Community Violence, Family Conflict, and Preschoolers' Socioemotional Functioning.

This study examined the relations among family conflict, community violence, and young children's socioemotional functioning and explored how children's social cognition and mothers' psychological functioning may mediate the outcomes associated with this exposure. Mothers of 431 Head Start preschoolers completed questionnaires about their family demography, exposure to community violence, family conflict, and children's distress symptoms. Children were administered a social cognition assessment, and teachers rated their behavior. Results showed that mothers' reports of children's co-witnessing of community violence were positively associated with police department crime rates, children's distress symptoms, and teachers' ratings of aggression. A path analysis revealed that children's social awareness and mothers' depressive symptoms partially mediated the effects of community violence and family conflict on outcomes for children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A rearrangement of the CDD gene at the 5'' UTR produces two types of transcripts that contain a natural antisense region

BACKGROUND: Mothers with multiple sclerosis (MS) often face fatigue and episodic exacerbations during their child-rearing years. These problems affect their support of their children, including physical affection. Children, depending on their age and gender, may or may not understand the changes. OBJECTIVES: To increase knowledge about mothers with MS concerning the relationship of fatigue and functional status to the perception of physical affection with their children, their perceptions of physical affection with their children in relation to exacerbation of their symptoms and the age and gender of their children, and the children's perceptions of their mothers' physical affection in relation to the children's age and gender and exacerbations in their mothers' symptoms. METHOD: Thirty-five mothers with relapsing-remitting MS and a child of each mother were studied, using interviews and questionnaires. RESULTS: Functional status and fatigue were not significant predictors of physical affection during an exacerbation. When the mothers' symptoms were stable, perceptions of mothers and children with respect to maternal physical affection were similar. Significant changes were reported in both the mothers' perceptions of their physical affection and the children's perceptions of their mothers' physical affection during exacerbations. There was a significant difference between the perceptions of the mothers and children regarding the magnitude of that change. Mothers significantly underestimated changes in their physical affection. CONCLUSIONS: Physical affection was selected as an important aspect of family functioning that could be affected by characteristics of illness, including exacerbations, fatigue, and functional status. However, fatigue and functional status did not explain the perception of physical affection during an exacerbation.     

Why are sicker patients less satisfied with their medical care? Tests of two explanatory models.

Two explanations were tested for why patients who are less healthy tend to be less satisfied with their medical care than healthier patients. The explanations were (a) that poor health produces dissatisfaction directly and (b) that poor health produces dissatisfaction through the mediating effect of physicians' behavior. Two studies are presented that measured patients' health status, patients' satisfaction with care, and their physicians' communication as reported on audiotape. In Study 1, 114 patients had first visits with rheumatologists; in Study 2, 649 patients had continuing-care visits with physicians in internal and family medicine. Causal modeling revealed that the first study supported the direct explanation. The second study also supported the direct explanation, as well as the mediation explanation with respect to the physician's use of social conversation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician practice styles and patient outcomes: differences between family practice and general internal medicine

OBJECTIVES: This study compared patient health status, patient satisfaction, and physician practice style between family practice and internal medicine. METHODS: New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care. Practice styles were characterized by the Davis Observation Code. Self-reported health status (Medical Outcomes Study, Short Form-36) and patient satisfaction also were measured. RESULTS: There were no significantly different changes in self-reported health status or patient satisfaction between family practice and internal medicine physicians during the course of the study. Family practice initial encounters, however, were characterized by a style placing greater relative emphasis on health behavior and counseling, whereas internists used a more technical style. Improved health status scores after treatment were predicted by a practice style emphasis on counseling, whereas improvements in patient satisfaction scores were predicted by a style of care stressing patient activation. Although this is the first known randomized trial studying this issue, the conclusions are limited by a 38% loss of patients from enrollment to care and a loss of 18% at the 1-year follow-up evaluation. CONCLUSIONS: There were significant differences in practice styles between family physicians and internists; however, it was the physician's behavior, not specialty per se, that affected patient outcomes. A practice style emphasizing psychosocial aspects of care was predictive of improvements in patient health status, whereas a practice style emphasizing patient activation was predictive of improvements in patient satisfaction.     

Effects of social, familial, and maternal state variables on neonatal and infant health.

The medical protocols of a Danish birth cohort of 5,036 infants were summarized into 5 infant outcome measures: birth weight, neonatal physical health, neonatal neurological status, 1-yr physical health, and 1-yr motor development. All Ss received uniform medical care during pregnancy. 17 indices representing both medical and environmental variables were used as predictors in hierarchical regression analyses. Consistent negative environmental influences on neonatal outcomes were not found, presumably due to the uniform medical care during pregnancy that each mother received. A stronger environmental influence was observable at 1 yr of age. Institutional daycare, mother's employment, family size, whether the child was planned, and SES all contributed significantly to the regression equation for 1-yr physical health. This effect was anticipated, since no uniform medical treatment was provided the cohort subsequent to birth. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal facial behavior and the recognition and production of emotional expression by maltreated and nonmaltreated children.

20 maltreated and 20 nonmaltreated children (ages?=?3–7 years) and their mothers were observed during a laboratory play session and 7 home observation visits. Ss' facial behavior was video recorded in the lab and coded live by observers in the home. Children also participated in an emotional-expression recognition task. Data analysis showed that both maltreatment status and mothers' facial behavior were predictors of children's recognition scores. Positive relationships were also found between mothers' and children's expressive behavior. Although maltreated and nonmaltreated children differed significantly in their recognition of emotional facial expressions, group differences were not found for either mothers' or children's expressive behavior. Overall, this study's findings indicate that children's recognition and production of facial expressions depends in part on the expressive environment provided by their mothers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A test of interventions to increase adherence to hypertensive medical regimens

Low rates of adherence to hypertensive therapy limit patients' securing the full benefits of treatment. While some factors related to adherence have been identified research on the effectiveness of interventions to increase adherence levels is sparse. The present study was designed to assess the impact of a series of different interventions on a group of some 400 patients, all under the care of private physicians in a small community. A factorial design was employed to deliver four, sequential educational interventions, about four months apart, to randomly selected sub-groups. Interviews before and after each intervention provided information concerning self-reported adherence, health status, health beliefs, and personal characteristics. Pertinent medical records and pharmacy data were also obtained. The first intervention - printed material - did not significantly affect adherence. The second and fourth interventions - nurse telephone calls and social support - each increased medication taking and the third intervention - self-monitoring - led to better weight control. There was no cumulative impact of the interventions and different aspects of regimens were not significantly related to one another.     

Evaluation of a stroke family care worker: results of a randomised controlled trial

OBJECTIVE: To examine the effect of contact with a stroke family care worker on the physical, social, and psychological status of stroke patients and their carers. DESIGN: Randomised controlled trial with broad entry criteria and blinded outcome assessment six months after randomisation. SETTING: A well organised stroke service in an Edinburgh teaching hospital. SUBJECTS: 417 patients with an acute stroke in the previous 30 days randomly allocated to be contacted by a stroke family care worker (210) or to receive standard care (207). The patients represented 67% of all stroke patients assessed at the hospital during the study period. MAIN OUTCOME MEASURES: Patient completed Barthel index, Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, mental adjustment to stroke scale, and patient satisfaction questionnaire; carer completed Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, caregiving bassles scale, and carer satisfaction questionnaire. RESULTS: The groups were balanced for all important baseline variables. There were no significant differences in physical outcomes in patients or carers, though patients in the treatment group were possibly more helpless less well adjusted socially, and more depressed, whereas carers in the treatment group were possibly less hassled and anxious. However, both patients and carers in the group contacted by the stroke family care worker expressed significantly greater satisfaction with certain aspects of their care, in particular those related to communication and support. CONCLUSIONS: The introduction of a stroke family care worker improved patients' and their carers' satisfaction with services and may have had some effect on psychological and social outcomes but did not improve measures of patients' physical wellbeing.     

Associations among family environment, sustained attention, and school readiness for low-income children.

In this study, we examined the developmental pathways from children's family environment to school readiness within a low-income sample (N = 1,046), with a specific focus on the role of sustained attention. Six distinct factors of the family environment representing maternal parenting behaviors, the physical home environment, and maternal mental health at 3 years of age were explored as independent predictors of children's observed sustained attention as well as cognitive and behavioral outcomes at 5 years of age. Children were grouped by poverty status (poor vs. near-poor). Results suggest specificity in the associations among attention (focused attention and lack of impulsivity) and its correlates, with different patterns emerging by poverty status group. Overall, the family environment was largely unrelated to children's sustained attention. For both groups, focused attention was associated with receptive vocabulary; however, it partially mediated the association between maternal lack of hostility and receptive vocabulary only among the near-poor. In addition, lack of impulsivity was associated with both receptive vocabulary and externalizing behaviors but only for the poor group. Findings indicate sustained attention as a potential target for efforts aimed at enhancing school readiness among predominantly poor children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health status and satisfaction with health care: Results from the medical outcomes study.

Relations between self-assessed health status and satisfaction with health care were examined using 2 waves of data obtained from participants in the Medical Outcomes Study. Using a multisample covariance modeling framework, separate models were examined for patients with significant symptoms of depression (n?=?417 ) and patients with chronic physical health conditions (n?=?535 ). The pattern of findings was essentially identical for both patient subgroups. General satisfaction with care was cross-sectionally associated with mental?but not physical--health status. In addition, significant cross-lagged effects were found linking baseline satisfaction with care to subsequent mental health and baseline mental health to subsequent satisfaction with care. By contrast, no crosslagged directional effects linking satisfaction with care and physical health status were identified. Finally, no evidence was found that satisfaction with specific aspects of health care contributed independently to either mental or physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital conflict, gender, and children's appraisals and coping efficacy as mediators of child adjustment.

The role of children's perceptions and appraisals in the impact of marital conflict was examined for 51 9- to 12-yr-olds from intact families. Gender differences were found in the cognitions and coping processes related to marital conflict and child adjustment. Appraisals of coping efficacy and the threat posed by marital conflict predicted adjustment in boys, whereas self-blame was linked with internalizing problems for girls. The appraised destructiveness of conflict was significantly related to perceived threat in boys and self-blame in girls. Boys appeared more attuned or, alternatively, less shielded from marital conflict, as reflected by the higher correlations with mothers' reports of marital conflict for boys than for girls. The significance of boys' appraisals to adjustment was suggested by the fact that boys' perceptions were better predictors of adjustment outcomes than were mothers' reports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast cancer screening adherence: does church attendance matter?

Little is known about the health behaviors of church attendees. This article reviewed telephone interview data of 1,517 women who were church members from 45 churches located in Los Angeles County to determine their breast cancer screening status and to identify the key predictors of screening. Almost all of this sample (96%) reported attending church at least once a month. Key predictors of screening included physician-patient communication, ethnic background, and having medical insurance. Although church-related predictors were not significantly related to screening adherence, the authors compared community-based screening rates from another sample to their sample rates and found that, when controlling for income and education, church members fared better on mammography screening than women who were community residents. This finding suggests that frequent church attendance contributes to better mammography screening status and that the relationship between religious involvement and health behaviors needs further explanation.     

Observed maternal strategies and children's health locus of control in low-income Mexican Americans.

This study examined the relationship among mothers' health locus of control (HLOC) beliefs, their socialization strategies, and their children's HLOC beliefs in 80 low-income Mexican American families. Maternal socialization strategies were assessed from videotaped interactions of mothers and children engaged in a structured task. Factor analysis of the coded strategies yielded 4 factors: Tell Answer, Teaching, Clarify, and Reinforce. Findings indicated that maternal-health-internally scores negatively predicted mothers' use of the Tell Answer strategies and positively predicted their use of Teaching strategies. Mothers who believed that Powerful Others (e.g., health professionals) controlled their health were more likely to use the Tell Answer strategy. In contrast, mothers who believed that health was due to chance were less likely to use Teaching. Maternal use of Teaching strategies predicted children's internal HLOC, whereas maternal Tell Answer strategies predicted children's external HLOC. Findings suggest that mothers' HLOC beliefs influence the socialization strategies they use and that these strategies are associated with children's HLOC beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors affecting young children's mental development and their significance in intervention

Factors affecting their developmental quotients (DQ) in 48 normal young children, who were involved in regular development assessments at child health care outpatient visits and whose parents received child-rearing guidance at Chaoyangmen Subdistrict of Dongcheng District, Beijing, and 43 controls aged 36 months were analyzed. Factors, such as their parents' receiving child-rearing guidance, paternal education, maternal education, paternal occupation, type of nursery schools, home environment quality score (HEQS) at 24 and 36 months of age, and mothers' knowledge of child-rearing were associated with children's DQ at their age of 36 months, with statistical significance at a level of 0.05 in univariate analysis. With multiple regression analysis, HEQS at the age of 36 months, family size at the age of 24 months, paternal education, children's sex, and mothers' age had influences on DQ at age of 36 months with statistical significance, and the degree of correlation of HEQS with DQ at 36 months was much higher than that of other factors, and it suggested that HEQS was an important link in child developmental intervention.     

Child's play with adults, toys, and peers: An examination of family and child-care influences.

Toddler-age children's (11 to 30 months old) play with care-giving adults and with toys and peers was observed and rated in family day-care homes. Fifty-five children, their mothers, and family day-care home providers participated in this study. The quality of the family day-care homes was assessed with the Harms and Clifford Family Day Care Rating Scale (FDCRS) and by measures of ratio and group size. Information on family stress, social support, child-rearing attitudes, and maternal role satisfaction was reported by mothers. More nurturing and supported families were associated with higher quality child care, whereas more restrictive and stressed families were associated with lower quality child care. More restrictive and stressed families were associated with more changes in child-care arrangements. Greater numbers of child-care changes also were associated with lower levels of competent play with objects and peers. When quality of care was controlled, both more nurturing and supported families and less restrictive and stressed families were associated with higher levels of competent play with adult caregivers, peers, and objects. When family characteristics were controlled, higher quality child care was associated with more competent play with adult caregivers and with peers and objects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of medical care by elderly people: general satisfaction and physician quality

OBJECTIVE: To identify personal characteristics and factors related to health and patterns of healthcare utilization associated with the elderly people's satisfaction with medical care. DATA SOURCES/STUDY SETTING: Data from the 1991 Medicare Current Beneficiary Survey (MCBS) on 8,859 persons age 65 and over living in the community. STUDY DESIGN: Items reflecting general satisfaction with care and views of physician quality are examined and, based on factor analysis, grouped in dimensions of two (global quality, access) and three (technical skills, interpersonal manner, information-giving), respectively. The relationship of high levels of satisfaction in each dimension to personal characteristics of elderly people, and to measures of access and utilization, is assessed using logistic regression. PRINCIPAL FINDINGS: While satisfaction is high, with over 90 percent surveyed expressing some satisfaction, there is substantial variation with less likelihood of high satisfaction among those 80 or older, with less education and income and in poorer health. Longer waiting time at visits and less frequent visits are factors in lower satisfaction as well. A favorable perception of physician quality, especially regarding technical skills, appears to play a significant role in satisfaction with global quality of care. CONCLUSIONS: Studies of patient satisfaction in elderly people are rare. Some factors expected to be related to positive assessment based on earlier studies, were, e.g., better health and shorter waiting time, while others were not, e.g., increasing age. Elderly people appear to place greater importance on physician technical skills, as opposed to interpersonal dimensions, in assessing global quality. These findings suggest the need for a better understanding of how elderly people evaluate care and what they value in interactions with the healthcare system.     

Personal, medical, and healthcare utilization among homeless veterans served by metropolitan and nonmetropolitan veteran facilities.

This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of health care utilization varied by metropolitan status. Of 3,595 respondents, 60% were residing in metropolitan areas. Age, sex, and marital status were similar between metropolitan and nonmetropolitan homeless. Metropolitan homeless were less likely to receive public financial support or to be employed, to have at least one medical problem, one psychiatric problem, or current alcohol dependency, but more likely to be homeless longer. Of the 52% of the sample who used VHA care in the last 6 months, 53% were metropolitan versus 49% nonmetropolitan (p = .01). Metropolitan status predicted at least one VHA visit within the prior 6 months (OR:1.3, CI:1.1, 1.6). Significant differences occur in the personal, medical, and health care utilization characteristics of homeless veterans in metropolitan versus nonmetropolitan areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults.

To assess predictors of latent tuberculosis infection (LTBI) completion by using structural equation modeling (SEM) among homeless adults, a group at great risk for LTBI and active tuberculosis (TB). LTBI therapy is effective in stemming the progression to active TB, yet treatment adherence among homeless persons is difficult to attain. Design: By using SEM, the authors assessed predictors of LTBI completion among a sample of 494 homeless adults in Los Angeles, CA, who received either a nurse case-managed program (NCM) or a usual care program. Main Outcome Measures: Latent variables were created with the baseline variables of site type, age, intervention status, dissatisfaction with health care, depression, TB risk assessment, alcohol use, heroin or cocaine use, and TB knowledge. Outcome variables included many of the same baseline variables as well as treatment completion. Results: LTBI treatment completion (100% adherence) was significantly and positively associated with participation in NCM, older age, and less heroin or cocaine use. NCM also predicted greater TB knowledge, greater ease of treatment, and more satisfaction with treatment (NCM completion rate = 64%, control rate = 42%). Conclusion: The culturally competent NCM program, combined with active tracking and incentives, was successful in a difficult-to-treat and highly transient population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Seeking urgent pediatric treatment: Factors contributing to frequency, delay, and appropriateness.

Explored the factors that contributed to mothers' decisions to seek urgent medical attention for their children when symptoms were not of a traumatic nature. 89 mothers (mean age 28.4 yrs) seeking treatment for their children (mean age 5.3 yrs) at a prepaid clinic completed a questionnaire eliciting their expectations regarding the course of their children's problems, seriousness of the problems, perceived responsibility for the symptoms, and extent to which a variety of factors contributed to their decisions to seek treatment. Demographic data and information about each child's symptoms and medical history were also obtained. Four major reasons for seeking treatment were identified: family history of the presenting complaint, worry regarding the symptoms, situational variables, and the extent of the child's illness behavior. The appropriateness of the visit, delay in seeking treatment, and frequency of mothers' use of the pediatric clinic were predicted by the nature of the presenting symptoms (particularly the presence of fever), the ages of the mother and child, and 2 of the reasons for seeking treatment factors (i.e., family history, child's illness behavior). It is suggested that mothers should pay more attention to presenting symptoms and to the children's behavior than to psychosocial stressors in deciding to seek urgent care. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)