Amy F. Sato

Stress and Paediatric Obesity: What We Know and Where To Go

Childhood obesity is a public health epidemic and is associated with substantial negative physical and psychosocial health consequences. Stress is thought to be one contributor to the development and maintenance of obesity in children and adolescents, yet the linkage between stress and paediatric obesity is a poorly understood phenomenon. This paper furthers the understanding of stress in the context of paediatric obesity by firstly presenting a focused review of what is known about links between chronic and acute stress and paediatric obesity risk and then synthesizing important areas from the literature. These critical areas of focus include the following: (1) physiological stress reactivity; (2) stress-induced eating; (3) stress and physical activity; (4) parent and family influences; and (5) stress in at-risk populations. This review is geared toward facilitating future research on the stress-obesity connection in youth.

Two-Year Follow-Up of an Adolescent Behavioral Weight Control Intervention

OBJECTIVE: This study examined the 24-month outcomes of a randomized controlled trial of a group-based behavioral weight control (BWC) program combined with either activity-based peer intervention or aerobic exercise. METHODS: At baseline, 118 obese adolescents (68% female; BMI = 31.41 ± 3.33) ages 13 to 16 years (mean = 14.33; SD = 1.02) were randomized to receive 1 of 2 weight loss interventions. Both interventions received the same 16-week group-based cognitive-behavioral treatment, combined with either aerobic exercise or peer-based adventure therapy. Eighty-nine adolescents (75% of original sample) completed the 24-month follow-up. Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 12 and 24 months following randomization. RESULTS: An intent-to-treat mixed factor analysis of variance indicated a significant effect for time on both percent over 50th percentile BMI for age and gender and standardized BMI score, with no differences by intervention group. Post hoc comparisons showed a significant decrease in percent overweight at 4 months (end of treatment), which was maintained at both 12- and 24-month follow-up visits. Significant improvements on several dimensions of self-concept were noted, with significant effects on physical appearance self-concept that were maintained through 24 months. CONCLUSIONS: Both BWC conditions were effective at maintaining reductions in adolescent obesity and improvements in physical appearance self-concept through 24-month follow-up. This study is one of the first to document long-term outcomes of BWC intervention among adolescents.

Associations between Parent Behavior and Adolescent Weight Control

OBJECTIVE To evaluate associations between parent behaviors (i.e., parent weight change, self-monitoring of their behavior, and feeding practices and attitudes) and changes in adolescent BMI and weight following 16-weeks of behavioral weight control (BWC) intervention. METHOD Adolescents (N = 86) 13-16 years old and 30-90% overweight (M = 60.54%, SD = 15.10%) who completed BWC intervention and their parents. Adolescents were randomized to 1 of 2 interventions involving 16 consecutive weeks of active treatment with 4 biweekly maintenance sessions. Adolescent weight and BMI were measured at baseline and 16-weeks. Feeding practices were measured at baseline. Parent self-monitoring was measured during the intervention. RESULTS The only independently significant predictor of adolescent BMI change (p < .01) was parent BMI change. Greater parent self-monitoring (p < .01) predicted greater adolescent weight loss. Greater parent pressure to eat predicted less adolescent weight loss (p < .01). CONCLUSIONS Findings highlight the potential importance of parent weight-related behaviors and feeding practices in the context of adolescent BWC.

Immigration and Acculturation-Related Factors and Asthma Morbidity in Latino Children

OBJECTIVE This article presents a summary of findings from asthma studies focusing on immigration and acculturation-related factors. A study examining associations between these processes, family cohesion and social support networks, and asthma morbidity in a sample of Dominican and Puerto Rican caregivers residing in the mainland U.S., is also described. METHODS Latino children with asthma (n = 232), ages 7-16 (49% female) and their caregivers completed interview-based questionnaires on immigration and acculturation-related processes, family characteristics, and asthma morbidity. RESULTS The frequency of ED use due to asthma may be higher for children of caregivers born in Puerto Rico. Acculturative stress levels were higher for Puerto Rican born caregivers residing in the mainland U.S. CONCLUSION Asthma-related educational and intervention programs for Latino children and families should be tailored to consider the effects that the immigration and acculturation experience can have on asthma management. Specific family-based supports focused on decreasing stress related to the acculturation process, and increasing social and family support around the asthma treatment process may help to reduce asthma morbidity in Latino children.

School Absenteeism in Pediatric Chronic Pain: Identifying Lessons Learned From the General School Absenteeism Literature

Although the high rates of school absenteeism among children and adolescents with chronic pain have been well-documented, school absenteeism among these youths remains a poorly understood phenomenon. Literature focusing on school avoidance or refusal in the general (non-pain) population holds potential for contributing to a better understanding of problematic school absenteeism in the pediatric chronic pain population. This article presents a focused review of what is known about school absenteeism in pediatric chronic pain and how the literature on problematic absenteeism in the general population can inform an understanding of this phenomenon.

The Effect of Group-Based Weight-Control Intervention on Adolescent Psychosocial Outcomes: Perceived Peer Rejection, Social Anxiety, and Self-Concept

This article examines the effectiveness of group-based weight-control treatment on adolescent social functioning. Eighty-nine adolescents, who were randomized to group-based cognitive behavioral treatment with aerobic exercise or peer-enhanced adventure therapy, completed measures of social functioning at baseline, end of treatment, and at a 12-month follow up. Results demonstrated significant reductions in adolescent perceptions of peer rejection and social anxiety over time, with no significant demonstrated group differences. Improvements in social functioning were related to increases in self-concept dimensions. Findings demonstrate benefits of group-based weight-control treatment for enhancing adolescent self-perceived social functioning across multiple domains.

Attributions of Teacher Reactions to Diabetes Self-care Behaviors

OBJECTIVE This study had two objectives: examine relationships among negative attributions of teacher reactions, anticipated adherence difficulties, teacher support, diabetes stress, and metabolic control; and develop questionnaires to test these relationships. METHODS One hundred and two youths with type 1 insulin-dependent diabetes completed instruments measuring attribution of teacher reactions, anticipated adherence, teacher support, and diabetes stress. Metabolic control was measured by percentage of hemoglobin A(1c). RESULTS Structural equation modeling demonstrated that negative attributions had direct effects on anticipated adherence difficulties and diabetes stress. Diabetes stress had a direct effect on metabolic control. Negative attributions had a significant indirect effect on metabolic control through associations with diabetes stress. Teacher support moderated the path between negative attributions and anticipated adherence difficulties. CONCLUSIONS Youths making negative attributions about teachers reactions are likely to find adherence difficult in school situations and have increased stress. Results are discussed in terms of a social information processing model of adjustment and practical applications.

Cognitive-Behavioral Interventions Via Telehealth: Applications to Pediatric Functional Abdominal Pain

This integrative literature review explores the utility of telehealth, specifically videoconferencing, for the delivery of cognitive-behavioral therapy (CBT) to youth with functional abdominal pain (FAP). Children with FAP and their families encounter a number of barriers to treatment that hinder access to traditional in-clinic treatments, such as CBT. Videoconferencing may be a feasible and effective alternative to traditional services and may hold benefits such as high rates of patient satisfaction, improved access to care, improved attendance rates, and cost reductions to the family. This article concludes that videoconferencing provides a good “fit” with the delivery of CBT to children and adolescents with FAP.

IMAGING CHARACTERISTICS OF INTRATHORACIC HISTIOCYTIC SARCOMA IN DOGS

In this retrospective study, two observers independently reviewed thoracic imaging studies of 39 dogs with confirmed histiocytic sarcoma. The most common findings were intrathoracic lymphadenopathy, identified by the first and second observers in 82.1% and 87.2% of dogs, respectively, and pulmonary masses (74.4% and 82.1%). Right middle lung lobe masses were significantly more common than masses in any other lung lobe (P < 0.0013), with the majority having a ventral distribution. Sternal and tracheobronchial lymphadenopathy were significantly more common than cranial mediastinal lymphadenopathy (P-values of 0.0002 and 0.012, respectively). Interobserver agreement regarding distribution of lymphadenopathy and pulmonary masses was good (kappa = 0.64 and 0.75, respectively). Other findings included pulmonary nodules, pleural effusion, and abnormal pulmonary patterns. In patients with CT examinations, the majority of masses were mildly to moderately enhancing and heterogeneous, poorly marginated, and bronchocentric. Lymphadenopathy and pulmonary masses are the most common intrathoracic findings in dogs with histiocytic sarcoma, and the strong predilection for the ventral aspect of the right middle lung lube may help to differentiate it from other types of neoplasia.

MAGNETIC RESONANCE IMAGING APPARENT DIFFUSION COEFFICIENTS FOR HISTOLOGICALLY CONFIRMED INTRACRANIAL LESIONS IN DOGS

Diffusion-weighted imaging is an advanced magnetic resonance imaging technique that is well established in the diagnosis of nonhemorrhagic infarction in people. However, recent investigations into intracranial neoplastic and inflammatory disease in people have identified variable and overlapping results. In this retrospective study of 37 dogs with histologically confirmed intracranial disease, we investigated whether histogram analysis of quantitative apparent diffusion coefficients (ADC) can differentiate specific disease processes. Disease categories included: meningiomas, glial cell tumors, choroid plexus tumors, pituitary tumors, inflammatory brain diseases, acute nonhemorrhagic infarcts, chronic nonhemorrhagic infarcts, and hemorrhagic infarcts. A wide range of ADC value distributions were identified within the disease groups, and there were overlapping ADC values between most groups. Low ADC values indicating restricted diffusion of water were identified in acute nonhemorrhagic infarcts as expected, but were also seen in meningiomas, glial cell tumors, and granulomatous meningoencephalitis. Based on this preliminary data it is unlikely that singular quantitative ADC values can be used to determine the histological type of canine intracranial disease.