Stability and change in the psychological adjustment of mothers of children and adolescents with cystic fibrosis and sickle cell disease

Found moderate stability in the classification of maternal adjustment in two longitudinal studies of mothers of children and adolescents with cystic fibrosis and sickle cell disease. In terms of the transactional stress and coping model, stable poor maternal adjustment was associated with higher levels of appraisal of daily stress and palliative coping and low levels of family supportiveness. With initial levels of maternal adjustment, demographic parameters, and follow-up interval controlled, concurrent levels of daily stress accounted for significant portions of variance in maternal adjustment at follow-up for both illness groups. In addition, illness severity, child psychological adjustment, and family conflict added significant increments to maternal adjustment at follow-up in the cystic fibrosis group. Findings are discussed in terms of a basis for subsequent intervention studies to enhance the adjustment of mothers of children with chronic illness.

Medium-chain acyl-coenzyme A dehydrogenase deficiency: clinical course in 120 affected children

Medium-chain acyl-coenzyme A dehydrogenase deficiency is an autosomal recessive disorder of beta-oxidation of fatty acids manifested by episodic hypoglycemia, encephalopathy, apnea, and sudden death. Medical data were obtained on 120 patients with medium-chain acyl-coenzyme A dehydrogenase deficiency referred to Duke University Medical Center for biochemical testing. There were 55 male and 65 female subjects ranging from birth to 19 years of age; 118 subjects were white. Twenty-three children (19%) died before the diagnosis was made. Follow-up data were available in the 97 surviving patients for an average of 2.6 years after diagnosis. Psychodevelopmental data were collected on 73 patients older than 2 years of age. Unexpected morbidity included developmental and behavioral disability, chronic muscle weakness, failure to thrive, and cerebral palsy. We conclude that unidentified patients with this disorder have a significant risk of sudden death in early childhood and that survivors have a significant risk of developmental disability and chronic somatic illness.

Nursery neurobiologic risk score: levels of risk and relationships with nonmedical factors

This study compares the Neurobiologic Risk Score (NBRS) with developmental outcome in 199 infants < or = 1500 g birth weight to determine levels of risk and to investigate the relative contributions of the NBRS and nonmedical factors to developmental outcome. The NBRS correlated significantly (p < .0001) with the Bayley Mental (MDI) and Psychomotor (PDI) Indexes, and neurologic examination score (NS) at 6, 15, and 24 months. Three risk groups were identified: low, NBRS < or = 4; intermediate, NBRS 5 to 7; and high, NBRS > or = 8 with an incidence of major handicaps at 24 months of 7%, 32%, and 50%, respectively. Of eight factors considered, the NBRS accounted for the greatest variance: MDI, 14 to 27%; PDI, 25 to 29%; NS, 34 to 42%. Additional increments of variance were contributed by gender (MDI, PDI, NS), maternal intelligence and race (MDI), and maternal education (PDI). The NBRS is a useful tool for identifying risk for developmental abnormalities due to neonatal medical events.

In Vivo Observations of Larval Brooding in the Chilean Oyster, Ostrea chilensis Philippi, 1845

The Chilean oyster Ostrea chilensis broods its larvae within the mantle cavity. In vivo observations, made with an endoscope, have demonstrated that the female does not undergo gill modification before or during the brooding process. The veliger larvae move freely, have no physical connections with the tissues of the mother, and are often seen as an aggregation ("swarm") around the labial palps. The larvae show a distinct circulation pattern inside the mantle cavity of the mother. Sporadic but strong pallial currents eject larvae from the swarm and transport them between the demibranchs to the posterior region, from which some return anteriorly in the basal ciliated tracts of the gills, and others on the marginal ciliated grooves. Larvae frequently move from the basal to the marginal groove of a demibranch via the ordinary filaments, although they occasionally travel in the opposite direction, moving along the principal filaments from the marginal groove to the basal tract. The circulation of the larvae in the mantle cavity may serve to irrigate them, thereby facilitating gas exchange and suspension-feeding. The veligers are not lecithotrophic, but readily remove and ingest particles suspended in the mantle cavity. The impact on the nutrition of the mother is not yet known, although the presence of particles in the food grooves and tracts and the transfer of material to the palps suggest that the feeding mechanism functions normally during brooding.

Psychological adjustment of mothers of children and adolescents with sickle cell disease: the role of stress, coping methods, and family functioning

Assessed the psychological adjustment of 78 mothers of children and adolescents (7-17 years of age) with sickle cell disease. Support was provided for a transactional stress and coping model in delineating the processes associated with maternal adjustment. In particular, poor maternal adjustment was associated with use of palliative coping methods and high levels of stress related to daily hassles. Variables of the model accounted for 55% of the variance in maternal psychological distress.

Sickle cell disease pain in children and adolescents: change in pain frequency and coping strategies over time

Examined 9-month follow-up data obtained from children and adolescents with sickle cell disease (SCD) and their parents participating in a longitudinal study of pain coping strategies. Of 87 subjects completing the baseline assessment of pain coping strategies, 70 (80%) of their parents completed a structured pain interview assessing their child's health care use and activity reduction during painful episodes over the follow-up period. Regression analyses controlling for age and pain frequency revealed that baseline Coping Attempts were associated with higher levels of school, household, and social activity during painful episodes. Baseline Passive Adherence was associated with more frequent health care contacts during the subsequent 9 months. Increases in Negative Thinking over time were associated with further increases in health care contacts during the follow-up period. Comparing pain coping strategies assessed at baseline to pain coping strategies measured at follow-up revealed that pain coping strategies were relatively stable over time for younger children but changed more for adolescents.

Roles of novobiocin-sensitive topoisomerases in chloroplast DNA replication in Chlamydomonas reinhardtii

We have examined DNA replication in Chlamydomonas reinhardtii chloroplasts in vivo when chloroplast type II topoisomerases are inactivated with sublethal doses of novobiocin. DNA replication is at first inhibited under these conditions. However, after a delay of several hours, chloroplast chromosomes initiate a novobiocin-insensitive mode of DNA replication. This replication starts preferentially near a hotspot of recombination in the large inverted repeats, instead of from the normal chloroplast origins, oriA and oriB. It replicates one, but not the other single-copy region of the chloroplast chromosome. We speculate that novobiocin-insensitive DNA replication in chloroplasts requires recombination in this preferred initiation region.

Role of child and maternal processes in the psychological adjustment of children with sickle cell disease

In this study, 64% of children aged 7-12 years with sickle cell disease were found to have a parent-reported behavior problem, and 50% met the criteria for a Diagnostic and Statistical Manual of Mental Disorders (3rd ed.) diagnosis based on a structural clinical interview of the child. Internalizing types of behavior problems and diagnoses were the most frequent. Support was provided for a transactional stress and coping model in delineating the processes associated with child adjustment. In particular, maternal anxiety accounted for 16%-33% of the variance in mother-reported internalizing and externalizing behavior problems, respectively, and child pain-coping strategies accounted for 21% of the variance in child-reported adjustment problems.

Mother-child agreement on the child assessment schedule with nonreferred children: a research note

This study replicated with nonreferred children the finding with psychiatrically referred children that mother-child concordance was a function of symptom type. Low mother-child concordance for internalizing problems and moderate concordance for externalizing problems characteristic of psychiatric samples was found to generalize to nonreferred children. Furthermore, mother-child concordance was also found to be a function of child gender and age. The implications of these findings for screening or assessment of nonreferred children were examined.

Role of child and maternal processes in the psychological adjustment of children with sickle cell disease

In this study, 64% of children aged 7-12 years with sickle cell disease were found to have a parent-reported behavior problem, and 50% met the criteria for a Diagnostic and Statistical Manual of Mental Disorders (3rd ed.) diagnosis based on a structural clinical interview of the child. Internalizing types of behavior problems and diagnoses were the most frequent. Support was provided for a transactional stress and coping model in delineating the processes associated with child adjustment. In particular, maternal anxiety accounted for 16%-33% of the variance in mother-reported internalizing and externalizing behavior problems, respectively, and child pain-coping strategies accounted for 21% of the variance in child-reported adjustment problems.

Risk status for dropping out of developmental followup for very low birth weight infants

Not keeping scheduled visits for medical care is a major health care issue. Little research has addressed how the interaction of demographic and biomedical parameters with psychosocial processes has an impact on appointment keeping. Typical factors are stress of daily living, methods of coping, social support, and instrumental support (that is, tangible assistance). In this study, the authors examine the role of these parameters and processes in the risk status for dropping out of a developmental followup program for very low birth weight infants. The findings suggest that the stress of daily living is a significant predictor for the mother's return when the infant is 6 months of age (corrected for prematurity). The predictors for return at 24 months corrected age include marital status, race, gestational age of the infant, maternal intelligence, and efficacy expectations. Providing transportation was found to be a successful intervention strategy for a subgroup at very high risk for dropping out due to a constellation of biomedical, demographic, and psychosocial factors.

Psychological adjustment of children with cystic fibrosis: the role of child cognitive processes and maternal adjustment

Found 60% of children 7-12 years old with cystic fibrosis to have a parent-reported behavior problem and 62% met the criteria for a DSM-III diagnosis based on a structured clinical interview with the child. Mixed internal and external behavior problem patterns and diagnoses of anxiety and oppositional disorder were most frequent. Support was provided for the hypothesized psycho-social/mediational roles of child perception of self-worth and maternal anxiety in child adjustment. Together, the variables of the transactional stress and coping model accounted for 39 and 43% of the variance in mother-reported internalizing and externalizing behavior problems and for 68% of the variance in child-reported problems.

Medical stress, appraised stress, and the psychological adjustment of mothers of children with myelomeningocele

This study investigated the relationship between medical severity, stress appraisals, and psychological symptoms in a representative sample of mothers of children with myelomeningocele. Although these mothers may be at risk for the development of depression and anxiety problems, substantial variability in their psychological adjustment exists, perhaps due to differences in illness severity and stress appraisals. A sample of 66 mothers answered several questionnaires, including the Stress Questionnaire and SCL-90-R. Medical indexes reflecting severity were obtained from medical charts. Correlational analyses indicated no relationship between medical indexes and maternal adjustment. Appraised illness stress was not related to medical indexes but was significantly related to adjustment. Regression analyses including demographic, medical, and appraised stress variables accounted for 32% of the variance in adjustment. The findings suggest the importance of cognitive appraisal of stress as opposed to objective medical severity in the explanation of maternal psychological adjustment to myelomeningocele.

The Missouri Children's Behavior Checklist behavioral classification system: a construct validity study with nonreferred children

This study provides validity information about the Missouri Children's Behavior Checklist (MCBC) classifications system with nonreferred children. MCBC behavior patterns of 41 children were related to DSM-III symptomatology ascertained through a structured clinical interview, the Child Assessment Schedule, conducted with the mother. The findings indicated that considering the Undifferentiated Disturbance pattern as an indicator of poor adjustment may be unwarranted with nonreferred children.

Stress, coping, and family functioning in the psychological adjustment of mothers of children and adolescents with cystic fibrosis

Assessed the role of illness parameters, demographic parameters, and hypothesized psychosocial/mediational processes in the psychological adjustment of 68 mothers of children and adolescents (7-17 years of age) with cystic fibrosis. Together the illness and demographic parameters accounted for only 13-15% of the variance in maternal adjustment. However, the hypothesized mediational processes accounted for 35-40% increment in the variance in maternal adjustment. More specifically, maternal adjustment was associated with lower levels of perceived daily stress, less use of palliative coping methods, and family functioning characterized by high levels of supportiveness.

Genes coding for proteins in central nervous system myelin

There has been considerable interest recently in a genetic component as a causative factor in multiple sclerosis, but the identity of putative susceptibility genes is unknown. In the past decade, the primary amino acid sequences of the four proteins making up 90% of the protein content of central nervous system myelin (proteolipid protein, myelin basic protein, 2',3'-cyclic nucleotide-3'-phosphohydrolase, and myelin-associated glycoprotein) have been determined in several species. Additionally, the structural genes coding for these proteins have been analysed and their human chromosomal localization determined. We have been analysing these genes for possible variants conferring susceptibility to multiple sclerosis. Recent results have shown that cholera and pertussis toxin substrates and low molecular-weight GTP-binding proteins are also present in central nervous system myelin. This implies the presence of signal transducing systems whose purpose is currently obscure. The emerging picture of central nervous system myelin is of a complex dynamic structure composed of many more proteins than was previously thought.

Structure and chromosomal localization of the human 2?,3?-cyclic nucleotide 3?-phosphodiesterase gene

Human brain cDNA clones for the myelin associated enzyme 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNPase) have been isolated and sequenced. The only 5' untranslated region (UTR) sequence found was that of a human CNPII mRNA, with no direct evidence for a CNPI mRNA. Human CNPase cDNAs were used to isolate genomic clones containing the human CNPase gene which is 9 kb long. Four exons were identified, separated by three introns, and the sequence of each exon and intron/exon boundary has been established. The polymerase chain reaction (PCR) was used to detect the presence of the human CNPase gene in DNA from a panel of rodent/human somatic cell hybrids. By this means the human CNPase gene was mapped to chromosome 17. In situ hybridization of a human CNPase genomic clone to metaphase chromosomes further localized this gene to chromosomal band 17q21.

Stress, coping, and psychological adjustment of adults with sickle cell disease

A transactional model of psychological adjustment to chronic illness was examined with 109 African-American adults with sickle cell disease (SCD). Good psychological adjustment was associated with lower levels of perceived daily stress and stress regarding SCD illness tasks, higher efficacy expectations, less use of palliative coping methods, less use of negative thinking/passive adherence pain-coping strategies, and family functioning characterized by high levels of support and low levels of conflict and control. Overall the underlying stress and coping conceptual model accounted for 44-50% of the variance in psychological adjustment.

Behavior patterns in nonreferred children: replication of the factor structure of the Missouri Children's Behavior Checklist

This study provided normative data with regard to the behavior classification system based on the Missouri Children's Behavior Checklist (MCBC) with a sample of 120 nonreferred children. The factor structure of the MCBC replicated with a high degree of congruence. Application of the MCBC behavior classification system provided information on the frequency of problem patterns and problem-free patterns by nonreferred children. Variability in MCBC factor scores and behavior patterns was examined as a function of demographic parameters of gender, race, age, and socioeconomic status.