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Biomedical subjects

R Seifer

Publications and source records attributed to R Seifer.

At least 37 records · Page 2Linked to original sources
PubMed1995

The relationship between oxygen saturation and the clinical assessment of acutely wheezing infants and children.

The objective of this study was to determine the relationship between oxygen saturation (Sao2) and traditional clinical assessment measures in infants and young children presenting as outpatients with acute wheezing. To accomplish this, Sao2 before and after medication was compared in a post hoc analysis with the clinical response to treatment (respiratory rate and a standardized index of respiratory distress) in children who participated in a randomized, placebo controlled medication trial. The study was done in a pediatric emergency department and outpatient clinic, and the participants were 74, full-term previously well infants and young children, aged 1 to 36 months (mean age 16.1 months), presenting with acute wheezing and participating in the randomized trial. The results showed that Sao2 was found to be inversely correlated with both respiratory rate (r = -0.29, P < or = 0.05) and an index of respiratory distress (r = -0.36, P < or = 0.01) prior to medication but not afterward. There was no significant difference in Sao2 when infants, who had a clinical response to treatment based on a priori criteria, were compared to nonresponders (mean difference per patient: responders = 0.86% vs nonresponders = 0.79%, P = 0.51). This was due to a large amount of individual variability in postmedication Sao2 in both groups. We conclude that, before therapy, there are only weak correlations between SaO2 and both respiratory rate and an index of respiratory distress in acutely wheezing infants and children. After therapy, young children can appear clinically improved but measured oxygen saturation may be variable and not correlated with traditional clinical assessment measures.

Acute Disease↗
PubMed1995

Is there a need for observationally based assessment of affective symptomatology in child and adolescent psychiatry?

There is growing dissatisfaction with current methods for rating affective symptoms in child and adolescent psychiatry. The need for additional reliable methods of evaluating mood disorders is significant. This annotation reviews the relative limitations of self-report and interview assessment techniques as contrasted with observationally based rating scales which offer additional advantages for assessment.

Adolescent↗
PubMed1995

Psychological distress in mothers of preterm infants.

The purpose of this study was to identify infant and maternal characteristics that predict psychological distress among mothers of preterm infants admitted to the neonatal intensive care unit (NICU). Infant characteristics included birth weight, gestational age, and ventilatory support, and maternal characteristics included age, parity, and socioeconomic status. Mothers (n = 142) completed questionnaires including a demographic form, the Parental Stressor Scale, and the Symptom Checklist 90-R. In hierarchical regression analyses, maternal NICU-specific distress was more strongly predicted by infant characteristics [F(3,135) = 6.80, p < .05] with maternal variables covaried. Maternal general psychological distress was more strongly predicted by maternal characteristics [F(3,135) = 6.05, p < .05]) with infant variables covaried. Twenty-eight percent of mothers reported clinically significant psychological distress compared with 10% in a normative population. Psychological distress among mothers of preterm infants appears to be common and deserves clinical consideration. The use of standardized questionnaires as part of the assessment process may improve case identification and psychosocial service delivery in the NICU.

Adaptation, Psychological↗
PubMed1994

Quality of toddler-mother attachment in children with Down syndrome: limits to interpretation of strange situation behavior.

Researchers studying social-emotional development have argued that primary attachment relationships, established by the end of the first year of life, are important organizing factors that influence the trajectory of development throughout childhood. Central to this argument is a dimension of "attachment security," along which attachments differ. For normally developing infants and toddlers, attachment security is assessed using the Ainsworth Strange Situation. However, it is not clear that this procedure is appropriate for evaluating attachment security in atypical populations. In this report, 3 samples of children with Down Syndrome (total N = 138) were assessed using the Strange Situation. The procedures were scored according to traditional protocols. Although the 3 samples differed with respect to chronological and developmental age, they showed basic similarity with respect to attachment variables. However, developmentally younger children were more difficult to classify using the standard scoring rules. Scores and classifications for the sample were compared to scores from a sample of normally developing children tested at about 12 months of age. Significant differences with respect to the distributions of cases to classification categories and with respect to the interactive scale scores suggest that the Strange Situation may be measuring different aspects of behavior for children with Down Syndrome, even when they are tested at similar developmental age levels.

Adult↗
PubMed1994

Infant temperament measured by multiple observations and mother report.

Observers and mothers rated infant behavior (n = 50) in the home on dimensions of temperament once a week for 8 weeks. Although week-to-week correlations were modest (intraclass correlations of .14-.36), aggregates of the 8 observations had high reliability for both observers and mothers. Mother reports were tied to our observation sessions by having mothers (a) rate their infants' behavior during the period when our observations were made and (b) use a questionnaire that mirrored the scoring system used for scoring the videotaped observation sessions. When direct observations were compared with mother reports (on the aggregated weekly reports and on 4 widely used questionnaires), little evidence of mother-observer correspondence was found. The interpretation of the large literature that has used maternal report is discussed, as well as the importance of direct observation of infant behavior when temperament is assessed.

Adult↗
PubMed1994

Relations among maternal stress, cognitive development, and early intervention in middle- and low-SES infants with developmental disabilities.

Relations between maternal stress and the development of infants with handicaps was examined in 72 middle-SES and 72 low-SES families who attended a weekly early intervention program. Measures of maternal stress and development of infants were obtained 10 months apart. Regression analyses predicted 81% of variance in later developmental level with initial Bayley MA, initial Mental Development Index (MDI), SES, initial stress, early intervention participation, and SES x Initial Stress x Attendance interaction. Subsequent maternal stress was predicted (42% variance explained) by initial stress, attendance, initial MDI, number of intervention agencies and MDI x SES x Attendance. Results were interpreted in terms of a transactional model.

Adaptation, Psychological↗
PubMed1994

Short-term longitudinal study of maternal ratings of temperament in samples of children with Down syndrome and children who are developing normally.

Ratings of temperament for 32 children with Down syndrome and 44 children who were developing normally over the developmental range from 12 to 36 months were compared. Mothers completed the Toddler Temperament Scales and/or the Bates Infant/Child Characteristics Questionnaire at two time points. Analyses tested for diagnostic group differences in temperament ratings. Multivariate repeated measures analyses of variance, with diagnosis and developmental age as grouping variables, were run for both instruments. For the Toddler Temperament Scales, no between-subjects main effects of diagnosis or interactions were significant; however, a significant multivariate main effect for diagnosis was obtained for the Bates Scales. Ordering consistency for the two samples was considered separately. Cross-time correlations were generally significant; however, relations tended to be of greater magnitude in the normally developing group. Results suggest that the development of temperament, as assessed with maternal ratings, follows a common path in these two groups.

Child, Preschool↗
PubMed1993

Stability of intelligence from preschool to adolescence: the influence of social and family risk factors.

Intelligence scores of children in a longitudinal study were assessed at 4 and 13 years and related to social and family risk factors. A multiple environmental risk score was calculated for each child by counting the number of high-risk conditions from 10 risk factors: mother's behavior, mother's developmental beliefs, mother's anxiety, mother's mental health, mother's educational attainment, family social support, family size, major stressful life events, occupation of head of household, and disadvantaged minority status. Multiple risk scores explained one-third to one-half of IQ variance at 4 and 13 years. The stability between 4- and 13-year environmental risk scores (r = .77) was not less than the stability between between 4- and 13-year IQ scores (r = .72). Effects remained after SES and race, or maternal IQ, were partialled; multiple risk was important in longitudinal prediction, even after prior measurement of child IQ was accounted for; the pattern of risk was less important than the total amount of risk present in the child's context.

Adolescent↗
PubMed1992

The efficacy of nebulized metaproterenol in wheezing infants and young children.

The benefit of beta-adrenergic agonists in the treatment of acutely wheezing infants and young children has not been well documented in the outpatient setting. To determine the efficacy of nebulized metaproterenol sulfate, 74 children aged 36 months or younger with acute wheezing participated in a double-masked, randomized, placebo-controlled clinical trial. Children received nebulized metaproterenol, either as an initial treatment or after a control treatment with normal saline solution. At baseline and 20 minutes after each treatment, an assessment was made that included measurements of heart rate, respiratory rate, oxygen saturation, and clinical variables related to respiratory compromise with the use of a standardized respiratory distress index (RDI). Children who received saline solution as initial therapy had no significant differences from baseline in any of the assessment measures. After metaproterenol therapy, children demonstrated an increase in heart rate ([mean +/- SD] 147 +/- 14 beats per minute vs 153 +/- 16 beats per minute), a decrease in respirations (50/min +/- 5/min vs 45/min +/- 7/min), improvement (lower scores) on the RDI (24 +/- 4 vs 15 +/- 2), and an increase in oxygen saturation (94.1% +/- 2.7% vs 95.3% +/- 3.0%). Patients aged 12 months or younger (n = 37) benefited from metaproterenol treatment (improvement in respiratory rate and RDI) but not to the same degree as children aged 24 months or older (n = 23) (improvement in respiratory rate, RDI, and oxygen saturation). Compared with assessments made before metaproterenol treatment, patients with respiratory syncytial virus infection (n = 21) had improvement in respirations (52/min +/- 7/min vs 45/min +/- 6/min) and RDI scores (22 +/- 4 vs 14 +/- 3). Based on a priori criteria (reduction in a premedication respiratory rate of 20% and an RDI score of 50%), responders to metaproterenol therapy included 45% of the entire sample and, respectively, 40% of those aged 12 months or younger, 52% of those aged 24 months or older, and 48% of patients who tested positive for respiratory syncytial virus. Although there appears to be an age-dependent degree of response, metaproterenol is effective in relieving the respiratory distress of young acutely wheezing children, including those with documented respiratory syncytial virus bronchiolitis.

Administration, Inhalation↗
PubMed1992

Child and family factors that ameliorate risk between 4 and 13 years of age.

Protective processes in at-risk children between 4 and 13 years of age were examined in a longitudinal study. A multiple risk index was used at 4 years to identify 50 high-risk children and 102 who were at low risk. Cognitive and social-emotional status were measured at each time point. The following indicators of protective processes were related to positive change in cognitive and/or social-emotional function in the high-risk children between 4 and 13 years: mother-child interaction; child perceived competence, locus of control, life events, and social support; and maternal parenting values, social support, depression, and expressed emotion. Many of these factors were also related to improvement in the low-risk children. Some variables showed an interaction effect, where impact was substantially higher in the high-risk group compared with the low-risk group. The utility of multiple risk constructs and process oriented approaches to protective factors are discussed.

Adolescent↗
PubMed1992

Hospitalized children of substance-abusing parents and physically and sexually abused children: a comparison.

The symptoms and diagnoses of 58 psychiatrically hospitalized children aged 12 or under who were children of substance abusing parents (COSAPs) were compared with a matched group of 51 children who were not COSAPs. These two groups were further subdivided according to history or lack of history of physical and/or sexual abuse. Symptoms and diagnoses of COSAPs and physically and/or sexually abused (P/SAs) children differed significantly from the hospitalized group who were neither COSAPs nor P/SAs. Being a COSAP and/or P/SA are strong correlates of psychiatric hospitalization for the children studied. Both high-risk groups should be awarded special diagnostic and treatment consideration that would include their systematic identification and focused treatment.

Adolescent↗
PubMed1992

Observational measurement of symptoms responsive to treatment of major depressive disorder in children and adolescents.

Observational methods were used to determine whether depressive symptoms in 20 inpatients with major depressive disorder could be observed to change during the course of treatment with antidepressant medication. Four consecutive weekly observation sessions were done using the Emotional Disorders Rating Scale, which collects information about symptoms of depression, mania, anxiety, hostility, and irritability. Only those scales indexing depressive symptoms evidenced change. Significant change was observed between the third and fourth weeks of hospitalization, thereby replicating the findings reported in the adult literature regarding depressive symptoms' responsiveness to antidepressants.

Adolescent↗
PubMed1991

Neurobehavioral syndromes in cocaine-exposed newborn infants.

The effects of fetal cocaine exposure on newborn cry characteristics were studied in 80 cocaine-exposed and 80 control infants. The groups were stratified to be similar on maternal demographic characteristics and maternal use of other illegal substances and alcohol during pregnancy. The hypothesis was that excitable cry characteristics were related to the direct effects of cocaine, while depressed cry characteristics were related to the indirect effects of cocaine secondary to low birthweight. Structural equation modeling (EQS) showed direct effects of cocaine on cries with a longer duration, higher fundamental frequency, and a higher and more variable first formant frequency. Indirect effects of cocaine secondary to low birthweight resulted in cries with a longer latency, fewer utterances, lower amplitude, and more dysphonation. Cocaine-exposed infants had a lower birthweight, shorter length, and smaller head circumference than the unexposed controls. Findings were consistent with the notion that 2 neurobehavioral syndromes, excitable and depressed, can be described in cocaine-exposed infants, and that these 2 syndromes are due, respectively, to direct neurotoxic effects and indirect effects secondary to intrauterine growth retardation.

Birth Weight↗
PubMed1991

Positive effects of interaction coaching on infants with developmental disabilities and their mothers.

Modification of maternal responsivity was attempted in a study of the effects of interaction coaching. Twenty-three mothers and their infants with developmental disabilities participated in an interaction coaching component that consisted of six sessions of providing feedback to mothers about incidence of overstimulation observed on videotapes. Suggestions were given for ways to interact in a more contingently responsive manner. Compared with a control group of 17 mother-infant pairs, the interaction coaching group mothers increased responsibility and decreased stimulation. The infants were less fussy and performed better on standardized developmental assessments.

Arousal↗
PubMed1990

An observationally based rating scale for affective symptomatology in child psychiatry.

There is growing dissatisfaction with current methods for rating affective symptoms in children. We report findings from a preliminary psychometric study of an alternative approach, that of direct observational ratings. The Emotional Disorders Rating Scale (EDRS) is an observation-based instrument containing 59 items divided into eight subscales. The results of this study indicate that measurement of nonverbal components of affective symptoms in children is feasible. Interrater reliability and internal consistency of the EDRS subscales were high. The EDRS also has potential as a measurement of state-related changes in affective behavior and as a technique for examining treatment response.

Adolescent↗
PubMed1989

Is major depressive disorder in adolescence a distinct diagnostic entity?

The concept of major depressive disorder in childhood and adolescence is reviewed and it is suggested that contemporary enthusiasm for this diagnosis may have outrun the evidence that it is a distinct categorical entity. To test the hypothesis that major depression is not a qualitatively distinct disorder in adolescence, but rather a continuously distributed, noncategorical syndrome, the behavioral rating scales (CBCL-P) of 216 hospitalized adolescent patients were analyzed first by principal components analysis and then by cluster analysis. Three behavioral syndromes were isolated by principal components analysis. Of three groups of patients identified by a subsequent cluster analysis, one was consistent with the concept of a categorically distinct "nuclear" depression. However, a noncategorical continuously distributed depressive syndrome appears to affect a larger number of patients in this age group, and the "nuclear" disorder may be less prevalent than is currently assumed. One explanation of these findings would combine a categorical model of nuclear depression with a dimensional model of dysthymia.

Adjustment Disorders↗
PubMed1989

Implications of research on infant development for psychodynamic theory and practice.

Recent research on infant development is reviewed to consider its implications for psychodynamic theory and practice. To address the question of the importance of early experiences for development, research on continuities and discontinuities in development, temperament, motivational systems in infancy, affect development and regulation, development of the sense of self, and infant-caregiver attachment are reviewed. Two major implications emerge, both emphasizing the need for more complexities in our conceptualizations. First, research on infant development underscores the importance of context in development and cautions about the limits of reductionistic thinking and theories. Second a major paradigmatic shift away from the fixation-regression model of psychopathology and development is indicated. A new model that better fits available data is proposed instead. In this continuous construction model, there is no need for regression, and ontogenetic origins of psychopathology are no longer necessarily tied to specific critical or sensitive periods in development. Implications for psychodynamic treatment are also described.

Humans↗