Vida L. Tyc

Effectiveness of psychological intervention for children and adolescents with chronic medical illness: a meta-analysis.

Outcomes from 42 studies of psychological interventions for children and adolescents with chronic medical conditions were analyzed using meta-analysis. Studies were divided into the four intervention categories suggested by LaGreca and Varni (1993), Disease Management, Emotional/Behavioral Problems, Health Promotion, and Prevention. Results supported overall effectiveness of psychological interventions, with an effect size (ES) of 1.12, as well as maintenance of treatment gains for at least 12 months posttreatment. Psychological interventions directed at disease-related or emotional/behavioral problems were both found to be effective, although too few studies of health promotion or disease prevention interventions were identified to be included in the analysis. Effectiveness of behavioral interventions, which were most heavily represented in the sample, demonstrated similar effects for disease management (ES = 1.20) and emotional/behavioral (ES = 1.03) problems. Although disease type, severity, and duration did not affect intervention effectiveness, some influences of patient age and gender were noted across studies. Recommendations for further intervention studies and improvements in study design are discussed.

Psychosocial adaptation of children and adolescents with limb deficiencies: A review

Abstract Children and adolescents with congenital or acquired limb loss must contend with a number of medical and psychosocial Stressors that might be expected to increase their risk of maladjustment. Yet several studies suggest remarkably good psychosocial adjustment in this population. This paper reviews the available data on the psychosocial status of the pediatric patient with a limb deficiency. Possible explanations related to disability characteristics, such as degree of disease visibility, are offered for the reported positive outcomes. Psychosocial factors that may influence the adaptation process are also reviewed. Finally, methodological limitations of prior studies are delineated and suggestions for future research are offered. Clearly, prospective longitudinal studies with appropriate control groups are necessary for an understanding of the adaptive process in specific pediatrie groups with limb deficiencies.

Smoking Rates and the State of Smoking Interventions for Children and Adolescents With Chronic Illness

Engaging in smoking is particularly risky for children and adolescents with chronic illness whose health status is already compromised because of disease- and treatment-related complications. Yet, some of these youngsters smoke at rates at least comparable to those of their healthy peers. To date, few randomized smoking-prevention and cessation trials have been conducted in children with chronic medical problems. In this review we report on the smoking rates among youngsters with chronic illness, identify specific disease- and treatment-related complications that can be exacerbated by smoking, examine risk factors associated with tobacco use among medically compromised youngsters, and review smoking interventions that have been conducted to date with pediatric populations in the health care setting. The following chronic illnesses are included in this review: asthma, cystic fibrosis, cancer, sickle cell disease, juvenile-onset diabetes, and juvenile rheumatoid arthritis. Objectives for a tobacco-control agenda and recommendations for future tobacco studies in chronically ill pediatric populations are provided. Finally, tobacco counseling strategies are suggested for clinicians who treat these youngsters in their practices.

Emerging issues in smoking among adolescent and adult cancer survivors: a comprehensive review.

The number of cancer survivors is significantly increasing, thereby prioritizing the importance of identifying and preventing adverse health outcomes within this high‐risk population. Cigarette smoking is of particular salience as it places both adolescents and adults with a cancer history at risk for various health problems, including second malignancies. The purpose of this article is to provide a comprehensive review of the smoking literature as it relates to adolescents and adults on‐treatment and surviving cancer. In particular, the article reviews the prevalence, risk factors, and health outcomes associated with smoking, in addition to the prevention and smoking cessation interventions available to adolescent and adult oncology patients. Furthermore, efficacious cessation strategies have recently emerged from the smoking literature in healthy populations, and their application to oncology populations is discussed. Cancer 2007.

Tobacco use among pediatric cancer patients: recommendations for developing clinical smoking interventions.

PURPOSE AND METHODS The current status of tobacco use among young cancer patients and the acute and chronic complications associated with tobacco use in these patients is reviewed. RESULTS AND CONCLUSION Studies report that adolescent cancer survivors use tobacco as much as their peers who have never been treated for cancer, despite the adverse consequences of engaging in this unhealthy habit. Health care professionals have the opportunity and responsibility to incorporate tobacco counseling as a routine component of medical care delivery. Nurse/physician-delivered smoking interventions have been found to promote smoking cessation in adults, although little effort has been devoted to the development of similarly effective smoking interventions for pediatric cancer patients who smoke. Components of existing smoking prevention/cessation curricula from successful school-based interventions and physician-delivered smoking interventions can be adapted and tailored to pediatric cancer patients in medical settings. Smoking interventions that educate patients about their increased vulnerability to tobacco-related consequences, relative to their healthy peers, may have an enhanced impact. Guidelines for conducting a comprehensive assessment of tobacco use and implementing smoking interventions with pediatric cancer patients is provided. Strategies for modifying the cancer patients perceived vulnerability to tobacco-related consequences is also discussed.

Risk factors for smoking among adolescent survivors of childhood cancer: A report from the childhood cancer survivor study.

Few studies have examined risk factors for smoking among adolescent survivors of childhood cancer. The present study reports on the rate of smoking and identifies factors associated with smoking in a sample of adolescent survivors from the Childhood Cancer Survivor Study (CCSS).

Reducing Secondhand Smoke Exposure Among Children and Adolescents: Emerging Issues for Intervening with Medically At-Risk Youth

OBJECTIVE To summarize information on rates of secondhand smoke (SHS) exposure among healthy and medically at-risk pediatric populations, discusses the clinical manifestations of pediatric disease that are exacerbated by exposure, and provide an overview of promising strategies for reducing SHS in vulnerable pediatric populations. METHODS The success of exposure reduction and smoking cessation interventions implemented with parents of healthy children and those with respiratory disease, in the context of their childs health care, is reviewed. RESULTS Concurrent implementation of multiple levels of intervention, including clinical interventions within the medical setting, will help to maximize the reduction in childhood SHS exposure. CONCLUSION Ongoing intervention research and identification of strategies to capitalize on opportunities for providing effective SHS counseling in primary care and specialty clinics will be critical for effective tobacco control among medically at-risk children.

Chemotherapy induced nausea and emesis in pediatric cancer patients: external validity of child and parent emesis ratings

Childrens and parents subjective ratings of the frequency and severity of nausea and emesis were assessed among 33 children with acute lymphoblastic leukemia receiving identical chemotherapy. Parents were trained to record the frequency of the childs actual emesis episodes during chemotherapy. Although parent and child ratings of nausea were significantly correlated, children generally rated their nausea and emesis as more frequent and more severe than did their parents. Parent ratings showed inadequate external validity when compared with behavioral observations. Children with greater anxiety and higher subjective ratings subsequently exhibited more frequent episodes of emesis by observation, suggesting that their perceptions of symptoms based on previous chemotherapy experiences may predict emesis during different chemotherapy. In a stepwise multiple regression analysis, antiemetic regimen and the childs anxiety as rated by the parent combined to account for approximately 47% of the variance in number of episodes of emesis. These findings are discussed in the context of factors limiting validity of parent and child reports of childrens symptomatology with implications for future epidemiologic and intervention research.J Dev Behav Pediatr 14:236–241, 1993. Index terms:childhood cancer, chemotherapy, emesis.

Anticipatory nausea and vomiting in pediatric cancer patients : An analysis of conditioning and coping variables

We examined the influence of cognitive factors and conditioning variables on anticipatory nausea and vomiting symptoms (ANV) in 32 pediatric cancer patients with postchemotherapy nausea and vomiting (PNV) who received ondansetron. The patients were compared with 18 patients without ANV (NANV). Age, gender, history of motion sickness, aggressiveness of the chemotherapy, PNV severity, number of chemotherapy treatments, number, type, and efficacy of self-reported coping strategies, and expectations of severity of postchemotherapy symptoms failed to differentiate the ANV and NANV groups. The amount of subjective distress associated with nausea and vomiting was significantly greater in the ANV group. Among patients in whom ANV developed, level of distress and expectations of severity of postchemotherapy symptoms were positively correlated with the severity of ANV and PNV symptoms. Therefore, greater distress might increase the likelihood of ANV conditioning. Once ANV is conditioned, cognitive factors might influence the severity of symptoms.

Are the Psychological Needs of Adolescent Survivors of Pediatric Cancer Adequately Identified and Treated

To describe the psychological needs of adolescent survivors of acute lymphoblastic leukemia (ALL) or brain tumor (BT), we examined the following: (i) the occurrence of cognitive, behavioral, and emotional concerns identified during a comprehensive psychological evaluation and (ii) the frequency of referrals for psychological follow‐up services to address identified concerns.