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Fox KR, Rausch JR, Grant VR, Ferketich AK, Groner JA, Garg V, Cua CL, Jackson JL. Associations of Impulsivity and Risky Decision-Making with E-Cigarette-Related Outcomes Among Adolescents with Congenital Heart Disease: Variable- and Person-Oriented Approaches. Behav Med 2024:1-12. [PMID: 38706412 DOI: 10.1080/08964289.2024.2347226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/01/2024] [Indexed: 05/07/2024]
Abstract
Adolescents with congenital heart disease (CHD) have elevated risk for acquired cardiovascular complications, increasing their vulnerability to e-cigarette-related health harms. Impulsivity and risky decision-making have been associated with adolescent substance use, but the relationships between these factors and e-cigarette-related outcomes among cardiovascular at-risk adolescents with CHD are unknown. This cross-sectional study aimed to (a) determine the associations of impulsivity and risky decision-making with e-cigarette-related outcomes (i.e. susceptibility, ever use, perceptions of harm and addictiveness) via variable-oriented analysis (logistic regression), (b) identify groups of adolescents with similar profiles of impulsivity and risky decision-making via exploratory person-oriented analysis (latent profile analysis; LPA), and (c) examine differences on e-cigarette-related outcomes between profile groups. Adolescents aged 12 to 18 years with CHD (N = 98) completed a survey assessing impulsivity facets (Short UPPS-P) and e-cigarette-related outcomes and were administered a risky decision-making task (Iowa Gambling Task, Version 2; IGT2). In variable-oriented analyses, impulsivity facets (negative urgency, positive urgency, lack of premeditation) but not risky decision-making were associated with e-cigarette susceptibility and ever use. The exploratory LPA identified two groups with similar patterns of responding on the Short UPPS-P and IGT2 labeled "Low Impulsivity" and "High Impulsivity," which were primarily characterized by significant differences in negative and positive urgency. Adolescents in the High Impulsivity group had increased odds of e-cigarette susceptibility but not ever use compared to the Low Impulsivity group. This work indicates that strategies to prevent e-cigarette use among adolescents with CHD may be enhanced by addressing impulsivity, particularly negative and positive urgency.
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Affiliation(s)
- Kristen R Fox
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Victoria R Grant
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Judith A Groner
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vidu Garg
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Fox KR, Ferketich AK, Groner JA, Rausch JR, Garg V, Grant VR, Neville SP, Cua CL, Jackson JL. The Association of Global and Disease-Related Stress With Susceptibility to and Use of E-Cigarettes and Marijuana Among Adolescents With Congenital Heart Disease. J Pediatr Psychol 2023; 48:458-467. [PMID: 36810676 PMCID: PMC10199730 DOI: 10.1093/jpepsy/jsad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Adolescents with congenital heart disease (CHD) are exposed to disease-related stressors and have elevated risk for cardiovascular and cognitive complications that are exacerbated by e-cigarettes and marijuana. The aims of this cross-sectional study are to: (1) identify the association between perceived global and disease-related stress and susceptibility to e-cigarettes and marijuana, (2) determine if the association between stress and susceptibility differs by gender, and (3) explore the association between stress and ever use of e-cigarettes and marijuana among adolescents with CHD. METHODS Adolescents with CHD (N = 98; aged 12-18 years) completed self-report measures of susceptibility to/ever use of e-cigarettes and marijuana and global and disease-related stress. RESULTS Susceptibility to e-cigarettes and marijuana was reported by 31.3% and 40.2% of adolescents, respectively. Ever use of e-cigarettes and marijuana was reported by 15.3% and 14.3% of adolescents, respectively. Global stress was associated with susceptibility to and ever use of e-cigarettes and marijuana. Disease-related stress was associated with susceptibility to marijuana. Females reported more global and disease-related stress than males, but the association of stress with susceptibility to e-cigarettes and marijuana did not differ by gender. CONCLUSIONS Susceptibility to e-cigarettes and marijuana is common among adolescents with CHD and is associated with stress. Future work to examine the longitudinal associations between susceptibility, stress, and use of e-cigarettes and marijuana is warranted. Global stress may be an important consideration in the development of strategies to prevent these risky health behaviors among adolescents with CHD.
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Affiliation(s)
- Kristen R Fox
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Judith A Groner
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Vidu Garg
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- The Heart Center and Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Victoria R Grant
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Steven P Neville
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Clifford L Cua
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
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Shenk CE, Rausch JR, Shores KA, Allen EK, Olson AE. Controlling contamination in child maltreatment research: Impact on effect size estimates for child behavior problems measured throughout childhood and adolescence. Dev Psychopathol 2022; 34:1287-1299. [PMID: 33719996 PMCID: PMC8440661 DOI: 10.1017/s0954579420002242] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Contamination, when members of a comparison or control condition are exposed to the event or intervention under scientific investigation, is a methodological phenomenon that downwardly biases the magnitude of effect size estimates. This study tested a novel approach for controlling contamination in observational child maltreatment research. Data from The Longitudinal Studies of Child Abuse and Neglect (LONGSCAN; N = 1354) were obtained to estimate the risk of confirmed child maltreatment on trajectories of internalizing and externalizing behaviors before and after controlling contamination. Baseline models, where contamination was uncontrolled, demonstrated a risk for greater internalizing (b = .29, p < .001, d = .40) and externalizing (b = .14, p = .040, d = .19) behavior trajectories. Final models, where contamination was controlled by separating the comparison condition into subgroups that did or did not self-report maltreatment, also demonstrated risks for greater internalizing (b = .37, p < .001, d = .51) and externalizing (b = .22, p = .028, d = .29) behavior trajectories. However, effect size estimates in final models were 27.5%-52.6% larger compared to baseline models. Controlling contamination in child maltreatment research can strengthen effect size estimates for child behavior problems, aiding future child maltreatment research design and analysis.
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Affiliation(s)
- Chad E Shenk
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Joseph R Rausch
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Elizabeth K Allen
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Anneke E Olson
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
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Jackson JL, Fox KR, Rausch JR, Swenski TN, Neville SP, Marousis NC, Korth CX, Cua CL, Garg V, Vannatta K. A Randomized Clinical Trial Demonstrating Feasibility and Preliminary Efficacy of a Videoconference-Delivered Physical Activity Lifestyle Intervention Among Adolescents With a Congenital Heart Defect. Ann Behav Med 2022; 56:673-684. [PMID: 34951444 PMCID: PMC9274981 DOI: 10.1093/abm/kaab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Individuals with congenital heart defects are at increased risk for developing further cardiovascular complications, which can be mitigated by increasing physical activity. Given that positive health behaviors begin declining during older adolescence, it is vital to promote lifestyle changes in this population. PURPOSE The current study aims to (a) determine the feasibility/acceptability of the Congenital Heart Disease Physical Activity Lifestyle (CHD-PAL) intervention among adolescents (ages 15-18) with moderate and complex congenital heart defects, and (b) estimate the preliminary efficacy of CHD-PAL for increasing time spent in moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness and decreasing sedentary behavior. METHODS Eligible participants were randomized into either CHD-PAL (eight 30-min videoconferencing sessions over 20 weeks with an interventionist + Fitbit + exercise prescription) or a comparator (Fitbit + exercise prescription). RESULTS Sixty adolescents were randomized (76% recruitment rate; 94% of participants were retained from baseline to follow-up). Most adolescents (73%) and their parents/guardians (76%) reported that the trial was enjoyable. While there was no effect of arm on change in MVPA, sedentary behavior, or cardiorespiratory fitness for the entire sample, among those who engaged in <21 min of MVPA on average at baseline, adolescents in the CHD-PAL intervention had an increase of 16 min/day of MVPA more than comparators (d = 0.90). CONCLUSIONS The CHD-PAL intervention warrants examination in a larger trial to establish efficacy among those adolescents with a congenital heart defect who engage in <21 min of MVPA/day and should include follow-up assessments to examine effect durability. CLINICAL TRIALS REGISTRATION NCT03335475.
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Affiliation(s)
- Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children’s Hospital, NEOB, Third Floor, 700 Children’s Drive, Columbus, OH, USA
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
| | - Kristen R Fox
- Center for Biobehavioral Health, Nationwide Children’s Hospital, NEOB, Third Floor, 700 Children’s Drive, Columbus, OH, USA
| | - Joseph R Rausch
- Center for Biobehavioral Health, Nationwide Children’s Hospital, NEOB, Third Floor, 700 Children’s Drive, Columbus, OH, USA
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
| | - Taylor N Swenski
- Center for Biobehavioral Health, Nationwide Children’s Hospital, NEOB, Third Floor, 700 Children’s Drive, Columbus, OH, USA
| | - Steven P Neville
- Center for Biobehavioral Health, Nationwide Children’s Hospital, NEOB, Third Floor, 700 Children’s Drive, Columbus, OH, USA
| | - Noelle C Marousis
- Center for Biobehavioral Health, Nationwide Children’s Hospital, NEOB, Third Floor, 700 Children’s Drive, Columbus, OH, USA
| | - Christina X Korth
- Center for Biobehavioral Health, Nationwide Children’s Hospital, NEOB, Third Floor, 700 Children’s Drive, Columbus, OH, USA
| | - Clifford L Cua
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Vidu Garg
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
- Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Nationwide Children’s Hospital, NEOB, Third Floor, 700 Children’s Drive, Columbus, OH, USA
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
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Stanek C, Theroux CI, Olsavsky AL, Hill KN, Rausch JR, O’Brien SH, Quinn GP, Gerhardt CA, Nahata L. Study protocol for fertility preservation discussions and decisions: A family-centered psychoeducational intervention for male adolescents and emerging adults newly diagnosed with cancer and their families. PLoS One 2022; 17:e0263886. [PMID: 35171948 PMCID: PMC8849538 DOI: 10.1371/journal.pone.0263886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 11/19/2022] Open
Abstract
Many childhood cancer survivors desire biological children but are at risk for infertility after treatment. One option for mitigating risk is the use of fertility preservation prior to gonadotoxic therapy. Adolescents and emerging adults may rely on their parents to help them decide whether to use fertility preservation. While this is often a collaborative process, it is currently unknown how parents can optimally support adolescents and emerging adults through this decision. To address this gap, we developed a family-centered, psychoeducational intervention to prompt adolescents and emerging adults to reflect on their future parenthood goals and attitudes towards fertility preservation, as well as to prompt their parents (or other caregivers) to reflect on their own and their child's perspectives on the topic. In this randomized controlled trial, families will be randomized to either the standard of care control group (fertility consult) or the intervention group. After their fertility consult, adolescents and emerging adults and parents in the intervention group will complete a fertility preservation values clarification tool and then participate in a guided conversation about their responses and the fertility preservation decision. The primary expected outcome of this study is that participation in the intervention will increase the use of fertility preservation. The secondary expected outcome is an improvement in decision quality. Chi-square analyses and t-tests will evaluate primary and secondary outcomes. The goal of this intervention is to optimize family-centered fertility preservation decision-making in the context of a new cancer diagnosis to help male adolescents and emerging adults achieve their future parenthood goals.
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Affiliation(s)
- Charis Stanek
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Charleen I. Theroux
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Anna L. Olsavsky
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Kylie N. Hill
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Joseph R. Rausch
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Sarah H. O’Brien
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Gwendolyn P. Quinn
- New York University Grossman School of Medicine, New York, New York, United States of America
| | - Cynthia A. Gerhardt
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Leena Nahata
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- * E-mail:
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Stern AR, Winning AM, Rausch JR, Holmbeck GN. Medical responsibility growth in youth with spina bifida: Neuropsychological and parenting predictors. Health Psychol 2021; 40:692-701. [PMID: 34881937 DOI: 10.1037/hea0001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE For youth with spina bifida (SB) there is a growing need to understand how responsibilities for health care are transferred from family- to self-management over time. The current study examined trajectories of responsibility for medical tasks in youth with SB across adolescence, as well as executive functioning/attention and parenting behaviors as predictors of growth. METHOD As part of a larger, longitudinal study, 140 youth with SB (ages 8-15 at time 1; Mage = 11.43) reported on their responsibility for relevant medical tasks across five time points. Attention and executive functioning were assessed via performance-based and parent/teacher-report methods. Parenting behaviors consisted of acceptance, behavioral control, and psychological control and were assessed via observational and parent-report. RESULTS Growth curve analyses revealed significant increases in youth medical responsibility across all SB tasks over time. Attention, executive functioning, maternal behavioral control, and paternal psychological control emerged as predictors of growth parameters in responsibility for communicating about SB and managing health care appointments. CONCLUSION Results indicated that youth with SB obtain increasing responsibility for their health care over time. The transfer of responsibility for SB management may differ based on individual (i.e., the child's neuropsychological abilities) and family level (i.e., parenting behaviors) factors. Further research is needed to understand how growth in medical responsibility relates to changes in other aspects of SB self-management across development, such as medical adherence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Joseph R Rausch
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health
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Winning AM, Merandi J, Rausch JR, Liao N, Hoffman JM, Burlison JD, Gerhardt CA. Validation of the Second Victim Experience and Support Tool-Revised in the Neonatal Intensive Care Unit. J Patient Saf 2021; 17:531-540. [PMID: 32175958 DOI: 10.1097/pts.0000000000000659] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to validate a revised version of the Second Victim Experience and Support Tool (SVEST-R). The SVEST survey instrument was developed to measure the emotional and professional impact of medical errors and adverse patient events on healthcare providers and can help healthcare organizations evaluate the effectiveness of support resources. METHODS An SVEST-R was completed by 316 healthcare providers from seven neonatal intensive care units affiliated with a large, pediatric hospital. The original 29-item measure was expanded to 43 items to assess eight psychosocial domains (psychological distress, physical distress, colleague support, supervisor support, institutional support, nonwork-related support, professional self-efficacy, resilience) and two employment-related domains (turnover intentions, absenteeism) associated with the second victim experience. Seven additional items assessed desired forms of support (e.g., time away from the unit). A confirmatory factor analysis evaluated the factor structure of the modified measure. RESULTS The initial confirmatory factor analysis did not reveal an acceptable factor structure; thus, eight items were removed because of inadequate factor loadings or for conceptual reasons. This resulted in an acceptable model for the final 35-item measure. The final version included nine factors (i.e., psychological distress, physical distress, colleague support, supervisor support, institutional support, professional self-efficacy, resilience, turnover intentions, and absenteeism), with Cronbach α ranging from 0.66 to 0.86. CONCLUSIONS The SVEST-R is a valid measure for assessing the impact of errors or adverse events on healthcare providers. Importantly, the SVEST-R now includes positive outcomes (i.e., resilience) that may result from the second victim experience.
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Jackson JL, Fox KR, Swenski TN, Neville SP, Marousis NC, Korth CX, Rausch JR, Cua CL, Garg V, Vannatta K. Gender Differences in Physical Activity Engagement Among Adolescents With Congenital Heart Disease. J Pediatr Psychol 2021; 47:859-869. [PMID: 34725688 DOI: 10.1093/jpepsy/jsab114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/28/2021] [Accepted: 10/10/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The current study aimed to (a) describe moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and cardiorespiratory fitness (VO2Peak) via objective assessment among adolescents with congenital heart disease (CHD), (b) examine gender differences on MVPA, SB, VO2Peak, and the Theory of Planned Behavior elements, and (c) identify whether gender moderates the relationships between the Theory of Planned Behavior elements and MVPA, SB, and VO2Peak. METHODS Adolescent CHD survivors (N = 86; ages 15-18 years) wore an accelerometer to assess MVPA and SB, underwent an exercise stress test to assess VO2Peak, and completed a survey of the Theory of Planned Behavior elements as measured by perceived benefits (attitudes), family/friend support and perceived norms (social norms), and self-efficacy and barriers (perceived behavioral control) to engaging in physical activity. RESULTS On average, CHD survivors engaged in 22.3 min (SD = 15.3) of MVPA/day and 9 hr of SB/day (M = 565.8, SD = 102.5 min). Females engaged in less MVPA but not more SB had a lower mean VO2Peak, reported lower self-efficacy, and perceived greater barriers than males. In a regression model, barriers explained unique variance in MVPA and VO2Peak, but the relationship between barriers and MVPA/VO2Peak did not vary by gender. Self-efficacy did not explain unique variance in MVPA and VO2Peak when included in a model with gender and barriers. CONCLUSIONS Family/friend support for physical activity engagement may be an important consideration when developing physical activity interventions for adolescent CHD survivors. The role of gender differences in self-efficacy and perceived barriers on physical activity engagement warrants further investigation.
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Affiliation(s)
- Jamie L Jackson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kristen R Fox
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Taylor N Swenski
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Steven P Neville
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Noelle C Marousis
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina X Korth
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Clifford L Cua
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vidu Garg
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Cardiovascular Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
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Winning AM, Moscato EL, Lehmann V, Keim MC, Rausch JR, Lipak KG, Himelhoch AC, Murphy LK, Prussien KV, Olshefski RS, Vannatta K, Compas BE, Gerhardt CA. Impact of central nervous system-directed treatment on competence and adjustment among children in early cancer survivorship. Pediatr Blood Cancer 2021; 68:e29220. [PMID: 34245215 DOI: 10.1002/pbc.29220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/12/2021] [Accepted: 06/05/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Central nervous system (CNS)-directed treatments can cause long-term academic, social, and emotional difficulties for children with cancer. However, limited research has examined the emergence of problems longitudinally and has often stratified risk by diagnosis alone. Therefore, this study compared competence and adjustment in children, who did and did not receive CNS-directed treatment, over the first 3 years following a cancer diagnosis. PROCEDURE Mothers, fathers, and children (ages 5-18 years at diagnosis) from 217 families reported on the child's competence (academic, social) and adjustment (anxious/depressed, withdrawn/depressed) near a new cancer diagnosis or relapse and 3 years later. Children were categorized into CNS-directed treatment (n = 112; including cranial radiation, intrathecal chemotherapy, and/or neurosurgery) and non-CNS-directed treatment (n = 105) groups. RESULTS At enrollment, there were few differences in competence and emotional adjustment among children based on treatment or diagnostic group. At 3 years, mothers and fathers reported poorer social competence for the CNS-directed treatment group, and fathers reported poorer school competence for the CNS-directed treatment group. Over time, father ratings of social competence increased for the non-CNS-directed treatment group, but not the CNS-directed treatment group. While father ratings of academic competence declined for the CNS-directed treatment group, mother ratings declined the most for children diagnosed with a brain tumor. All children demonstrated higher anxious/depressed scores over time. CONCLUSIONS CNS-directed treatment may be a valuable indicator to identify childhood cancer survivors at risk for poor competence during early survivorship. Follow-up screening and supportive services are recommended, as well as additional longitudinal research.
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Affiliation(s)
- Adrien M Winning
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Emily L Moscato
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Vicky Lehmann
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, USA
| | - Madelaine C Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Keagan G Lipak
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Alexandra C Himelhoch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lexa K Murphy
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Kemar V Prussien
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Randal S Olshefski
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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10
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Sheftall AH, Vakil F, Armstrong SE, Rausch JR, Feng X, Kerns KA, Brent DA, Bridge JA. Clinical risk factors, emotional reactivity/regulation and suicidal ideation in elementary school-aged children. J Psychiatr Res 2021; 138:360-365. [PMID: 33930615 PMCID: PMC8192478 DOI: 10.1016/j.jpsychires.2021.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Suicidal behavior (SB) in young children is rare yet in 2019, suicide was the fifth leading cause of death in 5-12-year-old youth. Understanding the risks associated with childhood suicidal ideation (SI) and SB will determine which factors should be targeted for prevention programming. This study examined clinical characteristics and emotional reactivity/regulation (ERR) in children with (SI+) and without (SI-) SI. METHOD One hundred seventeen children, 6-9 years, and one biological parent were enrolled. Children completed interviews concerning SI/SB and parents completed interviews/self-reports about SI/SB, psychiatric distress, and history of abuse/neglect and their child's SI/SB, mental health, and ERR. Independent t-tests and Chi-square analyses using Bonferroni correction were conducted to examine SI group differences. Variables were then screened using forward stepwise logistic regression to determine association with SI + status. The final logistic regression included variables that survived screening procedures only. RESULTS Univariate analyses revealed SI + children were more likely to have a parental history of suicide attempt (PH+), higher rates of current psychotropic medication use, higher scores on the CBCL-DSM oriented scales (e.g., ADHD problems), and higher negative affect compared to SI- children. After analytic screening procedures, PH+, anxiety problems, ADHD problems, and anger survived. The final logistic regression revealed PH + status and anxiety problems were associated with SI + status. CONCLUSION Long-term follow-up is needed to determine if these factors are predictive of a first-time suicide attempt in this at-risk group.
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Affiliation(s)
- Arielle H Sheftall
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA; Department of Pediatrics, The Ohio State University, College of Medicine, USA.
| | - Fatima Vakil
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA
| | - Sarah E Armstrong
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA
| | - Joseph R Rausch
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, USA
| | - Kathryn A Kerns
- Department of Psychological Sciences, Kent State University, USA
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, USA
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA; Departments of Pediatrics and Psychiatry & Behavioral Health, Ohio State University College of Medicine, USA
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11
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Winning AM, Stern A, Rausch JR, Starnes M, Holmbeck GN. [Formula: see text]Neurocognitive predictors of adaptive functioning trajectories among youth with spina bifida. Child Neuropsychol 2021; 27:447-467. [PMID: 33386061 PMCID: PMC8035277 DOI: 10.1080/09297049.2020.1862076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
Little is known about how youth with spina bifida (SB) acquire adaptive functioning skills across development. Therefore, the current study examined: (1) trajectories of adaptive functioning in youth with SB as they transitioned from childhood into adolescence, and (2) neuropsychological functioning as a potential risk factor for long-term adaptive functioning difficulties. Participants (n = 131 youth with SB) were recruited as part of a larger ongoing longitudinal study. Growth curves were used to examine changes over time across six adaptive functioning skills: communication, self-direction, functional academics, social, self-care, and home living skills. Additionally, youth's attention and executive functioning (i.e., working memory, planning/organizational skills, cognitive flexibility, inhibition) were assessed via questionnaires and performance-based assessments, and entered as predictors in the models. Youth's communication, self-direction, functional academics, self-care, and home living skills increased over time across age, whereas youth's social skills did not. Scaled scores for youth's social, communication, self-direction, and functional academics skills were generally within normal limits, whereas those for self-care and home living skills fell in the borderline range. Better attention and executive functioning predicted a higher intercept for many adaptive functioning abilities at 11.5 years old, above and beyond the influence of IQ. However, these variables did not predict growth in adaptive functioning. Results indicate that youth with SB acquire skills across development to better meet the demands of daily life. However, youth with poorer neurocognitive functioning may demonstrate adaptive functioning deficits in early childhood and benefit from timely intervention.
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Affiliation(s)
- Adrien M. Winning
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Alexa Stern
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Joseph R. Rausch
- The Research Institute at Nationwide Children’s Hospital, Center for Biobehavioral Health, 700 Children’s Drive, Columbus, OH 43205
| | - Meredith Starnes
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Grayson N. Holmbeck
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
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12
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Fisher RS, Kenney AE, Fults MZ, Manring S, Rodriguez EM, Desjardins L, Rausch JR, Young-Saleme T, Ranalli MA, Vannatta K, Compas BE, Gerhardt CA. Longitudinal understanding of prognosis among adolescents with cancer. Pediatr Blood Cancer 2021; 68:e28826. [PMID: 33320998 DOI: 10.1002/pbc.28826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Despite calls to increase prognosis communication for adolescents with cancer, limited research has examined their perceptions of prognosis as compared with their parents. We assessed adolescents' understanding of their prognosis relative to parents and oncologists. METHODS Families of adolescents (aged 10-17) were recruited at two pediatric institutions following a new diagnosis or relapse. Seventy-four adolescents, 68 mothers, and 40 fathers participated at enrollment; 76 adolescents, 69 mothers, and 35 fathers participated one year later. The adolescent's primary oncologist reported on prognosis only at enrollment. Participants rated the likelihood of the adolescent's survival in five years, as well as reporting prognosis communication and sources of information. RESULTS Most oncologists (65%) and fathers (63%) discussed prognosis in numerical terms with the adolescent at baseline, which was greater than mother report (49%) of discussions of numerical prognosis with adolescents. Adolescents reported a better prognosis than oncologists, but comparable with mothers at diagnosis and one year. Adolescents' prognosis estimates were stable over time (P > .05). At diagnosis, adolescent-father (P = 0.025) and adolescent-oncologist (P < 0.001) discrepancies were larger for youth with advanced than non-advanced cancer. Adolescents whose parents received numerical prognosis estimates from the oncologist, and whose fathers reported providing numerical prognosis estimates had more accurate understandings of prognosis (P < 0.05). CONCLUSIONS Adolescent prognosis estimates were comparable with those of parents at diagnosis and one year but more favorable than that of oncologists. Although additional research is needed, results suggest discrepancies in prognosis estimates between family members and oncologists, particularly for adolescents with advanced cancer.
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Affiliation(s)
- Rachel S Fisher
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Ansley E Kenney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Marci Z Fults
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Samantha Manring
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Erin M Rodriguez
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas
| | | | - Joseph R Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Tammi Young-Saleme
- Division of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Mark A Ranalli
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Division of Hematology/Oncology/Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Bruce E Compas
- Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
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13
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Nahata L, Morgan TL, Ferrante AC, Caltabellotta NM, Yeager ND, Rausch JR, O'Brien SH, Quinn GP, Gerhardt CA. Congruence of Reproductive Goals and Fertility-Related Attitudes of Adolescent and Young Adult Males and Their Parents After Cancer Treatment. J Adolesc Young Adult Oncol 2019; 8:335-341. [DOI: 10.1089/jayao.2018.0134] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Leena Nahata
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Taylor L. Morgan
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Amanda C. Ferrante
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicole M. Caltabellotta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas D. Yeager
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R. Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sarah H. O'Brien
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
- Center for Innovation and Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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14
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Stiles-Shields C, Driscoll CFB, Rausch JR, Holmbeck GN. Friendship Quality Over Time in Youth With Spina Bifida Compared to Peers. J Pediatr Psychol 2019; 44:601-610. [PMID: 30668779 DOI: 10.1093/jpepsy/jsy111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/28/2018] [Accepted: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Examine friendship qualities (i.e., control, prosocial skills, positive affect, support, companionship, conflict, help, security, and closeness) and perceived self-efficacy in friendships of children with spina bifida (SB) and chosen peers over time through observed behaviors and self-report. METHODS Families of children with SB (aged 8-15) were asked to invite the child's "best friend" to participate in-home assessment visits; 127 friendship dyads were included in the current study. Mixed-effects models were used to examine children with SB and their peers across age on observed behaviors and self-reported data about their friendships. RESULTS For observed behaviors, peers displayed more control (p = .002) and prosocial behaviors (p = .007) with age than youth with SB. Male peers displayed higher control in their interactions as they aged (p = .04); and males with SB maintained their level of prosocial behaviors with age, compared to an increase in prosocial behaviors with age for all other groups (p = .003). For self-reported data, there was no evidence to suggest significant differences in friendship qualities across age (ps ≥ .2), with the exception of increased help (p = .002). Female peers reported increases in companionship across age compared to the other groups (p = .04). CONCLUSIONS Differing from previous examinations of social characteristics in SB, most longitudinal trends in friendship qualities did not differ for youth with SB compared to their peers. Promotion of this existing social strength may be a key intervention target for future strategies that promote positive outcomes for youth with SB.
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Affiliation(s)
| | | | - Joseph R Rausch
- Nationwide Children's Hospital, The Research Institute.,Department of Pediatrics, The Ohio State University
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15
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Abstract
BACKGROUND AND OBJECTIVES Many adolescents with type 1 diabetes experience diabetes-related distress (DRD; the negative emotional reactions specific to managing diabetes), but most research on DRD among adolescents relies on cross-sectional data. We assess adolescents' longitudinal DRD patterns and predictors of chronic DRD. METHODS This secondary analysis of data from a depression prevention clinical trial included 264 adolescents with type 1 diabetes randomly assigned to a resilience or education intervention (mean age: 15.7 ± 1.1 years; 59.8% female). Youth reported their DRD at 5 assessments over 16 months. Using latent class growth analysis, we classified adolescents into trajectory groups according to baseline starting point (intercept) and rate of change (slope) of DRD. We examined bivariate associations between trajectory group membership and demographic and clinical factors. Baseline predictors of chronic DRD were assessed via multiple logistic regression. RESULTS Participants were classified into 4 groups: stable high DRD (7.2%; high intercept, flat slope), stable moderate DRD (28.0%; above-average intercept, flat slope), improving DRD (33.7%; average intercept, downward slope), and low DRD (31.1%; below-average intercept, downward slope). Lower hemoglobin A1c, greater adherence, fewer socioemotional difficulties, and more adaptive coping distinguished the improving and low DRD trajectories. Chronic DRD patterns were associated with female sex and higher depressive symptoms and hemoglobin A1c. CONCLUSIONS In this study of adolescents' DRD trajectories during and after a psychoeducational intervention, one-third of youth were classified as having chronic, elevated DRD. Links with multiple clinical factors support efforts for routine DRD screening and comprehensive interventions for distressed youth.
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Affiliation(s)
- Esti Iturralde
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, California
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus Ohio; and
| | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, California;
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16
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Fisher RS, Rausch JR, Ferrante AC, Prussien KV, Olshefski RS, Vannatta KA, Compas BE, Gerhardt CA. Trajectories of health behaviors across early childhood cancer survivorship. Psychooncology 2018; 28:68-75. [PMID: 30402997 DOI: 10.1002/pon.4911] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The majority of childhood cancer survivors develop at least one late effect subsequent to treatment (eg, cardiovascular disease and obesity). Consistent engagement in recommended health behaviors may mitigate some of these conditions. Researchers have identified early survivorship as a teachable moment, yet few studies have examined positive health behaviors during this period. METHODS Families of children with cancer (ages 5-17) were initially recruited following a diagnosis or relapse of cancer. Three years post diagnosis, survivors (n = 82, Mage = 13.3, SD = 3.7) and their mothers (n = 103, Mage = 41.1, SD = 7.6) completed a questionnaire assessing exercise, dietary, and sleep patterns among survivors. A follow-up assessment was conducted 2 years later. Mixed models tested change in health behavior over time. RESULTS At 3- and 5-year post diagnosis, mother and self-report indicated that few survivors engaged in appropriate levels of low-intensity exercise, fruit/vegetable intake, and dairy consumption. However, most survivors engaged in recommended levels of high intensity exercise, fast food restriction, and sleep. Health behaviors remained stable over time, except for mother report of sleep duration, which decreased (b = -0.6, P < 0.001). Brain tumor diagnosis predicted a larger decrease in self-report of sleep duration compared with other diagnoses (P = 0.04). Income predicted fast food intake such that higher income was associated with decreased intake over time, whereas lower income was associated with increased intake (P = 0.04). CONCLUSIONS During early survivorship, several health behaviors fell short of expectations for exercise and diet and did not improve upon reaching 5-year post diagnosis. Providers should evaluate survivors' health behaviors, including sleep, early and often, intervening when necessary.
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Affiliation(s)
- Rachel S Fisher
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Amanda C Ferrante
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Kemar V Prussien
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Randal S Olshefski
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Kathryn A Vannatta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
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17
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Ferrante AC, Gerhardt CA, Yeager ND, Rausch JR, Lehmann V, O'Brien S, Quinn GP, Nahata L. Interest in Learning About Fertility Status Among Male Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2018; 8:61-66. [PMID: 30260730 DOI: 10.1089/jayao.2018.0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE As many as two-thirds of male childhood cancer survivors are at risk for fertility impairment as a consequence of treatment. Despite this, survivorship guidelines lack concrete recommendations as to when fertility status conversations should happen between patients and providers and what should be discussed. Thus, conversations may be inconsistent, or do not occur at all in survivorship. To inform recommendations for fertility-related conversations in survivorship, this pilot study aimed to better understand background (e.g., age, diagnosis and treatment intensity) and psychosocial factors (i.e., perceived barriers and perceived susceptibility) associated with survivor interest in learning about fertility status. METHODS Male survivors (N = 45) 15-25 years of age were recruited within 1-8 years of completing treatment. Survivors completed questionnaires based on the Health Belief Model (HBM) to assess perception of infertility risk and attitudes toward testing. RESULTS Most survivors (n = 31; 69%) reported they were informed of their risk for infertility by a healthcare provider before treatment, but only 31% (n = 14) of the sample banked sperm. Nearly two-thirds of survivors (n = 29; 64%) were interested in learning more about their fertility post-treatment. This interest was significantly correlated with greater perceived susceptibility to infertility by survivors, but it was not associated with other psychosocial or background factors. CONCLUSION Informing survivors of their personal infertility risk may increase interest in pursuing testing. Offering opportunities for fertility testing and family planning alternatives may mitigate potential psychological distress and unplanned pregnancy. While additional research is needed, future survivorship guidelines should encourage regular communication about fertility status and offer fertility testing for male survivors.
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Affiliation(s)
- Amanda C Ferrante
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Cynthia A Gerhardt
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Nicholas D Yeager
- 2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,3 Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R Rausch
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Vicky Lehmann
- 4 Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sarah O'Brien
- 2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,3 Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio.,5 Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gwendolyn P Quinn
- 6 Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | - Leena Nahata
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,7 Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
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18
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Keim MC, Lehmann V, Shultz EL, Winning AM, Rausch JR, Barrera M, Gilmer MJ, Murphy LK, Vannatta KA, Compas BE, Gerhardt CA. Parent-Child Communication and Adjustment Among Children With Advanced and Non-Advanced Cancer in the First Year Following Diagnosis or Relapse. J Pediatr Psychol 2017; 42:871-881. [PMID: 28369400 DOI: 10.1093/jpepsy/jsx058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/09/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives To examine parent-child communication (i.e., openness, problems) and child adjustment among youth with advanced or non-advanced cancer and comparison children. Methods Families (n = 125) were recruited after a child's diagnosis/relapse and stratified by advanced (n = 55) or non-advanced (n = 70) disease. Comparison children (n = 60) were recruited from local schools. Children (ages 10-17) reported on communication (Parent-Adolescent Communication Scale) with both parents, while mothers reported on child adjustment (Child Behavior Checklist) at enrollment (T1) and one year (T2). Results Openness/problems in communication did not differ across groups at T1, but problems with fathers were higher among children with non-advanced cancer versus comparisons at T2. Openness declined for all fathers, while changes in problems varied by group for both parents. T1 communication predicted later adjustment only for children with advanced cancer. Conclusions Communication plays an important role, particularly for children with advanced cancer. Additional research with families affected by life-limiting conditions is needed.
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Affiliation(s)
- Madelaine C Keim
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Vicky Lehmann
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Emily L Shultz
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Adrien M Winning
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Joseph R Rausch
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Maru Barrera
- Hospital for Sick Children, Child Health Evaluative Sciences
| | - Mary Jo Gilmer
- Vanderbilt University, Department of Psychology and Human Development
| | - Lexa K Murphy
- Vanderbilt University, Department of Psychology and Human Development
| | - Kathryn A Vannatta
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Bruce E Compas
- Vanderbilt University, Department of Psychology and Human Development
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
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19
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Shultz EL, Lehmann V, Rausch JR, Keim MC, Winning AM, Olshefski RS, Vannatta KA, Compas BE, Gerhardt CA. Family estimates of risk for neurocognitive late effects following pediatric cancer: From diagnosis through the first three years of survivorship. Pediatr Blood Cancer 2017; 64. [PMID: 28121066 DOI: 10.1002/pbc.26462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/21/2016] [Accepted: 12/28/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Families often express a need for additional information about neurocognitive late effects (NCLE) after a pediatric cancer diagnosis. Therefore, we examined: (i) differences in parent, child, and oncologist estimates of risk for NCLE; (ii) whether the estimates of parents and/or children change over time; and (iii) whether estimates are different for children treated with central nervous system (CNS) directed therapies. PROCEDURE Mothers, fathers, and children (initial age: 5-17, self-report: >10) from 258 families reported their perceived likelihood of the child developing "thinking/learning problems" on a visual analog scale (0-100%) at 2 months (T1), 1 year (T2), and 3 years (T3) following cancer diagnosis/relapse. Oncologists estimated the likelihood of NCLE at T1. Children were separated into groups based on CNS-directed treatment (n = 137; neurosurgery, intrathecal chemotherapy, and/or craniospinal radiation) or no CNS treatment. RESULTS Mother, father, and child estimates of risk for NCLE were similar to oncologists and to one another around diagnosis (T1). Although there were no significant mean differences, a considerable subset of family members either underestimated their child's risk for NCLE (>40%) or overestimated the risk for NCLE (20%) in comparison to oncologists. At T2 and T3, the estimates of mothers were significantly higher than children. Linear growth curves indicated that mothers' estimates for children with CNS-directed treatment significantly increased throughout the first 3 years of survivorship. CONCLUSIONS Considering that accurate understanding of NCLE is essential to seeking appropriate assessment and intervention, healthcare providers should focus on implementing family-based education early in treatment and throughout survivorship care.
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Affiliation(s)
- Emily L Shultz
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Vicky Lehmann
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,The Department of Pediatrics at the Ohio State University College of Medicine, Columbus, Ohio
| | - Madelaine C Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Adrien M Winning
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Randal S Olshefski
- The Department of Pediatrics at the Ohio State University College of Medicine, Columbus, Ohio.,Nationwide Children's Hospital, Columbus, Ohio
| | - Kathryn A Vannatta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,The Department of Pediatrics at the Ohio State University College of Medicine, Columbus, Ohio.,The Department of Psychology at the Ohio State University, Columbus, Ohio
| | | | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,The Department of Pediatrics at the Ohio State University College of Medicine, Columbus, Ohio.,The Department of Psychology at the Ohio State University, Columbus, Ohio
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Thomson KE, Modi AC, Glauser TA, Rausch JR, Steve White H. The impact of nonadherence to antiseizure drugs on seizure outcomes in an animal model of epilepsy. Epilepsia 2017; 58:1054-1062. [PMID: 28401980 DOI: 10.1111/epi.13742] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Nonadherence to prescribed dosing regimens is a significant problem in the treatment of pediatric and adult chronic epilepsy, and can result in severe consequences to patient outcomes. In this first-of-kind preclinical study, the impact of nonadherence on seizure control was studied by simulating human patterns of nonadherence in an animal epilepsy model. METHODS In study 1, three different patterns of nonadherence were modeled in newly diagnosed epileptic rats treated with carbamazepine: perfect adherence (100% of pellets contained carbamazepine), variable nonadherence (50% of pellets contained carbamazepine with different dosing patterns between animals), and complete nonadherence (0% of pellets contained carbamazepine). In study 2, a cohort of newly diagnosed epileptic rats were subjected to a "drug holiday" nonadherence paradigm, that is, a 2-week on (100%), 2-week off (0%), and 2-week on (100%) carbamazepine paradigm. RESULTS In the first experiment, the 100% (0.3 ± 0.2 SD convulsive seizures per day) adherent cohort demonstrated better seizure control than either the 0% (1.1 ± 0.8 SD) or 50% (0.8 ± 0.6 SD) adherent cohorts, which had similar levels of seizure control. In the second study, poor seizure control was exhibited during the second 2 weeks; that is, the drug holiday epoch; however, this did not negatively affect restoration of seizure control upon reinstatement of CBZ. SIGNIFICANCE The results from this pilot investigation suggest that nonadherence to carbamazepine is associated with significant negative but reversible effects on seizure control in an animal model of epilepsy. Furthermore, these results demonstrate that animal studies of nonadherence can yield potentially important and translatable insights into the consequences of nonadherence on seizure control.
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Affiliation(s)
- Kyle E Thomson
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, Utah, U.S.A
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Tracy A Glauser
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Joseph R Rausch
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - H Steve White
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, Utah, U.S.A
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21
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Loiselle KA, Rausch JR, Bidwell S, Drake S, Davies SM, Pai ALH. Predictors of health-related quality of life over time among pediatric hematopoietic stem cell transplant recipients. Pediatr Blood Cancer 2016; 63:1834-9. [PMID: 27332623 DOI: 10.1002/pbc.26112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Advances in hematopoietic stem cell transplantation (HSCT) have contributed to increased survival for pediatric patients. However, there are inconsistent findings regarding the impact of HSCT on health-related quality of life (HRQOL) outcomes for children. This study aimed to establish trajectories of HRQOL following HSCT and identify predictors of the HRQOL course. PROCEDURE Ninety caregivers of a child who received HSCT (mean age = 6.42 years) for various oncologic, immunologic, and metabolic conditions completed questionnaires regarding family psychosocial functioning and child HRQOL at the time of discharge from HSCT and follow-up HRQOL at four additional time points. RESULTS There was a significant change in overall HRQOL in 3 months postdischarge, with the greatest improvement in physical functioning. Caregiver stress and social support, and child psychosocial problems predicted changes in HRQOL over time. CONCLUSIONS These results point to potentially modifiable factors that are related to the course of HRQOL following HSCT, and interventions aimed at these factors should be implemented.
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Affiliation(s)
- Kristin A Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph R Rausch
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio
| | - Sarah Bidwell
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sarah Drake
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stella M Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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22
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Ramsey RR, Loiselle K, Rausch JR, Harrison J, Modi AC. Predictors of trajectories of epilepsy-specific quality of life among children newly diagnosed with epilepsy. Epilepsy Behav 2016; 57:202-210. [PMID: 26974247 PMCID: PMC4828263 DOI: 10.1016/j.yebeh.2016.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/23/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of this study was to identify two-year trajectories of epilepsy-specific health-related quality of life (HRQOL) among children newly diagnosed with epilepsy and to evaluate the predictive value of a comprehensive set of medical, psychosocial, and family factors. METHODS Ninety-four children with epilepsy (8.14 ± 2.37 years of age and 63% male) and their caregivers participated in this study. Caregivers completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and measures of psychological and family functioning at one month postdiagnosis. The QOLCE was also given at eight additional time points during the subsequent two years as a part of a large observational study in children with epilepsy. Adherence data were collected via MEMS TrackCaps, and medical information was collected through chart review. RESULTS Unique trajectories were identified for the overall QOLCE scale, as well as the subscales. Most trajectory models for the QOLCE subscales contained at least one at-risk trajectory for children, indicating that there is a subgroup of children experiencing poor long-term HRQOL. Health-related quality-of-life trajectories remained predominantly stable during the two-year period following treatment initiation. The number of AEDs, internalizing problems, and externalizing problems emerged as the most consistent predictors across the HRQOL domains. SIGNIFICANCE Medical and psychosocial interventions, such as cognitive-behavioral strategies, should target modifiable factors (e.g., internalizing symptoms, externalizing symptoms, number of AEDs trialed) shortly after diagnosis to improve HRQOL for children with epilepsy over the course of their disease.
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Affiliation(s)
- Rachelle R. Ramsey
- Center for Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH, 45229, USA
| | - Kristin Loiselle
- Center for Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH, 45229, USA
| | - Joseph R. Rausch
- Center for Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH, 45229, USA
| | - Jordan Harrison
- Thomas E. Cook Counseling Center, Virginia Tech, 895 Washington St. SW, Blacksburg, VA, 24061, USA
| | - Avani C. Modi
- Center for Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH, 45229, USA
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23
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Kroner JW, Hershey AD, Kashikar-Zuck SM, LeCates SL, Allen JR, Slater SK, Zafar M, Kabbouche MA, O'Brien HL, Shenk CE, Rausch JR, Kroon Van Diest AM, Powers SW. Cognitive Behavioral Therapy plus Amitriptyline for Children and Adolescents with Chronic Migraine Reduces Headache Days to ≤4 Per Month. Headache 2016; 56:711-6. [PMID: 26992129 DOI: 10.1111/head.12795] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this secondary analysis of results from a previously published trial (Clinical Trials Registration Number: NCT00389038) in chronic migraine in children and adolescents was to examine if participants who received cognitive behavioral therapy and amitriptyline reached a greater level of reduction in headache frequency that no longer indicated a recommendation for preventive treatment as compared to those who received headache education and amitriptyline. BACKGROUND Chronic migraine negatively affects children's home, school, and social activities. Preventive medication therapy is suggested for 5 or more headaches per month. Reduction to one headache day per week or less may suggest that preventive treatment is no longer indicated and provide a clinically relevant outcome for treatment efficacy and patient care. METHODS Randomized study participants (N = 135) kept a daily record of their headache frequency during 20 weeks of treatment and during a 1 year follow-up period. Baseline headache frequency was determined at the end of a 28 day screening period. Post treatment frequency was determined at 20 weeks (N = 128 completed) and post treatment follow-up was measured 12 months later (N = 124 completed). A chi-square test of independence was conducted by treatment group and by time point to determine group differences in the proportion of headache days experienced. RESULTS At 20 weeks (post treatment), 47% of the cognitive behavioral therapy plus amitriptyline group had ≤4 headache days per month compared to 20% of the headache education plus amitriptyline group, (P = .0011), and 32% of the cognitive behavioral therapy plus amitriptyline group had ≤3 headache days per month at 20 weeks compared to 16% of the headache education plus amitriptyline group, (P = .0304). At the month 12 follow-up, 72% of the cognitive behavioral therapy plus amitriptyline group had ≤4 headache days per month compared to 52% of the headache education plus amitriptyline group, (P = .0249), and 61% of the cognitive behavioral therapy plus amitriptyline group had ≤3 headache days per month at their month 12 follow-up compared to 40% of the headache education plus amitriptyline group, (P = .0192). CONCLUSIONS Participants who received cognitive behavioral therapy and amitriptyline were more likely than participants who received headache education plus amitriptyline to reach the clinically meaningful outcome of less than or equal to 4 headache days per month at both time points. These results may help inform what treatment outcomes are possible for children and adolescents suffering from chronic migraine and provides further evidence for behavioral treatment to be considered as a key part of a first line treatment regimen.
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Affiliation(s)
- John W Kroner
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susmita M Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan L LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Janelle R Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shalonda K Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marium Zafar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Chad E Shenk
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joseph R Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ashley M Kroon Van Diest
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Loiselle KA, Ramsey RR, Rausch JR, Modi AC. Trajectories of Health-Related Quality of Life Among Children With Newly Diagnosed Epilepsy. J Pediatr Psychol 2016; 41:1011-21. [PMID: 27017987 DOI: 10.1093/jpepsy/jsw019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/25/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify two-year trajectories of health-related quality of life (HRQOL) among children with newly diagnosed epilepsy, and evaluate key predictors of HRQOL trajectories. METHODS This study is part of a prospective study of adherence and HRQOL outcomes in children with epilepsy. Caregivers completed an HRQOL questionnaire at one month post diagnosis and every three months thereafter for two years. Chart review and additional questionnaires were used to collect medical variables and seizure outcomes. RESULTS Participants included 120 children with epilepsy and their caregiver. Unique trajectories for overall HRQOL and PedsQL™ subscales were identified and were predominantly stable. A total side effects score emerged as a consistent predictor of all HRQOL domains. Other variables (i.e., socioeconomic status, seizures, internalizing and externalizing problems) uniquely predicted HRQOL domains. CONCLUSIONS Medical and psychosocial interventions should be implemented soon after treatment initiation to target modifiable factors (e.g., side effects, anxiety symptoms), which could improve HRQOL.
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Affiliation(s)
- Kristin A Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and
| | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and
| | - Joseph R Rausch
- Center for Biobehavioral Health, Nationwide Children's Hospital
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and
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Modi AC, Guilfoyle SM, Mann KA, Rausch JR. A pilot randomized controlled clinical trial to improve antiepileptic drug adherence in young children with epilepsy. Epilepsia 2015; 57:e69-75. [PMID: 26693964 DOI: 10.1111/epi.13289] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/30/2022]
Abstract
The primary aim was to examine the preliminary efficacy of a family tailored problem-solving intervention to improve antiepileptic drug (AED) adherence in families of children with new-onset epilepsy. Secondary aims were to assess changes in targeted mechanisms and treatment feasibility and acceptability. Fifty families (M(age) = 7.6 ± 3.0; 80% Caucasian; 42% idiopathic localization related) completed baseline questionnaires and were given an electronic monitor to observe daily AED adherence. If adherence was ≤ 95% in the first 7 months of the study, families were randomized (Supporting Treatment Adherence Regimens (STAR): n = 11; Treatment as Usual (TAU): n = 12). Twenty-one families were not randomized due to adherence being ≥95%. The STAR intervention included four face-to-face and two telephone problem-solving sessions over 8 weeks. Significant group differences in adherence were found during active intervention (weeks 4-6; TAU = -12.0 vs. STAR = 18.1, p < 0.01; and weeks session 6-8: TAU = -9.7 vs. STAR = 15.3, p < 0.05). Children who received the STAR intervention exhibited improved adherence compared to children in the TAU group during active treatment. Significant changes in epilepsy knowledge and management were noted for the STAR group. Families expressed benefitting from the STAR intervention. Future studies should include a larger sample size and booster intervention sessions to maintain treatment effects over time.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Shanna M Guilfoyle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Krista A Mann
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Joseph R Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Abstract
OBJECTIVE This study aimed to identify psychosocial predictors of two-year antiepileptic drug (AED) adherence trajectories among youth with newly diagnosed epilepsy, controlling for known demographic and medical factors. METHOD This study is part of a large, prospective, longitudinal observational study of AED adherence and medical outcomes in youth with newly diagnosed epilepsy. Parents completed questionnaires of psychosocial and family functioning at one month and one year following diagnosis. Chart review and questionnaires were used to collect medical variables and seizure outcomes. Previously established two-year AED adherence trajectories (Severe Early Nonadherence, Variable Nonadherence, Moderate Nonadherence, High Adherence) were used as the outcome variable. RESULTS Participants were 91 parents of youth with epilepsy (7.3±2.8years of age; 60% male) and their families. Early (one month following diagnosis) predictors of two-year adherence trajectories included socioeconomic status, epilepsy knowledge, family problem-solving, and family communication. Significant predictors one year following diagnosis included socioeconomic status, parent fears and concerns, and parent life stress. CONCLUSION There are modifiable parent and family variables that predict two-year adherence trajectories above and beyond known medical (e.g., seizures, side effects) factors. Psychosocial interventions delivered at key points during the course of epilepsy treatment could have a positive impact on adherence outcomes.
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Affiliation(s)
- Kristin Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Joseph R. Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
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Powers SW, Stark LJ, Chamberlin LA, Filigno SS, Sullivan SM, Lemanek KL, Butcher JL, Driscoll KA, Daines CL, Brody AS, Schindler T, Konstan MW, McCoy KS, Nasr SZ, Castile RG, Acton JD, Wooldridge JL, Ksenich RA, Szczesniak RD, Rausch JR, Stallings VA, Zemel BS, Clancy JP. Behavioral and nutritional treatment for preschool-aged children with cystic fibrosis: a randomized clinical trial. JAMA Pediatr 2015; 169:e150636. [PMID: 25938655 DOI: 10.1001/jamapediatrics.2015.0636] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Evidence-based treatments that achieve optimal energy intake and improve growth in preschool-aged children with cystic fibrosis (CF) are a critical need. OBJECTIVE To test whether behavioral and nutritional treatment (intervention) was superior to an education and attention control treatment in increasing energy intake, weight z (WAZ) score, and height z (HAZ) score. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included 78 children aged 2 to 6 years (mean age, 3.8 years) with CF and pancreatic insufficiency (intervention, n = 36 and control, n = 42). The study was conducted at 7 CF centers between January 2006 and November 2012; all 78 participants who met intent-to-treat criteria completed through follow-up. INTERVENTIONS Behavioral intervention combined individualized nutritional counseling targeting increased energy intake and training in behavioral child management skills. The control arm provided education and served as a behavioral placebo controlling for attention and contact frequency. Both treatments were delivered in person or telehealth (via telephone). Sessions occurred weekly for 8 weeks then monthly for 4 months (6 months). Participants then returned to standard care for 1 year, with 12-month follow-up thereafter. MAIN OUTCOMES AND MEASURES Changes in energy intake and WAZ score were examined from pretreatment to posttreatment (6 months) and change in HAZ score was assessed pretreatment to follow-up (18 months). Covariates included sex, Pseudomonas aeruginosa status at baseline, and treatment modality (in person vs telehealth). RESULTS At baseline, mean (SD) energy intake was 1462 (329) kcals/d, WAZ score was -0.44 (0.81), and HAZ score was -0.55 (0.84). From pretreatment to posttreatment, the intervention increased daily energy intake by 485 calories vs 58 calories for the control group (adjusted difference, 431 calories; 95% CI, 282 to 581; P < .001) and increased the WAZ score by 0.12 units vs 0.06 for the control (adjusted difference, 0.09; 95% CI, -0.06 to 0.24; P = .25). From pretreatment to follow-up, the intervention increased the HAZ score by 0.09 units vs -0.02 for the control (adjusted difference, 0.14 units; 95% CI, 0.001 to 0.27; P = .049). Measured treatment integrity and credibility were high for both groups. CONCLUSIONS AND RELEVANCE Behavioral and nutritional intervention improved energy intake and HAZ score outcomes but not WAZ score outcomes. Our results provide evidence that behavioral and nutritional treatment may be efficacious as a nutritional intervention for preschoolers aged 2 to 6 years with CF and pancreatic insufficiency. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT00241969.
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Affiliation(s)
- Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lori J Stark
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Leigh A Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie S Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stephanie M Sullivan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathleen L Lemanek
- The Ohio State University College of Medicine, Columbus4Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer L Butcher
- University of Michigan Medical School, Ann Arbor6C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | | | - Cori L Daines
- Department of Pediatrics, University of Arizona, Tucson
| | - Alan S Brody
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio9Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Teresa Schindler
- Case Western Reserve University School of Medicine, Cleveland, Ohio11Rainbow Babies and Children's Hospitals, Cleveland, Ohio
| | - Michael W Konstan
- Case Western Reserve University School of Medicine, Cleveland, Ohio11Rainbow Babies and Children's Hospitals, Cleveland, Ohio
| | - Karen S McCoy
- The Ohio State University College of Medicine, Columbus4Nationwide Children's Hospital, Columbus, Ohio
| | - Samya Z Nasr
- University of Michigan Medical School, Ann Arbor
| | - Robert G Castile
- The Ohio State University College of Medicine, Columbus4Nationwide Children's Hospital, Columbus, Ohio
| | - James D Acton
- Department of Child Health, University of Missouri Women and Children's Hospital, Columbia
| | - Jamie L Wooldridge
- Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - Roberta A Ksenich
- Case Western Reserve University School of Medicine, Cleveland, Ohio11Rainbow Babies and Children's Hospitals, Cleveland, Ohio
| | - Rhonda D Szczesniak
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio15Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph R Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Virginia A Stallings
- Perelman School of Medicine, University of Pennsylvania, Philadelphia17Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Babette S Zemel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia17Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John P Clancy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio15Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Abstract
OBJECTIVE The aim of the study was to determine sociodemographic, biological epilepsy-specific, and adherence predictors of long-term pediatric seizure outcomes. METHODS This study is a prospective, longitudinal, observational study of antiepileptic drug (AED) adherence and seizure outcomes in children with newly diagnosed epilepsy. Patients were recruited from April 2006 to March 2009 and followed for 2 years. Objective, electronic monitors were used to assess AED adherence. Medical chart reviews assessed medical variables and seizure outcomes. RESULTS Participants (n = 109) were 7.3 ± 2.9 years of age, and 62% male. Four adherence trajectory groups were identified: severe early nonadherence (n = 10), variable nonadherence (n = 16), moderate nonadherence (n = 40), and high adherence (n = 43). Two seizure probability trajectory groups were identified: high seizure (n = 28) and low seizure probability (n = 81). Participants with recognizable syndromes were less likely to be a member of the high seizure probability group (b = -2.372; odds ratio [OR] = 0.093; 95% confidence interval [CI]OR = 0.015, 0.595); those with the presence of epileptiform discharges on EEG were more likely to be in the high seizure probability group (b = 1.649; OR = 5.203; 95% CIOR = 1.422, 19.037). Adherence trajectory group status was a significant predictor of seizure trajectory group status (partial max-rescaled R(2) = 0.13). CONCLUSIONS Adherence trajectories and 2 biological epilepsy-specific variables explain a similar proportion of the variability in longitudinal seizure outcomes. The relationship between AED nonadherence and seizure outcomes is not linear. Early adherence interventions could change the course of seizure outcomes, particularly if variability in adherence was minimized postdiagnosis.
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Affiliation(s)
- Avani C Modi
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Yelena P Wu
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph R Rausch
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH
| | - James L Peugh
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tracy A Glauser
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH
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Shenk CE, Dorn LD, Kolko DJ, Rausch JR, Insana SP. Prior exposure to interpersonal violence and long-term treatment response for boys with a disruptive behavior disorder. J Trauma Stress 2014; 27:585-92. [PMID: 25270151 PMCID: PMC4943457 DOI: 10.1002/jts.21962] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interpersonal violence (IPV) is common in children with a disruptive behavior disorder (DBD) and increases the risk for greater DBD symptom severity, callous-unemotional (CU) traits, and neuroendocrine disruption. Thus, IPV may make it difficult to change symptom trajectories for families receiving DBD interventions given these relationships. The current study examined whether IPV prior to receiving treatment for a DBD predicted trajectories of a variety of associated outcomes, specifically DBD symptoms, CU traits, and cortisol concentrations. Boys with a DBD diagnosis (N = 66; age range = 6-11 years; 54.5% of whom experienced IPV prior to treatment) of either oppositional defiant disorder or conduct disorder participated in a randomized clinical trial and were assessed 3 years following treatment. Multilevel modeling demonstrated that prior IPV predicted smaller rates of change in DBD symptoms, CU traits, and cortisol trajectories, indicating less benefit from intervention. The effect size magnitudes of IPV were large for each outcome (d = 0.88-1.07). These results suggest that IPV is a predictor of the long-term treatment response for boys with a DBD. Including trauma-focused components into existing DBD interventions may be worth testing to improve treatment effectiveness for boys with a prior history of IPV.
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Affiliation(s)
- Chad E. Shenk
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, U.S.A
| | - Lorah D. Dorn
- College of Nursing, The Pennsylvania State University, University Park, PA, U.S.A
| | - David J. Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
| | - Joseph R. Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, U.S.A
| | - Salvatore P. Insana
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
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Aylward BS, Rausch JR, Modi AC. An examination of 1-year adherence and persistence rates to antiepileptic medication in children with newly diagnosed epilepsy. J Pediatr Psychol 2014; 40:66-74. [PMID: 24648257 DOI: 10.1093/jpepsy/jsu010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The primary aim of the current study was to use new methods to examine 1-year quality of medication dosing (adherence) and continuation with medication treatment (persistence) rates to antiepileptic drugs (AEDs) in children with newly diagnosed epilepsy. METHODS Medication-taking behaviors of AEDs were assessed using electronic monitors for 117 children with newly diagnosed epilepsy for the first year after diagnosis. RESULTS Approximately 15% of participants were categorized as nonpersistent (i.e., failed to take medication for >15 consecutive days) 6 months after AED initiation, which increased to 26.6% of participants at 1 year. The majority of medication dosing events took place within a +/-2-hr interval as recommended. The group with lower socioeconomic status demonstrated more nonpersistence over time. CONCLUSION Examining adherence and persistence in medication taking behaviors may yield different types of data for clinical and research purposes.
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Affiliation(s)
- Brandon S Aylward
- Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Joseph R Rausch
- Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Avani C Modi
- Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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Painter E, Rausch JR, Modi AC. Changes in daily activity patterns of caregivers of children with newly diagnosed epilepsy: a case-controlled design. Epilepsy Behav 2014; 31:1-6. [PMID: 24291521 DOI: 10.1016/j.yebeh.2013.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
Having a child diagnosed with a chronic pediatric illness is a major stressor for families that can alter their daily lives. The primary study aim was to use Daily Phone Diaries (DPDs), a cued-recall procedure to track parents through their activities over a 24-hour period, to assess the activity patterns of a group of caregivers with a child diagnosed with new-onset epilepsy (group with NOE; n=30) and a group of matched comparisons (comparison group; n=29). The time caregivers spent in sleep and recreation was evaluated over the first 5.5months after diagnosis. Caregivers of children with NOE spent significantly more time in recreation inside the home, while the comparison group spent significantly more time in recreation outside the home. These data suggest that families with children with NOE reallocate their time post-diagnosis from recreation outside to inside the home, which raises concerns about the overall adaptation of the family to the diagnosis and presents a critical opportunity for health-care teams to intervene and support families with children with NOE.
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Affiliation(s)
- Elizabeth Painter
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. (MLC 7019), Cincinnati, OH 45229, USA
| | - Joseph R Rausch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, 3333 Burnet Ave. (MLC 3015), OH 45229, USA
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. (MLC 7019), Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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Abstract
OBJECTIVE To examine the relationship between previously identified nonadherence trajectories during the first 6 months of antiepileptic drug (AED) therapy and long-term seizure-free rates (defined as ≥1 year of seizure freedom at the 4 years postdiagnosis milestone) in a cohort of children with newly diagnosed epilepsy. METHODS A prospective longitudinal observational study of AED adherence and seizure freedom in a consecutive cohort of 124 children (ages 2-12 years) with newly diagnosed epilepsy was conducted. The association between previously identified AED adherence trajectories (i.e., near-perfect adherence [e.g., average adherence = 96.8%] vs nonadherent) and seizure freedom for ≥1 year at the 4 years postdiagnosis milestone was determined. RESULTS Children who exhibited nonadherence to AED therapy in the first 6 months of treatment were 3.24 times more likely not to have achieved ≥1 year of seizure freedom at the 4 years postdiagnosis milestone compared to children in the near-perfect adherence group (χ² = 5.13; p = 0.02). Specifically, at the 4 years postdiagnosis milestone, only 12% of children in the near-perfect adherence group were continuing to experience seizures compared to 31% of children in the nonadherent group. CONCLUSIONS Children with epilepsy who achieved near-perfect adherence during the first 6 months of therapy experienced a higher rate of seizure freedom 4 years postdiagnosis compared with those children who demonstrated early nonadherence. This suggests that adherence intervention early in the course of treatment could play a role in improving long-term seizure freedom rates in children with epilepsy.
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Affiliation(s)
- Avani C Modi
- From the Cincinnati Children's Hospital Medical Center, OH
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Powers SW, Kashikar-Zuck SM, Allen JR, LeCates SL, Slater SK, Zafar M, Kabbouche MA, O'Brien HL, Shenk CE, Rausch JR, Hershey AD. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA 2013; 310:2622-30. [PMID: 24368463 PMCID: PMC4865682 DOI: 10.1001/jama.2013.282533] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Early, safe, effective, and durable evidence-based interventions for children and adolescents with chronic migraine do not exist. OBJECTIVE To determine the benefits of cognitive behavioral therapy (CBT) when combined with amitriptyline vs headache education plus amitriptyline. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial of 135 youth (79% female) aged 10 to 17 years diagnosed with chronic migraine (≥15 days with headache/month) and a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points were assigned to the CBT plus amitriptyline group (n = 64) or the headache education plus amitriptyline group (n = 71). The study was conducted in the Headache Center at Cincinnati Children's Hospital between October 2006 and September 2012; 129 completed 20-week follow-up and 124 completed 12-month follow-up. INTERVENTIONS Ten CBT vs 10 headache education sessions involving equivalent time and therapist attention. Each group received 1 mg/kg/d of amitriptyline and a 20-week end point visit. In addition, follow-up visits were conducted at 3, 6, 9, and 12 months. MAIN OUTCOMES AND MEASURES The primary end point was days with headache and the secondary end point was PedMIDAS (disability score range: 0-240 points; 0-10 for little to none, 11-30 for mild, 31-50 for moderate, >50 for severe); both end points were determined at 20 weeks. Durability was examined over the 12-month follow-up period. Clinical significance was measured by a 50% or greater reduction in days with headache and a disability score in the mild to none range (<20 points). RESULTS At baseline, there were a mean (SD) of 21 (5) days with headache per 28 days and the mean (SD) PedMIDAS was 68 (32) points. At the 20-week end point, days with headache were reduced by 11.5 for the CBT plus amitriptyline group vs 6.8 for the headache education plus amitriptyline group (difference, 4.7 [95% CI, 1.7-7.7] days; P = .002). The PedMIDAS decreased by 52.7 points for the CBT group vs 38.6 points for the headache education group (difference, 14.1 [95% CI, 3.3-24.9] points; P = .01). In the CBT group, 66% had a 50% or greater reduction in headache days vs 36% in the headache education group (odds ratio, 3.5 [95% CI, 1.7-7.2]; P < .001). At 12-month follow-up, 86% of the CBT group had a 50% or greater reduction in headache days vs 69% of the headache education group; 88% of the CBT group had a PedMIDAS of less than 20 points vs 76% of the headache education group. Measured treatment credibility and integrity was high for both groups. CONCLUSIONS AND RELEVANCE Among young persons with chronic migraine, the use of CBT plus amitriptyline resulted in greater reductions in days with headache and migraine-related disability compared with use of headache education plus amitriptyline. These findings support the efficacy of CBT in the treatment of chronic migraine in children and adolescents. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00389038.
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Affiliation(s)
- Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susmita M Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Janelle R Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio3Headache Center, Cincinnati Children's Hospital Medical Center
| | - Susan L LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center3Headache Center, Cincinnati Children's Hospital Medical Center
| | - Shalonda K Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marium Zafar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Chad E Shenk
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joseph R Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Rohan JM, Rausch JR, Pendley JS, Delamater AM, Dolan L, Reeves G, Drotar D. Identification and prediction of group-based glycemic control trajectories during the transition to adolescence. Health Psychol 2013; 33:1143-52. [PMID: 24274797 DOI: 10.1037/hea0000025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify trajectories of glycemic control over a period of 3 years in a pediatric sample of youth diagnosed with Type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family level baseline predictors of glycemic control group membership. METHODS This multisite, prospective study included 239 children and adolescents (ages 9-11 years at baseline) diagnosed with Type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at 6-month intervals over a period of 3 years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates. RESULTS Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and 3 trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high-risk group membership. CONCLUSIONS These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced.
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Affiliation(s)
- Jennifer M Rohan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Joseph R Rausch
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | | | | | - Lawrence Dolan
- Department of Endocrinology, Cincinnati Children's Hospital Medical Center
| | - Grafton Reeves
- Division of Pediatric Endocrinology, Alfred I. DuPont Hospital for Children
| | - Dennis Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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Hilliard ME, Rohan JM, Rausch JR, Delamater A, Pendley JS, Drotar D. Patterns and predictors of paternal involvement in early adolescents' type 1 diabetes management over 3 years. J Pediatr Psychol 2013; 39:74-83. [PMID: 24013966 DOI: 10.1093/jpepsy/jst067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To document trajectories of paternal involvement in diabetes management and examine bidirectional associations with diabetes outcomes across early adolescence. METHODS 3-year prospective assessment of paternal involvement, diabetes self-management, and glycemic control among 136 youth (age 9-12 at baseline) and their mothers and fathers. RESULTS Unconditional growth curves demonstrated decreasing amount (maternal report: F(1,128) = 14.79; paternal report: F(1,111) = 12.95, ps < 0.01) and level of contribution (maternal report: F(1,131) = 23.6, p < .01) of paternal involvement. Controlling for covariates, lower youth self-management predicted an increasing slope in fathers' self-reported amount of involvement (b = -0.15 to -0.22, p < .05), and higher levels of fathers' self-reported level of contribution predicted a decreasing slope in youths' self-reported self-management (b = -0.01, p < .05). CONCLUSIONS Like mothers, fathers' involvement declines modestly during early adolescence. Different aspects of paternal involvement influence or are influenced by youths' self-management. Communication about ways to enhance fathers' involvement before this transition may help prevent or reduce declining diabetes management and control common in adolescence.
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Affiliation(s)
- Marisa E Hilliard
- PhD, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Street, Suite 940, Houston, TX 77030, USA.
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Kuhl ES, Clifford LM, Bandstra NF, Filigno SS, Yeomans-Maldonado G, Rausch JR, Stark LJ. Examination of the association between lifestyle behavior changes and weight outcomes in preschoolers receiving treatment for obesity. Health Psychol 2013; 33:95-8. [PMID: 23815763 DOI: 10.1037/a0032741] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Preschoolers (ages 2-5 years) have been significantly underrepresented in the obesity treatment outcome literature, despite estimates that 12.1% are already obese. As such, little is known about the most important intervention targets for weight management within this age group. The aims of this study were (a) to examine lifestyle behavior changes for 30 obese preschoolers participating in a weight-control intervention and (b) to explore which lifestyle behavior changes predicted changes in body mass index (BMI) z score. METHOD Preschooler height, weight, diet (three 24-hr recalls), physical activity (accelerometry), and television use (parent report) were measured at baseline and posttreatment (6 months). A linear regression was conducted to examine pre- to posttreatment changes in diet (i.e., intake of calories, sugar-sweetened beverages, fruits and vegetables, and sweet and salty snacks) and activity (i.e., moderate-to-vigorous activity and television use) behaviors on changes in BMI z score. RESULTS Despite significant reductions in sugar-sweetened beverage intake and television use, and increases in fruit and vegetable intake, only reductions in absolute caloric intake significantly predicted reductions in BMI z score. CONCLUSION Our findings suggest that attaining healthy caloric goals may be the most important component of weight-control interventions for preschoolers. Future research using innovative methodologies, such as the Multiphase Optimization Strategy, may be helpful to prospectively identifying the lifestyle behavior changes that are most effective in helping families to achieve healthy weight outcomes for preschoolers and thereby improve intervention efficiency and decrease treatment burden for families.
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Affiliation(s)
| | | | | | | | | | | | - Lori J Stark
- Division of Behavioral Medicine and Clinical Psychology
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Modi AC, Ingerski LM, Rausch JR, Glauser TA, Drotar D. White coat adherence over the first year of therapy in pediatric epilepsy. J Pediatr 2012; 161:695-9.e1. [PMID: 22608905 PMCID: PMC3426618 DOI: 10.1016/j.jpeds.2012.03.059] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 02/01/2012] [Accepted: 03/29/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine white coat adherence over time in children with epilepsy. STUDY DESIGN This was a longitudinal prospective study to examine medication adherence prior to and following consecutive clinic visits over a 13-month period in 120 children with newly diagnosed epilepsy (M(age) = 7.2 ± 2.9 years; 38% female) and their caregivers. Electronic monitors were used to assess adherence and ordinal logistic regression models were employed. RESULTS Results demonstrated white coat adherence, with adherence increasing during the 3 days preceding clinic visits. Data also revealed a significant interaction, whereby adherence increased following initial clinic visits, but decreased following the last clinic visit. CONCLUSIONS White coat adherence occurs for children with newly diagnosed epilepsy. Increased awareness of white coat adherence has important implications for clinical decision-making and should be examined in other pediatric populations. Increased monitoring of medication patterns can help clinicians avoid unnecessary changes to the treatment regimen. Interventions targeting improved communication around adherence behaviors are necessary to maximize therapy benefits.
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Affiliation(s)
- Avani C. Modi
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
| | - Lisa M. Ingerski
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
| | - Joseph R. Rausch
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
| | - Tracy A. Glauser
- Cincinnati Children’s Hospital Medical Center, Division of Neurology
| | - Dennis Drotar
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
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Abstract
OBJECTIVES To examine whether health-related quality of life (HRQOL) for treatment-seeking preschoolers with obesity (N = 60) differed from preschoolers in a nonclinical comparison sample (N = 457). METHODS Parents in both samples completed the parent-proxy form of the pediatric quality of life inventory (PedsQL). Between-group comparisons were conducted to examine differences for all scales and summary scores of the PedsQL. RESULTS Parent proxy-reported HRQOL was significantly lower for treatment-seeking preschoolers with obesity for all scales and summary scores except school functioning. Differences on the total scale score met the criterion for being a clinically important difference. CONCLUSIONS Our study suggests treatment-seeking families perceive worse HRQOL for children with obesity as early as the preschool years. Discussion of HRQOL may be a more effective strategy for health care professionals in broaching the topic of weight with parents and identifying families who may be more receptive to weight management suggestions for preschoolers.
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Affiliation(s)
- Elizabeth S Kuhl
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA.
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Kelly NC, Ammerman RT, Rausch JR, Ris MD, Yeates KO, Oppenheimer SG, Enrile BG. Executive functioning and psychological adjustment in children and youth with spina bifida. Child Neuropsychol 2012; 18:417-31. [DOI: 10.1080/09297049.2011.613814] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rausch JR, Hood KK, Delamater A, Shroff Pendley J, Rohan JM, Reeves G, Dolan L, Drotar D. Changes in treatment adherence and glycemic control during the transition to adolescence in type 1 diabetes. Diabetes Care 2012; 35:1219-24. [PMID: 22474040 PMCID: PMC3357213 DOI: 10.2337/dc11-2163] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test models of unidirectional and bidirectional change between treatment adherence and glycemic control in youth with type 1 diabetes. RESEARCH DESIGN AND METHODS We conducted a 2-year longitudinal, multisite study of 225 youth with type 1 diabetes recruited at the cusp of adolescence (aged 9-11 years) to describe the mutual influences of glycemic control as measured by HbA(1c) and treatment adherence as measured by blood glucose monitoring frequency (BGMF) during the transition to adolescence. RESULTS HbA(1c) increased from 8.2 to 8.6% (P < 0.001) and BGMF decreased from 4.9 to 4.5 checks per day (P < 0.02) during the 2-year period. Changes in the BGMF slope predicted changes in HbA(1c). A change (increase) in HbA(1c) was associated with a change (decrease) in BGMF of 1.26 (P < 0.001) after controlling for covariates. CONCLUSIONS The magnitude of the effect of declining treatment adherence (BGMF) on glycemic control in young adolescents may be even greater than declines observed among older adolescents. BGMF offers a powerful tool for targeted management of glycemic control for type 1 diabetes during the critical transition to adolescence.
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Affiliation(s)
- Joseph R Rausch
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Hood KK, Rausch JR, Dolan LM. Depressive symptoms predict change in glycemic control in adolescents with type 1 diabetes: rates, magnitude, and moderators of change. Pediatr Diabetes 2011; 12:718-23. [PMID: 21564454 DOI: 10.1111/j.1399-5448.2011.00771.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether depressive symptoms in adolescents with type 1 diabetes predict change in glycemic control over time. RESEARCH DESIGN AND METHODS A total of 145 adolescents (aged 13-18 yr) participated in two study visits (baseline and 6 months). They completed a measure of depressive symptoms (Children's Depression Inventory; CDI) and had their A1c values and adherence to blood glucose monitoring (BGM) documented. RESULTS Three variables predicted A1c change over 6 months: CDI change score (B = 0.11; p < 0.001), BGM frequency at baseline (B = -0.21; p = 0.03), and A1c at baseline (B = -0.23; p = 0.002). A three-way interaction among these variables was significant (p < 0.01) and showed that adolescents with high adherence to BGM who were achieving optimal glycemic control (≤7.5%) at baseline were resistant to increasing A1c values, even if depressive symptoms worsened. However, as adherence to BGM declines, there is a synergistic effect with depressive symptoms to accelerate the increase of A1c values over time, making it more difficult to bring A1c back to optimal levels. CONCLUSIONS Results suggest that depressive symptoms are important predictors of A1c change by themselves as well as when considered with adherence to BGM. There is a need to screen for depressive symptoms and expand and develop prevention and intervention strategies in order to put adolescents with type 1 diabetes in the best position for optimal glycemic control.
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Affiliation(s)
- Korey K Hood
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Abstract
Longitudinal studies are necessary to examine individual change over time, with group status often being an important variable in explaining some individual differences in change. Although sample size planning for longitudinal studies has focused on statistical power, recent calls for effect sizes and their corresponding confidence intervals underscore the importance of obtaining sufficiently accurate estimates of group differences in change. We derived expressions that allow researchers to plan sample size to achieve the desired confidence interval width for group differences in change for orthogonal polynomial change parameters. The approaches developed provide the expected confidence interval width to be sufficiently narrow, with an extension that allows some specified degree of assurance (e.g., 99%) that the confidence interval will be sufficiently narrow. We make computer routines freely available, so that the methods developed can be used by researchers immediately.
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Affiliation(s)
- Ken Kelley
- Department of Management, Mendoza College of Business, University of Notre Dame, IN 46556, USA.
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Abstract
CONTEXT Because of epilepsy's common occurrence, the narrow therapeutic and safety margins of antiepileptic medications, and the recognized complications of medication nonadherence in adults with epilepsy, identifying the rates, patterns, and predictors of nonadherence in children with epilepsy is imperative. The onset and evolution of antiepileptic drug nonadherence in children with newly diagnosed epilepsy remains unknown. OBJECTIVES To identify and characterize trajectories of adherence in children with newly diagnosed epilepsy over the first 6 months of therapy and to determine sociodemographic and epilepsy-specific predictors of adherence trajectories. DESIGN, SETTING, AND PATIENTS Prospective, longitudinal observational study of antiepileptic drug adherence in a consecutive cohort of 124 children (2-12 years old) with newly diagnosed epilepsy at Cincinnati Children's Hospital Medical Center. Patients were recruited from April 2006 through March 2009, and final data collection occurred in September 2009. MAIN OUTCOME MEASURE Objective adherence measured using electronic monitors. RESULTS Fifty-eight percent of children with newly diagnosed epilepsy demonstrated persistent nonadherence during the first 6 months of therapy. Group-based trajectory models identified 5 differential adherence patterns (Bayesian information criterion = -23611.8): severe early nonadherence (13%; 95% confidence interval [CI], 8%-20%), severe delayed nonadherence (7%; 95% CI, 3%-12%), moderate nonadherence (13%; 95% CI, 8%-20%), mild nonadherence (26%; 95% CI, 19%-34%), and near-perfect adherence (42%; 95% CI, 33%-50%). The adherence pattern of most patients was established by the first month of therapy. Socioeconomic status was the sole predictor of adherence trajectory group status (χ(4)(2) = 19.3 [n = 115]; P < .001; partial r(2) = 0.25), with lower socioeconomic status associated with higher nonadherence. CONCLUSION Five trajectory patterns were identified that captured the spectrum of nonadherence to antiepileptic drugs among children with newly diagnosed epilepsy; the patterns were significantly associated with socioeconomic status.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Nelson TD, Aylward BS, Rausch JR. Dynamic p-technique for modeling patterns of data: applications to pediatric psychology research. J Pediatr Psychol 2011; 36:959-68. [PMID: 21486938 DOI: 10.1093/jpepsy/jsr023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Dynamic p-technique (DPT) is a potentially useful statistical method for examining relationships among dynamic constructs in a single individual or small group of individuals over time. The purpose of this article is to offer a nontechnical introduction to DPT. METHOD An overview of DPT analysis, with an emphasis on potential applications to pediatric psychology research, is provided. To illustrate how DPT might be applied, an example using simulated data is presented for daily pain and negative mood ratings. RESULTS The simulated example demonstrates the application of DPT to a relevant pediatric psychology research area. In addition, the potential application of DPT to the longitudinal study of adherence is presented. CONCLUSION Although it has not been utilized frequently within pediatric psychology, DPT could be particularly well-suited for research in this field because of its ability to powerfully model repeated observations from very small samples.
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Affiliation(s)
- Timothy D Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588-0308, USA.
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Modi AC, Ingerski LM, Rausch JR, Glauser TA. Treatment factors affecting longitudinal quality of life in new onset pediatric epilepsy. J Pediatr Psychol 2011; 36:466-75. [PMID: 21278379 DOI: 10.1093/jpepsy/jsq114] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Recognizing the importance of patient-reported outcomes, this longitudinal, prospective study examined: Changes in health-related quality of life (HRQOL) over seven months following antiepileptic drug (AED) initiation and the relationship of seizures, AED side-effects, and AED type to HRQOL. METHOD Parents of 124 children with newly diagnosed epilepsy completed measures of HRQOL and side-effects at each clinic visit. Treatment information was also collected. RESULTS HRQOL remained stable over time; however, seizures and AED side-effects significantly affected multiple HRQOL domains. Higher seizure activity was associated with decreased Physical HRQOL. Side-effects were negatively associated with all HRQOL domains. Children taking carbamazepine who experienced higher side-effects early in therapy demonstrated declining emotional functioning compared to children experiencing no/some side-effects. CONCLUSIONS AED side-effects, AED type, and seizure frequency were associated with longitudinal HRQOL in children with newly-diagnosed epilepsy. Routine assessment of AED side-effects and HRQOL may be useful for clinical decision making.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self Management, MLC-7039, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Abstract
The goal of this article is to review the recent literature on measures of glycemic variability, links between glycemic variability and psychological functioning, and methods for examining these links. A number of commonly used measures of glycemic variability are reviewed and compared, including recently proposed methods. Frequently used measures of glycemic variability are also discussed in the context of research that uses continuous glucose monitoring for the collection of blood glucose data. The results of previous studies that have examined the link between psychological functioning and glycemic variability within relatively short-term time frames are reviewed. Methods for examining glycemic variability and its link with psychological functioning are discussed so that important research questions can be addressed to aid in understanding the effect of changes in psychological functioning on glycemic variability and vice versa in future research.
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Affiliation(s)
- Joseph R Rausch
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Kuhl ES, Hoodin F, Rice J, Felt BT, Rausch JR, Patton SR. Increasing daily water intake and fluid adherence in children receiving treatment for retentive encopresis. J Pediatr Psychol 2010; 35:1144-51. [PMID: 20439348 DOI: 10.1093/jpepsy/jsq033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine the efficacy of an enhanced intervention (EI) compared to standard care (SC) in increasing daily water intake and fluid goal adherence in children seeking treatment for retentive encopresis. METHODS Changes in beverage intake patterns and fluid adherence were examined by comparing 7-week diet diary data collected during participation in the EI to achieved data for families who had previously completed the SC. RESULTS Compared to children in SC (n = 19), children in the EI (n = 18) demonstrated a significantly greater increase in daily water intake from baseline to the conclusion of treatment ( p ≤ .001), and were four and six times more likely to meet fluid targets in Phases 1 (Weeks 3-4) and 2 (Weeks 5-6) of fluid intervention, respectively (both p ≤ .001). CONCLUSIONS Enhanced education and behavioral strategies were efficacious in increasing children's intake of water and improving fluid adherence. Future research should replicate the findings in a prospective randomized clinical trial to discern their effectiveness.
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Affiliation(s)
- Scott E. Maxwell
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana 46556;
| | - Ken Kelley
- Inquiry Methodology Program, Indiana University, Bloomington, Indiana 47405;
| | - Joseph R. Rausch
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota 55455;
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Abstract
The present study examines the association between the self-concept and adaptation to conjugal loss; the primary aim was to explore whether those individuals high in self-esteem, environmental mastery, and optimism have more adaptive resources with which to ameliorate the detrimental sequelae of bereavement. Analyses were conducted on data collected from 58 widows every four months over a two-year period. One goal of the research was to explore the adequacy of the theoretically chosen operational definition of the self-concept; another goal was to analyze how changes in the level of self-concept components correlated with changes in levels of depression, health, and grief resolution as individuals adjusted to their losses. Analyses revealed that trajectories of depression and grief resolution were more highly related than health to changes in self-concept.
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Abstract
Methods for planning sample size (SS) for the standardized mean difference so that a narrow confidence interval (CI) can be obtained via the accuracy in parameter estimation (AIPE) approach are developed. One method plans SS so that the expected width of the CI is sufficiently narrow. A modification adjusts the SS so that the obtained CI is no wider than desired with some specified degree of certainty (e.g., 99% certain the 95% CI will be no wider than omega). The rationale of the AIPE approach to SS planning is given, as is a discussion of the analytic approach to CI formation for the population standardized mean difference. Tables with values of necessary SS are provided. The freely available Methods for the Behavioral, Educational, and Social Sciences (K. Kelley, 2006a) R (R Development Core Team, 2006) software package easily implements the methods discussed.
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Affiliation(s)
- Ken Kelley
- Inquiry Methodology Program, Indiana University, Bloomington, IN 47405, USA.
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