Bonney Reed-Knight

Association of Disease, Adolescent, and Family Factors with Medication Adherence in Pediatric Inflammatory Bowel Disease

OBJECTIVE To examine factors associated with adolescent and parent-reported adherence to prescription and over-the-counter (OTC) medications in a cross-sectional sample of youth with inflammatory bowel disease (IBD). METHOD Ninety adolescents and their parents completed measures of medication adherence and disease, individual, and family factors while attending an outpatient gastroenterology appointment. RESULTS Longer time since diagnosis, greater perceived disease severity, and a lack of autonomous motivation to adhere predicted adolescent report of lower adherence to prescription medications. Similarly, longer time since diagnosis predicted adolescent report of lower adherence to OTC medications. Less time since diagnosis, greater maternal involvement in the medical regimen, higher perceived disease severity, and less perceived conflict predicted better parent-reported adherence to OTC medications. CONCLUSIONS Interventions for improving adherence in adolescents with IBD should address disease, individual, and family factors with special attention given to adolescents who have been diagnosed longer.

Pediatric capsule endoscopy: review of the small bowel and patency capsules.

Background and Objective: Because capsule endoscopy (CE) avoids ionizing radiation, deep sedation, and general anesthesia, CE may be valuable in pediatrics. We report a single pediatric centers experience with the use and safety of CE. Methods: In a retrospective review of consecutive CE studies, 284 CE studies were performed in 277 patients with a mean age of 15 (±3.7) years during a 5-year period. The youngest to swallow the capsule was 4.6 years old. Twenty capsules were placed. Overall, 245 (86%) patients underwent CE for suspected (184, 65%) or confirmed (61, 21%) Crohn disease (CD); 27 (9.5%) anemia or gastrointestinal bleeding; 6 (2%) polyposis; and 4 (1.4%) celiac disease. Results: Positive findings were observed in 205 (72%) of the studies, with 152 (54%) having small bowel findings. Of these, 72 (47%) were diagnostic. Gastric (95, 33%) and colonic (31, 11%) abnormalities were also identified. Five CE studies (1.8%) resulted in retention of the capsule in nonsurgical patients. A patency capsule before CE in 23 patients allowed 19 CE to proceed with only 1 retained capsule. In 65 (21%) patients, the video capsule did not enter the colon before the videos end. Of these, 36 (65%) had significant findings, including 27 (49%) documenting small bowel (SB) CD. Conclusions: CE is useful to diagnose SB disease in children. Even in a study population with a high prevalence of confirmed and suspected CD, the risk of retention remains small. The patency capsule may lessen that risk. CE may identify gastric or colonic disease even when SB lesions are not present.

Posttraumatic Growth in Young Adults Who Experienced Serious Childhood Illness: A Mixed-Methods Approach

Sixty young adult survivors of a serious childhood illness completed quantitative and qualitative measures assessing the relationship between specific disease and distress factors and posttraumatic growth (PTG). Individuals who had recovered from their illness reported greater growth than those who were currently experiencing their illness. The regression model accounted for 47% of the variance in PTG, with perceived severity, illness status, and posttraumatic stress symptoms emerging as significant predictors. Qualitative analyses identified salient positive and negative factors associated with having had an illness, such as a positive shift in perspective and frequent medical requirements. Being past the daily demands of illness management may allow for greater PTG. Realization of positive aspects of having had an illness may require prompting.

Predictors of Long-Term Health-Related Quality of Life in Adolescent Solid Organ Transplant Recipients

OBJECTIVES This study aimed to identify prospective predictors of health-related quality of life (HRQOL) for adolescent solid organ (kidney, liver, heart, lung) transplant recipients. METHODS Data regarding demographics, individual/transplant characteristics, and environmental characteristics were gathered from 66 adolescent transplant recipients and their families at baseline and used to predict the physical functioning, mental health, and general health perceptions domains of HRQOL 18 months later. RESULTS Baseline levels of HRQOL explained the greatest amount of variance in levels of HRQOL at follow-up; however, specific demographic (i.e., income), individual/transplant (i.e., adherence, frequency of rescheduled clinic appointments, and presence of a rejection episode), and environmental factors (i.e., family conflict) contributed to the variance in HRQOL domains beyond baseline levels. CONCLUSIONS This study identified certain modifiable individual and environmental factors and non-modifiable risk factors associated with lower future HRQOL. Transplant centers should begin screening and addressing these factors to potentially improve HRQOL.

The transition of health care responsibility from parents to youth diagnosed with chronic illness: a developmental systems perspective.

With improved health care, increasing numbers of children and adolescents with chronic illness and disability now live into adulthood. With this change, the health care community needs to address problems related to the transition from parents caring for their young childrens needs to increasing health care responsibility being required of adolescents and young adults (AYA). The current article presents a conceptualization of relevant research related to the transition of health care responsibility from parent to AYA. Using a developmental systems perspective, representative literature on adolescent and dyad-level factors related to the transition of health care responsibility is reviewed to inform clinical practice and future intervention research. To identify the health care tasks that researchers have thus far considered as most important for successful transition, we review assessment measures in this area. The varying levels of agreement on transition of health care behaviors provide an index of current thought by experts in this field. Those behaviors consistently identified as key for successful transition of responsibility from parent to adolescent are outlined to inform future research and clinical practice.

Posttraumatic growth associated with a relative's serious illness.

Posttraumatic growth (PTG) involves personal psychological growth in response to a traumatic or very stressful event. Using theoretical guidance from Tedeschi and Calhouns cognitive model, this study evaluated the relationship between specific individual, distress, and stress-processing factors and PTG among young adults who experienced an illness-related trauma earlier in life through a relatives serious illness. Sixty individuals with a relative with a serious illness completed measures of PTG, posttraumatic stress symptoms (PTSS), anxiety, and coping. PTG was positively associated with trait anxiety, PTSS, and the use of active, problem-focused coping strategies. Factors associated with PTG development in individuals who have a relative with a chronic illness are similar to that of individuals who had a serious illness themselves. The relationship between PTSS and PTG is moderated by whether the relatives current illness status is resolved versus not resolved. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Increasing Parent–Pediatrician Communication about Children's Psychosocial Problems

OBJECTIVE To examine the differential effects of two scoring procedures for a parent-completed measure, the Pediatric Symptom Checklist (PSC), designed to assess childrens behavioral and emotional functioning, on parent-pediatrician communication concerning psychosocial issues. METHODS Prior to their medical appointment, 174 parents of children aged 4-16 were assigned to one of three experimental conditions: (1) typical medical care control, (2) Staff-Scored PSC administration, or (3) Parent-Scored PSC administration. Following the appointment, parent perception of parent-pediatrician communication was assessed. RESULTS For children with more emotional and behavioral problems, participants in the Parent-Scored group and the Staff-Scored group had better parent-pediatrician communication scores than those in the control group. CONCLUSIONS Both the Staff-Scored and Parent-Scored administrations of the PSC improved parent-pediatrician communication on psychosocial issues. The Parent-Scored PSC removed the scoring burden on the medical personnel.

Prospective comparison of parent and adolescent report of health-related quality of life in adolescent solid organ transplant recipients

Devine KA, Reed‐Knight B, Simons LE, Mee LL, Blount RL. Prospective comparison of parent and adolescent report of health‐related quality of life in adolescent solid organ transplant recipients.
Pediatr Transplantation 2010: 14:1000–1006.

A pilot study evaluating an abbreviated version of the cognitive remediation programme for youth with neurocognitive deficits

Primary objective: To determine the effectiveness of an abbreviated version of an established cognitive remediation programme for children with neurological disorders and attention problems in an outpatient setting. Methods and procedures: Eighteen 6–15-year-old children diagnosed with neurological and attention difficulties completed a six-module training programme aimed at improving attention. This programme was a shorter version of the Cognitive Remediation Programme (CRP), which has been successfully implemented with children with neurocognitive deficits. Parents completed measures of their childrens attention and children completed neuropsychological measures of attention. Main outcomes and results: The programme was associated with improvement in several aspects of parent-reported attention and childrens performance on tasks measuring attention. Conclusions: The shortened version of the CRP shows promise as a brief treatment for attention problems in outpatient neurological populations. Future research should assess programme effectiveness using a control group, longer-term follow-up and teacher reports.

Implementing psychological therapies for functional GI disorders in children and adults

ABSTRACT Introduction: Functional GI disorders (FGIDs) are common in adults and children. Psychological factors play an important role in the onset and maintenance of FGIDs and in explaining the associated disability. Psychological treatments such as Cognitive Behavioral Therapy and Hypnotherapy have been found efficacious in FGIDs but Integrating psychological treatments into traditionally medically-oriented care can be challenging. Areas covered: This review outlines the case for integrating psychological therapies into medical care for FGIDs and examine various models of integrated care that can be adapted to fit specific practice scenarios. Expert commentary: We advise integrating a psychologist in the care and treatment planning of every patient. Clinic-specific needs dictate how integrated care for patients with FGIDs can be delivered.