Camping Programs for Children with Chronic Illness as a Modality for Recreation, Treatment, and Evaluation: An Example of a Mission-Based Program Evaluation of a Diabetes Camp

KidsTUMove-A Holistic Program for Children with Chronic Diseases, Increasing Physical Activity and Mental Health

The prevalence of chronic diseases in children and adolescents has risen alarmingly worldwide. Diseases such as asthma, diabetes, obesity, mental disorders, and congenital heart defects are increasingly affecting the lives of children and pose significant challenges for the healthcare system. Physical activity plays a crucial role in preventing and treating these diseases. Numerous studies have shown that regular exercise improves physical performance, increases well-being, and leads to better health in the long term. Specially tailored sports programs that meet the individual needs and abilities of the children and adolescents affected are particularly important. The KidsTUMove project addresses this by developing tailored exercise programs for children with chronic diseases' specific needs, medical conditions, and physical abilities. Therefore, it closes the gap in care provision and can thus sustainably improve the health prospects of these children and adolescents. KidsTUMove is positioned to make a significant impact on the lives of affected children across Europe. Promotion of such programs should therefore be an integral part of future health strategies.

A centennial review of discoveries and advances in diabetes: Children and youth

Diabetes is an increasingly common chronic metabolic disorder in children worldwide. The discovery of insulin in 1921 resulted in unprecedented advancements that improved the lives of children and youth with diabetes. The purpose of this article is to review the history of diabetes in children and youth over the last century and its implications for future developments in the field. We identified 68 relevant events between 1921 and 2021 through literature review and survey of pediatric endocrinologists. Basic research milestones led to the discovery of insulin and other regulatory hormones, established the normal physiology of carbohydrate metabolism and pathophysiology of diabetes, and provided insight into strategies for diabetes prevention. While landmark clinical studies were initially focused on adult diabetes populations, later studies assessed etiologic factors in birth cohort studies, evaluated technology use among children with diabetes, and investigated pharmacologic management of youth type 2 diabetes. Technological innovations culminated in the introduction of continuous glucose monitoring that enabled semi-automated insulin delivery systems. Finally, professional organizations collaborated with patient groups to advocate for the needs of children with diabetes and their families. Together, these advances transformed type 1 diabetes from a terminal illness to a manageable disease with near-normal life expectancy and increased our knowledge of type 2 diabetes and other forms of diabetes in the pediatric population. However, disparities in access to insulin, diabetes technology, education, and care support remain and disproportionately impact minority youth and communities with less resources. The overarching goal of diabetes management remains promoting a high quality of life and improving glycemic management without undermining the psychological health of children and youth living with diabetes.

Stress and Coping in Youth With Spina Bifida: A Brief Longitudinal Study in a Summer Camp Setting

Introduction

It is well established that youth with chronic conditions experience elevated levels of stress; the manner in which they respond to or cope with this stress is likely to impact both health and psychosocial outcomes. The current study examined stress and coping in youth and young adults with spina bifida (SB) using the response to stress questionnaire-SB version (RSQ-SB; Connor-Smith et al., 2000).

Methods

Data were collected as part of a camp-based psychosocial intervention for children (ages 7–13), adolescents (ages 14–19), and young adults (ages 20–38) with SB. Participants completed the RSQ-SB as well as questionnaires assessing demographics and condition severity. Data were collected prior to camp (T1) and 1 month (T2) after camp ended. Self-report data were collected from adolescents and young adults; parents of children and adolescents reported on their child’s stress and coping. Ratios of primary control coping, secondary control coping, disengagement coping, involuntary engagement, and involuntary disengagement coping were calculated. Descriptive statistics and t-tests were utilized to describe coping and stress responses and to determine potential change over time. T-tests were also used to compare youth and parent reported coping styles with those of youth with type 1 diabetes (T1D) and sickle cell disease (SCD). Associations between demographic/disease factors and coping styles were also examined.

Results

Parent and youth report indicated that youth with SB tend to use primary control coping. Youth with SB use more primary control coping and less disengagement coping compared to youth with SCD and youth with T1D. Few significant changes in coping were found between T1 and T2. IQ and socioeconomic status were significantly associated with coping styles.

Conclusion

Youth with SB use more primary control coping compared to other coping methods and as compared to other pediatric populations. Future studies should examine mechanisms by which primary control coping is advantageous for youth with SB. Future interventions should be more focused on promoting adaptive coping behaviors and be tailored to developmental age and access to resources.

Psychological Outcomes in Children and Early Adolescents With Type 1 Diabetes Following Pediatric Diabetes Summer Camp: A 3-Month Follow-Up Study

Objective: The aim of this study was to assess general psychosocial adjustment to diabetes and perceived disease management among patients with type 1 diabetes (T1D) and their parents before and after patients' participation in a diabetes summer camp. Methods: In this follow-up study, 20 children and adolescents with T1D (eight boys; mean age = 11.01 ± 0.94 years; mean diabetes duration = 3.02 ± 2.27) attending a southern Italian diabetic center, along with their parents, were assessed prior to and 3 months after the youths participated in a 1 week camp-based intervention involving didactic and interactive child-centered education and recreational activities. Patients and their parents completed measures assessing patients' quality of life and strategies employed by patients to cope with pain. Patients also completed measures evaluating their diabetes psychosocial adjustment, diabetes self-efficacy management, and illness perception; also, their parents completed measures of caregivers' perceived diabetes burden and treatment satisfaction. Youths' glycated hemoglobin (HbA1c) and standardized body mass index (z-BMI) values were also assessed. Within-subjects repeated-measures analyses of variance evaluated pre- and post-camp changes. Results: Camp attendance showed no beneficial effects on glycemic control, as indicated by HbA1c values both before (7.02%) and after (7.28%) camp being lower than 7.5%. HbA1c values were found to have increased after camp (pre-camp = 7.02%, post-camp = 7.28%; p = 0.010), but since they still fell within an acceptable range, they did not reveal clinically relevant changes in glycemic control. No substantial significant improvement in psychosocial measures was observed in children or parents (all p > 0.05). According to the parents' evaluation, social support-seeking as a patient pain-coping strategy was slightly increased (p = 0.044) after attending the camp. Conclusions: This study does not provide empirical evidence of benefits of participating in a diabetes camp for either patients or their parents. These findings suggest that healthcare providers rethink such camps as an experience for youths with T1D that actively involves parents and that includes both youth- and parent-focused psychological interventions.

Pediatric medical psychology

Paediatric medical psychology is a specialised field within clinical health psychology focussed on the behavioural, developmental, and psychological needs of children, adolescents, and families in healthcare contexts. Paediatric medical psychologists address a myriad of problems by employing evidence-based evaluations and interventions in order to support the well-being of paediatric patients and their families. In this paper, we provide an overview of paediatric medical psychology including the education and training required to be a paediatric psychologist followed by common problems addressed by paediatric psychology, the settings paediatric psychologists work in, and the services they provide. Discussion concludes with future application of integrating paediatric psychology throughout the continuum of care to optimise adjustment and health of paediatric patients.

Effectiveness and safety of flexible therapeutic schemes including first- and secondgeneration basal insulins during a pediatric summer diabetes camp

Outcomes of insulin analogues in pediatric diabetes camps are poorly investigated; no data is available about insulin degludec (IDeg).Our aim was to assess impact of insulin therapy adopted by the participants to a 4-day diabetes camp held in 2017, hypothesizing a possible excess risk of hypoglycemia in patients treated with IDeg. Overall, 40 children with type 1 diabetes (mean age 13.4±3.0 years; 62.5% males) attended the camp (20.0% on continuous subcutaneous insulin infusion and 80.0% on multiple daily injections - MDI). Among children in MDI regimen, 71.9% were treated with IDeg as basal insulin and 28.1% with glargine U100 (IGlar). All patients used Lispro or Aspart as short-acting insulin. Daily plan of the camp included educational sessions, physical exercise, 3 main meals and 2 snacks. At the arrival, IGlar and short-acting insulin doses were revised according to existing guidelines, while IDeg dose was revised based on an empirical individualized approach. At the arrival, insulin doses were reduced in 22 participants (-19.4±10.5%), while doses were increased in 17 children (+17.8±12.7%), based on individual needs. No statistically significant between-group difference emerged in mean blood glucose and glucose variability. No excess risk of hypoglycemia was found in the IDeg group. The study suggests similar effectiveness and safety of different insulin schemes when associated with appropriate diabetes education and management, and flexible dose adjustments. Despite its longer halflife and the lack of a validated algorithm, IDeg was not associated with an excess risk of hypoglycemia.

Improvements in Hope and Beliefs about Illness Following a Summer Camp for Youth with Chronic Illnesses

This study evaluated changes in hope, attitude toward illness, and perceptions of illness benefit and burden following participation in a summer camp designed for youth with a variety of chronic illnesses. Participants were 62 youth campers (Age M = 13.45 years, SD = 2.41) with a variety of chronic illnesses. For youth who began camp low in hope about future goal attainment, participation in optional camp activities negatively predicted post-camp hope about future goal attainment. This relation was nonsignificant for campers who began camp high in hope. We found no significant changes in attitude toward illness or perceptions of illness benefit or burden. This study provides an important contribution to burgeoning research on summer camps designed for children with varying chronic illnesses. Findings were inconsistent with previous studies on chronic illness summer camp outcomes. Further work is needed to identify camp components that are related to desirable psychosocial outcomes for youth with chronic illnesses.

Diabetes Camp Counselors: An Exploration of Counselor Characteristics and Quality of Life Outcomes

Purpose The purpose of this study is to investigate the effect of volunteering at a diabetes camp on emerging adults with and without type 1 diabetes mellitus (T1DM). Methods Thirty counselors with and 22 without T1DM (19.07 ± 2.71 years old) volunteered at a 1-week T1DM camp in the northeastern United States. Counselors with T1DM had a range of self-reported A1C scores (5.8% or 39.9 mmol/mol to 14.0% or 129.5 mmol/mol). Self-report measures of quality of life, hope, and well-being were completed pre- and postcamp at 4 time points: 1 month before camp, arrival at camp, final day of camp, and 2 months postcamp. Open-ended questions regarding counselor experiences were analyzed to understand camp effect. Results There were significant differences between counselors' levels of trait hope in comparison to published norms. There were few clear differences in psychosocial outcomes pre- and postcamp; however, some increases in well-being were revealed in anticipation of camp. Major reasons for volunteering included assisting others and reciprocating or continuing a perceived positive experience as a camper. Conclusion No changes in psychosocial outcomes pre- to postcamp were observed. However, measures used in this study may be poorly defined for a counselor population. Further research on the characteristics of emerging adults who choose to be camp counselors is needed. By understanding the demographics of this population, health professionals can help target individuals to become camp counselors as well as enhance the camp experience to fit their developmental needs.

Camp for Youth With Type 1 Diabetes

Camps for youth with type 1 diabetes (T1D) have grown in size and scope since they first emerged in the 1920s. Anecdotal evidence suggests that attending camp with other youth with T1D is beneficial, largely attributed to sharing fun, active experiences and removing the isolation of living with diabetes. However, few studies have evaluated the psychosocial and medical impacts of T1D camp attendance during and after camp sessions. In addition, T1D camps have been a setting for numerous studies on a variety of T1D-related research questions not related to camp itself, such as testing novel diabetes management technologies in an active, non-laboratory setting. This paper reviews the evidence of psychosocial and medical outcomes associated with T1D camp attendance across the globe, provides an overview of other research conducted at camp, and offers recommendations for future research conducted at T1D camp.

Are diabetes camps effective?

In the present article data about Diabetes Camps (DC) from all continents were reviewed in order to answer the title question "are diabetes camps effective?". Articles from peer reviewed journals and abstracts published in international conferences proceedings were raised. The effectiveness was considered in terms of knowledge acquisition, and psychosocial and physiological changes. Even though expected improvements were not found in all studies, in a deeper and wider analysis the aspects that influence the most toward gains are identified. Among them are: number of participations in a DC, post-camp educational opportunities, staff training, and program oriented toward campers' autonomy. To conclude, practical recommendations are addressed intending to amplify DC's potential.

The psychological and social impact of camp for children with chronic illnesses: a systematic review update

Advances in medicine have reduced mortality among children with complex medical conditions, resulting in a growing number of young patients living with chronic illnesses. Despite an improved prognosis, these children experience significant psychosocial morbidity, such as depression and anxiety. Therapeutic summer recreation camps have been proposed as an intervention to enhance quality of life among these children. The purpose of this systematic review was to assess the psychosocial impact of camp for children with chronic illnesses. A systematic review of central databases was undertaken using key words, and a rating tool – the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies – was employed to rate methodological quality. 21 studies were included in this systematic review. Although overall methodological quality was weak, camp participation appeared to offer short-term psychosocial benefits on some parameters in children with a variety of chronic illnesses. There was some consistency in improved social outcomes, such as social interaction and acceptance. Based on the available evidence, it is premature to make robust claims regarding the psychosocial impact of camp as a therapeutic intervention. Theoretically informed camp programs, long-term follow-up, and incorporating camp-based messaging into routine hospital care,may enhance the utility of camp as a potential psychosocial intervention in paediatrics.

Positive youth development programs for adolescents with greater psychosocial needs: subjective outcome evaluation over 3 years

STUDY OBJECTIVES

This study examined the views of 153,761 students participating in a positive youth development program designed for participants with greater psychosocial needs (the Tier 2 Program) in the context of the Project P.A.T.H.S. in Hong Kong. The program was implemented in the extension phase of the project from 2009/10 to 2011/12 school years.

DESIGN

A validated subjective outcome evaluation scale was used to assess the views of the program participants toward the program qualities, implementer qualities, and program effectiveness after completion of the program. Nine datasets were used which were derived from the aggregated reports submitted by social service providers designing the Tier 2 Program.

RESULTS

Participants generally held favorable views of program qualities, implementer qualities, as well as program effectiveness of the Tier 2 Program. Some small grade and program differences on subjective outcome evaluation were also found. Both program qualities and implementer qualities were significant predictors of program effectiveness in different grades.

CONCLUSION

Consistent with the findings of the initial phase of the Project P.A.T.H.S., the present study suggests that the Tier 2 Program of the Project P.A.T.H.S. in Hong Kong is perceived favorably by program participants and its perceived effectiveness was high. Significant but small grade and program approach differences on subjective outcome evaluation were found. Both program and implementer qualities were predictive of perceived program effectiveness in different grades.

Exercise capacity, quality of life, and resilience after repair of tetralogy of Fallot: a cross-sectional study of patients operated between 1964 and 2009

INTRODUCTION

Patients with repaired tetralogy of Fallot have good long-term survival but less is known about the subjectively assessed quality of life or objectively measured functional status of those who have not required subsequent pulmonary valve replacement. We assessed these parameters in a group of children and adults free from pulmonary valve replacement after tetralogy of Fallot repair.

METHODS AND RESULTS

A random sample of 50 subjects--16 children and 34 adults, aged 4.1-56.7 years---who had undergone tetralogy of Fallot repair and were free from subsequent pulmonary valve replacement underwent cardiopulmonary exercise testing and completed standardised questionnaires assessing health-related quality of life and resilience. Patients were generally asymptomatic (median New York Heart Association class = I). Exercise capacity was within two standard deviations of normal for most children and adults (mean z VO2max: 0.20 ± 1.5; mean z VE/VCO2: -0.9 ± 1.3). Children reported a total health-related quality of life score similar to healthy norms (78 ± 10 versus 84 ± 1, p = 0.73). Adult survivors also reported quality of life scores comparable to healthy norms. Resilience was highly correlated with all domains of health-related quality of life (r = 0.713, p < 0.0001).

CONCLUSIONS

Patients who have undergone tetralogy of Fallot repair in childhood and have not required pulmonary valve replacement have a good long-term health-related quality of life. The finding that patients with greater resilience had better health-related quality of life suggests that it may be beneficial to implement interventions to foster resilience.

Effective peer-to-peer support for young people with end-stage renal disease: a mixed methods evaluation of Camp COOL

BACKGROUND

The Camp COOL programme aims to help young Dutch people with end-stage renal disease (ESRD) develop self-management skills. Fellow patients already treated in adult care (hereafter referred to as 'buddies') organise the day-to-day program, run the camp, counsel the attendees, and also participate in the activities. The attendees are young people who still have to transfer to adult care. This study aimed to explore the effects of this specific form of peer-to-peer support on the self-management of young people (16-25 years) with ESRD who participated in Camp COOL (CC) (hereafter referred to as 'participants').

METHODS

A mixed methods research design was employed. Semi-structured interviews (n = 19) with initiators/staff, participants, and healthcare professionals were conducted. These were combined with retrospective and pre-post surveys among participants (n = 62), and observations during two camp weeks.

RESULTS

Self-reported effects of participants were: increased self-confidence, more disease-related knowledge, feeling capable of being more responsible and open towards others, and daring to stand up for yourself. According to participants, being a buddy or having one positively affected them. Self-efficacy of attendees and independence of buddies increased, while attendees' sense of social inclusion decreased (measured as domains of health-related quality of life). The buddy role was a pro-active combination of being supervisor, advisor, and leader.

CONCLUSIONS

Camp COOL allowed young people to support each other in adjusting to everyday life with ESRD. Participating in the camp positively influenced self-management in this group. Peer-to-peer support through buddies was much appreciated. Support from young adults was not only beneficial for adolescent attendees, but also for young adult buddies. Paediatric nephrologists are encouraged to refer patients to CC and to facilitate such initiatives. Together with nephrologists in adult care, they could take on a role in selecting buddies.

A Review of Diabetes Mellitus–Specific Family Assessment Instruments

Family dynamics and attributes are increasingly recognized as affecting management of diabetes mellitus (DM); however, little research has been done on the validity and usefulness of family assessment instruments (FAIs). This article reviewed the literature that employs DM-specific FAIs and evaluates whether the instruments comprehensively captured family attributes/processes and were robust enough to be useful in understanding the relationship between family attributes/issues and DM-related health care. Studies using eight instruments were identified through a search of literature published from 1982 to 2010 and were analyzed with criteria derived from the measurement and family literatures. The findings of this study revealed that DM-specific FAIs yield useful data about family-related phenomenon; however, some domains of DM-specific care, such as family dynamics/functioning, were not overtly measured. Suggestions for improving DM-specific FAIs are provided and a rationale for why DM-specific and non-DM-specific FAIs is needed to fully measure family issues related to family dynamics/attributes on DM patient care.

Insulin dose changes in children attending a residential diabetes camp

AIMS

  To examine the effects of insulin dose adjustments on rates of hypoglycaemia for school-aged children with Type 1 diabetes attending camp.

METHODS

  Camp records for 256 children aged 7-15 years (55% on continuous subcutaneous insulin infusion) attending a week-long residential summer camp were analysed.

RESULTS

  In anticipation of increased physical activity, basal insulin was decreased for all children on continuous subcutaneous insulin infusion and injection therapy by 10% upon arrival at camp. During the first day, children on continuous subcutaneous insulin infusion received 11.1±6.3% less basal insulin than home doses, whereas children on injections decreased intermediate/long-acting insulin by 8.2±12.8%. Despite these decreases, 60% had at least one blood sugar level <70 mg/dl (3.9 mmol/l) during the first day. Children on continuous subcutaneous insulin infusion were more likely to have hypoglycaemia during the first day than those on injections. The number of episodes of hypoglycaemia increased with increasing camper age. Overall, children did not have further significant reductions in their total daily insulin dose by the last day of camp. However, on the last day, children had fewer episodes of hypoglycaemia than during the first day (0.7±0.9 vs. 1.1±1.2, P<0.001) and 51% had no low blood sugar levels that day.

CONCLUSIONS

  An empiric 10% reduction in basal insulin appears reasonable, as nearly equal numbers of children required dose increases as dose decreases as camp progressed. However, hypoglycaemia was still common in all age groups. Prospective studies characterizing individual variables are needed in order to facilitate tailored insulin dose adjustments that minimize glycaemic variability while optimizing control in the diabetes camp setting.

The experiences of young people with Epidermolysis Bullosa Simplex: a qualitative study

The objective of this study was to explore the experiences of young people with Epidermolysis Bullosa Simplex (EBS). Eleven participants aged 10 -14 years were interviewed and Interpretative Phenomenological Analysis was employed. A key theme was 'self as different'. This related to experiences of negative treatment and exclusion from peers; a lack of understanding of others about the condition; and a sense of the self as 'wrong'. Findings indicate the importance of providing appropriate psychological and peer support, as well as wider community education and intervention, as part of the holistic treatment of young people with this chronic, painful and visible skin condition.

Glycemic control and the psychosocial benefits gained by patients with type 1 diabetes mellitus attending the diabetes camp

OBJECTIVE

The aim of this study was to evaluate the effectiveness of diabetes camp on glycemic control, knowledge, and psychosocial benefits among patients with type 1 diabetes (T1D). Glycemic control among patients with infrequent and frequent self-monitoring of blood glucose (SMBG) was also compared.

METHODS

During a 5-day camp, 60 patients were taught diabetes self-management education (DSME). After camp, patients were divided into two groups based on frequency of SMBG (<3 versus 3-4 times/day) and were followed up until 6-month post-camp. Patients' HbA1c levels and knowledge were assessed at baseline, 3- and 6-month post-camp. Patients' impressions towards camp were assessed.

RESULTS

In both SMBG groups, HbA1c levels decreased significantly at 3-month post-camp but did not sustain at 6-month monitoring. The patients with frequent SMBG had a lower mean HbA1c level. A significant improvement in knowledge was noted and sustained up to 6-month post-camp. The patients found diabetes camp of benefit and felt they could better cope with diabetes.

CONCLUSIONS

Although the effect of the diabetes camp on glycemic control was short-lived, an improvement in knowledge and a better attitude towards having diabetes were seen among participants.

PRACTICE IMPLICATIONS

The psychosocial benefits and knowledge gained by patients attending diabetes camp underline the importance of including a camp in a diabetes management plan. To improve patients' long-term glycemic control, a continuous education is required.

Overview of camp research

Organized camp experiences for children have been a part of American culture for almost 150 years. Millions of young people and adults have had positive developmental experiences in outdoor camp environments. Research about the outcomes of camp as well as about camp operations has documented the role that camps play in enhancing human development. This article summarizes some of the trends that have occurred in camp research and offers suggestions for future directions to assure that camp experiences continue to "enrich lives and build tomorrows."

Camp experiences and developmental outcomes for youth

Most children view camp as an enjoyable experience. In addition to the essential fun aspect of camp, researchers are discovering several positive developmental outcomes. This article describes some of the developmental outcomes that occur at camp based on developmental theories that underlie camp programs and the research that has been conducted. The primary developmental outcomes examined relate to the broad areas of self-constructs, social relationships, skill building, and spirituality. The recent national data collected by the American Camp Association to document developmental outcomes are highlighted to better understand how "camp gives kids a world of good."