Biomedical subjects

S Simmens

Publications and source records attributed to S Simmens.

13 recordsLinked to original sources

PubMed2000

Relation of therapeutic alliance and perfectionism to outcome in brief outpatient treatment of depression.

Prior analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program demonstrated that perfectionism was negatively related to outcome, whereas both the patient's perception of the quality of the therapeutic relationship and the patient contribution to the therapeutic alliance were positively related to outcome across treatment conditions (S. J. Blatt, D. C. Zuroff, D. M. Quinlan, & P. A. Pilkonis, 1996; J. L. Krupnick et al., 1996). New analyses examining the relations among perfectionism, perceived relationship quality, and the therapeutic alliance demonstrated that (a) the patient contribution to the alliance and the perceived quality of the therapeutic relationship were independent predictors of outcome, (b) perfectionistic patients showed smaller increases in the Patient Alliance factor over the course of treatment, and (c) the negative relation between perfectionism and outcome was explained (mediated) by perfectionistic patients' failure to develop stronger therapeutic alliances.

Adult↗

PubMed1999

Family structure and patient survival in an African-American end-stage renal disease population: a preliminary investigation.

Few studies have examined the influence of the family on the course of chronic illness in African-Americans. We explore the relationship between family structure, defined as marital status and household composition, and patient survival. Patient gender was examined as a possible moderator in this relationship. Using data from a survey of 476 African-American end-stage renal disease (ESRD) patients, a significant association between household composition and patient survival was found. Results from Cox proportional hazards model, controlling for patient age, indicated that patients who live in 'complex' households (i.e. those with a partner and/or others) are at greater risk for shortened survival as compared to those who live alone or with a spouse/partner (p < 0.05). When we examined whether patient gender moderates this relationship, female patients who live in these households were found to be at 2 times greater risk for shortened survival (p < 0.01) than female patients who live alone or with their spouse/ partner only. Family structure was not significantly associated with survival in male patients. Discussion and implications of findings are addressed.

Adolescent↗

PubMed1999

Adolescents' relationships to siblings and mothers: a multivariate genetic analysis.

Research has consistently demonstrated that children's behavior toward their siblings tends to resemble interactions occurring in the parent-child relationship. This study examined the relative contributions of genetic and environmental influences to the covariation between sibling relationships and mother-adolescent relationships. Reported and observed family interactions were assessed for 719 same-sex sibling pairs of varying degrees of genetic relatedness. The covariance between mother-adolescent and sibling interactions was decomposed into genetic, shared, and nonshared environmental components. The overlapping effects of shared environment on the two relationship subsystems explained most of the covariance. Smaller but significant genetic and nonshared environmental effects were also found. The consistency of these findings with family processes, such as modeling, is discussed.

Adolescent↗

PubMed1999

The importance of shared environmental influences in explaining the overlap between mother's parenting and sibling relationships: reply to Neale (1999)

This article addresses concerns raised by M. C. Neale (1999) in his commentary on the D. A. Bussell et al. (1999) Nonshared Environment in Adolescent Development (NEAD) study. These concerns fall into two categories: (a) model assumptions and sample design and (b) testing of alternative models. The validity of the assumptions of quantitative genetic models is a concern for all researchers in this area. Discussion of those assumptions in this reply is brief and focuses on those most relevant to the NEAD sample. The two alternative models proposed by Neale were designed to provide alternatives to the large shared environmental effect found in the original report of Bussell et al. Because these alternative models did not provide a better fit, the appropriateness of Bussell et al.'s basic model and the importance of shared environmental influences for explaining the association among family subsystems are supported.

Adolescent↗

PubMed1998

Engagement of African American families in research on chronic illness: a multisystem recruitment approach.

Our multisystem approach addressed the recruitment of African American families with a chronically, physically ill member. The approach focused on the social transactions between the family, the healthcare team, and the research staff, and the influence of these transactions on family recruitment. This multisystem approach included three core strategies: defining the membership of families in a culturally appropriate fashion and engaging those members; engaging the healthcare team; and building and maintaining the skills and morale of the research staff. A description of a longitudinal family health study and potential sources of recruitment biases is provided. Descriptive and bivariate analyses examined the effectiveness of the recruitment approach. A focus groups explored the reciprocal process of family protectiveness that both facilitated and hindered family recruitment and the research staff's alliance with families and the dialysis staff. Discussion focuses on the family health study's recruitment rate, sampling biases, and methods for improving the effectiveness of the multisystem recruitment approach.

Adaptation, Psychological↗

PubMed1997

Lead levels in Maryland construction workers.

A cross-sectional study of unionized construction workers not currently known to be performing lead work was conducted. Participants completed an interviewer-administered questionnaire obtaining information about demographics, work history, other possible sources of lead exposure and health status (including hypertension, noise-induced hearing loss and renal disease). Blood was then obtained via venipuncture for whole blood lead level, hematocrit and free erythrocyte protoporphyrin determination. Two hundred and sixty-four Maryland construction workers had median whole blood lead determinations of 7 micrograms/dl and mean values of 8.0 micrograms/dl, with a skewed distribution ranging from 2 to 30 micrograms/dl. None were currently engaged in known lead work. Blood lead levels were significantly higher for the 124 who had 'ever' worked in demolition (8.8 micrograms/dl vs. 7.2 micrograms/dl, p = .004), and for the 79 who had ever burned paint and metal and welded on outdoor structures compared to the 48 who had done none of these activities (8.6 micrograms/dl vs. 6.8 micrograms/dl, p = .01). The 58 workers who had ever had workplace lead monitoring performed had higher lead levels (9.7 vs. 7.5 micrograms/dl, p = .003). Blood lead levels increased with age, and cigarette smoking. African Americans (N = 68) had higher lead levels (9.1 vs. 7.5 micrograms/dl, p = .01). There were only two women in the study, one with a lead level of 21 micrograms/dl and one, 7 micrograms/dl. Blood lead levels did not predict either systolic or diastolic blood pressure in this population. However, there was a significant interaction between race and lead as predictors of blood pressure, with blacks demonstrating a trend-significant correlation, and whites showing a nonsignificant but negative association. Demolition and hotwork on outdoor structures are known to cause acute episodes of lead poisoning. They also appear to cause slight but persistent increases in blood lead levels. Future workplace regulation should recognize and seek to maintain the low baseline now apparent even in urban, East Coast, construction workers.

Adolescent↗

PubMed1996

Staff security and work pressure: contrasting patterns of stability and change across five dialysis units.

Differences among clinical care units in social dynamics and social organization are associated with differences in the clinical course of patients with a range of chronic illness. These differences are also associated with well-being of staff members. Recent attention has focused on understanding these differences among units with an eye towards correcting deficiencies and enhancing strengths of clinical care units. The current study sought to delineate the effect of social and organizational dynamics unique to each unit on staff perceptions of the security of their relationships with other staff and their perceived work pressure. The unit as a major source of differences among staff subjects was compared with the impact of ethnic identity, of work in the morning shift vs other shifts, and of professional role. Results confirmed that unit membership was, by far, the most important correlate of staff perceptions of the unit, particularly those concerning security of relationships with others and perceived work pressure. Moreover, the results suggested that unit differences in perceived security were due to differences among units in long standing turmoil within the unit or long standing problematic ties between the unit and the larger institution which controls it. However, perceived work pressure seems more transient and may reflect the challenge of shorter-term fluctuations in the demands of patient care.

Adult↗

PubMed1996

The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

The relationship between therapeutic alliance and treatment outcome was examined for depressed outpatients who received interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Clinical raters scored videotapes of early, middle, and late therapy sessions for 225 cases (619 sessions). Outcome was assessed from patients' and clinical evaluators' perspectives and from depressive symptomatology. Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy. Ratings of patient contribution to the alliance were significantly related to treatment outcome; ratings of therapist contribution to the alliance and outcome were not significantly linked. These results indicate that the therapeutic alliance is a common factor with significant influence on outcome.

Adult↗

PubMed1995

Placental pathologic features of preterm preeclampsia.

OBJECTIVE: Our purpose was to compare the incidence and interrelationships of uteroplacental vasculopathy and chronic inflammatory and placental vasoocclusive lesions in preeclampsia and spontaneous delivery before 32 weeks' gestation. STUDY DESIGN: Review of singleton live-born nonanomalous infants born at 22 to 32 weeks' gestation identified 76 cases of preeclampsia and 353 cases of spontaneous prematurity (spontaneous premature membrane rupture [n = 192], preterm labor, intact membranes [n = 161]). Histologic lesions were considered as belonging to one of five major pathophysiologic groups: (1) uteroplacental vascular lesions and related villous lesions, (2) chronic inflammatory lesions, (3) coagulation-related lesions, (4) acute inflammatory lesions, and (5) unclassified lesions. Contingency table analyses considered p < 0.05 significant. Factor analysis extracted combinations of related variables. RESULTS: More frequent in preeclampsia versus spontaneous prematurity were chronic uteroplacental vasculitis (29% vs 20%, p < 0.05), chronic villitis (20% vs 3%, p < 0.001), avascular villi (39% vs 16%, p < 0.001), and "hemorrhagic endovasculitis" (9% vs 2.5%, p < 0.03). In the preeclampsia cases factor analysis extracted 13 categories of related lesions. Four categories contained uteroplacental vascular lesions. Five categories included lesions related to chronic inflammation, and eight included lesions related to coagulation. Four categories loaded lesions from one major pathophysiologic group only. Three categories loaded lesions from all three pathophysiologic groups. Unclassified lesions loaded into two factor categories that were unrelated to the other lesions. CONCLUSIONS: Chronic inflammatory and placental vasoocclusive lesions are more common in preterm preeclampsia than in spontaneous prematurity. Immunopathologic processes and coagulation may be involved in the pathophysiologic mechanisms of preterm preeclampsia independent of uteroplacental vascular pathologic features.

Acute Disease↗

PubMed1994

p,p'-DDT myoclonic/epileptic model: serotonin receptor binding and behavioral studies in the rat.

An abnormality of serotonergic neurotransmission has been hypothesized in p,p'-DDT intoxication to explain myoclonus and the antimyoclonic properties of 5-hydroxytryptophan (5-HTP). To study the role of serotonin (5-HT) receptors in myoclonus induced by p,p'-DDT in the rat, we performed time-course and dose-response studies of the effects of p,p'-DDT on behavior and regional 5-HT1 and 5-HT2 binding sites. At a time when low dose (80 mg/kg) p,p'-DDT elicited stimulus-sensitive and spontaneous myoclonus, there were no significant changes in Bmax or Kd of 5-HT1A, 5-HT1B, 5-HT1C sites in cortex, striatum, brainstem or spinal cord, agonist- or antagonist-labelled 5-HT2 sites in cortex, or 5-HT uptake sites. High dose p,p'-DDT (1000 but not 500 mg/kg), which also induced convulsions, only slightly increased 5-HT1 (unsubtyped) binding sites in cortex but not in brainstem or spinal cord and had no effect on antagonist-labelled 5-HT2 sites. In naive frontal cortex in vitro, 1 microM p,p'-DDT displaced neither [3H]5-HT or [3H]ketanserin specific binding. Lesions of central indoleamine neurons made with 5,7-dihydroxytryptamine significantly prolonged the latency and attenuated the severity of p,p'-DDT behavioral abnormalities, increasing the dose of p,p'-DDT which induced myoclonus (MD50) or convulsions (CD50) in 50 percent of the rats. This is the first report of 5,7-DHT-induced attenuation in the p,p'-DDT myoclonic model.

5,7-Dihydroxytryptamine↗

PubMed1993

A training program in universal precautions for second-year medical students.

BACKGROUND: A training program in universal precautions was developed and implemented in 1991-92 for second-year students at the George Washington University School of Medicine and Health Sciences. The students were required to participate in a three-hour session that consisted of lecture, demonstration, and practice components focused on the risks of bloodborne-disease exposure and the techniques of phlebotomy and intravenous insertion using universal precautions. METHOD: All 135 second-year students participated in the lecture component, but only 120 students, who were unfamiliar with the procedures, were required to participate in the demonstration and practice components. Each of these students was asked to answer pre- and postsession knowledge questions and to rate his or her preparedness on a five-point Likert scale, ranging from 1, "not prepared at all," to 5, "well prepared." Paired t-tests were used to compare the pre- and postsession knowledge scores and self-assessed preparedness scores. At the end of the training program, the students were offered the opportunity to volunteer for additional, individualized training with the hospital phlebotomy service. Unpaired t-tests were used to compare differences between the postsession knowledge scores of the volunteers and nonvolunteers. RESULTS: A total of 103 students completed both pre- and posttests. The students' knowledge scores increased from means of 64.7% to 88.5% (p = .001). Their self-assessed preparedness scores also increased, ranging from a low of means of 1.6 presession and 3.4 postsession for intravenous insertion to a high of means of 3.19 presession and 4.26 postsession for addressing personal concerns about possible exposure. The 43 students who volunteered for additional training scored significantly better on the postsession knowledge questions than did the nonvolunteers, suggesting that those who may have needed it most failed to sign up for additional training. CONCLUSION: The training session significantly improved the students' knowledge and sense of their own competency.

Curriculum↗

PubMed1993

Environmental medicine: its introduction into a medical school primary care requirement.

One hundred and twelve medical students participating in a required 6-week primary-care rotation completed a pretest of environmental medicine knowledge and attitudes at the start of the rotation and a similar posttest on the last day of the rotation. Control group students were to participate in the usual weekly didactic sessions of the clerkship. Intervention students were given a booklet describing environmental considerations in clinical medicine and introducing them to the concept of risk assessment, three computer-assisted instruction cases, and a problem-based learning (PBL) exercise involving role-play. Because voluntary compliance with evaluation forms was poor during year one, during the second year students in the intervention group were required to return evaluation forms in order to sit for the course final examination. Knowledge and attitudes of both intervention and control groups were compared at baseline and at the end of the rotation. Students in the intervention group also completed process evaluations of the intervention materials. Students in both intervention and control groups increased knowledge gains significantly during the second year of the intervention, while neither group improved during year 1. This may have been due to a 'spill-over' effect among primary-care teachers implementing the intervention. Students ranked both environmental and occupational medicine of least importance in their training compared with eight other aspects of medicine, and this ranking did not improve with intervention. The PBL exercise was well received by the students. Of 28 evaluations, 27 ranked the session in the highest 3 of a 5-part Likert scale for worthwhile content, and 24 would recommend the session to a friend.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗

PubMedDate not supplied

Sibling comparison of differential parental treatment in adolescence: gender, self-esteem, and emotionality as mediators of the parenting-adjustment association.

This study employs findings from social comparison research to investigate adolescents' comparisons with siblings with regard to parental treatment. The sibling comparison hypothesis was tested on a sample of 516 two-child families by examining whether gender, self-esteem, and emotionality-which have been found in previous research to moderate social comparison-also moderate sibling comparison as reflected by siblings' own evaluations of differential parental treatment. Results supported a moderating effect for self-esteem and emotionality but not gender. The sibling comparison process was further examined by using a structural equation model in which parenting toward each child was associated with the adjustment of that child and of the child's sibling. Evidence of the "sibling barricade" effect-that is, parenting toward one child being linked with opposite results on the child's sibling as on the target child-was found in a limited number of cases and interpreted as reflecting a sibling comparison process. For older siblings, emotionality and self-esteem moderated the sibling barricade effect but in the opposite direction as predicted. Results are discussed in terms of older siblings' increased sensitivity to parenting as well as the report of differential parenting reflecting the child's level of comfort and benign understanding of differential parenting, which buffers the child against environmental vicissitudes evoking sibling comparison processes.

Adolescent↗