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Molitor SJ, Fidler AL, Sinisterra M, Everhart RS, Delgado S, Fedele DA. Associations between symptoms of ADHD/ODD and health outcomes in youth with cystic fibrosis. Pediatr Pulmonol 2024; 59:809-812. [PMID: 38088197 DOI: 10.1002/ppul.26811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/16/2023] [Accepted: 12/02/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Stephen J Molitor
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrea L Fidler
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Manuela Sinisterra
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Silvia Delgado
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
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Sinisterra M, Sweenie R, Ezmigna D, Fedele DA. Youth and caregiver asthma functioning and quality of life throughout the COVID-19 pandemic. Front Allergy 2023; 4:1268112. [PMID: 37731770 PMCID: PMC10507404 DOI: 10.3389/falgy.2023.1268112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives The COVID-19 pandemic resulted in daily functioning changes for many families. Adjustments in daily functioning may have impacted asthma management and subsequent morbidity. The current study seeks to build upon extant literature by exploring differences in youth asthma exacerbations and control, as well as youth and caregiver asthma-related quality of life (ArQOL) throughout COVID-19 transitional points. Methods Ninety-three youth (9-17 years old) with asthma and their caregivers completed measures of demographic/medical information, asthma control, and ArQOL. Participants were recruited between January 2020 and October 2021 via their medical appointments and a hospital registry. We conducted Kruskal-Wallis H-tests to examine differences in youth asthma exacerbations (measured by short-acting beta agonist use), asthma control, and ArQOL, as well as caregiver ArQOL, across phases of the COVID-19 pandemic. Results Asthma exacerbations were higher prior to the onset of the pandemic compared to "during lockdown" and "post-lockdown," H(2) = 7.31, p < .05. Youth's asthma control was lower prior to the onset of the pandemic compared to youth enrolled "post-lockdown," H(2) = 7.04, p < .05. There were no differences in youth ArQOL across the duration of the pandemic. Caregiver ArQOL was significantly higher in the "post-lockdown," period, compared to caregivers enrolled prior to the pandemic onset, H(2) = 9.86, p < .01. Conclusion Youth and caregiver asthma functioning improved following the onset of the pandemic. These findings build upon existing literature to highlight higher ArQOL in caregivers following the pandemic onset, likely related to improvements in youth asthma control and morbidity. Future research should explore trajectories of asthma and psychosocial functioning throughout the pandemic for families.
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Affiliation(s)
- Manuela Sinisterra
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Rachel Sweenie
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Dima Ezmigna
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - David A. Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
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Fedele DA, Hollenbach J, Sinisterra M, LeFave E, Fishe J, Salloum RG, Bian J, Gurka MJ. Implementation of a pediatric asthma management program in rural primary care clinics. J Asthma 2022; 60:1080-1087. [PMID: 36194428 PMCID: PMC10115910 DOI: 10.1080/02770903.2022.2132954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Rural communities experience a significant asthma burden. We pilot tested the implementation of Easy Breathing, a decision support program for improving primary care provider adherence to asthma guidelines in a rural community, and characterized asthma risk factors for enrollees. METHODS We implemented Easy Breathing in two rural primary care practices for two years. Patient demographics, exposure histories, asthma severity, asthma medications, and treatment plans were collected. Providers' adherence to guidelines included the frequency of children with persistent asthma who were prescribed guidelines-based therapy and the frequency of children with a written asthma treatment plan on file. Clinicians provided feedback on the feasibility and acceptability of Easy Breathing using a validated survey tool and through semi-structured interviews. RESULTS Two providers implemented the program. Enrollment included 518 children, of whom 135 (26%) had physician-confirmed asthma. After enrollment into Easy Breathing, 75% of children with asthma received a written asthma treatment plan All children with persistent asthma were prescribed an anti-inflammatory drug as part of their treatment plan. Providers (n = 2) rated Easy breathing as highly acceptable (M = 4.5), feasible (M = 4.5), and appropriate (M = 4.5). Qualitative feedback was positive, with suggestions to integrate the paper-based program into the electronic health record system for broader uptake. Enrollees with asthma were more likely to have a family history of asthma and endorse exposure to tobacco smoke and cockroaches. CONCLUSIONS Easy Breathing shows promise as a decision support system that can be implemented in rural, medically underserved communities via primary care.
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Affiliation(s)
- David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Jessica Hollenbach
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Manuela Sinisterra
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Elizabeth LeFave
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Jennifer Fishe
- Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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Tully C, Wang CH, Sinisterra M, Clary L, Hilliard ME, Monaghan M, Wang J, Streisand R. Diabetes-specific functioning in parents of young children with recently diagnosed type 1 diabetes. Psychol Health 2022; 41:423-432. [PMID: 35549331 DOI: 10.1037/hea0001164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A Type 1 diabetes (T1D) diagnosis in young children can cause significant family stress. Parents may experience increased depressive symptoms, but less is known about early diabetes-specific functioning (i.e., parental self-efficacy to manage diabetes, hypoglycemia fear, and coparenting conflict). We evaluated a theoretically based model of diabetes-specific functioning among parents of young children newly diagnosed with T1D (YC-T1D). The model included parent demographic variables, child illness-factors, family protective factors, and general parent emotional functioning. METHOD One hundred fifty-seven newly diagnosed YC-T1D (Mage = 4.4 ± 1.7 years; M days postdiagnosis = 29.0 ± 15.4) and their primary caregivers (91.7% female; 61% non-Hispanic White) were assessed at baseline of a behavioral intervention randomized controlled trial. We used psychosocial measures to explore hypothesized domains associated with parents' diabetes-specific functioning using structural equation modeling. RESULTS More difficulties with parent emotional functioning were related to more problems with parent diabetes-specific functioning, and higher family protective factors were related to fewer problems with diabetes-specific functioning. Child-illness factors were also directly related to more difficulties with parent diabetes-specific functioning and emotional functioning. Parents with college education reported more difficulties with emotional functioning and parent diabetes-specific functioning. Younger child age was associated with fewer difficulties with emotional functioning and more family protective factors. CONCLUSIONS Results provide initial support for a model of parent diabetes specific-functioning at young child T1D diagnosis. Future research may examine this model in relation to children's glycemic outcomes over the first year after diagnosis. Implications are made for parent screening at the time of YC-T1D diagnosis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Sinisterra M, Wang CH, Marks BE, Barber J, Tully C, Monaghan M, Hilliard ME, Streisand R. Patterns of Continuous Glucose Monitor Use in Young Children Throughout the First 18 Months Following Type 1 Diabetes Diagnosis. Diabetes Technol Ther 2021; 23:777-781. [PMID: 34252292 PMCID: PMC9009587 DOI: 10.1089/dia.2021.0183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/30/2022]
Abstract
Objective: To describe sociodemographic and parent psychosocial characteristics associated with patterns of continuous glucose monitor (CGM) use across the first 18 months post-type 1 diabetes (T1D) diagnosis among young children. Methods: One hundred fifty-seven parent-child dyads enrolled in a behavioral intervention for parents of young children (1-6 years) newly diagnosed with T1D. Parents reported on baseline sociodemographic characteristics and psychosocial functioning; child CGM use was assessed at five time points during the first 18 months post-diagnosis. Results: Most participants (81.8%) used CGM at least once. Four CGM trajectories emerged (always, later/stable, inconsistent, and never). Participants with private insurance were more likely to be in the always, later/stable, or inconsistent groups versus the never group. Youth in the always and later/stable groups had lower mean HbA1c at 18 months than those in the never group. Conclusions: Given the health benefits of CGM, further exploration of barriers to CGM use in families with public health insurance is needed. ClinicalTrials.gov identifier: NCT02527525.
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Affiliation(s)
| | | | - Brynn E. Marks
- Children's National Hospital, Washington, District of Columbia, USA
| | - John Barber
- Children's National Hospital, Washington, District of Columbia, USA
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Carrie Tully
- Children's National Hospital, Washington, District of Columbia, USA
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Maureen Monaghan
- Children's National Hospital, Washington, District of Columbia, USA
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Marisa E. Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Randi Streisand
- Children's National Hospital, Washington, District of Columbia, USA
- The George Washington University School of Medicine, Washington, District of Columbia, USA
- Address correspondence to: Randi Streisand, PhD, Children's National Hospital, 6th Floor Main, CRI/CTS, 111 Michigan Avenue NW, Washington, DC 20010, USA.
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Shneider C, Hilliard ME, Monaghan M, Tully C, Wang CH, Sinisterra M, Jones J, Levy W, Streisand R. Recruiting and retaining parents in behavioral intervention trials: Strategies to consider. Contemp Clin Trials 2021; 108:106502. [PMID: 34237457 DOI: 10.1016/j.cct.2021.106502] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recruitment and retention are paramount to the success of randomized controlled trials (RCTs); however, strategies and challenges to optimize recruitment and retention are often omitted from outcomes papers. The current manuscript presents strategies used to recruit and retain over 97% parents of young children newly diagnosed with type 1 diabetes for over 15-months post-randomization enrolled in First STEPS, a behavioral, two-site RCT. METHOD Participants included 157 primary caregivers of young children newly diagnosed with type 1 diabetes. Recruitment and retention strategies are described and include collaboration with medical teams, careful selection and training of study staff, inclusion of a behavioral run-in prior to randomization, financial incentives, creation of a study identity using retention items, obtainment of feedback from community stakeholders, and minimization of participant burden. RESULTS Use of recruitment and retention strategies resulted in enrollment of 58% of eligible and reached families, with retention of the enrolled sample above 97% for over 15 months. Participants reported high acceptability of and satisfaction with specific recruitment and retention strategies. CONCLUSIONS The strategies used to recruit and retain caregivers of young children newly diagnosed with a chronic illness were feasible to implement within multidisciplinary diabetes clinics and may apply to other pediatric populations. Future research may benefit from a focus on strategies to engage more diverse samples. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02527525.
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Affiliation(s)
- Caitlin Shneider
- Children's National Hospital, Washington, DC, United States of America
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States of America
| | - Maureen Monaghan
- Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America
| | - Carrie Tully
- Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America
| | - Christine H Wang
- Children's National Hospital, Washington, DC, United States of America
| | | | - Jasmine Jones
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States of America
| | - Wendy Levy
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States of America
| | - Randi Streisand
- Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
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Sinisterra M, Kelly KP, Shneider C, El-Zein A, Swartwout E, Deyo P, Streisand R. Working Toward an mHealth Platform for Adolescents with Type 1 Diabetes: Focus Groups With Teens, Parents, and Providers. Diabetes Educ 2020; 46:444-454. [PMID: 32741264 DOI: 10.1177/0145721720943123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of the study was to explore facilitators and barriers to self-management behaviors in adolescents with type 1 diabetes (T1D) to inform the development of an mHealth platform. METHODS Eight adolescents with T1D, 9 parents, and 13 health care providers participated in separate focus groups that explored teen self-management behaviors. RESULTS Adolescents and their parents have distinct preferences for handling diabetes management and use of mHealth technologies. Health care providers support the use of new technologies yet acknowledge concern meeting the potential increased volume of communication requests from teens and families. CONCLUSION Stakeholders agreed that an ideal mHealth platform would facilitate open communication between teens and their care network and easily integrate with other diabetes technologies. Future directions include incorporating additional feedback from stakeholders to build and modify the mHealth platform. The use of mHealth platforms could be integrated into clinical practice to optimize self-management and support communication between educators, providers, and families in between clinic visits.
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Affiliation(s)
- Manuela Sinisterra
- Children's National Hospital, Division of Psychology & Behavioral Health, DC
| | - Katherine Patterson Kelly
- Children's National Hospital, Division of Psychology & Behavioral Health, DC.,The George Washington University School of Medicine, Washington, DC
| | - Caitlin Shneider
- Children's National Hospital, Division of Psychology & Behavioral Health, DC
| | | | | | | | - Randi Streisand
- Children's National Hospital, Division of Psychology & Behavioral Health, DC.,The George Washington University School of Medicine, Washington, DC
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Sinisterra M, Hamburger S, Tully C, Hamburger E, Jaser S, Streisand R. Young Children with Type 1 Diabetes: Sleep, Health-Related Quality of Life, and Continuous Glucose Monitor Use. Diabetes Technol Ther 2020; 22:639-642. [PMID: 32027177 PMCID: PMC7406998 DOI: 10.1089/dia.2019.0437] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Indexed: 12/25/2022]
Abstract
While children with type 1 diabetes (T1D) and their parents report significant sleep problems, few studies have focused on young children and included health-related quality of life (HRQOL) as an outcome of sleep disturbance. In addition, relatively little is known about the use of diabetes devices, such as continuous glucose monitors (CGMs), in young children and their link with sleep disturbances. This brief report examines the relationship between sleep quality and HRQOL and explores sleep disturbances related to CGM use in a sample of young children with T1D. Data are from the baseline of a behavioral intervention pilot for 46 parents of children ages 2-5 years with T1D. Parents reported on their child's sleep disturbances as a result of nighttime blood glucose monitoring (NBGM). Sleep was measured objectively in a subset of children (N = 11) who wore accelerometers for a 5-day period. All parents completed measures of pediatric and parental HRQOL. Greater child sleep disturbance due to NBGM was associated with lower pediatric HRQOL. Child sleep disturbances were negatively associated with parental life satisfaction. In addition, children who used CGM experienced fewer sleep disturbances than those who did not. However, parents of children who used CGM experienced greater sleep disturbances related to a higher frequency of NBGM. Pediatric and parental HRQOL were most related to child sleep disturbances by NBGM. CGM use may be associated with better child sleep, as parents are less likely to wake their child for NBGM, although CGM use may also be associated with greater sleep difficulties in parents. Future studies should further explore the relationship between sleep and technology use and impact on clinical outcomes in young children with T1D and their parents.
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Affiliation(s)
- Manuela Sinisterra
- Children's National Hospital, Center for Translational Research, Washington, District of Columbia
| | - Samantha Hamburger
- Children's National Hospital, Center for Translational Research, Washington, District of Columbia
| | - Carrie Tully
- Children's National Hospital, Center for Translational Research, Washington, District of Columbia
- The George Washington University School of Medicine, Washington, District of Columbia
| | - Emily Hamburger
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Randi Streisand
- Children's National Hospital, Center for Translational Research, Washington, District of Columbia
- The George Washington University School of Medicine, Washington, District of Columbia
- Address correspondence to: Randi Streisand, PhD, Children's National Hospital, Center for Translational Research, 6th Floor Main, CTR, 111 Michigan Avenue NW, Washington, DC 20010
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Jaser SS, Datye K, Morrow T, Sinisterra M, LeStourgeon L, Abadula F, Bell GE, Streisand R. THR1VE! Positive psychology intervention to treat diabetes distress in teens with type 1 diabetes: Rationale and trial design. Contemp Clin Trials 2020; 96:106086. [PMID: 32682996 DOI: 10.1016/j.cct.2020.106086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Adolescents with type 1 diabetes (T1D) experience high rates of diabetes distress, which negatively influence self-management and glycemic control. Building on effective positive psychology interventions to improve adherence in adults, as well as our pilot work to adapt these interventions for adolescents, we developed a positive psychology intervention for adolescents with T1D. The goal of THR1VE! is to reduce diabetes distress in adolescents with T1D and improve their diabetes outcomes. This multi-site randomized controlled trial compares a Diabetes Education + text-message-based Positive Affect intervention, to a Diabetes Education control condition. In the ongoing trial, we are evaluating the effects of the intervention on adolescents' diabetes distress, self-management, and glycemic control. This paper describes the rationale, trial design, and methodology of the THR1VE! Study.
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Gaudier-Diaz MM, Sinisterra M, Muscatell KA. Motivation, Belongingness, and Anxiety in Neuroscience Undergraduates: Emphasizing First-Generation College Students. J Undergrad Neurosci Educ 2019; 17:A145-A152. [PMID: 31360130 PMCID: PMC6650254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 06/10/2023]
Abstract
The growth of undergraduate neuroscience programs nation-wide demonstrates that interest in this field is escalating. By understanding what motivates neuroscience undergraduates to do well and how they generally feel toward their major and environment, educators will be better able to attend to the needs of their neuroscience students. Thus, the present study aimed to characterize the psychosocial profiles of neuroscience majors in the U.S., with a particular interest in potential differences by generation in college, school type, and gender. For this, U.S. institutions that offer a neuroscience major were identified, and program directors/coordinators were asked to share a study survey with neuroscience majors at their school. The survey, which included demographics and measures of motivation, sense of belongingness, and anxiety, was completed by 756 students from 69 different institutions. Results showed that first-generation college students had lower academic performance (i.e., GPA), which was mediated by differences in motivation, and test- and trait-anxiety. Further, students from Liberal Arts Colleges reported valuing neuroscience courses more than students at National Universities, and the desire to meet others expectations, value of neuroscience course work, and anxiety were higher among female neuroscience students than males. Finally, test-anxiety was the strongest correlate of academic performance. These insights help identify potential targets for developing new teaching and advising strategies that could be employed to facilitate success among all neuroscience undergraduates.
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Affiliation(s)
- Monica M Gaudier-Diaz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Manuela Sinisterra
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Keely A Muscatell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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Brodey B, Purcell SE, Rhea K, Maier P, First M, Zweede L, Sinisterra M, Nunn MB, Austin MP, Brodey IS. Rapid and Accurate Behavioral Health Diagnostic Screening: Initial Validation Study of a Web-Based, Self-Report Tool (the SAGE-SR). J Med Internet Res 2018; 20:e108. [PMID: 29572204 PMCID: PMC5889494 DOI: 10.2196/jmir.9428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/29/2018] [Accepted: 02/13/2018] [Indexed: 11/26/2022] Open
Abstract
Background The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate, reliable psychiatric diagnoses; however, because of its length, complexity, and training required, the SCID is rarely used outside of research. Objective This paper aims to describe the development and initial validation of a Web-based, self-report screening instrument (the Screening Assessment for Guiding Evaluation-Self-Report, SAGE-SR) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the SCID-5-Clinician Version (CV) intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care. Methods First, study staff drafted approximately 1200 self-report items representing individual granular symptoms in the diagnostic criteria for the 8 primary SCID-CV modules. An expert panel iteratively reviewed, critiqued, and revised items. The resulting items were iteratively administered and revised through 3 rounds of cognitive interviewing with community mental health center participants. In the first 2 rounds, the SCID was also administered to participants to directly compare their Likert self-report and SCID responses. A second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument that uses branching logic from a screener section to administer appropriate follow-up questions to refine the differential diagnoses. The SAGE-SR was administered to healthy controls and outpatient mental health clinic clients to assess test duration and test-retest reliability. Cutoff scores for screening into follow-up diagnostic sections and criteria for inclusion of diagnoses in the differential diagnosis were evaluated. Results The expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and DSM criteria for the covered diagnoses. These 664 items were iteratively submitted to 3 rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed on a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 min to complete in a nonclinical sample versus 24 min in a clinical sample. Responses to individual items can be combined to generate DSM criteria endorsements and differential diagnoses, as well as provide indices of individual symptom severity. Preliminary measures of test-retest reliability in a small, nonclinical sample were promising, with good to excellent reliability for screener items in 11 of 13 diagnostic screening modules (intraclass correlation coefficient [ICC] or kappa coefficients ranging from .60 to .90), with mania achieving fair test-retest reliability (ICC=.50) and other substance use endorsed too infrequently for analysis. Conclusions The SAGE-SR is a computerized adaptive self-report instrument designed to provide rigorous differential diagnostic information to clinicians.
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Affiliation(s)
| | | | - Karen Rhea
- Centerstone, Nashville, TN, United States
| | | | - Michael First
- Department of Psychiatry, Columbia University, New York City, NY, United States
| | | | | | | | | | - Inger S Brodey
- Department of English and Comparative Literature, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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