Journal of Pediatric Psychology最新文献

Objective: Although childhood cancer survivors require lifelong "risk-based" follow-up care, most adult survivors do not receive such care, and many are lost during the transition from pediatric to adult follow-up care. The goal of this study was to evaluate the feasibility and acceptability of the "Managing Your Health" self-management and peer mentoring intervention to improve transition readiness and self-management skills among young adult survivors of childhood cancer.

Methods: Survivors of childhood cancer ages 18-25 years were randomized 1:1 to the Managing Your Health intervention (six video/phone calls with a peer mentor, another young adult survivor, and five online educational modules) or usual care. Feasibility was measured through enrollment rates, retention rates, and engagement and satisfaction with the intervention. Participants completed measures of transition readiness, self-efficacy, and perceived support at baseline and 2-, 6-, and 12-months post-enrollment.

Results: A total of 50 participants (Mage = 21.1 years; 60% male) enrolled (32% of the total pool was contacted; 76% of those were screened; 94% of those screening eligible enrolled). Twenty-two (88%) of the 25 intervention participants completed the peer mentor calls. On average, participants completed 96% of the online modules, often closely timed to peer mentor calls. Participants indicated high satisfaction and acceptability of the intervention and suggested some improvements to the online modules.

Conclusions: Managing Your Health was feasible and acceptable to young adult survivors and mentors. Peer mentors appeared to serve as supportive accountability agents encouraging engagement with the online modules. Additional refinements will be made to the intervention prior to efficacy testing.

Objective: This study provided descriptive, psychometric, and correlational data on activity involvement, including engagement with and adherence to medical care activities, using the daily phone diary (DPD) methodology within the context of an ongoing longitudinal study of adolescents and young adults (AYAs) with spina bifida (SB).

Methods: As part of a longitudinal study, AYAs with SB aged 16-24 at Time 5 (n = 68) and aged 19-26 at Time 6 (n = 75) completed a DPD across 3 days, along with measures of demographics, condition severity, and medically related psychosocial constructs.

Results: Findings revealed that AYAs spent roughly two-thirds of their time either sleeping or engaged in recreational activities in their homes. They were more likely to spend time at home (with 50% of this time engaged in less active activities such as TV watching) and less time engaged in school and work activities than has been found in AYAs with other chronic medical conditions. Participants were also more likely to report low rates of catheterization, suggesting adherence challenges. The DPD method showed satisfactory stability over time. DPD data on medical care activities demonstrated adequate convergent validity as well as correlations with lesion level and measures of medical responsibility and medical skill mastery.

Conclusions: This study supports the use of the DPD method to assess engagement with and adherence to medical care activities in AYAs with SB. It also provides an assessment of engagement in other activities, such as in-home recreation and out-of-home school- and work-related activities.

Objective: This study aimed to investigate the role of environmental pollutants, specifically nitrogen dioxide (NO2) and particulate matter (PM10), on children and young adults (CYA) living with sickle cell disease (SCD) in the United Kingdom. Given the heightened vulnerability of this population due to socio-environmental factors, we explored how these pollutants influence hospitalization rates, sleep quality, and cognitive function.

Methods: Data were analyzed from the London Sleep Asthma Cohort, which included 94 CYA living with SCD at Visit 1, although this full sample was not available for all analyses. Participants' exposure to NO2 and PM10 was determined using air quality data linked to their residential postcodes. Hospitalizations, sleep quality, and cognitive function were assessed through medical records, caregiver questionnaires, and cognitive testing. Multiple regression analyses were conducted to determine the relationship between pollutant exposure and health outcomes, controlling for age, community deprivation, and asthma diagnosis.

Results: The study found that NO2 exposure significantly predicted lifetime hospitalizations for acute chest syndrome (ACS), particularly among participants with asthma. However, despite some trends toward significance, no significant relationships were observed between pollutant exposure and pain-related hospitalizations, sleep quality, or cognitive function.

Conclusions: Our preliminary findings suggest that NO2 exposure exacerbates respiratory complications in CYA with SCD, especially in those with asthma. Our results underscore the need for targeted public health interventions to mitigate air pollution in marginalized communities, which could reduce ACS-related hospitalizations and improve health outcomes for vulnerable populations. Further research is recommended to explore the mechanisms linking pollution to SCD complications.

Objective: Family partnerships in community-engaged research (CEnR) can promote family-centered, equitable interventions. This paper describes the process (meeting frequency, content) of a collaborative research family partnership and related methodological modifications to support equity and cultural humility during a multi-phase project adapting and evaluating an early childhood sleep intervention (Sleep Well!) for families of primarily lower socioeconomic status (SES) backgrounds in urban (large, metropolitan) primary care.

Methods: The Children's Hospital of Philadelphia Research Family Partners Program consulted on initial project development. Research family partners collaborated to modify intervention content, delivery methods, and research procedures in an open-pilot (NCT04046341) and randomized controlled trial (NCT04473222). We reviewed family partners meeting agendas, presentations, and minutes to identify meeting frequency, content, and resulting project modifications and to generate related themes. Family partners also provided recommendations for researchers, including for those without existing institutional CEnR resources.

Results: Ten 60-120-min meetings with 4-6 family partners occurred over 4 years. Themes representing the partnership process and project modifications included enhancing flexibility, centering cultural humility, and incorporating contextual factors (coronavirus pandemic, police violence, racism). These factors were especially relevant as project participants were primarily Black mothers and/or of lower-SES backgrounds. Family partner recommendations highlighted the need for collaborative, meaningful, and communicative relationships in pediatric intervention research.

Conclusions: The extent of recommended project modifications highlights the importance of family partnerships to support equity and cultural humility in pediatric psychology research and practice. Findings also underscore the need for representation of racial and ethnic minoritized scholars and families in this work.

Objective: Depression is associated with sleep problems, and both are associated with higher HbA1c in people with type 1 diabetes (T1D). However, little is known about depressed mood and sleep in young adults with T1D. The aims of this secondary analysis were to provide descriptive statistics of multiple aspects of mood and sleep in young adults with T1D and evaluate associations of depressed mood, diabetes distress, and sleep quality and duration.

Methods: At baseline of a behavioral intervention trial, young adults with T1D completed self-report measures of sleep, diabetes distress, and depressive symptoms. We described sleep metrics across racial/ethnic groups and conducted hierarchical regression models to evaluate associations of depressive symptoms and diabetes distress with sleep quality and duration, adjusting for demographic and clinical factors.

Results: Participants (n = 100) were 58% female, 12% Black/African American, 25% Hispanic/Latine, 54% non-Hispanic White, 9% multiple or another race/ethnicity, and 34% had public or no insurance. Mean HbA1c was 8.8 ± 2.0%. Approximately one-fifth of participants reported elevated depressive symptoms (19%) or high diabetes distress (20%), 27% reported poor sleep quality, and 28% reported <7 hr of sleep per night. Both regression models were significant, with diabetes distress but not depressive symptoms significantly associated with sleep quality (β = .38, p = .003) and duration (β = .32, p = .016) after controlling for other variables.

Conclusions: As diabetes-specific mood may be particularly relevant for sleep among young adults with T1D, routine screening and behavioral support for sleep health and diabetes distress may be warranted.

Objective: Reports of pain clinical trials evaluating psychological treatments often lack sufficient details on the potential and actual harm resulting from intervention. We aimed to understand how frequent and intense treatment reactions, conceptualized as unwanted symptoms, were in three clinical trials of digital Cognitive Behavioral Therapy (CBT) for adolescents with: (1) chronic primary pain, (2) sickle cell disease, and (3) chronic pancreatitis. We also aimed to understand any differences by demographic and clinical variables.

Method: Analyses were conducted with 246 youths (12-18 years old) experiencing chronic pain and one of their caregivers. 66% of the total sample was female. The number, intensity, and type of treatment reactions experienced were assessed post treatment. T-tests and Chi-squared tests were conducted to explore whether certain treatment reactions were more frequent as a function of baseline or clinical characteristics.

Results: 9% of participants experienced some negative treatment reaction. The average intensity of those events was very low on a 0-3 scale (M = 0.1, SD = 0.4). There were no differences in the prevalence or intensity as a function of participant's sex, age, race, or baseline pain intensity. However, baseline anxiety [t = -2.4 (244); p < .05] and baseline pain interference [t = -2.2 (223); p < .05] were significantly higher in those who experienced negative treatment reactions.

Conclusions: A small number of participants reported experiencing negative treatment reactions, with a low intensity level. Those experiencing negative treatment reactions showed higher baseline anxiety and pain interference. Future research may build from our example to standardize collection of harms data in trials of psychological interventions.

Objective: This QI project aimed to enhance pediatric intensive care unit (PICU) staff's ability to recognize and compassionately respond to caregiver fatigue (CF), tailoring interventions to the specific needs identified.

Methods: An interdisciplinary team of healthcare professionals developed and implemented a comprehensive strategy to improve the recognition and management of CF. This QI project included creating educational materials for staff, enhancing unit resources, and introducing targeted interventions. Data collection involved pre- and post-project surveys.

Results: The program led to significant improvements in PICU staff's confidence in recognizing and responding to CF, increased availability of unit resources, enhanced staff compassion, and reduced callousness toward others.

Conclusions: This QI project emphasized the role that structured initiatives and interdisciplinary collaboration can play in addressing CF within the PICU setting. Improvements in staff confidence, compassion, and reduced burnout demonstrate the program's effectiveness. These findings underscore the value of targeted interventions and provide a valuable framework for further research and can serve as a model for other healthcare units seeking to integrate CF management into comprehensive patient care.

Objectives: Caregivers of children with appearance-affecting conditions or injuries can experience common psychosocial challenges, regardless of the cause or nature of their child's visible difference. Despite these common challenges, there is a lack of evidence-based cross-condition support for caregivers of children with visible differences.

Methods: A self-guided acceptance and commitment therapy-based e-book intervention was developed utilizing a Participatory Action Research approach. Twenty-two caregivers of children with a range of visible differences reviewed the full pilot e-book intervention and responded to an online acceptability survey.

Results: While several changes aimed at increasing the accessibility of the intervention materials were discussed, overall the feedback suggested that The Visible Difference Parenting Toolkit addressed an unmet support need. Both the content and the format of the intervention were found to be acceptable by parents, with ehealth Impact Questionnaire scores of >80. Participants recommended specific changes related to accessibility including adding features such as hyperlinks and a search bar to enable users to navigate the e-book.

Conclusions: Caregivers reported that the content of The Visible Difference Parenting Toolkit was relevant to their lived experiences of caring for a child with a visible difference. Parents also reported that the presentation and format of The Visible Difference Parenting Toolkit was clear and accessible. The intervention addresses a previously unmet support need and is an acceptable intervention for caregivers of children with a visible difference.

Objective: The purpose of this systematic review and meta-analysis was to examine the effectiveness of psychological interventions at improving physical or mental health outcomes for youth living in rural communities who have, or are at-risk for, any chronic medical condition in comparison to control interventions conducted in rural communities.

Methods: Following prospective registration (OSF.IO/7TDQJ), 7 databases were searched through July 1, 2023. Studies were included if they were a randomized control trial of a psychological intervention conducted with youth living in a rural area who had, or were at-risk for, a chronic medical condition. Risk of bias was assessed with the Cochrane risk of bias version 2 tool. A qualitative synthesis and meta-analysis were conducted.

Results: 15 studies met inclusion criteria. Obesity studies (n = 13) primarily focused on body mass index metrics, with limited significant findings across studies. Asthma treatment interventions (n = 2) showed no impact on hospitalizations. 3 studies evaluated mental health outcomes with no significant group differences observed. We meta-analytically analyzed 9 studies that evaluated body mass index z-scores and identified an overall null effect (Hedge's g = 0.01, 95% CI [-0.07, 0.09], p = .85).

Conclusions: Most included studies focused on pediatric obesity, and there was a limited range of health outcomes reported. Compared to controls, minimal significant improvements in health outcomes were identified for psychological interventions for youth living in rural communities. Future efforts may benefit from situating this work more systematically within a health disparities framework with a focus on understanding mechanisms of disparities and translating this work into interventions and policy changes.