Psychological distress between chronic hemodialysis patients with and without low back pain

Objective

The aim of this study was to compare psychological distress between patients on chronic hemodialysis with and without chronic low back pain (CLBP).

Subjects and methods

A total of 72 patients on chronic hemodialysis, aged 72.9 ± 10.8 years, were enrolled in this cross-sectional study. Psychological distress using the K6, questionnaire for CLBP, and physical activity using the tri-accelerometer were evaluated.

Results

Twenty-nine patients (40.3 %) were having CLBP. The K6 scores were 4.0 ± 4.6 and physical activity (n = 55) was 1.0 ± 1.0 METs h/day. K6 scores in patients on chronic hemodialysis with CLBP were significantly higher than those in patients on chronic hemodialysis without CLBP even after adjusting for sex, age, duration of hemodialysis and physical activity.

Conclusion

These results suggest that higher psychological distress was a fundamental feature in patients on chronic hemodialysis with CLBP.

     

The role of mindfulness in distress and quality of life for men with advanced prostate cancer

Objective

To examine the extent to which mindfulness skills influence psychological distress and health-related quality of life (HRQOL) in men with metastatic or castration-resistant biochemical progression of prostate cancer.

Patients and methods

A cross-sectional survey of 190 men (46 % response; mean age 71 years, SD = 8.7, range 40–91 years) with advanced prostate cancer, assessed psychological and cancer-specific distress, HRQOL. Mindfulness skills were assessed as potential predictors of adjustment outcomes.

Results

Overall, 39 % of men reported high psychological distress. One third had accessed psychological support previously although only 10 % were under current psychological care. One quarter had accessed a prostate cancer support group in the past six months.Higher HRQOL and lower cancer-specific and global psychological distress were related to non-judging of inner experience (p < 0.001).Higher HRQOL and lower psychological distress were related to acting with awareness (p < 0.001). Lower distress was also related to higher non-reactivity to inner experience and a lower level of observing (p < 0.05).

Conclusions

Men with advanced prostate cancer are at risk of poor psychological outcomes. Psychological flexibility may be a promising target for interventions to improve adjustment outcomes in this patient group.

Clinical Trial Registry

Trial Registration: ACTRN12612000306819

     

Effects of the Caregiver Interaction Profile Training on Caregiver–Child Interactions in Dutch Child Care Centers: A Randomized Controlled Trial

Background

Previous studies underscore the need to improve caregiver–child interactions in early child care centers.

Objective

In this study we used a randomized controlled trial to examine whether a 5-week video feedback training can improve six key interactive skills of caregivers in early child care centers: Sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions.

Method

A total of 139 caregivers from 68 early child care groups for 0- to 4-year-old children in Dutch child care centers participated in this RCT, 69 in the intervention condition and 70 in the control condition. Caregiver interactive skills during everyday interactions with the children were rated from videotape using the Caregiver Interaction Profile (CIP) scales at pretest, posttest, and follow-up 3 months after the posttest.

Results

Results at posttest indicate a significant positive training effect on all six caregiver interactive skills. Effect sizes of the CIP training range between d = 0.35 and d = 0.79. Three months after the posttest, caregivers in the intervention group still scored significantly higher on sensitive responsiveness, respect for autonomy, verbal communication, and fostering positive peer interactions than caregivers in the control group with effect sizes ranging between d = 0.47 and d = 0.70.

Conclusions

This study shows that the quality of caregiver–child interactions can be improved for all six important caregiver skills, with a relatively short training program. Possible ways to further improve the training and to implement it in practice and education are discussed.

     

Using Electronic Health Record Alerts to Increase Safety Planning with Youth At-Risk for Suicide: A Non-randomized Trial

Background

No study to date has examined the effectiveness of integrating clinical decision support tools, like electronic health record (EHR) alerts, into the clinical care of youth at-risk for suicide.

Objective

This study aimed to examine the feasibility and acceptability of using an EHR alert to increase clinicians’ use of safety planning with youth at-risk for suicide in an outpatient pediatric psychiatry clinic serving an urban low-income Latino community.

Methods

An alert intervention was developed to remind clinicians to complete a safety plan whenever they documented that their patient endorsed suicidal ideation, plan, or attempt during a visit in EHR notes. The alert appeared as a separate window containing a reminder message to complete a safety plan once a clinician finished visit documentation.

Results

There were 69 at-risk patients between the ages of 13–21 in the intervention period (M = 15.71; SD = 1.86; 66.7% female) and 64 (M = 15.38; SD = 1.93; 68.6% female) in the control period. Logistic regression analyses indicated that patients in the intervention period were significantly more likely than patients in the control period to receive a safety plan (p < .01). The pattern of results remained the same after adjusting for demographic variables (p = .01). Forty clinicians also completed a questionnaire assessing their satisfaction with the EHR alert, indicating moderate satisfaction (M = 3.01; SD = 0.63; range = 1.11–4.11).

Conclusions

EHR alerts are associated with changes in clinicians’ behavior and improved compliance with best clinical practices for at-risk youth.

     

Correlation of emotional labor and cortisol concentration in hair among female kindergarten teachers

Objectives

The purpose of this study was to explore whether two types of emotional labor, surface acting and deep acting, are related to hair cortisol concentration among kindergarten teachers.

Methods

Surface acting and deep acting over the last month were measured with the Chinese version of the emotional labor scale in 43 kindergarten teachers. Hair samples with 1 cm in length were cut from their posterior vertex region to represent cortisol excretion over one month. Cortisol concentrations were analyzed with high-performance liquid chromatography–tandem mass spectrometry.

Results

Positive association of emotion labor with hair cortisol concentration was significant for surface acting (r = 0.34, p < 0.05) and not significant for deep acting (r = 0.14, p > 0.05).

Conclusions

More surface acting showed to be associated stronger with stress responses or higher HPA axis activity.

     

Predicting parent health-related quality of life: evaluating conceptual models

Purpose

Parents of children with chronic illnesses are at risk for poor health-related quality of life (HRQoL), with numerous identified risk factors, but the most informative statistical model considering their combined impact is unclear. The authors conceptualized risk for poor HRQoL using a summed model, comprehensive multivariate model, and latent profile analysis (LPA).

Methods

Community parents completed an online survey, providing information about demographics, child’s chronic illness, family functioning, and parent and child HRQoL. Parents reported that their children had a variety of chronic conditions (e.g., asthma, headaches, attention deficit/hyperactivity disorder, neurofibromatosis).

Results

The summed model did not account for a significant proportion of variance in parent HRQoL. The comprehensive multivariate model (R ² ?=?0.614) and LPA (R ² ?=?0.305) both significantly predicted parent HRQoL. The LPA identified two risk profiles for lower HRQoL: parents who reported milder illnesses, but poorer family functioning; and parents who reported greater disease severity, but better family functioning.

Conclusions

Comprehensive multivariate models or LPAs best conceptualize patterns of risk for poor parental HRQoL in the community; though the findings in the current community sample may not extend to parents recruited from specialty clinics whose children may have more severe chronic illnesses. Parents of children with mild chronic conditions are still at risk for poor HRQoL, warranting attention from health care providers.

     

Measuring Anxiety in Children: The Importance of Separate Mother and Father Reports

Background

Previous research suggests that it is important to use parental reports when assessing children’s anxiety, but it remains unclear to what extent there are differences between mothers’ and fathers’ scores and whether these potential differences have any repercussions for the psychometric properties of the scale being used.

Objective

This study was conducted to investigate parental differences on the Parent version of the Screen for Child Anxiety Related Emotional Disorders-Revised (SCARED-RP), a rating scale for measuring child anxiety symptoms. The second aim was to re-examine the reliability and validity of the SCARED-RP, in light of these possible differences.

Methods

The SCARED-RP and the Child Behaviour Checklist (CBCL) were administered to parents of clinically anxious children (n = 81), and control children (n = 108). All children (n = 189) completed the SCARED-R.

Results

Significant correlations between mother and father reports were found within the clinically anxious sample. Mothers showed significantly more correspondence with their children in the control group than fathers. The SCARED-RP internal consistency on total scale was excellent (mothers: .94; fathers: .94) and moderate to good for all subscales (from .66 Situational-Environmental Phobia to .93 Animal Phobia). The SCARED-RP differentiated well between clinically anxious and control children (mother and father data). The concurrent validity was supported by strong correlations with the CBCL anxious-depressed scale.

Conclusion

Differences between mother and father reports suggest the importance of obtaining information from both parents separately. Furthermore, the SCARED-RP is a useful instrument for assessing children’s anxiety disorder symptoms in clinical and research settings.

     

The effects of the Make a Wish intervention on psychiatric symptoms and health-related quality of life of children with cancer: a randomised controlled trial

Objective

Children with life-threatening medical conditions frequently undergo invasive medical procedures that may elicit anxiety and distress. However, there are few empirically validated interventions that reduce mental health symptoms and increase the resilience of children during the acute stages of illness. This study aimed to evaluate the efficacy of the Make a Wish intervention for children with life-threatening cancer.

Methods

The design was a wait-list-controlled trial with two parallel groups. Sixty-six children aged 5–12 with an initial diagnosis of life-threatening cancer were identified and randomly assigned to the Make a Wish intervention (n = 32) or a wait-list control group (n = 34). Children completed measures of psychiatric and health-related symptoms, positive and negative affect, hope, and optimism pre-intervention and post-intervention. After baseline data collection, children were interviewed and made an authentic wish that they wanted to come true. These wishes were made possible 5–6 months after baseline data collection, to fuel anticipation and excitement over the wish-fulfillment event. The post-intervention assessment point was 5 weeks after wish fulfillment (approximately 7 months after baseline data collection).

Results

Children in the intervention group exhibited a significant reduction in general distress (d = 0.54), depression (d = 0.70), and anxiety symptoms (d = 0.41), improved health-related quality of life (d = 0.59), hope (d = 0.71), and positive affect (d = 0.80) compared to decrease in positive affect and no significant changes in the other measures in the control group.

Conclusions

These findings emphasize the role of hope and positive emotions in fostering the well-being of children who suffer from serious illnesses.

     

Is It Safe? Reliability and Validity of Structured Versus Unstructured Child Safety Judgments

Background

The LIRIK, an instrument for the assessment of child safety and risk, is designed to improve assessments by guiding professionals through a structured evaluation of relevant signs, risk factors, and protective factors.

Objective

We aimed to assess the interrater agreement and the predictive validity of professionals’ judgments made with the LIRIK in comparison to unstructured judgments.

Method

In study 1, professionals made safety and risk judgments for 12 vignettes with the LIRIK (group 1, n = 36) or without an instrument (group 2, n = 43). In study 2, we compared professionals’ safety and risk judgments for 370 children made with the LIRIK (group 1, n = 278) or with no instrument (group 2, n = 92), with outcomes indicating actual unsafety in files 6 months later.

Results

In study 1, agreement about safety and risks was poor to moderate in both groups. Differences between groups were small and inconsistent. In study 2, the predictive validity of judgments was weak to moderate in both groups. In neither group had unsafe outcomes increased consistently when unsafety or risks were assessed as higher.

Conclusions

Judgments made with the LIRIK were not more reliable or valid than unstructured professional judgments. These findings raise important questions about the value of risk assessment instruments and about how professional safety and risk judgments can be improved.

     

The impact of living arrangements on quality of life among Korean elderly: findings from the Korean Longitudinal Study of Aging (2006–2012)

Purpose

To investigate the impact of different living arrangements on quality of life (QoL) and health-related quality of life (HRQoL) in the elderly.

Methods

We used data from the first to fourth wave of the Korean Longitudinal Study of Aging. Using the first wave as a baseline, the data included 5050 individuals aged 60 years and older with at least one living child. QoL and HRQoL were measured using a visual analogue scale developed by the Korean Labor Institute that bears similarity to the EQ-VAS. Living arrangements were categorized based on household composition (single household, one-generation household, two-generation household, and three-generation household) and the marital status of a cohabiting adult child. A generalized estimating equation was used to examine the association between living arrangements and QoL/HRQoL.

Results

Compared to elderly individuals living in three-generation families with a married child, those in a single household (QoL: β = ?2.67 [P = 0.001]; HRQoL: β = ?2.24 [P = 0.007]), those living in a three-generation family with an unmarried adult child (QoL: β = ?5.19 [P < 0.0001]; HRQoL: β = ?3.41 [P < 0.0001]), and those living in a two-generation family with an unmarried adult child (QoL: β = ?2.88 [P < 0.0001]; HRQoL: β = ?2.80 [P < 0.0001]) were more likely to have lower QoL and HRQoL. These associations were particularly strong for women and individuals in the lowest equivalent household income group.

Conclusion

It is necessary to devise government programs not only for elderly individuals living alone, but also for those living with an unmarried adult child; elderly persons who are female and part of the lowest equivalent household income group must receive particular attention.

     

Predictive Value of Parent-Professional Alliance for Outcomes of Home-Based Parenting Support

Background

Home-based parenting support within youth care services is one of the key interventions provided to families encountering difficulties with child rearing and child development. However, knowledge on factors contributing to positive outcomes of home-based parenting support is limited.

Objective

The current study investigated the predictive value of (1) early parent-professional alliance and (2) change in alliance during care for outcomes of home-based parenting support.

Method

Multi-informant self-report alliance and outcome data from 146 parents (Mage?=?40.00, SD?=?7.10; range 19–57 years) and their professionals collected early and late in care were analyzed using latent growth curve modeling.

Results

Findings demonstrated that higher levels of early parent-reported alliance predicted higher levels of parent-reported satisfaction with care, and improved parent functioning. Higher levels of early professional-reported alliance predicted higher levels of parent- and professional-reported satisfaction, and improved parent functioning. Increases in professional-reported alliance during care predicted higher levels of professional-reported satisfaction and parent functioning but were not related to parent-reported outcomes. Change in parent-reported alliance was not related to outcomes.

Conclusions

Together, our findings suggest that a strong parent-professional alliance represents a key process factor in realizing positive outcomes of home-based parenting support. Consequently, efforts in research and practice are needed to investigate precursors of strong alliances and to optimize professionals’ ability to develop and maintain strong parent-professional alliances.

     

Maternal restrictive feeding and eating in the absence of hunger among toddlers: a cohort study

Background

Restrictive feeding by parents has been associated with greater eating in the absence of hunger (EAH) among children, a risk factor for obesity. However, few studies have examined the association between restrictive feeding and EAH longitudinally, raising questions regarding the direction of associations between restrictive feeding and child EAH. Our objective was to examine the bidirectional prospective associations between restrictive feeding and EAH among toddlers.

Methods

Low-income mother-child dyads (n?=?229) participated when children were 21, 27, and 33 months old. Restriction with regard to food amount and food quality were measured with the Infant Feeding Styles Questionnaire. EAH was measured as kilocalories of food children consumed after a satiating meal. A cross-lagged analysis adjusting for child sex and weight-for-length z-score was used to simultaneously test cross-sectional and bidirectional prospective associations between each type of restriction and children’s EAH.

Results

At 21 months, mothers of children with greater EAH reported higher restriction with regard to food amount (b?=?0.17, p?<?.05). Restriction with regard to food amount at age 21 months was inversely associated with EAH at 27 months (b?=??0.20, p?<?.05). Restriction with regard to food amount at 27 months was not associated with EAH at 33 months and restriction with regard to food quality was not associated with EAH. EAH did not prospectively predict maternal restriction.

Conclusions

Neither restriction with regard to food amount nor food quality increased risk for EAH among toddlers. Current US clinical practice recommendations for parents to avoid restrictive feeding, and the potential utility of restrictive feeding with regard to food amount in early toddlerhood, deserve further consideration.

     

Forensic expertise and child abuse: a survey among preventive child healthcare workers in Amsterdam,the Netherlands

Aim

In the Netherlands, preventive child healthcare workers (PCHWs) have an important role in identifying signs of abuse, because they reach virtually all children. A closer cooperation of PCHWs and forensic physicians could improve the detection of child abuse. The aim of the study was to evaluate the use of forensic expertise by PCHWs.

Subjects and methods

In November 2013, a survey was distributed among PCHWs employed by the Amsterdam Public Health Service (n?=?221).

Results

Forty-nine percent of PCHWs indicated suspicions of physical abuse during the last 6 months (response rate: 43 %). In all, 89 % rated the consultation of forensic physicians as useful. In a 1-year period, only three respondents sought advice from a forensic doctor.

Conclusions

Although PCHWs regularly have suspicions of physical child abuse and have a very positive attitude towards consulting a forensic physician, consultation rates are very low. More research is needed to understand barriers to consultation of forensic physicians.

     

Cost and Budget Impact Analysis of an Accurate Intraoperative Sentinel Lymph Node Diagnosis for Breast Cancer Metastasis

Background

Conventional intraoperative sentinel lymph node biopsy (SLNB) in breast cancer (BC) has limitations in establishing a definitive diagnosis of metastasis intraoperatively, leading to an unnecessary second operation. The one-step nucleic amplification assay (OSNA) provides accurate intraoperative diagnosis and avoids further testing. Only five articles have researched the cost and cost effectiveness of this diagnostic tool, although many hospitals have adopted it, and economic evaluation is needed for budget holders.

Objective

We aimed to measure the budget impact in Japanese BC patients after the introduction of OSNA, and assess the certainty of the results.

Methods

Budget impact analysis of OSNA on Japanese healthcare expenditure from 2015 to 2020. Local governments, society-managed health insurers, and Japan health insurance associations were the budget holders. In order to assess the cost gap between the gold standard (GS) and OSNA in intraoperative SLNB, a two-scenario comparative model that was structured using the clinical pathway of a BC patient group who received SLNB was applied. Clinical practice guidelines for BC were cited for cost estimation.

Results

The total estimated cost of all BC patients diagnosed by GS was US$1,023,313,850. The budget impact of OSNA in total health expenditure was ?US$24,413,153 (?US$346 per patient). Two-way sensitivity analysis between survival rate (SR) of the GS and OSNA was performed by illustrating a cost-saving threshold: y ? 1.14x ? 0.16 in positive patients, and y ? 0.96x + 0.029 in negative patients (x = SR–GS, y = SR–OSNA). Base inputs of the variables in these formulas demonstrated a cost saving.

Conclusion

OSNA reduces healthcare costs, as confirmed by sensitivity analysis.

     

Diagnostic accuracy of parents’ ratings of their child’s oral health-related quality of life

Purpose

Oral health-related quality of life (OHRQoL) in children and adolescents can be assessed with two different approaches: children can directly report their own perceptions or parents can serve as proxies and rate their child’s OHRQoL from their perspectives. It was the aim to investigate whether parents can accurately rate their children’s OHRQoL and to compare agreement between OHRQoL domains and between age groups.

Methods

In this cross-sectional study, a sample of 140 children aged 7–17 years was consecutively recruited at a university-based orthodontic clinic and a public school. OHRQoL was assessed with the 19-item Child Oral Health Impact Profile (COHIP) with one version for the child and one for the parent. Correlation between child and parent ratings and diagnostic accuracy of the parental rating to assess children’s OHRQoL was calculated, and findings were compared between 7–11- and 12–17-year-old children.

Results

COHIP summary score differed only slightly between parents (mean 60.7 ± 9.8 points) and children (mean 61.9 ± 8.9 points). Correlation of summary scores was r = 0.38, corresponding to a moderate agreement. Median of item prevalence of all 19 items was 29.5 % for children and 41.7 % for parents. Median of positive predictive values was 50.9 % and median of negative predictive values 76.7 %, with no substantial differences in age groups.

Conclusions

Parents’ perception of their children’s OHRQoL is not accurate enough to detect oral health problems in an individual child aged between 7 and 17 years, and therefore, proxy OHRQoL assessment for individuals in this age group cannot be recommended.

     

The relationship between hypertension and health-related quality of life: adjusted by chronic pain,chronic diseases,and life habits in the general middle-aged population in Japan

Objectives

The aim of this study was to examine the relationship between hypertension and health-related quality of life (HRQoL) adjusted by chronic pain, other chronic diseases, and life habits in the general middle-aged population in Japan.

Methods

This study is a population-based cross-sectional study. In this study, 1117 participants aged 40–65 years and living in Shika Town completed a self-administered questionnaire including Short Form-36 (SF-36). The scores of SF-36 among hypertensives were compared with those of normotensives. The independent association of hypertension with each SF-36 subscale was analyzed using a multiple linear regression model adjusted by age, BMI, chronic pain, chronic diseases, sleep, exercise, and occupational status. We analyzed two groups; Group 1 which contained 846 participants completed the questionnaire without coronary heart disease and cerebral vascular disease, Group 2 which contained 686 participants without coronary heart disease, cerebral vascular disease, or diseases accompanied by chronic pain (gastroduodenal ulcer, fracture, osteoarthritis, osteoporosis, rheumatoid arthritis, and disc herniation).

Results

In Group 2, hypertensive women had a lower general health perception than normotensive women [unstandardized coefficients; B = ?8.84, 95 % confidence interval (95 % CI) = ?13.3 to ?4.34, standardized coefficients; β = ?0.200, p < 0.001], whereas hypertensive men had higher social functioning than normotensive men (B = 5.66, 95 % CI = 1.30–10.0, β = 0.149, p < 0.05) after adjusting by chronic pain and life habits.

Conclusions

These results may be due to the sex difference in the light of the perception for health.

     

Parent–Child Interaction Therapy for Child Disruptive Behaviour Disorders: A Meta-analysis

Background

Numerous studies have looked at the efficacy of Parent–Child Interaction Therapy (PCIT) for young children with externalizing behaviour problems.

Objective

The present study compiled these results through a comprehensive review to provide greater clarity regarding the efficacy of this treatment.

Methods

Using a random effects model, a meta-analysis was conducted to determine the weighted mean effect size. To be included in this analysis, studies were required to have implemented PCIT with children (ages 2–5) with clinically significant externalizing behaviour problems. Twelve studies comprising 254 treated and 118 control group children were included, with the majority of children being White males. This research also assessed whether gender and type of disruptive behaviour disorder (DBD) moderated the effectiveness of PCIT.

Results

PCIT had a large effect on improving externalizing behaviour problems in children with DBD based on the effect size derived from pre- and post-treatment behavioural outcomes (d = 1.65, 95 % CI [1.41, 1.90], p < .001) and treatment and control group data (d = 1.39, 95 % CI [1.05, 1.73], p < .001). Neither gender nor diagnosis was found to significantly moderate the effectiveness.

Conclusions

PCIT was found to be an efficacious intervention for child DBD, although the small number of eligible studies and lack of diversity in the sample populations suggests a need for further research. This study has important implications for both practitioners and researchers and provides an efficient summary of the research to date.

     

Does Maternal Parenting Stress Mediate the Association Between Postpartum PTS Symptoms and Children’s Internalizing and Externalizing Problems? A Longitudinal Perspective

Background

The research carried out in the last years outlined that childbirth could be considered as a sufficient stressor for the insurgence of posttraumatic stress (PTS) symptoms with important consequences for the child care.

Objectives

In a longitudinal perspective, this study focused on PTS symptoms after childbirth to understand their impact on maternal parenting stress and children’s adjustment. First, we investigated whether childbirth-related PTS symptoms, at 87 h and 3 months postpartum, were associated with parenting stress and children’s adjustment at 18 months. Second, we explored, at 18 months, the predictive effects of postpartum PTS symptoms on children’s adjustment and verified the mediational effect of parenting stress this association.

Methods

Eighty-eight women participated and completed the following questionnaires: PPQ (for assessing maternal PTS symptoms at 87 h, 3 and 18 months postpartum), PSI-SF (for maternal parenting stress at 18 months) and CBCL (for children’s adjustment at 18 months).

Results

Findings outlined that more PTS symptoms at 3 months are associated with greater levels of parental distress and they predicted children’s adjustment at 18 months. Moreover, maternal parenting stress explained the predictive effects of childbirth-related PTS symptoms on children’s adjustment. More precisely parental distress partially mediated the association between PTS symptoms and children’s internalizing behaviors, while the perception of the difficult child fully mediated the effects of PTS symptoms on externalizing behaviors.

Conclusion

This study was consistent with the idea that women may experience childbirth-related chronic distress and child adjustment was connected to different sources of parenting stress.