Biomedical subjects

J D McLennan

Publications and source records attributed to J D McLennan.

9 recordsLinked to original sources

PubMed2001

Prevalence, persistence, and correlates of depressive symptoms in a national sample of mothers of toddlers.

OBJECTIVES: To examine the prevalence, persistence, and correlates of depressive symptoms in mothers of toddlers in a nationally representative sample. METHOD: The self-report components of two linked databases were used for this study, the 1988 National Maternal and Infant Health Survey and the 1991 Longitudinal Followup. Depressive symptoms of 7,537 mothers were measured by the Center for Epidemiologic Studies-Depression Scale (CES-D) at both time points. Weighted bivariate and multivariate analyses were used to assess the stability of maternal depressive symptoms across two time points and maternal and child predictors of elevated depressive symptoms. RESULTS: Twenty-four percent of mothers at time 1 (mean child age 17 months) and 17% at time 2 (mean child age 35 months) had elevated depressive symptoms (CES-D score > or =16). Thirty-six percent of those with elevated scores at time 1 also had elevated scores at time 2. Not having breast-fed, a mistimed or unwanted pregnancy, and poor child health status were related to elevated depressive symptoms but not persistence. CONCLUSIONS: Elevated depressive symptoms are common in mothers of toddlers. Given the potential magnitude of need, a systematic clinical and public health approach may be required.

Adolescent↗

PubMed2001

Early termination of breast-feeding in periurban Santo Domingo, Dominican Republic: mothers' community perceptions and personal practices.

OBJECTIVES: The objectives of this study were to determine: 1) whether mothers' perceptions of typical community practice for breast-feeding duration influence their personal practices and 2) whether the mothers' reports of community reasons for terminating breast-feeding identify barriers not elicited through self-report. METHODS: The study was conducted in 1997 in a sample of poor neighborhoods in a periurban district of Santo Domingo, the capital of the Dominican Republic. A representative sample of 220 mothers from these neighborhoods was interviewed with a structured questionnaire. RESULTS: While the duration of breast-feeding was similar for self-report and for mothers' perceptions of typical community practice, there was no statistically significant correlation between these two variables. "Mother-driven" reasons for early termination of breast-feeding, such as "fear of loss of figure or of breast shape" and "not wanting to breast-feed," were frequently perceived as community reasons but rarely given as personal reasons. Personal reasons were predominately "child-driven," including "the child not wanting the breast," or reasons beyond the mother's control such as having "insufficient" milk. CONCLUSIONS: Maternal report of community reasons for early termination may be a useful way to identify factors that would not otherwise be revealed on self-report. These additional reasons may guide health promotion efforts aimed at increasing breast-feeding duration.

Adult↗

PubMed2000

Parental prevention practices for young children in the context of maternal depression.

OBJECTIVE: To assess the relationship between maternal depression and 4 parent-based prevention practices (use of car seats and electrical plug covers, presence of syrup of ipecac in the home, and reading to their child), using a large nationally representative follow-back sample. METHODS: The maternal self-report components of 2 databases were used for this study, the 1988 National Maternal and Infant Health Survey and the linked companion 1991 Longitudinal Follow-Up Survey. A total of 7537 mothers with newborns in 1988 served as the subjects. Measures of the 4 prevention practices were extracted from the 1991 survey. Depressive symptom measures were derived from both surveys using the Center for Epidemiologic Studies-Depression Scale. Weighted bivariate and multivariate logistic analyses were used to assess the relationship between maternal depressive symptoms (trichotomized to depression at both time points, at 1 time point, and at neither time point) and parental prevention practices, while controlling for a wide variety of sociodemographic variables. RESULTS: Mothers reporting a high level of depressive symptoms (Center for Epidemiologic Studies-Depression Scale score >/=16) reported significantly poorer prevention practices for car seat use, covering electrical plugs, and having syrup of ipecac in the home. High depressive symptoms were also related to a lower likelihood of daily reading, but only for those mothers presently living with a male partner. Engagement in all prevention practices, except having syrup of ipecac in the home, were less likely if the mother reported high levels of depressive symptoms at both time points versus a single time point. CONCLUSION: Maternal depression may significantly impede parental prevention practices. As maternal depression is a treatable condition, screening and treating this disorder may contribute to improvement in childhood prevention practices and ultimately child health.

Accident Prevention↗

PubMed2000

Prevention of diarrhoea in a poor District of Santo Domingo, Dominican Republic: practices, knowledge, and barriers.

The study, conducted in a poor periurban community of Santo Domingo, Dominican Republic, assessed the practices, knowledge, and barriers relating to prevention of diarrhoea. A total of 582 caregivers of children, aged less than 5 years, were systematically sampled from four barrios. Results of the study showed that 55% of the caregivers did not boil drinking water for children; 38% did not always wash hands of the children prior to meals; 87% of the children did not always wear shoes outside their house; and 54% were breastfed for less than one year. Biomedical knowledge about these practices was high among the caregivers, and was not related to the reported behaviours. However, several barriers were significantly related to practices, including lapse in caregiving, limited resources, erroneous beliefs, and non-compliance by children. Health education, based on a biomedical knowledge-deficit model, may have little impact on improving the diarrhoea-prevention practices in these communities. Greater attention should, therefore, be directed toward the barriers experienced by caregivers of children.

Breast Feeding↗

PubMed1999

Family planning and parenthood needs of women with severe mental illness: clinicians' perspective.

Family planning and parenthood are important issues for women with severe and persistent mental illness (SPMI). The role of adult mental health clinicians with regard to these issues has been under investigated. Clinicians treating patients with SPMI at a large community health center completed survey forms on 419 women. Clinicians reported that a large fraction of sexually active women were not thought to be using birth control. Despite this, many clinicians had not discussed birth control with these patients. Clinicians had concerns about childcare in 72% of cases where the patient with SPMI was the primary custodian of a younger child; however, the majority of these families were not receiving child or family services. Further consideration of the role of the adult mental health clinician in addressing issues of family planning and parenting is required.

Adult↗

PubMed1999

The Physician Belief Scale and psychosocial problems in children: a report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network.

Clinicians' management of children with psychosocial problems may vary with their attitudes and beliefs. However, we lack sound instruments to assess these factors. This study examined the psychometric properties of the Physician Belief Scale (PBS). A modified version of the PBS was sent to clinicians who participated in two primary care research networks. Using factor analysis, we reduced the PBS to 14 items and 2 subscales. Cronbach's alpha values were high. Female clinicians, those using DSM-IV, and those having completed training earlier rated themselves as more psychosocially oriented. Identification and treatment of psychosocial problems were significantly related to scores on the Belief and Feeling subscale. The PBS provided only a modest amount of information regarding primary care practices. It is not clear if these limitations are attributable to the instrument or the many other barriers to effective psychosocial care.

Attitude of Health Personnel↗

PubMed1998

Adolescents' insight in heavy drinking.

PURPOSE: Because so few adolescents with alcohol problems seek treatment, this study examined the factors associated with adolescents' recognition or insight into having a substance use problem. METHOD: Data were extracted from a self-report questionnaire used in an epidemiological study of public middle school students on substance abuse in Arkansas. Those drinking heavily were divided into "admitters" and "deniers" based on their response to the question of having a substance use problem. Odds ratios were calculated to measure the association of several variables with admitting a problem. RESULTS: Of 3395 adolescents, 13.4% (455) met or exceeded our threshold for heavy drinking. Only 15.9% (65) of these heavy drinkers acknowledged having a substance use problem. Reporting more types of negative social events related to alcohol use and scoring higher on a measure of positive alcohol expectancies were significantly related to admitting to a substance use problem. Recent health care contact and perceived environmental factors did not independently contribute to insight. CONCLUSIONS: If these results are generalizable, treatment and educational interventions should emphasize linking alcohol use and negative social consequences.

Adolescent↗

PubMed1998

Knowledge and practices of preventing diarrhoea in malnourished children.

Instructions for preventing diarrhoea, based on a knowledge-deficit model, are a common health-promotion approach aimed at the providers of child care attending nutritional rehabilitation centres. However, there is rarely an assessment of baseline knowledge to justify the need for this type of intervention and to guide its form. This study investigated the practice and knowledge of recommended diarrhoea-prevention behaviours of caregivers of 78 malnourished children consecutively admitted to a realimentation programme. Major deficits included: 39% not boiling (or not planning on boiling) drinking water after the child reached two years of age; 35% not always washing children's hands before meals; only 17% reporting that it was rare for their children to go barefoot; and the majority breastfeeding for less than one year. However, almost all measures of knowledge, based on open and closed questions, were not related to the corresponding practice. Several types of barriers to preventive practices were reported on open questions, including, "beliefs," "children as barriers," and "time." This information may be helpful in designing more effective health-promotion programmes.

Attitude of Health Personnel↗

PubMed1993

Sex differences in higher functioning people with autism.

Though a sex difference in the incidence of autism has frequently been reported, few studies have considered sex differences in the severity of features associated with autism. The Autism Diagnostic Interview was used to assess the difference between a group of 21 females and 21 males with autism with equivalent chronological nonverbal IQ greater than 60. Males were rated to be more severely autistic than females on several measures of early social development, but not in any other areas. Results are discussed in relationship to hypotheses based on sex differences in other populations.

Activities of Daily Living↗