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Brosbe MS, Zegelbone P, Radtke S, de la Uz C. Implementation and analysis of clinic administered behavioural health screen in an outpatient paediatric cardiology clinic. Cardiol Young 2024:1-8. [PMID: 39364547 DOI: 10.1017/s1047951124026003] [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: 10/05/2024]
Abstract
Previous studies investigating behavioural health screening processes have focused on selected diagnoses within paediatric cardiology and focused on a smaller number of potential concerns. We developed and administered a brief survey in our paediatric heart centre to assess the presence of a wider variety of behavioural health concerns and to connect patients with resources. A cohort of 305 patients aged 2-29 years (M = 11.97 years; SD = 6.00 years; 50.49% female), representing a variety of indications for a cardiology clinic visit, or a parent, completed a survey of 14 common behavioural health concerns. Behavioural health concerns were included based on practice patterns within paediatric psychology. Respondents indicated if they were currently receiving behavioural health services and if they were interested in behavioural health follow-up. Surveys were administered during check in and collected by clinic staff. A behavioural health provider attempted to reach all those who indicated interest by phone. Approximately 45% of the sample endorsed one or more behavioural health concerns and 30.16% of the sample endorsed at least one concern but were not already connected to services. Only 27.17% of this group requested follow-up. Most commonly endorsed concerns were anxiety, sleep problems, depressed/irritable mood, and somatic complaints. Survey results converge with existing literature to indicate that behavioural health concerns are common among youth seen in a paediatric cardiology clinic but most patients are not connected to appropriate services. Screening programmes can help meet this need but challenges remain. Clinical implications and future directions are discussed.
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Affiliation(s)
- Micah S Brosbe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip Zegelbone
- Division of Pediatric Cardiology, Department of Pediatrics, Holtz Children's Hospital/Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sarah Radtke
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Caridad de la Uz
- Department of Pediatrics, Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Alkan F, Sapmaz SY, Kardelen C, Bircan O, Bilac O, Kandemir H, Coskun S. Should pediatric cardiologists refer all patients with unexplained chest pain to a psychiatrist? Cardiol Young 2023:1-7. [PMID: 38149344 DOI: 10.1017/s1047951123004195] [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: 12/28/2023]
Abstract
OBJECTIVE The present study aimed to investigate the relationship between unexplained chest pain in children with parents' mental problems, parental attitudes, family functionality, and the child's mental problems. MATERIAL AND METHOD A total of 433 children (between 11 and 18 years of age) applied to the Pediatric Cardiology Outpatient Clinic due to chest pain in the last year. A clinical interview was conducted by a child psychiatrist with 43 patients and 33 controls included in the study due to unexplained chest pain. RESULTS Family history of physical illness was significantly higher in the chest pain group. When evaluated in terms of psychosocial risk factors, life events causing difficulties, derangement in the family, loss of a close person, and exposure to violence were statistically significantly higher in the group with chest pain. Mental disorders were observed in 67.4% of the children in the chest pain group as a result of the clinical interview. The total score of the DSM-5 somatic symptoms scale, which evaluates other somatic complaints in the chest pain group, was also significantly higher. When the family functions of both groups were evaluated, communication, emotional response, behaviour control, and general functions sub-dimensions were statistically significantly higher in families in the chest pain group. CONCLUSION We recommend that psychiatric evaluation be included in diagnostic research to prevent unnecessary medical diagnostic procedures in children describing unexplained chest pain, as well as to prevent the potential for diagnosing mental disorders in both children and adults.
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Affiliation(s)
- Fatos Alkan
- Division of Pediatrics Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Sermin Yalın Sapmaz
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Cansın Kardelen
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Onur Bircan
- Division of Pediatrics Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Oznur Bilac
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Hasan Kandemir
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Senol Coskun
- Division of Pediatrics Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Gumus YY, Senturk E. Anxiety, depressive, and somatoform disorders in children and adolescents referred to paediatric cardiology with somatic symptoms. Cardiol Young 2022; 33:1-6. [PMID: 35856274 DOI: 10.1017/s1047951122001949] [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: 11/05/2022]
Abstract
INTRODUCTION Chest pain, palpitations, and syncope are among the most common referrals to paediatric cardiology. These symptoms generally have a non-cardiac aetiology in children and adolescents. The aim of this study was to investigate the rate of common psychiatric disorders in children and adolescents referred to the paediatric cardiology clinic with chest pain, palpitations, and syncope and the relationship between cardiological symptoms and psychiatric disorders. METHODS Children and adolescents aged 8-16 years who presented at the paediatric cardiology clinic with primary complaints of chest pain, palpitation, or syncope were included in the study. After a detailed cardiology examination, psychiatric disorders were assessed using the DSM IV-TR diagnostic criteria and a semi-structured interview scale (KSADS-PL). The Child Depression Inventory and Spielberger's State-Trait Anxiety Inventory for Children were also applied to assess the severity of anxiety and depression. RESULTS The study participants comprised 73 (68.90%) girls and 33 (31.10%) boys with a mean age of 12.5 ± 2.4 years. Psychiatric disorders were determined in a total of 48 (45.3%) participants; 24 (38.7%) in the chest pain group, 12 (48.0%) in the palpitation group, and 12 (63.2%) in the syncope group. Cardiological disease was detected in 17% of the cases, and the total frequencies of psychiatric disorders (p = 0.045) were higher in patients with cardiological disease. CONCLUSION It is clinically important to know that the frequency of psychiatric disorders is high in patients presenting at paediatric cardiology with chest pain, palpitations, and syncope. Physicians should be aware of patients' psychiatric problems and take a biopsychosocial approach in the evaluation of somatic symptoms.
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Affiliation(s)
- Yusuf Yasin Gumus
- Department of Child Psychiatry, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Ekrem Senturk
- Department of Child Psychiatry, Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey
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Hu L, Liu ZZ, Wang ZY, Jia CX, Liu X. Associations between pain and depressive symptoms: A longitudinal study of Chinese adolescents. J Affect Disord 2022; 299:675-681. [PMID: 34953924 DOI: 10.1016/j.jad.2021.12.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022]
Abstract
AIMS Pain and depressive symptoms are prevalent in adolescents. Data on the association between pain and depressive symptoms in the general adolescent population are limited. The purpose of this study was to investigate the prospective associations of headache, stomachache, and other nonspecific pain with depressive symptoms in a large sample of Chinese adolescents. METHODS A total of 7072 adolescents who participated in the baseline survey and were followed up 1 year later were included in the prospective analysis. Participants completed a self-administered questionnaire to assess three types of pain (headache, stomachache, and other nonspecific pain) and demographics. Depressive symptoms were assessed by the Center for Epidemiology Studies Depression Scale. Logistic regression models were conducted to evaluate the associations between pain and depressive symptoms. RESULTS The prevalence and incidence rates of depressive symptoms significantly increased with elevated pain frequencies. After adjusting for insomnia symptoms and other adolescent and family covariates, frequent headache (OR=2.39, 95% CI =1.37-4.16) and other nonspecific pain (sometimes pain: OR=1.57, 95% CI =1.14-2.15; frequent pain: OR=2.78, 95% CI =1.33-5.82) were significantly associated with increased risk of depressive symptoms 1 year later. Study limitation: Pain and depressive symptoms were self-reports. CONCLUSIONS The findings suggest that frequent pain is associated with subsequent depressive symptoms. Further research is needed to determine the causal relationship between pain and depressive symptoms in adolescents.
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Affiliation(s)
- Lei Hu
- Shandong Mental Health Center, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhen-Zhen Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; School of Psychology, Northeast Normal University, Changchun, China
| | - Zi-Yang Wang
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianchen Liu
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, 19104, United States.
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Haavet OR, Šaltytė Benth J, Gjelstad S, Hanssen-Bauer K, Dahli MP, Kates N, Ruud T. Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office. BMJ Open 2021; 11:e050036. [PMID: 34952870 PMCID: PMC8712985 DOI: 10.1136/bmjopen-2021-050036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Young people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions. AIM To investigate whether shared care with mental health professionals in GP offices increases the detection of youth's mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician. DESIGN AND SETTING This was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3-8 GP offices. One GP office was randomised to the intervention group and the other to the control group. METHOD We used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth. RESULTS Over a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients' regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm. CONCLUSION Shared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient's regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group. TRIAL REGISTRATION NUMBER NCT03624829; Results.
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Affiliation(s)
- Ole Rikard Haavet
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ketil Hanssen-Bauer
- Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway
| | - Mina Piiksi Dahli
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nick Kates
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine McMaster University, Hamilton, Ontario, Canada
| | - Torleif Ruud
- Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway
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Are Maternal Personality Traits an Etiological Factor in Adolescents with Functional Chest Pain? Pain Manag Nurs 2021; 22:652-659. [PMID: 34078569 DOI: 10.1016/j.pmn.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 04/10/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the etiology of functional chest pain (FCP), parental personality traits are worth considering in the context of the biopsychosocial model. The αlpha factor sub-dimension of the five-factor personality model (5FPM) includes agreeableness, conscientiousness, and neuroticism. There is increasing evidence that this dimension may be related to psychosomatic diseases. It was aimed to investigate how maternal personality traits affect adolescents with FCP. The hypothesis was determined that adolescents diagnosed with FCP can have lower quality of life and be more depressive/anxious and their mothers can have factor-α personality traits and be more depressive/anxious. METHODS The sample of this single-center, cross-sectional, case-control study consisted of 25 adolescents with FCP and their parents. The control group consisted of 35 age and sex matched healthy adolescents and their parents. Psychopathology was screened using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) and psychiatric comorbidities were excluded. The Child Depression Inventory (CDI), the Spielberger State-Trait Anxiety Inventory (STAI), and KINDL forms were completed by the adolescents. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Five-Factor Personality Inventory short form (FFPI) were completed by the parents. RESULTS Mothers of adolescents with FCP scored significantly higher compared with mothers of healthy controls in agreeableness and conscientiousness and scored significantly lower in neuroticism. Higher levels of mothers' neuroticism scores were associated with higher CDI and STAI-1 scores in FCP group. Agreeableness (Exp (B) = 10.097; p = .004; confidence interval [CI] = 2.049-49.745) and conscientiousness (Exp (B) = 16.414; p = .011; CI = 1.902-141.682) were statiscally significant in regression model. CONCLUSIONS This study showed for the first time that mother's alpha factor personality traits may be one of the factors that contribute to the presence of FCP.
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Abstract
BACKGROUND Chest pain, as a common cause of hospital admissions in childhood, necessitates detailed investigations due to a wide range of differential diagnoses. In this study, we aimed to determine the distribution of diseases causing chest pain in children and investigate the clinical characteristics of children with chest pain. METHODS This study included 782 patients aged between 3 and 18 years who presented to a paediatric cardiology outpatient clinic with chest pain between April 2017 and March 2018. Aetiological causes and demographic features of the patients were analysed. RESULTS Most prevalent causes of chest pain were musculoskeletal system (33%) and psychogenic (28.4%) causes. Chest pain due to cardiac reasons was seen in eight patients (1%). Diseases of musculoskeletal and gastrointestinal systems and psychogenic disorders were significantly more common in male and female patients, respectively (p < 0.001 for all). In winter, patients' age and the number of patients with ≥12 years were higher than those in other seasons (p < 0.001). Most of the parents (70.8%) and patients (90.2%) thought that chest pain in their children was caused by cardiac causes. CONCLUSION Most of the diagnoses for chest pain in childhood period are benign and include the musculoskeletal system and psychogenic diseases. Although chest pain due to cardiac diseases is rare, a comprehensive analysis of medical history, detailed physical examination and cardiac imaging with echocardiography is needed to reach more accurate diagnoses.
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Mansiz-Kaplan B, Ayhan FF, Cagli M, Atik F, Ece İ. A preliminary study of the child abuse and central sensitization in adolescent patients with chronic non-organic chest pain and an overlooked condition: juvenile fibromyalgia syndrome. Pediatr Rheumatol Online J 2020; 18:28. [PMID: 32234044 PMCID: PMC7106712 DOI: 10.1186/s12969-020-00421-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/23/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Only a small percentage of pediatric chest pain is of cardiac origin and the most common detected cause is musculoskeletal. Among musculoskeletal causes, acute chest pain is better described, with the causes of chronic pain not being adequately investigated in the literature. The aim of studuy is to evaluate the musculoskeletal causes of non-cardiac chest pain and investigate the relationship of chest pain with child abuse and central sensitization. METHODS Patients aged 12 to 18 years presenting with chest pain for at least 3 months were evaluated by a pediatric cardiologist and those without an organic pathology were referred to the physical medicine and rehabilitation clinic. In addition to detailed history and physical examination, juvenile fibromyalgia was questioned according to the 2016 revised diagnostic criteria of the American College of Rheumatology. The visual analog scale (to measure intensity of chest pain), the Central Sensitization Inventory (to evaluate the presence of central sensitization), the Hospital Anxiety Depression Scale (to determine depression and anxiety), the Childhood Trauma Questionnaire (to assess the presence of child abuse) were administered. RESULTS The study was completed with 64 patients. Twenty-six percent of patient (n = 17) were diagnosed with juvenile fibromyalgia, and central sensitization was detected in 34.4% (n = 22). Pain intensity, anxiety, depression and abuse scores were higher in patients with juvenile fibromyalgia than those without juvenile fibromyalgia and in patients with central sensitization compared to those without central sensitization (p < 0.001 for both). Higher scores of pain were related with child abuse [beta = 0.763, p < 0.001, (%95 CI, 4.397; 8.841)] and central sensitization of pain [beta = 0.382, p = 0.008 (95% CI: (0.986;6.231)] in regression analyses. CONCLUSION In this study, juvenile fibromyalgia was detected as a cause of non-cardiac chest pain. Juvenile fibromyalgia or central sensitization may also indicate childhood abuse.
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Affiliation(s)
- Basak Mansiz-Kaplan
- Ankara Training and Research Hospital, Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara, Turkey.
| | - F. Figen Ayhan
- grid.440474.7School of Medicine, Department of Physical Medicine and Rehabilitation, Usak University, Usak, Turkey
| | - Mihriban Cagli
- grid.413783.a0000 0004 0642 6432Ankara Training and Research Hospital, Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Fatih Atik
- grid.413783.a0000 0004 0642 6432Ankara Training and Research Hospital, Department of Pediatric Cardiology, University of Health Sciences, Ankara, Turkey
| | - İbrahim Ece
- grid.413783.a0000 0004 0642 6432Ankara Training and Research Hospital, Department of Pediatric Cardiology, University of Health Sciences, Ankara, Turkey
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Li L, Zhao Y, Li H. Assessment of anxiety and depression in patients with incidental pulmonary nodules and analysis of its related impact factors. Thorac Cancer 2020; 11:1433-1442. [PMID: 32212379 PMCID: PMC7262923 DOI: 10.1111/1759-7714.13406] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 01/13/2023] Open
Abstract
Objectives To assess anxiety and depression in patients with incidental pulmonary nodules and analyze the related impact factors. Methods All patients were assessed by questionnaires for their anxiety and depression after incidentally found pulmonary nodules. Hospital anxiety and depression scale (HAD), generalized anxiety disorder scale‐7 (GAD‐7), and multidimensional scale of perceived social support (MSPSS) were used to evaluate their anxiety and depression in order to understand the basic information and social support, and to analyze the related factors. Results The HAD scale was used in 201 patients with pulmonary nodules. Univariate analysis showed the frequency of visits and social support had significant effects on anxiety (χ2 = 9.604, 20.912, P < 0.05). Regression analysis showed that social support (OR = 4.042, 95% CI: 2.1617.558, P < 0.05) was an independent influencing factor of anxiety. Univariate analysis showed that marital status, exposure history and social support had significant effects on depression (χ2 = 10.626, 6.005, 3.984, P < 0.05). Regression analysis showed that marital status (OR = 0.375, 95% CI: 0.186–0.754, P < 0.05) and social support (OR = 2.206, 95% CI: 1.016–4.789, P < 0.05) were independent influencing factors of depression. The results of GAD‐7 showed the incidence of anxiety in patients with pulmonary nodules was 59.3% (108/182). Univariate analysis showed that anxiety was correlated with a history of chronic disease, psychological disease and social support (χ2 = 9.949, 8.356, 11.872, P < 0.05). Further regression analysis showed that a previous history of psychological disease (OR = 5.088, 95% CI: 1.804–14.339) and social support (OR = 2.768, 95% CI: 1.505–5.094), were independent influencing factors of anxiety. Conclusions The results of the study concluded that anxiety was affected by social support and previous psychological factors, while depression was affected by marital status and social support. Doctors should therefore strengthen communication with patients, and alleviate the negative emotions of patients as far as possible.
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Affiliation(s)
- Lihong Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan Zhao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Kayali S, Tekin O. Chronic chest pain in adolescents : Is not only a medical condition, but also a social problem. KONURALP TIP DERGISI 2019. [DOI: 10.18521/ktd.430685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Although transthoracic echocardiography is the dominant imaging modality in CHD, optimal utilisation is unclear. We assessed whether adherence to the paediatric Appropriate Use Criteria for outpatient transthoracic echocardiography could reduce inappropriate use without missing significant cardiac disease. METHODS Using the Appropriate Use Criteria, we determined the indication and appropriateness rating for each initial echocardiogram performed at our institution during calendar year 2014 (N=1383). Chart review documented ordering provider training, patient demographics, and study result, classified as normal, abnormal, or abnormal motivating treatment within a 2-year follow-up period. We tested whether provider training level or patient age correlated with echocardiographic findings or appropriateness rating. RESULTS We found that 83.9% of echocardiograms were normal and that 66.7% had an appropriate indication. Nearly all abnormal results and all results motivating treatment were in appropriate studies, giving an odds ratio of 2.73 for an abnormal result if an appropriate indication was present (95% confidence interval 1.92-3.89, p<0.001). None of the remaining initial abnormal results with less than appropriate indications became significant, resulting in treatment over 2 years. Results suggest a potential reduction in imaging volume of as much as 33% with application of the criteria. Cardiologists ordered nearly all studies resulting in treatment but also more echocardiograms with less appropriate indications. Most examinations were in older patients; however, most abnormal results were in patients younger than 1 year. CONCLUSIONS The Appropriate Use Criteria can be used to safely reduce echocardiography volume while still detecting significant heart disease.
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Bolat N, Eliacik K, Yavuz M, Kanik A, Mertek H, Guven B, Dogrusoz B, Bakiler AR. Adolescent mental health, attachment characteristics, and unexplained chest pain: a case–control study. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1454374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Nurullah Bolat
- Department of Child and Adolescent Psychiatry, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Kayi Eliacik
- Division of Adolescent Medicine, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Mesut Yavuz
- Department of Psychology, İstanbul Aydin University, İstanbul, Turkey
- Child and Adolescent Psychiatry, French Lape Hospital, İstanbul, Turkey
| | - Ali Kanik
- Department of Paediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hilal Mertek
- Department of Paediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Baris Guven
- Department of Paediatric Cardiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Buket Dogrusoz
- Department of Paediatric Cardiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ali Rahmi Bakiler
- Department of Paediatric Cardiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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