Search PubMed⌕ Search

Biomedical subjects

D C Stewart

Publications and source records attributed to D C Stewart.

17 recordsLinked to original sources
PubMed2000

Perceived access to pediatric primary care by insurance status and race.

The Nemours system of children's clinics in Delaware was designed to offer comprehensive primary care (medical homes), to children regardless of families' abilities to pay for services. Racial and insurance status differences in perceptions of access to the provisions of medical home and differences by the Short Medical Home Index are assessed. A probabilities proportionate to size sampling method was used to randomly select families in nine clinics. A total of 323 caregivers of children ages 6 to 48 months were surveyed. Results suggest that there are minimal differences in perceptions of access to provisions of the medical home concept by insurance status and race in the clinics studied. However, when using a composite measure of medical home, differences in perceptions were found. The results suggest that insurance status and racial differences in perceptions of access remain even when the system is specifically designed to provide medical homes without regard to demographic factors. Future studies should focus on improving patient interactions with clinic personnel to ensure that access to provisions of care are understood by all consumers.

Black or African American↗
PubMed2000

The impact of a pediatric medical home on immunization coverage.

This study assessed whether having access to provisions in the American Academy of Pediatrics "medical home" concept was associated with being age-appropriately immunized at 3, 12, and 24 months. Cross-sectional data on 495 Delaware children were collected from June 1994 to June 1995. Immunization status was determined with the Delaware immunization registry. The medical home was not significantly associated with immunization coverage. This study confirms that race, insurance status, maternal education, and family incomes are predictive of having poor immunization outcomes. Simply providing medical homes may not be an effective strategy to improve use of preventive services.

Child, Preschool↗
PubMed1997

Construction of chimeric enzymes out of maize endosperm branching enzymes I and II: activity and properties.

Branching enzyme I and II isoforms from maize endosperm (mBE I and mBE II, respectively) have quite different properties, and to elucidate the domain(s) that determines the differences, chimeric genes consisting of part mBE I and part mBE II were constructed. When expressed under the control of the T7 promoter in Escherichia coli, several of the chimeric enzymes were inactive. The only fully active chimeric enzyme was mBE II-I BspHI, in which the carboxyl-terminal part of mBE II was exchanged for that of mBE I at a BspHI restriction site and was purified to homogeneity and characterized. Another chimeric enzyme, mBE I-II HindIII, in which the amino-terminal end of mBE II was replaced with that of mBE I, had very little activity and was only partially characterized. The purified mBE II-I BspHI exhibited higher activity than wild-type mBE I and mBE II when assayed by the phosphorylase a stimulation assay. mBE II-I BspHI had substrate specificity (preference for amylose rather than amylopectin) and catalytic capacity similar to mBE I, despite the fact that only the carboxyl terminus was from mBE I, suggesting that the carboxyl terminus may be involved in determining substrate specificity and catalytic capacity. In chain transfer experiments, mBE II-I BspHI transferred more short chains (with a degree of polymerization of around 6) in a fashion similar to mBE II. In contrast, mBE I-II HindIII transferred more long chains (with a degree of polymerization of around 11-12), similar to mBE I, suggesting that the amino terminus of mBEs may play a role in the size of oligosaccharide chain transferred. This study challenges the notion that the catalytic centers for branching enzymes are exclusively located in the central portion of the enzyme; it suggests instead that the amino and carboxyl termini may also be involved in determining substrate preference, catalytic capacity, and chain length transfer.

1,4-alpha-Glucan Branching Enzyme↗
PubMed1997

Snapping scapula syndrome: three case reports and an analysis of the literature.

The snapping scapula syndrome is an infrequently described source of shoulder discomfort characterized by painful, audible, and/or palpable abnormal scapulothoracic motion. The syndrome may be caused by skeletal or soft-tissue abnormalities that interfere with articulation between the scapula and the rib cage. Often, no obvious source of the snapping can be identified with imaging studies. Three new cases with electrodiagnostic and imaging studies are presented. For the first time a critical analysis and review by diagnoses, gender, age, treatment, and outcome of 89 reported cases is presented. Accurate recognition of the syndrome may lead to prompt and long-term relief of symptoms by conservative or surgical treatment.

Adult↗
PubMed1997

Comparing a computer-based childhood vaccination registry with parental vaccination cards: a population-based study of Delaware children.

We conducted a population-based study in Delaware to examine the reliability of childhood vaccination data in a comprehensive computer-based record system versus parental vaccination cards. We sampled 1,005 children born between January, 1991, and September, 1993. We oversampled for children whose mothers received Medicaid or were uninsured at the time of delivery. Of the survey responders, 276 (56%) had access to written records, and 409 (83%) records were located in the Delaware immunization computer database. The kappa coefficient was 0.18. The observed agreement was 59.8%. When the two databases were combined, the up-to-date rate for 2-year-olds was 58.4%, an increase of 12.7% and 24.2% from the computer database and the parental records, respectively. The computer database was 78.1% sensitive and the parental records were 54.9% sensitive. These results indicate that a comprehensive computer-based record system, with adequate provider participation and proper data management, can be more reliable than parental vaccination cards.

Child↗
PubMed1994

Impact of quality assurance program: providing practice assessment.

Participation in a self-administered quality assessment (SAQA) program led to changes in New Jersey dentists' perceptions of practice quality. Ninety-four percent indicated they discovered practice deficiencies. This study suggests that using a self-administered quality assessment program, such as the SAQA program, can lead to a better understanding of a practice's strengths and weaknesses.

Dental Care↗
PubMed1987

Sexuality and the adolescent: issues for the clinician.

The acquisition of a sexual identity is one of the key developmental tasks of adolescence. Physicians treating adolescents should be familiar with and comfortable with addressing both sexual behavioral norms and sexual dysfunction. This review attempts to describe current adolescent sexual belief systems and behaviors, as well as more problematic areas such as sexual dysfunction, unintended pregnancy, and sexual orientation issues. A developmentally based approach to addressing these issues is presented.

Adolescent↗
PubMedDate not supplied

Utilization of dental services and preventive oral health behaviors among preschool-aged children from Delaware.

PURPOSE: This study evaluated factors associated with age-appropriate dental care utilization and preventive behaviors among preschool-aged children in Delaware. METHODS: In June 1994, child health questionnaires were mailed to a simple random sample of 1,005 Delaware caregivers whose children were ages 6 to 36 months. RESULTS: Only 12% of children > or = 12 months old had been to the dentist. Child's race, maternal education, maternal age, dental insurance, having a regular place for medical care, receiving information on tooth care from medical personnel, and family income were not associated with having a dental visit. CONCLUSIONS: Improving information provided to caregivers and health professionals on appropriate timing of dental services and preventive dentistry is recommended to enhance oral health for preschool-aged children.

Chi-Square Distribution↗