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OBJECTIVE: To examine how height and youth as well as parenting characteristics associate with quality of life (QoL) and self-esteem among healthy youth undergoing growth evaluation with growth hormone (GH) testing. STUDY DESIGN: Healthy youth, aged 8-14 years, undergoing provocative GH testing, and a parent completed surveys at or around the time of testing. Surveys collected demographic data; youth and parent reports of youth health-related QoL; youth reports of self-esteem, coping skills, social support, and parental autonomy support; and parent reports of perceived environmental threats and achievement goals for their child. Clinical data were extracted from electronic health records. Univariate models and multivariable linear regressions were used to identify factors associated with QoL and self-esteem. RESULTS: Sixty youth (mean height z score -2.18 ± 0.61) and their parents participated. On multivariable modeling, youth perceptions of their physical QoL associated with higher grade in school, greater friend and classmate support, and older parent age; youth psychosocial QoL with greater friend and classmate support, and with less disengaged coping; and youth height-related QoL and parental perceptions of youth psychosocial QoL with greater classmate support. Youth self-esteem associated with greater classmate support and taller mid-parental height. Youth height was not associated with QoL or self-esteem outcomes in multivariable regression. CONCLUSIONS: Perceived social support and coping skills, rather than height, were related to QoL and self-esteem in healthy short youth and may serve as an important potential area for clinical intervention.
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Hormônio do Crescimento Humano , Qualidade de Vida , Adolescente , Criança , Humanos , Adaptação Psicológica , Qualidade de Vida/psicologia , Inquéritos e QuestionáriosRESUMO
PRCIS: Kahook Dual Blade (KDB) goniotomy can successfully lower intraocular pressure in some patients with uveitis-associated ocular hypertension or glaucoma. PURPOSE: The purpose of this study was to report a case series of patients that underwent KDB goniotomy at a single institution for uveitis-associated ocular hypertension or glaucoma with an open angle. METHODS: We performed a retrospective chart review of all patients with uveitis-associated ocular hypertension or glaucoma who underwent KDB goniotomy with trabecular meshwork excision alone or in combination with phacoemulsification cataract surgery at a single center between August 2017 and February 2020. The case series included 45 eyes of 37 patients. All eyes developed ocular hypertension refractory to maximum-tolerated medical therapy and required surgical intervention. Two eyes were excluded as they were lost to follow-up before 5 months postoperatively. Surgical success was defined as reaching the goal intraocular pressure or lower for each patient, including ongoing medical therapy. RESULTS: At most recent follow-up, 25 (55.6%) of 45 eyes had an intraocular pressure that was at goal. Mean follow-up time was 15.2±12.1 months ranging from 0.5 to 36 months postoperatively, considering that patients were eliminated from the data analysis once they required a second surgery. The mean number of preoperative medications, including oral carbonic anhydrase inhibitors was 3.7±1.2 medications. The mean number of postoperative medications through the last clinic visit was 2.5±1.9 medications for a mean reduction of 1.2±1.6 medications ( P -value <0.0001*). CONCLUSIONS: This larger case series shows that some patients with uveitis-associated ocular hypertension or glaucoma with an open angle may have success with KDB goniotomy.
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Glaucoma de Ângulo Aberto , Glaucoma , Hipertensão Ocular , Trabeculectomia , Uveíte , Humanos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular , Estudos Retrospectivos , Resultado do Tratamento , Glaucoma/cirurgia , Hipertensão Ocular/etiologia , Hipertensão Ocular/cirurgia , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/cirurgiaRESUMO
Parents are important for the development and maintenance of regulatory control. The current longitudinal study examined associations between parental coercion and autonomy support and impulse control in 117 youth (ages 8-16; Mage= 12.87, SD=2.53; 44% male) with Type 1 diabetes and explored whether youth negative affect mediated these associations. Parental coercion (but not autonomy support) was concurrently associated with lower impulse control and higher negative affect within individuals. Increases in youth negative affect partially mediated the within-person association between parental coercion and impulse control. These findings suggest that parent-directed interventions to reduce parental coercion may be most beneficial for impulse control if combined with youth-directed interventions to help them regulate negative affect. Replication of the current findings in a larger sample of youth with and without a chronic illness is needed to address the theoretical and empirical importance of negative affect as a potential mechanism through which parental coercion impacts youth impulsivity.
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OBJECTIVE: The ability of continuous glucose monitoring (CGM) to improve diabetes outcomes depends upon consistent use. To identify factors that facilitate long-term use of CGM, this study tested the hypothesis that youth involvement in the decision to initiate this therapy would influence subsequent CGM use and that CGM self-efficacy and satisfaction mediate this relationship. RESEARCH DESIGN AND METHODS: Before initiating CGM, parent-youth dyads (i.e., pairs) from an academic endocrinology clinic completed assessments, including a measure of the child's involvement in the decision to start CGM. Two months into CGM use, youth completed measures of CGM self-efficacy and satisfaction. Fidelity of CGM use between weeks 5 and 12 was accessed via a cloud-based data repository. Hypotheses were tested with linear mixed-effects models, accounting for patients clustered within provider and repeated measures within patients. RESULTS: CGM use in 108 dyads (youth mean age 13.4 ± 2.7 years; 73% White) was positively predicted by baseline parent report of youth involvement in the CGM decision (P < 0.0001), and this relationship was mediated by youth's perceptions of CGM self-efficacy (P < 0.0001) and hassle (P = 0.014). So, when the youth shared their opinions about CGM with parents and participated in the decision to start, they perceived higher self-efficacy and lower hassle at 2-month follow-up, which predicted more days of use. This pattern held in models adjusting for youth race and sex and family income. CONCLUSIONS: To achieve maximum clinical benefit from CGM use, providers should facilitate youth involvement in the decision to initiate the device.
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Tomada de Decisão Compartilhada , Diabetes Mellitus Tipo 1/sangue , Controle Glicêmico/instrumentação , Autoeficácia , Adolescente , Glicemia/análise , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/métodos , Automonitorização da Glicemia/psicologia , Criança , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobinas Glicadas/análise , Controle Glicêmico/métodos , Controle Glicêmico/psicologia , Humanos , Masculino , Prognóstico , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the impact of a primary care-based, parent-directed intervention on changes in parent-teen communication, parental beliefs about adolescents, parent and adolescent well-being, adolescent distress, and adolescent positive affect from baseline to 2-month follow-up. STUDY DESIGN: In this randomized controlled trial, 120 adolescents (13-15 years of age) scheduled for well visits and their parents were randomized to the strength intervention or control group. The intervention included a booklet highlighting 3 key messages about adolescence, instructions to have a discussion with their teen about each other's strengths, and clinician endorsement. Outcomes were assessed before the well visit and 2 months later. RESULTS: Adolescents were 61% female and 65% black. Parents were primarily female (97%); 72% had a 4-year degree or higher. The intervention had a positive impact on adolescent-reported open communication among adolescents with baseline low open communication scores (B = 3.55; P = .005; 95% CI, 1.07-6.03). Adolescents in the intervention group reported a decrease in distress (-1.54 vs 3.78; P = .05; partial eta squared [η2] = 0.038) and increase in positive affect (1.30 vs -3.64; P = .05; η2 = 0.04) compared with control group adolescents. The intervention did not affect parent-reported communication, parental beliefs, or adolescent well-being. Control parents demonstrated a marginal increase in well-being, whereas intervention parents did not (0.82 vs -0.18; P = .07; η2 = 0.029). CONCLUSIONS: This study highlights the potential impact of primary care-based, universal, low-intensity interventions targeting parents of adolescents on parent-teen communication and important adolescent health outcomes. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03496155.
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Comunicação , Relações Pais-Filho , Poder Familiar/psicologia , Atenção Primária à Saúde/métodos , Adolescente , Feminino , Seguimentos , Humanos , Masculino , Estudos RetrospectivosRESUMO
PRECIS: In a small case series of patients with uveitis-associated ocular hypertension (OHTN) or glaucoma, goniotomy with Kahook Dual Blade (KDB) was an effective surgical treatment option for lowering intraocular pressure (IOP). PURPOSE: The purpose of this study is to review the success of goniotomy using the KDB with trabecular meshwork (TM) excision in lowering the IOP of patients with uveitis-associated OHTN or glaucoma. MATERIALS AND METHODS: A retrospective chart review was completed for all patients with uveitis-associated OHTN or glaucoma who underwent KDB goniotomy with TM excision alone or in combination with phacoemulsification cataract surgery at a single institution. The study included 12 patients (16 eyes). Patients were followed for a minimum of 5 months postoperatively. The main outcome measures of this case series included postoperative IOPs, percent IOP reduction, and reduction of glaucoma medications. RESULTS: The mean maximum IOP of the patients before maximum-tolerated medical therapy or surgery was 35.6±5.8 mm Hg. The mean preoperative IOP at the clinical office visit before surgery of these patients was 28.1±8.5 mm Hg on maximum-tolerated medical therapy. Ten eyes (62.5%) have maintained an IOP at or below their goal through their most recent follow-up visit (mean follow-up time of 9.6±5.6 mo). The mean number of glaucoma medications was significantly reduced from 3.6±0.9 medications to 2.1±1.7 medications, for a mean reduction of 1.5±1.4 medications (P=0.004). CONCLUSIONS: On the basis of this small case series, KDB goniotomy may be a safe, less invasive, and effective first-line surgical alternative for patients with uveitis-associated OHTN or glaucoma refractory to medical therapy.
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Hipertensão Ocular/complicações , Hipertensão Ocular/cirurgia , Trabeculectomia , Uveíte/etiologia , Uveíte/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Estudos Retrospectivos , Tonometria Ocular , Malha Trabecular/patologia , Malha Trabecular/cirurgia , Trabeculectomia/efeitos adversos , Trabeculectomia/instrumentação , Trabeculectomia/métodos , Resultado do Tratamento , Adulto JovemRESUMO
Background The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia.Methods We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135 335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and highincome countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date whenrecruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality.
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Doenças CardiovascularesRESUMO
Families impacted by pediatric chronic illness must navigate treatment regimens that can present multiple problems and decisions to be addressed on a daily basis. The extent to which parents and children are able to solve such problems is likely to have implications for health behaviors and outcomes. The aims of this study were to examine correlates of problem resolution in families of children with a chronic illness. Participants were 167 children (ages 8-16) with type 1 diabetes or cystic fibrosis and a parent. Parent-child dyads recounted a recent discussion they had related to illness management and completed questionnaires. The research team coded the discussions for topic and outcome (i.e., did the dyad come up with a plan to address the problem). The results indicated that the majority of dyads in both illness groups came up with a plan during their discussions. Lack of problem resolution during the discussion was associated with higher parent coercion, more child resistance to the regimen, and worse adherence. Parent coercion and child resistance could be the targets of interventions to enhance problem solving and improve adherence.
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Several international guidelines recommend the consumption of two servings of fruits and three servingsof vegetables per day, but their intake is thought to be low world wide. We aimed to determine the extent to which suchlow intake is related to availability and aff ordability. Methods We assessed fruit and vegetable consumption using data from country-specific, validated semi-quantitativefood frequency questionnaires in the Prospective Urban Rural Epidemiology (PURE) study, which enrolled participants from communities in 18 countries between Jan 1, 2003, and Dec 31, 2013. We documented house hold income datafrom participants in these communities; we also recorded the diversity and non-sale prices of fruits and vegetables from grocery stores and market places between Jan 1, 2009, and Dec 31, 2013. We determined the cost of fruits andvegetables relative to income per house hold member. Linear random eff ects models, adjusting for the clustering ofhouseholds with in communities, were used to assess mean fruit and vegetable intake by their relative cost...
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Epidemiologia , FrutasRESUMO
The question of when and how to obtain child assent for nontherapeutic research has received increasing attention in recent years. Although child assent and parent permission are grounded in the principle of respect for persons, assent is often understood from the more narrow principle of respect for autonomy. When viewed in this way, "assent" is frequently conflated with "consent," and children are held to a higher standard than what might be sufficient for meaningful involvement in decision-making about research participation. When nested within the requirement for parental permission, child assent functions as a way to promote children's moral growth and developing autonomy, rather than as an autonomous decision. A developmental approach to child assent is necessary to understand how children can be meaningfully involved in decision-making about research participation across development. This approach suggests that the content and process of child assent should be allowed to vary across development. In addition, a developmental approach requires that future research employ longitudinal designs, examine the developmental mechanisms underlying age variations in child assent, and attend to both cognitive and noncognitive variables that may influence the assent process as children mature.