Volume 25, Issue 2

Parenting a child with chronic disease provides a unique set of challenges for both mothers and fathers throughout all phases of the illness. However, fathers of these children are under-represented in existing research. This review focuses on the fathers of children with chronic disease included in 44 original articles. We address the challenges to the father’s role as breadwinner, leader and strength-giver in the family. Three time-periods describe the obstacles fathers tackle when parenting children with chronic disease: a) diagnosis and short-term, characterized by distress, isolation and uncertainty; b) the mastery period, characterized by the struggle to establish routine and by support and spirituality; and c) the long-term, characterized by relationship and personality change, worries and bereavement. Overall, whilst current research has revealed some key themes pertaining to fathers of children with chronic disease, further studies are required to foster the development of support mechanisms for the specific needs of these fathers.

Background: Efforts to facilitate transition of care to adult providers for adolescents with chronic disease are not uniformly successful and many patients encounter challenges. The goal of this study was to assess transition readiness and preferences for tools to aid in the transition process with an emphasis on technology and social media. Methods: We surveyed and performed focus groups on patients aged 13–21 years from a pediatric university-based rheumatology and general pediatric practice. Demographics and transition readiness were assessed using a questionnaire. Transition readiness was assessed by examining patient knowledge and independence with care. Focus groups were conducted to elicit perspectives about desirable features of a transition program and useful tools. Results: Thirty-five patients completed surveys; and 20 patients and 13 of their parents participated in a focus group. The median patient age was 17 years and 74.3% were female. A Likert scale (0–10, 10=most) was used to evaluate concern over changing to an adult medical provider, (mean=6.4, SD=2.6), preparedness for disease self-management (mean=6.0, SD=2.8), and perceived importance of self-managing their condition (mean=7.1, SD=3.1). Themes that emerged from focus groups included a desire for support groups with other teens, a preference for using text messaging for communication and a desire for an online health management program. Conclusions: Teens with chronic disease are able to identify health maintenance tasks and strategies that will aid in developing independence with healthcare management. These findings support the idea that developing engaging applications and support groups will assist teens in the transitioning.

Background: There is a dearth of information on the compatibility of Western-developed, internet-based interventions that prevent onset and precipitation of depression in global settings. Recently, Project CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training), an information technology-based intervention, was adapted to prevent depression in Hong Kong Chinese adolescents. This paper evaluates qualitative data from consultations to develop a revised intervention of CATCH-IT for Hong Kong youth. Methods: A theoretical thematic analysis approach was used to analyze data. Materials from three consultation trips which included focus groups (2007), an expert panel (2007), a public health campaign (2009), and a joint primary care physician-social worker review group (2010) were compiled. Authors (KS and AZ) independently reviewed the data and applied the theoretical framework of behavioral vaccines to code the data. These data were subsequently consolidated to provide a coherent narrative analysis. Results: The cognitive behavioral therapy (CBT), behavioral activation (BA), and resiliency modules were maintained, while the interpersonal therapy (IPT) modules of CATCH-IT were excluded in the Hong Kong adaptation. Concurrent self-reports of drinking, smoking, illicit drug use and gambling behavior were added. Rather than primary care consultations, social worker consultations may be the best point of entry for intervention. Conclusion: Socio-cultural relevance of psychotherapeutics and delivery context of internet-based interventions will require significant adaptation for the Hong Kong setting. However, because of community engagement throughout the process of adaptation, we believe the CATCH-IT intervention can be adapted for Chinese adolescents in Hong Kong with retained fidelity. The revised intervention is called “Grasp the Opportunity”.

Adolescent pregnancy is associated with low birth weight. This has been explained by socioeconomic or emotional factors. However, an adolescent’s pelvis may not be completely developed and this can contribute to impairing fetal growth. Our aim was to compare the relationship between pelvic size and birth weight among adolescents and adult mothers. A cross-sectional study was carried out at Instituto de Medicina Infantil Professor Fernando Figueira (IMIP), Brazil. We studied 125 healthy adolescents and 207 healthy adult women, all of whom were primiparous with a singleton term and low-risk pregnancy. The conjugate, intercristal and interspinous diameters were assessed by the Collins pelvimeter. The effect of pelvic size on the birth weight was evaluated using principal component analysis and multiple linear regression model. The mean pelvic size was smaller in adolescent mothers compared to adult ones (35.1 cm vs. 37.5 cm; p<0.001; t-test). After adjusting for other confounding variables, the predicted birth weights corresponding to these mean values of pelvic size were: 3020±27 g for adolescent mothers and 3145±26 g for adult mothers and showed a significant difference (p<0.001). We concluded that a pelvis that is less than fully developed in adolescents, as assessed by pelvic size, may contribute to lower birth weight in adolescent mothers.

Background: Some studies showed associations of the minor T allele of the C1858T single nucleotide polymorphism (SNP) corresponding to the R620W amino acid substitution of protein tyrosine phosphatase ( PTPN22 ) with multiple autoimmune diseases, including systemic lupus erythematosus (SLE). Objectives: To study the frequency of PTPN22 R620W polymorphism among Egyptian patients with SLE and to test the association of the T allele with autoimmune thyroid disease in such patients. Methods: Clinical evaluation, measurement of thyroid hormones and antibodies, and genotyping of PTPN22 R620W polymorphism were done for 60 SLE patients and 60 age- and sex-matched healthy subjects. Results: Nineteen SLE cases (31.67%) had thyroid dysfunction with subclinical hypothyroidism being the most frequent form of thyroid dysfunction (20%) followed by primary hypothyroidism (6.67%), subclinical hyperthyroidism (3.33%) and primary hyperthyroidism (1.67%). Autoimmune thyroid disease was detected in 36.67% of cases. Systemic lupus erythematosus disease activity index (SLEDAI) score did not differ between patients with thyroid dysfunction and euthyroid patients (p=0.061) nor with the frequency of positive thyroid peroxidise antibodies (TPOAb, p=0.092) and antithyroglobulin antibodies (ATGAb, p=0.1). T allele frequency did not differ between cases and controls (p=1.19) and was associated with autoimmune thyroid disease in Egyptian SLE patients (p=0.002). Conclusions: R620W polymorphism of the PTPN22 gene is not a major risk allele for SLE susceptibility among Egyptian SLE patients but appears to be a risk factor for concurrent autoimmune thyroid disease and SLE.

Background: The objective was to determine whether motivation to change is significantly altered over the course of partial hospitalization in children and adolescents with eating disorders (EDs). Method: This study was a retrospective chart review of 30 sets of adolescents and their parents who completed the Motivational Stage of Change for Adolescents Recovering from an Eating Disorder (MSCARED) at both intake and discharge from partial hospitalization. The main outcome variables included change in stage of change (SOC) for patients and their parents. Secondary outcomes included correlations between SOC and other baseline variables, as well as changes in SOC and psychological test scores. Results: The SOC was significantly higher at discharge than at intake in both the patients and parents, but the two groups were not in agreement at discharge. The change in the SOC was correlated with change in Children’s Eating Attitudes Test scores. Assessment of decisional balance showed correlations with SOC. Age, change in weight, and psychiatric diagnoses did not correlate with initial SOC. Conclusion: The MSCARED may be a useful tool for monitoring young ED patients’ psychological improvements with day treatment. Initial SOC is not predictive of treatment outcomes.

Microfinance can be used to reach women and adolescent girls with HIV prevention education. We report findings from a cluster-randomized control trial among 55 villages in West Bengal to determine the impact of non-formal education on knowledge, attitudes and behaviors for HIV prevention and savings. Multilevel regression models were used to evaluate differences between groups for key outcomes while adjusting for cluster correlation and differences in baseline characteristics. Women and girls who received HIV education showed significant gains in HIV knowledge, awareness that condoms can prevent HIV, self-efficacy for HIV prevention, and confirmed use of clean needles, as compared to the control group. Condom use was rare and did not improve for women. While HIV testing was uncommon, knowledge of HIV-testing resources significantly increased among girls, and trended in the positive direction among women in intervention groups. Conversely, the savings education showed no impact on financial knowledge or behavior change.

Background: This study examines contraception choices among Hispanic and non-Hispanic girls, to determine if there are differences when the barrier of cost is removed by facilitating enrollment in a Title X Family Planning Program. Methods: Charts of adolescent females aged 13–19 years, seen for the first time at a university hospital clinic from January 1, 2005 to December 31, 2007, were reviewed. Access to contraception was facilitated by enrollment in the Title X Family Planning Program. Patients were categorized as public insurance if they had Medicaid or Child/Family Health Plus or chose to enroll in the Title X program. Results: Among the 666 eligible patients, 27% were Hispanic, with a mean age of 14.9 years. At least 20% had used one form of contraception before their first clinic visit. About one-third of the youth were enrolled in the Title X Family Planning Program, with no statistical difference between Hispanic and non-Hispanic youth. Three hundred and ninety subjects (58%) chose contraception during their visit. Hispanic subjects, who represented 32% of the group, were more likely to choose condoms and oral contraceptive pills compared to non-Hispanic subjects. The privately insured adolescents chose condoms less often than the publicly insured adolescents, and this was true regardless of ethnicity. Conclusion: There are significant differences in contraception choices between Hispanic and non-Hispanic youth. The Title X Family Planning Program allowed young women to make independent choices. Adolescents may benefit from further improvements in culturally sensitive family planning programs.

Background: Active travel has a potential to increase children’s physical activity (PA). Pedometers offer a valid option to measure PA, but do not capture cycling activity. Children’s self-reported cycling distances can be analyzed by the Geografic Information System (GIS). Aim: To combine pedometry and GIS mapping to identify the relative amount of cycling in children’s PA. Study group: Of all children in 4th grade (n=187) in Staffanstorp Sweden, 144 had valid pedometer data. Fifty-six children were non-cyclists while 88 children (32 boys, 47 girls, 9 gender unknown) reported at least one cycle journey. Methods: Cycle trips were entered into GIS and calculated to total cycling distance. Average length of the single distances cycled per day was 676 m (SD=534 m). A previously reported cycling speed (13.5 km/h) was used to calculate time spent cycling. Consequently distance=676 m, speed=13.5 km/h=13,500 m/3600 s=3.75 m/s and time=676m/3.75m/s=180.26 s=3 min. Expenditure of 4 and 5 metabolic equivalents (METs) has in children been reported equivalent to 122 and 127 steps/min, respectively. We estimated 4.7 METs (13.5 km/h) as 126 steps for every min of cycling (127–122=5×0.7=125.5). Results: The daily mean cycle distance was 676 m, on average 379 additional steps/day for cycling children (min. 21, max. 1385, SD=299) with no gender difference. Additional “steps” obtained by cycling corresponded to on average 3% of their PA. Conclusion: The relative contribution of cycling in 10-year-old children’s PA level is quite small and stable between children across different levels of activity levels, regardless of gender.

Background: Day treatment programs have increasingly become an important level of care in the medical and psychiatric management of patients with eating disorders, yet there is little in the literature describing the weight gain patterns of patients in these programs. Methods: Weight gain accomplished by 198 patients admitted to a day program over a 2-year period was studied. Weight gain was analyzed by demographic, diagnostic and program-related variables and was compared for weekdays and weekends. Results: The mean length of stay was 2.6 weeks and patients gained a mean of 2.1 pounds (0.95 kg) in the program. Approximately one-quarter of patients lost weight, one-quarter gained 0 to <2 pounds (0.9 kg), one-quarter gained 2–4 pounds (0.9–1.8 kg), and one-quarter gained more than 4 pounds (1.8 kg). Weight gain was greater in those with a diagnosis of anorexia nervosa or eating disorder not otherwise specified (compared to bulimia nervosa), a longer time in the program, and a lower body mass index on admission. Patients gained more on weekdays, while in the program, than on weekends, when they were home. Conclusions: The data showed that most patients accomplished modest weight gains during a relatively short stay in an eating disorders day program, demonstrating what can be expected for this level of care in the current healthcare environment.

This paper presents three cases involving young Orthodox Jewish males, each of whom lost 15–25 pounds over a course of time ranging between a few months and up to 2 years, as the result of decreased food intake because of misinterpretation of a religious concept learned in their Judaic studies. Although each had a body mass index between 15.8 and 16.1, they did not display the body image concerns necessary for the diagnosis of anorexia nervosa. The discussion covers the distinction between anorexia nervosa and the newly described diagnosis in these young men, i.e., weight loss as a result of religious zeal, along with a brief history of fasting for religious reasons as described in previous centuries.