Biomedical subjects
Publications and source records attributed to R Chamberlin.
Reversible protein phosphorylation is a major regulatory mechanism of intracellular signal transduction. Protein phosphatase 1 (PP1) is one of four major types of serine-threonine phosphatases mediating signaling pathways, but the means by which its activity is modulated has only recently begun to come into focus.
We have proposed computer-generated models of the catalytic subunits of the serine-threonine protein phosphatases PP1 and PP2A complexed with their endogenous substrate phospho-DARPP-32, and several known naturally occurring inhibitors. This study is part of an overall effort to elucidate the signal transduction pathways in which PP1 and PP2A may play an important role.
We evaluated a comprehensive program of prenatal and postpartum nurse home visitation for socially disadvantaged women bearing first children. Eighty-five per cent of the participating women were either teenagers (less than 19 years at registration), unmarried, or of low socioeconomic status. Women were randomly assigned to either nurse home visitation or comparison services (free transportation for prenatal and well-child care and/or sensory and developmental screening for the child). During the first four years after delivery of their first child, in contrast to their counterparts in the comparison group, nurse-visited White women who had not graduated from high school when they registered in the study returned to school more rapidly; nurse-visited, poor, unmarried White women showed an 82 per cent increase in the number of months they were employed, had 43 per cent fewer subsequent pregnancies, and postponed the birth of second children an average of 12 months longer.
A program of prenatal and infancy home visitation by nurses was tested as a method of preventing a wide range of health and developmental problems in children born to primiparas who were either teenagers, unmarried, or of low socioeconomic status. Among the women at highest risk for care-giving dysfunction, those who were visited by a nurse had fewer instances of verified child abuse and neglect during the first 2 years of their children's lives (P = .07); they were observed in their homes to restrict and punish their children less frequently, and they provided more appropriate play materials; their babies were seen in the emergency room less frequently during the first year of life. During the second year of life, the babies of all nurse-visited women, regardless of the families' risk status, were seen in the emergency room fewer times, and they were seen by physicians less frequently for accidents and poisonings than comparison group babies (P less than or equal to .05 for all findings, except where indicated.) Treatment differences for child abuse and neglect and emergency room visits were more significant among women who had a lower sense of control over their lives.
We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (less than 17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P less than or equal to .05 for all findings.)
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Interviewing skills of 34 pediatric house officers were compared with those of five practicing members of the clinical faculty. Interviews with a programmed mother were videotaped to evaluate physician-patient interaction, data gathering, hypothesis formation and provision of therapy education, reassurance, support, and anticipatory guidance. In addition, eight pediatric interns (PL-Is) were assigned to a study group and five to a control group at the beginning of their outpatient department rotation. The study group received feedback after the videotaped interviews and a 1 1/2-hour didactic session designed to teach interviewing skills. The control group received neither feedback nor the didactic session. Both groups were reevaluated at the end of the outpatient department rotation, again using the videotaped interview technique. Results showed that data-gathering ability increased significantly; that the focus of attention shifted from a more disease-oriented to a more patient-oriented interview; that data were obtained by means of less direct, less leading questions; and that more support and reassurance were provided as the level of training and experience increased. After the outpatient department rotation, members of both the study group and the control group of PL-1s had improved significantly and approached the proficiency-level of practicing pediatricians.
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The content and emphasis of well-child visits conducted by nine randomly selected pediatricians was compared with those of five experienced pediatric nurse practitioners. Twenty one nurse visits and 43 pediatrician visits with 1-year-old to 2-year-old children were monitored. The nurses discussed developmental and child behavior topics in significantly (P less than .05) greater depth, they asked more open-ended questions, made more specific recommendations, provided more maternal support, and the parents spoke a greater proportion of the time during the nurses' visits. Efficiency (number and depth of topics considered per unit time) of both groups was similar. Nurse visits were more time-consuming (mean, 25.5 vs 17.6 minutes for pediatricians). A subgroup of four pediatricians conducted visits much like those of the nurses, scoring as well in less time. The other five pediatricians conducted shorter visits, with little emphasis on child development and provided less time for the parent to talk. Overall, after five years in practice, these nurses were in no way less complete in child health supervision than a representative sample of pediatricians and were considerably more comprehensive in their approach than the average pediatrician.
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