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Cheng DT, Wee LYJ, Teoh OH, Thomas B. Approach to difficult-to-treat asthma in childhood: a narrative review. Singapore Med J 2024:00077293-990000000-00095. [PMID: 38363652 DOI: 10.4103/singaporemedj.smj-2023-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/02/2023] [Indexed: 02/18/2024]
Abstract
ABSTRACT Asthma is a major chronic disease affecting children, and children with difficult-to-treat asthma account for a disproportionate share of resource utilisation and healthcare costs. This review presents a comprehensive and up-to-date overview of the treatment strategies in difficult-to-treat paediatric asthma. Mimickers of asthma must first be ruled out, and the diagnosis confirmed with objective tests whenever possible. The effect of comorbid conditions such as obesity, smoking, other atopic conditions and psychosocial factors on asthma control and severity should be considered. Treatment can then be optimised by implementing personalised strategies, including the use of appropriate drug delivery devices and adherence monitoring. Biologics can be an alternative treatment option for selected patients but should not be a substitute for addressing poor adherence. Many patients with difficult-to-treat asthma may not have severe asthma, and the physician should work with patients and families to achieve good asthma control via an individualised approach.
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Affiliation(s)
- Duo-Tong Cheng
- Department of Paediatrics, Respiratory Medicine Service, KK Women's and Children's Hospital, Singapore
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Sun W, Li J, Zhou J, Li S, Hou L, Xiao W, Luo Z, Shan S, Zhang R, Song P. Meeting the Canadian 24-Hour Movement Guidelines and physical-mental comorbidity among Chinese children and adolescents: Prevalence, associations, and the population impacts. J Psychosom Res 2024; 176:111544. [PMID: 37977093 DOI: 10.1016/j.jpsychores.2023.111544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To examine the association between meeting the Canadian 24-Hour Movement Guidelines and physical-mental comorbidity among children and adolescents in a cross-sectional study. METHODS A total of 21,061 students aged 11-17 years from Zhejiang Province, China was recruited in the study. We examined the coexistence of five specific physical illnesses - hypertension, high myopia, dental caries, scoliosis, and obesity - with mental illness, specifically depressive symptoms. Generalized linear mixed models were performed to assess the association between overall and specific combinations of movement guidelines and physical-mental comorbidity, presented by odds ratio (OR) and 95% confidence interval (CI). Population attributable fraction (PAF) was calculated to estimate the preventable proportion of comorbid cases via meeting all three movement recommendations. RESULTS Of the included participants, 19.3% had physical-mental comorbidity. There were 3.8% and 17.0% meeting all three and none of the recommendations, respectively. Meeting at least one recommendation, except for moderate-to-vigorous physical activity recommendation only, was associated with a lower risk of physical-mental comorbidity, with ORs (95% CIs) ranging from 0.72 (0.66-0.79) to 0.40 (0.31-0.51). Meeting more recommendations was associated with decreased comorbid risks, and the association was stronger in 4th-6th graders. The association between specific combinations of recommendations and comorbid risks showed differences by gender and grade. Of the comorbid cases, 42.1% were attributed to not adhering to all three recommendations, and the PAFs varied from 27.4% to 55.7% across different genders and grades. CONCLUSION Adherence to the 24-h movement guidelines was associated with lower risks of physical-mental comorbidity among children and adolescents.
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Affiliation(s)
- Weidi Sun
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Juanjuan Li
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, Zhejiang, China
| | - Jiali Zhou
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, Zhejiang, China; School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shuting Li
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Leying Hou
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenhan Xiao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zeyu Luo
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shiyi Shan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ronghua Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, Zhejiang, China.
| | - Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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McVoy M, Miller D, Bransteter I, Gubitosi-Klug R, Segal T, Surdam J, Sajatovic M, Dusek JA. A self-management plus mind body intervention for adolescents and young adults with type 2 diabetes: Trial design and methodological report. Contemp Clin Trials 2023; 133:107317. [PMID: 37625585 DOI: 10.1016/j.cct.2023.107317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The onset of type 2 diabetes (T2D) is increasingly common in adolescents and young adults (AYAs). Improving self-management skills and the mental health of this population is important, but understudied. METHODS The goal of this research was to develop a mind-body intervention which could serve as an adjunctive therapy to support AYAs with T2D (INTEND intervention). Toward that end, we used an iterative process, including use of focus groups, advisory board, and cognitive semi-structured interviews with patients, parents of patient and clinical providers, to understand the gaps in the current information provided to AYAs with T2D. Based on the data gathered from the focus groups and interviews, we enhanced an existing self-management intervention for adults with T2D to include an additional mind body intervention for AYAs with T2D. The INTEND intervention will be piloted in a group of AYAs with T2D. RESULTS This report describes the methodology and design of the InterveNTion for Early oNset type 2 Diabetes (INTEND) study. The details of this single arm pre-post pilot feasibility trial are described. DISCUSSION If successful, the INTEND approach has the potential to advance care for vulnerable youth with T2D.
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Affiliation(s)
- Molly McVoy
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Cleveland Medical Center (UHCMC), USA; Rainbow Babies and Children, UHCMC, USA.
| | | | | | - Rose Gubitosi-Klug
- Case Western Reserve University School of Medicine (CWRU SOM), USA; Rainbow Babies and Children, UHCMC, USA
| | - Tracy Segal
- University Hospitals Connor Whole Health, USA
| | | | - Martha Sajatovic
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Cleveland Medical Center (UHCMC), USA
| | - Jeffery A Dusek
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Connor Whole Health, USA
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Sheng N, Ouyang N, Zhou P, Ge B, Cheng F, Lv H. Caregiver engagement interventions on reducing the anxiety and depression of children with chronic health conditions and their caregivers: A meta-analysis of randomized controlled trials. J Pediatr Nurs 2023:S0882-5963(23)00104-5. [PMID: 37164784 DOI: 10.1016/j.pedn.2023.04.015] [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: 09/20/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Anxiety and depression are common debilitating mental health issues in families of children with chronic health conditions. It is essential to consider the mediating role of caregivers between children and healthcare workers. Previous research has evaluated the effectiveness of caregiver engagement interventions in reducing anxiety and depression in chronically ill children and their caregivers, but their overall impact awaits a synthesis of the available evidence. METHODS We performed a comprehensive search using PubMed, Embase, Web of Science, Cochrane Library, Ovid, PsycINFO, APA PsycArticles, and Cumulative Index of Nursing and Allied Health Literature (CINAHL). RESULTS Twenty-nine studies were included. The results demonstrated that caregiver engagement interventions significantly decreased anxiety (standardized mean difference [SMD] = -0.49; 95% confidence interval [CI], -0.77 to -0.22; P < 0.001) and depression (SMD = -0.37; 95% CI, -0.55 to -0.18; P < 0.001) among caregivers, particularly in developing countries. However, no improvements in the anxiety (SMD = 0.00; 95% CI, -0.46 to 0.46; P = 0.99) and depression (SMD = -0.14; 95% CI, -0.32 to 0.04; P = 0.14) of children were observed. CONCLUSIONS Significant evidence exists regarding the positive effects of caregiver engagement interventions on caregivers' anxiety and depression. Further recommendations for future research should focus on engagement interventions that reduce the anxiety and depression for children with chronic conditions. IMPLICATIONS Clinicians should concentrate on the mental health of chronically ill children and their caregivers and extend caregiver engagement therapies to improve anxiety and depression resulting from managing the disease.
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Affiliation(s)
- Nan Sheng
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Na Ouyang
- School of Nursing, Yale University, CT, USA.
| | - Ping Zhou
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Binqian Ge
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Fangman Cheng
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Han Lv
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
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Muñoz-Violant S, Violant-Holz V, Rodríguez MJ. Factors of well-being of youth with complex medical conditions from the experience of hospitalization and convalescence: A pilot study. PLoS One 2023; 18:e0285213. [PMID: 37141278 PMCID: PMC10159209 DOI: 10.1371/journal.pone.0285213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
Well-being in children with a complex medical condition (CMC) impacts the way they view and communicate with their immediate environment as well as their development, and it is thus necessary to inquire about the contextual issues and different needs that a CMC carries. This pilot study aimed to identify factors of pediatric well-being from the experience of hospitalization and convalescence of youth with CMC and their caregivers, in a cross-sectional analysis using a selective methodology complemented by an indirect observational methodology. We analyzed the quality of life and well-being of youth with CMC using a validated KINDLR questionnaire. We collected 35 surveys: 11 from youth with CMC and 24 from caregivers from Spain. We focused the analysis on sociodemographics, well-being perceptions, and coping strategies variables. The results show that children aged between 3 and 6 years and their caregivers scored physical well-being the lowest out of all dimensions of well-being, and they scored family well-being the highest. Moreover, youth between the ages of 7 and 17 years and their caregivers scored school-related well-being the lowest. Coping strategies to deal with stressful situations differ between children and caregivers. While children mainly engage in social withdrawal, caregivers engage in cognitive restructuring and expressing emotions. However, we did not find a relationship between coping strategies and well-being perceptions. These results highlight the need to facilitate communication spaces with both families and health professionals where the voice of children is considered.
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Affiliation(s)
- Sarah Muñoz-Violant
- Hospital Pedagogy in Neonatology and Pediatrics-Research Group, Universitat de Barcelona, Barcelona, Spain
| | - Verónica Violant-Holz
- Hospital Pedagogy in Neonatology and Pediatrics-Research Group, Universitat de Barcelona, Barcelona, Spain
- Department of Didactics and Educational Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain
- International Observatory in Hospital Pedagogy, Universitat de Barcelona, Barcelona, Spain
| | - Manuel J Rodríguez
- Department Biomedical Sciences, Institute of Neurosciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Park H, Sanchez SM, Kuplicki R, Tsuchiyagaito A, Khalsa SS, Paulus MP, Guinjoan SM. Attenuated interoceptive processing in individuals with major depressive disorder and high repetitive negative thinking. J Psychiatr Res 2022; 156:237-244. [PMID: 36270063 PMCID: PMC11008725 DOI: 10.1016/j.jpsychires.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/30/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Repetitive negative thinking (RNT) is a transdiagnostic symptom associated with poor outcomes in major depressive disorder (MDD). MDD is characterized by altered interoception, which has also been associated with poor outcomes. The present study investigated whether RNT is directly associated with altered interoceptive processing. Interoceptive awareness toward the heart and stomach was probed on the Visceral Interoceptive Attention (VIA) task with fMRI in MDD individuals who were propensity-matched on the severity of depression and anxiety symptoms and relevant demographics but different in RNT intensity (High RNT [H-RNT, n = 48] & Low RNT [L-RNT, n = 49]), and in matched healthy volunteers (HC, n = 27). Both H-RNT and L-RNT MDD individuals revealed reduced stomach interoceptive processing compared to HC in the left medial frontal region and insular cortex (H-RNT: β = -1.04, L-RNT: β = -0.97), perirhinal cortex (H-RNT: β = -0.99, L-RNT: β = -1.03), and caudate nucleus (H-RNT: β = -1.06, L-RNT: β = -0.89). However, H-RNT was associated with decreased right medial temporal lobe activity including the hippocampus and amygdala during stomach interoceptive trials (β = -0.61) compared to L-RNT. Insular interoceptive processing was similar in H-RNT and L-RNT participants (β = -0.07, p = 0.92). MDD individuals with high RNT exhibited altered gastric interoceptive responses in brain areas that are important for associating the information with specific contexts and emotions. Attenuated interoceptive processing may contribute to RNT generation, non-adaptive information processing, action selection, and thus poor treatment outcome.
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Affiliation(s)
- Heekyeong Park
- Laureate Institute for Brain Research, Tulsa, OK, USA; Department of Psychology, University of North Texas, Dallas, TX, USA
| | | | | | | | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Salvador M Guinjoan
- Laureate Institute for Brain Research, Tulsa, OK, USA; Department of Psychiatry, Oklahoma University Health Sciences Center, Tulsa, OK, USA.
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Waters RC, Gould E. Early Life Adversity and Neuropsychiatric Disease: Differential Outcomes and Translational Relevance of Rodent Models. Front Syst Neurosci 2022; 16:860847. [PMID: 35813268 PMCID: PMC9259886 DOI: 10.3389/fnsys.2022.860847] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
It is now well-established that early life adversity (ELA) predisposes individuals to develop several neuropsychiatric conditions, including anxiety disorders, and major depressive disorder. However, ELA is a very broad term, encompassing multiple types of negative childhood experiences, including physical, sexual and emotional abuse, physical and emotional neglect, as well as trauma associated with chronic illness, family separation, natural disasters, accidents, and witnessing a violent crime. Emerging literature suggests that in humans, different types of adverse experiences are more or less likely to produce susceptibilities to certain conditions that involve affective dysfunction. To investigate the driving mechanisms underlying the connection between experience and subsequent disease, neuroscientists have developed several rodent models of ELA, including pain exposure, maternal deprivation, and limited resources. These studies have also shown that different types of ELA paradigms produce different but somewhat overlapping behavioral phenotypes. In this review, we first investigate the types of ELA that may be driving different neuropsychiatric outcomes and brain changes in humans. We next evaluate whether rodent models of ELA can provide translationally relevant information regarding links between specific types of experience and changes in neural circuits underlying dysfunction.
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Affiliation(s)
| | - Elizabeth Gould
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, United States
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