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Replacing limitations with empowerment
For Miss Tabitha Quake, 29, prosthetics and orthotics (P&O) is more than an intellectual pursuit that utilises her technical interests and skills. It enables the senior prosthetist and orthotist with Tan Tock Seng Hospital's (TTSH) Foot Care & Limb Design Centre to "help people with physical disabilities live better lives".
Prosthetists and orthotists treat physical limitations resulting from illness and disabilities. They design, fabricate and fit custom-made artificial limbs, braces and other external contraptions.
In 2008, Miss Quake secured a health sciences scholarship from the Ministry of Health Holdings (MOHH) to do a Bachelor of Science (Honours) degree in P&O at Scotland's University of Strathclyde.
The scholarship covered all her tuition fees during her four years of undergraduate study which she could not have afforded otherwise.
Clinical placements within the United Kingdom for hands-on experiences and exposure to cases not studied at Strathclyde meant Miss Quake never stayed in the same place for more than a year at a time.
"There were also two sought-after overseas placements per cycle," she says.
"I was fortunate to be assigned to Sweden's Skandinaviska Ortopedtekniska Laboratoriet, where I worked with different prosthetic systems using high-end components such as carbon fibre feet and bionic knees."
Miss Quake did her second-year mid-term attachment at TTSH, the largest public provider of P&O services in Singapore. The attachment eased her into Singapore's healthcare system and helped her understand the unique needs of the patients here.
After graduating in 2012, she joined the centre full-time, where her skills, design-technology interests and outside-the-box thinking are welcomed. She casts, fits and modifies customised artificial limbs and braces with the help of technicians.
"Adapting the techniques while managing expectations can be demanding, especially in Asian healthcare, where there is a greater disability stigma," she says.
Orthotics can be quite complex. An early case in her career saw her and a senior colleague in an operating theatre to cast a mould on a scoliosis patient for a spinal brace immediately after surgery.
"It was my biggest cast-and-brace case, but not the last. After handling hip disarticulation and more scoliosis cases, custom spinal braces became my sub-speciality," says Miss Quake.
From 2014 to 2016, she also ran a weekly paediatric clinic at KK Women's and Children's Hospital (KKH), where she mainly did spinal bracing. She is currently helping KKH set up its own P&O service centre, and has been supervising and guiding a P&O scholar working there, to ensure everything runs smoothly.


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Printed from https://ideas.repec.org/p/ulb/ulbeco/2013-307351.html
Violence exposure and poverty: Evidence from the Burundi civil war
Marion Mercier
Rama Lionel Ngenzebuke
Philip Verwimp
We investigate the relationship between exposure to the Burundi Civil War and household (food) poverty, using a three-wave household-level panel matched with data on local-level violence. We find that households living in localities exposed to the war have been subsequently more likely to be poor than non-exposed households. Within-household estimations, controlling for time-varying heterogeneity at the province level, confirm the positive impact of violence exposure on household poverty. We investigate some of the potential mechanisms at play in the violence – poverty nexus, and the role of violence exposure in household poverty dynamics over time. Our results notably suggest that the destruction of physical capital, as well as a shift of exposed households out of non-farm activities, shape poverty dynamics and lower their chances of durably remaining out of poverty.
Marion Mercier & Rama Lionel Ngenzebuke & Philip Verwimp, 2020. "Violence exposure and poverty: Evidence from the Burundi civil war," ULB Institutional Repository 2013/307351, ULB -- Universite Libre de Bruxelles.
Handle: RePEc:ulb:ulbeco:2013/307351
Note: SCOPUS: ar.j
File URL: https://dipot.ulb.ac.be/dspace/bitstream/2013/307351/3/civilwar_expo_preprint.pdf
File Function: Œuvre complète ou partie de l'œuvre
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Marion Mercier & Rama Lionel Ngenzebuke & Philip Verwimp, 2020. "Violence exposure and poverty: Evidence from the Burundi civil war," Post-Print hal-02895235, HAL.
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Burundi; Civil war; Panel data; Poverty;
O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
I32 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Measurement and Analysis of Poverty
H56 - Public Economics - - National Government Expenditures and Related Policies - - - National Security and War
O55 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Africa
NEP-DEV-2021-02-08 (Development)
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Motives for choosing growth-enhancing hormone treatment in adolescents with idiopathic short stature: a questionnaire and structured interview study
Hanneke Visser – van Balen1,2,
Rinie Geenen3,
Gerdine A Kamp4,
Jaap Huisman5,
Jan M Wit6 &
Gerben Sinnema1
Growth-enhancing hormone treatment is considered a possible intervention in short but otherwise healthy adolescents. Although height gain is an obvious measure for evaluating hormone treatment, this may not be the ultimate goal for the person, but rather a means to reach other goals such as the amelioration of current height-related psychosocial problems or the enhancement of future prospects in life and society. The aim of our study was to clarify the motives of adolescents and their parents when choosing to participate in a growth-enhancing trial combining growth hormone and puberty-delaying hormone treatment.
Participants were early pubertal adolescents (25 girls, 13 boys) aged from 11 to 13 years (mean age 11.5 years) with a height standard deviation score (SDS) ranging from -1.03 to -3.43. All had been classified as idiopathic short stature or persistent short stature born small for the gestational age (intrauterine growth retardation) on the basis of a height SDS below -2, or had a height SDS between -1 and -2 and a predicted adult height SDS below -2. The adolescents and their parents completed questionnaires and a structured interview on the presence of height-related stressors, parental worries about their child's behavior and future prospects, problems in psychosocial functioning, and treatment expectations. Questionnaire scores were compared to norms of the general Dutch population.
The adolescents reported normal psychosocial functioning and highly positive expectations of the treatment in terms of height gain, whereas the parents reported that their children encountered some behavioral problems (being anxious/depressed, and social and attention problems) and height-related stressors (being teased and juvenilized). About 40% of the parents were worried about their children's future prospects for finding a spouse or job. The motives of the adolescents and their parents exhibited rather different profiles. The most prevalent parental worries related to the current or future functioning of their children, while a few cases were characterized by no observed motives or by psychosocial problems only reported by the adolescents themselves.
The motives for participating in a growth-enhancing hormone trial are more obvious in the parents than in the adolescents themselves. Two out of three parents report worries about the future opportunities or observe modest current psychosocial problems in their children. The adolescents want to gain height, but the motivation underlying this remains unclear. Few of the adolescents experience psychosocial problems. Our analyses revealed differences among individuals in terms of motives, which implies that in an evaluation of hormone treatment, the importance of divergent outcome variables will also differ among individuals. Effectiveness evaluations of hormone treatment to increase height and the consequential fulfillment of other goals must be awaited.
Growth-enhancing hormone treatment is considered a possible intervention in short but otherwise healthy adolescents. Although height gain is an obvious measure for evaluating hormone treatment, this may not be the ultimate goal of the person, but rather a means to reach other goals such as to ameliorate current height-related psychosocial problems or to enhance future prospects in life and society.
Psychosocial functioning has been emphasized in considerations of the motives of children with idiopathic short stature (ISS) and their parents seeking hormone treatment to achieve a height gain. Children who have never been medically referred do not seem to suffer from their stature [1–4]. Most studies involving medically referred children have revealed reduced social competence [5–14], while internalizing and externalizing behavior, body image, self-esteem, and scholastic competence have been shown, on average, to be between normal and below normal [5–8, 10–17]. In addition to the possibility of improving psychosocial functioning, several other factors are hypothesized to motivate children and their parents to choose hormone treatment, including the experience of height-related psychosocial stressors (such as being teased or juvenilized), future expectations for finding a spouse and a desired career commensurate with intellectual potential and interests, and the expectation of a treatment-induced height gain.
Insight into the divergent motives at the time of choosing hormone treatment is important, because it will help in the choice of proper outcome measures for the evaluation of a trial. Insight into motivational factors is especially important in treatments combining biosynthetic growth hormone (GH) with a puberty-delaying hormone, because the possible benefits of enhancing growth must be balanced against the possible negative psychosocial consequences of delaying pubertal development. Moreover, such insight will clarify whether other treatments, such as psychosocial counseling, should be employed to solve current psychosocial problems and reach future goals.
Our study examined 38 medically referred early pubertal, short adolescents who agreed to participate in an experimental trial of a combined treatment of GH and a puberty-delaying hormone, and compared the results with short adolescents who received no intervention. Participants had a height standard deviation score (SDS) below -2, or between -1 and -2 with a predicted adult height SDS below -2, all without apparent underlying pathology. Twenty-six of the subjects had a normal birth weight and length and were classified as ISS [18], while 12 were born small for gestational age (SGA) [19, 20]. Both ISS and SGA have been associated with problems in behavior, social functioning, school competence, and attention [21–23], while SGA has also been associated with lowered intelligence and minor neurologic dysfunctions [21, 22, 24].
With the aim of clarifying the motives of parents and children for participation in the trial, we examined the baseline scores of the adolescents on the following psychosocial factors before initiating the treatment: presence of height-related stressors, parental worries about the child's behavior and future prospects, self-reported problems in psychosocial functioning, and treatment expectations.
Study population and procedures
The inclusion criteria for participation in the study were as follows: being in early puberty as documented by Tanner breast stage 2 or 3 for girls and Tanner genital stage 2 or 3 for boys; an actual height SDS for the same age and sex of less than -2.0, or a height SDS between -1.0 and -2.0 with a predicted adult height of more than -2.0 SDS; a chronological age and bone age of less than 12 years for girls and 13 years for boys; a documented GH response of >20 mU/L (>10 ug/L) after a standard provocation test and/or during a sleep test; a ratio of sitting height/subischial leg height between the 3rd and 97th percentiles; and normal blood tests and urinalysis.
The study population consisted of 38 early pubertal adolescents (25 girls,13 boys) aged from 11 to 13 years (mean age 11.5 years). Most of the cohort (17 girls, 9 boys) had a normal birth size and were classified as ISS. Twelve adolescents (8 girls, 4 boys) were known to have had a birth length of more than 2 SD below the mean for gestational age and were classified as short-stature-born SGA. The most likely reason for the girls substantially outnumbering the boys is that the combination of short stature and early puberty is more common in girls than boys. The mean height of the adolescents was 134.9 (5.8) cm, with a range of 120.0–148.5 cm, corresponding to a height SDS ranging from -1.03 to -3.43. There were nine adolescents with an actual height SDS between -1.0 and -2.0 and a predicted adult height SDS of less than -2.0.
The following four Dutch hospitals participated in this multi-center study: the University Medical Center Utrecht-Wilhelmina Children's Hospital, the VU University Medical Center Amsterdam, the Sophia Children's Hospital Rotterdam, and the Catharina Hospital Eindhoven [19]. The first 40 referred adolescents who fulfilled the inclusion criteria and agreed to participate after having been informed about the study participated in our randomized controlled trial with puberty-delaying gonadotropin-releasing hormone agonist (GnRHa) therapy in combination with GH therapy or no therapeutic intervention. Twenty of the adolescents were randomly selected to receive the combination therapy for three years, while the other 20 adolescents were to receive no treatment. Immediately after randomization, two participants (one from the treatment group and one from the control group) decided to stop participation.
The experimental trial examined the hypothesis that the combination of GH and GnRHa for three years would increase the final height in comparison with untreated controls [19]. For three years the adolescents in the treatment group were given GH daily by subcutaneous injection of 4 IU (1.33 mg) per square meter body surface; (Genotropin, Pharmacia, Sweden; now Pfizer, New York, USA) and a depot preparation of 3.75 mg of GnRHa (Decapeptyl-CR, Ferring, Sweden) every four weeks intramuscularly. The adolescents in the control group were followed yearly to document their growth and pubertal development [19]. Before treatment, and at one, two, and three years after beginning the treatment, the adolescents and the parents of both the treatment and control groups filled out questionnaires to assess the psychosocial functioning of the adolescents. The parents were also interviewed.
A skilled psychologist examined the adolescents and their parents in the interval between randomization and starting treatment. This interval was chosen for ethical reasons to avoid the suggestion that the answers of the parents or adolescents might affect the group allocation. Moreover, providing knowledge of the result of the randomization procedure to both parents and adolescents was assumed to make them better able to give unbiased responses to the questionnaires and interview. The adolescents filled out questionnaires on perceived competence, psychological distress, body image, self-image, and personality characteristics. The parents filled out questionnaires regarding emotional and behavioral problems of their children, and were interviewed by a psychologist.
The medical ethics committees at the four participating centers approved the study. The parents of all children provided written informed consent before participation.
Parental reports
A structured interview was conducted with parents to assess the adolescents' health-related development, current height-related stressors, and parental concerns about their child's future. Parents were asked about health problems, the child's age at which a physician was consulted for the first time because of the growth retardation, and who initiated the referral (school doctor, family doctor, or pediatrician). In order to determine the height-related psychosocial stressors encountered by the adolescents, the parents were asked whether their children were teased or juvenilized by other children. To find out parental worries about the future of their child, parents were asked whether they considered that the prospects of their child were equal to that of persons of normal height in the labor market and finding a spouse (yes, doubtful, no).
To assess behavioral and emotional problems, the parents filled out the Child Behavior Check List (CBCL) [25]. This questionnaire consists of the following eight syndrome areas (the so-called narrow-band scales): withdrawn behavior, somatic complaints, anxious/depressed behavior, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior. The scores of the subscales were summarized into a score for internalizing and externalizing problems, and a total problem score (the so-called broad-band scales).
The Silhouette Apperception Technique (SAT) has been shown to be a valid and useful instrument for assessing perceptions of the present and future heights of adolescents [7, 26–28]. The parents were shown drawings of people of different heights, corresponding proportionally with the heights of the 3rd, 25th, 50th, 75th, and 97th percentiles, and asked to identify the drawings that they thought best fit the current and future heights of their child.
Adolescents' self-reports
The adolescents completed a global intelligence test and a series of questionnaires regarding perceived competence, psychological distress, and personality characteristics.
The Dutch versions of the Self-Perception Profile for Children (CBSK) and the Self-Perception Profile for Adolescents (CBSA) were used [29, 30]. The CBSK consists of six perceived competence subscales: scholastic competence, social acceptance, athletic competence, physical appearance, behavior and conscience, and global self-worth. The CBSA consists of these six scales plus the scales of friendship and romantic love. In our study we only used the six scales that the CBSK and the CBSA have in common.
Anxiety was measured using the Dutch version of the State-Trait Anxiety Inventory for Children (ZBV-K), with the subscales of state anxiety and trait anxiety [31]. Depressive mood was assessed by the KDVK (Dutch Short Depression Questionnaire for Children) [32].
Personality characteristics of the adolescents were investigated using the Dutch Personality Questionnaire-Junior (NPV-J), with five subscales: inadequacy, perseverance, social inadequacy, recalcitrance, and dominance [33].
The SAT was used to measure perceptions of the present and future heights of the adolescents [7, 26–28].
Intelligence was assessed by the Dutch short version of the Wechsler Intelligence Scale for Children (Revised) (WISC-Rn) [34].
Data analyses
Standard deviation scores (SDS) were used to compare the results of the quantitative questionnaires with the means of the general Dutch population. This was performed by subtracting the mean score of the norm group of the same age and sex from the score of the participants, with this difference divided by the SD of the norm group. This score expresses how much each study subject deviates from the norm in SD units. T-tests examined whether these age-and sex-adjusted scores significantly deviated from zero (i.e., from the norm).
To categorize groups of adolescents with divergent motives for wanting hormone treatment, we formed subgroups based on the presence of height-related stressors (being teased or juvenilized), parental worries about future prospects (regarding finding a spouse or job), parental worries about their child's behavior (internalizing or externalizing problems), and self-reported problems in psychosocial functioning (low self-esteem, anxiety, or depressive mood). The cut-off score for having externalizing or internalizing problems was a norm deviation score of 1 SD higher than the mean for the same age and sex on the CBCL scales for internalizing and externalizing behavioral problems. This score corresponds with a CBCL T-score of 60 (84th percentile) in the healthy norm group, and conforms with CBCL standards for the borderline range of clinical problems [25]. The cut-off score for anxiety and low self-esteem was a norm deviation score of at least 1 SD higher (anxiety) or lower (self-esteem) than the means for the same age and sex on the trait anxiety and the global self-worth scale, respectively. The cut-off score for indicating clinical signs of depression was a raw score of 4 points or more on the depression scale [32].
Our study group was small and significant differences were generally not evident in the results between boys and girls, between adolescents with ISS and those born SGA, and between adolescents who were to receive hormone treatment and those who were not. Hence our report focuses primarily on the results for the whole group.
Medical referral
The mean age of the child when a physician was consulted for the first time because of the growth retardation was 7.3 years (SD = 3.5 years). Medical referral was initiated by the family physician (53%; seven adolescents with SGA, thirteen with ISS) or school physician (23.5%; two adolescents with SGA, seven with ISS), whereas some of the adolescents were already under supervision of a pediatrician as young children because of health problems other than short stature (23.5%; three adolescents with SGA, six with ISS). Ninety percent of the parents reported that their children had never experienced serious health problems.
Height-related psychosocial stressors and future expectations
Approximately one-quarter (28%) of parents reported that their child was teased by peers because of short stature (15% of boys, 35% of girls), and 14% of parents reported that their child was juvenilized by peers (23% of boys, 9% of girls). All but one adolescent took part in gymnastic lessons at school (97%).
Regarding the effects of short stature on future expectations, 44.5% of the parents expected their child to have a lower prospect in the labor market as an adult (39% of boys, 48% of girls), and 39% expected their child to have a lower prospect of finding a spouse (77% of boys, 17% of girls). This difference between boys and girls was significant (p < 0.01). No other significant differences between boys and girls were found.
Psychosocial functioning
On parental ratings of behavioral difficulties as measured by the CBCL, the short adolescents exhibited higher scores than the general Dutch norm group on the broad-band scales of internalizing problems (p < 0.05) and total behavioral problems (p < 0.05) (Table 1). The elevated score for withdrawn behavior was marginally significant (p < 0.10), while the higher score for anxious/depressed behavior was significant (p < 0.05). These narrow-band scales are summarized in the internalizing scale. The short adolescents also exhibited higher than normal scores on the social problems (p = 0.01) and attention problems (p < 0.05) scales. The scores deviated by 0.50–0.73 SDS from the norm (see Table 1), which reflects moderate effects. Three adolescents were in the clinical range for internalizing problems (CBCL T-score of 63; 90th percentile). The short adolescents did not score significantly higher than the norm group on the narrow-band scales of somatic complaints, thought problems, delinquent behavior and aggressive behavior, or the broad-band scale of externalizing problems. One adolescent scored in the clinical range for externalizing behavior.
Table 1 Emotional and behavioral problems of 34 adolescents with short stature as judged by their parents.
To clarify the nature of the problems perceived by the parents, we examined specific items on the CBCL scales where parents observed significant problems. Items for which the adolescents deviated at least moderately from the norm included generic items on the scale of anxious/depressed behavior, height-related items on the scale of social problems, and both generic and height-related items on the scale of attention problems (for the specific items, see Table 2).
Table 2 Scores at separate items of the CBCL scales anxious/depressed behavior, social problems, and attention problems.
Virtually none of the scores of the short adolescents on self-reported questionnaires differed significantly from the norm group (Table 3). Adolescents with ISS or SGA did not deviate from the norm group with respect to perceived competence and psychological distress. Indeed, their perceived social acceptance was higher than that in the norm group (p = 0.05). With respect to personality characteristics, adolescents with ISS or SGA described themselves to be more persistent (quiet, conscientious, and diligent) than the norm group (p < 0.05). Two adolescents were in the clinical range (deviation of more than 2SDs) for global self-worth. One adolescent was at the clinical level for trait anxiety.
Table 3 Psychological functioning and distress as reported by the adolescents with short stature.
Intelligence scores (corrected total WISC-Rn scores) ranged from 66 to 128, with a mean score of 99.8. Six adolescents (three ISS, three SGA) had an intelligence lower than 80. The intelligence did not differ significantly between adolescents with ISS and those with SGA.
Expectations of hormone treatment: perception of current and future heights
Perceptions of current and future heights were analyzed separately in adolescents who were to receive hormone treatment and those who were not (Table 4). Most parents and adolescents in both the treatment and control groups estimated the current height of the adolescent at the 3rd percentile of the population references, which corresponds well to their actual height. Parents of the adolescents in the treatment group expected a greater future height than the parents of the adolescents in the control group (Z = -2.68, p = 0.007). None of the other comparisons between the experimental and control groups revealed significant differences.
Table 4 Current and future heights as perceived by adolescents and their parents on the Silhouette Apperception Technique
Groups classified according to motives
To provide a summary description, four groups of adolescents were distinguished based on the presence of height-related stressors, parental worries about future prospects, parental worries about their children's behavior, and self-reported problems in psychosocial functioning (Table 5).
Table 5 Classification of adolescents based on motives
Group 1 consisted of four adolescents and their parents (12%) who did not report any psychosocial problems. However, all adolescents in this group reported having high expectations of the treatment in terms of height gain (these data are not listed in Table 5).
Group 2 consisted of 11 adolescents (32%) whose parents reported height-related psychosocial stressors or worries about future prospects, but no problems in psychosocial functioning (parental or adolescents' reports).
Group 3 consisted of 11 adolescents (32%) whose parents reported problems in psychosocial functioning as well as worries about future prospects and in most cases the presence of height-related psychosocial stressors. The adolescents themselves did not report problems in psychosocial functioning.
Group 4 consisted of eight adolescents (24%) who reported problems in psychosocial functioning, while their parents did not report height-related psychosocial stressors and worries about future prospects, and in most cases did not report behavioral problems.
In a medically referred group of early pubertal adolescents with ISS or SGA, the motivation of the adolescents and their parents for choosing hormone treatment was investigated before initiating a combined GH and puberty delaying hormone treatment.
Parental reports revealed that current height-related psychosocial stressors were not the main reason for wanting growth-enhancing hormone treatment. Some of the parents reported that their children were teased (28%) or juvenilized (14%) because of their stature. These findings are close to those from another Dutch study [7], but in contrast with an American study that showed teasing and juvenilizing rates of 50% and 70%, respectively [14]. According to their parents, most of the adolescents in the present study were relatively free of current stressors. More than 40% of the parents expected that their children would have a decreased prospect in the labor market or difficulties in finding a spouse. This suggests that the motivation of providing opportunities for the future of the adolescents was a compelling reason for parents to choose hormone treatment.
Another possible reason for wanting hormone treatment is parental worries about the psychosocial functioning of their children. On average, as judged by their parents, the adolescents encountered internalizing symptoms, such as anxious or depressed tendencies, as well as social and attention problems. These problems were of a moderate magnitude compared to Dutch norms. It is likely that our analysis overestimated the actual psychosocial dysfunctioning, because the normative criteria were based on a very healthy group: any child who had been referred to a mental-health professional in the past 12 months, or who was currently receiving special educational services, was excluded from the normative sample [25, 35]. Moreover, some of these problems are height-related issues that need not be a behavioral problem, such as preferring to be with younger kids or acting too young for his/her age.
The perceptions of adolescents about their own psychosocial functioning did not confirm the parental worries. The adolescents reported normal competence and personality, and even higher competence on social acceptance and perseverance, and little distress. This raises the question of whether adolescents or their parents are the best judges about well-being and functioning of adolescents. Adolescents may be unreliable informants because they are too young to give an adequate assessment of their own functioning, lack a time perspective, or have a tendency toward denial, while parents may be unreliable because of unrealistic anxieties about the health, future, and behavior of their children [36, 37]. Our observation of more psychosocial problems being reported by parents than adolescents suggests that the perception of psychosocial problems is a stronger motive for parents than for adolescents when choosing to participate in the hormone treatment trial.
The perception of the current height of the adolescents was accurate in the majority of parents, while several adolescents had a tendency to overestimate their current height. Consistent with previous observations [26, 38], several adolescents who were to receive hormone treatment had unrealistic expectations of their future height (as did their parents). Even those who were not to receive hormone treatment had high expectations of their future height. Optimism, even when unrealistic, has been shown to motivate the choice for a treatment and its adherence once started in several diseases [39, 40]. However, unrealistic expectations may also be associated with a poor psychosocial outcome, as has been demonstrated in persons seeking cosmetic surgery, for example [41].
The tentative breakdown of subgroups provides a descriptive summary of four rather different profiles of motives for hormone treatment in the adolescents and their parents. A small group of adolescents and their parents reported no psychosocial problems. Highly positive treatment expectations of the adolescents in terms of height gain was the only detected motive, with the underlying reason remaining unclear. Perhaps it predominantly reflects the developmental wish of any child to want to grow (up). The parents reported height-related stressors or psychosocial problems and in most cases these worries about current problems were accompanied by worries about future prospects. The final group consisted of adolescents who reported problems in their psychosocial functioning, while their parents did not necessarily observe problems and were not worried. The cause of these problems and the relation with height remain unclear. In choosing such an intensive hormone treatment involving daily injections, pubertal delay, and possible side effects, we would have expected at least a subgroup of cases to show a motivation in parents as well as adolescents. However, none of the adolescents exhibited elevated scores on all motives, and only two pairs of parents and adolescents were congruent with respect to the observation of psychosocial problems. In the majority of cases it was either the parents or the adolescents who reported one or more motives.
Our sample size was sufficiently large to allow conclusions to be drawn regarding the comparison with normative data, but a larger sample size is needed for examining with sufficient power the possible roles of gender, type of short stature, and risks and protective factors that may modulate the psychosocial functioning of these adolescents [42].
Our study demonstrates that the motives of parents to let their children participate in a growth-enhancing hormone trial are more obvious than the motives of the early pubertal adolescents themselves. Two out of three parents reported worries about the future opportunities or observed modest current psychosocial problems in their children. The adolescents wanted to gain height, but the underlying motivation remains unclear. Few of the adolescents experienced psychosocial problems. Our analyses showed that motives varied among individuals. This result implies that when evaluating hormone treatment, the importance of divergent outcome variables will also differ among individuals. Effectiveness evaluations of hormone treatment to increase height and the consequential fulfillment of other goals must be awaited.
ISS:
idiopathic short stature
SGA:
small for gestational age
SDS:
standard deviation score
GH:
GnRHa:
gonadotropin-releasing hormone agonists
CBCL:
Child Behavior Check List
Silhouette Apperception Technique
CBSK/A:
Dutch version of the Self-Perception Profile for Children/Adolescents
ZBV-K:
Dutch version of the State-Trait Anxiety Inventory for Children
KDVK:
Dutch Short Depression Questionnaire for Children
NPV-J:
Dutch Personality Questionnaire-Junior
WISC-Rn:
Dutch short version of the Wechsler Intelligence Scale for Children (Revised)
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Mul D, Versluis-den Bieman HJ, Slijper FM, Oostdijk W, Waelkens JJ, Drop SL: Psychological assessments before and after treatment of early puberty in adopted children. Acta Paediatr. 2001, 90: 965-971. 10.1080/080352501750064905.
Ross JL, Sandberg DE, Rose SR, Leschek EW, Baron J, Chipman JJ, Cassorla FG, Quigley CA, Crowe BJ, Roberts K, Cutler GBJ: Psychological adaptation in children with idiopathic short stature treated with growth hormone or placebo. J Clin Endocrinol Metab. 2004, 89: 4873-4878. 10.1210/jc.2004-0791.
Veerman JW, Straathof MAE, Treffers PDA, van den Bergh BRH, ten Brink LT: Handleiding bij de Competentie Belevingsschaal voor Kinderen, CBSK (Manual of the Self Perception Profile for Children - Dutch version). 1997, Lisse, Swets & Zeitlinger
Treffers PDA, Goedhart AW, Veerman JW, Van den Bergh BRH, Ackaert L, Rycke L: Competentiebelevingsschaal voor adolescenten (CBSA), handleiding (Manual of the Self perception Profile for Adolescents - Dutch version). 2002, Lisse, Swets & Zeitlinger
Bakker FC, Van Wieringen PCW, Van der Ploeg HM, Spielberger CD: Handleiding bij de Zelf-Beoordelings-Vragenlijst voor kinderen, ZBV-K (Manual of the Stait-Trait Anxiety for children - Dutch version). 1989, Lisse, Swets & Zeitlinger
de Wit CAM: Handleiding bij de depressievragenlijst voor kinderen, DVK en KDVK (Manual of the short depression questionnaire for children - Dutch version). 2001, Amersfoort/Leuven, Acco
Luteijn F, van Dijk H, van der Ploeg FAE: Handleiding bij de Junior Nederlandse Persoonlijkheidsvragenlijst, NPV-J (Manual of the Dutch Personality Questionnaire - junior). 1989, Lisse, Swets & Zeitlinger
Van Haassen PP, De Bruyn EEJ, Pijl YL, Poortinga YH, Lutjespelberg HC, van der Steene G, Coetsier P, Speolders-Claes R, Stinissen J: Handleiding bij de WISC-R (Manual of the Wechsler Intelligence Scale for Children - revised). 1986, Lisse, Swets & Zeitlinger
Sandberg DE, Meyer-Bahlburg HF, Yager TJ: The Child Behavior Checklist nonclinical standardization samples: should they be utilized as norms?. J Am Acad Child Adolesc Psychiatry. 1991, 30: 124-134.
Connolly MA, Johnson JA: Measuring quality of life in paediatric patients. Pharmacoeconomics. 1999, 16: 605-625.
Theunissen NC, Vogels TG, Koopman HM, Verrips GH, Zwinderman KA, Verloove-Vanhorick SP, Wit JM: The proxy problem: child report versus parent report in health-related quality of life research. Qual Life Res. 1998, 7: 387-397. 10.1023/A:1008801802877.
Erling A, Wiklund I, Albertsson-Wikland K: Prepubertal children with short stature have a different perception of their well-being and stature than their parents. Qual Life Res. 1994, 3: 425-429. 10.1007/BF00435394.
Gudas LJ, Koocher GP, Wypij D: Perceptions of medical compliance in children and adolescents with cystic fibrosis. J Dev Behav Pediatr. 1991, 12: 236-242.
Fournier M, De Ridder D, Bensing J: Optimism and adaptation to chronic disease: The role of optimism in relation to self-care options of type 1 diabetes mellitus, rheumatoid arthritis and multiple sclerosis. Br J Health Psychol. 2002, 7: 409-432. 10.1348/135910702320645390.
Honigman RJ, Phillips KA, Castle DJ: A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg. 2004, 113: 1229-1237. 10.1097/01.PRS.0000110214.88868.CA.
Cohen J: Statistical power analysis for the behavioral sciences. 1977, New York, Academic Press
Department of Pediatric Psychology, University Medical Center Utrecht, Wilhelmina Children's Hospital, P.O. Box 85090, 3508, AB, Utrecht, The Netherlands
Hanneke Visser – van Balen & Gerben Sinnema
Department of Developmental Psychology, Utrecht University, P.O. Box 80140, 3508, TC, Utrecht, The Netherlands
Hanneke Visser – van Balen
Department of Health Psychology, Utrecht University, P.O. Box 80140, 3508, TC, Utrecht, The Netherlands
Rinie Geenen
Department of Pediatrics, Gooi-Noord Hospital, P.O. Box 900, 1250, CA, Laren, The Netherlands
Gerdine A Kamp
Department of Medical Psychology, VU University Medical Center, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
Jaap Huisman
Department of Pediatrics, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
Jan M Wit
Gerben Sinnema
Correspondence to Hanneke Visser – van Balen.
The author(s) declare that they have no competing interests.
HVB and RG analyzed the data and wrote the manuscript together with GS (the project supervisor) who, along with JH, was also involved in the study design and acquisition of data. GAK and JMW (the medical supervisor) were responsible for the design and execution of the medical part of the study. All authors critically revised the manuscript, and read and approved the final version.
Visser – van Balen, H., Geenen, R., Kamp, G.A. et al. Motives for choosing growth-enhancing hormone treatment in adolescents with idiopathic short stature: a questionnaire and structured interview study. BMC Pediatr 5, 15 (2005). https://doi.org/10.1186/1471-2431-5-15
Received: 17 December 2004
Hormone Treatment
Psychosocial Problem
Parental Worry


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The Trefort Garden Foundation was established by former and current institute heads of Eötvös Loránd University's Faculty of Humanities with the aim of supporting the achievement of shared goals that advance the cause of the Faculty in terms of its physical environment (the Trefort Garden), the quality of education, its role as a centre of research and knowledge, its place as an intellectual community as well as a cultural centre.
The Trefort Garden Foundation welcomes all forms of support – whether they be for a specific project or the foundation in general and regardless of whether it comes from our alumni for the achievement of goals they consider important or from committed supporters of the Hungarian humanities, culture and science – which help us achieve our shared goals. These goals are not just those of the country's traditionally top-ranked, oldest, and biggest faculty with the most wide-ranging educational portfolio, but also those of Hungarian opinion leader humanities intellectuals and those that need to be achieved for the education of future generations. The goals of the foundation listed below complement the aims established by the Faculty's eternal mission.
Development and completion of the Trefort Garden's IT network.
Supporting the development of the Trefort Garden library.
Development and diversification of the Trefort Garden's cultural life through the organisation of cultural events and programmes.
Advancing instructor and student mobility at the Faculty of Humanities, developing ties among university citizens.
Promoting the continuous purchase of or subscription to major foreign and domestic academic databases and making them accessible to instructors and students.
Developing relations between the Faculty and its environment; establishing and developing communication channels (publications, website, etc.)
Preparation and dissemination of the Faculty's publications, brochures and other press materials.
Providing equal opportunities to the Faculty's disadvantaged students.
Development of the Faculty's student and instructor communities; encouragement of students and instructors to live a healthy, sports-filled lifestyle.
Implementation of the Green Faculty Programme, support of its goals and related events (landscaping of the Trefort Garden and its conversion into a cyclist-friendly institution, selective waste collection, the promotion of an environmentally-conscious mentality.
The Trefort Garden Foundation is a foundation of Eötvös Loránd University's Faculty of Humanities. Supporting the foundation means supporting the Faculty. The developments needed to be carried out at the Faculty are designed to improve the conditions of the educational, creative and academic work done here. We consider the foundation to be the official channel through which we can use the support we receive to achieve our goals.
We therefore ask everyone – whether they be a colleague, student, alumni, a supporter from the outside or a friend – to help achieve the goals of the foundation, and with it, those of the Faculty, through the help of their talent, connections or financial contributions. We ask in particular for the support of Hungarians and Hungarian organisations beyond the border, many of whom live and operate outside Europe, which feel they bear a responsibility for the preservation of the Hungarian humanities, the Hungarian language and culture, to donate to the Hungarian hub of this academic field, the number one centre of the training of Hungarian humanities intellectuals, who are a key part of our future.
preamble of the foundation's articles of association
The progress of societies depends primarily on the extent of progress in material and intellectual culture, i.e. on the amount of knowledge created and amassed by communities. Science is therefore the most important engine of progress of human civilization. Science is the main depositary of the creation and dissemination of knowledge. The rationalism of the Enlightenment placed science on an imaginary pedestal, giving it authority and setting high expectations of it. In the second half of the 19th century, those involved with science viewed their line of work as a means of simultaneously serving their tighter community, their nation and the broader community, humanity itself. The ethos of the practice of science led to the spread of the idea that knowledge has principles, as opposed to interests.
Universities are the most important forums of the acquisition of scientific knowledge. Wherever universities were and are born, venues for the creation (research) and dissemination of knowledge (the highest level of institutional education) were and are soon to emerge. Universities are thus the strongholds of science. Science, as Hungarian composer Zoltán Kodály wrote, "is the unrelenting search for truth, which can be neither a maid of theology or a prostitute to politics". Ideas must flow freely wherever science is practiced, and truth must be spoken. However, in a place that is the scene of the search for and transfer of truth in the atmosphere of the freedom of thought, the need for quality and responsibility are also of key importance. It is his need for quality and responsibility which the instructor and the student aspiring to become an intellectual both have a duty to represent before their narrower and broader environment. Loránd Eötvös, who was once a student, teacher, and eventually the rector of our university, placed heavy emphasis on personal responsibility: "School and education are […] only scientific where teaching is done by scientists […] The matter of the university […] is above all one of personnel, next to which the matters of the organisations and regulations of the university are but secondary." Just as it is not the desk that makes the one sitting at it great, but rather the other way around, it is primarily a university's teachers, professional and personnel excellence, that can make it an institution of prestige and excellence.
Despite the new circumstances and the global challenges, opportunities and problems of the open world, certain fundamental questions have remained unchanged. To this day, universities remain the institutions safeguarding the social prestige of science and higher education and the most important venues of the search for and transfer of truth.
We know very well that talent and determination alone are not enough for the practice of science. It also requires the external (institutional, infrastructural and financial) conditions vital for successful research. Those working at the universities of countries lacking in resources or under political leadership that spends less than it should on research and education can attest to the truth of this trivial sentence from personal experience. There was a reason why Loránd Eötvös once wrote: "we often receive [...] fairy tale-like news [...] from far-away lands. Lords, who had their practice of science to thank for the best hours of their lives, industrialists, who found the sources of their industry in the application of science, practically magically create new universities or breathe new life into old ones through their donations amounting to millions." The financial support of university studies, however, goes further back. In the 18th century, seeing members of the aristocracy take on the burden of financing the university studies of talented young people was no longer uncommon in Hungary, either. Those who took it upon themselves to finance the study allowance or foundation scholarship (the alumneum) were known as the alumni, and these early supporters of science were the ones who influenced the emergence of the so-called alumni movement in the West. This movement of alumni binds together the virtual community of those choosing to support their university in part, out of gratitude to their alma mater.
Wealthy members of civil society can still do a lot to ensure that our universities, including the Faculty of Humanities of our prestigious and storied Eötvös Loránd University, are more effective in serving Hungarians and humanity. The Trefort Garden Foundation mainly aims to reach those whose alma mater is our university's Faculty of Humanities. But they are not the only ones we wish to reach. We also want to reach out to everyone who considers it important that our donations are guaranteed to serve noble goals from a greater social perspective as well. And the declared goals of the Trefort Garden Foundation meet this criterion, as they aim to ensure that the Faculty, which plays a key role in the training of Hungarian humanities intellectuals, can operate in the modern conditions that allow it to provide its students with a quality education. The foundation aims to promote the education of future intellectuals who are creative, give credibility to the need for quality and responsibility through their own personal example, combine tradition and innovation, think and act in terms of a community and carry with them the desire for continuous modernisation and the courage for innovation.
Those who support the Trefort Garden Foundation do not just support Eötvös Loránd University's Faculty of Humanities, but also the cause of the future of Hungarian scientism, culture and education.
Dr. Jenő Kiss


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FDA approvals total 27 in 2013
FDA approved 27 new drugs last year, down from 39 new medications in 2012, which was a 15-year high, the Associated Press reported.
In spite of the decline, FDA said that the number of innovative drugs approved in 2013 is in line with the historical trend. FDA has approved 28 new drugs annually over the past 5 years on average.
"While the number of FDA drug approvals has declined from 39 new drugs in 2012 to 27 in 2013, FDA continues to demonstrate its ability to focus on ensuring that cutting-edge and innovative drugs are made available to certain populations that might otherwise not receive these high-level drug treatments," said Abimbola Farinde, PharmD, MS, who serves on the faculty at Columbia Southern University, Orange Beach, Ala. "For some population these drugs approval can mean the difference between life and death."
The number of drug approvals declined in 2013 mostly because there were fewer drugs submitted for review. FDA reportedly received at least 32 applications for innovative drugs 2013, down from 41 in 2012. In general, reviewing new drug applications takes FDA between 6 and 10 months.
"The growing awareness, prevalence, and research that has been focused on cancer in general," has made the approval of innovative cancer drugs in 2013 significant, according to Dr. Farinde.
Those approvals included the expanded indication of sorafenib (Nexavar, Bayer HealthCare Pharmaceuticals Inc. and Onyx Pharmaceuticals) to treat late-stage (metastatic) differentiated thyroid cancer; pertuzumab (Perjeta, Genentech, a member of the Roche Group) as part of a complete treatment regimen for patients with early stage breast cancer before surgery; and ibrutinib (Imbruvica, Pharmacyclics and Janssen) to treat patients with mantle cell lymphoma, a rare and aggressive type of blood cancer.
Read more about the progress in treating cancer here.
News | Community Practice | Chain Pharmacy | Health System


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The show title hotlinks below are to the upcoming playlists specified.
AntiquaNova – Sundays at 6 p.m., FM/HD1, Sundays at 12:30 p.m., HD2 *
produced by Anna Pranger, hosted by Meredith Granger
Christ Church Cathedral Choral Evensong Service – Sundays at 6:30 p.m., FM/HD1
produced by George Benn
Underwritten by Christ Church Cathedral
Choral Colors – Sundays at 7 a.m., FM/HD1, Sundays at 5 p.m., HD2 *
produced and hosted by Meredith Granger
The Chicago Symphony Orchestra – Sundays at 10 p.m., FM/HD1, Saturdays at 10 p.m., HD2 *
(playlists for this quarter)
Underwritten by MacAllister Machinery Co.
Classical Guitar Alive – Thursdays at 10 p.m., FM/HD1, Saturdays at 7 a.m., HD2 *
(playlist for this week)
Classical Music with Anna Pranger – Daily at 9 a.m., Weekdays at 3 p.m., HD2 *
produced and hosted by Anna Pranger
Classical Music with Meredith Granger – Weekdays at 4 p.m., FM/HD1
produced by Michael Toulouse, hosted by Meredith Granger
Classical Music with Michael Toulouse – Weekdays at 6 a.m., FM/HD1
Classical Music with Peter Van De Graaff – Weekdays at 12 a.m., FM/HD1, Weekends at 12 a.m., HD2 *
(playlists for several weeks)
produced and hosted by Michael Toulouse
Concert Band Hour – Saturdays at 7 a.m., FM/HD1, Saturdays at 5 p.m., HD2 *
Underwritten by Gayl and Beverly Doster
Deutsche Welle Festival Concerts – Tuesdays at 10 p.m., FM/HD1, Sundays at 7 a.m., HD2 *
Exploring Music with Bill McGlaughlin – Weeknights at 7 p.m., FM/HD1, Weekdays at 12 p.m., HD2 *
Underwritten by Alan and Laura Mendelsohn and by Melissa S. Brown
Live From the Metropolitan Opera – Saturdays at 1 p.m., Dec. through May, HD 2 *
We hope WICR will again broadcast the Metropolitan Opera when their 13/14 broadcast season begins Sat. Dec. 7. Please direct comments about Saturday afternoon programming to WICR, the University of Indianapolis, 1400 E. Hanna Ave., Indianapolis, IN 46227-3697, (317) 788-3280, or [email protected]
Masterworks – Wednesdays at 10 p.m., FM/HD1, Fridays at 10 p.m, HD2 *
Millennium of Music – Thursdays at 11 p.m., FM/HD1, Saturdays at 8 a.m., HD2 *
(playlist for several weeks)
The New York Philharmonic – Mondays at 10 p.m., FM/HD1, Saturdays at 6 p.m., HD2 *
Operas from the FAS Library – Sundays at 1 p.m., HD2 *
Sunday, November 10th Anna presents "Lulu" by Friedrich Kuhlau. Michael Schonwandt conducts the Danish Radio Symphony Orchestra and Choir. Risto Saarman sings the role of Lulu, Anne Frellesvig sings Sidi.
Underwritten by the Christel DeHaan Family Foundation in honor of the children and families of Christel House
UIndy Faculty Artist Concerts (October through June) – Sundays at 7 p.m, FM/HD1, Saturdays at 12 p.m., HD2 *
produced by Richard Ratliff, hosted by Michael Toulouse
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Programming subject to change or pre-emption without notice.
For information on program underwriting opportunities, contact:
Robert McIntyre (Corporate or Non-Profit Underwriters)
V.P. Program Underwriting
E-mail Robert
Chris Tolzmann (Individual Underwriters)
Director of Development & Marketing