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Hollier JM, Czyzewski DI, Self MM, Liu Y, Weidler EM, van Tilburg MA, Varni JW, Shulman RJ. Associations of Abdominal Pain and Psychosocial Distress Measures With Health-Related Quality-of-Life in Pediatric Healthy Controls and Irritable Bowel Syndrome. J Clin Gastroenterol 2021; 55:422-428. [PMID: 32554991 PMCID: PMC7738355 DOI: 10.1097/mcg.0000000000001373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children with irritable bowel syndrome (IBS) have lower health-related quality-of-life (HRQOL) than healthy controls (HC). Abdominal pain and psychosocial distress are negatively associated with HRQOL, although their relative effect is unclear. AIM The aim of this study was to compare the relative associations of abdominal pain and psychosocial distress with HRQOL in HC and IBS. STUDY Baseline abdominal pain, psychosocial distress, and HRQOL measures were obtained from HC and IBS pediatric clinical trial participants. Regression assessed which measures were most strongly associated with Physical and Psychosocial HRQOL separately by group. Interaction analyses examined group differences in the associations of abdominal pain and psychosocial distress with HRQOL. RESULTS Eight-five HC and 213 children with IBS participated. Somatization was most strongly associated with Physical HRQOL in HC, and functional disability was most strongly related in IBS. With respect to Psychosocial HRQOL, somatization was most strongly associated for both HC and IBS; depression was also significantly associated in HC. The strength of association between somatization and Physical HRQOL differed between groups; the negative association was less pronounced for IBS than HC. The association between functional disability and both Physical and Psychosocial HRQOL differed significantly between groups; the negative associations were more pronounced for IBS than HC. CONCLUSIONS Multiple psychosocial distress measures, including somatization, were associated with HRQOL in children with IBS; HRQOL in HC was driven consistently by somatization, to the exclusion of other psychosocial concerns. The associations of somatization and functional disability with HRQOL are distinctly different between HC and IBS. This knowledge supports utilization of psychosocial interventions to improve overall well-being for children with IBS.
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Affiliation(s)
- John M. Hollier
- Department of Pediatrics, Section of Gastroenterology,
Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas, United States
of America
- Texas Children’s Hospital, Houston, Texas, United
States of America
| | - Danita I. Czyzewski
- Texas Children’s Hospital, Houston, Texas, United
States of America
- Department of Pediatrics, Section of Psychology, Baylor
College of Medicine, Houston, Texas, United States of America
| | - Mariella M. Self
- Texas Children’s Hospital, Houston, Texas, United
States of America
- Department of Pediatrics, Section of Psychology, Baylor
College of Medicine, Houston, Texas, United States of America
| | - Yan Liu
- Department of Medicine, Section of Gastroenterology and
Hepatology, Baylor College of Medicine, Houston, Texas, United States of
America
| | - Erica M. Weidler
- Department of Pediatrics, Section of Gastroenterology,
Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas, United States
of America
- United States Department of Agriculture/Agricultural
Research Service Children’s Nutrition Research Center, Houston, Texas, United
States of America
| | - Miranda A.L. van Tilburg
- Department of Clinical Research, College of Pharmacy &
Health Sciences, Campbell University, Buies Creek, North Carolina, United States of
America
- Department of Medicine, University of North Carolina,
Chapel Hill, North Carolina, United States of America
- School of Social Work, University of Washington, Seattle,
Washington, United States of America
| | - James W. Varni
- Department of Pediatrics and Department of Landscape
Architecture and Urban Planning, Texas A&M University, College Station, Texas,
United States of America
| | - Robert J. Shulman
- Department of Pediatrics, Section of Gastroenterology,
Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas, United States
of America
- Texas Children’s Hospital, Houston, Texas, United
States of America
- United States Department of Agriculture/Agricultural
Research Service Children’s Nutrition Research Center, Houston, Texas, United
States of America
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Hollier JM, van Tilburg MA, Liu Y, Czyzewski DI, Self MM, Weidler EM, Heitkemper M, Shulman RJ. Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome. Neurogastroenterol Motil 2019; 31:e13509. [PMID: 30549152 PMCID: PMC6651721 DOI: 10.1111/nmo.13509] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety and depression are implicated as contributors to abdominal pain in pediatric irritable bowel syndrome (IBS) but is unclear if this pain is associated with other psychological factors. The study objective was to test if the impact of anxiety or depression on IBS symptom severity is mediated by somatization and/or pain catastrophizing. METHODS We utilized baseline data from local pediatric IBS clinical studies. Through mediation analysis, we assessed whether somatization or pain catastrophizing mediated (either independently or combined) the separate relationships of anxiety or depression with IBS abdominal pain severity. KEY RESULTS We analyzed 261 participants. All psychological factors were positively correlated with one another and IBS abdominal pain severity. The association of anxiety with IBS abdominal pain was mediated by both somatization and pain catastrophizing in individual analyses (each mediated standardized coefficient [β] 0.11, CI 0.05-0.18) and in multiple analysis (mediated standardized β 0.18, CI 0.09-0.27). The association of depression with IBS abdominal pain was also mediated by somatization (mediated standardized β 0.08, CI0.02-0.14) and pain catastrophizing (mediated standardized β 0.06, CI 0.01-0.11) in individual analyses and in multiple analysis (mediated standardized β 0.19, CI 0.04-0.19). CONCLUSIONS AND INFERENCES Somatization and pain catastrophizing mediate the relationships between anxiety/depression and IBS abdominal pain severity. These findings suggest that somatization and pain catastrophizing may be better treatment targets than anxiety and depression. Clinicians should assess these psychological factors in pediatric IBS patients and refer for intervention to improve outcomes.
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Affiliation(s)
- John M. Hollier
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,Texas Children’s Hospital, Houston, Texas, United States of America
| | - Miranda A.L. van Tilburg
- Department of Clinical Research, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina, United States of America,Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America,School of Social Work, University of Washington, Seattle, Washington, United States of America
| | - Yan Liu
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,Texas Children’s Hospital, Houston, Texas, United States of America
| | - Mariella M. Self
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,Texas Children’s Hospital, Houston, Texas, United States of America
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,United States Department of Agriculture/Agricultural Research Service, Children’s Nutrition Research Center, Houston, Texas, United States of America
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,Texas Children’s Hospital, Houston, Texas, United States of America,United States Department of Agriculture/Agricultural Research Service, Children’s Nutrition Research Center, Houston, Texas, United States of America
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Shulman RJ, Hollister EB, Cain K, Czyzewski DI, Self MM, Weidler EM, Devaraj S, Luna RA, Versalovic J, Heitkemper M. Psyllium Fiber Reduces Abdominal Pain in Children With Irritable Bowel Syndrome in a Randomized, Double-Blind Trial. Clin Gastroenterol Hepatol 2017; 15:712-719.e4. [PMID: 27080737 PMCID: PMC5064811 DOI: 10.1016/j.cgh.2016.03.045] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We sought to determine the efficacy of psyllium fiber treatment on abdominal pain and stool patterns in children with irritable bowel syndrome (IBS). We evaluated effects on breath hydrogen and methane production, gut permeability, and microbiome composition. We also investigated whether psychological characteristics of children or parents affected the response to treatment. METHODS We performed a randomized, double-blind trial of 103 children (mean age, 13 ± 3 y) with IBS seen at primary or tertiary care settings. After 2 weeks on their habitual diet, children began an 8-day diet excluding carbohydrates thought to cause symptoms of IBS. Children with ≥75% improvement in abdominal pain were excluded (n = 17). Children were assigned randomly to groups given psyllium (n = 37) or placebo (maltodextrin, n = 47) for 6 weeks. Two-week pain and stool diaries were compared at baseline and during the final 2 weeks of treatment. We assessed breath hydrogen and methane production, intestinal permeability, and the composition of the microbiome before and after administration of psyllium or placebo. Psychological characteristics of children were measured at baseline. RESULTS Children in the psyllium group had a greater reduction in the mean number of pain episodes than children in the placebo group (mean reduction of 8.2 ± 1.2 after receiving psyllium vs mean reduction of 4.1 ± 1.3 after receiving placebo; P = .03); the level of pain intensity did not differ between the groups. Psychological characteristics were not associated with response. At the end of the study period, the percentage of stools that were normal (Bristol scale scores, 3-5), breath hydrogen or methane production, intestinal permeability, and microbiome composition were similar between groups. CONCLUSIONS Psyllium fiber reduced the number of abdominal pain episodes in children with IBS, independent of psychological factors. Psyllium did not alter breath hydrogen or methane production, gut permeability, or microbiome composition. ClinicalTrials.gov no: NCT00526903.
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Affiliation(s)
- Robert J Shulman
- Department of Pediatrics, Baylor College of Medicine; Children's Nutrition Research Center; Texas Children's Hospital.
| | - Emily B Hollister
- Texas Children's Hospital; Texas Children's Microbiome Center; Department of Pathology and Immunology, Baylor College of Medicine; Department of Pathology, Texas Children's Hospital
| | - Kevin Cain
- Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle, Washington
| | - Danita I Czyzewski
- Texas Children's Hospital; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Mariella M Self
- Texas Children's Hospital; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Erica M Weidler
- Department of Pediatrics, Baylor College of Medicine; Children's Nutrition Research Center; Texas Children's Hospital
| | - Sridevi Devaraj
- Texas Children's Hospital; Texas Children's Microbiome Center; Department of Pathology and Immunology, Baylor College of Medicine; Department of Pathology, Texas Children's Hospital
| | - Ruth Ann Luna
- Texas Children's Hospital; Texas Children's Microbiome Center; Department of Pathology and Immunology, Baylor College of Medicine; Department of Pathology, Texas Children's Hospital
| | - James Versalovic
- Texas Children's Hospital; Texas Children's Microbiome Center; Department of Pathology and Immunology, Baylor College of Medicine; Department of Pathology, Texas Children's Hospital
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
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Weidler EM, Self MM, Czyzewski DI, Shulman RJ, Chumpitazi BP. Stooling Characteristics in Children With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2017; 15:140-141. [PMID: 27567692 PMCID: PMC5161651 DOI: 10.1016/j.cgh.2016.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 02/07/2023]
Affiliation(s)
- EM Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
,Children’s Nutrition Research Center, Houston, TX, USA
| | - MM Self
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
,Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX USA
| | - DI Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
,Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX USA
| | - RJ Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
,Children’s Nutrition Research Center, Houston, TX, USA
| | - BP Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
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5
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Abstract
OBJECTIVES A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report). METHODS Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency. RESULTS Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. CONCLUSIONS The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.
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Affiliation(s)
- Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
| | - Mariella M. Self
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
| | - Amy E. Williams
- Indiana University School of Medicine & Riley Child and Adolescent Psychiatry Clinic, Indianapolis, Indiana
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
- Children’s Nutrition Research Center, Houston, Texas
| | - Allison M. Blatz
- George Washington School of Medicine and Health Sciences, Washington, D.C
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
- Children’s Nutrition Research Center, Houston, Texas
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Chumpitazi BP, Self MM, Czyzewski DI, Cejka S, Swank PR, Shulman RJ. Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations. Neurogastroenterol Motil 2016; 28:443-8. [PMID: 26690980 PMCID: PMC4760857 DOI: 10.1111/nmo.12738] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rater reproducibility of the Bristol Stool Form Scale (BSFS), which categorizes stools into one of seven types, is unknown. We sought to determine reliability and agreement by individual stool type and when responses are categorized by Rome III clinical designation as normal or abnormal (constipation or diarrhea). METHODS Thirty-four gastroenterology providers from three institutions rated 35 stool photographs using the BSFS. Twenty rerated the photographs. KEY RESULTS 1190 individual stool type ratings were completed. Though only four photographs had absolute agreement (all Type 1 or Type 7), general agreement was high with 1132 (95.1%) of ratings being within one category type of the modal rating. Inter-rater and intra-rater reliability of the BSFS by individual stool type was excellent with intraclass correlations of 0.88 (95% CI: 0.86-0.90, p < 0.001) and 0.89 (95% CI: 0.86-0.91, p < 0.001), respectively. However, agreement decreased when using Rome III designations with 13 (37%) photographs having significantly diverging classifications (semi-interquartile range = 0.5). These 13 photographs were rated by the majority of raters as either type 2 vs type 3 or type 5 vs type 6 stools, representing the boundaries of normal vs abnormal stools. Inter-rater and intra-rater reliability of the BSFS by Rome III clinical categorization decreased with intraclass correlations of 0.75 (95% CI: 0.69-0.81, p < 0.001) and 0.65 (95% CI: 0.49-0.81, p < 0.001), respectively. CONCLUSIONS & INFERENCES The Bristol Stool Form Scale has excellent reliability and agreement when used to rate individual stool type by raters. However, BSFS reliability and agreement decreases when determining Rome III stool form categories.
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Affiliation(s)
- Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Section of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX
| | - Mariella M. Self
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Section of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX
| | - Sydney Cejka
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Paul R. Swank
- University of Texas School of Public Health, Houston, TX
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Section of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX,Children’s Nutrition Research Center, Houston, TX
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7
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Self MM, Williams AE, Czyzewski DI, Weidler EM, Shulman RJ. Agreement between prospective diary data and retrospective questionnaire report of abdominal pain and stooling symptoms in children with irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:1110-9. [PMID: 26017930 PMCID: PMC4545505 DOI: 10.1111/nmo.12590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/17/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND In functional gastrointestinal disorders, patient recall of symptoms drives diagnostic decisions and evaluation of treatment response, and research conclusions about potential treatments. In pediatrics, parent report also impacts assessment and care. Hence, identifying methods for accurately capturing patient and parent report of irritable bowel syndrome (IBS) symptoms is important. This study evaluated correspondence between retrospective questionnaire (parent and child report) and prospective diary data for children and adolescents with IBS. METHODS Participants included 50 children/adolescents with IBS per Rome III criteria. Children completed a 2-week pain and stool diary. Children and parents subsequently completed a 2-week recall questionnaire, reporting number of pain days, maximum pain, days without bowel movement, and days with diarrhea during the diary interval. Intraclass correlation coefficients and Bland-Altman plots assessed agreement. KEY RESULTS For pain and days without bowel movement, overall agreement between child recall questionnaire and child diary was strong, although under conditions likely to facilitate agreement and with individual variation observed. Parent recall and child diary were less concordant, and agreement about diarrhea was poor for parent and child. Age did not significantly correlate with agreement. CONCLUSIONS & INFERENCES Child questionnaire with short recall interval may be a reasonable approximation for diary data, although this varies by individual and replication/investigation of lengthier recall are needed. Relying on parent questionnaire does not appear a suitable proxy, and recall of stool form by both parent and child appears more problematic. These results combined with existing literature support use of diary data whenever possible.
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Affiliation(s)
- Mariella M. Self
- Department of Pediatrics, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas,Texas Children’s Hospital, Houston, Texas
| | - Amy E. Williams
- Department of Psychiatry, Indiana University School of Medicine; Psychiatry & Behavioral Sciences, Riley Hospital for Children, Houston, Texas
| | - Danita I. Czyzewski
- Department of Pediatrics, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas,Texas Children’s Hospital, Houston, Texas
| | - Erica M. Weidler
- Department of Pediatrics, Houston, Texas,Texas Children’s Hospital, Houston, Texas,Children’s Nutrition Research Center, Houston, Texas
| | - Robert J. Shulman
- Department of Pediatrics, Houston, Texas,Texas Children’s Hospital, Houston, Texas,Children’s Nutrition Research Center, Houston, Texas
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8
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Self MM, Czyzewski DI, Chumpitazi BP, Weidler EM, Shulman RJ. Subtypes of irritable bowel syndrome in children and adolescents. Clin Gastroenterol Hepatol 2014; 12:1468-73. [PMID: 24486406 PMCID: PMC4428553 DOI: 10.1016/j.cgh.2014.01.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 12/20/2013] [Accepted: 01/07/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Pharmacologic treatments for irritable bowel syndrome (IBS) and medical management of symptoms are increasingly based on IBS subtype, so it is important to accurately differentiate patients. Few studies have classified subtypes of pediatric IBS, and conclusions have been challenged by methodologic limitations. We performed a prospective study to investigate the distribution of IBS subtypes among children and adolescents based on stool diary information, and compared subtypes according to demographic and pain characteristics. METHODS We studied 129 subjects, ages 7 to 18 years (mean age, 11.4 ± 2.8 y; 60.5% female; 69.0% white) who met Pediatric Rome III IBS criteria and were part of larger studies of children with functional gastrointestinal disorders, recruited from primary and tertiary care centers. Children completed daily pain and stool diaries for 2 weeks. Participants were assigned IBS subtypes based on their reported stool information per adult Rome III criteria. IBS subtypes were compared for demographic variables and pain characteristics. RESULTS IBS with constipation was the most common subtype of the disorder (58.1% of subjects), whereas mixed IBS was the least common (2.3% of subjects); 34.1% of subjects were unsubtyped IBS and 5.4% had IBS with diarrhea. The groups of different IBS subtypes did not differ significantly by sex, age, ethnicity, or pain characteristics. CONCLUSIONS In contrast to adults, in children, IBS with constipation and unsubtyped IBS are the most common subtypes, whereas IBS with diarrhea and mixed IBS are less common. Demographic and pain characteristics cannot distinguish subtypes.
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Affiliation(s)
- Mariella M. Self
- Baylor College of Medicine Menninger Department of Psychiatry and Behavioral Sciences,Department of Pediatrics, Houston, Texas,Texas Children's Hospital, Houston, Texas
| | - Danita I. Czyzewski
- Baylor College of Medicine Menninger Department of Psychiatry and Behavioral Sciences,Department of Pediatrics, Houston, Texas,Texas Children's Hospital, Houston, Texas
| | - Bruno P. Chumpitazi
- Department of Pediatrics, Houston, Texas,Texas Children's Hospital, Houston, Texas
| | - Erica M. Weidler
- Department of Pediatrics, Houston, Texas,Texas Children's Hospital, Houston, Texas,USDA/ARS Children's Nutrition Research Center, Houston, Texas
| | - Robert J. Shulman
- Department of Pediatrics, Houston, Texas,Texas Children's Hospital, Houston, Texas,USDA/ARS Children's Nutrition Research Center, Houston, Texas
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9
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Williams AE, Czyzewski DI, Self MM, Shulman RJ. Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders? J Health Psychol 2013; 20:369-79. [PMID: 24155191 DOI: 10.1177/1359105313502564] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This study investigated individual and incremental contributions of somatization and trait anxiety to pain report in children with pain-related functional gastrointestinal disorders. Eighty children (7-10 years) with pain-related functional gastrointestinal disorders completed the State-Trait Anxiety Inventory for Children, the Children's Somatization Inventory, and 2-week pain diaries (assessing pain frequency and maximum pain). Hierarchical regressions indicated that both trait anxiety and somatization were significantly related to maximum pain and pain frequency, with somatization explaining more variance. Trait anxiety did not significantly add to prediction above somatization. Assessment of somatization may assist with treatment planning for children with functional abdominal pain.
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Affiliation(s)
| | | | - Mariella M Self
- Baylor College of Medicine, USA Texas Children's Hospital, USA
| | - Robert J Shulman
- Baylor College of Medicine, USA Texas Children's Hospital, USA Children's Nutrition Research Center, USA
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10
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Williams AE, Heitkemper M, Self MM, Czyzewski DI, Shulman RJ. Endogenous inhibition of somatic pain is impaired in girls with irritable bowel syndrome compared with healthy girls. J Pain 2013; 14:921-30. [PMID: 23685184 DOI: 10.1016/j.jpain.2013.03.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/27/2013] [Accepted: 03/11/2013] [Indexed: 12/17/2022]
Abstract
UNLABELLED Endogenous pain inhibition is often deficient in adults with chronic pain conditions including irritable bowel syndrome (IBS). It is unclear whether deficiencies in pain inhibition are present in young children with IBS. The present study compared endogenous pain inhibition, somatic pain threshold, and psychosocial distress in young girls with IBS versus controls. Girls with IBS did not show significant endogenous pain inhibition of heat pain threshold during a cold-pressor task in contrast to controls, who had significant pain inhibition. Girls with IBS did not differ from peers on measures of somatic pain but had more symptoms of depression, somatization, and anxiety than controls. When psychological variables were included as covariates, the difference in pain inhibition was no longer significant, although poor achieved power limits interpretation of these results. Higher-order cognitive processes including psychological variables may be contributing to observed pain inhibition. In girls with IBS, pain inhibition was positively related to the number of days without a bowel movement. To our knowledge, this is the first study to demonstrate deficiencies of endogenous pain inhibition in young children with IBS. Findings have implications for better understanding of onset and maintenance of IBS and other chronic pain conditions. PERSPECTIVE This study found that young girls with IBS have deficient endogenous pain inhibition compared to healthy girls, which is consistent with the literature on adults. This information can facilitate clinicians in identification of risk factors for onset/maintenance of IBS and other chronic pain conditions.
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Affiliation(s)
- Amy E Williams
- Department of Psychiatry & Behavioral Neurosciences, Loyola University Medical Center, Maywood, Illinois.
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Lane MM, Czyzewski DI, Chumpitazi BP, Shulman RJ. Reliability and validity of a modified Bristol Stool Form Scale for children. J Pediatr 2011; 159:437-441.e1. [PMID: 21489557 PMCID: PMC3741451 DOI: 10.1016/j.jpeds.2011.03.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 02/04/2011] [Accepted: 03/01/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to: evaluate the ability of children to reliably use a modified Bristol Stool Form Scale for Children (mBSFS-C), evaluate criterion-related validity of the mBSFS-C, and identify the lower age limit for mBSFS-C use. STUDY DESIGN The mBSFS-C comprises 5 stool form types described and depicted in drawings. Children 3 to 18 years old rated stool form for 10 stool photographs. Because of low reliability when stool form descriptors were not read aloud (n = 119), a subsequent sample of children (n = 191) rated photographs with descriptors read. RESULTS Intraclass correlation coefficients for descriptor-unread versus -read samples were 0.62 and 0.79, respectively. Children were increasingly reliable with age. Percentage of correct ratings varied with stool form type, but generally increased with age. With descriptors unread, children 8 years and older demonstrated acceptable interobserver reliability, with >78% of ratings correct. With descriptors read, children 6 years and older demonstrated acceptable reliability, with >80% of ratings correct. CONCLUSIONS The mBSFS-C is reliable and valid for use by children, with age 6 years being the lower limit for scale use with descriptors read and age 8 years being the lower limit without descriptors read. We anticipate that the mBSFS-C can be effectively used in pediatric clinical and research settings.
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Affiliation(s)
- Mariella M. Lane
- Baylor College of Medicine Menninger Department of Psychiatry and Behavioral Sciences, Houston, Texas, Texas Children’s Hospital, Houston, Texas
| | - Danita I. Czyzewski
- Baylor College of Medicine Menninger Department of Psychiatry and Behavioral Sciences, Houston, Texas, Department of Pediatrics, Houston, Texas, Texas Children’s Hospital, Houston, Texas
| | - Bruno P. Chumpitazi
- Department of Pediatrics, Houston, Texas, Texas Children’s Hospital, Houston, Texas
| | - Robert J. Shulman
- Department of Pediatrics, Houston, Texas, Texas Children’s Hospital, Houston, Texas, USDA/ARS Children’s Nutrition Research Center, Houston, Texas
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Chumpitazi BP, Lane MM, Czyzewski DI, Weidler EM, Swank PR, Shulman RJ. Creation and initial evaluation of a Stool Form Scale for children. J Pediatr 2010; 157:594-7. [PMID: 20826285 PMCID: PMC2937014 DOI: 10.1016/j.jpeds.2010.04.040] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/01/2010] [Accepted: 04/23/2010] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To develop a pediatric stool form rating scale and determine its interrater reliability, intrarater reliability, and agreement among pediatric gastroenterologists. STUDY DESIGN An ordinal stool scale with 5 categorical stool form types was created on the basis of the Bristol Stool Form Scale, and 32 color 2-dimensional stool photographs were shown to 14 pediatric gastroenterologists. Each gastroenterologist rated the stool form depicted in each photograph with the modified stool scale. Ten gastroenterologists agreed to rerate the stool form depicted in each photograph a minimum of 6 months after the first rating. RESULTS A total of 448 ratings were completed; 430 (94%) of all ratings were within at least 1 category type of the most common (modal) rating for each photograph. Eight (25%) stool photographs had complete agreement among all raters. Interrater and intrarater reliability was high with a single measure intraclass correlation of 0.85 (95% confidence interval: 0.78-0.91; P<.001) and 0.87 (95% confidence interval: 0.81-0.92; P<.001), respectively. CONCLUSION A modified pediatric Bristol Stool Form Scale provided a high degree of interrater reliability, intrarater reliability, and agreement among pediatric gastroenterologists.
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Affiliation(s)
- Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine,Texas Children’s Hospital, University of Texas Health Science Center- Houston
| | - Mariella M. Lane
- Department of Pediatrics, Baylor College of Medicine,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,Texas Children’s Hospital, University of Texas Health Science Center- Houston
| | - Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,Texas Children’s Hospital, University of Texas Health Science Center- Houston
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine,Texas Children’s Hospital, University of Texas Health Science Center- Houston,Children’s Nutrition Research Center, Houston, Texas
| | - Paul R. Swank
- Children’s Learning Institute, University of Texas Health Science Center- Houston
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine,Texas Children’s Hospital, University of Texas Health Science Center- Houston,Children’s Nutrition Research Center, Houston, Texas
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Lane MM, Dalton WT, Sherman SA, Bree AF, Czyzewski DI. Psychosocial functioning and quality of life in children and families affected by AEC syndrome. Am J Med Genet A 2010; 149A:1926-34. [PMID: 19504609 DOI: 10.1002/ajmg.a.32835] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ankyloblepharon-ectodermal defects-cleft lip/palate (AEC) syndrome, also known as Hay-Wells syndrome, is a rare genetic condition that results in abnormalities of the skin, hair, nails, and teeth and requires frequent self-management and medical care. We sought to describe the psychological adjustment and quality of life in children and adolescents with AEC syndrome, as well as the impact of the child's illness on their families. The sample included 18 children and adolescents with AEC syndrome and their parents who attended the International Research Symposium on AEC syndrome. Parents completed standardized self-report questionnaires about child and family functioning and participated in a semi-structured interview about the child's cognitive and social functioning and the impact of AEC syndrome on the child and family. Children completed standardized self-report questionnaires of psychosocial functioning and quality of life. Overall, results reflected a range of functioning across children and families, with some families reporting few ill effects of the condition and others describing reduced quality of life and negative impact on child and family. Identifying the domains that may be impacted should help clinicians better screen for problems in functioning of children affected by AEC syndrome and their families.
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Affiliation(s)
- Mariella M Lane
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Psychiatry and Psychology Service, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030-2399, USA.
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Lane MM, Weidler EM, Czyzewski DI, Shulman RJ. Pain symptoms and stooling patterns do not drive diagnostic costs for children with functional abdominal pain and irritable bowel syndrome in primary or tertiary care. Pediatrics 2009; 123:758-64. [PMID: 19254999 PMCID: PMC2821591 DOI: 10.1542/peds.2008-0227] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for the children in primary versus tertiary care, and (3) examine if symptom characteristics predicted the cost of medical evaluation. METHODS Eighty-nine children aged 7 to 10 years with functional abdominal pain or irritable bowel syndrome seen by a gastroenterologist (n = 46) or seen only by a pediatrician (n = 43) completed daily pain and stool diaries for 2 weeks. Mothers provided retrospective reports of their children's symptoms in the previous year. Cost of medical evaluation was calculated via chart review of diagnostic tests and application of prices as if the patients were self-pay. RESULTS Child-reported diary data reflected no significant group differences with respect to pain, interference with activities, or stool characteristics. In contrast, mothers of children evaluated by a gastroenterologist viewed their children as having higher maximum pain intensity in the previous year. Excluding endoscopy costs, cost of medical evaluation was fivefold higher for children evaluated by a gastroenterologist, with higher cost across blood work, stool studies, breath testing, and diagnostic imaging. Symptom characteristics did not predict cost of care for either group. CONCLUSIONS Despite the lack of difference in symptom characteristics between children in primary and tertiary care, a notable differential in cost of evaluation exists in accordance with level of care. Symptom characteristics do not seem to drive diagnostic evaluation in either primary or tertiary care. Given the lack of differences in child-reported symptoms and the maternal perspective that children evaluated by a gastroenterologist had more severe pain, we speculate that parent perception of child symptoms may be a primary factor in seeking tertiary care.
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Affiliation(s)
- Mariella M. Lane
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas,Psychiatry and Psychology Service, Texas Children’s Hospital, Houston, Texas
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas,Department of Gastroenterology, Texas Children’s Hospital, Houston, Texas,US Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center, Houston, Texas
| | - Danita I. Czyzewski
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas,Psychiatry and Psychology Service, Texas Children’s Hospital, Houston, Texas,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas,Department of Gastroenterology, Texas Children’s Hospital, Houston, Texas,US Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center, Houston, Texas
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Shulman RJ, Eakin MN, Czyzewski DI, Jarrett M, Ou CN. Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and irritable bowel syndrome. J Pediatr 2008; 153:646-50. [PMID: 18538790 PMCID: PMC2614282 DOI: 10.1016/j.jpeds.2008.04.062] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 04/03/2008] [Accepted: 04/24/2008] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine gastrointestinal (GI) permeability and fecal calprotectin concentration in children 7 to 10 years of age with functional abdominal pain and irritable bowel syndrome (FAP/IBS) versus control subjects and ascertain potential relationships with pain symptoms and stooling. STUDY DESIGN GI permeability and fecal calprotectin concentration were measured. Children kept a 2-week diary of pain episodes and stooling pattern. RESULTS Proximal GI permeability was greater in the FAP/IBS group (n = 93) compared with control subjects (n = 52) (0.59 +/- 0.50 vs 0.36 +/- 0.26, respectively; mean +/- SD; P < .001) as was colonic permeability (1.01 +/- 0.67 vs 0.81 +/- 0.43, respectively; P < .05). Gastric and small intestinal permeability were similar. Fecal calprotectin concentration was greater in children with FAP/IBS compared with control children (65.5 +/- 75.4 microg/g stool vs 43.2 +/- 39.4, respectively; P < .01). Fecal calprotectin concentration correlated with pain interference with activities (P = .01, r(2) = 0.36). There was no correlation between GI permeability and pain related symptoms. Neither permeability nor fecal calprotectin correlated with stool form. CONCLUSIONS Children with FAP/IBS have evidence of increased GI permeability and low-grade GI inflammation, with the latter relating to the degree to which pain interferes with activities.
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Affiliation(s)
- Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Wilmington, DE,Children’s Nutrition Research Center, Wilmington, DE
| | | | - Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Wilmington, DE
| | - Monica Jarrett
- Menninger Department of Psychiatry and Behavioral Sciences, University of Washington, Department of Biobehavioral Nursing and Health Systems, Seattle, Washington
| | - Ching-Nan Ou
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Wilmington, DE
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Czyzewski DI, Eakin MN, Lane MM, Jarrett M, Shulman RJ, M D. Recurrent Abdominal Pain in Primary and Tertiary Care: Differences and Similarities. Child Health Care 2007; 36:137-153. [PMID: 20357915 DOI: 10.1080/02739610701334970] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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17
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Shegog R, Bartholomew LK, Sockrider MM, Czyzewski DI, Pilney S, Mullen PD, Abramson SL. Computer-based decision support for pediatric asthma management: description and feasibility of the Stop Asthma Clinical System. Health Informatics J 2007; 12:259-73. [PMID: 17092998 DOI: 10.1177/1460458206069761] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical guidelines can assist in the management of asthma. Decision support systems (DSSs) can enhance adherence to clinical guidelines but tend not to provide clinicians with cues for behavioral change strategies to promote patient self-management. The Stop Asthma Clinical System (SACS) is a DSS designed for this purpose. To assess feasibility, seven clinicians used SACS to guide well visits with 26 predominantly persistent pediatric asthma patients. Data were collected via survey and in-depth semi-structured interviews. SACS improved assessment of asthma severity and control, classification of and intervention in medicine and environmental trigger management problems, and development of an action plan (all p < 0.05). Clinician-patient communication was enhanced. The primary challenge was that SACS increased clinic visit time. SACS can enhance clinician behavior to improve patient asthma self-management, but more studies are indicated to mitigate temporal constraints and evaluate impact on clinician and patient communication and behavior as well as clinical outcomes.
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Affiliation(s)
- Ross Shegog
- Center for Health Promotion and Prevention Research, UT-School of Public Health, 7000 Fannin, Suite 2668, Houston, TX 77030, USA.
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Abstract
OBJECTIVE To collect symptom data longitudinally from children with recurrent abdominal pain (RAP) and control (asymptomatic) children. PATIENTS AND METHODS Children with RAP (n = 77) and controls (n = 33) 7 to 10 years of age completed daily diaries for 2 weeks tracking pain frequency and severity, how often the pain interfered with activities, and stooling pattern. RESULTS RAP children reported a greater number of pain episodes and greater pain severity than control children. Pain commonly was reported to be in the periumbilical area and occurred evenly across the day in both groups. However, the pain interfered with activity more often in the RAP group. There was a positive relationship between pain and interference with activities. Both groups reported stool changes, but there were no differences between groups in stool character (eg, hard, mushy). For both groups, the presence of watery stool was related positively to pain. Of children with RAP, 65% could be categorized as having irritable bowel syndrome, whereas 35% were classifiable as having functional abdominal pain according to the pediatric Rome II criteria. CONCLUSIONS To the best of our knowledge, this is the first longitudinal report of symptoms in children with RAP compared with controls. These data demonstrate that there is considerable overlap between children with RAP and control children on a number of items commonly obtained in the history (eg, pain location, timing, stooling pattern). Most children with RAP could be characterized as having irritable bowel syndrome. The relationship between pain reports and interference with activities substantiates the need to deal specifically with the abdominal pain to decrease disability. The relationship between pain and watery stools requires further study.
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Affiliation(s)
- Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Children’s Nutrition Research Center, Houston, Texas
| | | | - Monica Jarrett
- University of Washington, Department of Biobehavioral Nursing, Seattle, Washington
| | - Danita I. Czyzewski
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Lonnie K. Zeltzer
- David Geffen School of Medicine at UCLA, Departments of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences, Los Angeles, California
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19
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Bartholomew LK, Sockrider M, Abramson SL, Swank PR, Czyzewski DI, Tortolero SR, Markham CM, Fernandez ME, Shegog R, Tyrrell S. Partners in school asthma management: evaluation of a self-management program for children with asthma. J Sch Health 2006; 76:283-90. [PMID: 16918856 DOI: 10.1111/j.1746-1561.2006.00113.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The "Partners in School Asthma Management" program for inner-city elementary school children comprises (1) case finding; (2) linkage of school nurses, parents, and clinicians; (3) a computer-based tailored educational program; and (4) school environmental assessment and intervention. Case finding identified 1730 children in 60 elementary schools with probable asthma; 835 (96% Hispanic or African American) joined the study. Baseline, posttest, and follow-up measures of asthma knowledge, self-efficacy, and self-management behavior were obtained from the children, and data on symptoms, emergency department visits, and hospitalizations were obtained from their parents. The schools provided data on grades and absences. Each school had a baseline and follow-up environmental assessment. The children in the intervention group showed greater increases in knowledge, self-efficacy, and some aspects of self-management. No differences between groups were found in health status variables, school performance, attendance, or levels of environmental allergens in schools. In 15 schools, an enhanced intervention allowed children and their parents to meet with a project physician, develop an asthma action plan, and receive a 1-month supply of medication; the project physician then followed up with the child's community physician. Children participating in this enhanced intervention had better school performance and fewer absences than the comparison group. Overall, the program was effective in improving children's asthma self-management but not in improving their health status. While the case-finding, computer-based self-management training program and linkage system were successfully implemented, the program failed in creating needed changes in the medical (action plans by community physicians) and physical environments (reduced school allergen levels) of the children.
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Affiliation(s)
- L Kay Bartholomew
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, 7000 Fannin, 25th Floor, Houston, TX 77030, USA.
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20
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Shegog R, Bartholomew LK, Czyzewski DI, Sockrider MM, Craver J, Pilney S, Mullen PD, Koeppl P, Gold RS, Fernandez M, Abramson SL. Development of an expert system knowledge base: a novel approach to promote guideline congruent asthma care. J Asthma 2004; 41:385-402. [PMID: 15281325 DOI: 10.1081/jas-120026098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Existing guidelines for the clinical management of asthma provide a good framework for such tasks as diagnosing asthma, determining severity, and prescribing pharmacological treatment. Guidance is less explicit, however, about establishing a patient-provider partnership and overcoming barriers to asthma management by patients in a way that can be easily adopted in clinical practice. We report herein the first developmental phase of the "Stop Asthma" expert system. We describe the establishment of a knowledge base related to both the clinical management of asthma and the enhancement of patient and family self-management (including environmental management). The resultant knowledge base comprises 142 multilayered decision rules that describe clinical and behavioral management in three domains: 1) determination of asthma severity and control; 2) pharmacotherapy, including prescription of medicine for chronic maintenance, acute exacerbation, exercise pretreatment, and rhinitis relief; and 3) patient self-management, including the process of intervening to facilitate the patient's asthma medication management, environmental control, and well-visit scheduling. The knowledge base provides a systematic and accessible approach for intervening with family asthma-related behaviors.
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Affiliation(s)
- R Shegog
- University of Texas, Houston, Texas 77225, USA.
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Abstract
ISSUES AND PURPOSE Review the etiology and pathophysiology of recurrent abdominal pain (RAP) and its potential role as a precursor to irritable bowel syndrome (IBS) in adults. CONCLUSIONS Physiological mechanisms not easily identifiable as an organic cause may underlie symptoms in RAP patients. They may be triggered by psychosocial factors that result in greater functional disability, more clinic visits, and lower academic and social competence. Of these children, 25% will experience similar symptoms as adults; many will be diagnosed with IBS. PRACTICE IMPLICATIONS Nurses can provide early and efficient management of these children's care if they view the issues of abdominal pain/discomfort from a broader focus that includes the context of the child's experiences.
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Affiliation(s)
- Monica Jarrett
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, USA.
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Abramson SL, Shegog R, Bartholomew LK, Sockrider MM, Mullen PD, Craver J, Pilney S, Koeppl P, Czyzewski DI, Gold RS. The “Stop Asthma” Clinical System: A novel computer-based decision-support program to enhance implementation of pediatric asthma management guidelines and promote communication skills. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)82095-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bartholomew LK, Shegog R, Parcel GS, Gold RS, Fernandez M, Czyzewski DI, Sockrider MM, Berlin N. Watch, Discover, Think, and Act: a model for patient education program development. Patient Educ Couns 2000; 39:253-268. [PMID: 11040725 DOI: 10.1016/s0738-3991(99)00045-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this report we describe the development of the Watch, Discover, Think and Act asthma self-management computer program for inner-city children with asthma. The intervention focused on teaching two categories of behaviors--asthma specific behaviors such as taking preventive medication and self-regulatory processes such as monitoring symptoms and solving asthma problems. These asthma self-management behaviors were then linked with empirical and theoretical determinants such as skills and self-efficacy. We then further used behavioral science theory to develop methods such as role modeling and skill training linked to the determinants. We matched these theoretical methods to practical strategies within the computer simulation and created a culturally competent program for inner-city minority youth. Finally, we planned a program evaluation that linked program impact and outcomes to the theoretical assumptions on which the intervention was based.
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Affiliation(s)
- L K Bartholomew
- Center for Health Promotion Research and Development, University of Texas Health Science Center at Houston 77225, USA.
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24
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Bartholomew LK, Gold RS, Parcel GS, Czyzewski DI, Sockrider MM, Fernandez M, Shegog R, Swank P. Watch, Discover, Think, and Act: evaluation of computer-assisted instruction to improve asthma self-management in inner-city children. Patient Educ Couns 2000; 39:269-280. [PMID: 11040726 DOI: 10.1016/s0738-3991(99)00046-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
An interactive multimedia computer game to enhance self-management skills and thereby improve asthma outcomes in inner city children with asthma was evaluated. Subjects aged 6-17 were recruited from four pediatric practices and randomly assigned to the computer intervention condition or to the usual-care comparison. The main character in the game could match the subject on gender and ethnicity. Characteristics of the protagonist's asthma were tailored to be like those of the subject. Subjects played the computer game as part of regular asthma visits. Time between pre- and post-test varied from 4 to 15.6 months (mean, 7.6 months). Analysis of covariance, with pre-test scores, age, and asthma severity as covariates, found that the intervention was associated with fewer hospitalizations, better symptom scores, increased functional status, greater knowledge of asthma management, and better child self-management behavior for those in the intervention condition. Interactions with covariates were found and discussed in terms of variable efficacy of the intervention.
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Affiliation(s)
- L K Bartholomew
- Center for Helath Promotion Research and Development, University of Texas Health Science Center at Houston 77225, USA.
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Perry BD, Czyzewski DI, Lopez MA, Spiller LC, Treadwell-Deering D. Neuropsychologic impact of facial deformities in children. Neurodevelopmental role of the face in communication and bonding. Clin Plast Surg 1998; 25:587-97, ix. [PMID: 9917978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The face is the primary tool of human communication. In early childhood, the face plays a crucial role in bonding and attachment. Severe craniofacial problems may alter bonding and attachment, thereby resulting in future risk for emotional, behavioral, and social problems. Clinical and research findings, while incomplete, suggest that this is the case. This conceptual understanding of the key role of face-to-face communication in early childhood provides a compelling rationale for early repair of craniofacial deformations.
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Affiliation(s)
- B D Perry
- CIVITAS Child Trauma Program, Baylor College of Medicine, Houston, Texas, USA.
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27
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Montagnino B, Czyzewski DI, Runyan RD, Berkman S, Roth DR, Gonzales ET. Long-term adjustment issues in patients with exstrophy. J Urol 1998; 160:1471-4. [PMID: 9751396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE We explored the psychological adjustment of children with bladder or cloacal exstrophy. MATERIALS AND METHODS We assessed 29 subjects with a mean age plus or minus standard deviation of 7.8 +/- 3.97 years using age appropriate standard psychological instruments. Psychological adjustment scores in the exstrophy group were compared to the norms of the various instruments. Subjects were divided into dichotomous groups according to several medical and demographic factors. For each factor the differences between the means of the 2 groups on the outcome variables were calculated using a t test. RESULTS Children with exstrophy perceived their appearance more positively than the norm. Older children performed more poorly than younger children in adaptive behavior, specifically in skills related to functioning in school. Children who achieved continence after age 4 years were more likely to have problems with acting out behavior. There were no differences in adjustment in boys versus girls, bladder versus cloacal exstrophy, type of continence strategy or gender reassignment versus no reassignment. CONCLUSIONS Children with exstrophy did not have clinical psychopathology. Differences existed in adaptive and acting out behavior rather than depression or anxiety, suggesting that improved outcomes may be achieved through a focus on normal adaptation rather than on potential psychological distress.
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Affiliation(s)
- B Montagnino
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA
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Abstract
The role of psychological factors in certain dermatological conditions is not disputed; however, these processes have been much more thoroughly explored in adult populations than in pediatric populations. Therefore, this article reviews relevant adult and child studies. This article explores three aspects of psychological functioning as they relate to dermatological conditions and their treatment, specifically stress and emotional regulation, behavioral and environmental issues, and compliance. The goal of this article is to give the practicing dermatologist a working overview of psychological factors in pediatric skin disease which will facilitate good communication with families around these issues and referral for adjunctive psychological treatment as needed.
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Affiliation(s)
- D I Czyzewski
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
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Bartholomew LK, Czyzewski DI, Parcel GS, Swank PR, Sockrider MM, Mariotto MJ, Schidlow DV, Fink RJ, Seilheimer DK. Self-management of cystic fibrosis: short-term outcomes of the Cystic Fibrosis Family Education Program. Health Educ Behav 1997; 24:652-66. [PMID: 9307900 DOI: 10.1177/109019819702400511] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study tested the efficacy of the Cystic Fibrosis Family Education Program, a cystic fibrosis self-management program, on improving participants' knowledge, self-efficacy, self-management behavior, health, and quality of life. A quasi-experimental pretest-posttest nonequivalent comparison group design was employed. Participants made up 104 patient-primary caregiver dyads from the intervention site cystic fibrosis center and 95 from the usual care comparison center. The intervention, a self-paced print curriculum based on social cognitive theory, targeted behavioral capability, self-efficacy, and outcome expectations and was implemented as an integral part of medical care. Parents, early childhood, middle childhood, and adolescents received separate materials on respiratory, nutrition and malabsorption, communication, and coping issues. Significant intervention effects were found on the knowledge scores for caregivers, adolescents, and children; caregiver and adolescent total self-management scores; Child Behavior Checklist total score; one parent coping scale score; the modified NIH score; NIH pulmonary factor 1; and the Brasfield total score. Significant interaction effects were evident in the self-efficacy scores for caregivers and children.
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Affiliation(s)
- L K Bartholomew
- Center for Health Promotion Research and Development, University of Texas Health Science Center at Houston 77225, USA.
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Dahlquist LM, Czyzewski DI, Jones CL. Parents of children with cancer: a longitudinal study of emotional distress, coping style, and marital adjustment two and twenty months after diagnosis. J Pediatr Psychol 1996; 21:541-54. [PMID: 8863463 DOI: 10.1093/jpepsy/21.4.541] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Evaluated emotional distress, coping style, and marital adjustment in 84 parents (42 couples) of children with cancer 2 months after diagnosis and again about 20 months after diagnosis. As expected, mothers' mean state anxiety and trait anxiety scores decreased to near normal levels over time. Fathers' scores were lower initially and did not change. Neither mothers' nor fathers' mean marital adjustment scores changed over time. Marital adjustment at treatment follow-up was predicted by depression and the spouse's marital satisfaction in mothers, and depression, child health status, and spouse's marital satisfaction in fathers. In contrast to findings obtained 2 months after diagnosis, coping style was not related to marital adjustment at follow-up. Results are discussed in terms of possible gender differences in the role of social support in marital adjustment and the stability versus situational specificity of coping styles.
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Czyzewski DI, Mariotto MJ, Bartholomew LK, LeCompte SH, Sockrider MM. Measurement of quality of well being in a child and adolescent cystic fibrosis population. Med Care 1994; 32:965-72. [PMID: 8090048 DOI: 10.1097/00005650-199409000-00007] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Parcel GS, Swank PR, Mariotto MJ, Bartholomew LK, Czyzewski DI, Sockrider MM, Seilheimer DK. Self-management of cystic fibrosis: a structural model for educational and behavioral variables. Soc Sci Med 1994; 38:1307-15. [PMID: 8016694 DOI: 10.1016/0277-9536(94)90194-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
One hundred and ninety-nine patients and their primary caregivers at two metropolitan cystic fibrosis centers participated in a clinical trial to evaluate the effectiveness of a health education program designed to help improve self-management skills for the care of CF. The baseline data from the study was used to test a structural model that hypothesized the relationship between educational, behavioral, and health status variables. Controlling for the effects of all other variables, including demographic, self-efficacy (confidence in being able to perform a behavior) was the most important educational factor predicting self-management behavior for monitoring and treating respiratory problems. Knowledge about the management of CF was only related to the ability of caretakers to apply coping skills to problems associated with CF. The more caretakers reported performing monitoring behaviors the more likely they were to report performing self-management treatment behaviors. The findings suggest that educational interventions that focus on increased knowledge alone are not likely to be effective in improving self-management behavior for CF. Based on the structural model analyses, it is recommended that educational programs for CF patients and families address increased self-efficacy and improved monitoring skills to influence the improvement of self-management treatment for CF.
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Affiliation(s)
- G S Parcel
- Center for Health Promotion Research and Development, University of Texas-Houston Health Science Center, Houston 77225
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Bartholomew LK, Sockrider MM, Seilheimer DK, Czyzewski DI, Parcel GS, Spinelli SH. Performance objectives for the self-management of cystic fibrosis. Patient Educ Couns 1993; 22:15-25. [PMID: 8134318 DOI: 10.1016/0738-3991(93)90085-b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Performance objectives for the self-management of cystic fibrosis (CF) were developed and subjected to a two-stage content validation. A multidisciplinary team of health care professionals generated a list of 149 medical and adjustment performance objectives. Behaviors included monitoring symptoms and judging their significance, treating symptoms and communicating with health care providers about symptoms and treatment plans. In the first stage a panel of experts in the medical and behavioral aspects of CF rated each behavior. In general, the eleven panelists rated the 149 behaviors as somewhat important or important (mean 2.6, S.D. 0.17, on a 3-point scale). In the second stage, 84 of 155 CF center directors rated all behaviors as somewhat important or important (mean 2.9, S.D. 0.23). Specific behaviors related to medical regimens were more consistently rated as important than were those related to psychosocial adjustment. The performance objectives provide a framework for developing and evaluating health education programs for the self-management of CF in order to promote optimum health and adjustment.
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Dahlquist LM, Czyzewski DI, Copeland KG, Jones CL, Taub E, Vaughan JK. Parents of children newly diagnosed with cancer: anxiety, coping, and marital distress. J Pediatr Psychol 1993; 18:365-76. [PMID: 8340845 DOI: 10.1093/jpepsy/18.3.365] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Evaluated anxiety, approach-avoidance coping style, and marital distress in 134 parents of children with cancer shortly after diagnosis. Of the 67 marital pairs studied, approximately 25% of the mothers and 28% of the fathers reported significant marital distress. Regression analyses revealed that marital distress was predicted by a combination of general emotional distress, the discrepancy between the couple's state anxiety levels, and the couple's use of sensitizing coping strategies. Greater differences in anxiety levels between the parents and greater stimulus approach coping activity in the marriage were associated with greater reported marital distress.
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Abstract
This research developed and determined the psychometric characteristics of a measure of self-efficacy expectations (a social cognitive theory construct) for the self-management of cystic fibrosis (CF). Items for the original instrument were sampled from 150 self-management performance objectives for CF that represented behaviors in eight domains of CF care, including aspects of medical care, coping, and communication. The instrument was administered to 199 parents of children and adolescents with CF from two CF centers. The findings support a multidimensional structure for self-efficacy consistent with the multiple types of behavior required for the management of a chronic illness such as CF. An alpha-factor analysis yielded solutions clearly reflecting five theorized aspects of self-management: medical judgment and communication, coping, family communication, compliance, and acceptance. The first factor of the caretaker's scale most closely represents the underlying conceptualization of self-management as requiring self-monitoring of health status and collaboration with the health care provider in making judgments about treatment. The unit weighted factors exhibited high internal consistencies (Cronbach's alpha-factors ranging from 0.73 to 0.88).
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Affiliation(s)
- L K Bartholomew
- Office of Educational Resources, Texas Children's Hospital, Houston
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