later. We used either the Bayley Scales, the Stanford-Binet Intelligence Scale, and the Minnesota Child Development Inventory (MCDI), Motor Age Quotient, or the Wechsler Scales, depending on the age of the child at testing. Social function was measured with the MCDI or the Child Behavior Checklist. All anthropometric measures were expressed relative to normal values for age and sex. Patients whose intellectual and motor scores were less than 80 before transplantation gained an average of 8 points, but these changes were not statistically significant, nor were the changes on these measures for the group as a whole. The development of children with onset of liver disease in the first year of life was more likely to remain delayed after transplantation. Older subjects improved significantly in social competence (p less than 0.008). There were significant increments after transplantation in weight, head circumference, and arm anthropometrics (p less than 0.0001 to 0.04), but there was no change in linear growth rate. Increments in length correlated negatively with steroid dosage, and change in head circumference was associated with age at time of transplantation (p less than 0.005 to 0.10).