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Williams FS, Garofalo R, Karnik NS, Donenberg G, Centola H, Becker S, Welch S, Kuhns L. Universal substance use care for adolescents with chronic medical conditions: a protocol to examine equitable implementation determinants and strategies for SBIRT at a pediatric hospital. Addict Sci Clin Pract 2024; 19:67. [PMID: 39261950 PMCID: PMC11391670 DOI: 10.1186/s13722-024-00492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 08/08/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Adolescents with chronic medical conditions (CMC) use alcohol and marijuana at levels equal to or even greater than their peers without CMC and are more likely to initiate substance use at 14 years or younger. Approximately 33% of adolescents with CMC binge drink alcohol and 20% use marijuana. When using substances, adolescents with CMC are at elevated risk for problem use and adverse consequences given their medical conditions. Although there has recently been progress integrating substance use services into adult hospitals, there has been almost no implementation of standardized substance use services into pediatric hospitals for adolescents with CMC. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents is an evidence-based, public health approach to promote the early detection and intervention of risky alcohol use in high-risk youth. This paper describes a study protocol combining two leading implementation science frameworks, the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation framework (HEIF), to engage pediatric hospital partners (hospital staff and clinicians, patients with CMC, and caregivers) to identify and specify contextual determinants of SBIRT implementation, which can be used to derive implementation strategies to optimize SBIRT adoption, reach, and fidelity. METHOD This study will use semi-structured interviews and focus groups with pediatric hospital partners (e.g., hospital staff and clinicians, adolescent patients, and caregivers) to identify SBIRT implementation determinants, using semi-structured interview and focus group guides that integrate CFIR and HEIF dimensions. DISCUSSION Understanding implementation determinants is one of the first steps in the implementation science process. The use of two determinant frameworks highlighting a comprehensive set of determinants including health equity and justice will enable identification of barriers and facilitators that will then map on to strategies that address these factors. This study will serve as an essential precursor to further work evaluating the feasibility of and the degree of engagement with SBIRT among this vulnerable pediatric population.
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Affiliation(s)
- Faith Summersett Williams
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
| | - Robert Garofalo
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Niranjan S Karnik
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Geri Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Hayley Centola
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sara Becker
- Department of Psychiatry, Feinberg School of Medicine, The Center for Dissemination and Implementation Science (CDIS), Northwestern University, Chicago, IL, USA
| | - Sarah Welch
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa Kuhns
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
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Phillips L, Dennermalm N, Örtqvist L, Engberg H, Holmdahl G, Fossum M, Möller A, Nordenskjöld A. A qualitative content analysis of the experience of living with hypospadias: varying impact on identity and interpersonal relationships. Front Pediatr 2024; 12:1459561. [PMID: 39268362 PMCID: PMC11390511 DOI: 10.3389/fped.2024.1459561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024] Open
Abstract
Objectives There is a lack of in-depth studies on men's personal experiences of having hypospadias across different aspects of their lives. We therefore aimed to explore the experience of having hypospadias in relation to identity and interpersonal relationships. Subjects and methods Using purposive sampling, we included 17 adult men aged 20-49 with variation in hypospadias phenotype. The informants further represented variation in sexuality, relationship status, parental status, and familial cultural context. In-depth interviews were conducted with each informant and the data was analysed using qualitative content analysis. Results We identified four categories. Firstly, The internal experience of hypospadias in relation to being different, being impacted, and being masculine. The remaining three categories related to interpersonal spaces: Intimate spaces, comprising personal relationship with sex, having sex, and being in a relationship; Familial spaces, comprising being a son, and becoming a father; and Public spaces, comprising being hidden, being naked, and peeing. We identified the latent theme varying impact and coping, highlighting differences in experiences relating to both the internal and interpersonal. Discussion Issues related to hypospadias included struggles with identity and confidence, as well as recurring patterns of social and sexual avoidance. While informants generally related to certain shared experiences, there is large variation in how much hypospadias impacts life, ranging from hardly at all to extensively. This could also fluctuate over time, with puberty and adolescence being an especially sensitive period. Functional and aesthetic outcomes are potentially important for well-being, especially in the case of more severe complications, while personal and interpersonal circumstances play a role in coping and the overall experience of the individual. Conclusion Healthcare, research, and other channels such as patient groups may be able to offer support to those who need it to help more boys and men with hypospadias live unhindered lives.
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Affiliation(s)
- Lottie Phillips
- Department of Women's and Children's Health and Centre of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Lisa Örtqvist
- Department of Women's and Children's Health and Centre of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Hedvig Engberg
- Department of Women's and Children's Health and Centre of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Gundela Holmdahl
- Department of Women's and Children's Health and Centre of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health and Centre of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Surgery, Rigshospitalet and Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Anders Möller
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health and Centre of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Kongsuwan W, Galvez B, Betriana F. Aesthetics in Nursing Practice as Experienced by Children During Hospitalization in Philippines: A Phenomenological Study. ANS Adv Nurs Sci 2024; 47:248-262. [PMID: 39093934 DOI: 10.1097/ans.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
This study aimed to describe the meaning of aesthetics in nursing practice as experienced by children during hospitalization. A hermeneutic phenomenological approach was used. Fifteen children who met the inclusion criteria participated in the study conducted from June to August 2021. Data were collected by drawing and interviewing. Kongsuwan's approach was used to analyze the data. Six thematic categories that revealed aesthetics in nursing practice were identified, namely, Enjoyment; Kindness; Creating impressive care; Appreciation of safeness; Intention to know children; and Connecting to others. The study findings present useful knowledge to inform nurses regarding special approaches to implementing aesthetic nursing care for children.
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Affiliation(s)
- Waraporn Kongsuwan
- Author Affiliations: Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand (Drs Kongsuwan and Betriana); and College of Nursing, Silliman University, Dumaguete City, Philippines (Dr Galvez)
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Weitzman ER, Minegishi M, Dedeoglu F, Fishman LN, Garvey KC, Wisk LE, Levy S. Disease-Tailored Brief Intervention for Alcohol Use Among Youths With Chronic Medical Conditions: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2419858. [PMID: 38985475 PMCID: PMC11238030 DOI: 10.1001/jamanetworkopen.2024.19858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/21/2024] [Indexed: 07/11/2024] Open
Abstract
Importance In the US, 25% of youths have a chronic medical condition (CMC). Alcohol use is prevalent among youths with a CMC and is associated with treatment nonadherence, simultaneous exposure to contraindicated medications, poor self-care, and elevated rates of progression to heavy and problem use by young adulthood. Preventive interventions targeting these youths are scarce and lack evidence about longer-term risk-stratified effects. Objective To evaluate the 12-month effects of a preventive intervention for alcohol use among youths with a CMC reporting baseline no or low-risk alcohol use vs high-risk alcohol use, testing the hypothesis of no difference. Design, Setting, and Participants This presepecified secondary analysis used data from a 2-group, parallel randomized clinical trial of the Take Good Care (TGC) intervention. Convenience samples of youths (aged 14-18 years) with a CMC, such as type 1 diabetes, juvenile idiopathic arthritis, or inflammatory bowel disease, were randomly assigned to the intervention or treatment as usual (TAU) between May 11, 2017, and November 20, 2018, and were followed up for up to 12 months. High-risk alcohol use was defined as heavy episodic (binge) alcohol use in the past 3 months and alcohol-related blackouts, injuries, vomiting, or emergency department visits in the past 12 months. Data were analyzed from September 21, 2023, to February 3, 2024. Interventions The self-administered, tablet computer-based TGC intervention was developed with patient and expert input, and it delivers disease-tailored psychoeducational content about the effects of alcohol use on overall health, disease processes, and treatment safety and efficacy. Main Outcomes and Measures The main outcome was self-reported frequency of alcohol use (in days) over the past 3 months, measured by a single validated question. Maximum likelihood methods incorporating all available data were used assuming data missing at random. Results The trial included 451 participants (229 female youths [50.8%]), with a mean (SD) age of 16.0 (1.4) years. Of these youths, 410 (90.9%) participated in the 12-month follow-up. At baseline, 52 youths (11.5%) reported high-risk alcohol use. Among participants with high-risk alcohol use, the observed mean (SD) frequency of alcohol use from baseline to the 12-month follow-up decreased in the intervention group (from 6.3 [4.6] to 4.9 [4.3] days) and increased in the TAU group (from 5.5 [4.9] to 9.0 [5.8] days), with an adjusted relative rate ratio of 0.60 (95% CI, 0.38 to 0.94). There were no group differences among youths reporting no or low-risk alcohol use. Conclusions and Relevance In this trial of a brief chronic illness-tailored preventive intervention, medically vulnerable youths with a high risk of alcohol use and harm decreased alcohol use. These findings support the use of a personalized preventive intervention with this group. Trial Registration ClinicalTrials.gov Identifier: NCT02803567.
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Affiliation(s)
- Elissa R. Weitzman
- Division of Addiction Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Machiko Minegishi
- Division of Addiction Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Fatma Dedeoglu
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Rheumatology Program, Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
| | - Laurie N. Fishman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Boston Children’s Hospital, Boston, Massachusetts
| | - Katharine C. Garvey
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Lauren E. Wisk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles
| | - Sharon Levy
- Division of Addiction Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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5
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Ferro MA, Chan CKY, Lipman EL, Lieshout RJV, Shanahan L, Gorter JW. Continuity of mental disorders in children with chronic physical illness. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02420-y. [PMID: 38519608 DOI: 10.1007/s00787-024-02420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Data on the chronicity of mental disorder in children with chronic physical illness (CPI) are limited. We examined the prevalence and predictors of homotypic and heterotypic continuity of mental disorder in children with CPI. A sample of 263 children aged 2-16 years with physician-diagnosed CPI were recruited from outpatient clinics (e.g., dermatology, respiratory) at a Canadian pediatric academic hospital and followed for 24 months. Parent and child-reported mental disorders (mood, anxiety, behavioral, attention-deficit hyperactivity disorder [ADHD]) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline, 6, 12, and 24 months. Marginal regression models were computed to identify clinical, parent, and demographic factors associated with mental comorbidity over time. Mental disorder was observed in 24-27% of children with CPI based on child reports and 35-39% based on parent reports. Parent-reported models revealed significant homotypic continuity for all mental disorders (ORs = 4.2-9.5), and heterotypic continuity between mood and anxiety disorders (OR = 2.2), ADHD and behavioral disorders (OR = 5.1), and behavioral and each mental disorder (ORs = 6.7-8.4). Child-reported models revealed significant homotypic continuity for mood (OR = 8.8) and anxiety disorder (OR = 6.0), and heterotypic continuity between anxiety and mood disorders (OR = 12.4). Child disability (ORs = 1.3-1.5) and parent psychopathology (ORs = 1.2-1.8) were the most consistent predictors of both child- and parent-reported mental disorder over time. Mental comorbidity was prevalent and persistent in children with CPI with homotypic and heterotypic continuity common across informants. Child disability and parent psychopathology may be priority targets within integrated family-centered models of care to prevent mental comorbidity in children with CPI.
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Affiliation(s)
- Mark A Ferro
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Christy K Y Chan
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ellen L Lipman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Lilly Shanahan
- Jacobs Center for Productive Youth Development, Zurich, Switzerland
| | - Jan Willem Gorter
- Pediatric Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Morales Viana LC, Castillo-Espitia E. Taking care of myself in a different and broken world: self-care practices of adolescents on dialysis. Int J Qual Stud Health Well-being 2023; 18:2171562. [PMID: 36722818 PMCID: PMC9897745 DOI: 10.1080/17482631.2023.2171562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Being on dialysis is a traumatic situation particularly during adolescence. Therefore, adolescents must have self-care support according to their special needs. The goal of this study was to describe the adolescents´ self-care practices when they are on dialysis. This paper reports only the adolescents´ selfcare practices based on the health care team guidelines but adjusted to their beliefs and habits. METHODS The methodology of the study was interpretive phenomenology. In-depth interviews were conducted with 15 adolescents; Smith´s IPA procedure was used for data analysis. RESULTS Being on dialysis meant to the adolescents living in a different and broken world. Self-care practices included: 1) coexisting with the dialysis slavery or being attached to a machine day or night, 2) struggling with the maddening thirst experience, 3) Deciding what, when and how much food to eat, 4) taking care of an alien that helps to survive, 5) taking the medicines when feeling in need of them. CONCLUSION The adolescents tried to care for themselves adjusting their care activities to the health team´s recommendations. However, they also adjusted those practices to their beliefs and habits, which allows them to live with dialysis in a less traumatic way.
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Affiliation(s)
- Liliana Cristina Morales Viana
- Department of Pediatric Nursing, Universidad del Valle, Cali, Colombia,CONTACT Liliana Cristina Morales Viana Department of Pediatric Nursing, Universidad del Valle, Cali760032, Colombia
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Dolley D, Du Randt R, Pühse U, Gerber M, Bosma J, Aerts A, Adams L, Arnaiz P, Joubert N, Müller I, Nqweniso S, Seelig H, Steinmann P, Utzinger J, Walter C. Relationship between Body Mass Index and Physical Activity among Children from Low-Income Communities in Gqeberha, South Africa: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1428. [PMID: 36674182 PMCID: PMC9864586 DOI: 10.3390/ijerph20021428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
This study aimed to establish the prevalence of underweight, overweight and obesity, the level of moderate-to-vigorous physical activity (MVPA) and the association thereof among vulnerable children from low-income communities in South Africa. Cross-sectional data were collected from 916 children (467 boys and 449 girls) aged 8-13 years (x̄ = 10.4 ± 1.2 years) attending eight low-income schools in Gqeberha, South Africa. Measured outcomes included accelerometery-measured physical activity (PA), weight, height and body mass index (BMI). Analysis of variance was used to determine the mean difference of total MVPA stratified by sex and BMI classification. Overall, 13% of the cohort were underweight, 19% were overweight/obese and 64% engaged in 60 min of MVPA per day. Girls presented nearly twice the odds of being overweight or obese than boys (95% CI: 1.40-2.77). Underweight to normal-weight children (boys: OR = 3.89, 95% CI: 2.18-6.93; girls: OR = 1.78, 95% CI: 1.13-2.80) were more likely to engage in 60 min/day of MVPA than overweight to obese children. There is an inverse association between BMI categories and theduration of MVPA achieved per day. Special attention should be aimed at increasing awareness of healthy nutrition and promoting a variety of PA, especially among girls and children with excess weight.
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Affiliation(s)
- Danielle Dolley
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Rosa Du Randt
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Jacob Bosma
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Ann Aerts
- Novartis Foundation, 4056 Basel, Switzerland
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Patricia Arnaiz
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Nandi Joubert
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4052 Basel, Switzerland
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4052 Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4052 Basel, Switzerland
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
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Phillips L, Dennermalm N, Örtqvist L, Engberg H, Holmdahl G, Fossum M, Möller A, Nordenskjöld A. A qualitative content analysis of the experience of hypospadias care: The importance of owning your own narrative. Front Pediatr 2023; 11:1118586. [PMID: 36873641 PMCID: PMC9982152 DOI: 10.3389/fped.2023.1118586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVES There is a lack of studies on men's individual experiences of living with hypospadias. We aimed to explore the personal experiences of having hypospadias in relation to healthcare and surgery. SUBJECTS AND METHODS Purposive sampling was used to include men (aged 18 and over) with hypospadias representing different phenotypes (from distal to proximal) and ages in order to maximise the variation and richness of our data. Seventeen informants, aged 20-49, were included in the study. In-depth semi-structured interviews were conducted between 2019 and 2021. Inductive qualitative content analysis was used to analyse the data. RESULTS We identified three categories: (1) Having surgery, which comprised the decision to operate, the experience of having surgery, and the outcomes of surgery; (2) Going to the doctor, which focused on follow-up care, re-entering care in adolescence or adulthood, and the experience of healthcare interactions; (3) Being informed, both about hypospadias in general, as well as about your specific body and medical history. There was overall a large variation in experiences. The latent theme across the data was the importance of owning your own narrative. CONCLUSION The experience of men with hypospadias in healthcare is complex and varied, highlighting the difficulty of fully standardised care. Based on our results, we suggest that follow-up should be offered in adolescence, and that ways of accessing care for late onset complications be made clear. We further suggest clearer consideration for the psychological and sexual aspects of hypospadias. Consent and integrity in all aspects and all ages of hypospadias care should be adapted to the maturity of the individual. Access to trustworthy information is key, both directly from educated healthcare staff and if possible, from websites or patient-led forums. Healthcare can play a key role in providing the growing individual with tools to understand and address concerns that may develop relating to their hypospadias through life, giving them ownership over their own narrative.
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Affiliation(s)
- Lottie Phillips
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Lisa Örtqvist
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Hedvig Engberg
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Gundela Holmdahl
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery and Faculty of Health and Medical Sciences, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anders Möller
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Weitzman ER, Wisk LE, Minegishi M, Cox R, Lunstead J, Brogna M, Levy S. Effects of a Patient-Centered Intervention to Reduce Alcohol Use Among Youth With Chronic Medical Conditions. J Adolesc Health 2022; 71:S24-S33. [PMID: 36122966 DOI: 10.1016/j.jadohealth.2021.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Alcohol poses unique risks for youth with chronic medical conditions (YCMC) yet many drink. Preventive interventions targeting YCMC are scarce. METHODS YCMC with type 1 diabetes, juvenile idiopathic arthritis, systemic lupus erythematosus, or inflammatory bowel disease were recruited and randomized to trial the effects of a self-administered condition-tailored psychoeducational intervention on frequency in days of past 3-month alcohol use, alcohol-related risk perceptions, and knowledge. Changes in outcomes over time were measured and compared by treatment arm using multivariate mixed effects models. RESULTS Among N = 418 participants (average age 16.0 years, 52.2% female, 84.7% white, 90.7% non-Hispanic), 24.2% reported past-year alcohol use at baseline. Alcohol-related knowledge increased overall and was greater for the intervention group (adjusted improvement in knowledge score +7.70, 95% confidence interval [CI] 2.92-12.48). By 6-month follow-up, the percentage of youth reporting any alcohol use is risky/dangerous increased among intervention arm participants from 41.5% to 45.4% at baseline and decreased from 38.9% to 37.4% among controls (adjusted intervention effect odds ratio 1.79, 95% confidence interval 1.02-3.13). Overall, frequency of drinking increased over time from 3.72 to 4.52 days on average, with no differences by treatment group. Among female drinkers, the predicted mean frequency of drinking days declined in the intervention group (4.11-3.33) and increased among controls (2.82-4.55) (adjusted intervention effect rate ratio .50, 95% confidence interval .25-.99). CONCLUSIONS Exposure to a chronic illness-tailored psychoeducational intervention targeting alcohol use increased knowledge and perceived risk and, among females, reduced alcohol use. Promising results merit future work to optimize the model for both males and females.
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Lauren E Wisk
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Division of General Internal Medicine and Health Services Research, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Machiko Minegishi
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Rachele Cox
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Julie Lunstead
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Melissa Brogna
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Sharon Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
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Lou TM, Zhang KL, Slesinger NC, Taddeo M, Serrano E, Begolka WS, Capozza K, Paller AS, Griffith JW, Fishbein AB. Positive Psychology Themes in Interviews of Children With Atopic Dermatitis: Qualitative Study. JMIR Pediatr Parent 2022; 5:e38725. [PMID: 36103242 PMCID: PMC9520397 DOI: 10.2196/38725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atopic dermatitis is a pruritic chronic condition associated with significant sleep disturbance, inattention, and sometimes behavioral problems. Enhancing resiliency in children with atopic dermatitis may promote coping strategies to improve quality of life. Positive psychology is one strategy that can be used to strengthen resiliency. OBJECTIVE Our objective was to identify positive psychology concepts mentioned by children with atopic dermatitis and their parent to inform strategies to strengthen resiliency in children with atopic dermatitis. METHODS A total of 20 patient-parent dyads were interviewed to share their experience with atopic dermatitis to help develop a novel psychologic intervention for atopic dermatitis. Patients were 8 to 17 years old and diagnosed with atopic dermatitis. Trained coders analyzed transcripts using a coding dictionary developed based on Seligman's PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) model of positive psychology. The frequency of unprompted mentions of PERMA themes and relevant quotations was captured. Transcripts were also separately coded for resiliency, which is the ultimate goal of PERMA. RESULTS Positive psychology concepts were mentioned by 100% (20/20) of children and 95% (19/20) of parents. Engagement and relationships, both negative and positive aspects, were the most common unprompted PERMA themes mentioned by children (14/20, 70%) and parents (13/20, 65%). Emotion elicited the most negative comments from children (19/20, 95%) and parents (17/20, 85%). When analyzed for resiliency, 8 participants were identified with at least one resiliency code. On average, participants with a resiliency code mentioned PERMA concepts 9.1 (SD 4.7) times compared to those who mentioned none (mean 5.9, SD 4.6) (P=.14). When participants were stratified by disease severity, on average, more positive psychology concepts were mentioned by patients with mild atopic dermatitis (mean 13, SD 3.0) than those with moderate symptoms (mean 6.2, SD 4.9) or severe symptoms (mean 6.1, SD 4.0) (P=.03). CONCLUSIONS Among PERMA themes, engagement and relationships are the two most commonly mentioned categories for children with atopic dermatitis. Strategies targeting PERMA such as affirmations and positive reframing may improve psychosocial well-being and resiliency in pediatric atopic dermatitis. Future directions will look at incorporating "positive medicine" into atopic dermatitis treatment to not only relieve symptoms but also strengthen positive aspects of life.
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Affiliation(s)
- Terry M Lou
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
| | - Kenneth L Zhang
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
| | - Noël C Slesinger
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Michelle Taddeo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eloisa Serrano
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, CA, United States
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Anna B Fishbein
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
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11
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Sobierajski F, Storey K, Bird M, Anthony S, Pol S, Pidborochynski T, Balmer-Minnes D, Tharani AR, Power A, Khoury M, Cunningham C, Jeewa A, Conway J. Use of Photovoice to Explore Pediatric Patients with Hypertrophic Cardiomyopathy and their Parents' Perceptions of a Heart-Healthy Lifestyle. J Am Heart Assoc 2022; 11:e023572. [PMID: 35301849 PMCID: PMC9075448 DOI: 10.1161/jaha.121.023572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Heart‐healthy lifestyles promote lifelong cardiovascular health. However, patients with hypertrophic cardiomyopathy are often advised to avoid strenuous exercise because of the risk of sudden cardiac death. Given these restrictions, this study explored youth and parent perceptions of a heart‐healthy lifestyle and the barriers and facilitators to this lifestyle. Methods and Results Youth and parents were purposefully recruited at 2 Canadian hospitals for this photovoice project. Participants were given cameras and took pictures of everyday heart‐healthy or heart‐unhealthy choices. Photos were discussed during one‐on‐one qualitative interviews with youth and parents separately to understand the photos’ meaning and significance. Inductive descriptive thematic analysis was employed. A total of 16 youth (median age, 14.4 years [range, 10.5–17.7 years]; 63% boys) and 16 parents (100% women) participated. A total of 15 youth were activity restricted. Data analysis revealed 7 categories organized into perceptions of healthy living (health is holistic and individualized) and factors influencing engagement in healthy living (self‐awareness, ownership and autonomy, feeling restricted and peer pressure, support from parents, and support from the cardiologist). Participants had a complex understanding of health and discussed the importance of physical, mental, and social well‐being. Youth used self‐awareness and taking responsibility as facilitators of healthy living. Healthy living was shaped by peers, parent role‐modeling, and cardiologist recommendations. Conclusions This study depicts the realities for youth with hypertrophic cardiomyopathy and can be used to inform the development of responsive interventions. Holistic, patient‐specific interventions may be more successful, and strategies such as shared decision making may be important to promote self‐awareness and autonomy.
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Affiliation(s)
| | - Kate Storey
- School of Public Health University of Alberta Edmonton AB Canada
| | - Melissa Bird
- School of Public Health University of Alberta Edmonton AB Canada
| | - Samantha Anthony
- Factor-Inwentash Faculty of Social Work University of Toronto Toronto ON Canada.,Child Health Evaluation SciencesThe Hospital for Sick Children Toronto ON Canada
| | - Sarah Pol
- Child Health Evaluation SciencesThe Hospital for Sick Children Toronto ON Canada
| | - Tara Pidborochynski
- Department of Pediatrics Division of Cardiology University of Alberta Edmonton AB Canada
| | - Diana Balmer-Minnes
- Department of Pediatrics Division of Cardiology The Hospital for Sick Children Toronto ON Canada
| | - Alliya Remtulla Tharani
- Department of Pediatrics Division of Cardiology The Hospital for Sick Children Toronto ON Canada
| | - Alyssa Power
- Department of Pediatrics Division of Cardiology The Hospital for Sick Children Toronto ON Canada
| | - Michael Khoury
- Department of Pediatrics Division of Cardiology University of Alberta Edmonton AB Canada.,Division of Pediatric Cardiology Stollery Children's Hospital Edmonton AB Canada
| | - Chentel Cunningham
- Division of Pediatric Cardiology Stollery Children's Hospital Edmonton AB Canada
| | - Aamir Jeewa
- Department of Pediatrics Division of Cardiology The Hospital for Sick Children Toronto ON Canada.,Department of Paediatrics University of Toronto Toronto ON Canada
| | - Jennifer Conway
- Department of Pediatrics Division of Cardiology University of Alberta Edmonton AB Canada.,Division of Pediatric Cardiology Stollery Children's Hospital Edmonton AB Canada
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12
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Thomas S, White V, Ryan N, Byrne L. Effectiveness of play therapy in enhancing psychosocial outcomes in children with chronic illness: A systematic review. J Pediatr Nurs 2022; 63:e72-e81. [PMID: 34776315 DOI: 10.1016/j.pedn.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 12/25/2022]
Abstract
PROBLEM To examine the nature, quality, and effectiveness of Play Therapy (PT) interventions in children with chronic health conditions (CHC) and to identify the measures used to evaluate psychosocial outcomes. ELIGIBILITY CRITERIA Systematic searches of the databases: Medline complete, PsycINFO, CINHAL, Embase and Sport Discuss were conducted to identify peer reviewed papers reporting original studies published in English between January1990 - April 2020. Studies testing any type of PT or Filial Therapy (FT) with children with CHC aged between 3 and 11 years, or their parents if FT, where outcomes were primarily psychosocial were eligible. SAMPLE AND RESULTS The title and abstract search identified 6742 papers and six studies (three each for PT and FT) including two randomized control trials were identified as eligible for review. All FT interventions involved group-based training, while only one PT study used a group format. Outcomes for children included emotional and behavioural issues including anxiety, depression, and self-concept and while constructs were broadly comparable across studies, the measures used differed. Sample size ranged between 4 and 58. Two studies suggested positive impact of PT on depression, with one finding improvements in self-concept. Three studies with sample sizes less than 30 found no effect. CONCLUSION With varied study designs, and small sample sizes, current evidence regarding the effectiveness of PT in improving psychosocial outcomes for children with chronic illnesses is inconclusive. IMPLICATIONS The field should move from small underpowered studies to randomized trials with comprehensive protocols and larger sample sizes.
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Affiliation(s)
- Sangeetha Thomas
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Victoria White
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Nicholas Ryan
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Linda Byrne
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
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13
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Leite ACAB, García-Vivar C, DeMontigny F, Nascimento LC. Waves of family hope: narratives of families in the context of pediatric chronic illness. Rev Lat Am Enfermagem 2021; 29:e3504. [PMID: 34816873 PMCID: PMC8616230 DOI: 10.1590/1518-8345.5515.3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze narratives about the experience of hope of families in the context of pediatric chronic illness. METHOD a narrative research using Family Systems Nursing as a conceptual framework. Three families of children and adolescents diagnosed with complex chronic illness participated in this study, totaling 10 participants. Data collection was developed using family photo-elicitation interviews. Family narratives were constructed and analyzed according to inductive thematic analysis with theoretical data triangulation. RESULTS the analytical theme - Waves of Family Hope in the Context of Pediatric Chronic Illness - is composed of four different types of hope: uncertain hope, caring hope, latent hope, and expectant hope. Movement through these hopes generates a driving energy and depends on a number of factors: support, information, searching for normality, and thoughts and comparisons. CONCLUSION the results highlight the interaction and reciprocities of the members of the family unit, and the dynamics of hope, and illustrate the different types of hope and the factors that influence them. This study highlights the experience of hope as a family resource rather than just an individual resource, and supports health professionals in the planning of family care considering hope as an essential and dynamic family resource.
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Affiliation(s)
- Ana Carolina Andrade Biaggi Leite
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
| | - Cristina García-Vivar
- Universidad Pública de Navarra, Departamento de Ciencias de la
Salud, Pamplona, Navarra, Spain
| | - Francine DeMontigny
- Université du Québec en Outaouais, Department of Nursing, Gatineau,
Quebec, Canada
| | - Lucila Castanheira Nascimento
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq), Brazil
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Di Riso D, Cambrisi E, Bertini S, Miscioscia M. Associations between Pretend Play, Psychological Functioning and Coping Strategies in Pediatric Chronic Diseases: A Cross-Illness Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124364. [PMID: 32570747 PMCID: PMC7345351 DOI: 10.3390/ijerph17124364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/16/2022]
Abstract
Children with chronic illnesses are called to undertake complicated processes of adjustment and re-organization in their daily lives; as a result, they could experience several internalizing problems. Symbolic play could be a useful way to cope with these difficulties. The main aim of this paper is to assess pretend play, coping, and psychological symptoms in three groups of school-aged children with pediatric chronic diseases. The study involved 44 Italian school-aged, chronically ill children: 16 with type 1 diabetes mellitus (T1DM), 12 with cystic fibrosis (CF), and 15 with Leukemia. All patients were assessed by the Affect in Play Scale–Brief version (APS-Br), and the Children’s Coping Strategies Checklist–Revision1 (CCSC-R1). Children with T1DM and CF also completed the Separation Anxiety Symptom Inventory for Children (SASI-C) and the Strengths and Difficulties Questionnaire (SDQ)–children’s version. Cohen’s d (effect size) was applied between clinical and normative samples, and it showed a more organized play (APS-BR), but a more negative affect tone, comfort, and frequency of affect expression. Comparing APS-BR and CCSC-R1 rates between the three groups, significant differences were found for all the APS-BR dimensions, except for tone, and for CCSC-R1 seeking understanding. Comparing SASI-C score between T1DM and CF, higher scores were found for children with CF. In the end, correlations between all dimensions highlighted several relationships between play, coping, and adjustment problems for children with T1DM, and relationship between affect play and all variables for children with CF. Symbolic play helps chronically ill children to express emotions; helping them, as well as clinicians, to understand the difficulties caused by chronic conditions, and to cope with them.
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Affiliation(s)
- Daniela Di Riso
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy; (D.D.R.); (E.C.); (S.B.)
| | - Elena Cambrisi
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy; (D.D.R.); (E.C.); (S.B.)
| | - Simone Bertini
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy; (D.D.R.); (E.C.); (S.B.)
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy; (D.D.R.); (E.C.); (S.B.)
- Department of Women’s and Children’s Health, Hospital-University of Padua, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-11-60
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15
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Christian BJ. Translational Research - Parental Stress Associated with Hospitalization of Children with Critical Life-Threatening Conditions and the Long-term Impact. J Pediatr Nurs 2020; 51:110-113. [PMID: 32001063 DOI: 10.1016/j.pedn.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Becky J Christian
- School of Nursing, The University of Louisville, KY, United States of America.
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