Christina L. Duncan

Efficacy of a Parent–Youth Teamwork Intervention to Promote Adherence in Pediatric Asthma

OBJECTIVE To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma. METHODS We used a randomized clinical trial with 48 youth (aged 9-15 years) assigned to 1 of 3 groups: Teamwork Intervention (TI), Asthma Education (AE), or Standard Care (SC). Treatment occurred across 2 months, with a 3-month follow-up assessment. Adherence to inhaled corticosteroids was assessed via the MDILog-II. Parent-adolescent conflict, asthma functional severity, and spirometry assessments were obtained pre-treatment, post-treatment, and on follow-up. Mixed linear model analysis was used to evaluate group and time effects for outcome measures. RESULTS TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions, and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group. CONCLUSIONS Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management.

Barriers to treatment of paediatric obstructive sleep apnoea: Development of the adherence barriers to continuous positive airway pressure (CPAP) questionnaire

BACKGROUND Continuous positive airway pressure (CPAP) treatment is often prescribed for youth as a treatment for obstructive sleep apnoea (OSA). Efficacy research in youth is limited, though some evidence suggests that it may relieve symptoms of OSA and possibly prevent future physical, emotional, and behavioural complications. However, the device must be used consistently for benefits to be realised. Non-adherence to medical treatment is prevalent among youth with chronic illness, yet little is known regarding adherence to CPAP in paediatric OSA. METHODS Using a sample of 51 youth (age 8-17 years) recruited from a paediatric sleep specialty clinic, the aims of the current study were to: (1) present descriptive data regarding CPAP adherence in youth with OSA, and (2) develop a psychometrically sound measure of barriers for adherence to CPAP use for youth with OSA. RESULTS Results indicated that adherence to CPAP is poor: youth in the current sample used their CPAP on average 3.35 h per night. The adherence barriers measure demonstrated excellent psychometric properties. CONCLUSIONS The adherence barriers to CPAP questionnaire has the potential to be a useful clinic-based tool for identifying patient-specific issues with CPAP adherence in youth with OSA.

Body Satisfaction, Nutritional Adherence, and Quality of Life in Youth With Cystic Fibrosis

Children with cystic fibrosis (CF) typically have similar nutritional intake as healthy peers, despite recommendations to consume more calories and fat. Body satisfaction may play a role in nutritional intake: females may be content with their smaller size despite recommendations for weight gain, while males may desire to be larger and more muscular, which is more congruent with medical advice. Females are especially at risk, given their propensity to desire a smaller body size, tendency for lower HRQOL, steeper trajectory of health decline and shorter life expectancy than males. This study evaluated body satisfaction in relation to nutritional adherence and HRQOL in youth with CF. Fifty‐four individuals with CF (age 9–17) completed the Cystic Fibrosis Questionnaire‐Revised (CFQ‐R), the Figure Rating Scale, and a 24‐hr diet recall interview with their caregiver. Twenty‐four percent of youth were non‐adherent with caloric goals, and 40.7% did not obtain the minimum recommendation for fat intake. Youth were classified as inconsistent with treatment goals (TI) if they desired a smaller body size or were content with their current size despite a BMI less than the 50th percentile; 44.8% of females were classified as TI, compared to only 8% of males. Statistical analyses were performed to evaluate the impact of gender and body satisfaction on HRQOL in youth with CF. Linear multiple regression models were fit; TI females had Emotional HRQOL scores 23 points lower than males. Results suggest that improving body satisfaction, especially for females, may help to improve overall quality of life and potentially impact nutritional adherence. Pediatr. Pulmonol. 2011; 46:1085–1092.

Association of caregiver health beliefs and parenting stress with medication adherence in preschoolers with asthma

Abstract Objective: This study examined the associations of parenting stress and caregiver negative health beliefs with medication adherence in a sample of preschool-aged children with asthma. Methods: Participants included 43 caregivers and their child with asthma, aged 2–5 years, who were prescribed a preventative or controller medication. Assessment included parent report of parenting stress associated with parental characteristics and difficult child behavior, health-related beliefs, and adherence to inhaled corticosteroids (ICS). Pharmacy refill records were reviewed to measure medication adherence objectively. Statistical analyses included paired samples t-test and Pearson’s correlation coefficients. Results: Parent-report and objective measures of adherence to ICS were significantly different, with parents reporting significantly higher rates of medication adherence (p < 0.001). Also, increased caregiver negative health beliefs, but not parenting stress, were significantly and negatively associated with an objective measure of ICS adherence (p < 0.01). Conclusions: Because the findings for parenting stress are not consistent with that of the literature on school-aged children with asthma, our results may suggest that preschool children are a unique developmental group. A review of endorsed health beliefs also highlights strengths and concerns for caregivers of these very young children. Overall, our study findings underscore the importance of caregivers’ health-related beliefs in promoting adherence to ICS in young children with asthma.

A Pilot Study of the Efficacy of Active Leptospermum Honey for the Treatment of Partial-Thickness Facial Burns.

OBJECTIVE:Research suggests that active Leptospermum honey (ALH) improves outcomes in patients with partial-thickness burns by enhancing healing and reepithelialization rates, as well as by protecting against antibiotic-resistant microorganisms. This study assessed the effectiveness of ALH gel on healing time, bacterial growth, patient satisfaction, and cost of treatment. DESIGN:Single-arm, prospective case series. SETTING AND PATIENTS:Seven patients (aged 7–64 years) with partial-thickness facial burns were recruited from a northeastern US burn center. INTERVENTION:All patients cleansed their wounds daily with soap and water, after which they applied ALH gel. MAIN OUTCOME MEASURES:Three physicians independently rated healing using wound photography and daily tests for the presence of exudate. Wound cultures on days 1 and 7 (±2 days) assessed bacterial growth. Patients completed a satisfaction survey at the end of treatment, and cost of treatment was calculated. MAIN RESULTS:Healing time ranged from 3 to 14 days (mean, 8.1 days). Wound cultures revealed normal bacterial growth on days 1 and 7 for all patients. Patients rated ALH gel favorably, with the most common complaint of stickiness in 5 patients. One patient experienced transient burning on application that did not interrupt treatment. Average hospital-based cost of treatment was

Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care

26.15 per patient. CONCLUSIONS:Healing time was congruent with or better than what would have been expected with standard treatment. Furthermore, despite no antibiotic treatment, wound culture results yielded no abnormal bacterial growth. Finally, patients overall reported satisfaction with treatment. The findings of this study suggest that ALH is a clinically and economically valuable treatment for partial-thickness facial burns.

A Review of Psychosocial Risk Factors for Pediatric Atopy

Burn care often involves procedures that result in significant pain experiences for patients which, in turn, can lead to poorer physical and psychological health outcomes. Distraction and virtual reality (VR) are an effective adjunct to pharmacological interventions in reducing pain. Much of the research that has demonstrated efficacy for VR in burn care has involved expensive and extensive technology. Thus, identifying cost-effective, feasible, acceptable, and effective approaches to apply distraction within routine burn care is important. The objective of this mixed-methods study was to evaluate key stakeholder (i.e., patients, providers) perceptions of feasibility, acceptability, and effectiveness for the use of low-cost VR technology during routine burn care with adult patients. Ten adult patients used VR during burn care dressing changes in an outpatient clinic setting, after which they completed a satisfaction survey and individual qualitative interview. Providers also completed a satisfaction/perception survey after each participants care. Quantitative and qualitative results from both patient and provider perspectives consistently supported the feasibility and utility of applying low-cost VR technology in this outpatient burn clinic setting. Special considerations (e.g., aspects to consider when choosing an apparatus or application) stemming from stakeholder feedback are discussed.

Developing pictorial asthma action plans to promote self-management and health in rural youth with asthma: A qualitative study

Pediatric atopy is increasing in prevalence and creates a significant financial and quality of life burden for children and families (e.g., frequent clinic visits, academic, and social challenges). Thus, it is important to understand modifiable risk factors related to disease onset or exacerbation in young children. The existing research base suggests that while a genetic link has been identified, specific family psychological factors (e.g., parent stress) also appear to play a significant role in the development of pediatric atopy. The function of psychological stress in the clinical expression and exacerbation of allergic diseases in young children is hypothesized to be due to neuroendocrine and immunologic systems. Specifically, stress-related activation of the sympathetic and adrenomedullary (SAM) system as well as the hypothalamic-pituitary-adrenocortical (HPA) axis from both the intrauterine environment and early childhood experiences may increase risk of childhood atopy above and beyond genetic risk. Consequently, prevention and intervention strategies aimed at reducing childrens early exposure to stress and psychological difficulties in parents may prove beneficial in preventing or reducing the likelihood that their children will develop atopy.

Social competence in pediatric burn survivors: A systematic review.

ABSTRACT Objective: Asthma action plans (AAPs) provide asthma management instructions to families; however, AAPs typically are written at a 7th–9th grade reading level, making them less useful in lower literacy families. There is a need to develop simpler AAP formats and content to optimize their utility across all families, including those who are rural and may be at a risk for literacy concerns. Because using pictures can simplify and enhance health education, our studys aim was to develop a pictorial AAP through a series of focus groups with key stakeholders – youth with asthma, caregivers, and physicians. Methods: Fourteen caregiver/youth dyads and four physicians participated in separate focus groups where their preferences for pictorial AAP structure and content were obtained. Focus groups were audio recorded, transcribed, coded with ATLAS.ti, and analyzed for themes. Results: Youth and their caregivers prefer that the AAPs include simple, cartoon-like pictures customized to the patient. Physicians emphasized AAPs capability to display pictures of controller medication given its importance in preventing asthma exacerbations. A stoplight format, currently used in most written AAPs, received positive reviews. Specific suggestions for pictures showing symptoms, medications, and how to take medication were suggested. Words and short phrases accompanying the pictures were thought to add clarity. Conclusions: Key stakeholders viewed pictorial AAPs as positive and potentially effective alternatives to standard written AAPs. It is expected that low literacy youth and caregivers would more easily understand a pictorial AAP presentation, which should facilitate better medication adherence and asthma outcomes in these children.

Primary Insomnia and Sleep Apnea in Pediatric and Adult Populations

Objective: Youth sustaining burn injuries during childhood have dramatically increased survival rates due to improvements in medical treatment and multidisciplinary approaches to burn critical care and recovery. Despite positive advancements in burn treatment, youth sustaining such injuries may experience social deficits. Thus, this systematic review without meta-analysis investigation contributes to the growing literature on this topic by comparing social competence of pediatric burn survivors to youth without burns, and examining potential correlates of social competence among children and adolescents who have sustained burn injuries. Method: Fifteen empirical studies assessing social competence among youth with burns and published in the last 4 decades (i.e., 1980–2015) were identified. Data from youth, parent, and teacher perspectives related to social competence in pediatric burn survivors were extracted from studies meeting inclusion criteria. Results: Results comparing social competence levels between pediatric burn survivors and youth without burns were mixed; some studies indicate that the social competence levels of pediatric burn survivors fell within the normal range, whereas other work found these youth to display social deficits. Conclusions: Implications for clinical practitioners, methodological strengths and limitations of the included research studies, and directions for future research are discussed.