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Milliren CE, Crowley M, Carmody JK, Bern EM, Eldredge O, Richmond TK. Pediatric hospital utilization for patients with avoidant restrictive food intake disorder. J Eat Disord 2024; 12:42. [PMID: 38528642 DOI: 10.1186/s40337-024-00996-z] [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: 03/09/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Avoidant restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder added to the DSM-5 in 2013 and ICD-10 in 2018. Few studies have examined hospital utilization for patients with ARFID specifically, and none to date have used large administrative cohorts. We examined inpatient admission volume over time and hospital utilization and 30-day readmissions for patients with ARFID at pediatric hospitals in the United States. METHODS Using data from the Pediatric Health Information System (PHIS), we identified inpatient admissions for patients with ARFID (by principal International Classification of Diseases, 10th Revision, ICD-10 diagnosis code) discharged October 2017-June 2022. We examined the change over time in ARFID volume and associations between patient-level factors (e.g., sociodemographic characteristics, co-morbid conditions including anxiety and depressive disorders and malnutrition), hospital ARFID volume, and hospital utilization including length of stay (LOS), costs, use of enteral tube feeding or GI imaging during admission, and 30-day readmissions. Adjusted regression models were used to examine associations between sociodemographic and clinical factors on LOS, costs, and 30-day readmissions. RESULTS Inpatient ARFID volume across n = 44 pediatric hospitals has increased over time (β = 0.36 per month; 95% CI 0.26-0.46; p < 0.001). Among N = 1288 inpatient admissions for patients with ARFID, median LOS was 7 days (IQR = 8) with median costs of $16,583 (IQR = $18,115). LOS and costs were highest in hospitals with higher volumes of ARFID patients. Younger age, co-morbid conditions, enteral feeding, and GI imaging were also associated with LOS. 8.5% of patients were readmitted within 30 days. In adjusted models, there were differences in the likelihood of readmission by age, insurance, malnutrition diagnosis at index visit, and GI imaging procedures during index visit. CONCLUSIONS Our results indicate that the volume of inpatient admissions for patients with ARFID has increased at pediatric hospitals in the U.S. since ARFID was added to ICD-10. Inpatient stays for ARFID are long and costly and associated with readmissions. It is important to identify effective and efficient treatment strategies for ARFID in the future.
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Affiliation(s)
- Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - McGreggor Crowley
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Julia K Carmody
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Elana M Bern
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Olivia Eldredge
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Tracy K Richmond
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Carmody JK, Duraccio KM, Krietsch KN, Simmons DM, Byars KC. Factors affecting pediatric adherence to positive airway pressure: Patient- and caregiver-reported treatment barriers and sleep difficulties. Sleep Med 2023; 101:58-65. [PMID: 36335892 DOI: 10.1016/j.sleep.2022.10.011] [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: 06/17/2022] [Revised: 09/24/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/BACKGROUND Adherence to positive airway pressure (PAP) treatment among children and adolescents is often suboptimal. Little is understood about modifiable determinants of PAP adherence. We evaluated whether patient and caregiver-perceived treatment barriers (across behavioral, environmental, emotional, and physical domains), as well as insomnia severity, were associated with PAP adherence among youth with sleep disordered breathing (SDB). PATIENTS/METHODS We conducted a retrospective review of 188 patients prescribed PAP, ages 2-19 years. At the clinical visit, PAP adherence was assessed via objective download/smartcard and patients and their caregivers completed validated standardized questionnaires on barriers to PAP adherence and sleep onset and maintenance difficulties. We tested predictors of PAP adherence using linear regression. RESULTS On average, patients wore their PAP 2/3 of nights for 5.3 ± 3.4 h. Patients reported more barriers overall compared to caregivers, and specifically more behavioral and emotional barriers (e.g., over a third of patients reported they just want to forget about sleep apnea). After controlling for demographic/treatment characteristics, patient-reported barriers accounted for a significant proportion of the variance in percent nights used (51%) and average nightly use (42%). Greater difficulties with sleep maintenance predicted poorer PAP adherence (percent nights and nightly duration). CONCLUSIONS Study findings suggest that assessment of both patient and caregiver-perceived barriers to PAP adherence, as well as evaluating for sleep maintenance concerns, may provide important treatment targets for promoting PAP adherence among youth. Results also support the potential benefit of a multi-disciplinary team-based approach to managing SDB and promoting PAP adherence.
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Affiliation(s)
- Julia K Carmody
- Division of Gastroenterology, Hepatology, & Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, MA, USA.
| | | | - Kendra N Krietsch
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Danielle M Simmons
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kelly C Byars
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Plevinsky JM, Carmody JK, Young MA. Introduction to the special issue on pediatric adherence and self-management: Topical reviews and clinical applications of evidence-based assessment and intervention. Clinical Practice in Pediatric Psychology 2022. [DOI: 10.1037/cpp0000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ramsey RR, Plevinsky JM, Guilbert TW, Carmody JK, Hommel KA. Technology-Assisted Stepped-Care to Promote Adherence in Adolescents with Asthma: A Pilot Study. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09905-5. [PMID: 35986811 PMCID: PMC9391214 DOI: 10.1007/s10880-022-09905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
To examine the feasibility, acceptability, and preliminary efficacy of a technology-assisted stepped-care behavioral intervention to improve adherence in adolescents with asthma. Thirty adolescents (Mage = 14.66, 53% male) with moderate to severe-persistent asthma completed daily adherence monitoring and medication reminders via a mobile app (Step 1). Participants with < 68% adherence during Step 1 received a telehealth behavioral intervention (Step 2). Twenty-six of 30 participants (87%) completed Step 1. Step 2 was indicated for 18 participants and was completed by 17. Participants favorably rated their experience in the study. Improvements in adherence (40–58%, p = .048) and decreases in asthma composite severity scores (CASI 6.08–5.08, p = .023) were observed for the full sample. Technology-assisted stepped-care is feasible and acceptable. Participants demonstrated improved adherence and asthma composite severity scores once they received the appropriate step of the intervention. Future studies should include a control group, a longer time-frame and an intermediate intervention step.
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Affiliation(s)
- Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC: 7035, Cincinnati, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA.
| | - Jill M Plevinsky
- Division of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Theresa W Guilbert
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Julia K Carmody
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, USA
- Department of Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, USA
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC: 7035, Cincinnati, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
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Carmody JK, Stromberg SE, Dumont-Driscoll MC, Janicke DM. Youth safety perceptions of weight control behaviors: A moderated mediation study. Eat Behav 2020; 39:101437. [PMID: 33130365 DOI: 10.1016/j.eatbeh.2020.101437] [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: 04/06/2020] [Revised: 08/03/2020] [Accepted: 09/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Youth may engage in healthy weight control behaviors (HWCBs) and unhealthy weight control behaviors (UWCBs) to lose or maintain weight. Youth observation of WCBs by supporter groups (parents/siblings/peers) and youth beliefs about the safety of WCBs may impact which WCBs youth use. The primary aim of this study was to examine the mediating role of youth safety perceptions of WCBs on the relationships between supporter group engagement in WCBs and youth engagement in WCBs. Youth BMI-z-score was analyzed as a moderator. METHODS Participants were 219 youth (52.1% females), ages 10-17, attending an outpatient medical appointment. Participants completed questionnaires about their WCB use, whether they perceived WCBs as safe/unsafe, and whether they perceived parents, siblings and peers to use WCBs. A standardized formula including youth age, sex, height, and weight was used to calculate BMI-z-score. RESULTS A moderated mediation model examining parental and youth engagement in UWCBs revealed that for youth in the healthy to overweight/obese (OV/OB) range, greater safety perception of UWCBs mediated the relationship between higher parent engagement in UWCBs and higher youth engagement in UWCBs. Furthermore, youth safety perception of HWCBs mediated the relationship between perceived parent, sibling, and peer engagement in HWCBs and youth engagement in HWCBs. CONCLUSION This study identifies perceived parent, sibling, and peer WCBs and youth safety perceptions as mechanisms affecting youth WCB engagement, particularly for youth in the OV/OB range. Intervention effectiveness may increase if parent, sibling, and peer WCBs are targeted and education about safe/unsafe ways to control weight is provided.
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Affiliation(s)
- Julia K Carmody
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America
| | - Sarah E Stromberg
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America.
| | - Marilyn C Dumont-Driscoll
- General Pediatrics, University of Florida College of Medicine, 1699 SW 16(th) Ave., Gainesville, FL 32608, United States of America
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America
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Plevinsky JM, Gutierrez-Colina AM, Carmody JK, Hommel KA, Crosby LE, McGrady ME, Pai ALH, Ramsey RR, Modi AC. Patient-Reported Outcomes for Pediatric Adherence and Self-Management: A Systematic Review. J Pediatr Psychol 2020; 45:340-357. [PMID: 31845997 DOI: 10.1093/jpepsy/jsz096] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/30/2019] [Revised: 08/23/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Treatment adherence is approximately 50% across pediatric conditions. Patient-reported outcomes (PROs) are the most common method of measuring adherence and self-management across research and clinical contexts. The aim of this systematic review is to evaluate adherence and self-management PROs, including measures of adherence behaviors, adherence barriers, disease management skills, and treatment responsibility. METHODS Following PRISMA guidelines for systematic reviews, literature searches were performed. Measures meeting inclusion/exclusion criteria were evaluated using Hunsley and Mash's (2018) criteria for evidence-based assessment across several domains (e.g., internal consistency, interrater reliability, test-retest reliability, content validity, construct validity, validity generalization, treatment sensitivity, and clinical utility). Rating categories were adapted for the present study to include the original categories of adequate, good, and excellent, as well as an additional category of below adequate. RESULTS After screening 172 articles, 50 PROs across a variety of pediatric conditions were reviewed and evaluated. Most measures demonstrated at least adequate content validity (n = 44), internal consistency (n = 34), and validity generalization (n = 45). Findings were mixed regarding interrater reliability, test-retest reliability, and treatment sensitivity. Less than half of the measures (n = 22) exhibited adequate, good, or excellent construct validity. CONCLUSIONS Although use of adherence and self-management PROs is widespread across several pediatric conditions, few PROs achieved good or excellent ratings based on rigorous psychometric standards. Validation and replication studies with larger, more diverse samples are needed. Future research should consider the use of emerging technologies to enhance the feasibility of broad implementation.
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Affiliation(s)
- Jill M Plevinsky
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Ana M Gutierrez-Colina
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Julia K Carmody
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Kevin A Hommel
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Lori E Crosby
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Meghan E McGrady
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Ahna L H Pai
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Rachelle R Ramsey
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Avani C Modi
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
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Plevinsky JM, Young MA, Carmody JK, Durkin LK, Gamwell KL, Klages KL, Ghosh S, Hommel KA. The Impact of COVID-19 on Pediatric Adherence and Self-Management. J Pediatr Psychol 2020; 45:977-982. [PMID: 32929482 PMCID: PMC7522296 DOI: 10.1093/jpepsy/jsaa079] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has presented unique circumstances that have the potential to both positively and negatively affect pediatric adherence and self-management in youth with chronic medical conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders, school closures, changes in pediatric healthcare delivery) impact disease management at the individual, family, community, and healthcare system levels. We also discuss how barriers to pediatric adherence and self-management exacerbated by the pandemic may disproportionately affect underserved and vulnerable populations, potentially resulting in greater health disparities. Given the potential for widespread challenges to pediatric disease management during the pandemic, ongoing monitoring and promotion of adherence and self-management is critical. Technology offers several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover, pediatric psychologists are uniquely equipped to develop and implement adherence-promotion efforts to support youth and their families in achieving and sustaining optimal disease management as the current public health situation continues to evolve. Research efforts addressing the short- and long-term impact of the pandemic on pediatric adherence and self-management are needed to identify both risk and resilience factors affecting disease management and subsequent health outcomes during this unprecedented time.
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Affiliation(s)
- Jill M Plevinsky
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | - Julia K Carmody
- Division of Gastroenterology and Nutrition, Boston Children's Hospital
| | - Lindsay K Durkin
- Department of Clinical Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science
| | - Kaitlyn L Gamwell
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Kimberly L Klages
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Shweta Ghosh
- Cancer and Blood Disorders Center, Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital
| | - Kevin A Hommel
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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Carmody JK, Simon SL, Mara CA, Byars KC. Validation and confirmatory factor analysis of the pediatric Adherence Barriers to Continuous Positive Airway Pressure Questionnaire. Sleep Med 2020; 74:1-8. [PMID: 32828897 PMCID: PMC7541536 DOI: 10.1016/j.sleep.2020.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/10/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate and refine a newly proposed factor structure for the Adherence Barriers to Continuous Positive Airway Pressure Questionnaire (ABCQ) and to present psychometric data from a large, geographically diverse sample of children and young adults with sleep disordered breathing (SDB) treated with positive airway pressure (PAP). METHODS A sample of 181 patients prescribed PAP for treatment of SDB, ages 8-21 years, and caregivers (n = 234) of patients ages 2-21 years, completed the ABCQ during routine sleep medicine clinic visits. Adherence data from participants' PAP machines were obtained via electronic download, providing objective data on PAP adherence immediately preceding the clinic visit during which the ABCQ was completed. RESULTS A three-factor structure (1. Behavior, Beliefs, Environment, 2. Emotional Barriers, & 3. Physical Barriers) exhibited good model fit in confirmatory factor analysis. Results indicate that the ABCQ has strong psychometric properties, including good internal consistency among subscales and strong convergent validity with objectively measured PAP adherence. Analysis of the Receiver Operator Characteristic Curve (ROC) yielded an ABCQ total cut-off score of 46.5 for patient report and 53.5 for caregiver report. Scores above the cutpoint predicted nonadherence to PAP, defined as failure to use PAP for ≥4 h on 70% of nights. CONCLUSIONS The three-factor ABCQ appears to be a useful patient- and caregiver-report instrument to measure barriers to PAP treatment in children and young adults with sleep disordered breathing.
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Affiliation(s)
- Julia K Carmody
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Stacey L Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children's Hospital of Colorado, Aurora, CO, USA
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Kelly C Byars
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, USA
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Carmody JK, Plevinsky J, Peugh JL, Denson LA, Hyams JS, Lobato D, LeLeiko NS, Hommel KA. Longitudinal non-adherence predicts treatment escalation in paediatric ulcerative colitis. Aliment Pharmacol Ther 2019; 50:911-918. [PMID: 31373712 PMCID: PMC8215554 DOI: 10.1111/apt.15445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/20/2019] [Revised: 04/26/2019] [Accepted: 07/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Medication non-adherence in paediatric ulcerative colitis (UC) has been associated with negative health outcomes including flares in disease activity. However, no studies to date have examined longitudinal adherence to maintenance medication in a prospective controlled trial. AIMS To determine whether objectively measured adherence to standardised mesalazine (mesalamine) therapy over time was related to remission at 52 weeks and the need for treatment escalation in newly diagnosed paediatric patients with UC METHODS: PROTECT (NCT01536535) was a prospective, inception cohort, multi-site study of paediatric patients aged 4-17 years with newly diagnosed UC followed for 52 weeks. Patients received standardised mesalazine, with pre-established criteria for escalation to thiopurines or anti-TNFα inhibitors. Patients used pill bottles with electronic caps to monitor mesalazine adherence. We tested whether longitudinal adherence to mesalazine predicted steroid-free remission at week 52 (i.e. quiescent disease on mesalazine alone with no corticosteroids ≥4 weeks prior) and need for treatment escalation (i.e. introduction of immunomodulators, calcineurin-inhibitors or anti-TNFα inhibitors). RESULTS Among 268 patients, average mesalazine adherence trajectories did not predict week 52 steroid-free remission. Declining adherence over time strongly predicted treatment escalation (β = -.037, P = .001). By month 6, adherence rate ≤85.7% was associated with treatment escalation. CONCLUSIONS Non-adherence may have affected therapeutic efficacy of standardised mesalazine, thereby contributing to need for treatment escalation. Routine adherence monitoring for at least 6 months following treatment initiation and addressing adherence difficulties early in the disease course are recommended.
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Affiliation(s)
- Julia K. Carmody
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH, USA
| | - Jill Plevinsky
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH, USA
| | - James L. Peugh
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lee A. Denson
- Cincinnati Children’s Hospital Medical Center, Schubert-Martin Inflammatory Bowel Disease Center, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati, OH, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey S. Hyams
- Connecticut Children’s Medical Center and University of Connecticut School of Medicine, Hartford, CT, USA
| | - Debra Lobato
- Hasbro Children’s Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neal S. LeLeiko
- Hasbro Children’s Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin A. Hommel
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Ramsey RR, Carmody JK, Holbein CE, Guilbert TW, Hommel KA. Examination of the uses, needs, and preferences for health technology use in adolescents with asthma. J Asthma 2019; 56:964-972. [PMID: 30207802 PMCID: PMC6414273 DOI: 10.1080/02770903.2018.1514048] [Citation(s) in RCA: 15] [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] [Received: 06/21/2018] [Revised: 08/03/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
Objective: To examine the health technology uses and preferences of adolescents with asthma using a qualitative descriptive individual interview approach. Methods: Twenty adolescents were recruited from regularly scheduled asthma clinic appointments from February to July 2016. Patients were interviewed about their technology use and ways in which health technology could improve their asthma management using an open-ended semi-structured interview format. Interviews were audio recorded, transcribed, and coded into themes. Results: Social media (e.g. Snapchat, Instagram) and general communication (e.g. messaging) were the most common uses of technology while medical reminders (e.g. appointment, refill, medication) were the most common use of health technology. Adolescents identified ways in which health technology could improve their asthma management including (1) tracking symptoms and medication, (2) medical reminders, and (3) asthma and self-management knowledge specifically related to medications and individual action plans. Other themes that emerged included a desire to customize health technology to fit with individual schedules and medical routines and use of health technology data with medical providers. Conclusions: Adolescents and parents experience a number of challenges related to managing asthma, and health technology interventions should focus on ways to improve adherence and self-management. Future research considerations and potential interventions including ways to integrate adolescent preferences with evidence-based interventions are discussed.
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Affiliation(s)
- Rachelle R Ramsey
- a Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
- b Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Julia K Carmody
- a Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Christina E Holbein
- a Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Theresa W Guilbert
- b Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati , OH , USA
- c Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
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Carmody JK, Simakajornboon N, Gurbani N, Burrows C, Krietsch K, Graef D, Byars KC. 0731 Factors Affecting Pediatric Adherence to Positive Airway Pressure: Treatment Barriers, Sleep Difficulties, and Behavioral Sleep Medicine Consultation. Sleep 2019. [DOI: 10.1093/sleep/zsz067.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julia K Carmody
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Neepa Gurbani
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carolyn Burrows
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kendra Krietsch
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Danielle Graef
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kelly C Byars
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Carmody JK, Denson LA, Hommel KA. Content and Usability Evaluation of Medication Adherence Mobile Applications for Use in Pediatrics. J Pediatr Psychol 2019; 44:333-342. [PMID: 30358863 PMCID: PMC6415658 DOI: 10.1093/jpepsy/jsy086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/19/2018] [Revised: 09/16/2018] [Accepted: 10/01/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The objective of this study was to systematically evaluate commercially available medication adherence apps for the inclusion of behavior change techniques (BCTs) and to conduct a usability analysis on a subset of apps with adolescents and young adults living with a chronic illness. METHODS Medication adherence apps were identified via a search of iTunes app store in August 2016. Seventy-five apps meeting initial inclusion criteria were independently coded by two researchers for the presence/absence of 26 BCTs. Twenty adolescents and young adults (ages: 13-20 years) with inflammatory bowel disease conducted usability testing on a subset of apps (n = 4). RESULTS Across 75 apps coded for presence/absence of 26 BCTs, only 7 unique BCTs were identified. The number of BCTs per app ranged from 2 to 6, with an average of 3.3 BCTs. In usability testing, quality ratings varied across apps. Medisafe received the highest average scores on engagement, functionality, aesthetics, and information subscales. Medisafe and MyTherapy ranked first and second, respectively, on overall quality and perceived impact ratings. CONCLUSION Content evaluation revealed only a limited number of BCTs that have been translated to medication adherence apps. Among apps with comparable content, clear user preferences emerged based on perceived quality and usability. Greater collaboration is needed between psychologists and health technologists to incorporate more evidence-based BCTs in apps. Findings also indicate a need for app developers to consider and incorporate the preferences of younger end users to improve app quality and engagement for pediatric populations.
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Affiliation(s)
- Julia K Carmody
- Center for Adherence and Self-Management
- Center for Health Technology Research
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Lee A Denson
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Kevin A Hommel
- Center for Adherence and Self-Management
- Center for Health Technology Research
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
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13
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Holbein CE, Carmody JK, Hommel KA. Topical Review: Adherence Interventions for Youth on Gluten-Free Diets. J Pediatr Psychol 2018; 43:392-401. [PMID: 29096013 PMCID: PMC6658851 DOI: 10.1093/jpepsy/jsx138] [Citation(s) in RCA: 2] [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: 05/01/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 02/07/2023] Open
Abstract
Objective To summarize gluten-free diet (GFD) nonadherence risk factors, nonadherence rates, and current intervention research within an integrative framework and to develop a research agenda for the development and implementation of evidence-based GFD adherence interventions. Methods Topical review of literature published since 2008 investigating GFD adherence in pediatric samples. Results Reviews of pediatric studies indicate GFD nonadherence rates ranging from 19 to 56%. There are few evidence-based, published pediatric GFD adherence interventions. Novel assessments of GFD adherence are promising but require further study. Nonmodifiable and modifiable factors within individual, family, community, and health systems domains must be considered when developing future interventions. Clinical implications are discussed. Conclusions Avenues for future research include development and refinement of adherence assessment tools and development of evidence-based GFD adherence interventions. Novel technologies (e.g., GFD mobile applications) require empirical study but present exciting opportunities for adherence intervention.
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Affiliation(s)
- Christina E Holbein
- Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center
| | - Julia K Carmody
- Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center
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14
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Klitzman PH, Carmody JK, Belkin MH, Janicke DM. Behavioral and Pharmacological Adherence in Pediatric Sickle Cell Disease: Parent–Child Agreement and Family Factors Associated With Adherence. J Pediatr Psychol 2017; 43:31-39. [DOI: 10.1093/jpepsy/jsx077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/04/2017] [Indexed: 11/13/2022] Open
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Chardon ML, Stromberg SE, Lawless C, Fedele DA, Carmody JK, Dumont-Driscoll MC, Janicke DM. The Role of Child and Adolescent Adjustment Problems and Sleep Disturbance in Parent Psychological Distress. J Clin Child Adolesc Psychol 2016; 47:374-381. [PMID: 27646109 DOI: 10.1080/15374416.2016.1204923] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The goal of this study was to examine the moderating role of youth sleep disturbance on the relationship between youth internalizing and externalizing symptoms and parent psychological distress. Participants were 225 youth (ages 8-17) and parent dyads attending a primary care clinic appointment. Participants completed questionnaires that assessed parent psychological distress, youth internalizing symptoms, youth externalizing symptoms, and youth sleep disturbance. Moderation analyses were conducted to examine whether youth sleep disturbance moderated the relationship between youth internalizing and externalizing symptoms and parent psychological distress. The interaction between youth internalizing symptoms and youth sleep disturbance was significantly related to parent psychological distress, such that having increased sleep disturbance amplified the positive relationship between internalizing symptoms and parent psychological distress. The moderation model explained 52% of the variance in parent psychological distress. The interaction between youth externalizing symptoms and youth sleep disturbance was also significantly related to parent psychological distress, such that increased sleep disturbance amplified the positive relationship between externalizing symptoms and parent psychological distress. This model accounted for 53% of the variance in parent psychological distress. Greater youth sleep disturbance strengthens the positive relationship between youth internalizing/externalizing symptoms and parent psychological distress. Accordingly, reducing youth sleep disturbance may serve as an appropriate intervention target in families experiencing increased parent psychological distress.
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Affiliation(s)
- Marie L Chardon
- a Department of Clinical and Health Psychology , University of Florida
| | - Sarah E Stromberg
- a Department of Clinical and Health Psychology , University of Florida
| | - Casey Lawless
- a Department of Clinical and Health Psychology , University of Florida
| | - David A Fedele
- a Department of Clinical and Health Psychology , University of Florida
| | - Julia K Carmody
- a Department of Clinical and Health Psychology , University of Florida
| | | | - David M Janicke
- a Department of Clinical and Health Psychology , University of Florida
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Chardon ML, Janicke DM, Carmody JK, Dumont-Driscoll MC. Youth internalizing symptoms, sleep-related problems, and disordered eating attitudes and behaviors: A moderated mediation analysis. Eat Behav 2016; 21:99-103. [PMID: 26826649 DOI: 10.1016/j.eatbeh.2016.01.007] [Citation(s) in RCA: 16] [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: 08/21/2015] [Revised: 01/04/2016] [Accepted: 01/19/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE Internalizing symptoms increase the risk for disordered eating; however, the mechanism through which this relationship occurs remains unclear. Sleep-related problems may be a potential link as they are associated with both emotional functioning and disordered eating. The present study aims to evaluate the mediating roles of two sleep-related problems (sleep disturbance and daytime sleepiness) in the relationship between youth internalizing symptoms and disordered eating, and to explore if age moderates these relations. METHODS Participants were 225 youth (8-17years) attending a primary care appointment. Youth and legal guardians completed questionnaires about youth disordered eating attitudes and behaviors, internalizing symptoms, sleep disturbance, and daytime sleepiness. Mediation and moderated mediation analyses were utilized. RESULTS The mediation model revealed both youth sleep disturbance and daytime sleepiness independently mediated the association between internalizing symptoms and disordered eating attitudes and behaviors, and explained 18% of the variance in disordered eating. The moderated mediation model including youth age accounted for 21% of the variance in disordered eating; youth age significantly interacted with sleep disturbance, but not with daytime sleepiness, to predict disordered eating. Sleep disturbance only mediated the relationship between internalizing symptoms and disordered eating in youth 12years old and younger, while daytime sleepiness was a significant mediator regardless of age. CONCLUSION As sleep-related problems are frequently improved with the adoption of health behaviors conducive to good sleep, these results may suggest a relatively modifiable and cost-effective target to reduce youth risk for disordered eating.
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Affiliation(s)
- Marie L Chardon
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA
| | - Julia K Carmody
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA
| | - Marilyn C Dumont-Driscoll
- Department of Pediatrics, University of Florida College of Medicine, P.O. Box 100296, Gainesville, FL 32610, USA
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