Children and adolescents with traumatic brain injury (TBI) often experience behavior difficulties... more Children and adolescents with traumatic brain injury (TBI) often experience behavior difficulties that may arise from problem-solving deficits and impaired self-regulation. However, little is known about the relationship of neurocognitive ability to post-TBI behavioral recovery. To address this question, we examined whether verbal intelligence, as estimated by Vocabulary scores from the Wechsler Abbreviated Scale of Intelligence, predicted improvements in behavior and executive functioning following a problem-solving intervention for adolescents with TBI. One hundred and thirty-two adolescents with complicated mild-to-severe TBI were randomly assigned to a six-month Web-based problem-solving intervention (CAPS; n = 65) or to an Internet resource comparison (IRC; n = 67) group. Vocabulary moderated the association between treatment group and improvements in metacognitive abilities. Examination of the mean estimates indicated that for those with lower Vocabulary scores, pre-intervention Metacognition Index scores from the Behavior Rating Inventory of Executive Function (BRIEF) did not differ between the groups, but post-intervention scores were significantly lower (more improved) for those in the CAPS group. These findings suggest that low verbal intelligence was associated with greater improvements in executive functioning following the CAPS intervention and that verbal intelligence may have an important role in response to intervention for TBI. Understanding predictors of responsiveness to interventions allows clinicians to tailor treatments to individuals, thus improving efficacy.
Icons are frequently used in contexts where comprehension needs to be consistent across cultural ... more Icons are frequently used in contexts where comprehension needs to be consistent across cultural and linguistic barriers. This paper reports on a study comparing the comprehension of 54 universal medical icons in rural Tanzania and the United States of America. It finds that most of the icons were not understood cross-culturally. The premise of the study was that this misunderstanding might have two causes: cultural distinctions and lack of knowledge. To test the premise we studied icon comprehension by those in two different cultures with two levels of medical knowledge: ‘standard’ and ‘advanced’. The results show that most (33 of 47) poorly comprehended icons failed due to lack of medical knowledge or unfamiliarity with technology, while few (5 of 47) poorly comprehended icons failed due to cultural differences. Analysis of icons that failed due to cultural differences suggests that the primary drivers of cultural misunderstanding were the use of culturally sensitive metaphor and the incorporation of learned signs (non-representational symbols such as words) in icon design. Awareness of these causes of poor comprehension across cultures might help designers design effective universal icons by incorporating into the design process research methods that identify disparities of specific knowledge in the target people group and by avoiding use of metaphor and learned signs. These findings empower calls for cultural sensitivity in visual communication with guidance for implementation.
Icons are frequently used in contexts where comprehension needs to be consistent across cultural ... more Icons are frequently used in contexts where comprehension needs to be consistent across cultural and linguistic barriers. This paper reports on a study comparing the comprehension of 54 universal medical icons in rural Tanzania and the United States of America. It finds that most of the icons were not understood cross-culturally. The premise of the study was that this misunderstanding might have two causes: cultural distinctions and lack of knowledge. To test the premise we studied icon comprehension by those in two different cultures with two levels of medical knowledge: ‘standard’ and ‘advanced’. The results show that most (33 of 47) poorly comprehended icons failed due to lack of medical knowledge or unfamiliarity with technology, while few (5 of 47) poorly comprehended icons failed due to cultural differences. Analysis of icons that failed due to cultural differences suggests that the primary drivers of cultural misunderstanding were the use of culturally sensitive metaphor and the incorporation of learned signs (non-representational symbols such as words) in icon design. Awareness of these causes of poor comprehension across cultures might help designers design effective universal icons by incorporating into the design process research methods that identify disparities of specific knowledge in the target people group and by avoiding use of metaphor and learned signs. These findings empower calls for cultural sensitivity in visual communication with guidance for implementation.
Journal of pediatric rehabilitation medicine, 2013
Investigate the efficacy of risedronate sodium (Procter and Gamble, Cincinnati, USA) for treating... more Investigate the efficacy of risedronate sodium (Procter and Gamble, Cincinnati, USA) for treating reduced lumbar spine (LS) bone mineral density (BMD) in non-ambulatory patients. Nine (10-39 years, mean age 23.0 years, 7 males) in the risedronate arm and 10 (10-35 years, mean age 21.4 years, 8 males) in the placebo arm completed 24 months of therapy at baseline, 6, 12, 18, and 24 months. The primary outcome was change in LS BMD assessed by dual energy x-ray absorptiometry (DXA). Secondary outcomes included changes in serum bone markers, bone specific alkaline phosphatase, osteocalcin, and N-telopeptides. Mixed models examined group, time, and the group by time interaction for the 4 post-baseline time points. The change in LS BMD score from baseline to 24 months was 0.069 (95% CI 0.014 to 0.124) in risedronate participants compared to -0.015 (95% CI -0.073 to 0.042) (t Value = -2.40, P > t=0.03) in the controls. When controlling for baseline scores, the difference was consistent a...
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013
To study the intra- and inter-observer reliability of pediatric ophthalmologists in grading retin... more To study the intra- and inter-observer reliability of pediatric ophthalmologists in grading retinal hemorrhages in abusive head trauma. Pediatric ophthalmologists attending the 2009 annual meeting of the American Association for Pediatric Ophthalmology and Strabismus participated in an onsite survey. The participants were required to compare a collection of fundus photographs of patients with abusive head trauma to two standardized photographs, A and B. Participants graded photographs as normal (no retinal hemorrhages), better than A but not normal, same as A, between A and B, same as B, or worse than B. The survey was divided into four parts: part 1 consisted of 20 photographs to be graded; part 2 was a questionnaire about participant's professional experience; part 3 consisted of 20 photographs to be graded (including 15 graded in part 1 but reordered); and part 4 asked about the criteria used to grade the photographs. Of the 95 participants, 92 (97%) were licensed physicians with a mean of 14 years in practice. The intra-rater reliability was found to be high, with overall average of 85% pre- and post-agreement on the common pictures. Kendall's coefficient of concordance was used as the statistical measure of inter-rater reliability and had a high value (0.82). Pediatric ophthalmologists showed high intra- and inter-observer reliability in grading retinal hemorrhages in abusive head trauma.
Surgical site infection (SSI) after vascular surgery is a serious complication increasing morbidi... more Surgical site infection (SSI) after vascular surgery is a serious complication increasing morbidity, mortality, and costs for healthcare systems. A 4-year retrospective cohort study was performed in a university hospital with patients who had undergone arterial vascular surgery below the aortic arch. Investigated variables included demographics and clinical data. Forty-four of 756 patients experienced SSI, 29 of which were superficial, five were deep, and 10 had organ/space infections. Coagulase-negative staphylococci (22%), enterococci (20%), and Staphylococcus aureus (18%) were the most common pathogens. Independent risk factors for SSIs were femoral grafting [odds ratio (OR) 6·7], peripheral atherosclerotic disease, Fontaine stages III-IV (OR 4·1), postoperative drainage >5 days (OR 3·6), immunosuppression (OR 2·8), duration of operation >214 min (OR 2·8), and body mass index >29 (OR 2·6). The application of perioperative antibiotic prophylaxis was an independent protective factor (OR 0·2). Patients with certain risk factors for SSIs warrant special attention for infection prevention.
Children with long QT syndrome (LQTS) live with the risk of sudden death, activity restrictions, ... more Children with long QT syndrome (LQTS) live with the risk of sudden death, activity restrictions, and the need for daily medications. We sought to evaluate the quality of life (QOL), self-perception, and behavior of patients with LQTS as perceived by both patients and their parents and identify predictors of lower QOL. QOL (Pediatric QOL Inventory [PedsQL] and Pediatric Cardiac Quality of Life Inventory [PCQLI]), self-perception, and behavioral inventories were completed by patients with LQTS and their parents. Comparison of PedsQL scores was made to published data for healthy children using t tests, and PCQLI scores were compared with those of patients with differing complexity of congenital heart disease. Mixed modeling was used for multivariable analysis. Sixty-one patients with LQTS were evaluated (age 13.6 ± 3.0 years; male 49%). Compared with healthy children, the PedsQL Total, Psychosocial, and Physical Health Summary scores were significantly lower for patients with LQTS and parent proxy reports (p ≤0.001). In general, PCQLI scores of patients with LQTS and parents were similar to those of patients with tetralogy of Fallot (p ≥0.2), lower than those of patients with bicuspid aortic valve (p ≤0.02), and higher than those of patients with single ventricle (p ≤0.03). Lower patient and parent PCQLI scores were associated with internalizing problems. For parents, the presence of a cardiac device and medication side effects were additionally associated with lower PCQLI scores. In conclusion, patients with LQTS and their parents report lower QOL than normal children secondary to physical and psychosocial factors. Increasing focus on the psychological well-being of these patients is needed in an effort to improve their QOL.
Advancements in paediatric heart failure management have resulted in improved survival and a focu... more Advancements in paediatric heart failure management have resulted in improved survival and a focus on long-term outcomes including health-related quality of life. We compared health-related quality of life in children with heart failure with healthy patients, children with chronic conditions, and children with cardiovascular disease. Families (n=63) and children (n=73) aged 2-20 years with heart failure were enrolled and compared with data previously published for healthy patients (n=5480), those with chronic conditions (n=247), and those with cardiovascular disease (n=347). Patients and parents completed the PedsQL 4.0 and the Cardiac 3.0 Module health-related quality-of-life questionnaires. PedsQL scores including Total, Psychosocial Health Summary, and Physical were compared between groups. In general, patients with heart failure had lower scores than the healthy population (p=0.001), and comparable scores with those with chronic conditions. Parents perceived no difference in phy...
Purpose As our ability to diagnosis cardiac muscle disease or cardiomyopathy in children matures ... more Purpose As our ability to diagnosis cardiac muscle disease or cardiomyopathy in children matures and genetic testing becomes more widespread there has been a substantial increase in the pediatric cardiomyopathy population. The diagnosis will affect the patient and family perceptions of possible future morbidity and mortality as well as quality of life. The study’s aim was to evaluate health-related quality of life (HRQOL) and the self-perceptions in children with cardiomyopathy, as well as their caregivers, and compare to previously published data of normal children. Methods This study was a prospective study performed at The Heart Institute Cardiomyopathy and Advanced Heart Failure Clinic at Cincinnati Children’s Hospital Medical Center. Subjects were selected based on the clinical diagnosis of cardiomyopathy. HRQOL was assessed using the Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Core Scales (ages 2-18). Data regarding disease-specific medical information, health behaviors...
Purpose: Mortality rates in children with congenital heart disease (CHD) have fallen dramatically... more Purpose: Mortality rates in children with congenital heart disease (CHD) have fallen dramatically. Survivors are at risk for morbidities that may negatively affect their quality of life (QOL). To date, there has not been a comparison of QOL between a multi-site cohort of patients with CHD and a healthy control population. The purpose of this study was to compare patient and proxy reported QOL scores between a geographically diverse population of children and adolescents with CHD and a healthy control population. Methods: The Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) is a QOL measure for the pediatric population with proxy reporting that generates a Total score, a Physical Health Summary score (PhysHSS), and a Psychosocial Health Summary score (PsychHSS). An analysis was performed comparing PedsQL scores between a geographically diverse 7-site English-speaking CHD cohort from the Pediatric Cardiac Quality of Life Inventory (PCQLI) Testing Study with summary...
To examine the efficacy of counselor-assisted problem solving (CAPS) in improving long-term care... more To examine the efficacy of counselor-assisted problem solving (CAPS) in improving long-term caregiver psychological functioning following traumatic brain injury (TBI) in adolescents. METHODS: This randomized clinical trial compared CAPS (n = 65), a predominantly online problem-solving intervention, with an Internet resource comparison (n = 67) program. Families of adolescents with TBI completed a baseline assessment and follow-up assessments 6, 12, and 18 months later. General linear mixed models were used to examine longitudinal changes in caregiver global psychological distress, depressive symptoms, and caregiving self-efficacy. Family income and injury severity were examined as moderators of treatment efficacy. RESULTS: Family income moderated long-term changes in caregiver psychological distress. For lower-income caregivers, the CAPS intervention was associated with lower levels of psychological distress at 6, 12, and 18 months post baseline. CONCLUSIONS: These findings s...
The journal of the American Academy of Psychiatry and the Law, 2011
This study evaluated the Brief Rating of Aggression by Children and Adolescents-Preliminary Versi... more This study evaluated the Brief Rating of Aggression by Children and Adolescents-Preliminary Version (BRACHA 0.8), an actuarial method of assessing the risk of aggressive behavior by hospitalized children and adolescents. Licensed psychiatric social workers used a 16-item questionnaire to assess all patients seen in the emergency department (ED) of a major urban children's hospital. Over a six-month period, 418 patients (age range, 3.5-19.0 years) underwent psychiatric hospitalization after ED evaluation. The hospital nursing staff recorded the inpatients' behavior, with the Overt Aggression Scale (OAS). Inpatients were deemed aggressive if, during the first six days of their hospital stay, they scored one or higher on any OAS subscale. We evaluated questionnaire properties, items, and demographic covariates (e.g., age, sex, and living situation) by using factor analyses, logistic regression models, and receiver operating characteristic (ROC) methods. A total of 292 aggressiv...
Research suggests that pediatric TBI results in injury-related stress and burden and psychologica... more Research suggests that pediatric TBI results in injury-related stress and burden and psychological distress for parents. However, existing studies have focused almost exclusively on mothers, so that we know relatively little about the impact of childhood TBI on fathers. The aims were to prospectively examine differences in maternal and paternal response to early childhood TBI over time relative to a comparison cohort of mothers and fathers of children with orthopedic injuries (OI). The concurrent cohort/prospective research design involved repeated assessments of children aged 3-6 years with TBI or OI requiring hospitalization and their families. Shortly after injury and at 6, 12, and 18 months post injury, parents of 48 children with TBI (11 severe and 37 moderate) and 89 with OI completed standardized assessments of injury-related stress and burden, parental distress, and coping strategies. Mixed models analyses and Generalized Estimating Equations examined differences in maternal...
The study aimed to determine which acute injury variables were predictors of long-term functional... more The study aimed to determine which acute injury variables were predictors of long-term functional outcome following inflicted traumatic brain injury (iTBI). A retrospective case review of 35 children with iTBI was performed. After controlling for age at injury and time since injury, the generalized estimation equations method was used to identify acute injury variables that were significantly related to the Glasgow Outcome Scale scores at the initial follow-up assessments. When available, functional sequelae at these and longer-term follow-ups were also examined. In bivariate generalized estimation equations analyses, a low Glasgow Coma Scale (GCS) eye component score, a low GCS motor component score, a low GCS verbal component score, need for neurosurgical intervention, seizures in the first week after injury, need for mechanical ventilation for more than 10 days, length of intensive care unit stay of more than 10 days, initial hyperglycemia, and neuroimaging findings of cerebral edema or loss of gray-white matter differentiation were significantly (p ≤ 0.05) related to having a poor outcome, as defined by their Glasgow Outcome Scale score at the initial follow-up. In multivariable analyses, considering the significant predictors while controlling for age at injury and time since injury, the presence of cerebral edema on neuroimaging (odds ratio, 27.21; 95% confidence interval, 4.40-168.22), and length of intensive care unit stay of more than 10 days (odds ratio, 21.57; 95% confidence interval, 3.09-150.48) were significantly related to having a poor outcome. Early clinical data following iTBI help predict long-term functional outcome. Further research to support these findings may help delineate acutely after injury which children with iTBI are at risk for a poor prognosis and should be more closely followed up over time. Prognostic study, level IV.
Children and adolescents with traumatic brain injury (TBI) often experience behavior difficulties... more Children and adolescents with traumatic brain injury (TBI) often experience behavior difficulties that may arise from problem-solving deficits and impaired self-regulation. However, little is known about the relationship of neurocognitive ability to post-TBI behavioral recovery. To address this question, we examined whether verbal intelligence, as estimated by Vocabulary scores from the Wechsler Abbreviated Scale of Intelligence, predicted improvements in behavior and executive functioning following a problem-solving intervention for adolescents with TBI. One hundred and thirty-two adolescents with complicated mild-to-severe TBI were randomly assigned to a six-month Web-based problem-solving intervention (CAPS; n = 65) or to an Internet resource comparison (IRC; n = 67) group. Vocabulary moderated the association between treatment group and improvements in metacognitive abilities. Examination of the mean estimates indicated that for those with lower Vocabulary scores, pre-intervention Metacognition Index scores from the Behavior Rating Inventory of Executive Function (BRIEF) did not differ between the groups, but post-intervention scores were significantly lower (more improved) for those in the CAPS group. These findings suggest that low verbal intelligence was associated with greater improvements in executive functioning following the CAPS intervention and that verbal intelligence may have an important role in response to intervention for TBI. Understanding predictors of responsiveness to interventions allows clinicians to tailor treatments to individuals, thus improving efficacy.
Icons are frequently used in contexts where comprehension needs to be consistent across cultural ... more Icons are frequently used in contexts where comprehension needs to be consistent across cultural and linguistic barriers. This paper reports on a study comparing the comprehension of 54 universal medical icons in rural Tanzania and the United States of America. It finds that most of the icons were not understood cross-culturally. The premise of the study was that this misunderstanding might have two causes: cultural distinctions and lack of knowledge. To test the premise we studied icon comprehension by those in two different cultures with two levels of medical knowledge: ‘standard’ and ‘advanced’. The results show that most (33 of 47) poorly comprehended icons failed due to lack of medical knowledge or unfamiliarity with technology, while few (5 of 47) poorly comprehended icons failed due to cultural differences. Analysis of icons that failed due to cultural differences suggests that the primary drivers of cultural misunderstanding were the use of culturally sensitive metaphor and the incorporation of learned signs (non-representational symbols such as words) in icon design. Awareness of these causes of poor comprehension across cultures might help designers design effective universal icons by incorporating into the design process research methods that identify disparities of specific knowledge in the target people group and by avoiding use of metaphor and learned signs. These findings empower calls for cultural sensitivity in visual communication with guidance for implementation.
Icons are frequently used in contexts where comprehension needs to be consistent across cultural ... more Icons are frequently used in contexts where comprehension needs to be consistent across cultural and linguistic barriers. This paper reports on a study comparing the comprehension of 54 universal medical icons in rural Tanzania and the United States of America. It finds that most of the icons were not understood cross-culturally. The premise of the study was that this misunderstanding might have two causes: cultural distinctions and lack of knowledge. To test the premise we studied icon comprehension by those in two different cultures with two levels of medical knowledge: ‘standard’ and ‘advanced’. The results show that most (33 of 47) poorly comprehended icons failed due to lack of medical knowledge or unfamiliarity with technology, while few (5 of 47) poorly comprehended icons failed due to cultural differences. Analysis of icons that failed due to cultural differences suggests that the primary drivers of cultural misunderstanding were the use of culturally sensitive metaphor and the incorporation of learned signs (non-representational symbols such as words) in icon design. Awareness of these causes of poor comprehension across cultures might help designers design effective universal icons by incorporating into the design process research methods that identify disparities of specific knowledge in the target people group and by avoiding use of metaphor and learned signs. These findings empower calls for cultural sensitivity in visual communication with guidance for implementation.
Journal of pediatric rehabilitation medicine, 2013
Investigate the efficacy of risedronate sodium (Procter and Gamble, Cincinnati, USA) for treating... more Investigate the efficacy of risedronate sodium (Procter and Gamble, Cincinnati, USA) for treating reduced lumbar spine (LS) bone mineral density (BMD) in non-ambulatory patients. Nine (10-39 years, mean age 23.0 years, 7 males) in the risedronate arm and 10 (10-35 years, mean age 21.4 years, 8 males) in the placebo arm completed 24 months of therapy at baseline, 6, 12, 18, and 24 months. The primary outcome was change in LS BMD assessed by dual energy x-ray absorptiometry (DXA). Secondary outcomes included changes in serum bone markers, bone specific alkaline phosphatase, osteocalcin, and N-telopeptides. Mixed models examined group, time, and the group by time interaction for the 4 post-baseline time points. The change in LS BMD score from baseline to 24 months was 0.069 (95% CI 0.014 to 0.124) in risedronate participants compared to -0.015 (95% CI -0.073 to 0.042) (t Value = -2.40, P > t=0.03) in the controls. When controlling for baseline scores, the difference was consistent a...
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013
To study the intra- and inter-observer reliability of pediatric ophthalmologists in grading retin... more To study the intra- and inter-observer reliability of pediatric ophthalmologists in grading retinal hemorrhages in abusive head trauma. Pediatric ophthalmologists attending the 2009 annual meeting of the American Association for Pediatric Ophthalmology and Strabismus participated in an onsite survey. The participants were required to compare a collection of fundus photographs of patients with abusive head trauma to two standardized photographs, A and B. Participants graded photographs as normal (no retinal hemorrhages), better than A but not normal, same as A, between A and B, same as B, or worse than B. The survey was divided into four parts: part 1 consisted of 20 photographs to be graded; part 2 was a questionnaire about participant's professional experience; part 3 consisted of 20 photographs to be graded (including 15 graded in part 1 but reordered); and part 4 asked about the criteria used to grade the photographs. Of the 95 participants, 92 (97%) were licensed physicians with a mean of 14 years in practice. The intra-rater reliability was found to be high, with overall average of 85% pre- and post-agreement on the common pictures. Kendall's coefficient of concordance was used as the statistical measure of inter-rater reliability and had a high value (0.82). Pediatric ophthalmologists showed high intra- and inter-observer reliability in grading retinal hemorrhages in abusive head trauma.
Surgical site infection (SSI) after vascular surgery is a serious complication increasing morbidi... more Surgical site infection (SSI) after vascular surgery is a serious complication increasing morbidity, mortality, and costs for healthcare systems. A 4-year retrospective cohort study was performed in a university hospital with patients who had undergone arterial vascular surgery below the aortic arch. Investigated variables included demographics and clinical data. Forty-four of 756 patients experienced SSI, 29 of which were superficial, five were deep, and 10 had organ/space infections. Coagulase-negative staphylococci (22%), enterococci (20%), and Staphylococcus aureus (18%) were the most common pathogens. Independent risk factors for SSIs were femoral grafting [odds ratio (OR) 6·7], peripheral atherosclerotic disease, Fontaine stages III-IV (OR 4·1), postoperative drainage >5 days (OR 3·6), immunosuppression (OR 2·8), duration of operation >214 min (OR 2·8), and body mass index >29 (OR 2·6). The application of perioperative antibiotic prophylaxis was an independent protective factor (OR 0·2). Patients with certain risk factors for SSIs warrant special attention for infection prevention.
Children with long QT syndrome (LQTS) live with the risk of sudden death, activity restrictions, ... more Children with long QT syndrome (LQTS) live with the risk of sudden death, activity restrictions, and the need for daily medications. We sought to evaluate the quality of life (QOL), self-perception, and behavior of patients with LQTS as perceived by both patients and their parents and identify predictors of lower QOL. QOL (Pediatric QOL Inventory [PedsQL] and Pediatric Cardiac Quality of Life Inventory [PCQLI]), self-perception, and behavioral inventories were completed by patients with LQTS and their parents. Comparison of PedsQL scores was made to published data for healthy children using t tests, and PCQLI scores were compared with those of patients with differing complexity of congenital heart disease. Mixed modeling was used for multivariable analysis. Sixty-one patients with LQTS were evaluated (age 13.6 ± 3.0 years; male 49%). Compared with healthy children, the PedsQL Total, Psychosocial, and Physical Health Summary scores were significantly lower for patients with LQTS and parent proxy reports (p ≤0.001). In general, PCQLI scores of patients with LQTS and parents were similar to those of patients with tetralogy of Fallot (p ≥0.2), lower than those of patients with bicuspid aortic valve (p ≤0.02), and higher than those of patients with single ventricle (p ≤0.03). Lower patient and parent PCQLI scores were associated with internalizing problems. For parents, the presence of a cardiac device and medication side effects were additionally associated with lower PCQLI scores. In conclusion, patients with LQTS and their parents report lower QOL than normal children secondary to physical and psychosocial factors. Increasing focus on the psychological well-being of these patients is needed in an effort to improve their QOL.
Advancements in paediatric heart failure management have resulted in improved survival and a focu... more Advancements in paediatric heart failure management have resulted in improved survival and a focus on long-term outcomes including health-related quality of life. We compared health-related quality of life in children with heart failure with healthy patients, children with chronic conditions, and children with cardiovascular disease. Families (n=63) and children (n=73) aged 2-20 years with heart failure were enrolled and compared with data previously published for healthy patients (n=5480), those with chronic conditions (n=247), and those with cardiovascular disease (n=347). Patients and parents completed the PedsQL 4.0 and the Cardiac 3.0 Module health-related quality-of-life questionnaires. PedsQL scores including Total, Psychosocial Health Summary, and Physical were compared between groups. In general, patients with heart failure had lower scores than the healthy population (p=0.001), and comparable scores with those with chronic conditions. Parents perceived no difference in phy...
Purpose As our ability to diagnosis cardiac muscle disease or cardiomyopathy in children matures ... more Purpose As our ability to diagnosis cardiac muscle disease or cardiomyopathy in children matures and genetic testing becomes more widespread there has been a substantial increase in the pediatric cardiomyopathy population. The diagnosis will affect the patient and family perceptions of possible future morbidity and mortality as well as quality of life. The study’s aim was to evaluate health-related quality of life (HRQOL) and the self-perceptions in children with cardiomyopathy, as well as their caregivers, and compare to previously published data of normal children. Methods This study was a prospective study performed at The Heart Institute Cardiomyopathy and Advanced Heart Failure Clinic at Cincinnati Children’s Hospital Medical Center. Subjects were selected based on the clinical diagnosis of cardiomyopathy. HRQOL was assessed using the Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Core Scales (ages 2-18). Data regarding disease-specific medical information, health behaviors...
Purpose: Mortality rates in children with congenital heart disease (CHD) have fallen dramatically... more Purpose: Mortality rates in children with congenital heart disease (CHD) have fallen dramatically. Survivors are at risk for morbidities that may negatively affect their quality of life (QOL). To date, there has not been a comparison of QOL between a multi-site cohort of patients with CHD and a healthy control population. The purpose of this study was to compare patient and proxy reported QOL scores between a geographically diverse population of children and adolescents with CHD and a healthy control population. Methods: The Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) is a QOL measure for the pediatric population with proxy reporting that generates a Total score, a Physical Health Summary score (PhysHSS), and a Psychosocial Health Summary score (PsychHSS). An analysis was performed comparing PedsQL scores between a geographically diverse 7-site English-speaking CHD cohort from the Pediatric Cardiac Quality of Life Inventory (PCQLI) Testing Study with summary...
To examine the efficacy of counselor-assisted problem solving (CAPS) in improving long-term care... more To examine the efficacy of counselor-assisted problem solving (CAPS) in improving long-term caregiver psychological functioning following traumatic brain injury (TBI) in adolescents. METHODS: This randomized clinical trial compared CAPS (n = 65), a predominantly online problem-solving intervention, with an Internet resource comparison (n = 67) program. Families of adolescents with TBI completed a baseline assessment and follow-up assessments 6, 12, and 18 months later. General linear mixed models were used to examine longitudinal changes in caregiver global psychological distress, depressive symptoms, and caregiving self-efficacy. Family income and injury severity were examined as moderators of treatment efficacy. RESULTS: Family income moderated long-term changes in caregiver psychological distress. For lower-income caregivers, the CAPS intervention was associated with lower levels of psychological distress at 6, 12, and 18 months post baseline. CONCLUSIONS: These findings s...
The journal of the American Academy of Psychiatry and the Law, 2011
This study evaluated the Brief Rating of Aggression by Children and Adolescents-Preliminary Versi... more This study evaluated the Brief Rating of Aggression by Children and Adolescents-Preliminary Version (BRACHA 0.8), an actuarial method of assessing the risk of aggressive behavior by hospitalized children and adolescents. Licensed psychiatric social workers used a 16-item questionnaire to assess all patients seen in the emergency department (ED) of a major urban children's hospital. Over a six-month period, 418 patients (age range, 3.5-19.0 years) underwent psychiatric hospitalization after ED evaluation. The hospital nursing staff recorded the inpatients' behavior, with the Overt Aggression Scale (OAS). Inpatients were deemed aggressive if, during the first six days of their hospital stay, they scored one or higher on any OAS subscale. We evaluated questionnaire properties, items, and demographic covariates (e.g., age, sex, and living situation) by using factor analyses, logistic regression models, and receiver operating characteristic (ROC) methods. A total of 292 aggressiv...
Research suggests that pediatric TBI results in injury-related stress and burden and psychologica... more Research suggests that pediatric TBI results in injury-related stress and burden and psychological distress for parents. However, existing studies have focused almost exclusively on mothers, so that we know relatively little about the impact of childhood TBI on fathers. The aims were to prospectively examine differences in maternal and paternal response to early childhood TBI over time relative to a comparison cohort of mothers and fathers of children with orthopedic injuries (OI). The concurrent cohort/prospective research design involved repeated assessments of children aged 3-6 years with TBI or OI requiring hospitalization and their families. Shortly after injury and at 6, 12, and 18 months post injury, parents of 48 children with TBI (11 severe and 37 moderate) and 89 with OI completed standardized assessments of injury-related stress and burden, parental distress, and coping strategies. Mixed models analyses and Generalized Estimating Equations examined differences in maternal...
The study aimed to determine which acute injury variables were predictors of long-term functional... more The study aimed to determine which acute injury variables were predictors of long-term functional outcome following inflicted traumatic brain injury (iTBI). A retrospective case review of 35 children with iTBI was performed. After controlling for age at injury and time since injury, the generalized estimation equations method was used to identify acute injury variables that were significantly related to the Glasgow Outcome Scale scores at the initial follow-up assessments. When available, functional sequelae at these and longer-term follow-ups were also examined. In bivariate generalized estimation equations analyses, a low Glasgow Coma Scale (GCS) eye component score, a low GCS motor component score, a low GCS verbal component score, need for neurosurgical intervention, seizures in the first week after injury, need for mechanical ventilation for more than 10 days, length of intensive care unit stay of more than 10 days, initial hyperglycemia, and neuroimaging findings of cerebral edema or loss of gray-white matter differentiation were significantly (p ≤ 0.05) related to having a poor outcome, as defined by their Glasgow Outcome Scale score at the initial follow-up. In multivariable analyses, considering the significant predictors while controlling for age at injury and time since injury, the presence of cerebral edema on neuroimaging (odds ratio, 27.21; 95% confidence interval, 4.40-168.22), and length of intensive care unit stay of more than 10 days (odds ratio, 21.57; 95% confidence interval, 3.09-150.48) were significantly related to having a poor outcome. Early clinical data following iTBI help predict long-term functional outcome. Further research to support these findings may help delineate acutely after injury which children with iTBI are at risk for a poor prognosis and should be more closely followed up over time. Prognostic study, level IV.
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