Biomedical subjects

D Drotar

Publications and source records attributed to D Drotar.

At least 55 records · Page 3Linked to original sources

PubMed1995

Assessing the effects of traumatic brain injury on family functioning: conceptual and methodological issues.

Reviewed empirical literature published since 1975 on the effects of pediatric traumatic brain injury (TBI) on the family. Few systematic, hypothesis-driven investigations of the impact of TBI on family functioning have been conducted. However, existing findings indicate that severe TBI can adversely affect families and individual family members. Certain factors, such as poor preinjury functioning and parental psychological disorder, appear to place families at greater risk for long-term disruption. Issues associated with the conceptualization of the impact of TBI on various aspects of family functioning are discussed and methodological considerations are outlined. Special attention is given to novel strategies for studying these complex, multifaceted issues. Finally, a framework is proposed for examining the processes of family adaptation after pediatric TBI to guide future research directions.

Adaptation, Psychological↗

PubMed1994

Psychological research with pediatric conditions: if we specialize, can we generalize?

Considered threats to validity and generalizability of psychological research with pediatric populations and proposed ways to better understand and manage these problems. Variation due to characteristics of acute and chronic conditions (e.g. duration, severity, illness course), settings and referral patterns, family environmental characteristics, as well as investigators' decisions concerning criteria and recruitment limit inferences concerning the impact of pediatric conditions on psychological development and generalizability of findings. These problems call for an expanded use of replication, cross-center, population-based, and theory-driven research. Scientific progress will be made by increasing dialogues and collaboration among researchers concerning generalizability problems and improving research training in epidemiological methods, analysis of large-scale data sets, and meta-analysis.

Humans↗

PubMed1994

Impact of parental health problems on children: concepts, methods, and unanswered questions.

Described conceptual and methodological issues that arise in the design and analysis of data from studies of the impact of parental health problems on children. Researchers should consider how the functional effects, duration, and type of exposure of parental health problems affect children's psychological experience. Multiple pathways (e.g., parental modeling, family socialization practices, and genetic factors) that affect the transmission of psychological and/or health risk to children need to be considered. Important methodological issues in this area of research include sample selection and bias, confounding factors, and limited assessment of family influences. Future work should identify factors that enhance child and family resilience to the effects of parental health problems. Studies are also needed to develop and test interventions to reduce the psychological morbidity associated with parental health problems.

Adaptation, Psychological↗

PubMed1994

Maternal child-rearing behavior in three groups: cystic fibrosis, insulin-dependent diabetes mellitus, and healthy children.

Compared child-rearing behaviors among mothers of children (ages 4-14) with cystic fibrosis (CF) (N = 26), insulin-dependent diabetes mellitus (IDDM) (N = 26), and mothers of physically healthy children (N = 26), on six domains, including involvement, limit setting, responsiveness, reasoning and guidance, free expression, and intimacy using the Iowa Parent Behavior Inventory. Maternal Reports of their child-rearing behavior were comparable across the three groups with one exception: Mothers of children with chronic illnesses (CF and IDDM) were significantly less likely to set limits than mothers of healthy children. The present findings are consistent with those of other studies that have identified few differences in child-rearing practices between mothers of children with chronic illnesses and mothers of healthy children. Future research should identify situation-specific parenting tasks unique to childhood chronic illness.

Adolescent↗

PubMed1994

Age differences in parent and child responsibilities for management of cystic fibrosis and insulin-dependent diabetes mellitus.

Mothers (n = 26) of children and young adolescents (ages 4 to 14) with insulin-dependent diabetes mellitus (IDDM) and mothers (n = 26) of children and young adolescents with cystic fibrosis (CF) (ages 4 to 14) described family responsibilities for treatment-related tasks and their children's general independence. Contrary to prediction, children and adolescents with CF and IDDM demonstrated comparable levels of independence concerning treatment-related responsibilities and their general adaptive behavior. As hypothesized, older children assumed higher levels of independence in managing their conditions, as well as sharing of treatment-related responsibilities with their parents. However, parents, especially mothers, continued to be very involved in most tasks, even for young adolescents. Independence in assuming treatment-related responsibilities was highly related to general independence among children and adolescents with both conditions. Children's independence in chronic illness management was not related to help mothers received from others as measured by the frequency and/or number of people helping. Findings have implications for pediatricians' monitoring and support of adaptive family responsibilities for chronic illness management.

Adolescent↗

PubMed1994

A prospective study of family environments of children hospitalized for nonorganic failure-to-thrive.

Family functioning of nonorganic failure-to-thrive (NOFT) infants was compared with that of physically healthy, normally growing infants of similar socioeconomic status shortly after the time of the diagnosis of this condition (average age of 5 months) and again at 4 years of age. Families of NOFT infants demonstrated less adaptive relationships than did comparison-group infants, as measured by the Family Relationships Inventory (FRI) at both time points, but a comparable number of changes in residence and constellation on follow-up. Contrary to prediction, the quality of family relationships at point of diagnosis did not predict subsequent family relationships, residence, or constellation changes in the NOFT sample. However, more adaptive family relationships in the comparison group at study entry predicted fewer residence and constellation changes and more cohesive relationships 3 years later. The impact of significant discontinuities in family functioning and status should be considered in research and in clinical interventions with NOFT children.

Child, Preschool↗

PubMed1994

Use of desmopressin acetate to reduce blood transfusion requirements during cardiac surgery in patients with acetylsalicylic-acid-induced platelet dysfunction.

OBJECTIVE: To determine whether desmopressin acetate (DDAVP) has the ability to reduce blood loss in patients with a known bleeding tendency. DESIGN: A randomized, double-blind, placebo controlled study. SETTING: A university teaching hospital. PATIENTS: Men under the age of 70 years who had taken acetylsalicylic acid within 7 days of scheduled coronary artery bypass surgery. Patients with an abnormal hematologic profile or a history of bleeding or who were receiving heparin or undergoing repeat coronary bypass surgery were excluded. Forty-four patients were randomized with restriction in blocks of 10; 20 received DDAVP and 24 received a placebo. MAIN OUTCOME MEASURES: Blood loss and blood transfusion requirements. RESULTS: Patients treated with DDAVP lost significantly (p < 0.01) less blood than those receiving a placebo (1543 mL versus 2376 mL respectively). Nineteen patients had a blood loss of more than 2000 mL; 15 of these were in the placebo group. Significantly (p < 0.02) fewer patients receiving DDAVP required blood transfusion (9 versus 18). CONCLUSIONS: DDAVP reduces blood loss during cardiac bypass surgery in patients who have taken acetylsalicylic acid within 7 days before operation.

Aspirin↗

PubMed1993

Influences on collaborative activities among psychologists and pediatricians: implications for practice, training, and research.

Addresses the need for a comprehensive framework that describes the broad range of professional interactions between psychologists and pediatricians, presents a generic model of influences or collaboration and proposes specific implications for training, practice, and research. Three primary influences on the development of collaborative activities are proposed: (a) participants' beliefs about the need for and expectations of the potential outcomes of collaboration; (b) participants' knowledge, skills, and prior experiences, especially in collaborative work; and (c) setting-based barriers and supports. Interventions that promote positive beliefs and expectations among colleagues concerning interdisciplinary work, facilitate specific skills related to cooperative research and management of clinical problems, and develop new practice settings should enhance collaboration.

Curriculum↗

PubMed1993

Pediatric psychologists' perceptions of their work settings.

Describes the results of a survey of pediatric psychologists' perceptions of their work settings. Respondents (n = 261) described heterogeneous work settings, professional activities, expectations for workload and administrative arrangements. Clinical activities were prominent, accounting for nearly half the respondents' time. Respondents generally reported high levels of overall satisfaction with their work environments. Highest ranked sources of satisfaction included professional autonomy, patient care, and relationships with colleagues. Highest ranked sources of dissatisfaction included lack of time for research, salary, and patient care workload. Pediatric psychologists in private practice reported higher work satisfaction than those in other settings. Findings have implications for the work-related functioning of pediatric psychologists that should be addressed in research and professional activity.

Adult↗

PubMed1993

Issues involved in the definition and classification of chronic health conditions.

The need for a widely applicable definition of chronic conditions for research, policy, and program development has led to an extensive review of the development of such definitions, the considerations involved in their use, and some recommendations for a new approach. This paper examines some of the methodologic and conceptual issues related to defining and classifying chronic conditions and describes some consequences resulting from decisions made about these issues. While most examples are taken from child health applications, the basic concepts apply to all age groups. The dominant method for identifying and classifying children as having a chronic condition has relied on the presence of an individual health condition of lengthy duration. This condition-specific or "categorical" approach has increasingly seemed neither pragmatically nor conceptually sound. Thus, the development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended. Such a definition might reflect the child's functional status or ongoing use of medical services over a specified time period. In addition, it is suggested that conditions be classified based on the experience of individual children, thus emphasizing the tremendous variability in expression of seemingly similar conditions.

Child↗

PubMed1992

Personality development, problem solving, and behavior problems among preschool children with early histories of nonorganic failure-to-thrive: a controlled study.

Using a prospective study design, 48 preschool children with early histories of nonorganic failure-to-thrive (NOFT) and 47 physically healthy children of comparable age, sex, birth order, and family demographics were compared on measures of problem solving and personality development (ego control and ego resiliency). In responding to structured measures, NOFT children demonstrated deficits in behavioral organization, ego control, and ego resiliency compared with controls. Parents also identified higher levels of behavioral symptoms in children with early histories of NOFT compared with controls. However, home observational measures of ego control and ego resiliency did not differentiate the two groups. Deficiencies in problem solving and personality development and increased levels of behavioral symptoms in preschool children with early histories of NOFT may affect their future socioemotional development and learning.

Child Behavior Disorders↗

PubMed1991

The family context of nonorganic failure to thrive.

Family influences on the etiology, clinical presentation, and prognosis of nonorganic failure to thrive are reviewed in terms of the effect of family economic resources, functioning, and child rearing beliefs on the availability and allocation of food; and of the role of dysfunctional family feeding and caretaking patterns in determining the child's response to food, maternal psychological adjustment, and the quality of mother-child interaction. Family centered approaches to intervention and research are discussed.

Child↗

PubMed1991

Coming of age: critical challenges to the future development of pediatric psychology.

Described five professional challenges that will affect the future development of pediatric psychology: specialization and professional identity, relationships with other professions, securing resources necessary for effective functioning, the conflict between clinical service delivery and prevention, and development of training models. To meet these challenges, pediatric psychologists need to maintain strong connections with other psychologists, develop new models of collaborative training, practice, and research, emphasize prevention activities, and enhance the scientific basis of pediatric psychology through innovative training programs and support for faculty development.

Child↗

PubMed1991

Cautions in using the Child Behavior Checklist: observations based on research about children with a chronic illness.

The Child Behavior Checklist (CBCL) and the related instruments, the Teacher's Report Form (TRF) and Youth Self-Report (YSR), are frequently used in research assessing the behavioral adjustment of children. This paper describes some issues relevant to children with a chronic physical illness that should be considered when using these instruments. Salient problems include (a) possible bias in interpreting data concerning physical symptoms; (b) limited sensitivity to identify mild adjustment problems of the sort most often encountered in children with chronic physical illnesses; and (c) incomplete and potentially misleading assessment of social competence. When using these instruments investigators should also be aware of several general methodologic issues before collecting, analyzing, and interpreting data regarding children with chronic illnesses.

Adaptation, Psychological↗

PubMed1991

Coping with cancer in remission: stressors and strategies reported by children and adolescents.

Thirty-nine school-age children and adolescents with cancer in remission completed the Children's Stress Inventory (CSI) and a cancer-related stress and coping measure (McCabe & Weisz, 1988) that elicited information about their life stressors and coping strategies. Children identified a range of stressors including general life and cancer-related stress, but general life stressors accounted for the majority of their perceived stress. Children were not consistent across cancer-related and non-cancer-related stressful situations, except for their use of intrapsychic coping strategies. Compared with school-age children, adolescents used more emotion-management and less problem-solving coping strategies when faced with cancer-related stressors, but not when dealing with non-cancer-related stress. When coping with cancer-related stress, females used more emotion-management and less problem-solving strategies than males. Findings have implications for refinement of measures and future research.

Adaptation, Psychological↗

PubMed1991

Shared dilemmas of research and practice in developmental and behavioral pediatrics: introduction to the special issue on methodology.

Research in developmental and behavioral pediatrics is characterized by special methodological problems involving measurement, design, and analysis related to research questions, populations, and nature of interventions in this field. To sensitize researchers and practitioners to these problems and to enhance the quality of research and critical consumption of research reports, this special issue provides a summary of basic methodological issues in developmental and behavioral pediatrics. Advances in this field will require the kind of critical observation and decision making that are shared by researchers and practitioners and are illustrated by contributions to this issue.

Child↗

PubMed1990

Maternal interactional behavior with nonorganic failure-to-thrive infants: a case comparison study.

Mothers of 47 6-month-old infants with early histories of nonorganic failure to thrive (NOFT) infants and a matched comparison group of physically healthy infants were observed in interactions with their infants in their homes one month following hospitalization. Mothers of NOFT infants were observed to have less adaptive social interactional behavior, less positive affective behavior, and demonstrated more arbitrary termination of feedings. No group differences were found in flexibility or sensitivity of maternal feeding, or in environmental circumstances such as number of persons present, noise level, or level of activity. These salient deficiencies in maternal interactional behavior may continue to disrupt the NOFT child's physical growth and psychological development following initial diagnosis and hospitalization. Additional studies are needed to identify patterns of maternal interactional behavior which influence psychological prognosis and to assess the responsiveness of maternal interactional behavior to intervention.

Adult↗

PubMed1990

Sampling issues in research with nonorganic failure-to-thrive children.

Describes the methodological problems posed by sampling characteristics of nonorganic failure-to-thrive (NOFT) children and strategies to address them. Sources of variance in sample characteristics include the criteria used to define NOFT, populations from which samples are drawn, parent refusal and sample attrition, medical and psychological treatment, and individual differences in environmental or biologic risk factors. Undesirable consequences of unrecognized intrasample variation in NOFT include sample bias, limited generalizability of findings across different settings, and erroneous assumption of sample homogeneity. Comprehensive description of sample selection and characteristics will enhance more accurate definition of NOFT, generalizability of findings, and evaluation of the impact of sampling characteristics. Future studies should focus on objective assessment of subtypes of NOFT and the relationship of individual difference variables to psychological status and prognosis.

Diagnosis, Differential↗