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Biomedical subjects

R E Stein

Publications and source records attributed to R E Stein.

At least 37 records · Page 2Linked to original sources
PubMed1998

Depressive symptoms in inner-city mothers of young children: who is at risk?

OBJECTIVE: To identify factors associated with depressive symptoms in inner-city mothers of young children. DESIGN: A cross-sectional survey was administered to a convenience sample of English-speaking mothers attending a well-child visit for a child aged 6 months to 3 years in a hospital-based, inner-city, general pediatric clinic. The maternal interview collected data on sociodemographic characteristics, and mothers' health and financial status. Mothers completed the Psychiatric Symptom Index (PSI), a 29-item checklist shown to have very good validity and reliability in a multicultural population. A total score of >/=20 represents high levels of symptoms; scores >/=30 strongly suggest major depression. RESULTS: Two hundred seventy-nine mothers completed the PSI. Mothers ranged in age from 14 to 48 years (mean, 27 years). Seventy-one percent were unmarried; 57% received public assistance. Forty-two percent of mothers were Hispanic, 40% black, 9% white, and 10% mixed or other races. Forty-eight percent were foreign-born. Twenty-four percent reported having a medical condition; 6% had activity limitation because of illness. The mean PSI score was 19; 18% of mothers had a PSI score >/=30 and 39% scored >/=20. PSI scores did not vary by age, race, birthplace, educational level, employment, marital status, or family composition. PSI scores were higher for mothers receiving public assistance (21 vs 17), with self-reports of poor or fair financial status (22 vs 15) and poor health status (52 vs 17). Mothers with activity limitations because of illness had significantly higher PSI scores (34 vs 18). Multiple regression analyses confirmed the independent relationships of these maternal characteristics to high PSI scores. CONCLUSIONS: Depressive symptoms in inner-city mothers of young children are common. In this population of women with many risk factors, traditional sociodemographic risk factors did not successfully identify those who are depressed. However, mothers' self-reports of poor financial status, health status, or activity limitation because of illness were associated with higher levels of depressive symptoms. These findings may assist clinicians in distinguishing which mothers are likely to be depressed when almost all are at high risk.

Adolescent↗
PubMed1998

Comparison of adjustment of school-age children with and without chronic conditions: results from community-based samples.

We assessed whether children in the 1990s who were identified as having chronic conditions by using a new noncategorical technique (the Questionnaire for Identifying Children with Chronic Conditions) were as well adjusted as children without chronic conditions, and whether selection factors or sociodemographic variables accounted for any observed differences. Random-digit-dial telephone surveys were conducted using two separate samples: one consisting of 1275 children in 654 inner-city households and the other of 1388 children in a national sample of 712 households. Children with chronic conditions had poorer parent-reported functioning on the Personal Adjustment and Role Skills Scale total score and three of its six subscales (Hostility, Dependency, and Productivity). Differences in two other subscales (Withdrawal and Anxiety/Depression) were significant only for the inner-city sample. The results were consistent when controlling for other potentially confounding factors. These findings demonstrate that mental health risks continue to occur among contemporary community-based samples of children with chronic health conditions who are identified by using noncategorical techniques. These risks have implications for the care of those children.

Analysis of Variance↗
PubMed1997

Monitoring health care for children with chronic conditions in a managed care environment.

OBJECTIVE: Children with chronic health conditions face special issues in their interactions with managed care. These children often require additional and more varied services than do other children. Managed care plans increasingly include these children, especially with the growth of Medicaid managed care. This article examines the special issues facing children with chronic conditions and develops strategies for monitoring their care in managed care settings. METHODS: The project staff conducted an extensive review of the research and policy literature related to managed care and the special needs of families with children with chronic conditions. The project also reviewed current and proposed plans of federal, state, and private groups for monitoring and, working with parents and other outside groups, identified key issues to consider in developing monitoring plans. RESULTS: The relative rarity of many childhood conditions and the complex interactions among child, family, and community over time make assessment of their care difficult. We describe these child and family characteristics, outline essential features and domains for monitoring systems, and describe population-based and plan-based monitoring systems to assess managed care for these children and their families. CONCLUSIONS: Monitoring for children with chronic conditions in managed care arrangements will require public health agencies and health providers to define populations systematically, assess across a variety of conditions, and monitor several domains central to the health of these families.

Adolescent↗
PubMed1997

The Questionnaire for Identifying Children with Chronic Conditions: a measure based on a noncategorical approach.

OBJECTIVE: To report on the development of the Questionnaire for Identifying Children with Chronic Conditions (QuICCC). This new instrument identifies children and adolescents who have chronic health conditions based on the noncategorical conceptual framework outlined in our earlier work. It uses the consequences of conditions as a method for identifying children with chronic health conditions and is completely independent of diagnosis. METHOD: Through a combination of techniques, we developed and piloted items and created 39 brief question sequences that were designed to be administered to a parent or guardian of children < 18 years of age. The prototype was field tested extensively and refined using data from local hospital-based samples representing 318 households and 666 children. The instrument was then administered to two large representative samples (local: 657 households, 1275 children; national: 712 households, 1388 children) to establish validity and reliability. RESULTS: Content, convergent, construct, and criterion validity each have been demonstrated. The QuICCC has good test-retest reliability. Parents find the questions easy to answer. It took 7 to 8 minutes on average to obtain information about all the children in a family. The QuICCC successfully identified children with a wide range of different conditions that are usually considered chronic, and excluded those with acute illnesses and those with conditions but no current consequences. CONCLUSIONS: The Questionnaire for Identifying Children with Chronic Conditions is a practical instrument that can be used for epidemiological purposes. It offers considerable flexibility and has many potential applications in health care delivery research.

Adolescent↗
PubMed1996

Moderating effects of family structure on the relationship between physical and mental health in urban children with chronic illness.

Examined whether certain family structures modify the relationship between psychological adjustment and severity of physical illness, as measured by an index of functional status, among children with chronic illness. 352 families were divided into four types: two biological parents (n = 149), mother plus another adult relative (n = 47), mother plus unrelated spouse or partner (n = 23), and mother alone (n = 133). Correlations between children's functional status and adjustment were higher in the mother plus unrelated partner and mother alone families, and lower when mother lived with either the biological father or another adult relative. Children in the mother plus unrelated partner group also tended to have poorer overall adjustment than other children. Results are discussed in terms of family structure, childhood illness and adjustment, and the possible mechanisms that interrelate these variables.

Activities of Daily Living↗
PubMed1996

Maternal discipline of young children: context, belief, and practice.

This report describes maternal discipline of infants and toddlers, focusing on how the context of the misbehavior affects maternal beliefs and practices. Mothers of 1- to 4-year-old children were interviewed using a 20-minute, structured questionnaire at two practice sites: (1) an inner-city teaching hospital pediatric clinic (n = 104) and (2) a private pediatrician's office in a nearby suburban neighborhood (n = 100). Measures were constructed to assess beliefs and practices about three kinds of discipline (teaching, spanking, and removing) and about two approaches to discipline (positive or negative). We found that mothers believe significantly (p < .001) more strongly in all three kinds of discipline for dangerous misbehavior compared with annoying ones. Belief in teaching, spanking, and negative approach increase with age; belief in removing decreases (p < .001); and belief in positive approach remains stable. Belief in spanking starts earlier than belief in teaching, and belief in negative tone increases with age. Mothers seem to have better formulated beliefs about spanking and negative and positive approach to discipline than about teaching or removing. Eighty-five percent believe time-out is at times appropriate for 2 year old, but only 67% had practiced it in the past week. Belief and practice of time-out varied by the age of the child and practice site. Explaining, distracting, and praising were practiced frequently, whereas bribing was less common. Less than half (44%) reported that they had ever discussed discipline with their child's physician, although 85% thought that their physician could give good advice. There is evidence that mothers change their minds about the appropriateness of time-out as their child gets older, but beliefs about other kinds of discipline remain relatively constant. We conclude that the type of misbehavior and the age of the child affect a mother's beliefs about discipline. These findings suggest a role for pediatricians in exploring and broadening parents' concepts of discipline.

Child Behavior Disorders↗
PubMed1996

Content validity of the Psychiatric Symptom Index, CES-depression Scale, and State-Trait Anxiety Inventory from the perspective of DSM-IV.

We compared the item content of three commonly used scales of psychiatric symptoms [the broad-band Psychiatric Symptom Index (Ilfeld) and two narrow-band scales, the Center for Epidemiologic Studies-Depression Scale (Radloff) and the State-Trait Anxiety Inventory (Spielberger)], with diagnostic criteria and criterion-based symptoms for Major Depressive Episode and Generalized Anxiety Disorder as they appeared in DSM-IV. The Psychiatric Symptom Index and the Center for Epidemiologic Studies-Depression Scale each measured 7 of 9 criterion-based symptoms of Major Depressive Episode. The Psychiatric Symptom Index and State-Trait Anxiety Inventory each measured 5 of 8 domains for Generalized Anxiety Disorder. The Psychiatric Symptom Index had comparable content validity to the narrow-band measures. All met a majority of DSM-IV criteria for depression and anxiety, supporting their applicability for current research.

Adult↗
PubMed1996

Monitoring and evaluating managed care for children with chronic illnesses and disabilities.

OBJECTIVE: Children with chronic illnesses and disabilities are increasingly enrolling in managed care arrangements. Yet, the rapid expansion of managed care has unknown consequences for children with chronic conditions and disabilities. As managed care is likely to become the predominant mode of medical practice for children with chronic health problems, information gained from a thorough assessment of existing managed care models could be helpful in indicating adjustments and modifications that could result in improved outcomes for this population. the purpose of this article is to outline a new strategy for collecting needed information on the effects of managed care on children with chronic health problems. METHODS: We reviewed the literature on the effects of managed care on children with chronic conditions and disabilities. We identified key domains relevant to monitoring and evaluating managed care for this population. RESULTS: Two research approaches can provide helpful information for assessing the effects of managed care on children with chronic conditions. First, a monitoring strategy could be pursued in which enrollment trends in managed care, enrollee perceptions of access and satisfaction with care, and other general indicators of outcomes would be tracked over time using inexpensive and rapid turnaround data sources. Second, an evaluative strategy could be pursued using experimental or quasiexperimental designs, in which outcomes across a variety of domains for children with chronic conditions in managed care are compared with: (a) outcomes for the same children before enrollment in managed care; or (b) outcomes for similar children remaining in traditional fee-for-service settings. Evaluation and monitoring strategies should focus on outcomes in a number of domains including: (1) access to care; (2) utilization of services; (3) quality of care; (4) satisfaction with care; (5) expenditures for care; (6) health outcomes; and (7) family impact. CONCLUSION: Assessing outcomes that result from enrollment in managed care for children with chronic health problems presents a formidable challenge. The research strategy outlined in this article presents one approach to meeting that challenge. The monitoring and evaluation strategies described here would require commitment of additional resources on the part of government, private foundations, and/or health plans. Given the paucity of existing information and the stakes for children with chronic conditions and their families, investment of added resources in a comprehensive monitoring and evaluation strategy is essential.

Child↗
PubMed1995

Catalytic strategy of citrate synthase: subunit interactions revealed as a consequence of a single amino acid change in the oxaloacetate binding site.

The active site of pig heart citrate synthase contains a histidine residue (H320) which interacts with the carbonyl oxygen of oxaloacetate and is implicated in substrate activation through carbonyl bond polarization, a major catalytic strategy of the enzyme. We report here the effects on the catalytic mechanism of changing this important residue to glycine. H320G shows modest impairment in substrate Michaelis constants [(7-16)-fold] and a large decrease in catalysis (600-fold). For the native enzyme, the chemical intermediate, citryl-CoA, is both hydrolyzed and converted back to reactants, oxaloacetate and acetyl-CoA. In the mutant, citryl-CoA is only hydrolyzed, indicating a major defect in the condensation reaction. As monitored by the carbonyl carbon's chemical shift, the extent of oxaloacetate carbonyl polarization is decreased in all binary and ternary complexes. As indicated by the lack of rapid H320G--oxaloacetate catalysis of the exchange of the methyl protons of acetyl-CoA or the pro-S-methylene proton of propionyl-CoA, the activation of acetyl-CoA is also faulty. Reflecting this defect in acetyl-CoA activation, the carboxyl chemical shift of H320G-bound carboxymethyl-CoA (a transition-state analog of the neutral enol intermediate) fails to decrease on formation of the H3020G-oxaloacetate-carboxymethyl-CoA ternary complex. Progress curves and steady-state data with H320G using citryl-CoA as substrate show unusual properties: substrate inhibition and accelerating progress curves. Either one of two models with subunit cooperativity [Monod, J., Wyman, J., & Changeux, J.-P. (1965) J. Mol. Biol. 12, 88; Koshland, D. E., Jr., Nemethy, G., & Filmer, D. (1966) Biochemistry 5, 365] quantitatively accounts for both the initial velocity data and the individual progress curves. The concentrations of all enzyme forms and complexes are assumed to rapidly reach their equilibrium values compared to the rate of substrate turnover. The native enzyme also behaves according to models for subunit cooperativity with citryl-CoA as substrate. However, the rates of formation/dissociation and reaction of complexes are kinetically significant. Comparisons of the values of kinetic constants between the native and mutants enzymes lead us to conclude that the mutant less readily undergoes a conformation change required for efficient activation of substrates.

Acetyl Coenzyme A↗
PubMed1995

Consistent but not the same. Effect of method on chronic condition rates.

OBJECTIVE: To determine rates of chronic physical conditions for children and youths. DESIGN: Secondary analysis of the Health Examination Surveys, cycles 2 and 3, National Center for Health Statistics. SETTING: National household survey of noninstitutionalized civilians in the United States. PARTICIPANTS: Multistage probability samples of children aged 6 to 11 years (cycle 2, 1963 to 1965) and youths aged 12 to 17 years (cycle 3, 1966 to 1970), and a longitudinal subsample assessed at both times. Excludes persons with an IQ lower than 80. RESULTS: Selected items from developmental and medical histories and screening physical examinations were used to classify those with chronic physical conditions. Rates of persons with chronic conditions are 25.2% for the children and 35.3% for the youths. Parental histories produce rates equal to or greater than 11%, and physical examinations produce rate of 15.7% for children and 22% for youths. About 4% in each cycle are identified by both screening physical examination and parental history. Little overlap occurs in identification by the two sources, accounting for the higher rates for the combined indicators. Combining data sources identifies 13% of the longitudinal subsample as having a chronic physical condition at both times. CONCLUSIONS: Rates of chronic physical conditions seem to be altered by combining different indicators to categorize children. For either source used alone (eg. parental report or physical screening physical examination) the estimate is similar in magnitude, but the composition of the affected group differs. These findings have major implications for research, service, and policy.

Adolescent↗
PubMed1995

Enhanced lexical processing of smoking stimuli during smoking abstinence.

In a group of heavy smokers, overnight abstinence from smoking facilitated the perception of briefly presented smoking words. Subjects in the nicotine-abstinent condition accurately identified significantly more smoking-related words than food-related or neutral words. However, a group tested in a non-abstinent condition showed no significant differences in ability to identify the three different word types. Smokers deprived of cigarettes were also significantly better able to categorize smoking words than non-abstinent subjects. These results demonstrate an abstinence-based facilitation of processing smoking-related stimuli at the semantic level, consistent with the hypothesis that smoking-related concepts are activated, or primed, during deprivation from nicotine.

Adult↗
PubMed1995

The role of maternal psychological adjustment in the measurement of children's functional status.

Studied the ways that mothers interpret illness behavior in their children to assess whether maternal psychological adjustment predicts maternal perceptions of children's behavioral limitations and attribution of these behaviors to chronic illness. Functional status ratings and attributions to illness by 365 mothers of 5- to 8-year-old children with chronic illnesses were associated with children's overall adjustment but not with mothers' own psychological distress. Illness attributions also were related to the child's medical visits and hospitalizations. Thus, mother's illness attributions are related to her perceptions of the child's health and more general behavioral adjustment, but not to her own mental health. Results support the validity of the FS II(R) as a measure of functioning related to children's health status that is not influenced by maternal psychological adjustment.

Activities of Daily Living↗
PubMed1995

Spanking infants and toddlers: maternal belief and practice.

OBJECTIVE: To describe maternal beliefs and practices of spanking infants and toddlers and the relations between factors affecting these beliefs and practices. DESIGN: Cross-sectional survey. SETTING: Site 1 was an inner-city teaching hospital pediatric clinic. Site 2 was a private pediatrician's office in a nearby suburban neighborhood. PARTICIPANTS: Mothers of children less than 4 years old in the waiting area. Site 1: n = 104; site 2: n = 100. SELECTION: Systematic sample of convenience. METHODS: Mothers were interviewed using a 20-minute structured questionnaire. Measures were constructed to assess beliefs (Cronbach's alpha = .90) and practices about spanking and approach to discipline (alpha > .71). RESULTS: Belief in spanking correlated significantly (P < .001) with belief in negative approach (r = .52) and with the practice (r = .46) and severity (r = .34) of spanking. Nineteen percent of the mothers believed that there are times when it is appropriate to spank a child less than 1 year old, and 74% believed this about children 1 to 3 years old. Forty-two percent reported that they had spanked their own child in the past week. Mothers believed more strongly in spanking for dangerous misbehaviors than for annoying ones (P < .001). Belief in spanking and negative approach were stronger for older toddlers (P < .001). Belief in and frequency of spanking were more common at the inner-city site (P < .001). CONCLUSIONS: The belief in and practice of spanking are prevalent in disciplining very young children. The context of the spanking affects beliefs and practices. The finding that belief and practice of spanking are highly correlated suggests that belief rather than impulse largely explains spanking of children less than 4 years old. The high correlation between spanking and negative approach toward discipline raises questions about whether negative consequences of spanking are the result of spanking per se, the negative approach toward the child, or both.

Child Rearing↗