Elizabeth Soliday

Family environment, child behavior, and medical indicators in children with kidney disease

Effects of family environment on child behavior symptoms and medical indicators in children with one of three kidney diseases were examined. Parents (n = 41) of children with nephrotic syndrome, chronic renal insufficiency, or kidney transplant completed family environment and child behavior questionnaires. Medical indicators (utilization and medications) were collected from medical records. A model including child age, diagnostic group, and family environment variables successfully predicted all outcomes except internalizing behavior. Higher family conflict predicted more externalizing symptoms and higher number of prescribed medications; higher family cohesion predicted fewer hospitalizations. Nontraditional family structure predicted higher number of prescribed medications. Results are discussed as they relate to a stress and resistance framework, need for research on direction of effect, and clinical recommendations.

Behavioral effects of corticosteroids in steroid-sensitive nephrotic syndrome

Objectives. The objective of this study was to define the frequency and severity of steroid-related behavioral side effects in children with steroid-sensitive idiopathic nephrotic syndrome (SSNS) during treatment for relapse. Study Design. We conducted a prospective, repeated- measures study in which 10 children with SSNS underwent behavioral assessment using the Child Behavior Checklist at baseline and during high dose prednisone therapy for relapse. Results. Of the 10 children, 8 had normal behavior at baseline. Of these 8 children, 5 had Child Behavior Checklist scores above the 95th percentile for anxious/depressive behavior and/or aggressive behavior during relapse. Such scores are in the range normally considered appropriate for referral to a mental health provider. The 2 children who had abnormal behavior at baseline also experienced a worsening of their behavior during relapse. The behavioral changes occurred almost exclusively at prednisone doses of 1 mg/kg every 48 hours or more. Regression analysis showed that prednisone dose was a strong predictor of abnormal behavior, especially increased aggression. Conclusion. Children with SSNS often experience serious problems with anxiety, depression, and increased aggression during high-dose prednisone therapy for relapse.

Health beliefs and pediatric emergency department after-care adherence

This study’s purpose was to apply a multivariate adaptation of the Health Belief Model (HBM) to examine parental adherence to pediatric emergency department (ED) after-care instructions. Parents/legal guardians (n=162) of children ages 0–17 years with minor (noncritical) conditions (e.g. abrasion/contusion, laceration) completed health beliefs and demographics questionnaires while waiting for their child to be seen. Postdischarge, children’s medical records were reviewed for after-care instructions and insurance status, and parents were phoned to assess adherence to specific after-care instructions. In logistic regressions, health beliefs (barriers, severity, susceptibility) and child age significantly predicted several postdischarge adherence behaviors, including home care procedures and prescription medication purchase. Results are discussed as they relate to the effects of specific health belief variables and the need for further refinement of the HBM in accordance with the changing health care system; clinical applications are proposed.

Family structure and the course of steroid-sensitive nephrotic syndrome

Abstract. The number of children in nontraditional families is growing. The objective of this study was to determine the effects of family structure on the course of childhood steroid-sensitive idiopathic nephrotic syndrome (SSNS). Sixteen children, 2–15 years of age, with SSNS were enrolled in the study. The effects of family structure (traditional versus nontraditional) on the number of hospitalizations and outpatient visits for the previous 2 years and disease relapses for the preceding year were evaluated. Behavior differences were assessed using the Child Behavior Checklist (CBCL). Of the 16 families, 9 were traditional and 7 nontraditional. Hospitalizations, outpatient visits, and behavior were not different between family groups. However, children from nontraditional homes relapsed 3 times more than children from traditional homes (P=0.003). We conclude that children with SSNS from nontraditional homes may be at risk for more relapses compared with children from traditional families. Heightened support and monitoring is necessary for these children.

Pathways to violated expectations of epidural uptake

Objective: To examine maternal prenatal expectations for epidural uptake with their intrapartum actual epidural uptake followed by maternal postpartum reporting. Background: Childbearing women may or may not expect to have an epidural in childbirth, but the match between expected and actual epidural uptake has not been examined. The issue is important because childbirth expectations have been associated with actual experiences and later adjustment. Methods: Prospective, longitudinal study of 55 obstetric clinic patients from the US Pacific Northwest region. In the third trimester of pregnancy, participants reported on epidural expectation and fear of childbirth pain. Postpartum reports included birth characteristics, satisfaction, and description of epidural uptake. Results: Of the 21 participants who expected to have an epidural, 18 (86%) did; of those who did not expect one, 6/16 (38%) did not have one. Fourteen (78%) of the 18 who expected to ‘wait and see’ had an epidural. Birth satisfaction was significantly higher in confirmed vs. violated expectation subgroups. Qualitative data identified factors potentially involved in epidural uptake expectancy violations. Conclusions: This study on expected vs. actual epidural uptake has identified specific factors in the pathway to expectancy violation such as late-term pregnancy concerns, labour onset timing, and medical induction, which has important implications for research and counselling on birth options.

Patient-reported benefits of acupuncture in pregnancy

As U.S. expenditures on acupuncture treatment rise, so does the need to examine specific acupuncture patient subpopulations because their treatment needs and goals vary. This study focused on treatment benefits reported by former obstetric acupuncture patients, which addresses a critical research gap on subjective patient experiences. Of 265 former clinic patients, 137 (51.7%) completed an internet survey with an open-ended question on treatment benefits. Using standard qualitative analytic strategies, we identified five major themes related to benefits, including, for example, treated chief concerns, helped achieve a desired birth experience, and provided holistic benefit. Identified themes and subthemes spoke to benefits of acupuncture on specific pregnancy symptoms and on the birth process. Clinical and research implications for identified themes, including those related to the birth process and birth setting, are discussed.

Patient Expectations of Acupuncture in Pregnancy

Background: Expectations for treatment have been associated with outcomes. Expectations in acupuncture treatment have rarely been addressed, and due to the unique concerns of pregnancy and childbirth, obstetric patients merit special attention. Primary Study Objective: Assess treatment expectations of acupuncture clinic patients treated for obstetric and related concerns. Methods/Design: Descriptive follow-up involving a patient-completed survey; chief treatment concern and number of treatment sessions were validated against patient records. Participants: Of 265 former clinic patients, 137 (51.7%) completed the internet survey. Main Outcome Measures: Self-reported demographic variables; responses to open-ended questions on treatment expectations; general treatment variables. Results: Using standard qualitative data analytic strategies, we identified five major treatment expectations, for example, affecting labor and delivery, benefiting the whole system, and treating specific symptoms. Limitations: Retrospective method and recall bias may have influenced reported expectations. Conclusion: Obstetric acupuncture patients’ expectations overlap with other subgroups in terms of symptom treatment. They also indicate a distinct interest in taking an active role in childbirth and in replacing conventional interventions, warranting further inquiry into obstetric acupuncture effects and safety in childbearing women.

Impact of a Breast Cancer Diagnosis on Adult Children's Cognitive and Emotional Coherence

The current study examined whether adult children of recently diagnosed breast cancer patients experience heightened general and major stressor-related distress, and identified a potential mediator between these two forms of distress. Unique from other stress studies, the current study proposed a novel intrapsychic construct, the extent to which one understands and recognizes his or her thoughts and feelings related to a major stressor, for which we coined the term cognitive and emotional coherence. Albeit preliminary, findings supported study hypotheses and argue that this construct may represent an important mediator of distress as well as a pivotal target for psychosocial intervention.

Engaging Practitioners in Advancing Research on Acupuncture in Pregnancy.

OBJECTIVES Women across the globe seek acupuncture to treat pregnancy concerns. Randomized controlled trials have indicated limited benefits of acupuncture in pregnancy, but field studies involving practitioners are needed to better understand the outcomes of usual care. To advance research on pregnancy acupuncture, this study engaged field-based practitioners to discuss research strategies. SETTINGS/LOCATION U.S. Pacific Northwest region. DESIGN AND PARTICIPANTS Live focus group with regional specialized acupuncturists. Content analysis involved research team and interviewees. RESULTS Practitioners generally focused on patient care, although they discussed valuing research for communicating with patients and biomedical practitioners. To increase research in this area, practitioners proposed partnering with professional organizations, using social media, assuring confidentiality, and designing brief measurement tools. CONCLUSIONS Practitioners valued evidence for specific uses and proposed several novel research strategies. On the basis of these results, a framework is proposed for building a patient-centered collaboration between research and practice communities that is responsive to paradigmatic preferences and the overarching goals of science.

Decisions in Childbirth Reported by a Sample of U.S. Women

Increasing patient-centeredness in birth care partly involves understanding of women’s decision making. Toward that aim, we assessed how many women reported unanticipated decisions in childbirth, and we examined their written descriptions thereof. Of 70 women recruited in pregnancy, 64 (91.4%) completed a 1-month postpartum follow-up, and of those, 39 (61%) reported having been involved in an unanticipated decision in childbirth. Quantitative analysis revealed no differences between the decision and no-decision group on background characteristics or on pregnancy risk. Thematic analysis indicated that women’s views on agency in birth decisions ranged from having decisions made for them to their having had an active role. Nearly all reported decisions centered on a specific intervention tied to an identified medical cause. We discuss providing anticipatory guidance to prepare women for the likelihood of being involved in childbirth decisions while under labor stress.