Katherine S. Salamon

A family-based randomized controlled trial of pain intervention for adolescents with sickle cell disease.

The study had 2 aims---to determine the efficacy of a family-based cognitive-behavioral pain management intervention for adolescents with sickle cell disease (SCD) in (1) reducing pain and improving health-related variables and (2) improving psychosocial outcomes. Each adolescent and a family support person were randomly assigned to receive a brief pain intervention (PAIN) (n=27) or a disease education attention control intervention (DISEASE ED) (n=26) delivered at home. Assessment of primary pain and health-related variables (health service use, pain coping, pain-related hindrance of goals) and secondary psychosocial outcomes (disease knowledge, disease self-efficacy, and family communication) occurred at baseline (before randomization), postintervention, and 1-year follow-up. Change on outcomes did not differ significantly by group at either time point. When groups were combined in exploratory analyses, there was evidence of small to medium effects of intervention on health-related and psychosocial variables. Efforts to address barriers to participation and improve feasibility of psychosocial interventions for pediatric SCD are critical to advancing development of effective treatments for pain. Sample size was insufficient to adequately test efficacy, and analyses did not support this focused cognitive-behavioral pain management intervention in this sample of adolescents with SCD. Exploratory analyses suggest that comprehensive interventions, that address a broad range of skills related to disease management and adolescent health concerns, may be more effective in supporting teens during healthcare transition.

A problem-solving intervention for children with persistent asthma: A pilot of a randomized trial at a pediatric summer camp

Background: Pediatric summer camps are emerging as a means to increase social support and improve childrens attitudes about their chronic illness. Because of the high rate of camp attendance, it may be feasible to implement interventions within that setting; however, it has yet to be determined what components of camp are beneficial. Objective: The objective of this pilot study was to determine the efficacy of a problem-solving intervention targeting disease management in improving psychosocial functioning of children with persistent asthma, over and above the benefits of participation in a pediatric summer camp. Methods: Fifty campers were randomly assigned to receive camp plus a nightly problem-solving intervention activity or camp as usual. Changes in self-reported asthma knowledge and problem-solving skills and self- and parent-reported child self- and social competence health-related quality of life were assessed thrice: before camp, on the last day of camp, and 3-months post-camp. Results: There were no significant differences between the problem-solving intervention group and the camp as usual group in change across psychosocial variables from before camp to last day of camp or before camp to 3-months post-camp. Increases in asthma knowledge and problem-solving were found 3-months post-camp when groups were combined. Conclusions: Although support was found for improvements in disease knowledge and problem-solving skills after camp participation, there were no identified benefits to the problem-solving intervention. Children with asthma who participated in camp were functioning at a high level in terms of knowledge, problem-solving, and social and self-competence, suggesting that interventions may be more effective if targeted to patients with identified problems with disease management.

Improving adherence in social situations for adolescents with type 1 diabetes mellitus (T1DM): a pilot study.

AIMS Management of type 1 diabetes mellitus (T1DM) involves adherence to complex daily behaviors. Some adolescents have difficulty maintaining these regimens within social contexts due to peer pressure and apprehension about being singled out (Wysocki et al., 2003 [1]). Previous research suggests that negative social attributions have a role in adherence difficulties (Hains et al., 2006 [6]). This pilot study examined a cognitive-behavioral intervention geared towards challenging and restructuring negative thinking patterns. METHODS Ten adolescents with T1DM and HbA1c readings greater then 7.0% were recruited from a large, Midwestern Childrens Hospital. The intervention consisted of a 1-h session followed by three weekly phone calls, which focused on cognitive restructuring and problem-solving training. Measures of diabetes-related stress and concerns surrounding self-care in social situations were completed by the adolescents pre- and post-intervention and at one-month follow-up. RESULTS A series of repeated measure ANOVAS did not reveal significant differences between pre-intervention and follow-up scores across measures. CONCLUSIONS While there were no significant differences between pre-intervention and follow-up scores, the results highlight some important trends. Specifically, preliminary results suggest that the trends in individual scores indicate that problem-solving may be helpful for improving adherence in social situations.

A preliminary report of parent/nurse-controlled analgesia (PNCA) in infants and preschoolers.

BackgroundInfants and young children are often unable to verbalize pain or advocate for themselves which may increase their risk for poor pain assessment and management. Although patient-controlled analgesia (PCA) has been shown to be safe, effective, and superior to intermittent opioid dosing, infants and young children are not able to operate PCA independently. Allowing a parent or nurse to operate the PCA for the child [parent/nurse-controlled analgesia (PNCA)] may be an option for these children. However, the use of PNCA has been heavily scrutinized and more evidence of safety is needed to support this practice. ObjectivesThe primary purpose of this study was to evaluate safety outcomes associated with PNCA for infants and preschool aged children. Secondary outcomes regarding the frequency of untoward side effects and clinical effectiveness were also examined. MethodsA retrospective review of treatment with PNCA was conducted from a convenience sample of charts for 107 infants and preschoolers. Data were collected for 72 hours or until the PNCA was discontinued. ResultsOne hundred and seven infants and preschoolers with a mean age of 19.6 months (±12.12) were represented in this study. Mean pain scores were low, as was the number of PNCA injections and attempts and amount of opioid administered. Common opioid side effects were reported. Naloxone was administered to 1.9% of patients for respiratory depression, and potential contributing factors were identified. DiscussionDiligent monitoring and education are crucial to ensure safety. Untoward side effects adverse events and pain scores suggest PNCA may be an effective method of pain control for this patient population.

Adolescents and Type 2 Diabetes Mellitus: A Qualitative Analysis of the Experience of Social Support

Objective. Research on how adolescents with type 2 diabetes mellitus (T2DM) understand and use social support is limited. Therefore, we explored how adolescents with T2DM experience and perceive social support. Methods. Adolescents with T2DM were interviewed, and data were qualitatively analyzed using Consensual Qualitative Research methodology. Results. Four themes emerged: support for nondiabetes and diabetes-specific behaviors, feelings of belonging, and disclosure. All participants expressed emotional and self-care-specific support. For some, disclosure and a sense of belonging with others who had diabetes often led to support elicitation. Participants also expressed a fear of disclosing their diabetes to others. Discussion. Adolescents with T2DM value tangible and emotional support for behaviors both related and not related to diabetes. Fear of disclosure was a typical experience with disclosure often limited to close friends and family. Recommendations for health professionals to assist adolescents in promoting appropriate disclosure and means of requesting support are discussed.

Experiencing Type 2 Diabetes Mellitus Qualitative Analysis of Adolescents’ Concept of Illness, Adjustment, and Motivation to Engage in Self-Care Behaviors

Purpose The purpose of this study was to explore the perspectives of adolescents diagnosed with type 2 diabetes mellitus (T2DM) in terms of how youths conceptualized the effect of T2DM on daily life, adjustment to the illness, and motivation related to diabetes self-care management. The aims of the study were to gather essential information in order to develop appropriate intervention techniques and inform future studies intended to understand the psychosocial experiences of youths with T2DM. Methods Eight adolescents diagnosed with T2DM were recruited from an outpatient pediatric diabetes clinic at a Midwestern children’s hospital. A qualitative interview was developed, which was scheduled to last about 30 to 45 minutes. Data were analyzed using the consensual qualitative research methodology, wherein qualitative coders developed core ideas and themes related to the adolescent experience of T2DM. Results Three main themes were identified, including how the youths conceptualized the impact of T2DM, adjustment to self-care, and motivation to perform self-care behaviors. Knowledge related to the cause of T2DM and adjustment to completing self-care behaviors was varied among youths. Few adolescents spoke about motivation sources, although when mentioned, it typically involved witnessing negative health consequences in family members or friends with T2DM. Conclusions The data represent essential initial information related to youths with T2DM, which will help guide in developing future studies designed to understand the psychosocial experiences of youths with T2DM and appropriate intervention techniques. Future research that aims to increase internal and external motivation may be able to subsequently impact adherence to self-care behaviors.

A pilot study of yoga for chronic headaches in youth: promise amidst challenges.

The primary aim of the current study was to provide preliminary data on the feasibility, acceptability, and safety of alignment-based yoga for youths with chronic headaches. A secondary aim was to provide preliminary estimates of yogas ability to improve headache pain, daily functioning, quality of life, and anxiety level in this population. The yoga intervention consisted of 8 weekly, 75-minute classes. Participant flow data revealed challenges to feasibility primarily due to recruitment and retention. Scores on most outcome measures changed in the predicted direction with medium effect sizes found for the functional outcomes. Pain measures did not change significantly. This pilot suggests that yoga for pediatric headaches may be acceptable, as indicated by positive parent and participant ratings of the yoga experience. These preliminary findings suggest that yoga trials for pediatric headaches include both challenges and promise. Recommendations for overcoming challenges include designs that optimize family convenience.

The Pain Frequency-Severity-Duration Scale as a Measure of Pain: Preliminary Validation in a Pediatric Chronic Pain Sample

Typically, pain is measured by intensity and sensory characteristics. Although intensity is one of the most common dimensions of pain assessment, it has been suggested that measuring pain intensity in isolation is only capturing part of the pain experience and may not lead to an accurate measurement of how pain impacts a childs daily functioning. The current study aimed to develop a measure that would capture pain intensity along with frequency and duration in a clinical sample of youth diagnosed with chronic pain. The pain-frequency-severity-duration (PFSD) scale was developed and data were collected from a multidisciplinary pain clinic at a large, midwestern childrens hospital. Validated measures of functional limitations and health related quality of life were also collected. Significant correlations were found between the PFSD composite score, functional limitations, and health related quality of life. Future research should continue to evaluate this questionnaire utilizing other validated pain measures and other areas potentially impacted by chronic pain and with more diverse samples. This initial finding suggests that the PFSD is a convenient self-reported measure and is strongly related to health related quality of life and functional disability.

Hatha Yoga for Pediatric Obesity: A Pilot Study

Objective: Little is known about the benefits of yoga for pediatric obesity, and no studies have examined the benefits of yoga for physical activity in either adults or children. The purpose of this pilot study was to examine whether Hatha yoga would improve overall, physical and psychosocial functioning in youth with severe obesity. We also sought to determine whether participants would increase the vigor of, and time spent in, physical activity. Methods: This study utilized a pre-test/post-test design. Sixteen youth with severe obesity completed an 8 week Hatha yoga intervention involving fifteen, 60-minute classes. Physical and psychosocial functioning, fitness and state-anxiety were assessed at baseline and post-intervention; parents completed proxy-reports of physical and psychosocial functioning at both time points. To assess physical activity, participants wore an Actical Accelerometer for 7 days pre and post-yoga. Results: Significant improvements were found in: Overall, Physical and Psychosocial functioning, back and hamstring flexibility, and state-anxiety. Changes in the proportion of time spent in both light and moderate levels of physical activity were marginally significant. Although 3 tests of fitness, and time spent in physical activity did not improve significantly, trends were in the expected direction. Conclusions: Youth with severe obesity may benefit from a Hatha yoga intervention. Yoga may also offer a way to engage in physical activity that is not precluded by bodily pain.

Pain reports in children and adolescents with type 1 diabetes mellitus

The purpose of this study is to examine prevalence rates of pain reports in youth with type 1 diabetes mellitus (T1DM) and potential predictors of pain. Pain is a common and debilitating symptom of diabetic polyneuropathies. There is currently little research regarding pain in youth with T1DM. It was predicted that self-care and general health factors would predict pain as suggested by the general pain literature. Participants (N = 269) ranged in age from 13 to 17 years; youth had a mean time since diagnosis of 5.8 years. Data collected included diabetes self-management variables, ratings of the patient’s current functioning and pain intensity (‘current’), and information collected about experiences that occurred in the time preceding each appointment (‘interim’). About half of the youth (n = 121, 49.0%) reported any interim pain across both appointments. Female adolescents and those individuals who were physically active and/or utilized health-care system more acutely were more likely to report interim central nervous system pain. Improved diabetes self-management and increased level of physical activity may reduce experiences of pain and increase the quality of life of youth with T1DM. Regular monitoring of both current and interim pain experiences of youth with T1DM is recommended.