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Biomedical subjects

J D Singer

Publications and source records attributed to J D Singer.

At least 37 records · Page 2Linked to original sources
PubMed1990

Providing therapeutic services to children in special educational placements: an analysis of the related services provisions of Public Law 94-142 in five urban school districts.

Using the sample of 1726 special education students from the Collaborative Study of Children With Special Needs, the authors describe the related services being provided to the children and then analyze the relationship between service provision and class placement. Related services are provided in all settings, with a concentration in special schools and special classes. For even the most severely involved children the trade-off with academics is no more than 1 hour per day. It is argued that schools now are major sites of therapeutic service provision for children with special needs.

Child↗
PubMed1989

Double-strand breaks stimulate alternative mechanisms of recombination repair.

To test the double-strand break repair model, we used HO nuclease to introduce double-strand breaks at several sites along a yeast chromosome containing duplicated DNA. Depending on the configuration of the double-strand break and recombining markers, different spectra of recombinant products were observed. Different repair kinetics and recombinant products were observed when a double-strand break was introduced in unique or duplicated DNA. The results of this study suggest that double-strand breaks in yeast stimulate recombination by several mechanisms, and we propose an alternative mechanism for double-strand break-induced gene conversion that does not depend on direct participation of the broken ends.

Alleles↗
PubMed1989

Patterns of response in families of chronically disabled children: an assessment in five metropolitan school districts.

Interviews with parents of 1,726 special education students yielded reports of stress that varied significantly by type of disability and by maternal education level; family involvement in the special education process also varied significantly by level of education. Clinically important differences in family perceptions and coping mechanisms are described and the need for better child care provisions and involvement of low-income parents in the education process is highlighted.

Adaptation, Psychological↗
PubMed1989

Mainstreaming children with handicaps: implications for pediatricians.

The judicial precedents and legislative mandates passed during the past two decades to ensure full appropriate public education for all children have resulted in a movement toward mainstreaming children with a wide range of physical and developmental disabilities into regular education classroom settings. Although some child development and pediatric literature has addressed the effects of these initiatives on the children with handicaps, less attention has been paid to the effect that mainstreaming has on their nondisabled peers in the classroom. As knowledgeable community advocates, pediatricians should be informed about the specifics of the mainstreaming movement. This paper outlines the movement's historical underpinnings, discusses current definitions of "mainstreaming", and briefly reviews the literature on the effects of this policy on classrooms, teachers, and students with and without disabilities. The impact of mainstreaming children with handicaps in regular classroom settings is equivocal, with many studies lacking methodological sophistication to yield reliable and valid data. Results of the few well-designed studies do show, however, that academic and social outcomes for both the handicapped child and for his/her nondisabled peers are consistently better in mainstreamed classrooms where adequate resources have been made available to the child and teacher than in more segregated settings. Furthermore, the literature consistently points out the key role both regular and special education teachers play in successful mainstreamed classrooms. Pediatricians can help families with children with disabilities negotiate the educational system in order to achieve the appropriate classroom placement.

Child↗
PubMed1987

Early identification of children's special needs: a study in five metropolitan communities.

In a study of special education programs in five urban school systems, parent interview data for 1726 children revealed how early the children's problems were identified and how the medical system was involved in the diagnosis. Problems included speech impairment, learning disabilities, emotional disturbance, mental retardation, sensory disorders, and physical and health disabilities. Overall, 4.5% of the children's problems were identified at birth, and only 28.7% before the age of 5 years. Variation in age at identification depended on the condition: 1 year for Down syndrome and cerebral palsy versus a 6-year range for mental retardation. Although physicians were most likely to identify the less common, more severe handicaps, they also identified from 15% to 25% of learning disabilities, speech impairments, emotional disorders, hyperactivity, and "other" development problems. The type, severity, and complexity of the condition were significant predictors of physician identification. No racial, socioeconomic, or site biases were associated with whether a physician was first to identify. Age at identification was predicted by the complexity of the problem, the association with other health and developmental concerns, socioeconomic indicators, and whether a physician was involved in the diagnosis. In the absence of clear assumption of responsibility for early identification, much terrain remains uncharted by medical practitioners and the schools. A better systematic sharing of responsibility for the early identification of developmentally disabling conditions is needed.

Affective Symptoms↗
PubMed1987

Health insurance coverage and physician use among children with disabilities: findings from probability samples in five metropolitan areas.

The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P less than .05); Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P less than .001), but there was no similar statistically significant difference between blacks and whites; and wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various low-prevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care.

Child↗
PubMed1987

Physician familiarity with the educational programs of their special needs patients.

As part of an analysis of health care for children in special education programs, physician familiarity with the educational status and program enrollment of their disabled patients was examined. Telephone interviews were performed with a random sample of 411 of the children's physicians. The majority (70%) of the physicians interviewed professed no knowledge of their patients' current special educational program. Certain physician, child, and family characteristics were associated with physician awareness of the children's programs. These were physician specialty, physician gender, child's disability, and severity of the child's problem. This study suggests that, although some physicians of very involved patients do familiarize themselves with their patients' day-to-day school life, many other physicians are poorly informed about the school activities and functional status of their young patients with disabilities. Better mechanisms are needed to ensure physicians' understanding of these aspects of child health.

Affective Symptoms↗
PubMed1986

Health care access and use among handicapped students in five public school systems.

The authors studied the health care access and utilization patterns for a stratified random sample of 1,726 special education students in five large metropolitan school systems. Overall, 7% of the special education students had no regular source of care, 26% had no regular physician, and 38% had not visited a physician in the previous year; 13% had no health insurance. Each of these measures was worse for nonwhite and poorer children as well as for those whose mothers who had less formal education. Insurance coverage was associated with physician visits, with 45% of the uninsured children visiting a physician compared with 63% of those with public insurance and 66% of those with private insurance. Odds ratios for all health care access and use measures showed striking geographic variations. Thus, even for children identified as handicapped by their communities, barriers to health care are evident and are significantly greater for groups traditionally at risk.

Child↗
PubMed1985

Escherichia coli transcription termination factor rho has a two-domain structure in its activated form.

Limited tryptic digestion of Escherichia coli transcription termination factor rho [an RNA-dependent nucleoside triphosphatase (NTPase)] yields predominantly two fragments (f1 and f2) when the protein is bound to both poly(C) and ATP. The apparent molecular masses of the two fragments are 31 kDa for f1 and 15 kDa for f2, adding up to the molecular mass of the intact rho polypeptide chain (46 kDa). Sequence analysis of the amino termini demonstrates that f1 is derived from the amino-terminal portion of rho and that the trypsin cleavage that defines f2 occurs at lysine-283. These results suggest that, in the liganded (activated) form, the native rho protein monomer is organized into two distinct structural domains that are separable by a single proteolytic cleavage. The f1 fragment, purified from NaDodSO4/polyacrylamide gels and renatured, binds poly(C) but the f2 fragment does not; neither regains any ATPase activity. ATP- and polynucleotide-dependent changes in the rate of proteolysis and in the character of the fragments produced suggest that rho undergoes a series of conformational transitions as a consequence of RNA binding, NTP binding and NTP hydrolysis. The rate of loss of rho ATPase activity and of intact rho monomers is slower in the presence of adenosine 5'-[gamma-thio]triphosphate than in the presence of either ATP or ADP, indicating that the hydrolysis of ATP may result in different conformational effects than does the binding of this ligand. These findings are discussed within the context of recent models of rho-dependent transcription termination.

Adenosine Triphosphate↗
PubMed1985

Medical care use and expenditure among children and youth in the United States: analysis of a national probability sample.

Good access to health care for all US children and youth remains an important social policy goal. Recent patterns of access as reflected in the presence of regular care sources, health care use, health insurance coverage, and expenditures for medical care are described and analyzed using the subsample of all children 0 to 18 years of age from the 1980 National Medical Care Utilization and Expenditure Survey. Data from the survey indicate that in 1980, 92% of US children and youth had a regular care source and the same percentage were covered for the full year or part of the year by some form of public or private health insurance. However, use rates and patterns of expenditure continued to differ dramatically according to family background factors, particularly race, ethnicity, poverty status, and location of residence. These differences are analyzed and comparative data are presented for groups of children from various sociodemographic groups. Minority-group and near-poor children were found to be at highest risk for limited utilization of services and inadequate insurance coverage.

Adolescent↗
PubMed1979

Plasma assay of fetal factors VIIIC and IX for prenatal diagnosis of haemophilia.

Fetal blood unmixed with maternal blood or amniotic fluid was obtained by direct-vision fetoscopy in 22 consecutive cases at 15--22 weeks' gestation; the investigation was done either for prenatal diagnosis or before therapeutic abortion. Fetal plasma factors VIIIC and IX averaged 50 I.U./dl (S.D. 12.8) and 12.5 I.U./dl (S.D. 2.4), respectively. Two male fetuses at risk of haemophilia had normal factor VIIIC levels by these criteria, and both pregnancies ended in the birth of a normal boy. Five others gave 3 normal and 2 haemophilic results, which were confirmed in two of the three terminated pregnancies.

Amniocentesis↗
PubMed1979

Sixteen years' experience of counselling, diagnosis, and prenatal detection in one genetic centre: progress, results, and problems.

The work of one Genetic Centre over 16 years, covering about 14 000 kinships, is described. The numbers registered in a year increased from an average of 477 in the early 1960s to 1612 in 1976/1977. The increase is largely, but not entirely, attributable to the advent of prenatal diagnosis, and an account is given of our experience with this. In 1916 patients who had a successful amniocentesis, results indicative of fetal abnormality were found in 4.3% and a balanced translocation was found in an additional 0.9%. Results indicative of fetal abnormality were found in 3.5% of mothers referred because of a maternal age of 40 or more, 3.9% referred because of a high risk of neural tube defect, and 19.3% referred because of a high risk of an inborn error of metabolism. A number of cases with difficult diagnostic problems are described.

Amniocentesis↗
PubMed1977

Congenital renal abnormalities in the Laurence-Moon-Biedl syndrome.

Two children with Laurence-Moon-Biedl syndrome had radiographic evidence of cysts in the renal medulla, and one had impaired renal function and infection. The frequency of cystic disease in this syndrome implies that intravenous urography should be carried out on all patients with this syndrome. Children with renal abnormalities should be followed to avoid further damage from urinary infection, or from dehydration in those with a concentrating defect. Regular renal function tests should be carried out on other children. and full investigation should follow if abnormalities are found in order that the natural history of the often fatal renal lesion can be clarified.

Child↗
PubMed1975

Ultrasound in the diagnosis of spina bifida.

Three patients who were at risk of having a baby with a neural-tube defect were investigated by ultrasonic examination and alpha-fetoprotein (A;F.P.) estimation. In all three cases amniotic-fluid A.F.P. levels were significantly raised and pregnancy was terminated. In the first case ultrasound failed to detect a small lumbo-sacral meningocele; In the second case ultrasound successfully diagnosed a dorso-lumbar meningo-myelocele but did not recognise internal hydrocephalus. In the third case ultrasound did not define any lesion, and pathological examination of the fetus revealed no abnormality. It is concluded that ultrasonic examination is an important diagnostic technique in the antneatal investigation of spina bifida.

Abortion, Therapeutic↗