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Biomedical subjects

D A Mrazek

Publications and source records attributed to D A Mrazek.

At least 37 records · Page 2Linked to original sources
PubMed1991

Early asthma onset: consideration of parenting issues.

This report examines the relationship between early parental behavior and the later onset of asthma in a cohort of 150 children who were genetically at risk for developing asthma. Judgments of both parenting problems and maternal coping were made during a home visit when the infant was 3 weeks old. A clinical interview with the mother was developed and reliably coded. The sample was divided into two groups based on the presence or absence of concerns about coping and parenting. During the following 2 years, the respiratory status of the children was monitored. Four categories of respiratory status were defined: (1) asthma; (2) recurrent infectious wheezing; (3) a single isolated wheezing episode; or (4) no wheezing. Early problems in coping and parenting were associated with the later onset of asthma (p less than 0.001). Furthermore, parents of children who developed asthma were more likely to have been having difficulties at the 3-week visit than those whose children developed infectious wheezing (p less than 0.005).

Adaptation, Psychological↗
PubMed1991

Current status of research activity in American child and adolescent psychiatry: II. A developmental analysis by age cohorts.

A survey designed to assess research activity was sent to 622 full-time child and adolescent psychiatric faculty at 127 academic programs. A 78.5% response rate was achieved. An examination of the responses of three age cohorts was conducted. Only about 10% of the respondents met the empirical definition of a researcher based on percentage of effort, publication, and funding. No increase in research activity was found for the youngest cohort, although significantly more younger women were holding academic appointments. Younger researchers identified psychobiological studies as a particular interest. Researchers at all ages identified a mentor program as a critical aspect of their training.

Adolescent↗
PubMed1990

Twin temperament during the transition from infancy to early childhood.

A multiple-regression model for the analysis of twin data in which one twin's score is predicted from that of its co-twin, the coefficient of relationship, and the interaction term provides direct estimates of heritability (h2) and the proportion of variance due to shared environmental influences (c2). Several multiple-regression models were fitted to parental ratings of infant and toddler temperament for 306 pairs of twins. High estimates of h2 were found for eight of the nine temperament scales, and three scales showed significant effects of c2. No differential heritability was found between males and females across the infant and toddler years.

Child, Preschool↗
PubMed1989

Determinants of school performance in children with chronic asthma.

We have documented performance on standardized academic achievement tests for reading and mathematics in 99 children with moderately severe to severe chronic asthma. Academic performance and intelligence test scores indicated that, overall, the academic capabilities of the children with asthma were average to above average. A stepwise regression analysis was used to examine relationships between the dependent variables of reading and mathematics and the independent variables of socioeconomic status, school attendance, medical factors relating to asthma, age, and emotional and behavioral problems of the children. Factors that were associated significantly with low performance scores were low socioeconomic status, older age, history of continuous oral steroid use (prednisone or methyl prednisolone taken at least every other day for the year prior to evaluation), and presence of emotional and behavioral problems. School absenteeism, use of medical resources, oral steroid dosage, other medications used to treat asthma, and pulmonary functions were not associated with academic performance. Investigation of poor classroom performance of a child with chronic asthma should include investigation of the roles of socioeconomic status, oral steroid therapy, and emotional and behavioral problems.

Absenteeism↗
PubMed1989

Outcome of long-term hospitalization for asthma in children.

Children whose asthma continues to be poorly controlled with outpatient management are often referred to a long-term hospital program for care. Although these programs have been in existence since the 1950s, there has been no systematic study of their effectiveness. The purpose of the present study was to determine outcome in 103 children discharged consecutively after a long-term hospitalization. These children had both severe asthma and significant psychologic problems. Eighty-three of the 103 children had required continuous or frequent intermittent steroids for asthma control. In the year before admission, they had been hospitalized for asthma a mean of 2.6 times for 11.8 days and had had 4.6 visits to emergency rooms and 6.6 visits to physician offices for acute wheezing. Use of medical resources for asthma decreased significantly in the year after long-term hospitalization compared to the year before hospitalization (hospitalization: -34%, p less than 0.0001; hospital days: -39%, p less than 0.0002; emergency room visits: -46%, p less than 0.00001; physician office visits for acute asthma, -42%; p less than 0.00001; and a composite score giving increasing weight to more intensive and costly care: -30%, p less than 0.0001). Long-term hospitalization for children with asthma not responsive to outpatient management is associated with improvement in their use of medical resources.

Adolescent↗
PubMed1989

Cardiovascular fitness in children with asthma correlates with psychologic functioning of the child.

Abnormalities in fitness in asthmatic children are assumed to derive from illness severity. We studied 90 children with moderately severe to severe but stable asthma for (1) fitness levels using bicycle ergometry, (2) measures of asthma severity, (3) clinician's impression of child (Child Global Assessment Scale), and (4) mother's rating of child's behavior (Child Behavior Checklist). Fitness values ranged from 15% to 120% of normal values for age, sex, and body surface area: 48% were abnormal (less than 2 SD below mean) and 5% were borderline (1 to 2 SD below mean). Associations between levels of fitness and medical and psychologic criteria were tested using regression analyses. Of the 11 medical variables used to define the severity of asthma, recent exacerbation of disease, forced expiratory volume in 1 second, and specific airway conductance together accounted for 8.1% of the variability in the workload ratios (ie, R2 = 0.081). The importance of the psychologic factors in determining the variability in the workload ratios was tested after the importance of the medical variables had been considered: Child Global Assessment Scale accounted for a significant amount of variability, improving the R2 to 0.180 (an increase to 0.100, P = .003). These data suggest that, within the spectrum of disease presented by the patients in this study, adjustment to the disease is at least as important as severity of disease in determining fitness.

Adolescent↗
PubMed1988

47,XXX: what is the prognosis?

Eleven unselected 47,XXX girls, now 15 to 22 years of age, have been observed from birth in a prospective study of children with sex chromosome anomalies. A description of their growth and development is presented. The 47,XXX infants were not generally distinguishable from chromosomally normal children in the first year of life, even though there was a slight delay in neuromotor development. By 2 years of age, developmental delays in speech and language often became evident, and speech therapy was often necessitated in the preschool years. Early school problems included speech and language deficiencies, lack of coordination, poor academic performance, and immature behavior; these persisted throughout the school years. By high school age, a 47,XXX girl was generally tall and often subject to somatic complaints. Sexual development was generally normal. Seven of the 11 propositae had a diagnosed psychiatric disorder or disturbance at some time during adolescence. Variability within this syndrome is great; one proposita is in college and another is mentally retarded. The frequency of the diagnosis of the 47,XXX karyotype by genetic amniocentesis is estimated to be 1/1000, the same incidence as in the newborn population. Expectant parents must be counseled as to the significance of this karyotype and prognostic information must be given. Suggested guidelines are included.

Adaptation, Psychological↗
PubMed1987

Resilience in child maltreatment victims: a conceptual exploration.

While many child maltreatment victims suffer serious negative emotional sequelae, others do surprisingly well. Resilience in children is a relative concept which can change over time and is affected by environment and genetics. Resilience is fostered by protective factors which ameliorate or alter a child's response to the hazards of maltreatment that usually predispose to maladaptive outcome. Personal characteristics or skills that may foster resilience include (1) rapid responsivity to danger; (2) precocious maturity; (3) dissociation of affect; (4) information seeking; (5) formation and utilization of relationships for survival; (6) positive projective anticipation; (7) decisive risk taking; (8) the conviction of being loved; (9) idealization of an aggressor's competence; (10) cognitive restructuring of painful experiences; (11) altruism; and (12) optimism and hope. There are also generic life circumstances, such as having access to good health, educational, and social welfare services, that foster resilience in children regardless of the specific nature of the stressor. Additionally, there may be abuse-specific protective factors in the environment. Examples might include the quick and full acknowledgment of an offender regarding abuse, or timeliness and permanence of legal actions affecting a child's custody. The life stories of three well-known survivors of various forms of child maltreatment illustrate how protective factors contribute to resilience. A caution is noted regarding how personal characteristics developed for survival may become maladaptive if overused and/or not given up when the stressor no longer exists. Characterological problems are most likely to develop when a child's life circumstances fail to change and the environment never becomes secure.

Adaptation, Psychological↗
PubMed1987

Psychomotor adaptation in children with severe chronic asthma.

Acute effects of steroid medications or hypoxic-induced brain damage have been hypothesized to cause neuropsychologic impairment in children with severe asthma. The present investigation included neuromotor, cognitive, psychosocial, and medical evaluations of 67 hospitalized asthmatic children from 9 to 14 years of age, at risk for motor dysfunction. Mean scores from the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were similar to test norm means and were not indicative of neuromotor impairment. Scores of the BOTMP correlated significantly (P less than .01) with measures of child and family psychosocial adaptation but not with measures of cognitive ability, steroid dose at admission, or severity of asthma. Thirteen children had battery composite scores more than 1 SD below age means but did not demonstrate decreased IQ or increased steroid use, respiratory failure, seizures, or abnormal neurologic signs compared with the other 55 children. These results indicate that most severely asthmatic children, including many with histories of hypoxia and high-dose steroid use, do not demonstrate psychomotor impairments indicative of brain damage. It is concluded that neuromotor development in asthmatic children is associated with psychologic characteristics that influence adaptation to illness and activity level.

Adaptation, Psychological↗
PubMed1985

Physiologic and psychological characteristics associated with deaths due to asthma in childhood. A case-controlled study.

Several reports have documented characteristics of children who die of asthma; however, to the best of our knowledge, no studies have used case controls to clarify the clinical characteristics associated with death. We conducted a case-controlled study of 21 patients with severe asthma hospitalized between 1973 and 1982 who died of asthma sometime following discharge. Average age at death was 13 years (range, 8 to 18 years). Twenty-one asthmatic control cases were matched for age at the time of hospitalization, sex, and severity of illness. Hospital records were evaluated for 57 physiologic and psychological variables. A stepwise discriminant analysis determined that the following eight variables could discriminate the two groups effectively: history of seizures associated with an asthma attack; conflicts between the patient's parents and hospital staff regarding medical management of the patient; self-care of asthma while in the hospital that was not appropriate for age; prednisone dosage having been decreased by more than 50% during the course of hospitalization; inhaled beclomethasone dipropionate required for treatment; increased asthmatic symptoms during the week preceding discharge; depressive symptoms; and disregard of asthmatic symptoms. Most of the clinical characteristics previously thought to place patients at greater risk for a fatal asthmatic attack were found as often in the control cases as in the children who died. This study indicates that psychologic risk factors were prominent in severely asthmatic children who subsequently died of asthma. The variables defined in this study may be important in identifying patients who are at high risk for dying of asthma and in developing treatment plans to prevent deaths.

Adolescent↗
PubMed1983

A survey of training in child and adolescent psychiatry.

In a survey of training in child psychiatry in Great Britain, all senior registrars were sent questionnaires; the response rate was 69 per cent. We describe background factors of the trainees, details of the clinical and academic experience available to them, and their attitudes towards their training. Most trainees had had extensive previous experience in adult psychiatry and the predominant orientation was psychoanalytic. In general, they approved of the guidelines for training issued by the Joint Committee for Higher Psychiatric Training. Family therapy was the most popular treatment method. We comment on their training experience where the interest expressed was not matched by adequate availability of the training facilities.

Adolescent Psychiatry↗