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Biomedical subjects

D E Stewart

Publications and source records attributed to D E Stewart.

At least 55 records · Page 3Linked to original sources
PubMed1997

Neurodevelopment of children exposed in utero to antidepressant drugs.

BACKGROUND: Many women of reproductive age have depression, necessitating therapy with either a tricyclic antidepressant drug or a drug, such as fluoxetine, that inhibits the reuptake of serotonin. Whether these drugs affect fetal neurodevelopment is not known. METHODS: We studied the children of 80 mothers who had received a tricyclic antidepressant drug during pregnancy, 55 children whose mothers had received fluoxetine during pregnancy, and 84 children whose mothers had not been exposed during pregnancy to any agent known to affect the fetus adversely. The children's global IQ and language development were assessed between 16 and 86 months of postnatal age by age-appropriate Bayley Scales of Infant Development or the McCarthy Scales of Children's Abilities (for IQ) and the Reynell Developmental Language Scales. RESULTS: The mean (+/-SD) global IQ scores were 118+/-17 in the children of mothers who received a tricyclic antidepressant drug, 117+/-17 in those whose mothers received fluoxetine, and 115+/-14 in those in the control group. The language scores were similar in all three groups. The results were similar in children exposed to a tricyclic antidepressant drug or fluoxetine during the first trimester and those exposed throughout pregnancy. There were also no significant differences in temperament, mood, arousability, activity level, distractibility, or behavior problems in the three groups of children. CONCLUSIONS: In utero exposure to either tricyclic antidepressant drugs or fluoxetine does not affect global IQ, language development, or behavioral development in preschool children.

Adult↗
PubMed1996

A curriculum on physician-patient sexual misconduct and teacher-learner mistreatment. Part 2: Teaching method.

Medical educators have become increasingly aware of the need for health care professionals to receive more training about the causes and consequences of physician-patient sexual misconduct and teacher-learner mistreatment and harassment. A curriculum in use at the University of Toronto includes a didactic component, consisting of lectures, and an experiential component, consisting of a workshop. This article concerns how, by discussing case vignettes designed to illustrate salient points, the participants have an opportunity to consider their responses in actual clinical and teaching situations. Evaluation of the course by 373 participants shows that the curriculum is considered acceptable and is likely to be of benefit. Of the course participants, 54% (15/28) of those attending the course for faculty and 39% (133/345) of those at subsequent courses stated that they would change their clinical and teaching practices in positive ways as a result of attending. A further 38% (130/345) stated that they already practised in a manner congruent with the model discussed.

Curriculum↗
PubMed1996

Antenatal psychosocial risk factors associated with adverse postpartum family outcomes.

OBJECTIVE: To determine the strength of the association between antenatal psychosocial risk factors and adverse postpartum outcomes in the family, such as assault of women by their partner, child abuse, postpartum depression, marital dysfunction and physical illness. DATA SOURCES: MEDLINE, Cinahl, Famli, Psych Abstracts and the Oxford Database of Perinatal Trials were searched from relevant articles published from Jan. 1, 1980, to Dec. 31, 1993, with the use of MeSH terms "depression, involutional," "child abuse," "child neglect," "domestic violence," "family," "marital adjustment," "family health," "newborn health," "child health," "physical illness," "social support," "psychosocial risk," "prediction," "risk factors," "obstetrics" and "prenatal care." Further articles were identified from bibliographies. STUDY SELECTION: Of the 370 articles identified through the search, 118 were included for review. Studies were included if they examined the association between psychosocial risk factors and the outcomes of interest. Articles were excluded if they were reviews of poor quality or they had one or more of the following features: insufficient description of the sample, a high attrition rate, a lack of standardized outcome measures, outcomes other than the ones of interest or results that had already been reported in a previous study. DATA EXTRACTION: The strength of evidence of each study was evaluated. On the basis of the evidence, each risk factor was assigned a rating of the strength of its association with each of the postpartum outcomes. The ratings were class A (good evidence of association), class B (fair evidence) and class C (no clear evidence). Of the 129 antenatal psychosocial risk factors studied, 15 were found to have a class A association with at least one of the postpartum outcomes. DATA SYNTHESIS: Child abuse and abuse of the mother by her partner were most strongly correlated (class A evidence) with a history of lack of social support, recent life stressors, psychiatric disturbance in the mother and an unwanted pregnancy. Child abuse was also strongly associated with a history of childhood violence in the mother or her partner, previous child abuse by the mother's partner, a poor relationship between the mother and her parents, low self-esteem in the mother and lack of attendance at prenatal classes. Postpartum abuse of the mother was also associated with a history of abuse of the mother, prenatal care not started until the third trimester and alcohol or drug abuse by the mother or her partner (class A evidence). Child abuse had a fair (class B) association with poor marital adjustment or satisfaction, current or past abuse of the mother and alcohol or drug abuse by the mother or her partner. There was class B evidence supporting an association between abuse of the mother and poor marital adjustment, traditional sex-role expectations, a history of childhood violence in the mother or her partner and low self-esteem in the mother. Postpartum depression was most strongly associated with poor marital adjustment, recent life stressors, antepartum depression (class A evidence), but was also associated with lack of social support, abuse of the mother and a history of psychiatric disorder in the mother (class B evidence). Marital dysfunction was associated with poor marital adjustment before the birth and traditional sex-role expectations (class A evidence), and physical illness was correlated with recent life stressors (class B evidence). CONCLUSIONS: Psychosocial risk factors during the antenatal period may herald postpartum morbidity. Research is required to determine whether detection of these risk factors may lead to interventions that improve postpartum family outcomes.

Child↗
PubMed1996

A curriculum on physician-patient sexual misconduct and teacher-learner mistreatment. Part 1: content.

Although health care professionals, licensing bodies, governments and the community are paying increasing attention to the negative consequences of sexual misconduct by physicians, education for professionals about this subject is rare and limited. Even less attention has been paid to the adverse effects of violations of boundaries between teachers and learners (students, residents, interns and other trainees). A curriculum now being used at the University of Toronto to teach faculty and students about these topics includes a didactic portion and a workshop component. The didactic portion consists of lectures on the definitions, causes and consequences of physician-patient sexual misconduct and teacher-learner mistreatment and harassment. Relationships after termination of treatment and the complaint and discipline procedures of the College of Physicians and Surgeons of Ontario are also discussed. This article reviews the topics covered in this portion of the curriculum. A subsequent article will discuss the workshop component of the course.

Curriculum↗
PubMed1996

Chronic gynecologic pain.

Patients with chronic gynecologic pain are frequently seen by consultation psychiatrists working on gynecologic services. This paper reviews the classification and assessment of chronic gynecologic pain and comments on recent studies of these disorders. The role of the psychiatrist in the multidisciplinary assessment and treatment of these women is discussed.

Chronic Disease↗
PubMed1995

Cigarette smoking during pregnancy.

OBJECTIVES: To determine: 1. the prevalence of regular smoking in the latter half of pregnancy in a sample of Canadian prenatal patients; 2. the psycho-social and demographic characteristics that differentiate smoking from nonsmoking patients; 3. the characteristics that differentiate prenatal patients who smoke more than 10 cigarettes per day from those who smoke 1 to 10 cigarettes per day; and 4. the psychiatric morbidities or psychological attitudes associated with smoking in pregnancy. METHODS: Consecutive consenting women 20 or more weeks pregnant were given, at a prenatal clinic, the General Health Questionnaire (GHQ), the Fetal Health Locus of Control (FHLC), and a study questionnaire to complete. RESULTS: Five-hundred and forty-five women completed the questionnaires. Eighty-nine (16.3%) women reported regular daily cigarette smoking in the second half of pregnancy, while 43 (7.9%) smoked more than 10 cigarettes per day. Women who smoked were more likely than nonsmokers to be under 21, born in Canada, have only elementary education, be unemployed and unmarried, eat unhealthy diets, drink alcohol, use nonprescription and illicit drugs, have unplanned pregnancies, histories of emotional and physical problems, and have suffered physical abuse before and during pregnancy. Smokers were more likely than nonsmokers to meet case status on the GHQ and on the FHLC to believe "chance" and less likely to believe that "internal control" or "powerful others" affected the health of their fetuses. "Social disorganization", "health risks", and "poor health" factors accounted for 83.1% of the total variance. CONCLUSIONS: Women who smoke in pregnancy have a higher rate than nonsmokers of other health risk behaviours, social disadvantage, and emotional disturbance. Psychiatrists can play an important role in identifying and treating emotional and psychiatric morbidity in women of reproductive age to facilitate a reduction in smoking rates in this high-risk population.

Adolescent↗
PubMed1994

Incidence of postpartum abuse in women with a history of abuse during pregnancy.

OBJECTIVE: To determine whether women with a history of physical abuse during pregnancy have an increased incidence of physical abuse in the 3 months after delivery. DESIGN: Follow-up survey. SETTINGS: A primary care community-based prenatal clinic, private obstetricians' and family physicians' offices in a large city, family physicians' offices in a small town and a tertiary care university teaching hospital. PATIENTS: Thirty-six women identified in a study of physical abuse during pregnancy; 30 (83.3%) agreed to participate. OUTCOME MEASURES: Number of incidents of physical abuse during the 3 months before conception, during the first, second and third trimesters of pregnancy and during the 3 months after delivery. General Health Questionnaire (GHQ) score to determine psychologic distress and predict psychiatric morbidity. Interview to diagnose psychiatric disorders according to defined criteria. RESULTS: Twenty-seven (90.0%) of the 30 participants reported a total of 57 incidents of abuse in the 3 months after delivery. For each period, the mean number of incidents of abuse per woman abused in that period was calculated and was found to be significantly higher for the postpartum period (2.1) than for the 3 months before conception (1.5) or for the first, second or third trimesters (1.4, 1.3 and 1.1) (F = 18.87, p < 0.001, one-way repeated measures analysis of variance.) This finding was confirmed by the Newman-Keuls post-hoc test, which also showed that the means for the preconception period and the three trimesters did not differ significantly between themselves. Nineteen (95%) of the 20 women who were abused in the first trimester were abused in the 3 months after delivery. Fourteen women (51.9%) obtained medical care for injuries from the postpartum abuse. The mean GHQ score was 7.7 (a score of 3 or more suggests psychiatric morbidity); from the psychiatric interview, 16 women (53.3%) were found to meet the diagnostic criteria for a major depressive episode, 9 (30.0%) had another psychiatric disorder, and 5 (16.7%) had no psychiatric disorder. CONCLUSIONS: A significant increase was found in the mean number of incidents of physical abuse per woman abused during the 3 months after delivery over the mean number of incidents per woman abused during each of the three other periods. Physicians should be alert to physical abuse in postpartum women and should make specific enquiries if there is a history of abuse, current injury or depression.

Adult↗
PubMed1994

Fatal injuries to restrained passenger car occupants in Canada: crash modes and kinematics of injury.

Passenger car collisions with other vehicles and with fixed objects were studied from a representative sample of fatal and injury-producing collisions collected according to a prescribed sampling plan. This paper describes our analysis of accidents involving restrained passenger car occupants who are fatally injured in collisions. Lateral collisions were found to be predominant, and both lateral and frontal collisions were associated with marked intrusion into the occupant compartment, causing direct, severe injuries to the head and chest of these occupants. Multiple severe injuries to more than one body region were common, and 90% of these victims died within one hour of the collision. The seat belt generally offered no protection to these fatally injured occupants. Reducing the incidence of fatal injury to properly restrained passenger car occupants will necessitate diminishing these very severe intrusion forces, especially from heavy trucks and fixed vertical hazards. For vehicle design modifications to be effective, it appears likely that roadway and roadside design and management must be included in the safety equation. Excessive speeds, inadequate traffic control, and unforgiving roadside hazards are playing a major role in the incidence of fatal injuries documented in this study.

Abbreviated Injury Scale↗
PubMed1994

Alcohol drinking in pregnancy.

Our study attempted to determine the prevalence of regular drinking during the second half of pregnancy among prenatal patients; the characteristics that differentiate drinkers from nondrinkers; and characteristics that differentiate prenatal patients who drink 7 or fewer standard drinks per week and those who drink more than 7. In our survey of consecutive English-speaking prenatal patients over 20 weeks' gestation, women self-reported on health habits from a study questionnaire and completed the General Health Questionnaire and Fetal Health Locus of Control. Eighty-three percent (466 of 561) of women provided data on alcohol intake during the second half of pregnancy: 106 (22.7%) reported regular weekly drinking in pregnancy, and the mean number of standard drinks was 1.97 (SD 9.78, range 0.5-184) per week. Thirty-eight (8.2%) women reported drinking more than seven standard drinks, and 14 (3.0%) reported more than 14 standard drinks per week. Women who drank more than seven standard drinks per week were significantly more likely to be under 21 years of age, poorly educated, unemployed, unmarried, to have unplanned pregnancies, emotional problems, eat unhealthy diets, smoke, use illicit drugs, and be physically abused. They also were more likely to meet psychiatric case status on the General Health Questionnaire (t = 3.85, p = 0.0001) and to believe that "chance" (t = 3.41, p = 0.001) rather than "internal control" (t = -3.54, p = 0.001) affected the health of their fetuses as measured by the Fetal Health Locus of Control. We concluded that pregnant women who drink alcohol often have other health risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗
PubMed1994

The effect of educational brochures on follow-up compliance in women with abnormal Papanicolaou smears.

OBJECTIVE: To determine whether women with abnormal Papanicolaou smears who received educational brochures at the initial booking for colposcopy were more likely to complete recommended treatment and follow-up after 18-24 months than were those who did not receive the brochures. METHODS: One hundred eight women participated in an earlier randomized study of the effect of educational brochures on emotional distress and knowledge about abnormal Papanicolaou smears. Their medical records were reviewed 18-24 months later for completed treatment and follow-up compliance. RESULTS: Women who received the brochure had more completed treatment and follow-up compliance (75.4%) than did those who did not receive the brochure (45.8%). The difference in compliance was 30% (99% confidence interval [CI] 6-54%, P = .002). There were no significant differences in age, education, marital status, or levels of emotional distress between subjects with complete and incomplete follow-up. Knowledge of the recommended number of follow-up visits was greater in women who completed follow-up (difference in frequency 30.4%; 99% CI 7-54%, P = .002). All women with completed treatment and follow-up who had received the brochure found it helpful. CONCLUSIONS: Given the high patient acceptability and demonstrated effectiveness in improving completed treatment and follow-up compliance, educational brochures should routinely accompany, or immediately follow, notification about abnormal Papanicolaou smears.

Adult↗
PubMed1994

Vulvodynia and psychological distress.

OBJECTIVE: To determine whether women with vulvodynia differ psychologically from women with other vulvar pathology and whether women with essential vulvodynia differ psychologically from women with vulvodynia in whom a cause has been identified. METHODS: Women attending a vulvar clinic were given a package consisting of the Brief Symptom Inventory, the Center for Epidemiologic Studies-Depression Scale, the Barsky Somatosensory Amplification Scale, the Whitely Index for hypochondriasis, and a study questionnaire. A gynecologist and dermatologist then took a careful history and performed a gynecologic examination, colposcopy, biopsies, and laboratory examinations. RESULTS: Vulvodynia patients (n = 50) were more symptomatic than women with other vulvar pathology (n = 32) on questions about interference with sexual function (mean difference 1.29, 95% confidence interval [CI] 0.36-2.23, P = .01) and number of doctor visits (mean difference 1.0, 95% CI 0.12-2.12, P = .03). Vulvodynia patients also scored higher than other vulvar patients on the Whitely Index (mean difference 0.45, 95% CI 0.04-0.86, P = .04) and on the Brief Symptom Inventory anxiety subscale (mean difference 0.31, 95% CI 0.09-0.51, P = .05) and somatization subscale (mean difference 0.29, 95% CI 0.10-0.46, P = .04). Women with essential vulvodynia (n = 32) were more anxious (mean difference 0.28, 95% CI 0.02-0.54, P = .02) and more suggestible (mean difference 0.62, 95% CI 0.48-1.72, P = .05) than women with vulvodynia with a physical cause (n = 18). CONCLUSIONS: Vulvodynia patients are more psychologically distressed than women with other vulvar pathology, and women with essential vulvodynia are more distressed than vulvodynia patients with an identified physical cause. Optimal management of vulvodynia patients should include attention to anxiety reduction, sexual function, normalization of every-day bodily sensations, reassurance about the absence of serious disease, and coordination of clinical care to ensure the maximum benefit from consultations.

Adult↗
PubMed1993

Physical abuse in pregnancy.

OBJECTIVES: To determine the prevalence of physical abuse during late pregnancy and to investigate how abused and nonabused pregnant women differ in demographic characteristics, health habits, psychologic distress and attitudes about fetal health. DESIGN: Survey of women attending for prenatal health care or admitted to hospital for delivery. The information was obtained on one occasion from self-report questionnaires, completed with the option of anonymity. SETTINGS: Community-based prenatal clinic, private obstetricians' offices in a large city, private family physicians' offices in a large city, family physicians' offices in a small town, and a university teaching hospital. PATIENTS: English-speaking women at 20 weeks' or more gestation attending or admitted consecutively. INTERVENTIONS: Three self-report questionnaires: the General Health Questionnaire (GHQ), the Fetal Health Locus of Control (FHLC) and the study questionnaire. RESULTS: Thirteen women (2.4%) refused to participate in the survey. Of the 548 women who completed the questionnaires 36 (6.6%) reported physical abuse during the current pregnancy and 60 (10.9%) before it. There were no significant differences in rates of abuse between settings. Of the women abused during the pregnancy 23 (63.9%) reported increased abuse during the pregnancy, and 28 (77.8%) remained with the abuser. Twenty-four pregnant women (66.7%) received medical treatment for abuse, but only 1 (2.8%) told her prenatal care provider of the abuse. Factor analysis revealed three factors associated with physical abuse in pregnancy: "social instability" (comprising low age, unmarried status, lower level of education, unemployment and unplanned pregnancy), "unhealthy lifestyle" (comprising poor diet, alcohol use, illicit drug use and emotional problems) and "physical health problems" (comprising health problems and prescription drug use). The GHQ scores showed that the abused women were significantly more emotionally distressed than the nonabused women (p < 0.001). The FHLC scores showed that the abused women believed they had little "internal control" over the health of their fetuses and that "chance" played the most important role in the outcome of their pregnancy (p < 0.001). CONCLUSIONS: Abused pregnant patients are a frequently undetected high-risk group. Prenatal care should include a routine screening question about domestic violence, and identified patients should be appropriately counselled and referred.

Adolescent↗
PubMed1993

Modeling the structure of Pyrococcus furiosus rubredoxin by homology to other X-ray structures.

The three-dimensional structure of rubredoxin from the hyperthermophilic archaebacterium, Pyrococcus furiosus, has been modeled from the X-ray crystal structures of three homologous proteins from Clostridium pasteurianum, Desulfovibrio gigas, and Desulfovibrio vulgaris. All three homology models are similar. When comparing the positions of all heavy atoms and essential hydrogen atoms to the recently solved crystal structure (Day, M. W., et al., 1992, Protein Sci. 1, 1494-1507) of the same protein, the homology model differ from the X-ray structure by 2.09 A root mean square (RMS). The X-ray and the zinc-substituted NMR structures (Blake, P. R., et al., 1992b, Protein Sci. 1, 1508-1521) show a similar level of difference (2.05 A RMS). On average, the homology models are closer to the X-ray structure than to the NMR structures (2.09 vs. 2.42 A RMS).

Amino Acid Sequence↗
PubMed1993

Investigations of the thermostability of rubredoxin models using molecular dynamics simulations.

The affects of differences in amino acid sequence on the temperature stability of the three-dimensional structure of the small beta-sheet protein, rubredoxin (Rd), was revealed when a set of homology models was subjected to molecular dynamics simulations at relatively high temperatures. Models of Rd from the hyperthermophile, Pyrococcus furiosus (Pf), an organism that grows optimally at 100 degrees C, were compared to three mesophilic Rds of known X-ray crystal structure. Simulations covering the limits of known Rd thermostabilities were carried out at temperatures of 300 K, 343 K, 373 K, and 413 K. They suggest that Rd stability is correlated with structural dynamics. Because the dynamic behavior of three Pf Rd models was consistently different from the dynamic behavior of the three mesophilic Rd structures, detailed analysis of the temperature-dependent dynamic behavior was carried out. The major differences between the models of the protein from the hyperthermophile and the others were: (1) an obvious temperature-dependent transition in the mesophilic structures not seen with the Pf Rd models, (2) consistent AMBER energy for the Pf Rd due to differences in nonbonded interaction terms, (3) less variation in the average conformations for the Pf Rd models with temperature, and (4) the presence of more extensive secondary structure for the Pf Rd models. These unsolvated dynamics simulations support a simple, general hypothesis to explain the hyperthermostability of Pf Rd. Its structure simplifies the conformational space to give a single minimum accessible over an extreme range of temperatures, whereas the mesophilic proteins sample a more complex conformational space with two or more minima over the same temperature range.

Computer Simulation↗
PubMed1993

Consultation-liaison psychiatry as a subspecialty. A Canadian survey.

In Canada, in recent years, there has been increased interest in the issue of subspecialization in psychiatry. One hundred and forty-four members of the Section on Psychosomatic Medicine of the Canadian Psychiatric Association responded to a survey about their opinions on teaching, training, continuing education, and designation of consultation-liaison (C-L) psychiatry as a subspecialty. Fifty-five percent of respondents agreed that C-L psychiatry should receive designation as a psychiatric subspecialty, 35% were opposed, and 10% did not give an opinion. The results also indicated that formal teaching in C-L psychiatry has increased, particularly over the past 20 years; that training in C-L psychiatry is believed by many to have been inadequate, regardless of when the training took place; and recent graduates were more likely than psychiatrists graduating more than 10 years ago to agree that C-L psychiatry should be designated as a subspecialty. Psychiatrists who devote more of their time to the care of patients with combined medical and psychiatric illness were also more likely to favor subspecialty designation. Factors unique to Canada that may influence attitudes toward psychiatric subspecialization include the number and geographic distribution of psychiatrists, their educational background, and governmental funding priorities.

Adult↗