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Biomedical subjects

M A Stewart

Publications and source records attributed to M A Stewart.

At least 55 records · Page 3Linked to original sources
PubMed1984

What is a successful doctor-patient interview? A study of interactions and outcomes.

The discipline of family medicine has espoused a patient-centred model of the doctor-patient interaction. Patient-centred interactions are those in which the patient's point of view is actively sought by the physician. This implies that the physician behaves in a manner that facilitates the patient's expressing himself and that, for his part, the patient speaks openly and asks questions. The present exploratory study was undertaken to assess whether patient-centred interviews are related to positive outcomes. The study was conducted in 24 family physicians' offices where 140 doctor-patient interactions were audiotaped. Patients with both acute and chronic illnesses were included. The taped interactions were analysed using Bales Interaction Process Analysis. Ten days after the audiotaped visit the patients were interviewed in their home in order to assess their satisfaction with care, their reported compliance and to conduct a pill count. Bivariate analysis indicated that interviews in which physicians demonstrated a high frequency of patient-centred behaviour were related to significantly higher reported compliance and close to significantly better pill counts and satisfaction. Furthermore, in most instances, when the patient and physician scores were considered in combination, there was evidence that the physician's behaviour, particularly that sort of behaviour which initiated a discussion such as an explicit request for the patient's opinion, had more impact upon outcome than did the patient behaviour. The study suggests the importance in the setting of family practice of a patient-centred approach, one which is similar to models such as the negotiated approach to patienthood, described by psychiatrists.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Aggressive conduct disorder: the influence of social class, sex and age on the clinical picture.

Past studies have shown that aggressive conduct disorder is more common in boys and in families of low socioeconomic status, and that affected children are usually seen in child psychiatry clinics before the age of 10. In this work we aimed to find how socioeconomic status, sex and age at admission influence the clinical picture of this disorder. We divided a series of 58 affected children into two groups on each of the three factors and compared the groups on 175 variables. We found little evidence that the children's difficulties varied with social class, sex or age. This apparent constancy of the clinical picture reinforces the idea that aggressive conduct disorder is a valid, though broadly defined, psychiatric syndrome.

Age Factors↗
PubMed1983

Multiple heterogeneities in the transcribed spacers of ribosomal DNA from Xenopus laevis.

Ribosomal DNA (rDNA) from Xenopus laevis contains several heterogeneities in all three transcribed spacers, as revealed by analysis of cloned and uncloned amplified rDNA from oocytes and cloned chromosomal rDNA from erythrocytes. Heterogeneities include single base changes and length variants of one to several nucleotides. Sites of variation are widely but non-uniformly distributed, some occurring only a short distance outside the boundaries of the rRNA coding regions. No two transcription units that we have yet examined are identical throughout their transcribed spacer regions.

Animals↗
PubMed1983

Etiological implication of maternal age and birth order in infantile autism.

Birth orders and maternal ages of the 113 autistic patients were compared with those of the general population. An excess of mothers aged 35 or older was observed in the autistic group, though the mean maternal age for the whole group was very similar to those of the general population. A deviation from average in birth order was observed in autistics. Significantly more autistics were products of at-risk pregnancies (defined as either first, fourth, or later born, or born to mothers aged 30 or older) than the base population. The results suggest that at least some environmental factors are involved in the causation of autism. The findings support the idea that a multifactorial mechanism is responsible for some or all of the cases.

Adolescent↗
PubMed1983

Familial subtypes of childhood hyperactivity.

On the basis of family history data we defined two subtypes of childhood hyperactivity: family history-positive (FH+), in which at least one biological parent of the child had a diagnosis in the antisocial spectrum; and family history-negative (FH-), in which neither parent had such a diagnosis. While children in both subgroups were equally deviant on measures of the core components of childhood hyperactivity (e.g., inattention and reactivity), the FH+ children were also deviant on dimensions of conduct disturbance and had siblings with a high prevalence of conduct disorder. FH- children showed little evidence of conduct disturbance, had more learning and academic problems, and had siblings with attentional and learning disabilities, but not conduct disorder. These findings suggest that the study of family constellations should be a fruitful method for resolving the heterogeneity of the hyperactive child syndrome.

Age Factors↗
PubMed1983

Subtypes of aggressive conduct disorder.

The subjects were 46 boys with aggressive conduct disorder who were admitted to a psychiatric ward. We divided them according to level of activity and number of antisocial "symptoms"; then compared the resulting groups on clinical and social variables. Seventy-four per cent of the boys were observed to be hyperactive. Compared to those with a normal level of activity, this group developed their problems earlier, had more frequent speech and language deficits and came from more disrupted homes. Thirty boys were classed as antisocial and 16 as not. The former differed from the latter chiefly in their failure to respond to treatment. At follow-up significantly more non-antisocial boys were improved than antisocial. The results suggest that antisocial behavior affects outcome, while the variations in activity level are related to different origins of the disorder.

Age Factors↗
PubMed1983

Father-son resemblances in aggressive and antisocial behaviour.

At a child psychiatry clinic 122 boys were scored on scales of aggressiveness, noncompliance and antisocial behaviour. Their biological fathers were scored on aggressiveness and antisocial behaviour. The fathers' scores were modestly but significantly correlated with those of their sons. The correlations were also computed separately for the 64 boys whose biological fathers were no longer in the home and for the 58 whose fathers had stayed. Father-son resemblances for the latter group were considerably higher than those observed in the whole sample, and for the father-absent group were insignificant.

Adolescent↗
PubMed1983

A four-year follow-up of hyperactive boys with and without conduct disorder.

A four-year follow-up of clinically selected hyperactive boys with and without associated conduct disorder investigated their outcome during early adolescence and was taken from a structured behavioural interview and standard psychological testing. Boys originally diagnosed as "purely" hyperactive continued to be inattentive and impulsive at follow-up, but showed very few aggressive and antisocial behaviours. Hyperactive boys who had earlier been undersocialized and aggressive continued to have problems with attention and impulsivity, were reported to be aggressive, noncompliant, egocentric, exhibiting antisocial behaviours and using alcohol. These findings suggest that antisocial and delinquent behaviour often reported in follow-up studies of hyperactive boys may be linked to childhood aggression and unsocialized behaviour, rather than the syndrome of hyperactivity.

Adolescent↗
PubMed1983

Morphological cerebral asymmetries in autistic children.

A group of 36 children with infantile autism and various neurological disorders matched closely on age, sex, and handedness underwent computerized tomographic (CT) scanning of the brain. All CT scans were assessed blindly and independently by a neuroradiologist. Two techniques modified from two published CT studies concerning cerebral asymmetries were used for measuring frontal and parieto-occipital asymmetries. The present study found that the CT pattern of cerebral asymmetries in autistic children is the same as observed in the neurological patients. Contradictory results were noted when the distributions of such asymmetries between the present autistic group and normal adults included in two previous studies were compared. One of the striking findings in this study is that the brains of the present autistic patients seem to be more symmetric than those of the normals. This finding, however, is also noted in the present matched controls as well as in the dyslexic children previously studied by other investigators. Further sophisticated studies are needed to explain the difference in the brain morphology between normals and children with a developmental disorder or a neurological disorder.

Adolescent↗
PubMed1982

18S coding sequences in amplified ribosomal DNA from Xenopus laevis oocytes are highly homogeneous, unmethylated, and lack major open reading frames.

We have used two approaches to search for sequence variants in the 18S coding region of amplified ribosomal DNA (rDNA) from Xenopus laevis oocytes. First, using clones derived from amplified rDNA, we compared the equivalent of a complete 18S coding region from two clones and short regions from two other clones with the 18S sequence previously determined from a "reference" clone. The respective sequences in all the clones were identical. Secondly, we examined greater than 60% of the 18S sequence in "pooled 18S genes" in uncloned amplified rDNA. The predominant sequence corresponded to that in the reference clone and no heterogeneities were apparent. Since many chromosomal rDNA units contribute to rDNA amplification the findings indicate that 18S coding sequences in X. laevis are largely homogeneous. The previously established sequence is the predominant one, thus providing a reliable basis for studies on 18S rRNA. Sequencing gels on uncloned amplified rDNA confirmed the absence of methylated cytosine in this DNA. The 18S sequence lacks major open reading frames.

Animals↗
PubMed1982

Social class distribution of fathers of children enrolled in the Iowa Autism Program.

The social class distribution of fathers with autistic children attending a locally well-known and state-supported modern autism program was examined and was compared to the social class distributions observed in a nonautistic, mentally retarded population, in children with other psychiatric disorders, and in the general population from which the present autistic sample was drawn. No significant differences were found among the groups. The findings supported the view that if studies are not biased by certain selection factors outside the autistic child's clinical picture and diagnosis, and if services become better known and readily available, then no differences in social class distribution between autistic and nonautistic groups occur. The results suggest that social class is not an important factor in the origin of autistic syndrome.

Autistic Disorder↗
PubMed1982

Aggressive conduct disorder of children.

We studied 58 children with aggressive conduct disorder who had been admitted to a psychiatric ward and 33 with other disorders, excluding autism and organic syndromes, who were also inpatients. Nurses's observations of the children's behavior on the ward sharply separated the two groups and confirmed the parents' and teachers' descriptions of the conduct disorder children's behavior at home and in school. Items in the clinical history also separated the two groups; for example, conduct disorder began at a much earlier age than the other disorders. Our evidence gives further support to the validity of aggressive conduct disorder as a psychiatric syndrome.

Aggression↗
PubMed1982

Is there a syndrome of pure hyperactivity?

A comparison of hyperactive boys with and without associated conduct disorder was made to determine the validity of a narrowly defined concept of pure hyperactivity. Although clinical differences between the two sub-groups supported the diagnostic distinction, few differences appeared with respect to various possibly causal background factors. A small group of boys with pure hyperactivity was separated, however, on the basis of subnormal IQ scores. In contrast to the hyperactive boys with normal IQ, these boys showed a more serious history of developmental disturbances which appeared to be linked to organicity. It was concluded that pure hyperactivity is an elusive concept and probably defines a heterogeneous group of children whose primary problems are cognitive in nature.

Aggression↗
PubMed1982

Unfavourable left-right asymmetries of the brain and autism: a question of methodology.

Thirty-six patients with infantile autism and various neurological disorders underwent computerized tomographic (CT) scanning of the brain. All CT scans were assessed blindly and independently by a diagnostic radiologist. Two techniques modified from two previous studies were used for measuring parieto-occipital asymmetry. The frequency of reversed asymmetry in autistic patients was the same as that in patients with various neurological disorders, and there was no significant association between reversed asymmetry and delayed language development. The study does not support the concept that unfavourable morphological asymmetries of the brain near the posterior language zone may contribute to the difficulties autistic children experience in acquiring language. Methodological difficulties and the design of new studies are discussed.

Adolescent↗