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Biomedical subjects

L C Mayes

Publications and source records attributed to L C Mayes.

At least 19 recordsLinked to original sources
PubMed1996

Preoperative anxiety in children. Predictors and outcomes.

OBJECTIVE: To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery. DESIGN: A prospective, longitudinal study. SETTING: A university children's hospital. PARTICIPANTS: One hundred sixty-three children, 2 to 10 years of age (and their parents), who underwent general anesthesia and elective surgery. MAIN OUTCOME MEASURES: In the preoperative holding area, anxiety level of the child and parents was determined using self-reported and independent observational measures. At separation to the operating room, the anxiety level of the child and parents was rated again. Postoperative behavioral responses were evaluated 3 times (at 2 weeks, 6 months, and 1 year). RESULTS: A multiple regression model (R2 = 0.58, F = 6.4, P = .007) revealed that older children and children of anxious parents, who received low Emotionality, Activity, Sociability, and Impulsivity (EASI) ratings for activity, and with a history of poor-quality medical encounters demonstrated higher levels of anxiety in the preoperative holding area. A similar model (R2 = 0.42, F = 8.6, P = .001) revealed that children who received low EASI ratings for activity, with a previous hospitalization, who were not enrolled in day care, and who did not undergo premedication were more anxious at separation to the operating room. Overall, 54% of children exhibited some negative behavioral responses at the 2-week follow-up. Twenty percent of the children continued to demonstrate negative behavior changes at 6-month follow-up, and, in 7.3% of the children, these behaviors persisted at 1-year follow-up. Nightmares, separation anxiety, eating problems, and increased fear of physicians were the most common problems at 2-week follow-up. Multivariate analysis demonstrated that child's age, number of siblings, and immediate preoperative anxiety of the child and mother predicted later behavioral problems. CONCLUSIONS: Variables such as situational anxiety of the mother, temperament of the child, age of the child, and quality of previous medical encounters predict a child's preoperative anxiety. Although immediate negative behavioral responses develop in a relatively large number of young children following surgery, the magnitude of these changes is limited, and long-term maladaptive behavioral responses develop in only a small minority.

Age Distribution↗
PubMed1996

Israeli preschoolers under Scud missile attacks. A developmental perspective on risk-modifying factors.

BACKGROUND: The devastating effects of traumatic events on children are modulated by risk and protective factors. This study examines the differential effects of traumatic displacement of preschool children and their families following Scud missile attacks on Israel during the Persian Gulf War. METHODS: Three groups participated in the study: families displaced after their houses were damaged, undisplaced families from the same neighborhood (without home damage), and families from a distant city that was threatened but not directly attacked. Data concerning the traumatic event, the child (personality, internalizing, externalizing, and stress symptoms), the mother (Symptom Checklist-90-Revised), and the family (Family Adaptability and Cohesion Evaluation Scales) were gathered 6 months after the end of the war. RESULTS: Displaced children and mothers showed higher externalizing and stress symptom levels compared with undisplaced and threatened subjects. Destruction of the house and displacement, but not mere distance from the missile impact, explained symptomatic behavior. Inadequate family cohesion predicted symptomatic reaction for 3- and 4-year-old children but not for older ones. CONCLUSION: Both human and nonhuman factors contribute to the preschool child's adaptive mechanisms that regulate environmental stressful stimuli. These risk-modifying factors become more autonomous of caretakers with increasing age.

Adaptation, Psychological↗
PubMed1996

Preoperative preparation in children: a cross-sectional study.

STUDY OBJECTIVE: To evaluate the effectiveness of a behavioral preparation program on reducing anxiety in children and their parents prior to elective surgery. DESIGN: Cross-sectional study. SETTING: A children's hospital. PATIENTS: 143 children undergoing outpatient surgery, and their parents. INTERVENTIONS: A behavioral preoperative preparation program. MEASUREMENTS AND RESULTS: Overall anxiety in children and their parents did not differ significantly between the group that received the preoperative program and the group that did not (p = NS). Children older than 6 years were least anxious on separation from their parents if they participated in the preparation program more than 5 to 7 days prior to surgery, moderately anxious if they did not receive preparation, and most anxious if they received the preparation 1 day prior to surgery (P = 0.04). Multivariable regression analysis (for overall model, F = 2.14, p = 0.02) revealed that although the preparation program itself was not a predictor of a child's behavior on separation to the operating room, the interaction between child's age and timing of the program (p = 0.003), and child's previous hospitalization were predictors of children's anxiety response. Similarly, in the preoperative holding area, independent predictors of anxiety included timing of the preparation program, age of child, and the child's baseline temperament characteristics. CONCLUSIONS: The results highlight the complexities in assuming that a behavior-based preoperative preparation program is effective for all pediatric outpatients. The effects of such an intervention vary with the child's age, the timing of the intervention, and a history of previous hospitalization.

Ambulatory Surgical Procedures↗
PubMed1996

Parental presence during induction of anesthesia. A randomized controlled trial.

BACKGROUND: To determine whether parental presence during induction of anesthesia is an effective preoperative behavioral intervention, a randomized controlled trial with children undergoing outpatient surgery was conducted. METHODS: Eighty-four children were randomly assigned to a parent-present or parent-absent group. Using multiple behavioral and physiologic measures of anxiety, the effect of the intervention on the children and their parents was assessed. Predictors for the response to the intervention were examined using multivariate linear regression analysis. RESULTS: When the intervention group (parent-present) was compared to the control group (parent-absent), overall there were no significant differences in any of the behavioral or physiologic measures of anxiety tested during induction of anesthesia. Using the child's serum cortisol concentration as the outcome, parental presence, the child's age and baseline temperament, and trait anxiety of the parent, were identified as predictors of the child's anxiety during induction. Analysis of variance demonstrated that three groups showed diminished cortisol concentrations with parental presence: children older than 4 yr (P = 0.001), children whose parent had a low trait anxiety (P = 0.02), and children who had a low baseline level of activity as assessed by temperament (P = 0.05). CONCLUSIONS: Children who were older than 4 yr or those with a parent with a low trait anxiety or who had a low baseline level of activity/temperament benefited from parental presence during induction.

Anesthesia↗
PubMed1996

Cocaine-abusing parturients undergoing cesarean section. A cohort study.

BACKGROUND: Cocaine use in the United States is prevalent among pregnant women from inner city neighborhoods. To determine the anesthetic implications of cocaine use in parturients undergoing cesarean section delivery, the authors conducted a cohort study. METHODS: One thousand nine hundred seven women presenting for prenatal care were interviewed regarding substance abuse. Urine was analyzed for benzoylecgonine, tetrahydracannabinol, benzodiazepines, and opioids. Next all parturients who underwent cesarean section delivery were identified and their records reviewed for anesthetic and obstetric outcomes. RESULTS: Among the 51 women who were classified as cocaine abusers, the most frequent reasons for cesarean section were fetal distress (48%) and abruptio placenta (21%). In a multivariate model, cocaine abuse before delivery was shown to be an independent predictor of preoperative diastolic hypertension (F = 10.6, P = 0.01). Similarly, univariate analysis showed that immediately after intubation, diastolic blood pressure was significantly higher among parturients who used cocaine (99 +/- 13 mmHg v. 87 +/- 18 mmHg; P = 0.02). In contrast, epidural anesthesia was associated with hypotension significantly more often among cocaine-abusing parturients (44% vs. 10%; P = 0.04). A higher rate of perioperative wheezing was reported among patients who abused cocaine (16% vs. 6%; relative risk = 2.7); this finding, however, did not persist in multivariate analysis. Operative blood loss was similar in all groups (P = NS), and no ventricular dysrhythmias or cerebrovascular or coronary ischemic episodes were reported in any of the parturients. CONCLUSIONS: Although cocaine-abusing parturients are at higher risk for interim peripartum events such as hypertension, hypotension, and wheezing episodes, there is no significant increase in rates of maternal morbidity or death.

Adult↗
PubMed1996

Parental presence during induction of anaesthesia: practice differences between the United States and Great Britain.

A questionnaire was sent to 1353 paediatric anaesthetists in Great Britain and the United States. Nineteen questions were asked about attitudes toward parental presence during induction of anaesthesia and the prevalence of such practice. Overall, respondents from Great Britain support parental presence more than the United States respondents. For example, 82% of the Great Britain respondents, vs 64% of the United States respondents thought that parental presence during induction decreases the anxiety (P = 0.001) and increases the cooperation of the child (P = 0.001). Most United States respondents (58%) allow parental presence in less than 5% of their cases, but most Great Britain respondents (84%) allow parental presence in more than 75% of their cases. We conclude that in contrast to the respondents from Great Britain, the majority of the United States sample does not feel that parental presence is useful and so does not routinely use this technique in their practice.

Adult↗
PubMed1996

Test-retest reliability for false-belief tasks.

Despite notable variations in children's rate of success on theory of mind tasks and the presumed theoretical implications drawn from a child's success or failure on such tasks, there have been no studies of the test-retest reliability of children's performance on these tasks. Twenty-three children (mean age 49.6 months, SD 8.6) watched three videotaped stories illustrating a false-belief situation: the standard experimenter narrated false-belief task, a minor variant replacing the narration of the story with a dialogue among the characters, and a third version involving a humorous situation. The time elapsed between test and retest was 2-3 weeks and the order of presentation was counterbalanced. Results corroborated previous findings of a developmental trend in the understanding of false-belief questions but, despite a general improvement in children's comprehension of the stories, the test-retest reliability for the false belief questions was poor. Although changes recorded between test-retest sessions frequently occurred in the direction of children answering correctly questions they had previously failed, a subset of children incorrectly answered questions they had initially passed. These findings underscore the need for validation assessments of techniques for studying children's developing theories of mind.

Child↗
PubMed1996

Children's developing theory of mind.

Studies from the developmental research perspective inform analytic understanding of the neuropsychological preconditions necessary for children's increasing awareness of their own and others' mental lives. Conversely, psychoanalytically informed observations of children's early development demonstrate how the child's emerging understanding of other minds is contextualized in the earliest interactions between parent and child. The notion of a gradually developing understanding of mind that becomes most evident in observational studies between 4 and 6 years of age provides a developmental context for considering children's capacity for internalization, their creation of an inner, psychic reality, and their response to therapeutic interventions during an analytic hour. Significant for psychoanalytic work with children is the suggestion that only after children are able to understand how their own and other's mental states are constructed and how such states are behind all actions and language can they then reflect upon their own thoughts and mental life. Developing a theory of the mind of the other integrates psychoanalytic notions of self-other differentiation, of the development of internalized representations of others, and ultimately of the capacity for self-reflection.

Child, Preschool↗
PubMed1996

Neonatal withdrawal syndrome in infants exposed to cocaine and methadone.

The effect of concomitant cocaine and methadone use on the neonatal withdrawal syndrome was examined in a group of 68 infants born to mothers participating in a methadone maintenance program. Fifty-three (78%) of the mothers in the sample reported regular use of cocaine during their pregnancy and/or had positive urine screens. Infants exposed to both cocaine and methadone had significantly higher first withdrawal scores. However, cocaine exposed infants did not require more medication for withdrawal management either in terms of dosage or of days treated. Additionally, there was no difference in the occurrence of intrauterine growth retardation, prematurity, or early perinatal complications such as respiratory distress.

Cocaine↗
PubMed1995

Thrombocytopenia in pregnant women who use cocaine.

OBJECTIVE: Our purpose was to determine the prevalence of cocaine-associated thrombocytopenia. STUDY DESIGN: This cohort study was conducted in an inner-city prenatal center. A total of 1907 patients were screened by the Mother's Project, which is an intervention project for inner-city cocaine-abusing parturients. Platelet counts were grouped by illicit drug usage. RESULTS: Platelet counts were available in 37% (709) of subjects; there were no differences between subjects with available platelet counts and those without on illicit drug use or other demographic measures. Five groups were defined: drug-free group (n = 331), cocaine group (n = 104), cocaine and opiates group (n = 11), opiates group (n = 18), and other-drug group (n = 236). Nineteen subjects had a low platelet count (< 150 x 10(9)/L). The medical records of all subjects with a low platelet count were reviewed for any medical condition known to be associated with thrombocytopenia, and two subjects were excluded. The rate of thrombocytopenia in the drug-free group was 1.5%, whereas the rate in the cocaine group was 6.7% (relative risk 4.4, p < 0.05). Because of the reported association of thrombocytopenia with seropositive human immunodeficiency virus status, seropositive women were excluded from the analysis. Even after human immunodeficiency virus status adjustments for the estimated rate, the cocaine-using group continued to have a significantly higher rate of thrombocytopenia (5.4% to 7.2% vs 1.23% to 1.26%, p < 0.05 to p < 0.005). CONCLUSIONS: These results indicate that cocaine use is an independent risk factor for thrombocytopenia in an inner-city parturient population.

Adult↗
PubMed1995

Information processing and developmental assessments in 3-month-old infants exposed prenatally to cocaine.

OBJECTIVE: To determine the effect of prenatal cocaine exposure on 3-month infant information processing and developmental assessments. METHODS: One hundred and eight infants, 61 cocaine-exposed and 47 controls, participated at 3 months of age in an infant-control habituation and novelty responsiveness procedure and in a developmental assessment using the Bayley Scales of Infant Development both administered by experimenters blind to the drug exposure status of the infant. RESULTS: Compared to the non-drug-exposed group, infants exposed prenatally to cocaine were significantly more likely to fail to start the habituation procedure and, for those who did, significantly more likely to react with irritability early in the procedure. The majority of infants in both groups reached the habituation criterion, and among those who did there were no significant differences between cocaine and non-cocaine-exposed infants in habituation or in recovery to a novel stimulus. Infants who were cocaine-exposed showed comparatively depressed performance on the motor (Psychomotor Developmental Index) but not the mental (Mental Developmental Index (MDI)) scales of the Bayley. These results obtained for habituation and Bayley MDI controlling for both perinatal and sociodemographic factors. CONCLUSIONS: Differences in reactivity to novelty but not in information processing between cocaine-exposed and non-cocaine-exposed infants suggest that the effects of prenatal cocaine exposure may be on arousal and attention regulation rather than early cognitive processes.

Adult↗
PubMed1994

Understanding adaptive processes in a developmental context. A reappraisal of Hartmann's problem of adaptation.

Hartmann's theory of adaptation introduced the metapsychology of ego as an agent of adaptation to external reality as well as a defense against internal conflict. His notions of autonomous ego functions serving adaptation and of the child's biological preparedness for adaptation made a significant contribution to psychoanalytic developmental theory. However, the study of children developing in the midst of environmental discord and violence who enter such environments with or without an adequate endowment encourages a reappraisal of three issues in Hartmann's view of adaptation: (1) the developmental vicissitudes of adaptation, (2) the notion of an average expectable environment; and (3) the distinction between adaptation as state and as process. These issues are reviewed to outline factors that may preserve and foster adaptation for children in the face of adversity and chronic trauma. It is suggested that adaptation is better understood as the individual's reaching a relative state of autonomy vis-à-vis deviations from average expectable endowment, experience, or environment and as one that occurs not in spite of but in the context of adversity.

Adaptation, Psychological↗
PubMed1994

Monitoring the analytic surface.

How do we listen during an analytic hour? Systematic analysis of the speech patterns of one patient (Mrs. C.) strongly suggests that the clustering of shared pronouns (e.g., you/me) represents an important aspect of the analytic surface, preconsciously sensed by the analyst and used by him to determine when to intervene. Sensitivity to these patterns increases over the course of treatment, and in a final block of 10 hours shows a striking degree of contingent responsivity: specific utterances by the patient are consistently echoed by the analyst's interventions.

Association↗
PubMed1994

Experiencing self and others: contributions from studies of autism to the psychoanalytic theory of social development.

Psychoanalysts have long been interested in autism as a disorder in which the development of a sense of self and other is altered dramatically. This paper outlines how our psychoanalytic understanding of the process of emergence and maintenance of the self and of inner world may be informed by recent findings from developmental psychology about how normal and autistic children develop the capacity to attribute mental states such as desires, feelings, and beliefs to others. Because autistic individuals frequently fail to develop an understanding of the relation between feelings or beliefs and the behaviors of themselves or others, studies of autism provide a clinical model for how these neurocognitively based functions, related to acquiring a so-called theory of mind, are involved in the elaboration of an inner world and in the ongoing definition of self. Understanding how both autistic and normal children develop, or fail to develop, the capacity to attribute meaning to others' actions, beliefs, and feelings speaks to psychoanalytic notions of internalization, identification, and introjection and provides a neurocognitive frame for how representations of self and others are created in the inner world. Conversely, the psychoanalytic view that the infant's emerging sense of self is also shaped by the infant's desire for mother underscores that affective precursors are absolutely necessary for a theory of mind to emerge.

Autistic Disorder↗
PubMed1994

Understanding therapeutic action in the analytic situation: a second look at the developmental metaphor.

A root metaphor for the psychoanalytic therapeutic process is the mother-infant caretaking relationship. This developmental metaphor has assumed a dominant role for some analysts in how the psychoanalytic process and therapeutic relationship are conceptualized. In this paper, a distinction is made between two uses of the developmental metaphor--naïve and informed. The naïve view as commonly applied constrains our view of the unique relationship between analyst and analysand. The informed view takes into account current research in early social development that has emerged in the last decade of empirical studies with infants, young children, and their parents. While the parent-child relationship may be an inexact model for the analytic connection, some of the implications of the former, as they become more clearly understood in the course of careful research, may provide useful information about how change does or does not occur as a result of the analytic process, and how an analytic process needs to be in place in the analysand before that change can occur.

Child Development↗
PubMed1993

Playing and therapeutic action in child analysis.

From its inception, child psychoanalysis has used fantasy play as a window to both the content and process of children's inner worlds. Because of the link to action and primary process, young children's imaginary play is rich in symbolic expressions that facilitate analytic interpretive interventions addressing the conflicts impeding development. There are inevitable tensions between allowing play to emerge as a therapeutic process in its own right and the usual psychoanalytic emphasis on clarification, verbalisation and, above all, interpretation within and about the transference. For many children, the very act of playing carries much of the therapeutic work aimed toward facilitating their return to developmentally appropriate and adaptive psychic functioning. The mobilisation of capacities for play in the analysis allows children to do what is needed for their development to continue and makes use of the developmentally restorative functions of play in the service of therapeutic action.

Adolescent↗