Web-survey of pharmacological and non-pharmacological sleep interventions for children with early-onset bipolar spectrum disorders

BackgroundA web-based survey was developed to explore the effect of pharmacological and non-pharmacological interventions for sleep difficulties associated with Early-Onset Bipolar Spectrum Disorders (EBSD).MethodFour hundred ninety four parents of 4–12 year-olds, identified by parents as being diagnosed with EBSD, provided information about which professionals were consulted regarding their child's EBSD-sleep problems and pharmacological and non-pharmacological interventions that helped or worsened sleep.ResultsMost parents reported consulting at least one medical, mental health, and/or school professional regarding their child's sleep problems. Psychiatrists and other physicians were most often consulted. The majority of parents reported several medications/supplements as helpful, most commonly, atypical antipsychotics (54.4%). Over half identified various pharmacological agents that worsened sleep, most commonly, stimulants (35.0%). Most parents also reported several non-pharmacological interventions that aided sleep problems, most frequently, a sleep routine. Over two-thirds reported a variety of non-pharmacological interventions that worsened sleep, most notably, punishment (34.8%).LimitationsThe sample was non-random consisting of self-selected and web-savvy parents who self-identified their children as having EBSD and provided only parent derived data.ConclusionsAlthough exploratory and despite limitations, this is the first survey to report data on both pharmacological and non-pharmacological treatments for EBSD-sleep problems. It highlights clinical interventions that may improve or worsen EBSD-sleep and provides directions for future research.     

The impact of inadequately controlled asthma in urban children on quality of life and productivity.

BACKGROUND: The burden of inadequately controlled pediatric asthma on education and other daily activities is not well described. OBJECTIVE: To evaluate asthma-related activity limitations and productivity losses among children and caregivers. METHODS: Surveys were mailed to caregivers of children with asthma. Caregivers provided demographics, health-related quality of life (HRQL), workplace productivity, and asthma-related costs. Adolescents (aged 12-18 years) provided HRQL, asthma control, and school-based productivity, and young children (aged 4-11 years) completed an asthma control questionnaire with help from a caregiver. RESULTS: Among the 239 respondents, the mean age was 10.1 years; 49% were girls. More than half were inadequately controlled as measured using the Asthma Control Test. Both HRQL and productivity were significantly lower in patients with inadequately controlled asthma compared with those with controlled asthma. In the previous year, caregivers reported missing 1.4 days of work due to their child's asthma, with the child missing an average of 4.1 school days. Fewer adolescents with controlled asthma reported missing 1 or more school days in the previous week compared with adolescents with inadequately controlled asthma (3.5% vs 34.0%; P < .001). There were similar differences in caregiver workdays missed and health care resource use: both were significantly higher in children with inadequately controlled asthma. CONCLUSIONS: Inadequately controlled asthma has a significant impact on asthma-specific HRQL, school productivity and attendance, and work productivity of children and their caregivers.     

Pediatric Caregiver Attitudes Toward Email Communication: Survey in an Urban Primary Care Setting

Background

Overall usage of email communication between patients and physicians continues to increase, due in part to expanding the adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their health care providers.

Objective

We conducted a survey to assess pediatric caregiver access to and attitudes toward the use of electronic communication modalities to communicate with health care providers in an urban pediatric primary care clinic.

Methods

Participants were pediatric caregivers recruited from an urban pediatric primary care clinic in Baltimore, Maryland, who completed a 35-item questionnaire in this cross-sectional study.

Results

Of the 229 caregivers who completed the survey (91.2% response rate), 171 (74.6%) reported that they use email to communicate with others. Of the email users, 145 respondents (86.3%) stated that they would like to email doctors, although only 18 (10.7%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with health care providers (adjusted OR 0.34, 95% CI 0.14-0.82) as were those with annual incomes less than US $30,000 (adjusted OR 0.26, 95% CI 0.09-0.74).

Conclusions

Caregivers of children have access to email and many would be interested in communicating with health care providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email.     

Adherence to Combination Antiretroviral Treatment in Children

Abstract

Purpose: To assess the level of nonadherence to combination antiretroviral therapy of HIV-infected children and to identify the main problems faced by caregivers when giving medicines to children. Method: A questionnaire was administered to the caregivers of HIV-infected children who were under combination antiretroviral treatment and were followed at our institution. Results: We evaluated 44 children (mean age, 9.4 years); 13 were treated with a two-drug regimen, 30 with a three-drug regimen, and 1 with a four-drug regimen. Each child received a mean of 8.1 pills and/or syrup doses. In 54.5% of treatments, food restrictions were necessary. The mother was the main person giving medicines to the child (56.8%). A complete written schedule of the child’s treatment was present in 50% of families. About 20.5% and 31.8% of children had missed at least one dose of antiretroviral drugs in the last 3 days before assessment and since last visit (1-2 months earlier), respectively. Main problems reported by caregivers were: (a) too many medicines/ pills (34%); (b) difficulty in swallowing pills (29.5%); (c) taking medicines at school or out of home (27.3%); (d) child resisting/refusing therapy/spitting out (25%); and (e) food interactions (22.7%). Conclusion: The observed high level of nonadherence was similar to what was reported by other pediatric studies. Specific interventions aimed at improving compliance in pediatric patients were identified: improvement of anti-HIV drug formulations, better counselling for children and their families, and tailoring of antiretroviral treatment. However, caution is necessary in generalizing our results due to the small sample size and to the heterogeneity of the cohort.     

Brief report: behaviors identified by caregivers to detect pain in noncommunicating children

OBJECTIVE: To develop an observational measure, based on caregiver reports, to assess chronic pain in children with significant cognitive impairment who are unable to communicate verbally. The issue of whether these children share a core set of cues to express pain was investigated. METHODS: Specific pain cues were elicited during detailed interviews with 29 female caregivers of noncommunicating children. Pain cues were categorized by a two-stage Delphi process and cues indicating severe and definite pain identified. RESULTS: Six cues from five different categories were used by 90% of caregivers to identify definite or severe pain in their child. CONCLUSIONS: Although the specific expression of pain may be very individual, there is a shared set of core pain cues. The relationship between these cues and evidence of pain and distress is discussed.     

Effects of perceived stress on pediatric chronic pain

The dearth of theoretically driven research on the predictors of pediatric chronic pain may unwittingly contribute to needless suffering in children and adolescents by underinvestigating a potentially treatable condition. The objective of the present study was to investigate the hypothesized predictive effects of perceived stress on pediatric chronic pain intensity in 148 children and adolescents. Consistent with thea priori Biobehavioral Model of Pediatric Pain, higher perceived stress was predictive of greater pediatric pain intensity. The results are discussed with regard to the implications for cognitive-behavioral pediatric pain treatment.     

Judgments of infant pain: the impact of caregiver identity and infant age

OBJECTIVE: To examine whether caregiver judgments of infant pain would vary systematically with different infant caregiver groups and infant age. METHODS: A total of 123 caregivers (41 parents, 41 in patient nurses, 41 pediatricians) viewed videotapes of the vigorous behavioral responses of healthy infants (aged 2, 4, 6, 12, and 18 months) to a routine immunization injection and provided ratings of both the affective distress and pain intensity observed. RESULTS: A principal components analysis of affective and intensity ratings yielded a weighted pain summary score for each injection event. Older infants were attributed significantly more pain than younger infants, even though the vigor of the behavioral reactions was experimentally controlled across age groups. A profile analysis contrasting observer groups indicated that pediatricians attributed significantly lower levels of pain than parents, while nurses were intermediate to the other groups, not significantly differing from either group. These systematic differences in judgments were consistent across infant age groups. CONCLUSIONS: The findings reveal systematic sources of significant variations in observer judgments of infant pain. Despite an absence of differences in the behavioral reactions of the children, both the type of caregiver and their knowledge of the child's age systematically influenced attributions of pain to infants. This work suggests the important role of caregiver role variation and perceived developmental maturity as determinants of infant pain judgments and highlights potential areas of difficulty in controlling the unnecessary suffering of infants.     

Psychological adjustment in caregivers of school-age children infected with HIV: stress, coping, and family factors

OBJECTIVE: To assess for significant differences in psychological functioning between caregivers of HIV-infected children and caregivers of healthy children, and to examine the utility of applying a stress and coping model to caregivers of children with HIV disease. METHODS: Participants included caregivers of HIV-infected children (n = 36) and caregivers of a demographically matched control group of healthy children (n = 32). During their child's pediatric clinic visits, caregivers completed measures of psychological adjustment, stress, coping style, and family resources and support. They also completed a measure of their child's psychological adjustment. RESULTS: Caregiver psychological distress scores did not significantly differ between the HIV and control groups, and clinically significant rates of psychological distress were reported by more than a third of caregivers in both groups. Hierarchical multiple regression analyses revealed that independent of their child's illness status, stress and coping style were significant predictors of caregiver's psychological adjustment. In addition, caregiver psychological distress was a significant predictor of children's maladjustment. CONCLUSIONS: High rates of psychological distress were observed in caregivers of children with HIV disease; however, similarly high rates of psychological adjustment problems were found in caregivers of healthy children. Caregivers who reported high levels of daily stress and emotion-focused coping styles tended to report more psychological distress. Further, caregivers who reported more psychological distress also reported more internalizing and more externalizing behavior problems in their children, regardless of the child's illness status. These findings reflect the impact of poverty and environmental stress on caregivers' adjustment.     

儿科身份识别现状调查及原因分析

目的 调查儿科身份识别现状,分析儿科身份识别不佳的原因。方法 采用结构式观察法和半结构式会谈法,调查儿科有家属陪伴病区的31名临床护理人员及患儿照顾者进行身份识别情况,并与被观察者会谈影响患儿身份识别的原因。结果 31名护士中,对患儿身份识别时机正确者19人（61.29%）,对识别查对内容正确者22人（70.97%）,身份识别方式正确者14人（45.16%）,整体身份对识别方式正确率41.94%（13/31）;不同工作年限、职称和班次护理人员身份识别正确率比较,差异无统计学意义（P＞0.05）;身份识别意识差、照顾患儿分别是影响护理人员身份识别和配合护理人员进行身份识别的首要原因。结论 儿科身份识别正确率较低,其原因可能与使用身份识别的意识较差、患儿照顾者关于身份识别的宣教不足有关。     

Strategies for Managing Osteoarthritis

Background

Although there are recommendations for the management of osteoarthritis (OA), little is known about how people with OA actually manage this chronic condition.

Purpose

The aims of this study were to identify the non-pharmacological and pharmacological therapies most commonly used for the management of hip or knee OA, in a community-based sample of adults, and to compare these with evidence-based recommendations.

Methods

A questionnaire was mailed to 2,200 adult members of Arthritis Queensland living in Brisbane, Australia. It included questions about OA symptoms, management therapies, and demographic characteristics.

Results

Of the 485 participants (192 men, 293 women) with hip or knee OA who completed the questionnaire, most had mild to moderate symptoms. Ninety-six percent of participants (aged 27?C95?years) reported using at least one non-pharmacological therapy, and 78% reported using at least one pharmacological therapy. The most common currently used non-pharmacological strategy was range-of-motion exercises (men 52%, women 61%, p?=?0.05) and the most common frequently used pharmacological strategy was glucosamine/chondroitin (men 51%, women 60%, ns). For the most highly recommended strategies, 65% of men and 54% of women had never attended an information/education course (p?=?0.04), and fewer than half (46% of women and 42% of men, p?=?0.03) were frequent users of anti-inflammatory agents.

Conclusion

The findings suggest that many people with knee or hip OA do not follow the most highly endorsed of the Osteoarthritis Research Society International recommendations for management of OA. Health professionals should be encouraged to recommend evidence-based therapies to their patients.     

Psychological Consultation in a Children's Hospital: An Evaluation of Services

The pediatric psychologist's role in children's inpatient medicalhospitals has rapidly expanded. Few studies have examined thetypes of referrals for psychological consultation or programevaluation of these services. This paper describes an archivalevaluation of the types of referrals received by a pediatricpsychology inpatient service over a period of 4 1/2 years andan evaluation of these services by physicians, nurses, and socialworkers. The survey of services indicated that the most frequentreferrals were for depression/suicide attempt, poor adjustmentto a chronic illness, and behavior problems. Medically relatedproblems accounted for 42% of all of the consults. Approximatelytwo-thirds of the children were referred for outpatient psychologicalservices. The pediatric psychology service was more likely tofollow, on an outpatient basis, children with medically relatedproblems. A 26-item questionnaire obtained an overall responserate of 48% and response rate of 84 and 60% for faculty andresident physicians having contact with the pediatric psychologyconsult service. The evaluation of the pediatric psychologyservice by physicians, nurses, and social workers indicatedoverall satisfaction with the services they received. The levelof satisfaction was strongly related to the level of diagnosticagreement between the physicians/nurses and psychologist. Thelowest level of satisfaction was on verbal and written feedback.Suggestion for further research was offered.     

Evidence-Based,Non-Pharmacological Treatment Guideline for Depression in Korea

Although pharmacological treatment constitutes the main therapeutic approach for depression, non-pharmacological treatments (self-care or psychotherapeutic approach) are usually regarded as more essential therapeutic approaches in clinical practice. However, there have been few clinical practice guidelines concerning self-care or psychotherapy in the management of depression. This study introduces the ''Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea.'' For the first time, a guideline was developed for non-pharmacological treatments for Korean adults with mild-to-moderate depression. The guideline development process consisted of establishing several key questions related to non-pharmacologic treatments of depression, searching the literature for studies which answer these questions, assessing the evidence level of each selected study, drawing up draft recommendation, and peer review. The Scottish Intercollegiate Guidelines Network grading system was used to evaluate the quality of evidence. As a result of this process, the guideline recommends exercise therapy, bibliotherapy, cognitive behavior therapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy as the non-pharmacological treatments for adult patients with mild-to-moderate depression in Korea. Hence, it is necessary to develop specific methodologies for several non-pharmacological treatment for Korean adults with depression.     

Factors affecting quality of life in children and adolescents with hypermobile Ehlers‐Danlos syndrome/hypermobility spectrum disorders

Hypermobile Ehlers‐Danlos syndrome (hEDS) is a hereditary disorder of connective tissue, often presenting with complex symptoms can include chronic pain, fatigue, and dysautonomia. Factors influencing functional disability in the pediatric hEDS population are incompletely studied. This study's aims were to assess factors that affect quality of life in children and adolescents with hEDS. Individuals with hEDS between the ages 12–20 years and matched parents were recruited through retrospective chart review at two genetics clinics. Participants completed a questionnaire that included the Pediatric Quality of Life Inventory (PedsQL?), PedsQL Multidimentional Fatigue Scale, Functional Disability Inventory, Pain‐Frequency‐Severity‐Duration Scale, the Brief Illness Perception Questionnaire, measures of anxiety and depression, and helpful interventions. Survey responses were completed for 47 children and adolescents with hEDS/hypermobility spectrum disorder (81% female, mean age 16 years), some by the affected individual, some by their parent, and some by both. Clinical data derived from chart review were compared statistically to survey responses. All outcomes correlated moderately to strongly with each other. Using multiple regression, general fatigue and pain scores were the best predictors of the PedsQL total score. Additionally, presence of any psychiatric diagnosis was correlated with a lower PedsQL score. Current management guidelines recommend early intervention to prevent disability from deconditioning; these results may help identify target interventions in this vulnerable population.     

胃镜检查诊断消化道疾病儿童临床特征与营养状况分析

目的 分析胃镜检查诊断为消化道疾病的6～18岁儿童的临床表现、胃镜结果与营养状况关系.方法 以2010年8月至2011年1月在重庆医科大学附属儿童医院内镜中心行胃镜检查的儿童为研究对象,进行问卷调查,测量体格生长指标（身高和体重）,分析临床表现和胃镜检查结果,参照WHO 2007年制定的＂儿童生长标准＂评价胃镜检查诊断为消化道疾病儿童的营养状况.结果 研究期间431例儿童行胃镜检查,排除资料不完整者25例,406例（94.2%）进入分析,其中6～12岁313例,～18岁93例.①244例以慢性反复性腹痛为主诉,病程多在1年以上;急性腹痛就诊59例,以进食后早饱、食欲不振就诊40例;以进食后恶心、呕吐就诊15例.②389/406例（95.8%）胃镜检查结果异常,其中73.3%（285例）为慢性胃炎,十二指肠、食管和急性胃黏膜病变检出率分别为78例（20.1%）、11例（2.8%）和8例（2.1%）.③389例胃镜检查结果异常儿童BMI呈偏态分布;胃部病变、十二指肠病变、食管病变儿童BMI＜P5分别占23.7%（71/300例）、16.7%（13/78例）和9.1%（1/11例）;在BMI＜P5的67例慢性胃炎患儿中,HP相关性慢性胃炎占38.8%（26/67例）.④胃镜检查结果异常的243/389例慢性腹痛儿童中,40例（16.5%）BMI＜P5;58/389例急性腹痛儿童中,1例（1.7%）BMI＜P5;39/389例以＂消瘦＂为主诉就诊的儿童中,38例（97.4%）BMI＜P5.结论 上消化道疾病儿童体型消瘦的比例较高.慢性腹痛、无明原因的体重减轻或消瘦等症状的学龄儿童和青少年需除外慢性上消化道疾病.     

Pain among children and adults living with arthrogryposis multiplex congenita: A scoping review

Clinical interventions and research have mostly focused on the orthopedic and genetic outcomes of individuals with arthrogryposis multiplex congenita (AMC), and although pain has gained recognition as an important issue experienced by individuals with AMC, it has received little attention within the AMC literature. The aims of this scoping review were to describe the pain experiences of children and adults with AMC, to identify pain assessment tools and management techniques, and document the impact of pain on participation in everyday activities among children and adults with AMC. A search of the literature was conducted in four search engines and identified a total of 89 articles. Once study eligibility was reviewed, 21 studies met the selection criteria and were included in this review. Pain appears to be more commonly experienced in adults with AMC compared with children with AMC, with individuals having undergone multiple corrective procedures self‐reporting pain more often. In adult populations, musculoskeletal chronic pain is a significant problem, resulting in restrictions in activities of daily living, mobility, and participation. Researchers and clinicians must agree on the use of validated measures appropriate for evaluating pain in AMC and the use of appropriate pain management techniques to relieve pain. Pediatric studies should focus on determining how commonly pain is experienced in infants, children, and adolescents with AMC. Pain in adults with AMC should be acknowledged to offer proper client‐centered interventions throughout the lifespan.     

Comparison of itraconazole,voriconazole, and posaconazole as oral antifungal prophylaxis in pediatric patients following allogeneic hematopoietic stem cell transplantation

Oral antifungal prophylaxis with extended-spectra azoles is widely used in pediatric patients after allogeneic hematopoietic stem cell transplantation (HSCT), while controlled studies for oral antifungal prophylaxis after bone marrow transplantation in children are not available. This survey analyzed patients who had received either itraconazole, voriconazole, or posaconazole. We focused on the safety, feasibility, and initial data of efficacy in a cohort of pediatric patients and adolescents after high-dose chemotherapy and HSCT. Fifty consecutive pediatric patients received itraconazole, 50 received voriconazole, and 50 pediatric patients received posaconazole after HSCT as oral antifungal prophylaxis. The observation period lasted from the start of oral prophylactic treatment with itraconazole, voriconazole, or posaconazole until two weeks after terminating the oral antifungal prophylaxis. No incidences of proven or probable invasive mycosis were observed during itraconazole, voriconazole, or posaconazole treatment. A total of five possible invasive fungal infections occurred, two in the itraconazole group (4 %) and three in the voriconazole group (6 %). The percentage of patients with adverse events potentially related to clinical drugs were 14 % in the voriconazole group, 12 % in the itraconazole group, and 8 % in the posaconazole group. Itraconazole, voriconazole, and posaconazole showed comparable efficacy as antifungal prophylaxis in pediatric patients after allogeneic HSCT.     

The development of a motivational interviewing intervention to promote medication adherence among inner-city, African-American adolescents with asthma

Objective

To develop and assess the feasibility of a motivational interviewing (MI) based asthma self-management program for inner-city, African-American, adolescents with asthma.

Methods

37 African-American adolescents (age 10-15 years) recently seen in an inner-city emergency department for asthma and prescribed an asthma controller medication participated in the newly developed program consisting of 5 home visits. Adolescents and their caregivers completed phone-based surveys before and after the intervention.

Results

95% of the adolescents completed all 5 sessions; 89% of caregivers and 76% of adolescents believed other families would benefit from the intervention. Caregivers were more likely to report 100% adherence post-intervention compared to pre-intervention and reported a trend for adolescents taking greater responsibility for their asthma. There were no pre-post-differences in adolescent-reported medication adherence, but adolescents did reported increased motivation and readiness to adhere to treatment. Caregivers and adolescents each reported statistically significant increases in their asthma quality of life.

Conclusions

The findings from this pilot study suggest that MI is a feasible and promising approach for increasing medication adherence among inner-city adolescents with asthma and is worthy of further evaluation in a randomized trial.

Practice Implications

Incorporating MI into disease management programs may enhance their effectiveness.