Family environment, child behavior, and medical indicators in children with kidney disease

International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024

The "International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024" updates and replaces the "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates-2006" and the "2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update." The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.

Socioeconomic status and problem behaviors in young Chinese children: A moderated mediation model of parenting styles and only children

Introduction

This study tested a moderated mediation model of child number (CN) and parenting styles (PS) in the relationships between family socioeconomic status (SES) and young children's problem behaviors (PB).

Methods

A sample of 1,101 children (M_age = 4.90 years, SD = 1.07) and their parents participated in this study. Parents reported on PS, SES, and children's PB.

Results and Discussion

The results show SES was positively related to authoritative parenting and negatively related to authoritarian parenting; problem behaviors were negatively related to authoritative parenting and positively related to authoritarian parenting; authoritative parenting and authoritarian parenting mediated the relationship between SES and PB; and singleton moderated the relationship between SES and PB. The combination of only children and low levels of SES could lead to high PB levels, while the combination of non-only children and high levels of SES could lead to high PB levels. At the same SES, only children had higher PB levels than non-only children.

A Review of Family Environment and Neurobehavioral Outcomes Following Pediatric Traumatic Brain Injury: Implications of Early Adverse Experiences, Family Stress, and Limbic Development

Pediatric traumatic brain injury (TBI) is a public health crisis, with neurobehavioral morbidity observed years after an injury associated with changes in related brain structures. A substantial literature base has established family environment as a significant predictor of neurobehavioral outcomes following pediatric TBI. The neural mechanisms linking family environment to neurobehavioral outcomes have, however, received less empiric study in this population. In contrast, limbic structural differences as well as challenges with emotional adjustment and behavioral regulation in non-TBI populations have been linked to a multitude of family environmental factors, including family stress, parenting style, and adverse childhood experiences. In this article, we systematically review the more comprehensive literature on family environment and neurobehavioral outcomes in pediatric TBI and leverage the work in both TBI and non-TBI populations to expand our understanding of the underlying neural mechanisms. Thus, we summarize the extant literature on the family environment's role in neurobehavioral sequelae in children with TBI and explore potential neural correlates by synthesizing the wealth of literature on family environment and limbic development, specifically related to the amygdala. This review underscores the critical role of environmental factors, especially those predating the injury, in modeling recovery outcomes post-TBI in childhood, and discusses clinical and research implications across pediatric populations. Given the public health crisis of pediatric TBI, along with the context of sparse available medical interventions, a broader understanding of factors contributing to outcomes is warranted to expand the range of intervention targets.

Family functioning mediates the relationship between child behavior problems and parent feeding practices in youth with overweight or obesity

Parental feeding practices play a significant role in children's health behaviors. Given the high prevalence of childhood obesity, it is important to examine factors that may influence parental feeding practices. This study examined the role of family functioning on the relationship between child behavior problems and parent feeding practices. We hypothesized that higher problematic child behavior would correlate with lower parental engagement in healthy parent feeding practices, with greater family dysfunction mediating that relationship. Participants (n = 220) were rural-dwelling parents of school-aged children with overweight or obesity. Participants completed the McMaster Family Assessment Device, Child Behavior Checklist (CBCL), and Child Feeding Questionnaire at baseline. Mediation models were used with youth behavioral problems (CBCL) as the independent variable, parental feeding practices as the dependent variable, and family functioning as the mediator. Two significant mediation models revealed (a) family functioning mediated the relationship between child behavior problems and parental perception of responsibility taking for child eating, and (b) family functioning mediated the relationship between child behavior problems and parental monitoring of their child's eating. More child behavior problems were associated with unhealthier family functioning, which was associated with less parental monitoring of children's unhealthy food intake and reduced responsibility taking for feeding and meal planning of their children. These findings suggest the synergistic effect of child behavior problems with poorer family functioning may be a risk factor for unhealthy parent feeding practices in children with overweight or obesity. If these relationships are supported by longitudinal research, behavior interventions for children with obesity should consider poor family functioning and child behavior as potential barriers to parental monitoring and responsibility of children's feeding practices.

Psychosocial functioning in pediatric heart transplant recipients and their families

Across pediatric organ transplant populations, patient and family psychosocial functioning is associated with important health-related outcomes. Research has suggested that pediatric heart transplant recipients and their families are at increased risk for adverse psychosocial outcomes; however, recent investigation of psychosocial functioning in this population is lacking. This study aimed to provide a contemporary characterization of psychosocial functioning in pediatric heart transplant recipients and their families. Associations between psychosocial function, demographic variables, and transplant-related variables were investigated. Fifty-six parents/guardians of pediatric heart transplant recipients completed a comprehensive psychosocial screening measure during transplant follow-up clinic visits. Descriptive statistics, correlational analyses, and independent samples t tests were performed. Forty percent of pediatric heart transplant recipients and their families endorsed clinically meaningful levels of total psychosocial risk. One-third of patients presented with clinically significant psychological problems per parent report. Psychosocial risk was unassociated with demographic or transplant-related factors. Despite notable improvements in the survival of pediatric heart transplant recipients over the past decade, patients and families present with sustained psychosocial risks well beyond the immediate post-transplant period, necessitating mental health intervention to mitigate adverse impact on health-related outcomes.

A systematic review of parent and family functioning in pediatric solid organ transplant populations

The process of pediatric solid organ transplantation (SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict psychological and health outcomes for pediatric patients and their families, and provide opportunity for targeted intervention. This systematic review investigated parent and family functioning and factors associated with poorer functioning in the pediatric SOT population. Thirty-seven studies were identified and reviewed. Studies featured a range of organ populations (eg, heart, liver, kidney, lung, intestine) at various stages in the transplant process. Findings highlighted that parents of pediatric SOT populations commonly report increased stress and mental health symptoms, including posttraumatic stress disorder. Pediatric SOT is also associated with increased family stress and burden throughout the transplant process. Measures of parent and family functioning were associated with several important health-related factors, such as medication adherence, readiness for discharge, and number of hospitalizations. Overall, findings suggest that family stress and burden persists post-transplant, and parent and family functioning is associated with health-related factors in SOT, highlighting family-level functioning as an important target for future intervention.

Sibship and Self-esteem in Children with Asthma

This study has explored the valence of sibship that may empower the self-esteem of children with asthma at the interpersonal, environmental control competence, emotionality management, and body-image levels. It has been assumed that the relationship between siblings may have a moderating effect on the negative impact that asthma has on child's development. Seventy children suffering from chronic asthma have been involved: 40 children with siblings (experimental group) and 30 sibling-free children (control group). The children with asthma have exhibited higher levels of self-esteem in comparison with the sibling-free children. The results of the study, at the clinical significance level, highlight how meaningful could be the involvement of healthy siblings to support the development, and to ease the compliance of children suffering from asthma. The outcomes have confirmed the supportive valence of sibship for the self-esteem of the children with asthma.

Family Functioning and the Well-Being of Children With Chronic Conditions: A Meta-Analysis

For children with chronic conditions, well-being is closely related to how well their families function. Most prior research syntheses on family functioning and child well-being have focused on children with a single condition, thereby limiting the potential to aggregate and build on what is known across conditions. To address this challenge, research reports were reviewed and meta-analyses conducted of findings on the relationship between family functioning and child well-being across a range of chronic physical conditions. The sample was derived from a larger systematic review study that included 1,028 reports published between January 1, 2000 and March 31, 2014. The current review includes 53 studies in which a relationship between family functioning and child well-being was analyzed using one of four family measures: Family Adaptability and Cohesion Evaluation Scales, Family Environment Scale, Family Relationship Index, or Family Assessment Device. Most studies were cross-sectional and observational (n = 43, 81%). The most frequently studied conditions were diabetes, cancer, sickle cell disease, and asthma. In 37 studies, findings were sufficiently comparable to conduct meta-analyses. Significant correlations were identified between children's psychological health and seven of nine dimensions of family functioning. Significant correlations also were found between dimensions of family functioning and children's problem behaviors, social competence, quality of life, and, to a lesser extent, adherence and physical health. Of the family dimensions, cohesion and conflict were associated most strongly with child outcomes. Understanding the specific family variables, such as conflict, linked to varied child outcomes is key for intervention development. © 2016 Wiley Periodicals, Inc.

Health-related quality of life of children and adolescents with CKD stages 4-5 and their caregivers

BACKGROUND

Renal replacement therapies may affect the quality of life of patients and their primary caregivers (PC).

METHODS

This study describes the perception of health-related quality of life (HRQoL) of children/adolescents with CKD stages 4-5, as well as of their PC (n = 64), in comparison to healthy peers and their PC (n = 129), respectively, based on the Peds QL™ 4.0 and Short Form-36 (SF-36) questionnaires and selected biomarkers.

RESULTS

Patients reported a deleterious impact on physical capacity and on social and school activities. A negative influence on emotional aspects was reported by older patients, but not by their PC. Hemodialysis, followed by peritoneal dialysis, had a more negative impact on patients' physical functioning domain. PC HRQol proxy reports differed from those of their children, especially in older patients. PC of both groups presented similar SF-36 scores. An association was demonstrated between the magnitude of treatment target inadequacies, lower specific dominion scores in the patients/PC proxy reports and PC SF-36 general health scores.

CONCLUSION

The HRQoL of patients with CKD stages 4-5 is negatively affected to different degrees depending on age and treatment modality. The results suggest an association between worsening HRQoL parameters and inadequate control of recognized therapeutic CKD treatment targets.

Good cop, bad cop: quality of parental involvement in type 1 diabetes management in youth

Sustained parental involvement in diabetes management has been generally advised to counteract the deteriorating adherence and glycemic control often seen during adolescence, yet until recently, little attention has been given to the optimal amount, type, and quality of parental involvement to promote the best health outcomes for adolescents with type 1 diabetes (T1D). This review synthesizes research regarding the involvement of caregivers-primarily mothers and fathers-of youth with T1D, with a focus on biopsychosocial outcomes. The recent literature on parental involvement in diabetes management highlights a shift in focus from not only amount but also the types (e.g., monitoring, problem-solving) and quality (e.g., warm, critical) of involvement in both mothers and fathers. We provide recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with T1D.

Coesão familiar associada à saúde bucal, fatores socioeconômicos e comportamentos em saúde

Pesquisas sobre saúde geral têm relacionado coesão familiar a fatores socioeconômicos e comportamentais. O objetivo deste estudo foi investigar a associação entre coesão familiar e fatores socioeconômicos, comportamentais e de saúde bucal. Este foi um estudo transversal com amostra por conglomerados em dois estágios. A amostra randomizada de 524 adolescentes era proveniente de escolas públicas da cidade de Piracicaba-SP. As variáveis foram avaliadas por questionários autoaplicáveis e os dados de saúde bucal, pelos índices CPO e CPI. A coesão familiar percebida pelo adolescente foi avaliada por meio da escala de adaptabilidade e coesão familiar. Análise univariada e regressão logística multinominal mostraram que adolescentes com baixa coesão familiar apresentaram mais chance de terem baixa renda (OR 2,28 IC95% 1,14-4,55), presença de cárie (OR 2,23 IC95% 1,21-4,09) e baixa frequência de escovação diária (OR 1,91 IC95% 1,03-3,54). Adolescentes com alta coesão familiar apresentaram mais chance que adolescentes com média coesão de terem alta renda e fator de proteção contra o hábito de tabagismo. Desta forma, a coesão familiar percebida pelo adolescente associou-se com variáveis comportamentais, socioeconômicas e de saúde bucal, indicando a importância de uma abordagem integral da saúde do paciente.

Quality of life and adjustment in youths with asthma: the contributions of family rituals and the family environment

This cross-sectional study explored the relationships among family ritual meaning, cohesion, conflict, and health-related quality of life (both specific to chronic health conditions and in general), and the emotional and behavioral problems reported by youths with asthma. Participants included 149 Portuguese children and adolescents between the ages of 8 and 18 who had been diagnosed with asthma and attended outpatient services at three public hospitals. The results showed that stronger family ritual meaning predicted a more positive family environment (i.e., higher cohesion levels and lower conflict levels), better health-related quality of life, and fewer emotional and behavior problems in youths. Furthermore, family cohesion and conflict mediated the links between family ritual meaning and health-related quality of life, and emotional and behavioral problems. These results did not change after controlling for participant age, gender, and asthma severity. The findings of this study suggest that family ritual meaning contributes to the adaptation of youths with asthma via its positive association with the family environment. The implications for multicontextual interventions with families are briefly discussed with regard to the positive role of family rituals and of their potential as a modifiable factor in families with increased health challenges.

Depressive symptomatology in children and adolescents with chronic renal insufficiency undergoing chronic dialysis

This paper presents a descriptive study, using the Birleson Scale to determine the frequency of depressive symptomatology in children and adolescents with chronic renal insufficiency (CRI) undergoing hemodialysis (HD) and chronic peritoneal dialysis (CPD). There were 67 patients (40 female and 27 male) with a mean age of 14.76 ± 2.71 years, duration of illness ≥3 months, 43 (64.18%) patients with CPD and 24 (35.82%) undergoing HD. The frequency of high occurrence, low occurrence, and absence of depressive symptomatology was 10.45% (n = 7), 43.28% (n = 29), and 46.27% (n = 31), respectively; all of the seven (100%) patients with high occurrence of depressive symptomatology were female (P = 0.04), and none of these (0%) had a friend to confide in (P = 0.03). Depressive symptomatology in patients with CPD was associated with a lower weekly K(t)/V compared to those without depressive symptomatology (2.15 ± 0.68 versus 2.52 ± 0.65; P = 0.01). There was no association with patient age, caregiver, time and dialysis type, anemia, bone disease, nutritional or financial status, origin, schooling, or employment.

Health care transition for adolescents with CKD-the journey from pediatric to adult care

The design of Health Care Transition (HCT) services for adolescents and emerging adults with CKD or end-stage kidney disease (ESKD) needs to take into account patient cognition/developmental stage, family factors, and health resources within the hospital setting and community. Patient and family education is fundamental and teaching and learning tools must be literacy-accessible. Adolescents and emerging adults with CKD/ESDK have complex medical and dietary regimes, and therapeutic adherence is important for optimizing their health, quality of life, and longevity. Health providers need to identify ways of engaging them to become successful disease self-mangers. Interdisciplinary collaboration between the pediatric- and adult-focused health care teams and the services of a dedicated transition coordinator are paramount to ensure clear communication between the patient and the health professionals involved. Valid measurement tools to monitor and assess the HCT process and health outcomes need to be developed. The aims of planned HCT for adolescents and/or emerging adults with CKD/ESKD are anchored by the goals of optimizing health outcomes, health-related quality of life, and continuous quality improvement. The care of young people with CKD/ESKD can be both challenging and rewarding; we offer strategies for planned HCT services geared to these vulnerable patients.

Fathers and mothers developing skills in managing children's long-term medical conditions: how do their qualitative accounts compare?

BACKGROUND

Little is known about the respective experience of fathers and mothers within couples when managing their child's long-term medical condition. This study therefore aimed to obtain and compare fathers' and mothers' accounts of managing long-term kidney conditions.

METHODS

Qualitative study involving individual then joint semi-structured interviews with 14 couples (biological fathers and mothers of 15 children whose care is managed at a specialist unit). Interviews were digitally recorded, transcribed and analysed using Framework Analysis. Transcripts within and across couples were compared.

RESULTS

Fathers and mothers made a significant contribution to management and a key theme identified was 'developing skills' in: information processing, sharing/negotiating caregiving, restraining children, adapting to treatment regimens and communicating. Although skill development was often a challenging and uncertain process, both fathers and mothers wanted to and did participate in caregiving; they often negotiated this with each other to accommodate caring for other children, paid employment and to provide mutual practical and emotional support. Developing skills in holding their child for procedures and treatments was a major concern, but it was fathers who assumed the 'protector' role and worried more about their child's long-term health and well-being, while mothers concerned themselves more with current clinical issues and maintaining relationships with professionals. Expressing appreciation for fathers' and mothers' skill development may promote good 'working relationships' between professionals and both parents over the many years of the trajectory.

CONCLUSION

Developing skills for home-based caregiving of long-term conditions is a challenging and uncertain process. Both parents often participate in caregiving, and the findings reported here may help professionals decide how best to support both parents in their home-based caregiving.

Fathers' contributions to the management of their child's long-term medical condition: a narrative review of the literature

CONTEXT

Fathers' contributions to the management of long-term childhood medical conditions are under-represented in the literature; therefore, the full extent of their involvement is poorly understood by practitioners and researchers, so strategies for promoting their involvement have not yet been fully considered.

OBJECTIVE

To review studies of fathers' actual contributions in a wide range of conditions, the potential to optimize their contribution through additional interventions by health professionals and a direction for future research.

DESIGN

Narrative review of the literature.

METHODS

CINAHL, Medline, PsychInfo and ERIC databases were searched electronically between the years 1995-2008. The terms adherence, adjustment, child, chronic, compliance, concordance, condition, coping, disease, father, illness, information, long-term, management/intervention, mother, role, self-care and treatment were searched for separately and in combination. English language papers reporting primary research were selected and supplemented by hand-searching reference lists. Thirty-five papers (arising from 29 studies) met criteria and were selected for narrative review.

RESULTS

Five themes were identified: (i) the impact of long-term conditions on fathers' ability to promote their child's well-being, (ii) factors influencing fathers' involvement in health care, (iii) personal growth/beneficial effects for fathers, (iv) the impact of father's involvement on family functioning and (v) strategies that increase fathers' participation in their child's health care and in research investigating fathers' participation.

CONCLUSIONS

The review suggests that fathers' involvement in children's health care can positively impact on fathers', mothers' and children's well-being and family functioning. A range of strategies are identified to inform the promotion of fathers' contributions and future research investigating their input.

Pediatric chronic kidney disease and the process of health care transition

Health care transition is a process that involves purposeful, planned efforts to prepare the pediatric patient to move from caregiver-directed care to disease self-management. Acquisition of sufficient disease self-management skills for a complex regimen requires cognitive ability consideration for each patient. Transition programs that involve patients, families, pediatric and adult health care providers, and interdisciplinary collaboration are key to ensuring a successful transfer to adult-focused health services. Tools to measure and diagnose the process of transition and acquisition of disease self-management skills are introduced. An evidence-based transition process requires planning and education, in addition to effective coordination.

Intellectual and motor performance, quality of life and psychosocial adjustment in children with cystinosis

Cystinosis is a rare multisystemic progressive disorder mandating lifelong medical treatment. Knowledge on the intellectual and motor functioning, health-related quality of life and psychosocial adjustment in children with cystinosis is limited. We have investigated nine patients (four after renal transplantation) at a median age of 9.7 years (range 5.3-19.9 years). Intellectual performance (IP) was analysed with the Wechsler Intelligence Scale for Children-III (seven children) and the Kaufman Assessment Battery for Children (two children). Motor performance (MP) was evaluated using the Zurich Neuromotor Assessment Test, and quality of life (QOL) was studied by means of the Netherlands Organization for Applied Scientific Research Academical Medical Center Child Quality of Life Questionnaire. Psychosocial adjustment was assessed by the Child Behavior Checklist. The overall intelligence quotient (IQ) of our patient cohort (median 92, range 71-105) was significantly lower than that of the healthy controls (p = 0.04), with two patients having an IQ < 85. Verbal IQ (93, range 76-118) was significantly higher than performance IQ (90, range 68-97; p = 0.03). The MP was significantly below the norm for pure motor, pegboard and static balance, as well as for movement quality. The patients' QOL was normal for six of seven dimensions (exception being positive emotions), whereas parents reported significant impairment in positive emotions, autonomy, social and cognitive functions. Significant disturbance was noted in terms of psychosocial adjustment. Based on the results from our small patient cohort, we conclude that intellectual and motor performance, health-related QOL and psychosocial adjustment are significantly impaired in children and adolescents with cystinosis.

Behavior profile of children with nephrotic syndrome

BACKGROUND

Nephrotic syndrome, a primarily paediatric disease, is associated with a high relapse rate. Studies have reported behavioral and psychological difficulties in children with nephrotic syndrome, their caregivers and siblings, a factor that is likely to influence the overall outcome of the disease in an adverse manner. In clinical practice, however, the psychosocial aspects of care may be overlooked in the pressure to treat the disease process, unless their importance is stressed by appropriate evidence.

OBJECTIVES

The study aims to assess the prevalence of behavior abnormalities in children with nephrotic syndrome attending the renal clinic of a state medical college in eastern India and to compare this with the prevalence in a control group of school children without any detectable physical illness. It also aims to explore the relationship between sociodemographic, disease, and treatment related variables and behavioral abnormalities in the nephrotic syndrome group.

MATERIALS AND METHODS

We assessed the prevalence of behavior abnormalities in 50 consecutive children with nephrotic syndrome attending the renal clinic of a state medical college and 51 school children as controls using the Developmental Psychopathology Checklist (DPCL). We also assessed the statistical association between sociodemographic, disease and treatment related variables and behavior profile in the nephrotic children group.

RESULTS

Prevalence of behavior disturbance in children with nephrotic syndrome was 68%, significantly higher than that in the control group (21.6%). The behavior abnormalities found in the nephrotic syndrome group were hyperkinesis, obsessive compulsive neurosis, conduct disorder, and emotional disorder, in that order. Frequency of relapse and low socioeconomic status showed significant association with presence of behavior disturbance in the nephrotic syndrome group. This association persisted even after adjusting for other sociodemographic, disease, and treatment related variables, including steroid therapy.

Psychosocial functioning of pediatric renal and liver transplant recipients

The current study examined child- and parent-reported child psychosocial functioning in a large sample of children who received solid organ transplantation. Participants included 64 children who received kidney or liver transplantation and 64 parents who completed a standardized measure of children's psychosocial functioning (BASC; Reynolds & Kamphaus, 1992). Although post-transplant children reported significantly fewer psychosocial difficulties than the normative average, parents reported that children had some psychosocial difficulties, particularly internalizing problems. There were no differences in psychosocial functioning between deceased donor organ and living donor organ recipients. Given the discrepancy between parent and child report, the results suggest that children may underreport psychosocial difficulties following transplantation or parents may over-report children's difficulties. Clinicians and researchers are encouraged to obtain assessment information from multiple reporters when assessing psychosocial functioning in this population.

Outcome after renal transplantation. Part II: quality of life and psychosocial adjustment

Knowledge of health-related quality of life (QOL) and psychosocial adjustment (PA) in children after renal transplantation (RTPL) is limited. QOL and PA were evaluated by standardized tests in patients after RTPL. Thirty-seven children of median age 14.5 years (range 6.5-17 years) were investigated a mean 4.5 years (range 0.5-12.8 years) after RTPL. Child- and parent-rated QOL was evaluated with the Child Quality of life Questionnaire of The Netherlands Organization for Applied Scientific Research Academical Medical Centre (TNO-AZL). PA was assessed by the Child Behaviour Checklist (CBCL) providing parental reports of a child's behaviour. In patients' self-ratings, the QOL dimension physical complaints (P < 0.0005) scored significantly better than that of healthy controls, whereas the dimension positive emotional functioning was impaired (P = 0.02). Parents rated motor functioning (P = 0.002), autonomy (P = 0.01), cognition (P = 0.04) and positive emotions (P < 0.0005) as significantly impaired. Parents also assessed PA significantly (P = 0.02) impaired with regard to internalizing behaviour. Dialysis duration, young age at RTPL, living-related donation, steroid treatment, adverse family relationships and maternal distress had a significantly negative impact on QOL and PA (P < 0.05). Patients rated QOL higher than did healthy controls. Parents evaluated their children's QOL and PA more pessimistically than did the patients themselves. Both illness-related variables and family environment played an important role.

Factors associated with depression and resilience in asthmatic children

The purposes of this study were to examine relationship between depression and resilience in children with asthma and identify factors associated with depression. Data were collected from 86 children who ranged in age from 10 to 15 years and who had been diagnosed with asthma for over 6 months. Resilience was measured with an instrument developed by Kim (2002) and depression with the Child Depression Inventory by Kovac (1985). The results showed that older children, children with lower resilience scores, and children whose parents were rigid and restrictive had significantly more depression. Education on parenting should be included in comprehensive care programs for asthmatic children.

Psicopatología del síndrome nefrótico idiopático en la edad pediátrica

AIM

To analyze the influence of several variables in the genesis of psychological morbidity in children with idiopathic nephrotic syndrome (INS) as compared with healthy controls.

METHODS

The Strengths and Difficulties Questionnaire (SDQ) was administered to children with INS (n = 23) and a control group of healthy children (n = 38). The SDQ is a well-known screening instrument for psychological/psychiatric morbidity in childhood. The questionnaire consists of five scales that evaluate emotional symptoms, behavioral problems, hyperactivity, peer problems and prosocial behavior. The total score is calculated by adding all the subscales except the prosocial behavior scale. In children with INS, type of treatment, sex, steroid dose, disease stage, disease duration, and prognosis (number of relapses/disease stage) were also noted.

RESULTS

Statistically significant differences were found in two of the scales (emotional symptoms and peer problems), as well as in the total score in children with INS as compared with the control group (p < 0.05). A positive correlation was found between disease duration and total score in the INS group.

CONCLUSIONS

Emotional and behavioral problems were more frequent in children with INS. The only variable related to the severity of the symptoms studied in these children was disease duration.

Trends in treatment and outcomes of survival of adolescents initiating end-stage renal disease care in the United States of America

This study characterizes treatment and outcome trends of adolescent patients initiating renal replacement therapy in the USA from 1978 to 2002. This is a retrospective analysis of data from the US Renal Data System (USRDS) of incident end-stage renal disease (ESRD) patients, ages 12 years through 19 years, initiating renal replacement therapy between 1978 and 2002. Survival analyses were conducted from either the first date of kidney failure or date of transplantation until death or 31 December 2002. The ESRD incidence per million adolescents increased from 17.6 in 1978 to 26.0 in 1990, with no change in incidence in the ensuing 12 years. Incidence was slightly higher among males than females and was twice as great in black than in white populations. The major cause of ESRD was glomerulonephritis followed by cystic/congenital diseases and focal segmental glomerulosclerosis (FSGS). Incidence increased with age, from 13.0 per million for children aged 13 years to 32.6 per million for 19 year olds. Three-quarters of all adolescent patients received at least one transplant, and one-fifth of patients received two or more transplants. Ten percent of incident adolescent patients received a preemptive transplant. The 10-year survival rate was lowest in the 1978-1982 incident cohort (77.6%) and improved to approximately 80% for later cohorts. Survival was better for younger adolescents, transplant recipients, preemptive transplant recipients, males, Caucasian, and Asian patients. The primary mode of renal replacement therapy is transplantation in most adolescent ESRD patients. The 80% 10-year survival rate for adolescent-onset ESRD is very good when compared with adult-onset ESRD. However, this represents a 30-fold increase in mortality compared to the general US adolescent population.

An example of psychological adjustment in chronic illness: Hirschsprung's disease

The aim of this study was to investigate the outcomes after definitive surgical correction for children with Hirschsprung's disease (HD) and the psychosocial impact of HD on the child and family. The total sample comprised 72 children with HD along with their families. The development of a condition-specific questionnaire measured the functional and psychosocial outcomes for children with HD with parental perception of their child's condition. Psychiatric measures were also examined to assess psychiatric morbidity. The greatest functional problem after definitive surgery for HD was faecal soiling (76%). The principle findings of the study were that (1) HD did not have a significant impact on the child's rate of psychiatric morbidity and levels of hopefulness in comparison to the normal population, (2) surgical and psychosocial functioning improved with increasing age and, (3) families remain troubled about their future with HD and dealing with psychosocial difficulties related to the condition (such as distress because of faecal soiling). Specifically, faecal soiling was found to be physically, emotionally and psychosocially distressing complication. Bowel functioning and psychosocial distress improves with increasing age and parental and medical professional support. Despite the significant impairment of faecal continence, we found that children/young adults with HD have minimal psychiatric morbidity, yet experience condition-specific psychosocial problems (e.g. embarrassment and distress/discomfort). HD does not increase the rate of clinical psychiatric morbidity in children and families with HD, but does determine the context of their daily distress and concern.

Strengthening the parent-child relationship: a review of family interventions and their use in medical settings

The quality of family functioning is important for both psychological well-being and physical health. This review describes family interventions that aim to improve the strength of the parent-child relationship and considers ways in which these approaches can be applied to physical health care. This review first describes the development of family therapy in dealing with children's behavioural and emotional difficulties. As shown in psychotherapeutic settings, parenting skills can affect children's emotional well-being and ability to control their own conduct. Intervention strategies that focus on developing the ability of parents to provide a benign and nurturing parenting style are considered. The review then considers how the principles of family therapy can be applied to settings where physical health is the central issue. In medical settings, families are not only affected by medical interventions but they can also serve to facilitate or hinder clinical effectiveness. Illustrations of how these interventions can be applied in medical settings are provided. Although a practising clinician will need training in using family therapy techniques, it may be possible to recruit a family therapist to help in particular cases.

Health-related quality of life and psychosocial adjustment in steroid-sensitive nephrotic syndrome

OBJECTIVES

To evaluate quality of life (QOL) and psychosocial adjustment by standardized tests in well-characterized patients with steroid-sensitive nephrotic syndrome.

STUDY DESIGN

Forty-five patients were investigated at a median age of 9.8 years (range, 3.4 to 19.8) and 5.9 years (range, 0.1 to 16.3) since diagnosis. Child- and parent-rated QOL was evaluated by the The Netherlands Organization for Applied Scientific Research Academical Medical Center (TNO-AZL) Child Quality of life Questionnaire. Psychosocial adjustment was assessed by the Child Behavior Checklist and the Teacher Report Form.

RESULTS

In patients, only the QOL subscale "social functioning" was impaired compared with that in control subjects, whereas parents rated 4 of a total of 7 subscales as abnormal. Psychosocial adjustment was impaired at home and at school. Steroid dependency and cytotoxic treatment had a significant negative impact on QOL only, whereas family climate, especially maternal distress, negatively affected both QOL and psychosocial adjustment.

CONCLUSIONS

QOL and psychosocial adjustment are impaired in steroid-sensitive nephrotic syndrome. Both illness-related variables and family climate play an important role.