Eve S. Puffer

Use of Handheld Wireless Technology for a Home-based Sickle Cell Pain Management Protocol

PURPOSE To evaluate use of a handheld electronic wireless device to implement a pain management protocol for participants with sickle cell disease (SCD). METHODS Participants were 19 patients with SCD aged 9-20 who experienced vaso-occlusive pain. A single-session training on the use of cognitive-behavioral coping skills was followed by instruction on how to practice these skills and monitor daily pain experience using the device. Daily pain experience and practice of coping skills were collected for the 8-week intervention period using wireless technology. RESULTS High rates of participation, daily diary completion and consumer satisfaction support the use of handheld wireless devices to implement this protocol. A comparison of the rates of self and device-recorded skills practice provides important information about the use of electronic monitoring for behavioral interventions. CONCLUSION Wireless data transfer technology has significant potential to become a practical method to improve symptom monitoring and communication between patients and providers.

The Association of Oral Hydroxyurea Therapy with Improved Cognitive Functioning in Sickle Cell Disease

This study examined potential cognitive benefits of oral hydroxyurea therapy for children with sickle cell disease (SCD). Cognitive abilities of 15 children with SCD on hydroxyurea were compared to 50 other children with SCD, controlling for demographics and hematocrit. Children on hydroxyurea scored significantly higher on tests of verbal comprehension, fluid reasoning, and general cognitive ability than children not on the drug. The data therefore provide preliminary evidence of cognitive benefits of hydroxyurea. Mechanisms for this effect may be improved blood/oxygen supply to the brain or reduced fatigue and illness.

Individual- and Family-Level Psychosocial Correlates of HIV Risk Behavior Among Youth in Rural Kenya

Associations between individual- and family-level psychosocial factors and sexual behavior were examined among 325 adolescents ages 10–18 in rural Kenya. History of sexual activity was reported by 51% of males and 30% of females. Among those reporting sex within the past year, 64% of males and 32% of females had multiple partners; 85% of males and 54% of females reported not using a condom at last sex. Multivariate logistic regression modeling demonstrated sexually active adolescents were significantly more likely to be older, male, more accepting of risky behavior, and have greater perceived HIV risk, caregiver social support, social support related to HIV, and emotional problems. Youths reporting high-risk behavior (unprotected sex or multiple partners) were significantly more likely to be younger, male, and have lower sex-related self-efficacy, lower caregiver monitoring, and more externalizing problems. Future studies should evaluate HIV prevention interventions targeting improvements in mental health and family relationships.

Women’s perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries: consequences and unexpected opportunities

BackgroundThe aim of this paper is to explore women’s perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war.MethodsThe study was conducted in two locations in Sierra Leone and two in Liberia, using focus group discussions (N groups =14) and individual interviews (N = 20).ResultsWomen perceive the causes of IPV to be linked with other difficulties faced by women in these settings, including their financial dependence on men, traditional gender expectations and social changes that took place during and after the wars in those countries. According to respondents, the wars increased the use of violence by some men, as violence became for them a normal way of responding to frustrations and challenges. However, the war also resulted in women becoming economically active, which was said by some to have decreased IPV, as the pressure on men to provide for their families reduced. Economic independence, together with services provided by NGOs, also gave women the option of leaving a violent relationship.ConclusionsIPV was found to be a significant problem for women in Sierra Leone and Liberia.The interactions between war experiences and financial and cultural issues are multi-faceted and not uniformly positive or negative.

An Evidence-Based Group Coping Intervention for Women Living with HIV and History of Childhood Sexual Abuse

Abstract Women living with HIV/AIDS and a history of childhood sexual abuse often exhibit sexual trauma symptoms and elevated rates of HIV-risk behaviors. In this paper, we describe a coping skills group intervention that reduced traumatic stress and sexual-risk behavior in a recent randomized clinical trial. We focused on clinical issues that emerged among female participants receiving the intervention. Clinical observations showed that recognizing connections between trauma, psychological distress, and high risk behaviors was a new and powerful experience for many participants. Participants successfully applied psychoeducational material, expressing an increased sense of power and control over their relationships and behaviors as they developed more adaptive cognitive and behavioral skills. Women expressed high levels of satisfaction with the intervention. Recommendations for clinical practice are provided.

Language Processing Deficits in Sickle Cell Disease in Young School-Age Children

Verbal IQ deficits are frequently reported for school-age children with sickle cell disease (SCD), yet the profile of language abilities in SCD is unclear. We examined semantic, syntactic, and phonological processing in five-to-seven-year-olds at high neurologic risk based on SCD subtype (N = 33), at low neurologic risk with SCD (N = 21), and without SCD (N = 54). Low-risk SCD did not show language processing deficits. High-risk SCD showed deficits in all three language domains. Language processing deficits in SCD at the start of middle childhood are related to neurologic risks and include language skills beyond vocabulary.

Neurodevelopmental screening in toddlers and early preschoolers with sickle cell disease.

Sickle cell disease is associated with an elevated risk for neurologic complications beginning in early childhood. Detecting higher-risk cases with developmental screening instruments may be a cost-effective method for identifying young children in need of more frequent or intensive assessment. We evaluated the validity of the Denver II test as a tool to detect lower levels of developmental attainment and their association with neurologic risk in 50 young children with sickle cell disease. Children with suspect Denver II outcomes showed lower scores for functional communication skills, had lower hematocrit percentage, higher mean velocities on transcranial Doppler ultrasound imaging, and were more likely to have had preterm birth. Validity of age equivalencies from specific Denver II areas was demonstrated for Language and Fine Motor scores, suggesting the instrument could be used to index childrens developmental levels in these domains. The Denver II may be a useful behavioral screening tool for neurodevelopmental risk in sickle cell disease.

Changes in coping, pain, and activity after cognitive-behavioral training: a randomized clinical trial for pediatric sickle cell disease using smartphones.

Objectives:We examined the outcomes of a cognitive-behavioral therapy (CBT) intervention for pain in pediatric sickle cell disease (SCD) using smartphones as a novel delivery method. Materials and Methods:Forty-six children with SCD received CBT coping skills training using a randomized, waitlist control design. The intervention involved a single session of CBT training and home-based practice using smartphones for 8 weeks. Pre-post questionnaires between the randomized groups were used to evaluate changes in active psychological coping and negative thinking using the Coping Strategies Questionnaire. Daily diaries completed by the full sample during the treatment period were used to assess whether CBT skill use was related to reductions in next-day pain intensity and increases in same-day functional activity. Results:The pre-post group comparison suggested that the youth increased active psychological coping attempts with the intervention. Daily diary data indicated that when children used CBT skills on days with higher pain, there were reductions in next-day pain intensity. There was no such association between skill use and functional activity. Discussion:CBT coping skills training supported using smartphones can increase coping and reduce pain intensity for children with SCD; however, additions to the study protocols are recommended in future studies. Advantages and caveats of using smartphones are also discussed.

Relationships between Somatic Growth and Cognitive Functioning in Young Children with Sickle Cell Disease

OBJECTIVE Children with sickle cell disease (SCD) exhibit poor somatic growth due to nutritional and metabolic effects, but potential relationships between growth and other areas of development are unclear. We examined whether growth is related to cognition and whether growth might be one marker of neurocognitive risk. METHODS Sixty-four children with SCD and eighty-one demographically similar controls, ages 4 to 8 years, completed cognitive and anthropometric measures. RESULTS Height-for-age partially accounted for cognitive decrements related to SCD on all cognitive measures. Higher body-mass-index was a significant predictor of higher visual-motor and academic achievement scores in children with SCD, but not in controls. CONCLUSIONS In some children with SCD, especially those with HbSS and Hb Sbeta(0), low height-for-age may help to explain neurocognitive risk. Higher body-mass-index may be related to better cognitive outcomes in children with SCD. Nutrition deficits in SCD could explain the association between somatic growth and cognitive deficits.

The nature and impact of chronic stressors on refugee children in Ban Mai Nai Soi camp, Thailand

Refugee camps are replete with risk factors for mental health problems among children, including poverty, disruption of family structure, family violence and food insecurity. This study, focused on refugee children from Burma, in Ban Mai Nai Soi camp in Thailand, sought to identify the particular risks children are exposed to in this context, and the impacts on their mental health and psychosocial well-being. This study employed two qualitative methods – free list interviews and key informant interviews – to identify the main problems impacting children in Ban Mai Nai Soi camp and to explore the causes of these problems and their impact on childrens well-being. Respondents in free list interviews identified a number of problems that impact children in this context, including fighting between adults, alcohol use by adults and children, and child abuse and neglect. Across the issues, the causes included economic and social conditions associated with living in the camp and changes in family structures. Children are chronically exposed to stressors during their growth and development in the camp environment. Policies and interventions in areas of protracted displacement in camp-based settings should work to address these stressors and their impacts at community, household and individual levels.